Education and WHO Recommendations for Fruit and Vegetable Intake Are Associated with Better Cognitive Function in a Disadvantaged Brazilian Elderly Population: A Population-Based Cross-Sectional Study

Abstract

Brazil has one of the fastest aging populations in the world and the incidence of cognitive impairment in the elderly is expected to increase exponentially. We examined the association between cognitive impairment and fruit and vegetable intake and associated factors in a low-income elderly population. A cross-sectional population-based study was carried out with 1849 individuals aged 65 or over living in São Paulo, Brazil. Cognitive function was assessed using the Community Screening Instrument for Dementia (CSI-D). Fruit and vegetable intake was assessed with a Food Frequency Questionnaire (FFQ) and categorized into quartiles of intake and into total daily fruit and vegetable intake using the cut-off points for the WHO recommendations (<400grams/day or ≥400 grams/day). The association between cognitive impairment and each quartile of intake, and WHO recommendation levels, was evaluated in two separate multivariate logistic models. The WHO recommendations for daily intakes ≥400 grams/day were significantly associated with 47% decreased prevalence of cognitive impairment. An effect modification was found in both models between cognitive impairment and “years of education and physical activity” and “years of education and blood levels of HDL” So that, having 1 or more years of education and being physically active or having 1 or more years of education and levels higher than 50 mg/dl of HDL-cholesterol strongly decreased the prevalence of cognitive impairment. In this socially deprived population with very low levels of education and physical activity and fruit and vegetable intake, those who attained WHO recommendations, had 1 year or more of education and were physically active had a significantly lower prevalence of cognitive impairment. A more comprehensive understanding of the social determinants of mental health is needed to develop effective public policies in developing countries.

Cognition and Indicators of Dietary Habits in Older Adults from Southern Brazil

“…[ 21 ] Moreover, a study conducted in São Paulo found that fruit and vegetable intake (≥ 5 servings/day) was associated with a smaller prevalence of compromised cognition in older adults from lower-income areas (OR = 0.53; 95% CI 0.31 to 0.89). [ 22 ] Concordantly, a Chinese study found that adequate fruit and vegetable intake was associated with lower risk of compromised cognition in women (OR = 0.73; 95% CI 0.54 to 1.00). [ 38 ] In studies of Chen et al[ 33 ].…”

“…In Brazil only two population-based studies[ 21 , 22 ] have investigated the association between fruit and vegetable intake and cognition in older adults. However, the studies were conducted in the Brazilian Southeast region and reflect the conditions of its population.…”

Diet–Cognition Associations Differ in Mild Cognitive Impairment Subtypes

“…O’Brien et al followed up 15,467 women aged 70 or older for 6 years and observed that those with a higher long-term nut intake (>5 servings of nuts/week) had a significantly higher score of global cognitive function than that of non-consumers [ 43 ]. In the Chinese population, adults with a daily nut consumption of more than 10 g had 40% decreased odds of poor cognitive function (OR = 0.60, 95%CI: 0.43~0.84) among the sample of 4822 participants aged 55 and over [ 44 ]; those aged 65 years old and over with at least 1 serving/week of fish tended to have a better global cognitive function, found in a prospective cohort study with a follow-up of 5.3 years of 1566 participants [ 22 ]. Generally, the frequent consumption of fruit, vegetables, fish, and nuts was related to relatively healthy cognitive function, which was similar to results from our study that increased consumption of these foods decreased the odds of MCI and some of its subtypes, as well as was positively associated with higher scores of extensive cognitive domains.…”

Lipophilic Antioxidants and Cognitive Function in the Elderly

“…40 Nooyens et al 41 found no association between vitamin E and CF, although the mean age was younger at 55 compared with this study at 70.7. Pastor-Valero et al 42 found a significant association between age and CF but none with smoking status or hypertension. Inconsistencies in BMI and CF in several studies on elderly individuals were reported by Miller and Spencer.…”