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Diet as a Risk Factor for Cognitive Decline in African American Caucasians with a Parental History of Alzheimer’s Disease: A Cross Sectional Pilot Study Dietary Patterns. Article Summary:

In this article, Nutaitis et. al (2019) delve into the development of Alzheimer’s disease (AD) in African Americans and Caucasians. The researchers employ cross-sectional observation study to probe how dietary modification reduces the risk of developing AD among risk groups like African American people. The researchers start by providing a in-depth background of AD disease. It notes that currently in the United States, more than five million people have Alzheimer’s disease and the number is likely to reach sixteen million over the next thirty years. Compared to their white counterparts, African Americans are at 64% more risk of developing Alzheimer ’s disease (Nutaitis, Tharwani, Serra, Goldstein, Zhao, Sher, & Wharton, 2019). Additionally, people with parental history of the disease are ten times at risk of becoming afflicted themselves. The article mentions various preventative efforts to so with lifestyle interventions such as exercise, diet and cognitive training. The text notes that neuropathological changed relating to the disease start during middle life (40-65 years) and they tend to have lasting effects. As such, middle adulthood is the optimal time to institute AD focused lifestyle intervention. The article states that adhering to healthy diet leads to cognitive benefits during old age. This diet includes a prudent and Mediterranean diet which is characterized by vegetables, legumes, fruit, oil and fish. While this information is promising, very few studies examine the influence that diet has on ethnically diverse and middle aged population at higher risk of Alzheimer’s disease. According to current literature, racial and geographic differences in cardiovascular risk are linked with Southern dietary patter such as fats, eggs, fried foods, and processes sugar and meats which makes it possible for southern dietary patterns to lead to cognitive decline. The aim of the research was to probe the relationship between cognitive decline, dietary patterns and vascular function in racially diverse and middle-aged cohort who are at an increased risk of suffering Alzheimer’s disease because of parental history predisposition to the disease. The researchers hypothesized that consuming high intake of southern patterns and reduced intake of healthy diets raises the risk of cognitive impairment and vascular dysfunction particularly among African Americans.

The study involved sixty-six subjects who enrolled in a study funded by the NIH and those whose parents show history of Alzheimer’s disease. They were participants of a cross-sectional pilot study. Parental history of Alzheimer’s disease was confirmed through autopsy or through the Dementia Questionnaire. The subjects received cognitive and vascular assessments in line with the approved IRB protocol. Demographic data like gender, age, income, level of education, smoking status, exercise, and depression status were collected using a self reported survey. Exercise was collected in terms of the mean number of days that the person does cardiovascular exercises in a week. Dietary patters were evaluated using a abbreviated version of the food frequency questionnaire by the Lower Mississippi Delta Nutrition Intervention Research Initiative. The food questionnaire is a product of the Jackson Herat Study. The questionnaire comprised on 160 items and took approximately 20 minutes to fill. The subjects self-reported frequency and quantity of foods and drink consumption using an online survey taken from home via an individualized web link. As compensation, the participants were awards a $15 gift card after completing the survey. The food items were categorized in two groups; prudent and southern diets in accordance to the reasons for racial and geographical differences. Southern diets including foods like sugarsweetned drinks, processes meats, organ meats fats, eggs, and fried foods were categorized as Southern diets while healthy foods such as whole grains, fruits, fish, and whole grain were categorized as prudent diet because they were healthy foods.

As regards cardiovascular assessment, the selected participants went through a one-hour fasting evaluation that included micro vascular vasodilatory function that employed digital amplitude tonometry and macrovascular function. Additionally, blood pressure was monitored round-the-clock using a 24 hours ambulatory pressure monitor. They used it examine diastolic and systolic blood pressure as well as dipping patterns, which are all linked to Alzheimer’s disease and cognition.

To analyze the data, the researchers employed SPSS IBM version 22 to test the differences showed between African Americans and their white counterparts as regards their demographics, cognitive performance and vascular risk factors. Noteworthy, they carried out two independent t-test for chi-square and continuous variables for characteristics that control age, education and gender. Since there is no sufficient power for detecting an interaction between race and diet, the researchers resulted to examining the link between cognition and diet in each racial group independently. The correlation between food and cognitive performance were evaluated with the help of Person’s r partial correlation. This helped control age and education on the tests found to have racial differences at the threshold of p=0.10. Since eight cognitive tests were part of the analysis, the significance level threshold when employing false discovery rate approximation had to be adjusted to the point that the study used a threshold p-value of 0.03.

The results revealed that there is a connection between worse cases of cognitive performance and couther diet among African American population. African Americans who consumed mashed potatoes, sugar drinks, tea, and pie prohibited terrible cognitive performance, of p <0.05, as compared to their Caucasian counterparts. Additionally, cooking oil and fat and gravy recorded negative trends of p=0.06, for cognitive performance in African Americans. Both Caucasians and African Americans show a greater adherence to prudent dietary pattern linked with improved cognitive outcomes. The results from the cardiovascular exercise indicated that overall, the participants were healthy. Both African Americans and Caucasians did not differ in vascular measure including arterial stiffness, blood pressure and endothelial function.

The strength of this research is that it entails complete battery of vascular measures and neuropsychology testing. Moreover, the study employed a racially and ethnically diverse cohort who was at increased risk of suffering Alzheimer’s disease. Additionally, the food questionnaires employed in the study were both geographically and racially sensitive. As regards limitations, the pilot project included a small sample size and it took into consideration, the overall health of the subject cohort. The fact that died is likely to have a more visible impact on people with preceding health complications is a reality. Another limitation is that the food questionnaire does not include information to do with longitudinal food options and it would be good if these kinds of data would be incorporated in future studies.

The research concludes that without a doubt, dietary factors have a link with cognitive outcomes. Nutaitis et al. (2019) cross sectional study indicates that the food characteristics of the Prudent and Southern diets have different impacts on cognitive function among middle aged adults and that they remain at an increases of suffering Alzheimer’s disease. Additionally, the results indicate that diet can be an effective non-pharmaceutical tool in preventing cognitive decline among racially diverse populations. There is a possibility that high prevalence of Alzheimer’s disease in African Americans can be controlled through diet modification. In summary, the results of these study insist on the need to undertake more research on the same subject of how dietary intake influences their exposure to Alzheimer’s disease. Since African American people are at increased prevalence and incidence f Alzheimer’s disease, it is prudent that investigation be done regarding modifiable risk factors which target high risk groups. Particularly, dietary interventions and nutritional education meant to shift black people from Southern diets to prudent diets that are much healthier is cost effective means of preserving cognitive function among healthy individuals.

How This Article Identifies With Me

This article summarized above written by Nutaitis et. al relates with me because it touches on a person who is special to me. I have an uncle who has Down syndrome and he is also in the early stages of Alzheimer’s disease. His condition has been deteriorating fast and it makes me sad particularly because the person that is suffering from the disease in my favorite of all my uncles. I share a good relationship with him because he raised me at a certain point of my life. I lived with him through high school and it makes me sad to watch him suffer at the hands of Alzheimer’s disease knowing that I cannot do anything to help him. What worries me the most is the fact that Alzheimer’s disease has no known cure. This means that we can only rely on treatment options to help with the management of the symptoms. I have heard that there is a good chance that with treatments options the symptoms of Alzheimer’s disease can be eliminated all together. I hope one day, my uncle’s condition can get to this point. I feel sad when I see him having a memory loss episode. There was this time he could not remember his name at all which was very frustrating for him.

References

Nutaitis, A. C., Tharwani, S. D., Serra, M. C., Goldstein, F. C., Zhao, L., Sher, S. S., … & Wharton, W. (2019). Diet as a risk factor for cognitive decline in African Americans and Caucasians with a parental history of Alzheimer’s disease: a cross-sectional pilot study dietary patterns. The journal of prevention of Alzheimer’s disease, 6(1), 50-55.