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Shan Hai,1 Qi Gao,2 Xinyi Gwee,2 Denise Qian Ling Chua,2 Keng Bee Yap,3 Tze Pin Ng2 1Gerontology and Geriatrics Centre, West China Hospital of Sichuan University, Chengdu, People’s Republic of China; 2Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 3Department of Medicine, Ng Teng Fong General Hospital, SingaporeCorrespondence: Tze Pin NgDepartment of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Kent Ridge Road, 119228, SingaporeTel +65 6772 4518; +65 6772 3478Fax +65 6777 2191Email pcmngtp@nus.edu.sgPurpose: Malnutrition and population ageing are doubly global healthcare challenges. It is widely recognized that disability is a major contributor to malnutrition among older people, but the importance of reducing malnutrition risk (MR) for disability prevention is given little attention. We investigated the association between MR and risk of incident disability and functional decline among community-dwelling older persons.Materials and Methods: Prospective cohort study of community-dwelling older adults aged 55 and above (Singapore Longitudinal Ageing Study) with 3– 5 years follow-up. MR was measured at baseline using an appropriate and validated index (ENIGMA); physical and functional measures at baseline and follow-up included instrumental and basic activity of daily living (ADL), knee extension (KES), gait velocity (GV), timed up-and-go (TUG).Results: Compared to low MR, mild-moderate MR (OR = 1.43, 95% CI = 1.02– 2.01) and severe MR (OR=1.74, 95% CI=1.10– 2.74) were associated with higher risks of incident disability. Severe MR was associated with functional decline (OR = 1.69, 95% CI = 1.11– 2.57). Estimates were adjusted for demographic, social, lifestyle behaviour and health variables. In particular, eating difficulty was associated with incident disability and functional decline, and low lymphocyte with functional decline. Severe MR and low albumin were associated with 37% worse GV and 126% worse TUG declines; consuming few vegetables or fruits with 34% worse KES decline; polypharmacy with 56% worse TUG decline.Conclusion: Malnutrition risk increased the risk of incident disability and functional decline in non-disabled persons, it worsened physical performance declines. Further studies should investigate the effectiveness of nutritional interventions in reducing the risk of disability among older people.Keywords: malnutrition, functionality, ageing, prospective cohort study

Experimental evidence suggest that tea polyphenols have anti-depressant effect and tea consumption may reduce the risk and severity of depression. We investigated whether tea consumption was associated with changes in depressive symptoms over time among Asian older adults. Population-based prospective cohort study with mean 4 years of follow up. Singapore Longitudinal Ageing Study (SLAS) of community-living older persons. 3177 participants overall (mean age 67 years) and 3004 participants who were depression-free at baseline. Baseline tea consumption which include Chinese (black, oolong or green) tea or Western (mixed with milk) tea and change in Geriatric Depression Scale (GDS) measure of depression. Incident depression was defined by GDS≥5, and GDS depression improvement or deterioration by GDS change of ≥4 points. Estimated odds ratio and 95% confidence intervals (OR, 95%CI) were adjusted for baseline age, sex, ethnicity, education, housing type, single/divorced/widowed, living alone, physical and social activity, smoking, alcohol, number of comorbidities, MMSE, and baseline GDS level. Compared to non-tea drinkers, participants who consumed ≥3 cups of tea of all kinds were significantly less likely to have worsened GDS symptoms: OR=0.32, 95% CI=0.12, 0.84. Among baseline depression-free participants, the risk of incident GDS (≥5) depression was significantly lower (OR=0.34, 95%CI=0.13, 0.90) for daily consumption of all types of tea, and Chinese (black, oolong or green) tea (OR=0.46, 95%CI=0.21,0.99). This study suggests that tea may prevent the worsening of existing depressive symptoms and the reduce the likelihood of developing threshold depression.

Background real-world observations on the long-term benefits of Tai Chi (TC) exercise, in terms of physical and cognitive functioning, frailty, quality of life (QOL) and mortality are lacking. Methods prospective cohort study participants were community-dwelling adults aged 55+, including 5,407 non-frequent TC participants ( Results frequent TC participation was associated with 0.7-fold lower prevalence of impaired physical QOL [95% confidence interval (CI) = 0.57–0.91], decreased 0.4-fold odds of incident prefrailty/frailty among robust participants at baseline and 0.7-fold odds of impaired mental QOL at follow-up among participants with normal mental QOL at baseline. Lower odds of mortality risk (HR = 0.89, 95%CI = 0.72–1.09) were not significant after controlling for socioeconomic, behavioural and health factors. Composite indexes of physical functional and neurocognitive performance were maintained at high level or increased at follow-up among frequent TC participants. Conclusion TC exercise practised among community-dwelling older adults is associated with better physical, cognitive and functional wellbeing.

The potential neurocognition protective effects of dietary curcumin in curry consumed with food was investigated in this study of 2734 community-dwelling adults (aged ≥ 55, mean ± SD: 65.9 ± 7.4). We analyzed longitudinal data of baseline curry consumption (“never or rarely”, “occasionally”: once a month and once a week or daily) and baseline and 4.5-year follow-up cognitive function in mixed model analyses controlling for confounding risk factors. Significant between-exposure differences were found for Digit Span-Backward (DS-B), Verbal Fluency-Animals (VF-A) and Block Design (BD). Compared to “never or rarely” consumption, “very often” and “often” consumptions were associated with higher DS-B performance; “very often”—with higher VF-A, and “occasional”, “often” and “very often” consumptions—with higher BD: Cohen’s d: from 0.130 to 0.186. Among participants with cardiometabolic and cardiac diseases (CMVD), curry consumption was associated with significantly higher DS-B and VF-A. Among CMVD-free participants, curry consumption was associated with significantly higher DS-B, VF-A and BD: Cohen’s d: from 0.098 to 0.305. The consumption of dietary curcumin was associated with the maintenance over time of higher functioning on attention, short-term working memory, visual spatial constructional ability, language and executive function among community-dwelling older Asian adults.

Physical frailty commonly is associated with COPD, and its evaluation in COPD may provide important prognostic information for risk stratification.What are the comorbid associations of physical frailty with COPD? Does physical frailty singly and in combination with FEVProspective cohort study of community-dwelling adults 55 years of age or older in the Singapore Longitudinal Ageing Study. Baseline data of 1,162 participants with COPD and 3,465 participants without COPD included physical frailty, FEVBaseline prevalence of prefrailty (48.8%) and frailty (6.8%) in participants with COPD were significantly higher than in participants without COPD: frailty OR, 1.61; 95% CI, 1.15-2.26. Prefrailty or frailty was associated significantly with twofold increased odds of prevalent and incident IADL and basic ADL disability and mortality in participants with COPD. In combination with FEVThe study supports the use of physical frailty in addition to lung function and dyspnea in multidimensional evaluation of COPD.

We previously developed a malnutrition risk index, the Elderly Nutritional Index for Geriatric Malnutrition Assessment (ENIGMA) with good predictive accuracy for mortality risk in an original population cohort (SLAS1). Herein, we further evaluate the concurrent and predictive validity of the ENIGMA construct in an external validation cohort (SLAS-2) of 2824 community-dwelling older adults aged 55+ years. They were assessed on the ENIGMA index, Mini Nutritional Assessment-Short Form (MNA-SF) and the Geriatric Nutritional Risk Index (GNRI), known correlates of malnutrition, and baseline and follow-up functional dependency and 10-year mortality risk. Higher ENIGMA risk categories were significantly associated (P < 0·001) with lower education, living alone, smoking, low physical activity, BMI < 18·5 kg/m2, poorer muscle strength and functional mobility, exhaustion, physical frailty, homocysteine, glomerular filtration rate, Hb, red and white blood cell counts, platelets, systemic inflammation indexes, metabolic syndrome, CVD, cognitive impairment and depressive symptoms (Geriatric Depression Scale ≥ 5). ENIGMA scores showed statistically significant (P < 0·001) correlations but low-to-moderate concordance with MNA-SF (r = 0·148, agreement = 45·9 %, kappa = 0·085) and GNRI scores (r = 0·156, agreement = 45·8 %, kappa = 0·096). Controlling for known correlates of malnutrition, only high-risk ENIGMA among the indexes significantly predicted baseline functional dependency (OR = 1·64, 95 % CI 1·01, 2·65) and mortality (hazard ratio = 1·65 (95 % CI 1·04, 2·62). ENIGMA marginally out-performed MNA-SF and GNRI in predicting baseline functional dependency (AUC: 0·625 v. 0·584 v. 0·526), follow-up functional dependency (AUC: 0·594 v. 0·525 v. 0·479) and 10-year mortality risk (AUC: 0·641 v. 0·596 v. 0·595). The concurrent and predictive validity of the ENIGMA construct is replicated in an external evaluation study of community-dwelling older persons.

Introduction: The identification of modifiable health span-promoting factors is a public health priority. Objective: To explore the socio-environmental, lifestyle, behavioural, and psychological determinants of a clinical phenotypic measure of biological ageing in the Singapore Longitudinal Ageing Study (SLAS) cohort. Methods: Using cross-sectional data on 2,844 SLAS-2 adults with a chronological age (CA) ≥55 years, we estimated biological age (BA) using a validated panel of clinical, biochemical, physiological, and functional indicators (8 in men and 10 in women) and calculated the difference between BA and CA (BA – CA in years). Potential determinants included education, housing status, loss of a spouse, living alone, lifestyle and health activity, smoking, alcohol consumption, nutritional risks, consumption of milk, soy, fruit, vegetables, coffee and tea, sleep parameters, and life satisfaction. Results: The mean CA was 67.0 (standard deviation [SD] 7.9; range 55–94) years. The estimated BA varied more widely (SD 8.9 years; range 47.5–119.9 years), and BA – CA ranged from –11.3 to 30.0 years. In stepwise selection regression analyses, multiple significant independent determinants in a final model were larger for private housing, being single/divorced/widowed, productivity, cognitive and leisure time activity scores, 10 h/week of moderate-to-vigorous physical activity, unintended loss of weight, life satisfaction, and daily consumption of fruits 1–2 or ≥3 servings and Chinese tea 1–2 or ≥3 cups daily, together explaining 16% of BA – CA variance in men and 14% in women. Associated BA – CA estimates were highest in men with high-end housing status (–1.8 years, effect size 0.015) and unintended weight loss (1.5 years, effect size 0.017). Conclusion: We identified determinants of biological ageing which can promote health span.

Studies suggest that nutritional interventions using the whole diet approach such as the Mediterranean diet may delay cognitive decline and dementia onset. However, substantial numbers of older adults are non-adherent to any ideally healthy dietary pattern and are at risk of malnutrition. The present study investigated the relationship between global malnutrition risk and onsets of cognitive decline and neurocognitive disorders (NCD), including mild cognitive impairment (MCI) or dementia in community-dwelling older adults. Participants aged ≥55 years in the Singapore Longitudinal Ageing Studies (SLAS) were assessed at baseline using the Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA) and followed up 3–5 years subsequently on cognitive decline (MMSE drop ≥ 2) among 3128 dementia-free individuals, and incident neurocognitive disorders (NCD) among 2640 cognitive normal individuals. Individuals at high nutritional risk score (≥3) were more likely to develop cognitive decline (OR=1.42, 95%CI=1.01–1.99) and incident MCI-or-dementia (OR=1.64, 95%CI=1.03–2.59), controlling for age, sex, ethnicity, low education, APOE-e4, hearing loss, physical, social, and mental activities, depressive symptoms, smoking, alcohol, central obesity, hypertension, diabetes, low HDL, high triglyceride, cardiac disease, and stroke. Among ENIGMA component indicators, low albumin at baseline was associated with cognitive decline and incident NCD, and 5 or more drugs used, few fruits/vegetables/milk products daily, and low total cholesterol were associated with incident NCD. The ENIGMA measure of global malnutrition risk predicts cognitive decline and incident neurocognitive disorders, suggesting the feasibility of identifying vulnerable subpopulations of older adults for correction of malnutrition risk to prevent neurocognitive disorders.

Background There are inconsistent evidence for the association between fish consumption and dementia risk, and emerging evidence suggesting that dairy consumption is associated with lower dementia risk, based on a limited number of prospective cohort studies. Methods We investigated the association of dairy and fish consumption with the risk of developing mild cognitive impairment (MCI) and dementia. High intake of daily consumption of milk and dairy products and consumption of fish at least three servings per week were determined at baseline for 1,164 community-living and cognitively normal Chinese individuals aged 55 + in the Singapore Longitudinal Ageing Study (SLAS-1), who were followed-up (average 3.5 years) for incident cases of MCI and dementia determined by established criteria. Results The participants’ mean (SD) age was 65.1 (6.9) years, 66.8% were female. Controlling for sex, age, low or no education, APOE-e4 status, physical, social and productive activity, depression (GDS ≥ 5), central obesity, prediabetes/diabetes, hypertension, abnormal lipids, cardiac diseases, and daily fruit/vegetable intake in multivariable analysis, daily intake of milk and dairy products was significantly associated with lower risk of incident MCI (OR = 0.61; 95% CI = 0.39–0.96) or MCI-dementia (OR = 0.62; 95% CI = 0.40–0.95). Fish intake was not significantly associated with lowered risk of incident MCI and MCI-dementia, (OR = 0.74, 95%CI = 0.49–1.13 for MCI; OR = 0.76, 95% CI = 0.51–1.14 for MCI-dementia). Conclusions High dairy intake was associated with approximately 40% reduced risk of MCI or dementia. There is weak support in this study of an association between fish intake and MCI-dementia risk. Trial Registration: ClinicalTrials.gov NCT03405675. Registered 23 January 2018 (retrospectively registered).

Background/Aim: Studies of the associations of the metabolic syndrome (MetS) with cognitive function and decline are inconclusive. We investigated the associations of the MetS with cognitive functions in 823 Chinese >55-year-olds followed up over 4.5 years. Methods: The relationships between the MetS and baseline and follow-up z-scores of cognitive domain functions were examined using mixed model analysis. Results: There were specific inverse cross-sectional associations of single cardiometabolic risk factors with cognition, such as hyperglycemia with processing speed (p = 0.045). The MetS was negatively associated with 3 out of 4 cognitive domains (p = 0.018 to p = 0.003), and the count of cardiometabolic risk factors with all cognitive domains (p = 0.025 to p = 0.002). Longitudinally, dyslipidemia was associated with worse decline in memory and learning (p = 0.022). The count of cardiometabolic risk factors was associated with worse declines in cognition (p = 0.032 for global cognition). Conclusion: Among middle-aged and older Asians, an increased number of component cardiometabolic risk factors of the MetS was associated with a worse decline in cognitive function over time.