NATALIA GOMES GONCALVES
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LIM/22 - Laboratório de Patolologia Cardiovascular, Hospital das Clínicas, Faculdade de Medicina
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- Different Sources of Sugar Consumption and Cognitive Performance in Older Adults: Data From the National Health and Nutrition Examination Survey 2011-2014(2023) GONCALVES, Natalia Gomes; SUEMOTO, Claudia Kimie; FERREIRA, Naomi VidalObjectives Excess sugar consumption, particularly in sugar-sweetened beverages (SSBs), has been linked to poor cognitive performance. We aimed to assess the association of consumption of total sugar, as well as the consumption of SSBs, solid desserts, and 100% fruit juice with cognitive performance among older adults. Methods Consumption of total sugar, SSBs, solid desserts, and 100% fruit juice were obtained from the 24-hr recall interview. Cognitive performance was evaluated using the Consortium to Establish a Registry for Alzheimer's Disease word list, the Animal Fluency Test, and the Digit Symbol Substitution Test. Binary logistic regression models were used to evaluate the association between consumption of sugar (total and from different sources) and cognitive performance. Results A total of 1,938 participants aged 60 years or older from the National Health and Nutrition Examination Survey 2011-2014 were included. Compared to the lowest tertile, the highest tertile of total sugar consumption was independently associated with higher odds of low memory performance (odds ratio [OR] = 1.87, 95% confidence interval [CI] = 1.00; 3.50, p = .049). Consumption of SSBs was associated with higher risk of low memory (OR = 1.58, 95% CI = 1.11; 2.25, p = .014), whereas consumption of solid desserts was associated with lower risk of low verbal fluency performance (OR = 0.62, 95% CI = 0.41; 0.95, p = .032). Discussion Higher consumption of total sugars and SSBs was associated with lower memory performance, while consumption of solid desserts was associated with higher verbal fluency performance.
- Dissipating the fog: Cognitive trajectories and risk factors 1 year after COVID-19 hospitalization(2023) GONCALVES, Natalia Gomes; ALIBERTI, Marlon Juliano Romero; BERTOLA, Laiss; AVELINO-SILVA, Thiago; DIAS, Murilo Bacchini; APOLINARIO, Daniel; BUSATTO, Geraldo; FORLENZA, Orestes; NITRINI, Ricardo; BRUCKI, Sonia Maria Dozzi; BRUNONI, Andre Russowsky; VIDAL, Kallene Summer Moreira; JACOB-FILHO, Wilson; SUEMOTO, Claudia KimieIntroduction: Cognitive impairment is common after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, associations between post-hospital discharge risk factors and cognitive trajectories have not been explored. Methods: A total of 1105 adults (mean age SD 64.9 9.9 years, 44% women, 63% White) with severe coronavirus disease 2019 (COVID-19) were evaluated for cognitive function 1 year after hospital discharge. Scores from cognitive tests were harmonized, and clusters of cognitive impairment were defined using sequential analysis. Results: Three groups of cognitive trajectories we re observed during the follow-up: no cognitive impairment, initial short-term cognitive impairment, and long-term cognitive impairment. Predictors of cognitive decline after COVID-19 were older age (beta = -0.013, 95% CI = -0.023;-0.003), female sex (beta = -0.230, 95% CI = -0.413;-0.047), previous dementia diagnosis or substantial memory complaints (beta = -0.606, 95% CI = -0.877;-0.335), frailty before hospitalization (beta = -0.191, 95% CI = -0.264;-0.119), higher platelet count (beta = -0.101, 95% CI = -0.185;-0.018), and delirium (beta = -0.483, 95% CI = -0.724;-0.244). Post-discharge predictors included hospital readmissions and frailty. Discussion: Cognitive impairment was common and the patterns of cognitive trajectories depended on sociodemographic, in-hospital, and post-hospitalization predictors. Highlights Cognitive impairment after coronavirus disease 2019 (COVID-19) hospital discharge was associated with higher age, less education, delirium during hospitalization, a higher number of hospitalizations post discharge, and frailty before and after hospitalization. Frequent cognitive evaluations for 12-month post-COVID-19 hospitalization showed three possible cognitive trajectories: no cognitive impairment, initial short-term impairment, and long-term impairment. This study highlights the importance of frequent cognitive testing to determine patterns of COVID-19 cognitive impairment, given the high frequency of incident cognitive impairment 1 year after hospitalization.
- cognitive performance Natalia Gomes Gonc,alves,1 Laiss Bertola,2 Cleusa Pinheiro Ferri,2 Claudia Kimie Suemoto1(2023) GONCALVES, Natalia Gomes; BERTOLA, Laiss; FERRI, Cleusa Pinheiro; SUEMOTO, Claudia KimieObjectives: Rural residents are exposed to many risk factors for poor diet quality, such as low socioeconomic status and food insecurity. However, the differences between urban and rural residents regarding the association of fruit and vegetable consumption with cognitive performance have not been explored. The aim of this study was to investigate the association of fruit and vegetable consumption with cognitive performance in urban and rural areas in a nationally representative sample of Brazilian older adults. Methods: The sample included 9,412 adults aged 50 years or older from the Brazilian Longitudinal Study of Aging (Estudo Longitudinal da Sau ' de dos Idosos Brasileiros [ELSI]). The association between consumption of fruits and vegetables and cognitive performance was evaluated using linear regression. Results: In 8,158 participants (mean age 61.6 +/- 9.3 years, 54% women, 44% White, and 15% from rural areas), the mean frequency of fruit and vegetable consumption was 2.0 +/- 1.3 times a day. Higher intake of fruits and vegetables was associated with better memory (i3 = 0.031, 95%CI 0.014-0.049), verbal fluency (i3 = 0.030, 95%CI 0.004-0.056), and global cognition (i3 = 0.035, 95%CI 0.015-0.055) performance in urban, but not rural residents (p for interaction = 0.036). Conclusion: Higher frequency of fruit and vegetable intake was associated with better cognitive performance in urban, but not in rural areas in Brazil.
- Prevalence of Dementia and Cognitive Impairment No Dementia in a Large and Diverse Nationally Representative Sample: The ELSI-Brazil Study(2023) BERTOLA, Laiss; SUEMOTO, Claudia Kimie; ALIBERTI, Marlon Juliano Romero; GONCALVES, Natalia Gomes; PINHO, Pedro Jose De Moraes Rebello; CASTRO-COSTA, Erico; LIMA-COSTA, Maria Fernanda; FERRI, Cleusa P.Background Approximately 77% of older adults with dementia in Brazil have not been diagnosed, indicating a major public health issue. Previous epidemiological dementia studies in Brazil were based on data from 1 geopolitical region. Methods We aimed to estimate the general and subgroup-specific (age, education, and sex) prevalence of dementia and cognitive impairment no dementia (CIND) classification using data from 5 249 participants aged 60 years and older from the ELSI-Brazil, a large nationally representative sample. Participants were classified as having normal cognitive function, CIND, or dementia based on a combination of the individual's cognitive and functional status. Results We found a general prevalence of 5.8% (95% CI = 4.7-7.2) for dementia and 8.1% (95% CI = 6.8-9.5) for CIND. Dementia prevalence ranged from 3.2% (60-64 years old) to 42.8% (>= 90 years old) by age, and from 2.1% (college level or higher) to 16.5% (illiterates) by education. Females had a higher dementia prevalence (6.8%) than males (4.6%). CIND prevalence was similar across age, sex, and education. Conclusions The estimated dementia prevalence is lower than that in previous Brazilian epidemiological studies, but is in line with other Latin American studies. Only 1.2% of the ELSI-Brazil participants reported having a previous diagnosis of dementia, revealing that underdiagnosis is rampant and a common reality. Based on our results and national statistics projections, we estimate that in 2019, there were 1 757 480 people aged 60 years and older living with dementia in Brazil and, at least, another 2 271 314 having to deal with some form of cognitive impairment.
- Association Between Consumption of Ultraprocessed Foods and Cognitive Decline(2023) GONCALVES, Natalia Gomes; FERREIRA, Naomi Vidal; KHANDPUR, Neha; STEELE, Euridice Martinez; LEVY, Renata Bertazzi; LOTUFO, Paulo Andrade; BENSENOR, Isabela M.; CARAMELLI, Paulo; MATOS, Sheila Maria Alvim de; MARCHIONI, Dirce M.; SUEMOTO, Claudia KimieImportance Although consumption of ultraprocessed food has been linked to higher risk of cardiovascular disease, metabolic syndrome, and obesity, little is known about the association of consumption of ultraprocessed foods with cognitive decline.Objective To investigate the association between ultraprocessed food consumption and cognitive decline in the Brazilian Longitudinal Study of Adult Health.Design, Setting, and Participants This was a multicenter, prospective cohort study with 3 waves, approximately 4 years apart, from 2008 to 2017. Data were analyzed from December 2021 to May 2022. Participants were public servants aged 35 to 74 years old recruited in 6 Brazilian cities. Participants who, at baseline, had incomplete food frequency questionnaire, cognitive, or covariate data were excluded. Participants who reported extreme calorie intake (6000 kcal/day) and those taking medication that could negatively interfere with cognitive performance were also excluded.Exposures Daily ultraprocessed food consumption as a percentage of total energy divided into quartiles.Main Outcomes and MeasuresChanges in cognitive performance over time evaluated by the immediate and delayed word recall, word recognition, phonemic and semantic verbal fluency tests, and Trail-Making Test B version.Results A total of 15 105 individuals were recruited and 4330 were excluded, leaving 10 775 participants whose data were analyzed. The mean (SD) age at the baseline was 51.6 (8.9) years, 5880 participants (54.6%) were women, 5723 (53.1%) were White, and 6106 (56.6%) had at least a college degree. During a median (range) follow-up of 8 (6-10) years, individuals with ultraprocessed food consumption above the first quartile showed a 28% faster rate of global cognitive decline (beta = -0.004; 95% CI, -0.006 to -0.001; P = .003) and a 25% faster rate of executive function decline (beta = -0.003, 95% CI, -0.005 to 0.000; P = .01) compared with those in the first quartile.Conclusions and Relevance A higher percentage of daily energy consumption of ultraprocessed foods was associated with cognitive decline among adults from an ethnically diverse sample. These findings support current public health recommendations on limiting ultraprocessed food consumption because of their potential harm to cognitive function.
- Dietary folate intake and its association with longitudinal changes in cognition function(2023) PALCHETTI, Cecilia Zanin; GONCALVES, Natalia Gomes; FERREIRA, Naomi Vidal; SANTOS, Itamar S.; LOTUFO, Paulo Andrade; BENSENOR, Isabela M.; SUEMOTO, Claudia Kimie; MARCHIONI, Dirce Maria LoboBackground & aims: Folate (vitamin B9) is an essential co-factor for one-carbon metabolism. Contro-versial evidence has emerged regarding the association between folate and cognitive performance. The aim of the study was to investigate the association between baseline dietary folate intake and cognitive decline in a population exposed to mandatory fortification during a median follow-up of 8 years. Methods: Multicenter, prospective cohort study involving 15,105 public servants aged 35-74 years old, both sexes, from The Brazilian Longitudinal Study of Adult Health (EL SA-Brasil). Baseline dietary intake was assessed by a Food Frequency Questionnaire (FFQ). Six cognitive tests were performed in the three waves to assess memory, executive function and global cognition. Linear mixed-effects models were used to assess the association between dietary folate intake at baseline and changes in cognition over time. Results: Data from 11,276 participants were analyzed. The mean (SD) age was 51.7 (9) years, 50% were women, 63% were overweight/obese, and 56% had graduated from college or more. Overall dietary folate intake was not associated with cognitive decline; neither vitamin B12 intake was a modifier of this association. General dietary supplements and specifically multivitamins use did not affect these findings. Natural food folate group was associated with a slower rate of global cognitive decline (b (95% CI): 0.001 (0.000; 0.002), P 1/4 0.015). There was no association between fortified food group and cognition scores. Conclusion: Overall dietary folate intake was not associated with cognitive function in this Brazilian population. However, folate naturally occurring in food sources may slow global cognitive decline.(c) 2023 European Society for Clinical Nutrition and Metabolism.
- Education and cognitive function among older adults in Brazil and Mexico(2023) GONCALVES, Natalia Gomes; AVILA, Jaqueline Contrera; BERTOLA, Laiss; OBREGON, Alejandra Michaels; FERRI, Cleusa Pinheiro; WONG, Rebeca; SUEMOTO, Claudia KimieEducation is protective against cognitive impairment. We used nationally representative data from Mexico and Brazil to assess the association between education and cognitive function. The sample included adults & GE; 50 years from the Brazilian Longitudinal Study of Aging (ELSI) and the Mexican Health and Aging Study (MHAS). Participants were classified as cognitively impaired or not impaired. We used logistic regression models to estimate the association between education and cognitive function. Education level was higher in MHAS than in ELSI. Participants with at least 1 year of education were less likely to have cognitive impairment than those with no formal education in both cohorts. Men in ELSI had higher odds for cognitive impairment compared to men in MHAS. In both cohorts, higher educational level was associated with lower odds of cognitive impairment compared to no formal education. Sex was an effect modifier in MHAS but not in ELSI.HIGHLIGHTSCognitive test batteries were harmonized using a regression-based approach.Even very low levels of education were associated with reduced odds of cognitive impairment compared to no formal education.Brazilians were more likely to have cognitive impairment than Mexicans given the same education level.The differences in the association of education with cognition between Brazil and Mexico were only observed among men.