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This report summarises a Forum conducted in June 2023 to explore the current state of the knowledge around the Eatwell Guide, which is the UK government's healthy eating tool, in relation to population and planetary health. The 1.5‐day Forum highlighted the limited, albeit promising evidence linking higher adherence to the Eatwell Guide with favourable health outcomes, including reduced overall mortality risk, lower abdominal obesity in post‐menopausal women and improved cardiometabolic health markers. Similarly, evidence was presented to suggest that higher adherence to the Eatwell Guide is associated with reduced greenhouse gas emissions. Presentations were given around cultural adaptations of the Eatwell Guide, including African Heritage and South Asian versions, which are designed to increase the acceptability and uptake of the Eatwell Guide in these communities in the United Kingdom. Presentations highlighted ongoing work relevant to the applications of the Eatwell Guide in randomised controlled trials and public health settings, including the development of a screening tool to quantify Eatwell Guide adherence. The Forum ended with a World Café‐style event, in which the strengths and limitations of the Eatwell Guide were discussed, and directions for future research were identified. This Forum report serves as a primer on the current state of the knowledge on the Eatwell Guide and population and planetary health and will be of interest to researchers, healthcare professionals and public health officials. [ABSTRACT FROM AUTHOR]

Background: Hand grip strength is a well validated measure of physical strength, while anthropometric measures such as weight, waist, hip and mid upper arm circumference, are well validated to determine physical health. The present analysis investigated the relationship between hand grip strength, anthropometric measures and dementia incidence in 70–90‐year‐old men residing in Northern Ireland (NI). Method: The PRIME‐COG study is nested in PRIME (Prospective Epidemiological Study of Myocardial Infarction), a cohort study of men in NI. In the most recent follow up for PRIME‐COG, men underwent a comprehensive cognitive assessment from which a consensus diagnosis of normal cognitive function, MCI or dementia was made by experienced clinical researchers. Hand grip strength and anthropometrics measures were also recorded. Logistic regression models were performed to assess the association between hand grip strength and anthropometric measures and cognitive endpoints. Result: The analysis identified that low hand grip strength was associated with dementia and/or MCI, although this did not reach statistical significance (OR 1.39, p = 0.18). In the anthropometric measures, a significant relationship was observed between hip circumference and dementia and/or MCI at PRIME‐COG follow up (OR 0.93, p = 0.01), whereas BMI was non‐significantly associated (OR 1.22, p = 0.58). The remaining anthropometric measures investigated were not found to hold any significant relationships with the cognitive outcomes. Conclusion: Within a cohort of older men residing in NI, low hand grip strength was associated with a 39% increased risk of dementia or MCI, although this was not statistically significant. In anthropometric measures, hip circumference was found to be significantly negatively associated with a 7% reduced risk of dementia or MCI, while BMI was associated with a 22% increased risk, which again was not of statistical significance. The present study helps further contribute to the evidence base that physical well‐being is associated with cognitive function. [ABSTRACT FROM AUTHOR]

Aims: Type 2 diabetes is a risk factor for late‐life dementia, but dementia prevention strategies have yet to be comprehensively evaluated in people with diabetes. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) demonstrated cognitive benefits of a 2‐year multidomain lifestyle intervention. However, given the intensive nature of FINGER, there is uncertainty about whether it can be implemented in other high‐risk populations. Our aim was to explore attitudes towards dementia risk, and barriers to an intervention based on the FINGER model in older adults with type 2 diabetes living in rural areas of Ireland. Methods: Focus groups were conducted with 21 adults (11 men and 10 women) aged 60+ years with type 2 diabetes living in border regions of north and south Ireland. Data were analysed using thematic analysis. Results: There was limited understanding of diabetes as a risk factor for late‐life dementia. The main barriers to engagement with the multidomain intervention were eating foods that were not compatible with cultural norms, time and travel constraints, and perceived lack of self‐efficacy and self‐motivation for adopting the desired diet, exercise and computerised cognitive training (CCT) behaviours. Facilitators for intervention acceptability included the provision of culturally tailored and personalised education, support from a trusted source, and inclusion of goal setting and self‐monitoring behavioural strategies. Conclusions: While there was high acceptability for a brain health intervention, several barriers including cultural food norms and low self‐efficacy for adopting the diet, exercise and CCT components would need to be considered in the intervention design. Findings from this study will be used to inform local decisions regarding the adaptation of FINGER for people with type 2 diabetes. The feasibility of the adapted multidomain intervention will then be evaluated in a future pilot trial. [ABSTRACT FROM AUTHOR]

Dementia is a major public health challenge owing to its increasing prevalence and recognised impact on disability among older adults. Observational data indicate that weight loss is associated with increased dementia risk of 30%–40% and precedes a diagnosis of cognitive impairment or dementia by at least one decade. Although relatively little is known about the mechanisms of unintentional weight loss in dementia, this provides a window of opportunity to intervene with strategies to counteract undernutrition and delay, or prevent, the onset of dementia. This article provides an overview of the PROMED‐COG project and associated work packages. The project aimes to (1) strengthen the epidemiologic evidence to better understand the potential benefits of combating undernutrition for healthy neurocognitive ageing; (2) increase scientific knowledge on the balance between a protein enriched Mediterranean diet (PROMED) and physical exercise to prevent undernutrition and promote healthy neurocognitive ageing, and generate data on mechanistic pathways; (3) stimulate collaboration and capacity building for nutrition and neurocognitive ageing research in Europe; and (4) develop public and practice recommendations to combat undernutrition and promote healthy neurocognitive ageing in older adults. Findings will provide new and critical insights into the role of undernutrition in neurocognitive ageing, how this role can differ by sex, genetic risk and timing of undernutrition exposure, and how modifications of dietary and physical activity behaviour can reduce the burden of undernutrition and neurodegeneration. The research outcomes will be useful to inform policy and practice about the dietary guidelines of older people and provide insight to industry for the development of food‐based solutions to prevent undernutrition. [ABSTRACT FROM AUTHOR]

Background: Periodontitis (gum disease) is a is a chronic inflammatory disorder. Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Aggregatibacter actinomyecetemcomitans (Aa), and Treponema denticola (Td) are the most common periodontal pathogens. Evidence of a longitudinal association between periodontitis and dementia is currently lacking. We therefore proposed that prior periodontitis in 60‐70 year old men increases the longitudinal risk of cognitive decline. Method: PRIME‐COG is a nested in PRIME (Prospective Epidemiological Study of Myocardial Infarction), a cohort study of men in Northern Ireland (NI). Between 2001 and 2003, 1400 men underwent a periodontal examination, had inflammatory markers measured in blood, exposure to periodontopathogens identified within dental plaques, and a cognitive assessment. 874 men had a comprehensive cognitive assessment fifteen to twenty years later from which a consensus diagnosis of normal cognition, mild cognitive impairment (MCI) or dementia was made by experienced clinical researchers. Logistic regression models were performed to assess the association between periodontitis and future cognitive endpoints. In addition, serum IgG levels to Pg, Tf, Aa and Td and a panel of pro‐inflammatory cytokines were determined at baseline and follow‐up visits. Result: We did not identify any significant associations between periodontitis and dementia and/or MCI or cognitive decline in the extended follow up period. No differences in IgG serum titres to pathogens in baseline and follow‐up visits were seen for patients diagnosed with dementia or MCI, whereas levels were significantly decreased in the normal cognition group. Serum levels of IL‐6 at baseline were significantly higher in patients with MCI and dementia compared to those with normal cognition among men aged 76 years plus (p = 0.002); and 81 years plus (p = 0.02) respectively. IL‐8 levels were significantly different in patients with MCI aged 81+ years compared to those with normal cognition at baseline (p = 0.014) and follow‐up (p = 0.012). Conclusion: Within a cohort of older men residing in the NI, periodontitis was not associated with later onset of dementia or MCI following an extended follow up. Maintenance of high IgG levels over the years might indicate ongoing persistent infection associated with dampened immune response. This could contribute to increased risk of dementia/MCI. [ABSTRACT FROM AUTHOR]

Background: Nutritional influences, and antioxidant status in particular, have been implicated in the aetiology of cognitive decline. This study investigated the neuroprotective effects of serum antioxidants in a prospective cohort of older men to identify associations with cognitive outcomes, independent of traditional risk factors. Method: This cohort study included 873 Northern Irish men nested within PRIME (Prospective Epidemiological Study of Myocardial Infarction) who were followed‐up for at least 15 years. Mini Mental State Examination (MMSE) was carried out at baseline. The Addenbrooke's Cognitive Examination‐R and MMSE were carried out at follow‐up. A consensus diagnosis of normal cognition for age, mild cognitive impairment (MCI) or dementia was made using accepted clinical criteria. Serum concentrations of retinol, two forms of vitamin E (α‐ and ϒ‐tocopherol) and six carotenoids measured from baseline samples were quantified by high‐performance liquid chromatography and assessed by multiple logistic regression analyses. Result: The case definition included the 163 men characterised with MCI and 46 men with dementia; 664 participants were considered cognitively normal controls (Table 1). In unadjusted analyses, serum levels of the carotenoids α‐carotene, β‐carotene, lycopene and β‐cryptoxanthin were significantly lower in MCI/dementia cases than controls, in contrast to ϒ‐tocopherol, which was significantly higher (Table 2). Following adjustment for traditional risk factors including height, APOε4 genotype, diastolic blood pressure, smoking status and the presence of (pre)diabetes or depression, the effect size of those carotenoids significant in the unadjusted analysis was attenuated somewhat; only α‐carotene remained significantly associated with MCI/dementia (odds ratio = 0.55; confidence interval: 0.31‐0.99; Table 2). Conclusion: Our data implicates lower levels of serum carotenoids as potential early biomarkers of MCI/ dementia before overt manifestation of symptoms, independent of traditional risk factors. These findings are consistent with hypotheses supportive of a neuroprotective role of dietary antioxidants and corroborate previous associations of higher serum carotenoid levels with better cognition in aging subjects. There is emerging evidence that carotenoids, through their potent antioxidant and anti‐inflammatory properties, may positively impact cognitive function. Limiting cognitive decline through lifestyle, exercise, and a higher carotenoid intake, may prove beneficial. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the association between the Mediterranean diet (MedDiet) and the Mediterranean- DASH diet Intervention for Neurodegeneration Delay ( MIND diet) and cognition in a nationally representative population of older U.S. adults. Design Population-based cross-sectional study. Setting Health and Retirement Study. Participants Community-dwelling older adults (N = 5,907; mean age 67.8 ± 10.8). Measurements Adherence to dietary patterns was determined from food frequency questionnaires using criteria determined a priori to generate diet scores for the MedDiet (range 0-55) and MIND diet (range 0-15). Cognitive performance was measured using a composite test score of global cognitive function (range 0-27). Linear regression was used to compare cognitive performance according to tertiles of dietary pattern. Logistic regression was used to examine the association between dietary patterns and clinically significant cognitive impairment. Models were adjusted for age, sex, race, educational attainment, and other health and lifestyle covariates. Results Participants with mid (odds ratio ( OR) = 0.85, 95% confidence interval ( CI) = 0.71-1.02, P = .08) and high ( OR 0.65, 95% CI = 0.52-0.81, P < .001) MedDiet scores were less likely to have poor cognitive performance than those with low scores in fully adjusted models. Results for the MIND diet were similar. Higher scores in each dietary pattern were independently associated with significantly better cognitive function ( P < .001) in a dose-response manner ( Ptrend < .001). Conclusion In a large nationally representative population of older adults, greater adherence to the MedDiet and MIND diet was independently associated with better cognitive function and lower risk of cognitive impairment. Clinical trials are required to elucidate the role of dietary patterns in cognitive aging. [ABSTRACT FROM AUTHOR]

Background: Prior studies have reported associations between periodontitis, as a proxy for inflammation, and increased risk of cognitive decline and dementia, but findings for specific markers of periodontal disease (PDD) have been inconsistent with the few longitudinal studies in diverse cohorts. The goal of this study was to assess whether measures of PDD were associated with subsequent cognitive decline in a cohort of older Black and white adults. Method: We studied 967 Black and white adults, aged 70‐79 at baseline (51.8% female and 32.8% Black), enrolled in the Health, Aging and Body Composition study. Participants received a periodontal exam in year 2 which assessed indicators of PDD: gingival index (a rating of gingival inflammation), mean attachment loss, and mean pocket probing depth. Cognitive testing was repeated at baseline, years 3, 5, 8, 10, and 11, and included the Modified Mini‐Mental State (3MS) Examination and the Digit Symbol Substitution Test (DSST). We evaluated the association between PDD, categorized as tertiles, and cognitive decline over 11 years of follow‐up with linear mixed‐effects models. Result: In unadjusted models, higher gingival index was associated with greater decline on 3MS (high vs. low gingival index β = ‐0.27, 95% CI ‐0.48 to ‐0.05) but not DSST. This relationship remained significant after adjusting for race, sex, education, and socioeconomic status (β = ‐0.26, 95% CI ‐0.48 to ‐0.04). Models stratified by race suggest that this association was stronger among older Black adults (Black: β = ‐0.44, 95% CI ‐0.81 to ‐0.06; white: β = ‐0.13, 95% CI ‐0.40 to ‐0.12). Mean attachment loss and mean pocket probing depth were not consistently associated with cognitive decline. Conclusion: Gingival index was associated with worse decline in global cognition among Black and white older adults. Further work is necessary to understand other measures of poor oral health as markers of cognitive aging in diverse populations. [ABSTRACT FROM AUTHOR]

Background: Greater adherence to a Mediterranean Diet (MD) has been associated with reduced cognitive decline and dementia risk. The Prospective Epidemiological Study of Myocardial Infarction (PRIME) recruited 10,600 European male participants between 1991 and 1993 aged 50‐59 years. The aim of this study was to examine the association between adherence to a MD (at baseline) and subsequent cognitive performance. Method: Dietary data was collected via a short, self‐administered 16‐item Food Frequency Questionnaire; an adapted version of the traditional MD Score was also developed (aMDSR) and median values of intake for each MD component were used as the cut‐off point to calculate the aMDSM. In 2017, follow‐up cognitive assessments using the Addenbrooke's Cognitive Examination – Revised (ACER) commenced within the Belfast cohort (n=405). Result: For aMDSM, those in the Low MD category scored lower on all cognitive tests compared to the High MD category, with significant differences reported for ACE‐R (p = 0.001), ACE‐R sub domain of memory (p = 0.038), fluency (p = 0.001) and visuospatial skills (p = 0.030). For participants with a ACE‐R score below 88, suggestive of cognitive impairment, there were 19.3% in the Low MD category and 7.2% in the High MD category (p = 0.004). There were 7.4% in the Low MD category and 2.7% in the High MD category who obtained an ACE‐R score below 82, indicative of probable dementia, with no statistically significant difference between categories (p=0.09). In an adjusted model for age, education and cardiovascular risk factors, this significant difference was maintained, with those in the High MD category being 56% less likely to have an ACE‐R score of <88/100 (OR 0.442, 95% CI 0.241‐0.810, p=0.008) compared to those in the Low MD category. For participants with a ACE‐R score below 82, indicative of probable dementia, there were 7.4% in the Low MD category and 2.7% in the High MD category with no statistically significant difference between categories (OR 0.661, 95%CI 0.269‐1.621, p=0.37). Conclusion: In the PRIME Belfast cohort, higher adherence to a MD was associated with better cognitive performances 26 years later in some but not all analyses. [ABSTRACT FROM AUTHOR]