Are you old enough? The REACH study (Researching Eating, Activity and Cognitive Health) is looking for participants 65-74 years old.
Can your diet slow age-related cognitive decline?
finger, silky, university, rose, yellow – remember these 5 words
As you age the brain slows down and loses its sharpness – this is a natural process of ageing, but could lifestyle and diet play a part in the rate of age-related cognitive decline?
Many fear the loss of cognition. The accompanying loss of independence is a primary reason for entry into a residential care facility. Can lifestyle or food choices maximise cognitive function, thus preserving independence in the later years? Could it be as easy as eating more fish with potatoes or maybe some broccoli with blueberries?
A study at Massey University, Auckland is currently recruiting 360 adults aged 65-74 years to explore lifestyle choices (primarily the diet) and age-related cognitive decline.
The REACH study (Researching Eating, Activity and Cognitive Health) is very comprehensive; collecting a multitude of data on the diet, cognitive function, physical attributes including activity levels, health and demographics, anthropometry measurements and blood markers including whether participants carry the Apolipoprotein ε4 (ApoE ε4) gene.
Using the collected dietary data and statistical techniques, a dietary pattern is established. A dietary pattern scrutinises the complete diet, rather than individual components of the diet in isolation e.g. fish intake. This method retains the significance of the combination and interactions between foods. The dietary pattern is tested for associations with cognitive function. Important risk factors are also considered in the process.
Physical activity is one modifiable risk factor to help maintain good cognitive function. Others include keeping weight, blood pressure and blood sugars under control and not smoking. Some risk factors are not modifiable e.g. age and our genetic make-up. One genetic factor, ApoE ε4, is seen more in people who develop Alzheimer’s Disease than others. This gene not only increases the risk of developing Alzheimer’s Disease but also puts healthy individuals at risk of a faster cognitive decline as they age. A quarter of the population carries the ApoE ε4 gene. Not everyone who carries the gene develops dementia.
“I’m fascinated with how we can use food to improve our health, well-being and performance. Traditionally, nutrition research has focussed on individual foods and nutrients, however this has several limitations as people don’t eat foods and nutrients in isolation – they eat combinations of foods as meals or snacks to form an overall dietary pattern”
~Dr Kathryn Beck
Dr Kathryn Beck is the key investigator of the REACH study and acquired funding for the study from an Emerging Researcher grant from Health Research Council.
If you would like to be part of this study, please go to the REACH study website where you will find more information and can register your interest. The study is recruiting til the end of 2018. Participants will visit Massey University, Albany, Auckland for one morning only for data collection and cognitive testing.
Sign up to my blog if you would like to hear more about the study or share this blog with others who may be interested and are aged between 65 and 74 years.
So what were those five words at the beginning of this blog?
Fats are trending and topical because of uncertainty within the research arena but a common theme is there are healthy fats which we should all eat along with a good dose of vegetables.
Foods with a high-fat content include butter, cream, nuts, olives, avocados, seeds, eggs, cheese and obviously fatty meats, salami, sausages.
What do fats do?
Fats provide energy for the body and the brain. Eating too much fat will make you fat, but fat is an essential component of the diet.
Fats are integral to the cell structure – the cell membrane is made up primarily of fat.
Fats insulate body organs
Fats are involved in the manufacture of hormones
Fats have many functions and there are different types of fat. Fats are categorised by their chemistry and can be considered either healthy or unhealthy.
Fats have different structures
Understanding fat is about understanding the physical structure of the fat, in particular triglycerides, which are the main type of fat in the diet.
A triglyceride is three fatty acids held together by a glycerol. Think of an “E” – the vertical part is the glycerol and the three horizontal bars are the fatty acids. The fatty acids attached to the glycerol can be the same or different.
A fatty acid is a chain of carbons with hydrogens attached. It is the way those carbons are holding hands which defines whether it is saturated or unsaturated. The saturated fatty acid has a simple hand hold whereas the unsaturated fatty acid has a more intricate handhold. It may be a mono (single) or poly (many) handholds in a ‘cis’ or a ‘trans’ grip.
The length of the fatty acid – short, medium or long chain fatty acid – determines the melting point of the fat. A long chain fatty acid will have a lower melting point and will be liquid at room temperature e.g. oils and a short chain fatty acid will have a higher melting point and will be solid at room temperature e.g. butter. The medium chain fatty acid is in between e.g. coconut oil.
The length of the fatty acid determines whether the fat is solid or liquid at room temperature and the type of carbon bonds (handholds) determine the fats saturation.
Recommended daily intake of total fats
A total fat recommendation has not been set by New Zealand Ministry of Health as it is the type of fat consumed which is important rather than the overall fat intake but there are guidelines of between 20 – 35% of energy intake (1). Eating insufficient fat can be detrimental to maintaining weight and it becomes very difficult to meet all nutritional requirements (1).
Using the above guidelines 20 – 35% of total energy intake for a 30 year old woman (1.6 m high) with mild physical activity requires 8800 kJ/day of energy this equates to 47 – 83 g of fat per day.
Nutrition Information Panel
Total fat content is required on the New Zealand Nutrition Information Panel per 100g of food and per serving. Saturated fat is also required as a separate entry.
On the chocolate Nutrition Information Panel below, it has nutritional information per serving (20 g), % daily intake of the three macronutrients per serving and per 100 g of chocolate. The fat in 20 grams of this chocolate provides 7% of your suggest fat intake based on a daily intake of 8700 kJ and a suggested total fat intake of 32% of total energy.
Nutrition Information Panels are confusing, perhaps a blog on Nutrition Information Panels is required – sign up for an alert when my Foodproof blogs are released.
Food confusion is evident with fat, the science is changing and the literature is not clear on the right direction. Fats are vital to our diet and understanding the difference between good and not so good fat is a great start. From here, it becomes easier to focus on replacing the not so good fats with the good fats in the diet.
This blog has touched on the differences in the structure of fat. The next blog will look more closely at saturated fats – sign up by email.
Eight percent and could it be from sugar-sweetened beverages? This study highlights toothache is 2.5 times more likely where > 500ml per day of sugar-sweetened beverage is consumed
Soft drinks, fruit juice and energy drink contribute to sugar intake
Too much sugar in the diet is a public health concern and linked to unhealthy weight gain and dental caries. WHO recommend sugar intake should be less than 10% of total energy intake and substantial oral health benefits have been recognised when sugar intake is less than 5% of total energy intake (1).
An earlier blog discusses the WHO sugar recommendation
However, in Australia, many adolescents exceed this recommendation and sugar contributes to 15% of adolescents energy intake (2). Sugar-sweetened beverages (SSB) are a contributor of added sugar in the Australian adolescent diet. Dr Louise Hardy, from the University of New South Wales, looked at the oral health issues (OHI), the prevalence of obesity and its association with the consumption of sugar-sweetened beverages in Australian adolescents in her recent study (3).
What causes tooth decay?
Acid is a by-product of bacteria in the mouth, feeding on sugars from food. It is the acid which decays the teeth.
The authors (from the study) say …
There were clear and consistent associations between OHI and the consumption of energy, sports drinks and flavoured water, more so than the traditional soft drink. Additionally, the prevalence of unhealthy weight was higher in the consumers of these same drinks.
This was a concern, as the perception of these, more modern, beverages as a healthy alternative is at the expense of healthy teeth.
Sports drinks are primarily marketed to provide hydration during physical activity. Energy drinks are promoted to provide increased energy, enhance mental alertness, physical performance and better health with added antioxidants and vitamins but this is all detrimental to teeth, and there are other discussions about whether young people require drinks with caffeine and other stimulants.
Reducing the frequency and volume of SSBs to young people could have a significant impact on adolescent oral health.
Trained field staff collected height and weight measurements and a weight to height ratio (WtH) were calculated.
The consumption of SSB data was collected through a validated short food frequency questionnaire (FFQ) and included soft drinks, diet soft drinks, sports drinks, fruit juice, flavoured water and energy drinks. Even though the FFQ was validated, it did have inconsistencies with the quantities of SSB’s consumed e.g. the question on energy drinks was about times consumed (per week) whereas the other SSB questions collected volume per day or week, so some adjustments were made to standardise this inconsistency.
There was no clinical dental examination to determine the prevalence of OHI. Instead, two questions were asked from the National Dental Telephone Survey. These validated questions have a strong correlation with the presence of dental caries. An OHI was defined where there were ‘often’ or ‘very often’ toothaches or problems with the mouth or teeth so some foods were avoided.
The statistical analysis considered the frequency of teeth brushing (OHI) and level of physical activity (for weight), along with age, sex, socio-economic status, residence (urban or rural) and language background.
As expected the data showed an association between SSB and OHI
In total, 8% (266 adolescents) of the study group experienced frequent OHI. Eleven percent (384 adolescents) of the study group did not drink SSBs.
The overall outcome showed 16% (539 adolescents) of the study group drank more than 2 cups of any SSB per day and were 2.5 to 3 times more likely to have OHI than someone who did not drink SSBs. The result was dose responsive, therefore, the prospect of an OHI increased as consumption of SSB’s increased.
Looking at one class of SSBs, the prevalence of OHI was highest in diet soft drinkers but this only affected 2% (83 adolescents) of the study group. These 83 adolescents consumed more than 1 cup of diet soft drink per day and were 4-5 times more likely to have OHI than the remaining 3377 adolescents, who consumed less than 1 cup of diet soft drink per day.
For consumers of diet soft drinks the prevalence of OHI was considered high and without a reason, even though it affected only a small group the researchers felt it could be worth exploring whether the prevalence was due to the artificial sweeteners or some other habit undertaken by this segment of the population i.e. sucking confectionary?
In another class, 20% (671 adolescents) of the study group regularly consumed energy drinks and were twice as likely to have OHI as those who did not drink energy drinks at all.
One person could be in more than one class of SSB as more than half the study group consumed a range of SSBs.
In total, 27% (961 adolescents) were in an unhealthy weight range.
The overall result did not show any association of SSBs with unhealthy weight. This is not consistent with meta-analyses suggesting higher intakes of SSBs are associated with unhealthy weight outcomes. However, this study showed regular consumers of energy drinks were 1.3 to 1.6 times more likely to have an unhealthy weight or WtH ratio than non-consumers of energy drinks.
This study adds weight to the argument that adolescents should reduce their consumption of sugar-sweetened beverages
NSW Ministry of Health funded this study and the authors state no conflicting interests.
The only thing that differentiates table salt, sea salt, rock salt, Himalayan rock salt or organic salt is a few minerals and a marketing strategy – they are the same thing. Salt or sodium chloride is the primary source of sodium for the human body.
Sodium Chloride has two elements –
sodium (40%) and chloride (60%)
Sodium is a key component of our body for regulating fluids i.e. our blood volume. Too much sodium increases the volume of the blood (by attracting water) thereby adding stress to the blood vessels and heart (more blood to pump around) and resulting in increased blood pressure. The connection between high blood pressure and increased risk of strokes, cardiovascular disease has been firmly established (1).
What is the evidence?
Initially, it was the Intersalt observational study (2) which found the association between sodium and blood pressure. Since then many randomised controlled trials have been organised to test this association.
Evidence of sodium intake affecting blood pressure is definite. The World Health Organisation (WHO) conducted a meta-analysisandsystematic review. The overall objective was to assess the effect of reduced sodium intake on blood pressure, kidney function and blood lipids. Other specific objectives include looking at the effect of consuming less salt compared with consuming more and reducing the salt by varying amounts to establish the best intake zone (3).
in normotensive and more so in hypertensive people
regardless of how much the salt reduction was and
regardless of whether blood pressure medication was taken or not
A reduction in salt intake is able to reduce resting diastolic blood pressure.
For the greatest positive effect in systolic and diastolic pressure, the sodium intake was less than 2g (5g salt) per day,
The same meta-analysis also confirmed blood lipids (total cholesterol, HDL and LDL and triglycerides) were not affected by changes in salt (3).
The evidence for reducing salt in the diet for healthy blood pressure and the evidence for raised blood pressure being a significant factor in strokes and cardiovascular disease is of highquality.
The relationship between high salt intake and increased systolic blood pressure (and thereby cardiovascular disease) makes high salt intake a major population health concern. WHO considers reducing daily salt intake will have significant health and financial benefits to the global population. New Zealand modelling has found similar effects and NZ would benefit financially and in terms of life quality with population salt reduction.
1 gram of sodium chloride (salt) contains 390 mg sodium
WHO stronglyrecommends the intake of sodium be less than 2g/day (5g of salt). This equates to a global target of a 30% sodium reduction with a targeted date of 2025 (4).
Current daily salt intake around the world is shown in the graph below – Australia 9.6g (5), New Zealand 8.4g (6), United States 8.3g (7) and United Kingdom 8.0g (8).
The majority of sodium comes from processed foods and it is challenging to leave the salt out of food processing. Changing the salt content in the food affects many things – taste, texture, shelf life and food safety. Initiatives to reformulate food with this goal in mind has been undertaken globally. Incognito salt reductions have already been accepted by consumers, up to 40% and 70% of salt has been removed from bread and processed meats (9).
Salt in the United Kingdom
The United Kingdom has actively been reducing salt in their food since 2003. Voluntary salt reduction in food manufacturing, public awareness campaigns and mandatory labelling of high salt foods has resulted in a 15% reduction in salt intake since the work started (10).
Salt in Australia and New Zealand
The Healthy Food Partnership, comprising of the Australian Government, public health groups and the food industry is also working towards reducing salt by reformulating food. Voluntary targets were set in 2009 for 10 food categories. However, a 2017 study (11) found only 17 of 33 large Australian food manufacturers have publicly available strategies to reduce salt content in their foods. The authors conclude insufficient efforts were being made to make “significant and comprehensive positive (nutrition) changes” in relation to salt or healthier food products”.
New Zealand has no government-led salt reduction strategy. The New Zealand Heart Foundation (NZHF) has led the charge, urging voluntary reductions from manufacturers through the NZHF ‘Tick’, initiated in 1991. This front-of-pack nutrition logo helps consumers determine heart-healthy foods and encourages ‘Tick’ food manufacturers to produce heart-healthy products. Over a 12 month period (1998/1999) The Tick program resulted in 33 tonnes of salt being removed from food products (12).
In 2010, 50% of New Zealand and 72% of Australian bread had reduced sodium levels to below 450mg/100g or 1.1 g salt per 100 g of bread (13)). Another New Zealand study demonstrated a 12% reduction in salt content in 182 foods over the 10 years to 2013 (14). The graph below shows different food groups and changes in salt quantity from this study.
Even though Australia and New Zealand have voluntary salt reduction programmes (and have seen some results in the food chain) they have not yet reported reductions in population salt intake and it is considered that the WHO global target will not be met in 2025 (15). This is not the case everywhere, 12 countries have reported reduced salt intakes in their population – will this correspond to reduced blood pressures?
New Zealand has a strong and committed non-government organisation, New Zealand Heart Foundation, to lead the salt reduction initiatives using food reformulation, front-of-pack labelling and consumer education but is this enough? Do we need a government led salt reduction programme to provide more resources and maybe even legislate?
Can we be more responsible for what our children eat?
High sugar intake is a known variable in the obesity equation
Obesity is expensive, avoidable, claims lives and life quality
New Zealand adults (and probably children) consume more dietary sugars than recommended by World Health Organisation
The cost of sugar
Obesity costs New Zealand NZ$ 624,000,000 per annum (last calculated in 2006) . This is likely to be higher now as New Zealand has the third highest rate of obesity in the OECD – trailing behind the United States and Mexico.
These unnecessary healthcare costs come from the obesity-associated non-communicable diseases being type 2 diabetes and cardiovascular disease, gout and some cancers. More people die from non-communicable diseases (11.4%) than tobacco-related deaths (9.1%) and both are largely preventable. Life expectancy may have increased in the last 100 years but over the years gained 20 – 30% are lived in poor health .
Obesity is not an easy topic as there are many variables behind carrying too much weight. The drivers of obesity include diet, physical activity levels, maternal health (yes, your mother’s health during pregnancy), sleep and the obesogenic environment, where food supply and marketing promote high energy intake with energy-dense and nutritionally poor foods , .
New Zealand children
Obese children are likely to grow into obese adults. As well as the adult risks later in life, obese children have their own special health consequences: obstructive sleep apnoea, musculoskeletal problems, asthma and psychological problems (body dissatisfaction, poor self-esteem and depression) are all associated with child obesity. Additionally, their learning can suffer and they may be targeted for bullying .
Eleven out of 100 NZ children (2-14 years) are obese and another 21 (out of the same 100) are in the overweight category. Rates are higher in Pacific and Maori children – 61% and 44% respectively are overweight or obese .
What is even more disconcerting is 50% of parents of obese children do not believe their child is overweight – this is higher in obese children aged 2-4 years where 90% of parents do not consider their child to be neither under- or overweight . This is another story!
High sugar intake is one of the determinants of a poor diet and a contributor to obesity. One-quarter of sugar in a child’s diet comes from sugar-sweetened beverages , which are of low nutritional quality leading to a poor diet, weight gain and associated risks. The consumption of high sugar food generally displaces the consumption of more nutritious foods and increases the energy intake.
New Zealand Ministry of Health’s (MOH) recommendation on sugar intake suggests “snacks and drinks … are … low in sugar especially added sugar ” and to “limit drinks such as fruit juice, cordial, fruit drink, fizzy drinks (including diet drinks), sports drinks and sports water” .
The American Heart Association (AHA) has a more cut and dry nutrition recommendation of fewer than six teaspoons of added sugar per day for children 2-18 years.
Since 1989, World Health Organisation (WHO) has strongly recommended1 children reduce their dietary intake of free sugars to less than 10% of total energy intake (<10% EI) and in 2015 suggested a further reduction of free sugars to below 5% of total energy intake (<5% EI) . This is a conditional recommendation2 and is based on very low-quality evidence where a dose-response between reduced free sugar intakes of <5% EI and reduced dental caries was observed. No evidence of harm has been identified with reducing free sugars to <5% EI .
The strong WHO recommendation to restrict free sugar intake to <10% EI is based on moderate quality evidence3 being 
A meta-analysis of five randomised controlled trials with interventions to encourage children to reduce their sugar intake in food and beverages. The quality of the evidence was moderate but without effect in four of the five studies i.e. no changes in weight loss, this was likely to be due to low compliance by the study participants (children) willing to follow the dietary advice intervention .
A meta-analysis of prospective cohort studies did find associations with one or more servings of sugar-sweetened beverages per day and overweight or obese children , .
An effect of reducing or increasing sugar is dose dependent with regards to body weight – more sugar, higher BMI .
The evidence for the effect of increasing free sugar intake on body weight in children is of low quality .
Observational studies have found moderate quality evidence for a positive association between dental caries and sugar intake , , regardless of exposure to fluoride .
This is where it all becomes tricky, what exactly is ‘sugar’ – total, free or added? MOH describe sugar as monosaccharides and disaccharides. WHO talk about ‘free sugar’ and AHA refer to added sugar. Sometimes when comparing sugar it is not quite ‘apples’ to ‘apples’ but more a generalisation and you need a feel for the situation
And do we meet the guidelines?
The University of Sydney recently evaluated the free sugar intake of the Australian population (10) and the University of Otago has done the same for New Zealand adults (11). The graph, below, shows the average free sugar intake as a % of energy is higher than the WHO recommendation for all age groups except 51-70 year olds.
Australian children’s (2-14 years) mean intake of free sugars was between 11.5 and 13.8 of total EI. New Zealand does not have a free sugar intake calculated for NZ children. My rough calculation of children’s free sugar intake, based on the 2002 Nutrition Survey for Children, was an average of 12% for boys and girls aged 2-14 years4 – higher than the recommendation but a formal study is required as my data was old and limiting. Perhaps it is time for another Children’s Survey.
So now what?
Awareness of what is in our foods is key – excess sugar is associated with excess body fat, NZ children are consuming too much sugar, obese children become obese adults and obesity is associated with non-communicable diseases.
Nutrition research is in its infancy and WHO feels more research is required to evaluate different behavioural-change approaches to help promote the reduction of free sugars in children thus creating higher compliance rates in randomised controlled trials .
I cannot wait that long and feel that we are all in this together and need to take personal responsibility with regards to our (and our children’s) sugar consumption. Is it necessary to regularly buy sweet treats for our children – is this an act of love?
9. Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ (Clinical research ed) 2012;346:e7492-e. doi: 10.1136/bmj.e7492.
1. A strong recommendation from WHO suggests the desirable outcome from the recommendation outweigh any undesirable outcome 2. There is less certainty between the benefits and harms or disadvantages of implementing this recommendation still requires debate 3. Moderate quality of evidence = moderately confident that the true effect lies close to the estimate effect ut there is a possibility that it could be substantially different. Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate 4.Based on the median daily (total) sugar intake for NZ children (127 g for boys and 115 g for girls), 51% and 50% was from beverages, sugar and sweets, biscuits, cakes, desserts and cereals, which equates to 65 and 58 grams and my estimate of free sugar intake. Using a median energy intake of 9.1 MJ for boys and 7.8 MJ for girls from the same study, my estimated ‘free sugar’ consumption for both NZ boys and girls is 12% of energy.
Sugar produces 16.7 kJ per gram .. 65 g of sugar produces 1085.5 kJ (65 * 16.7) of energy .. this equates to 12% of total energy intake (1085.5/9100).