食物不足、补充营养援助计划 (SNAP) 状况与老年人认知功能的 9 年轨迹：2012-2020 年纵向国家健康与老龄化趋势研究。
Food Insufficiency, Supplemental Nutrition Assistance Program (SNAP) Status, and 9-Year Trajectory of Cognitive Function in Older Adults: The Longitudinal National Health and Aging Trends Study, 2012-2020.
机构信息
Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA, USA.
Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA, USA.
出版信息
J Nutr. 2023 Jan;153(1):312-321. doi: 10.1016/j.tjnut.2022.12.012. Epub 2022 Dec 27.
BACKGROUND
Despite findings from cross-sectional studies, how food insecurity experience/Supplemental Nutrition Assistance Program (SNAP) status relates to cognitive decline over time has not been fully understood.
OBJECTIVES
We aimed to investigate the longitudinal associations between food insecurity/SNAP status and cognitive function in older adults (≥65 y).
METHODS
Longitudinal data from the National Health and Aging Trends Study 2012-2020 were analyzed (n = 4578, median follow-up years = 5 y). Participants reported food insecurity experience (5-item) and were classified as food sufficient (FS, no affirmative answer) and food insufficient (FI, any affirmative answer). The SNAP status was defined as SNAP participants, SNAP eligible nonparticipants (≤200% Federal Poverty Line, FPL), and SNAP ineligible nonparticipants (>200% FPL). Cognitive function was measured via validated tests in 3 domains, and the standardized domain-specific and combined cognitive function z-scores were calculated. Mixed-effect models with a random intercept were used to study how FI or SNAP status was associated with combined and domain-specific cognitive z-scores over time, adjusting for static and time-varying covariates.
RESULTS
At baseline, 96.3% of the participants were FS and 3.7% were FI. In a subsample (n = 2832), 10.8% were SNAP participants, 30.7% were SNAP eligible nonparticipants, and 58.6% were SNAP ineligible nonparticipants. Compared with the FS group in the adjusted model (FI vs. FS), FI was associated with faster decline in the combined cognitive function scores [-0.043 (-0.055, -0.032) vs. -0.033 (-0.035, -0.031) z-scores per year, P-interaction = 0.064]. Cognitive decline rates (z-scores per year) in the combined score were similar in SNAP participants (β = -0.030; 95% CI: -0.038, -0.022) and SNAP ineligible nonparticipants (β = -0.028; 95% CI: -0.032, -0.024), both of which were slower than the rate in SNAP eligible nonparticipants (β = -0.043; 95% CI: -0.048, -0.038; P-interaction < 0.0001).
CONCLUSIONS
Food sufficiency and SNAP participation may be protective factors preventing accelerated cognitive decline in older adults.
背景
尽管横断面研究有相关发现，但食物不安全感体验/补充营养援助计划（SNAP）状况与随时间推移的认知能力下降之间的关系仍未完全阐明。
目的
我们旨在调查老年人（≥65 岁）中食物不安全感/ SNAP 状况与认知功能之间的纵向关联。
方法
对 2012-2020 年国家健康与老龄化趋势研究的纵向数据进行了分析（n=4578，中位随访年限=5 年）。参与者报告了食物不安全感体验（5 项），并被归类为食物充足（FS，无肯定回答）和食物不足（FI，有任何肯定回答）。SNAP 状况定义为 SNAP 参与者、SNAP 合格非参与者（≤200%联邦贫困线，FPL）和 SNAP 不合格非参与者（>200% FPL）。认知功能通过 3 个领域的经过验证的测试进行测量，并计算了标准化的特定领域和综合认知功能 z 分数。使用具有随机截距的混合效应模型，根据静态和时变协变量，研究 FI 或 SNAP 状况与随时间推移的综合和特定领域认知 z 分数之间的关系。
结果
在基线时，96.3%的参与者为 FS，3.7%为 FI。在一个亚样本（n=2832）中，10.8%为 SNAP 参与者，30.7%为 SNAP 合格非参与者，58.6%为 SNAP 不合格非参与者。在调整模型中，与 FS 组相比（FI 与 FS），FI 与综合认知功能评分的下降速度更快[-0.043（-0.055，-0.032）与-0.033（-0.035，-0.031）z 分数/年，P 交互=0.064]。综合评分的认知衰退率（z 分数/年）在 SNAP 参与者中相似（β=-0.030；95%CI：-0.038，-0.022）和 SNAP 不合格非参与者中相似（β=-0.028；95%CI：-0.032，-0.024），两者均慢于 SNAP 合格非参与者（β=-0.043；95%CI：-0.048，-0.038；P 交互<0.0001）。
结论
食物充足和 SNAP 参与可能是预防老年人认知能力加速下降的保护因素。
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