The Effects of "Diet-Smoking-Gender" Three-Way Interactions on Cognitive Impairment Among Chinese Older Adults

Overview

Journal Nutrients

Date 2022 May 28

PMID 35631285

Authors

Huashuai Chen

Xuxi Zhang

Qiushi Feng

Yi Zeng

Affiliations

Soon will be listed here.

Abstract

Investigations on gender variations in the risk factors of cognitive impairment are required to promote future precision medicine among older adults, as well as to contribute to a better understanding of the "male-female health-survival paradox". With this study, we aimed to investigate the effects of "diet-smoking-gender" three-way interactions on cognitive impairments among Chinese older adults. We conducted a 16-year prospective cohort study among 15,953, 15,555, 16,849, 9716, 7116, and 13,165 older adults from the 2002, 2005, 2008-2009, 2011-2012, 2014, and 2017-2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), respectively. Cognitive impairment was measured by the Mini-Mental State Examination (MMSE). The dietary diversity score (DDS) was calculated using the CLHLS food frequency questionnaire. Generalized estimating equations (GEE) were used to assess the "diet-smoking-gender" three-way interaction effects on cognitive impairment across the six waves of CLHLS. We found that higher dietary diversity was associated with lower probability of cognitive impairment among older adults (OR = 0.92; 95%CI = 0.90, 0.98). However, smoking behavior may negatively influence the protective effect of higher dietary diversity on cognitive function among females (OR = 1.26; 95%CI = 1.07, 1.49). Our findings imply that we should take gender differences and lifestyle behaviors into consideration in implementing dietary interventions to improve cognitive function among older adults.

Citing Articles

The mediating role of psychological equilibrium in the relationship between dietary variety and self-reported health among older adults in rural China.

Jiang Z, Xu Z, Zhou M, Zhang H, Zhou S Sci Rep. 2025; 15(1):4240.

PMID: 39905120 PMC: 11794650. DOI: 10.1038/s41598-025-88835-2.

Integrated healthy lifestyle even in late-life mitigates cognitive decline risk across varied genetic susceptibility.

Wang J, Chen C, Zhou J, Xu Z, Xu L, Li X Nat Commun. 2025; 16(1):539.

PMID: 39789005 PMC: 11718162. DOI: 10.1038/s41467-024-55763-0.

Effect of ferric citrate on hippocampal iron accumulation and widespread molecular alterations associated with cognitive disorder in an ovariectomized mice model.

Cui L, Zhou H, Hao Y, Yang X, Li Z, Gao Y CNS Neurosci Ther. 2024; 30(9):e70018.

PMID: 39252474 PMC: 11386256. DOI: 10.1111/cns.70018.

Anti-Inflammatory Diet and Protein-Enriched Diet Can Reduce the Risk of Cognitive Impairment among Older Adults: A Nationwide Cross-Sectional Research.

Wang L, Xian X, Zhou M, Xu K, Cao S, Cheng J Nutrients. 2024; 16(9).

PMID: 38732579 PMC: 11085298. DOI: 10.3390/nu16091333.

Decoding emotional resilience in aging: unveiling the interplay between daily functioning and emotional health.

Guo M, Xu S, He X, He J, Yang H, Zhang L Front Public Health. 2024; 12:1391033.

PMID: 38694972 PMC: 11061423. DOI: 10.3389/fpubh.2024.1391033.

References

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

Jee S, Suh I, Kim I, Appel L . Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study. JAMA. 1999; 282(22):2149-55. DOI: 10.1001/jama.282.22.2149. View

Park B, Park J, Jun J, Choi K, Suh M . Gender differences in the association of smoking and drinking with the development of cognitive impairment. PLoS One. 2013; 8(10):e75095. PMC: 3790774. DOI: 10.1371/journal.pone.0075095. View

Chen R, Chang Y, Lee M, Wahlqvist M . Dietary quality may enhance survival related to cognitive impairment in Taiwanese elderly. Food Nutr Res. 2011; 55. PMC: 3205824. DOI: 10.3402/fnr.v55i0.7387. View

Oksuzyan A, Shkolnikova M, Vaupel J, Christensen K, Shkolnikov V . Sex differences in health and mortality in Moscow and Denmark. Eur J Epidemiol. 2014; 29(4):243-52. PMC: 4090601. DOI: 10.1007/s10654-014-9893-4. View

Anstey K, Von Sanden C, Salim A, OKearney R . Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies. Am J Epidemiol. 2007; 166(4):367-78. DOI: 10.1093/aje/kwm116. View

Zeng Y, Feng Q, Hesketh T, Christensen K, Vaupel J . Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study. Lancet. 2017; 389(10079):1619-1629. PMC: 5406246. DOI: 10.1016/S0140-6736(17)30548-2. View

Wang C, Lu T, Liao W, Yuan S, Kuo P, Chuang H . Cigarette smoking and cognitive impairment: a 10-year cohort study in Taiwan. Arch Gerontol Geriatr. 2009; 51(2):143-8. DOI: 10.1016/j.archger.2009.09.041. View

Milte C, Ball K, Crawford D, McNaughton S . Diet quality and cognitive function in mid-aged and older men and women. BMC Geriatr. 2019; 19(1):361. PMC: 6925482. DOI: 10.1186/s12877-019-1326-5. View

10.

Crimmins E, Kim J, Sole-Auro A . Gender differences in health: results from SHARE, ELSA and HRS. Eur J Public Health. 2010; 21(1):81-91. PMC: 3023013. DOI: 10.1093/eurpub/ckq022. View

11.

Gu Q, Sable C, Brooks-Wilson A, Murphy R . Dietary patterns in the healthy oldest old in the healthy aging study and the Canadian longitudinal study of aging: a cohort study. BMC Geriatr. 2020; 20(1):106. PMC: 7077120. DOI: 10.1186/s12877-020-01507-w. View

12.

Deschasaux M, Huybrechts I, Julia C, Hercberg S, Egnell M, Srour B . Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality: EPIC cohort study in 10 European countries. BMJ. 2020; 370:m3173. PMC: 7491938. DOI: 10.1136/bmj.m3173. View

13.

Reitz C, Luchsinger J, Tang M, Mayeux R . Effect of smoking and time on cognitive function in the elderly without dementia. Neurology. 2005; 65(6):870-5. PMC: 2669791. DOI: 10.1212/01.wnl.0000176057.22827.b7. View

14.

Wang J, Xiao L, Wang K, Luo Y, Li X . Gender Differences in Cognitive Impairment among Rural Elderly in China. Int J Environ Res Public Health. 2020; 17(10). PMC: 7277614. DOI: 10.3390/ijerph17103724. View

15.

Abolfathi Momtaz Y, Ibrahim R, Hamid T, Chai S . Smoking and cognitive impairment among older persons in Malaysia. Am J Alzheimers Dis Other Demen. 2014; 30(4):405-11. PMC: 10852561. DOI: 10.1177/1533317514552318. View

16.

Scarmeas N, Anastasiou C, Yannakoulia M . Nutrition and prevention of cognitive impairment. Lancet Neurol. 2018; 17(11):1006-1015. DOI: 10.1016/S1474-4422(18)30338-7. View

17.

de Oliveira Otto M, Anderson C, Dearborn J, Ferranti E, Mozaffarian D, Rao G . Dietary Diversity: Implications for Obesity Prevention in Adult Populations: A Science Advisory From the American Heart Association. Circulation. 2018; 138(11):e160-e168. PMC: 6894732. DOI: 10.1161/CIR.0000000000000595. View

18.

Li Y, Li S, Wang W, Zhang D . Association between Dietary Protein Intake and Cognitive Function in Adults Aged 60 Years and Older. J Nutr Health Aging. 2020; 24(2):223-229. DOI: 10.1007/s12603-020-1317-4. View

19.

Samieri C, Jutand M, Feart C, Capuron L, Letenneur L, Barberger-Gateau P . Dietary patterns derived by hybrid clustering method in older people: association with cognition, mood, and self-rated health. J Am Diet Assoc. 2008; 108(9):1461-71. DOI: 10.1016/j.jada.2008.06.437. View

20.

Au B, Dale-McGrath S, Tierney M . Sex differences in the prevalence and incidence of mild cognitive impairment: A meta-analysis. Ageing Res Rev. 2016; 35:176-199. DOI: 10.1016/j.arr.2016.09.005. View