nutrition as a determinant of successful aging: the quebec longitudinal study «nuage» pierrette...
Post on 19-Dec-2015
217 Views
Preview:
TRANSCRIPT
Nutrition as a Determinant of Successful Aging: The Quebec Longitudinal Study «NuAge»
Pierrette GaudreauDepartment of Medicine, University of Montreal
and Centre Hospitalier de l’Université de Montréal Research Center, Angus Technopole, Montreal, Quebec, Canada
andH Payette3, A Khalil3, B Shatenstein1, I Dionne3, M Brochu3, J Morais2, G
Ferland1, T Fulop3, K Gray-Donald2, D Jacques3, MJ Kergoat1, D Tessier3, R Wagner3.
Nutrition and Successful Aging Research Section, Quebec Network for Research on Aging and 1University of Montreal, 2McGill University and 3University of Sherbrooke
Composition:15 co-investigators, 4 Quebec universities2 collaborators from 2 Ontario universities
Expertise: nutrition, geriatrics, biology of aging
(physiology, immunology, cellular and molecular biology, neuroendocrinology), epidemiology, evaluative research, social sciences
Approaches: fundamental, clinical, epidemiological,
evaluative and social
THE TEAM
Management structure:Executive committee: 5 co-principal
investigators (McGill, Montreal and Sherbrooke Universities)
Accountability: General coordination Scientific issues (originality, quality, productivity)Financial integrityEthical issuesMentorship
THE TEAM
PROGRAMMATIC RESEARCH
NuAge sub-studies:
Sarcopenia, voluntary and non-voluntary physical activity
Insulin resistance, sarcopenia and hormonal regulationNutrition and cognitive declineFunctional foods, oxidative stress and
immune/endocrine functionsEating behavior and peripheral peptide levels
regulating appetiteQuality of diet and efficacy of anti-influenza
vaccination Identification of gene markers of successful agingDeterminant of weight loss
95
90
85
80
75
70
2003 2008 2013
Ag
e
SampleRandom sampleQuebec Medicare database, n = 1,793 men/women, Montreal/Sherbrooke
EligibilityGood physical/mental health, Functional autonomy
Follow-upAnnual face-to-face interview,Semi-annual telephone interview
60 502-year-old men and women
60 20 2-year-old men and women
STUDY DESIGN
INCLUSION Community-dwelling men and women 68 to 82 years of age French or English speaking Willing to commit for a 5 year-period Able to walk without help Free of disabilities in activities of daily living No cognitive impairment (3MS > 79) Able to walk 300 m and climb 10 stairs without rest Able to sign an informed consent
EXCLUSION Class II heart failure COPD requiring home oxygen therapy or oral steroids Inflammatory digestive diseases Cancer (radiation therapy, chemotherapy or surgery during
5 previous years)
ELIGIBILITY CRITERIA
RECRUITMENT STRATEGY
Random sample from Quebec Medicare databaseStratification for age and gender (36,183 men/women)
Contacted by mail(18,874)
Phone number No phone number(10,962: 58%) (7,912: 42%)
Telephone contact Telephone contact(8,598: 78%) (735: 9%)
+ 206 Volunteers
Total sample: 1793
Telephone contact(8,598)
Telephone contact(735)
FINAL COHORT AT T1
33% Non eligible 46%
51% Refusal
18%
1322 Recruited
265
COMPUTER-BASED DATA COLLECTION
William softwareTM: 1,000 variables/year/participant
Nutritional: diet, food habits, sensory/physiological functions, anthropometry, body composition
Functional: strength, physical activity, performance
Medical: physical, mental and cognitive health
Social: network, support, participation
COMPUTER-BASED DATA COLLECTION
Nutritional status determinants General questionnaire: socio-demographic information, socioeconomic resources and income, social network and activities, lifestyle habits, physical health status and disability, medication, health care services access and utilization, eating habits, food-related beliefs and perceptions, hunger and appetite, weight history, osteoporosis risk
Energy and nutrient intakes Life-time food frequency questionnaire Life-time functional food frequency questionnaire Three non-consecutive 24-hour dietary recalls (including 1 during w-end) Nutritional risk assessment questionnaire (Dépistage Nutritionnel des Aînés (DNA©))
Anthropometric indices and body composition estimates Standing height and weight Seated knee height - Triceps, biceps, subscapular and suprailiac skinfold thicknesses Left standing mid-upper-arm, calf, thigh, waist and hip circumferences Fat mass and Fat Free Mass (dual-energy x -ray absorptiometry (DXA))
COMPUTER-BASED DATA COLLECTION
Muscle strength Maximal voluntary handgrip strength (KPa, Martin Vigorimeter) Maximum isometric strength of the knee extensors and elbow flexors (pound, dynamometer Microfet2TM)
Physical Performance Tests 10 meter walking speed (m/sec) Chair-stands test (time to rise 5 times in sec) Timed Up and Go (TUG) test (chair stand and walking performance) Tinetti balance scale questionnaire (scores 14 items on balance and 10
on gait)
Functional status Nagi score questionnaire (perceived difficulty to carry out 5 daily life tasks) SMAF questionnaire (functional ability in activities of daily living, self-care tasks, instrumental activities of daily living, adaptive tasks, mobility, communication, mental functions) Breslau score (ability to perform walking, bathing, transferring from a bed to a
chair or going to the toilet without help)
COMPUTER-BASED DATA COLLECTION
Mental health status Cognitive function (Modified Mini-Mental State Examination) Depression (Geriatric Depression Scale)
Health-related quality of life MOS 36-item Short Form Health Survey questionnaire (SF-36) (perceived general health and its consequences on physical, social and emotional functions, life satisfaction)
Physical activity Lifetime total physical activity questionnaire (3 major types of physical
activity throughout life: occupational, household and exercise/sports) Physical Activity Scale for the Elderly (PASE) questionnaire (daily time
for leisure activity, household activity, work-related activity in the past week)
Social activities Social activities questionnaire (social part of the Elderly Activity Inventory questionnaire, 19 types of valued activities)
COMPUTER-BASED DATA COLLECTION
Follow-up calendar Falls Health events Medication Utilization of health services
Telephone interview (6 months after visit) Falls Health events Medication Utilization of health services 24-hour dietary recall
BIOLOGICAL SAMPLE COLLECTION, BIOLOGICAL SAMPLE COLLECTION, IDENTIFICATION AND MANAGEMENTIDENTIFICATION AND MANAGEMENT
Dedicated computer
Bar code printer
Code 128 is used: alphanumeric symbol of very high density Portable terminal and bar code
reader
Blood: overnight fast (≈50 mL)Saliva: morning and evening (≈2 mL) Urine: fresh morning (≈5 mL)
SCHEME FOR BLOOD PROCESSING
SAMPLES AND PARAMETERS(SERUM)
Blood (serum) Table 1# tubes Volume (uL) Analysis
1 250 Proteins – Free insulin-like growth factor-1
2 250 Proteins – Insulin
3 1000 Proteomics
4 1000 Proteomics
5 1000 Proteomics
6 1000 Proteomics
7 1000 Proteomics
8 250 Proteins – Leptin
9 250 Proteins – Cholecystokinin (CCK)
10 250 Proteins – Ghrelin
11 250 Proteins – Neuropeptide Y (NPY)
12 250 Proteins – Peptide YY 3-36
13 250 Proteins– C-Reactive protein
14 250 Proteins – Tumor necrosis factor alpha (TNF
15 250 Proteins – Interleukin-6
16 250 Proteins – Interleukin-2
17 250 Proteins – Interleukin-4
SAMPLES AND PARAMETERS (SERUM)
Blood (serum) Table 118 250 Proteins – Interleukin-10
19 250 Proteins – Interleukin-12
20 250 Proteins – Interleukin-15
21 250 Proteins – Interferon gamma
22 250 Proteins – soluble intercellular adhesion molecule-1 (sICAM)
23 250 Proteins – soluble vascular cellular adhesion molecule (sVCAM)
24 500 Metabolic status marker – Free fatty acids
25 400 Cognitive status marker – Vitamin B12 + Folic acid
26 250 Cognitive status marker – Apolipoprotein E
27 250 Steroid hormones – Total testosterone
28 250 Steroid hormones – Total 17--oestradiol total
29 250 Thyroid hormones – Free thyroxine (T4)
30 250 Thyroid hormones – Total thyroxine (T4)
31 500 Steroid hormones – Dehydroepiandrosterone (DHEAS)
32 100 Total antioxidant status (TAS)
33 1000 Future analysis
SAMPLES AND PARAMETERS (PLASMA)
# tubes Vol. (uL) Analysis
1 400Plasma treated with 10% metaphosphoric acid + 0.1 mM
EDTA
2 350Plasma treated with 10% metaphosphoric acid/ 1 mM N-ethyl maleimide + 0.1 mM EDTA
3 250 Oxidative stress marker – Vitamin E
4 200 Oxidative stress marker – malondyaldehyde (lipid damage)
5 250 Oxidative stress marker – F2-isoprostanes (lipid damage)
6 250 Oxidative stress marker – Carbony groups (protein damage)
7 200 Cognitive status marker – Vitamin B6
8 200 Cognitive status marker– Homocysteine
# tubes Vol. (uL) Analysis
1 150 Oxidative stress marker– Vitamine C
2 100 Oxidative stress marker– GSH
3 150 Future analysis
SAMPLES AND PARAMETERS (PLASMA)
# tubes Vol. (uL) Analysis
1 100 Oxidative stress marker– GSSG
2 150 Future analysis
3 100 Future analysis
# tubes Vol. (uL) Analysis
1 400Plasma treated with 10% metaphosphoric acid + 0.1 mM
EDTA
2 350Plasma treated with 10% metaphosphoric acid/ 1 mM N-ethyl maleimide + 0.1 mM EDTA
3 250 Oxidative stress marker – Vitamin E
4 200 Oxidative stress marker – malondyaldehyde (lipid damage)
5 250 Oxidative stress marker – F2-isoprostanes (lipid damage)
6 250 Oxidative stress marker – Carbony groups (protein damage)
7 200 Cognitive status marker – Vitamin B6
8 200 Cognitive status marker– Homocysteine
SCHEME FOR SALIVA AND URINE PROCESSING
SAMPLES AND PARAMETERS (SALIVA, URINE)
# tubes Volume (uL) Saliva analysis
1 1000 Morning cortisol
2 250, 500 or 750 Future analysis
3 1000 Bed time cortisol
4 250, 500 or 750 Future analysis
# tubes Volume (uL) Urine analysis
1 1000 Oxidative stress marker– F2-isoprostanes (lipid damage)
2 1000 Oxidative stress marker– F2-isoprostanes (lipid dmage)
3 1000 Oxidative stress marker– 8-oxo-dGuo (DNA damage)
4 1000 Oxidative stress marker– 8-oxo-dGuo (DNA damage)
5 1000 Oxidative stress marker– 8-oxo-dGuo (DNA damage)
Life habits
Smoking (%)* 8.88.8 4.9
Alcohol (%<1/month) 84-8984-89 89-97
Socio-demographic
Married (%)* 76 43
Living alone (%)* 18 45
Education (years, X±SD) 11.4±3.9 11.9±5.1
* Age effect
CHARACTERISTICS OF THE COHORT AT T1
Male Female(845) (940)
0102030405060708090
100
Normal Mild Moderate-Severe
Geriatric Depression Scale (GDS)
%
M
F
0 20 40 60 80
Osteoporosis
Thy roïd
Diabetes
Cardiac &
circulatory
Arthritis
Hy pertension
Rep
orte
d di
seas
es
% *P < .01 by age groups
M
F
0
1
2
3
4
5
6
M F
x #
Me
d. P
res
cri
be
d
Age 70
Age 75
Age 80
Mental health Reported diseases
Medication
CHARACTERISTICS OF THE COHORT AT T1
**
**
**
26.5
27
27.5
28
28.5
29
M F
P = .019 NS
BM
i (kg
/m2 )
Age 70
Age 75
Age 80
0
2
4
6
8
10
12
14
M F
P < .000 P < .000
TUG
(sec
) Age 70
Age 75
Age 80
0
10
20
30
40
50
60
70
80
M F
P < .000 P < .000
Kne
e ex
tens
ion
stre
ngth
(lbs
)
Age 70
Age 75
Age 800
10203040506070
M F M F M F
Low Moderate High
Nutritional risk (ENS©)Male P= .002 Female = NS
%
Age 70
Age 75
Age 80
CHARACTERISTICS OF THE COHORT AT T1
Male Female(845) (940)
Meals-On-Wheels (%)* 1.3 1.6
Restaurant (% regularly) 44 42
Prescribed diet (%)* 7 9
3 meals/day (%) >88 >92
Vitamin/mineral supplements
regularly (%) 33 67
winter only (%) 6 6
occasionally/never (%) 61 27
* Age effect
FOOD BEHAVIOR AT T1
Male Female(845) (940)
Nutrition-related
Problem with Taste (%) 5.2 6.8Smell (%)* 13.5 9.6Swallowing (%)* 9.0 14.1Chewing (%)* 4.3 6.7
Appetite (score>5/10) 68 71
Food habits (% change) 33 39
Quantity of food (% change) 34 39
Food excluded (%) 36 44
* Age effect
CHARACTERISTICS OF THE COHORT AT T1
Characteristics Associated with Dietary Intakes
Energy Protein
F 0.17* (P=0.003) 0.16 (P=0.005)
AppetiteAppetite (1-10)M 0.21 (P=0.001) 0.26 (P<0.000)
* Pearson correlation (r) 2-tailed
NOT associated :life habits, socio-demographic, physiological problems, food habits and behaviors
CHARACTERISTICS OF THE COHORT AT T1
PRELIMINARY RESULTS IN A SUB-GROUP OF 360 PARTICIPANTS AT T1
Objectives:1. To measure serum levels of markers influencing muscle
strength, anthropometric indices and/or dietary intakes (serum free IGF-1, insulin, glucose)
2. To assess muscle strength
3. To assess anthropometric indices
4. To examine dietary intakes
SERUM FREE IGF-1, INSULIN AND GLUCOSE LEVELS AT T1: TRANSVERSAL DATA
0102030405060708090
100
Insulin (pmol/L)
70 years 75 years 80 years
Men
Women
0
0,10,2
0,30,4
0,50,6
0,70,8
Free IGF-1 (ng/mL)
70 years 75 years 80 years
Men
Women
5
5,1
5,2
5,3
5,4
5,5
5,6
5,7
5,8
Glucose (mmol/L)
70 years 75 years 80 years
Men
Women
Women: P< 0.05, one-way ANOVA
Women: P< 0.05, one-way ANOVA
MUSCLE STRENGTH AT T1: TRANSVERSAL DATA
0
20
40
60
80
100
Rig
ht
Gri
p S
tre
ng
th (
KP
a)
70 years 75 years 80 years
Men
Women
0
20
40
60
80
Rig
ht
Bic
ep
S
tre
ng
th (
Po
un
d)
70 years 75 years 80 years
Men
Women
0
20
40
60
80
100
Rig
ht
Qu
ad
ric
ep
S
tre
ng
th (
Po
un
d)
70 years 75 years 80 years
Men
Women
Women: P< 0.001, one-way ANOVA
***
Men: P< 0.0001, one-way ANOVA
Men: P< 0.0001, one-way ANOVA
Women: P< 0.0001, one-way ANOVA
******
Men: P< 0.001, one-way ANOVA
Women: P< 0.05, one-way ANOVA
****
ANTHROPOMETRIC INDICES AT T1: TRANSVERSAL DATA
0102030405060708090
Measured BW (kg)
70 years 75 years 80 years
Men
Women
1,45
1,5
1,55
1,6
1,65
1,7
Measured height (m)
70 years 75 years 80 years
Men
Women
80
85
90
95
100
105
Waist circum-ference (cm)
70 years 75 years 80 years
Men
Women
Men: P< 0.01, one-way ANOVA
*
MACRONUTRIENTS AND ENERGY INTAKES AT T1: TRANSVERSAL DATA
0102030405060708090
Protein intake (g/day)
70 years 75 years 80 years
Men
Women
0
10
20
30
40
50
60
70
80
Total lipid intake (d/day)
70 years 75 years 80 years
Men
Women
170
180
190
200
210
220
230
240
Glucid intake (g/day)
70 years 75 years 80 years
Men
Women
0
500
1000
1500
2000
2500
Energy intake
(Kcal/day)
70 years 75 years 80 years
Men
Women
Men: P< 0.05, one-way ANOVA
*
VITAMIN C INTAKE AT T1: TRANSVERSAL DATA
0
20
40
60
80
100
120
140
Vitamin C (mg/day)
70 years 75 years 80 years
Men
Women
PRELIMINARY RESULTS IN A SUB-GROUP OF 103 PARTICIPANTS AT T1
Objectives:
1. To examine the relationship between serum/plasma markers of oxidative stress defenses (TAS, vitamin C and vitamin E) and consumption of antioxidant-rich food (ARF)
2. To be done… To determine the beneficial effects of consuming ARF, related to regulation of OS, on the maintenance of immune and endocrine status and general health
LIFETIME CONSUMPTION OF ANTIOXIDANT-RICH FOODS
Shatenstein B et al. 2003 An approach for evaluating lifelong intakes of functional foods in elderly people. J Nutr 133:2384
CHARACTERISTICS OF THE QUESTIONNAIRE
Non quantitative questionnaire
Categorization of frequency of consumption Never or rarely (few times/year) Often (several times/month) Regularly (everyday)
Evaluation of present and past consumption at 65, 45, 25 and 10 years of age
Fiability: 73%
27 foods (fruits, vegetables, corn cereal, nuts, cacao-containing products, green tea, red wine)
Exemple de substances antioxydantes présentes aliments fonctionnels
Family Class Example ________________________________________________________Phytochemicals
Polyphenols Flavonoids Blueberry, red winePhenolic acids green tea, dark
chocolate
Terpenes Carotenoids Carrot, tomato
Sulfur compounds Allyl sulfide GarlicIsothiocyanates Brussels sprouts,
broccoli
Vitamins Vitamin E Nuts(alpha et gamma tocopherol) Vitamin C Citrus fruits
FAMILIES AND CLASSES OF ANTIOXIDANT-RICH FOODS
STUDY POPULATION: FIRST 103 MEN AND WOMEN ENROLLED
Age group (years) Men (%) Women (%)
70 2 27 45
75 2 43 35
80 2 30 20
CORRELATION BETWEEN DAILY PRESENTAND PAST CONSUMPTION OF 27 ARF
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
Pea
rso
n c
orr
elat
ion
(r)
men women
65 years
45 years
25 years
10 years
**
*
*P <0.001
*
**
Reported consumption of ARFF at T1 is strongly correlated with that reported for the ages of 65, 45, 25, and 10 years
DETECTION OF TAS AND VITAMINS C AND E
Total antioxidant statut (TAS) Spectrophotometric analysis of serum capacity to inhibit
2,2’- azinobis (3-ethylbenzothiazoline-6-sulfonate) (ABTS) formation (ABTS) en the presence de H2O2 and metmyoglobin
Percentage of inhibition corresponds to TAS value expressed in Trolox (vitamin E analog) equivalent
Vitamin E Plasma, hexane/methanol extraction, HPLC/coulometric electrochemical detection
Vitamin CPlasma, HPLC/coulometric electrochemical detection
Résumé
Positive and significant correlation (Pearson r) between current consumption frequency of ARF and TAS (P = 0.026)
Significant correlation between the sum of 27 ARF eaten currently and daily and circulating TAS and vitamin C (modulated by gender)
No correlation with vitamin E No association between TAS and vitamin C levels Dietary supplements (vitamins A, C, E and/or selenium) did not significantly
affect TAS and, vitamin C levels or modify the relationship between TAS, vitamin C and current daily consumption of ARF
0 1 2 3 4 5 6 7 8 9 10
Nbre d'AFRAO /jour
30,00
40,00
50,00
60,00
Vit
am
ine
C
Men
Women
p = 0,002 R Square = 0,139
Y = 28,997 + 2,225 X + 12,749 SEXE
SERUM TAS AND PLASMA VITAMIN C LEVELS IN MEN AND WOMEN AT T1: TRANSVERSAL DATA
Unique initiative in research on aging and nutrition Efficacy of the various procedures Preliminary results (T1) indicate promising research avenues
(serum free IGF-1 levels,
AFR consumption and serum/plasma TAS and vitamin C) A gold mine of data and biospecimens Importance to conduct targeted sub-studies
Development Nutrition health promotion programs Disease prevention strategies Guidelines for optimal nutrition Evidence-based data for health care policy makers Food products
CONCLUSION AND PERSPECTIVE
Research personnel Coordinators Dieticians, nurses, laboratory technicians Secretaries
Collaborators Members of the Nutrition and Successful Aging Research Section, Quebec Network for Research on Aging
1,793 kind women and men
ACKNOWLEDGEMENTSACKNOWLEDGEMENTS
top related