western diet and dementia

1. Western Diet as Risk Factor
of Dementia
PROF. GHIZAL FATIMA,
ERA UNIVERSITY,
LUCKNOW, INDIA

2. I AM GREATFUL TO Dr Itoh and Dr Watanabe for the Financial support for attending this meeting.
INTRODUCTION
Diet is found to be an important modifiable lifestyle factor related to dementia risk.
In the past two decades.
Many studies have focused on dietary patterns such as the
Mediterranean diet,
Western vs. traditional diets, Indo-Mediterranean diets rich in whole grains, (Singh et al, lancet 2002)
showing that higher adherence to healthy diets is associated with a reduced risk of dementia (for
recent systematic reviews and meta-analyses.
MEDITERRANEAN type diets rich in antioxidants (e.g., from fruits, vegetables, coffee,tea), healthy fats (e.g., omega-
3 fatty acid from fish, nuts, olive oil), with lower intake of;
WESTERN: red meat consumption, and consumption of refined sugars, carbohydrates and unhealthy fats
may protect against dementia.
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1.Aridi, Y.S.; Walker, J.L.; Wright, O.R.L. The association between the Mediterranean dietary pattern and
cognitive health: A systematic review. Nutrients 2017.
2.Cao, L.; Tan, L.; Wang, H.F.; Jiang, T.; Zhu, X.C.; Lu, H.; Tan, M.S.; Yu, J.T. Dietary patterns and risk of
dementia: A systematic review and meta-analysis of cohort studies. Mol. Neurobiol. 2016, 53, 6144–6154.
3.Yusufov, M.; Weyandt, L.L.; Piryatinsky, I. Alzheimer’s disease and diet: A systematic review. Int. J. Neurosci.
2017, 127, 161–175.
4.Hardman, R.J.; Kennedy, G.; Macpherson, H.; Scholey, A.B.; Pipingas, A. Adherence to a Mediterranean-style
diet and effects on cognition in adults: A qualitative evaluation and systematic review of longitudinal and
prospective trials. Front. Nutr. 2016, 3, 22.

3. The Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study participants were first
examined at midlife (baseline) in the North Karelia Project and the FINMONICA population-
based studies in Finland, 1972. (Puska, P. From Framingham to north karelia: From descriptive epidemiology to public health
action. Prog. Cardiovasc. Dis. 2010, 53, 15–20).
CAIDE Population based cohort study,in 2000 subjects
(70-78 yrs), showed that healthy dietary changes in
midlife,
from Western to Mediterranean style diets characterized
by modifying the quality of fats, increasing vegetable
consumption, and decreasing salt and sugar
consumption, are associated with a reduced risk of
dementia in later life.
Sindi et al, Nutrients, 2018

4. Objective: Our study aims to determine the association of Western diet with
risk of cognitive deficit and dementia.
Study Design and Setting. Cross-sectional survey in a hospital.
Subjects and Methods.
After written informed consent and approval from hospital ethic committee, all
subjects (n=2002) above 25 years of age (1016 males and 986 females) were
randomly selected and recruited from urban population of Moradabad, North
India.
Clinical data and risk factors were recorded with the help of case record form
and validated questionnaires.
Assessment of cognitive decline and dementia was made by Singh,s Memory
function rating scale. Subjects were classified in to normal, mild, moderate and
severe dementia by assessment of memory function.
The association of dementia with risk factors was calculated by multivariate
logistic regression analysis after adjustment of age and sex, obesity, diabetes and
CVDs.

5. Attributes of memory dysfunction(Singh,s
Questionnaire)Have a look sir
Never Rarely Few times Often Very often
1.Difficulty in remembering names of neighbours
2.Describe program just now you saw in television.
3.Need a list for shopping to make sure that you
do not forget any thing.
4.Can you tell what food you ate yesterday?
5.Forget where you have left your keys, purse and
other personal objects.
6.Do you forget what works to be done during the
day?
7.After going out, do you forget what for you came
out?
8.Is it difficult to recollect what you were talking a
few seconds before?
9.How often you forget day and date?

6. Singh,s Questionnaire Continued.
11.Do you often forget to use buttons and zippers?
12.Do you repeat several times to yourself things that you
have to do?
13.Do you often forget names of your siblings, children,
parents etc?
14.Do you find difficulty in recollecting a word that is on tip
of your tongue?
15.do you lose track of your ideas when you listen to some
one else?
16.Do you have difficulty in saying what you want to say?
17.Do you need to check if you locked the door?
18.Do you forget your address and other personal data?
19.do you have difficulty in doing simple calculations?
20.Do you work slowly to calculate correctly?
Score 36-60 =Memory deficit; Score >60 = Dementia.

7. Results. The overall prevalence of dementia was
significantly more common among men compared to
women (total= 2.95%, n=59), (18.9% vs 1.0%; P<0.01;n=
38 vs 21), respectively and
the risk increased with increase in age.
The risk of memory dysfunction or dementia overall
showed a graded increase with age from 25 to 84 years in
both sexes and the trends were significant)P<0.02) for both
genders.

8. Men (n=1016) Women (n=986) Total (n=2002)
Age group No Dementia No
(%)
No Dementia No
(%)
No Dementia No
(%)
25-34 304 - 354 - 658 -
35-44 290 9(3.1) 254 7(2.7) 544 16(2.9)
45-54 182 11(6.0) 171 10(5.8) 353 21(5.9)
55-64 128 19(14.8)* 123 11(8.9)* 251 30(11.9)*
65-74 65 22(33.8)* 54 12(22.2)* 119 34(28.6)*
75-84 47 23(48.9)* 30 13(43.3)* 77 36(46.7)*
X2 for trend
P Value
102.4
0.002
62.2
0.002
112
0.001
Total 1016 84(8.26) 986 53(5.37) 2002 137(6.84)
Table 1. Prevalence of dementia (including memory dysfunction) by age and sex
among urban population in North India. Showed that it increased with age

9. Risk factors of dementia and
depression.
Men (n=1016) Women
(n=986)
Total
(n=2002)
Behavioral risk factors
Mood and anxiety disorders 225(22.1)_ 215(21.8) 440(22.0)
Tobacco intake 202(19.8)** 18(1.8) 220(10.9)
Alcoholism(>10 drinks/week) 31(2.9)** - 31(2.9)
Western type diet 518(51.0) 492(50.0) 1018(50.8)
Sedentary behavior 768(75.6) 789(80.0) 1557(77.8)
Low cognitive activity 105(10.3) 118(12.0) 223(11.7)
Low education 85(8.4) 97(9.8) 182(9.1)
Biological risk factors
Age >60 years. 226(22.2)* 169(17.1) 395(19.7)
Diabetes mellitus 81(8.0)* 52(5.3) 133(6.6)
Hypertension(>140/90mm Hg) 285(28.0) 248(25.1) 533(26.6)
Hypercholesterolemia (>5.18mmol/L) 313(30.8) 317(32.1) 630(31.4)
Obesity (BMI>25Kg/M2) 321(31.6) 324(32.8) 645(32.2)
Coronary artery disease. 132(13.0)* 98(9.9) 230(11.4)
Table 2. Prevalence of risk factors of dementia among men and women.
*=P<0.05, **=P<0.01, by Chi square test, Values are number (%).

10. Risk factors. Dementia (n=137) No(%) No dementia. (n=1865) No (%)
Behavioral risk factors
Mood and anxiety disorders 43(31.4)* 397(21.3)
Tobacco(>once/week) 39(28.4)** 183(9.8)
Alcoholism(>10drinks/wk) 8(5.8)* 23(1.2)
Western type diet 93(67.8)* 925(49.6)
Sedentary behavior 124(90.5)* 1433(76.8)
Low cognitive activity 34(24.8)** 199(10.7)
Low education 26(18.9) 156(8.4)
Table 3. Behavioral and biological risk factors of dementia compared to rest
of the subjects in both sexes combined.

11. Biological risk factors were also more
common among dementia patients.
Age >60 years 84(61.3)** 311(17.2)
Diabetes mellitus 59(43.1)** 74(4.1)
Hypertension 49(35.7)* 484(26.8)
Hypercholesterolemia (>5.18mmol/L) 62(45.2)* 568(31.5)
Obesity 78(56.9)** 567(31.4)
Coronary artery disease 28(20.4)* 202(11.2)
Family history of dementia or depression. 10(7.3)* 74(4.1)
*=P <0.0, **= P<001, P values were calculated by Chi square
test. Tobacco and alcohol are not common in women.

12. Foods (g/day) Male (n=1016) Female (n=986)
Prudent foods Mean ±SD Mean ± SD
Wheat, rice and millets 269±37.3 242± 21
Roots and tubers 81± 15.6 74±6.2
Nuts including pea nuts 53±11.4 41±5.2
Fruits and vegetables. 103± 34 109±27.5
Whole grains and pulses 90±17.6 70±14.8
Milk and curd 214.5±28 203±23.3
Mustard/olive oil. 13.5±3.4 10.8±3.2
Total prudent foods 824.0±230 751.8±201
Table 4. Food consumption pattern among men and women based on dietary diaries.

13. Western type foods consumption was also
common.
Refined foods. 107.5±32.6 105.1±25.3
Sugar and syrups 60.0±15.5 41.1±12.6
Clarified butter, butter and trans fat 16.6±3.5 12.6±2.5
W-6 rich oils.(Sun flower, corn, soy bean ) 29.2±3.6 12.4±2.6
Meat and eggs. 65.6±14.2 49.1±8.8
Salt 12.2±3.1 10.2±2.0
Total Western type foods 391.1±33.5 306.5±25.5
Total foods 1215.1±262.2 1058.3±211

14. Dementia
Men (n=1016) Women (n=986)
Risk factors Odds ratio,(95%
confidence interval)
Odds ratio, (95%
confidence interval)
Low cognitive
activity,
0.83-(0.75-0.92)* 0.89(0.84-0.99)*
Diabetes mellitus 0.71(0.65-0.78)** 0.78 (0.74- 0.86)**
Hypertension 0.80(0.71-0.89)** 0.85 (0.79-0.91)**
Mood and anxiety
disorders
0.92(0.85- 0.99)* 0.90 (0.85-0.97)*
Sedentary
behavior
0.74 (0.69-0.79)** 0.71 (0.63-0.74)**
Tobacco intake 0.88 (0.77- 0.97)* 0.90( 0.81-1.01)
Low education 0.87(0.70-0.99) 1.11(1.00-1.25)
Western type diet. 0.88(0.80-0.95)* 0.89(0.81-0.99)*
Dementia= All the
subjects with
manifestation of
memory
dysfunction were
included under
dementia.
. *= P < 0.05, **= P
, 0.001, P value
was obtained by
regression
analysis.
Table 5. Multivariate logistic regression analysis for association of risk factors with risk of
dementia after adjustment of age and body mass index, among men and women.

15. Dementia
Men (n=1016) Women (n=986)
Risk factors Odds ratio,(95%
confidence interval)
Odds ratio, (95%
confidence interval)
Lower fruits intake, 0.85-(0.78-0.96)* 0.87(0.82-0.98)*
Lower vegetables 0.70(0.66-0.77)** 0.76 (0.71- 0.84)**
Lower whole grain 0.80(0.74-0.87)** 0.84 (0.78-0.90)**
Mood and anxiety
disorders
0.92(0.85- 0.99)* 0.90 (0.85-0.97)*
Sedentary behavior 0.74 (0.69-0.79)** 0.71 (0.63-0.74)**
Tobacco intake 0.88 (0.77- 0.97)* 0.90( 0.81-1.01)
Low education 0.87(0.70-0.99) 1.11(1.00-1.25)
Table 6. Multivariate logistic regression analysis for association of Food Intakes with risk of
dementia after adjustment of age and body mass index and cadiometabolic diseases among men
and women.
Dementia= All the subjects with manifestation of memory dysfunction were included under dementia. *= P < 0.05, **=
P , 0.001, P value was obtained by regression analysis.

16. Western Food Cause Hyperglycemia
Even a single instance of elevated glucose in the blood stream
can be harmful to the brain, resulting in slowed cognitive function
and deficits in memory and attention.
Sugar also affects mood. Studies of long-term diabetics show
progressive brain damage leading to deficits in learning, memory, motor
speed, and other cognitive functions.
Frequent exposure to high glucose levels diminishes mental
capacity, as higher HbA1c levels have been associated with a
greater degree of brain shrinkage.
Higher sugar consumption is associated with lower scores on
tests of cognitive function. These effects are thought to be
due to a combination of hyperglycemia, hypertension, insulin
resistance, and elevated cholesterol.

17. MECHANISMS OF DIET CAUSING BRAIN DYSFUNCTION
High Refined CHO
High Refined CHO

18. CONCLUSIONS
The findings of our study indicate that western type foods such as
refined CH0 (bread, biscuits, syrups),white rice, white flkour
chapatti,red meat, preserved meat high trans fat and total fat are risk
factors of dementia.
However, Indo-Mediterranean foods, gram, beans, legumes, millets, all
whole grains,such as Medical Rice, vegetables, fruits, fish may be
protective.