Ji Eun Kim; Sangah Shin; Dong Woo Lee; Joon Hyun Park; Eun Joo Hong; Hyojee Joung

doi:10.4163/jnh.2015.48.3.221

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Kim, Shin, Lee, Park, Hong, and Joung: Association between compliance with dietary guidelines and Alzheimer's disease in Korean elderly∗

Research Article

J Nutr Health 2015;48(3):221-227.

Published online: 19 January 2015

DOI: https://doi.org/10.4163/jnh.2015.48.3.221

Association between compliance with dietary guidelines and Alzheimer's disease in Korean elderly^∗

Ji Eun Kim¹, Sangah Shin^2,³, Dong Woo Lee⁴, Joon Hyun Park⁴, Eun Joo Hong⁵, Hyojee Joung^1,^2,^†

¹Department of Public Health Nutrition of Graduate School of Public Health, Seoul National University, Seoul 151-742, Korea

²Institute of Health and Environment. Seoul National University, Seoul 151-742, Korea

³Department of Global Health Policy and AXA Department of Health and Human Security, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan

⁴ ⁴Department of Psychiatry, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 139-707, Korea

⁵Department of Economics and Finance, Hanyang Cyber University, Seoul 133-791, Korea

^†To whom correspondence should be addressed. tel: +82-2-880-2716, e-mail: hjjoung@snu.ac.kr

^∗ This research was supported by the grant from the Brain Korea 21 project in 2012 and the Korea Food and Drug Administration

Received 28 January 2015 Revised 16 February 2015 Accepted 3 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Confronting the growing burden of dementia requires understanding the causes and predictors of dementia in order to develop preventive strategies. In Korea a large proportion (71%) of dementia is Alzheimer's disease, and the risk factors have not yet been elucidated. Dietary factors may be possible risk factors, however research on the relationship between Alzheimer's disease and dietary behaviors has been insufficient. The purpose of this study was to investigate the association between compliance with the “Dietary Guidelines for Elderly (The Ministry of Health and Welfare, 2011)” and Alzheimer's disease among Korean elderly.

Methods:

Elderly persons who visited a University hospital or a dementia center of Seoul and agreed to participate in the examinations were selected. Among 277 subjects, 89 Alzheimer patients were selected with diagnosis and 118 subjects were assigned to the control group. Diagnosis of Alzheimer's disease was based on Alzheimer's disease criteria of Diagnostic and Statistical manual of Mental Disorders, 4th edition (DSM-IV) and criteria of National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and related Disorders Association (NINCDS-ADRDA). Information on the general characteristics, health related behaviors and compliance with the dietary guidelines for Korean elderly was collected by face to face interview using a structured questionnaire. Anthropometric variables were measured during the survey.

Results:

Total compliance score of dietary guidelines was significantly lower in the Alzheimer's disease group than in the control group (p = 0.0001). The odds ratio of Alzheimer's disease was significantly decreased in the group with the highest dietary guideline compliance score (OR = 0.47, 95 % CI = 0.18~1.09) compared to the group with the lowest compliance score.

Conclusion:

The results indicate that increasing compliance with the dietary guidelines could be an effective strategy to decrease the risk of Alzheimer's disease among Korean elderly.

Keywords: compliance, dietary guidelines, Alzheimer's disease

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Table 1.

General characteristics of subjects

	Alzheimer's Disease (n = 89)	Controls (n = 118)	p-value
	Mean ± SD	Mean ± SD	p-value
Sex (N (%))¹⁾
Male	41 (46.1)	50 (42.4)	0.596
Female	48 (53.9)	68 (57.6)
Age (years)²⁾	77.8 ± 6.7	69.9 ± 5.9	< 0.0001
Height (cm)³⁾	157.5 ± 9.8	158.6 ± 8.9	0.7558
Weight (kg)³⁾	55.6 ± 11.6	60.2 ± 10.3	0.5363
BMI^3), ⁴⁾	22.3 ± 3.5	23.9 ± 3.5	0.5099

¹⁾ p-value from χ²-test.

²⁾ p-value from t-test.

³⁾ p-value fromgenerealized linear model adjusted age and sex.

⁴⁾ kg/m²

Table 2.

Dietary behaviors of subjects

N (%)
Alzheimer's Disease (n = 89)		Controls (n = 118)	p-value
Dietary habit changes over the past five years¹⁾
Changed	24 (27.6)	37 (31.9)	0.5074
Not changed	63 (72.6)	79 (68.1)
Eating speed (per mael)
Fast (< 10 min)	42 (47.2)	53 (44.9)	0.8444
Medium (10~20 min)	32 (36.0)	47 (39.8)
Slow (≥ 20 min)	15 (16.9)	18 (15.3)
Skipping meals (per week)
Breakfast
Never	83 (93.3)	105 (89.0)	0.4301
1~4 times	3 (3.4)	9 (7.6)
Over 5 times	3 (3.4)	4 (3.4)
Lunch
Never	73 (82.0)	100 (84.8)	0.2382
1~4 times	12 (13.5)	17 (14.4)
Over 5 times	4 (4.5)	1 (0.9)
Dinner
Never	84 (94.4)	105 (89.0)	0.3618
1~4 times	4 (4.5)	9 (7.6)
Over 5 times	1 (1.1)	4 (3.4)
Unbalanced diet (self reported)
Yes	29 (32.6)	33 (28.0)	0.4727
No	60 (67.4)	85 (72.0)
Not preferred food
Vegetables (%)	9 (10.1)	6 (5.1)	0.1672
Fruits (%)	2 (2.3)	2 (1.7)	0.7751
Meats (%)	12 (13.5)	18 (15.3)	0.7201
Fishes (%)	9 (10.1)	6 (5.1)	0.1672
Seasonings (%)	5 (5.6)	2 (1.7)	0.1221

p-value from χ²-test.

¹⁾ missing = 4

Table 3.

Adherence to the dietary guidelines for Korean elderly of subjects

Alzheimer's Disease (n = 89)		Controls (n =118)	p-value
Mean ± SD		Mean ± SD	p-value
Eat a variety of protein foods, include meat, fish, eggs, beans and peas daily.	3.2 ± 1.5	3.6 ± 1.2	0.0375
Eat a variety of side dishes with vegetables daily.	3.3 ± 1.6	3.8 ± 1.2	0.0021
Eat a diary products or fortified soy beverages daily.	3.1 ± 1.6	3.0 ± 1.5	0.7438
Eat a fresh seasonal fruit daily.	3.0 ± 1.6	3.4 ± 1.2	0.0132
Eat food with bland taste.	3.1 ± 1.5	3.0 ± 1.2	0.5425
Eat liquid less when you eat soup and pot stew.	3.0 ± 1.7	3.0 ± 1.3	0.8914
Do not add more salt or soy sauce at the table.¹⁾	3.1 ± 1.8	3.4 ± 1.5	0.0699
Have three meals a day.	3.4 ± 1.8	4.0 ± 1.3	0.0006
Consider nutrition and hygiene when eating out.	3.2 ± 1.3	3.4 ± 1.2	0.3529
Eat fresh and clean foods and reject them if in doubt.	3.5 ± 1.6	4.0 ± 1.1	0.0046
Maintain nutrition balance with foods and be careful to take dietary supplement.	3.3 ± 1.5	3.5 ± 1.3	0.0415
Drink plenty of water frequently although you are not thirsty.	3.1 ± 1.7	3.3 ± 1.4	0.4774
Limit yourself to 1 drink a day only.	2.6 ± 2.3	3.5 ± 1.9	0.0111
Reduce time spent in dedentary behaviors and increase physical activity where possible.¹⁾	2.8 ± 1.7	3.4 ± 1.3	0.0167
Try to maintain healthy weight.	2.7 ± 1.6	3.5 ± 1.3	0.0007
Do aerobic exercise for more 30 minutes everyday.	2.8 ± 1.7	2.8 ± 1.3	0.2348
Exercise muscles for more 20 minutes a time and at least twice a week.	2.6 ± 1.7	2.2 ± 1.2	0.0086
Total score of dietary guidelines for elderly^2,3)	51.8 ± 10.8	56.6 ± 8.7	0.0001

Each item score: 0~5 (strongly agree = 5, strongly disagree = 1)

p-value from Generalized linear model adjusting age, sex, dietary habit change.

¹⁾ missing = 1

²⁾ missing = 2

³⁾ Perfect score = 85

Table 4.

Multivariate adjusted odds and 95% confidence intervals for Alzheimer's disease by the level of adherence to the dietary guidelines

Q1			Q2	Q3	p for trend
The total score of dietary guidelines	OR (95% CI)	1.00	0.51 (0.22_1.2)	0.47 (0.18_1.09)	0.0645
Eat a variety of protein foods, include meat, fish, eggs, beans and peas daily.	OR (95% CI)	1.00	0.58 (0.22_1.54)	0.89 (0.4_1.98)	0.8035
Eat a variety of side dishes with vegetables daily.	OR (95% CI)	1.00	0.32 (0.13_0.76)	0.63 (0.26_1.54)	0.4410
Eat a diary products or fortified soy beverages daily.	OR (95% CI)	1.00	1.02 (0.41_2.55)	0.56 (0.22_1.38)	0.1643
Eat a fresh seasonal fruit daily.	OR (95% CI)	1.00	0.47 (0.17_1.29)	0.48 (0.22_1.05)	0.0734
Eat food with bland taste.	OR (95% CI)	1.00	0.27 (0.1_0.71)	0.38 (0.14_1.042)	0.1705
Eat liquid less when you eat soup and pot stew.	OR (95% CI)	1.00	0.33 (0.13_0.83)	0.45 (0.19_1.11)	0.2244
Do not add more salt or soy sauce at the table.	OR (95% CI)	1.00	0.38 (0.16_0.9)	0.68 (0.28_1.67)	0.5787
Have three meals a day.	OR (95% CI)	1.00	0.2 (0.07_0.58)	0.39 (0.18_0.87)	0.0291
Consider nutrition and hygiene when eating out.¹⁾	OR (95% CI)	1.00	0.74 (0.29_1.85)	0.65 (0.28_1.48)	0.2591
Eat fresh and clean foods and reject them if in doubt.	OR (95% CI)	1.00	1.03 (0.43_2.46)	1.35 (0.6_3.03)	0.4644
Maintain nutrition balance with foods and be careful to take dietary supplement.	OR (95% CI)	1.00	0.59 (0.22_1.58)	0.58 (0.27_1.28)	0.1735
Drink plenty of water frequently although you are not thirsty.	OR (95% CI)	1.00	0.43 (0.16_1.18)	0.58 (0.24_1.44)	0.3381
Limit yourself to 1 drink a day only.	OR (95% CI)	1.00	0.33 (0.12_0.89)	0.5 (0.23_1.08)	0.1199
Reduce time spent in dedentary behaviors and increase physical activity where possible.	OR (95% CI)	1.00	0.37 (0.14_1.0)	0.18 (0.07_0.46)	0.0002
Try to maintain healthy weight.	OR (95% CI)	1.00	0.73 (0.26_2.01)	0.49 (0.23_1.04)	0.0434
Do aerobic exercise for more 30 minutes everyday.	OR (95% CI)	1.00	0.17 (0.07_0.43)	0.39 (0.15_0.97)	0.0889

Logistic analysis adjusted for age, sex and dietary habit change.

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