Dietary Patterns Derived by Hybrid Clustering Method in Older People: Association with Cognition, Mood, and Self-Rated Health

doi:10.1016/j.jada.2008.06.437

Journal of the American Dietetic Association

Volume 108, Issue 9, September 2008, Pages 1461-1471

https://doi.org/10.1016/j.jada.2008.06.437 Get rights and content

Abstract

Background

Several nutritional factors, including dietary fatty acids, antioxidants, and folates, have been related to pathological brain aging. Dietary patterns that represent a combination of foods may better predict disease risk than single foods or nutrients.

Objective

To identify dietary patterns by a mixed clustering method and to analyze their relationship with cognitive function, depressive symptoms, and self-rated health in older people.

Design

Cross-sectional population-based study.

Subjects/setting

Subjects included 1,724 elderly community dwellers living in Bordeaux, France from 2001 to 2002.

Statistical analysis

Cluster analysis, combining hybrid clustering, and research for stable groups during the k-means step on mean number of weekly servings of 20 predetermined food groups, separately in men and women.

Results

Five dietary clusters were identified in each sex. A “healthy” cluster characterized by higher consumption of fish in men (n=157; 24.3%) and fruits and vegetables in women (n=267; 24.8%) had significantly lower mean number of errors to Mini Mental State score after adjustment for socio-demographic variables (β=−0.11; 95% confidence interval [CI], −0.22 to −0.004 in men; β=−0.13; 95% CI, −0.22 to −0.04 in women). The same cluster was associated with borderline significance with lower depressive symptoms in women (β=−0.16; 95% CI, −0.33 to 0.007). Men in the “pasta eaters” cluster (n=136; 21%) had higher depressive symptoms (β=0.26; 95% CI, 0.06 to 0.46) and higher risk to report poor health (polytomous regression, odds ratio [OR]=1.91; 95% CI, 1.21 to 3.01) than the “healthy” cluster. Women in the “biscuits and snacking” cluster (n=162; 15%) had greater risk of poor perceived health (OR=1.69; 95% CI, 1.15 to 2.48) compared to “healthy” eaters. Additional adjustment for body mass index and medication use strengthened these associations.

Conclusions

Sex-specific dietary patterns derived by hybrid clustering method are associated with fewer cognitive and depressive symptoms and better perceived health in older people.

Section snippets

Participants

The study was conducted among participants in the Three-City study, a large ongoing prospective cohort study of vascular risk factors for dementia that included 9,294 community dwellers in Bordeaux (n=2,104), Dijon (n=4,931), and Montpellier (n=2,259), France, at baseline in 1999 to 2000. To be eligible for recruitment into the Three-City study, individuals had to be living in one of these three French cities, aged 65 years or older, and not institutionalized. Methods of the study and baseline

Dietary Clusters

After exclusion of 66 individuals with at least two missing dietary data and six with missing sociodemographic information, the sample consisted of 1,724 participants (647 men and 1,077 women). Five dietary clusters in men (Table 1) and five in women (Table 2) were identified.

Among both men and women, the first cluster labeled “small eaters” (31% of participants) did not represent a particular food group. It was characterized by a slightly lower mean number of servings per week than the overall

Discussion

Using an innovative approach with a mixed clustering strategy, we identified five dietary patterns that differed between older men and women. A “healthy” dietary pattern characterized by higher consumption of fish in men and fruits and vegetables in women was related to better cognitive performance and self-rated health in both sexes, and less depressive symptoms in women.

Nutritional data are difficult to cluster into stable nonoverlapping groups because of small food consumption differences

C. Samieri is a doctorate student, M.-A. Jutand is a lecturer, C. Féart is a research fellow, L. Letenneur is a researcher, and P. Barberger-Gateau is an associate professor and head of “Nutritional epidemiology” team, INSERM, U897, Bordeaux, France; and University Victor Segalen Bordeaux 2, Bordeaux, France.

References (62)

J.A. Luchsinger et al.
Dietary factors and Alzheimer's disease
Lancet Neurol
(2004)
P.F. Jacques et al.
Are dietary patterns useful for understanding the role of diet in chronic disease?
Am J Clin Nutr
(2001)
A.K. Kant
Dietary patterns and health outcomes
J Am Diet Assoc
(2004)
R.L. Bailey et al.
Comparative strategies for using cluster analysis to assess dietary patterns
J Am Diet Assoc
(2006)
K.L. Tucker et al.
Dietary patterns of elderly Boston-area residents defined by cluster analysis
J Am Diet Assoc
(1992)
M.E. Payne et al.
Vascular nutritional correlates of late-life depression
Am J Geriatr Psychiatry
(2006)
M.F. Folstein et al.
“Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician
J Psychiatr Res
(1975)
R.E. Patterson et al.
Health lifestyle patterns of US adults
Prev Med
(1994)
M.B. van den Bree et al.
Genetic and environmental influences on eating patterns of twins aged >/=50 y
Am J Clin Nutr
(1999)
H. Lin et al.
Dietary patterns of Hispanic elders are associated with acculturation and obesity
J Nutr
(2003)

K.L. Tucker et al.

Bone mineral density and dietary patterns in older adults: The Framingham Osteoporosis Study

Am J Clin Nutr

(2002)

D.K. Goodwin et al.

The relationship between self-rated health status and the overall quality of dietary intake of US adolescents

J Am Diet Assoc

(2006)

K. Manderbacka et al.

Do risk factors and health behaviours contribute to self-ratings of health?

Soc Sci Med

(1999)

M.L. Omran et al.

Assessment of protein energy malnutrition in older persons, part I: History, examination, body composition, and screening tools

Nutrition

(2000)

R.A. Floyd et al.

Oxidative stress in brain agingImplications for therapeutics of neurodegenerative diseases

Neurobiol Aging

(2002)

J. Durga et al.

Effect of 3-year folic acid supplementation on cognitive function in older adults in the FACIT trial: A randomised, double blind, controlled trial

Lancet

(2007)

E. Reynolds

Vitamin B12, folic acid, and the nervous system

Lancet Neurol

(2006)

C. Feart et al.

Plasma eicosapentaenoic acid (EPA) is inversely associated with severity of depressive symptomatology in the elderly: Data from the Bordeaux sample of the Three-City study

Am J Clin Nutr

(2008)

S. Yoshida et al.

Pathophysiological effects of dietary essential fatty acid balance on neural systems

Jpn J Pharmacol

(1998)

S. Gillette Guyonnet et al.

IANA task force on nutrition and cognitive decline with aging

J Nutr Health Aging

(2007)

K.B. Michels

Nutritional epidemiology-past, present, future

Int J Epidemiol

(2003)

K. Tucker

Commentary: Dietary patterns in transition can inform health risk, but detailed assessments are needed to guide recommendations

Int J Epidemiol

(2007)

F.B. Hu

Dietary pattern analysis: A new direction in nutritional epidemiology

Curr Opin Lipidol

(2002)

P.K. Newby et al.

Empirically derived eating patterns using factor or cluster analysis: A review

Nutr Rev

(2004)

C. Bamia et al.

Dietary patterns among older Europeans: The EPIC-Elderly study

Br J Nutr

(2005)

K. Schroll et al.

Food patterns of elderly EuropeansSENECA Investigators

Eur J Clin Nutr

(1996)

P.P. Huijbregts et al.

Dietary patterns and cognitive function in elderly men in Finland, Italy and The Netherlands

Eur J Clin Nutr

(1998)

N. Scarmeas et al.

Mediterranean diet and risk for Alzheimer's disease

Ann Neurol

(2006)

A. Sanchez-Villegas et al.

Mediterranean diet and depression

Public Health Nutr

(2006)

Y. Benyamini et al.

Positive affect and function as influences on self-assessments of health: Expanding our view beyond illness and disability

J Gerontol B Psychol Sci Soc Sci

(2000)

P.K. Myint et al.

Fruit and vegetable consumption and self-reported functional health in men and women in the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk): A population-based cross-sectional study

Public Health Nutr

(2007)

Cited by (136)

Assessing dietary, exercise, and non-pharmacological modalities within psychiatric hospitals
2022, General Hospital Psychiatry
The ‘Lifestyle Medicine’ approach may offer an effective strategy for improving the outcomes of psychiatric care when used alongside conventional biological and psychotherapeutic treatments. Lifestyle interventions may also be useful in inpatient psychiatric settings, as this context provides a unique setting for adopting lifestyle changes that can be translated following discharge. While the data revealed by the small-scale feasibility studies reporting on the design and implementation of these interventions within psychiatric settings are compelling and indicative of improved patient outcomes, the strength and nature of the relationship between lifestyle factors and psychiatric care provision and outcomes remain unclear. It is strongly suggested that future research should focus on identifying any relevant organisational and programmatic challenges in psychiatric care settings, hence provide clear guidelines to enhance health-promoting behaviours and develop relevant public healthcare standards.
Psychosocial factors influencing the eating behaviours of older adults: A systematic review
2022, Ageing Research Reviews
Citation Excerpt :
Eleven studies investigated the associations between mental health measures and eating outcomes amongst older adults (Andre et al., 2017; Bailly et al., 2015; Dean et al., 2009; Engel et al., 2011; Iizaka et al., 2008; Kimura et al., 2012; Locher et al., 2008; Porter and Johnson, 2011; Samieri et al., 2008; Schnettler et al., 2017; Starr et al., 2014). Here, poorer mental health was associated with higher nutritional risk scores (Bailly et al., 2015; Dean et al., 2009; Iizaka et al., 2008), lower dietary healthiness/diversity (Dean et al., 2009; Kimura et al., 2012; Samieri et al., 2008; Schnettler et al., 2017), less eating pleasure (Bailly et al., 2015; Schnettler et al., 2017) and poorer appetite (Engel et al., 2011). In terms of anthropomorphic outcome measures, findings were mixed; one study found that increased levels of stress (but not depression or anxiety) was associated with higher BMI (Porter and Johnson, 2011), whereas another found that higher depression levels were associated with a lower BMI, but no association was found with stress (Starr et al., 2014).
Our understanding of how eating behaviours change in later life have been dominated by the studies of physiological and biological influences on malnutrition. Insights from these studies were consequently used to develop interventions, which are predominantly aimed at rectifying nutritional deficiencies, as opposed to interventions that may enable older adults to eat well and enjoy their food-related life well into older age. The objective of the present review is to summarise the existing knowledge base on psychosocial influences on eating behaviours in later life. Following comprehensive searches, review, and appraisal, 53 articles were included (22 qualitative and 31 quantitative) to provide a greater understanding of the mechanisms underpinning the psychosocial factors influencing eating behaviours. Our analysis identified eight underpinning psychosocial factors that influences eating behaviours in later life; (1) health awareness & attitudes, (2) food decision making, (3) perceived dietary control, (4) mental health & mood, (5) food emotions & enjoyment, (6) eating arrangements, (7) social facilitation, and (8) social support. The importance and lasting influence of early food experiences were also identified as contributing to eating behaviours in later life. The review concludes with the call for further investigation into specific psychosocial factors that influence eating behaviour, calls for improvements in methodologies, and a summary of psychosocial barriers and enablers to eating well in later life.
Mediterranean diet and prudent diet are both associated with low circulating esterified 3-hydroxy fatty acids, a proxy of LPS burden, among older adults
2021, American Journal of Clinical Nutrition
LPS-type endotoxins, naturally found in the gut microbiota, are recognized as triggers of inflammation and emerge as detrimental factors of healthy aging. Nutrition represents a promising strategy to reduce LPS burden, yet little is known about the relation of diet to circulating LPS concentrations.
The aim was to evaluate the associations between food groups, dietary patterns, and circulating 3-hydroxy fatty acids (3-OH FAs), a proxy of LPS burden.
In a cross-sectional study of 698 French older community-dwelling individuals, 3-OH FA concentrations were measured by LC–tandem MS. Dietary patterns were determined using food-frequency questionnaires. Adherence to a Mediterranean-type diet was computed according to the consumption of 8 food groups (fruits, vegetables, legumes, cereals, fish, olive oil, meat, and dairy products) and alcohol intake (range: 0, low adherence, to 18, high adherence). Three a posteriori dietary patterns were derived from factor analysis: complex carbohydrate (rich in rice, pasta, eggs, poultry, and potatoes), traditional (rich in alcohol, meat, processed meats–cold cuts, and legumes), and prudent (rich in vegetables and fruits and low in cookies) diets. Linear regression models were applied.
The frequency of consumption of each food group was not associated with 3-OH FA concentrations. Greater adherence to both the Mediterranean diet and the prudent diet were associated with lower circulating 3-OH FAs (β [95% CI] for each additional point of score: −0.12 [−0.22, −0.01] and −0.27 [−0.48, −0.07], respectively). In contrast, greater adherence to the traditional diet was associated with higher concentration of 3-OH FAs (β [95% CI] 0.22 [0.001, 0.46]). The adherence to the complex-carbohydrate diet was not associated with 3-OH FA concentrations.
Based on 2 complementary approaches, the identified plant-based dietary patterns were associated with lower 3-OH FA concentrations, and thus a lower LPS burden, which is considered a potent trigger of inflammatory response.
Dietary fiber deficiency as a component of malnutrition associated with psychological alterations in alcohol use disorder
2021, Clinical Nutrition
Chronic alcohol consumption can cause malnutrition that may contribute to alcohol-induced organ injury and psychological disorders. We evaluated the link between nutrient intake, especially dietary fibers (DF) and different parameters reflecting mental health and well being, namely anxiety, depression, alcohol craving, sociability, fatigue and intestinal comfort in alcohol use disorder (AUD) patients.
Cross-sectional data from 50 AUD patients, hospitalized for a 3-week detoxification program were used. Three 24-h recalls allowed to calculate dietary habits and nutrient intakes, that was also assessed in healthy subjects (HS). Diet quality was measured using the NOVA score. Psychological factors and intestinal discomfort were evaluated using validated self-administered questionnaires.
Energy intake (excluding alcoholic beverage), total fat, monounsaturated and polyunsaturated fatty acids, protein and DF intakes were lower in AUD subjects compared to HS. Ninety percent of patients had a DF intake below the recommendation. AUD patients consumed more than twice as much ultra-processed food than HS. Fructan intake was negatively associated with anxiety (p = 0.04) adjusted for main confounders. Total DF, insoluble, soluble DF and galacto-oligosaccharide intakes were associated with higher sociability score. Soluble DF intake was associated with better satisfaction of bowel function (p = 0.02) and a lower intestinal discomfort (p = 0.04).
This study reveals that insufficient DF intake is part of AUD-related malnutrition syndrome, and is associated with higher anxiety, lower sociability score and intestinal discomfort. Our results suggest that an adequate intake of DF might be beneficial for recovery from AUD.
NCT03803709, https://clinicaltrials.gov/ct2/show/NCT03803709.
Association between dietary diversity and cognitive impairment among the oldest-old: Findings from a nationwide cohort study
2021, Clinical Nutrition
Citation Excerpt :
Beneficial effects of dietary variety on cognitive function were observed in a study on younger elderly (mean age 60) in Australia [14]. Furthermore, a cross-sectional study on older adults with an average age of 75 in France has shown that a combination of fish, fruit, and vegetables was associated with fewer errors on MMSE, and higher intake of biscuits and snack were related to more errors on MMSE [43]. In cohort studies on older adults in Canada and Sweden (mean age was 74 and 70, respectively), higher adherence to a western diet was associated with cognitive decline [44,45].
Dietary diversity is widely recommended in national and international guidelines; however, whether the beneficial effects on cognitive function still apply in the oldest-old (80+) has rarely been studied. This study aimed to evaluate the associations of dietary diversity with cognitive function among the oldest-old in a large prospective cohort in China.
We conducted a long-term prospective analysis on 11,970 participants aged 80+ (6581 octogenarians, 3730 nonagenarians, and 1659 centenarians). We constructed the baseline dietary diversity score (DDS) based on eight food items of a food frequency questionnaire. Mini-mental state examination (MMSE) was used to classify the participants as having cognitive impairment or not and was also used as a continuous metric. Non-linear associations of DDS with cognitive impairment was evaluated by cox models with penalized splines. We used mixed-effect models for longitudinal data with repeated measurements of MMSE (for up to seven time during the follow-up between 1998 and 2014).
We documented 4778 cognitive impairment during 46,738 person-years of follow-up. Each one unit increase in DDS was associated with a 4% lower risk of cognitive impairment (adjusted hazard ratio (HR): 0.96; 95% confidential interval (CI): 0.94–0.98). Compared to participants with DDS of 0 score, those with a DDS of 1–2, 3–4, and higher than 5 scores had a lower cognitive impairment risk, the HRs were 0.86 (0.79–0.95), 0.82 (0.74–0.91), and 0.72 (0.64–0.82) respectively, and a significant trend emerged (p < 0.001). Compared with DDS of zero score, a DDS of 1–2,3–4, ≥5 was related to slower MMSE decline (β = 0.128, 0.162, 0.301, respectively, p < 0.01).
Even after the age of 80, dietary diversity may offer a simple and straightforward mean of identifying and screening individuals at high risk for cognitive impairment. Recommendation of dietary diversity may be advocated to attenuate cognitive decline and decrease the risk of cognitive impairment in the oldest-old, especially in a low income or middle-income countries.
Dairy products and brain structure in French older adults
2024, British Journal of Nutrition

View all citing articles on Scopus

L. Capuron is a researcher, Psynugen, UMR INRA-UB2 1286, CNRS-UB2 5226, Institut François Magendie, Bordeaux, France.

View full text

ResearchCurrent ResearchDietary Patterns Derived by Hybrid Clustering Method in Older People: Association with Cognition, Mood, and Self-Rated Health

Abstract

Background

Objective

Design

Subjects/setting

Statistical analysis

Results

Conclusions

Section snippets

Participants

Dietary Clusters

Discussion

Lancet Neurol

Am J Clin Nutr

J Am Diet Assoc

J Am Diet Assoc

J Am Diet Assoc

Am J Geriatr Psychiatry

J Psychiatr Res

Prev Med

Am J Clin Nutr

J Nutr

Am J Clin Nutr

J Am Diet Assoc

Soc Sci Med

Nutrition

Neurobiol Aging

Lancet

Lancet Neurol

Am J Clin Nutr

Jpn J Pharmacol

IANA task force on nutrition and cognitive decline with aging

J Nutr Health Aging

Nutritional epidemiology-past, present, future

Int J Epidemiol

Commentary: Dietary patterns in transition can inform health risk, but detailed assessments are needed to guide recommendations

Int J Epidemiol

Dietary pattern analysis: A new direction in nutritional epidemiology

Curr Opin Lipidol

Empirically derived eating patterns using factor or cluster analysis: A review

Nutr Rev

Dietary patterns among older Europeans: The EPIC-Elderly study

Br J Nutr

Food patterns of elderly EuropeansSENECA Investigators

Eur J Clin Nutr

Dietary patterns and cognitive function in elderly men in Finland, Italy and The Netherlands

Eur J Clin Nutr

Mediterranean diet and risk for Alzheimer's disease

Ann Neurol

Mediterranean diet and depression

Public Health Nutr

Positive affect and function as influences on self-assessments of health: Expanding our view beyond illness and disability

J Gerontol B Psychol Sci Soc Sci

Fruit and vegetable consumption and self-reported functional health in men and women in the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk): A population-based cross-sectional study

Public Health Nutr

Research
Current Research
Dietary Patterns Derived by Hybrid Clustering Method in Older People: Association with Cognition, Mood, and Self-Rated Health