Pastor-Valero Maria, Furlan-Viebig Renata, Menezes Paulo Rossi, da Silva Simone Almeida, Vallada Homero, Scazufca Marcia
Departamento de Salud Pública Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, España; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, España.
University of São Paulo, Faculty of Medicine, Department of Preventive Medicine, Brazil.
PLoS One. 2014 Apr 15;9(4):e94042. doi: 10.1371/journal.pone.0094042. eCollection 2014.
Brazil has one of the fastest aging populations in the world and the incidence of cognitive impairment in the elderly is expected to increase exponentially. We examined the association between cognitive impairment and fruit and vegetable intake and associated factors in a low-income elderly population. A cross-sectional population-based study was carried out with 1849 individuals aged 65 or over living in São Paulo, Brazil. Cognitive function was assessed using the Community Screening Instrument for Dementia (CSI-D). Fruit and vegetable intake was assessed with a Food Frequency Questionnaire (FFQ) and categorized into quartiles of intake and into total daily fruit and vegetable intake using the cut-off points for the WHO recommendations (<400 grams/day or ≥ 400 grams/day). The association between cognitive impairment and each quartile of intake, and WHO recommendation levels, was evaluated in two separate multivariate logistic models. The WHO recommendations for daily intakes ≥ 400 grams/day were significantly associated with 47% decreased prevalence of cognitive impairment. An effect modification was found in both models between cognitive impairment and "years of education and physical activity" and "years of education and blood levels of HDL" So that, having 1 or more years of education and being physically active or having 1 or more years of education and levels higher than 50 mg/dl of HDL-cholesterol strongly decreased the prevalence of cognitive impairment. In this socially deprived population with very low levels of education and physical activity and fruit and vegetable intake, those who attained WHO recommendations, had 1 year or more of education and were physically active had a significantly lower prevalence of cognitive impairment. A more comprehensive understanding of the social determinants of mental health is needed to develop effective public policies in developing countries.
巴西是世界上人口老龄化速度最快的国家之一，预计老年人认知障碍的发病率将呈指数级增长。我们研究了低收入老年人群中认知障碍与水果和蔬菜摄入量及相关因素之间的关联。对居住在巴西圣保罗的1849名65岁及以上的个体进行了一项基于人群的横断面研究。使用社区痴呆筛查工具（CSI-D）评估认知功能。通过食物频率问卷（FFQ）评估水果和蔬菜摄入量，并根据摄入量四分位数以及使用世界卫生组织建议的切点（<400克/天或≥400克/天）将其分类为每日水果和蔬菜总摄入量。在两个单独的多变量逻辑模型中评估了认知障碍与每个摄入量四分位数以及世界卫生组织建议水平之间的关联。世界卫生组织建议的每日摄入量≥400克/天与认知障碍患病率降低47%显著相关。在认知障碍与“教育年限和身体活动”以及“教育年限和高密度脂蛋白血液水平”的两个模型中均发现了效应修正。因此，接受1年或以上教育且身体活跃，或者接受1年或以上教育且高密度脂蛋白胆固醇水平高于50毫克/分升，可显著降低认知障碍的患病率。在这个教育水平、身体活动水平以及水果和蔬菜摄入量都非常低的社会贫困人群中，达到世界卫生组织建议、接受1年或以上教育且身体活跃的人群认知障碍患病率显著较低。在发展中国家制定有效的公共政策需要对心理健康的社会决定因素有更全面的了解。
