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Title:	Risk evaluation of sugar intake in relation to cognitive impairment among older adults in Malaysia
Authors:	Chong Ching Phang (P82509)
Supervisor:	Suzana Shahar, Prof. Dr.
Keywords:	Cognitive Behavioral Therapy Cognitive Aging Universiti Kebangsaan Malaysia -- Dissertations Dissertations, Academic -- Malaysia
Issue Date:	7-Mar-2019
Description:	The intake of excess sugar has been linked to an increased risk of cognitive impairment. As yet, the risk evaluation of sugar intake concerning cognitive impairment has yet to be conducted. This study consisted of two phases. Phase-I aimed to determine the type of and total sugar content in foods commonly consumed by older adults in Malaysia (n=120). Phase-II aimed to investigate the risk of sugar intake on cognitive impairment among older adults; the underlying biochemical mediators; and the optimum cut-off values of sugar intake. The results from sugar analysis revealed that the average sugar content in processed foods, local cakes & desserts, fruits, snacks, beverages and cooked dishes were 26.1%, 13.7%, 12.2%, 11.8%, 8.8%, 7.6% and 2.3% respectively. The highest sugar content was found in palm sugar (87.3%) and the lowest sugar content was found in dhal fritter (0.3%). Notably, sucrose was the primary type of sugar found in this study. As for the crosssectional study, a total of 1,209 subjects aged ≥ 60 years were recruited through multistage random sampling from selected states (Perak, Selangor, Johor, Kelantan) in Malaysia. The dietary intake was derived using a 7-day dietary history questionnaire (DHQ) and supplemented with a semi-quantitative food frequency questionnaire (FFQ) for added sugar intake. Cognitive functions were assessed using the Minimental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), digit span, digit symbol, Rey's Auditory Learning Test (RAVLT) and visual reproduction test (VR). The prevalence of cognitive impairment as defined by the MMSE score less than 24 was 31.9%, while the prevalence of mild cognitive impairment was 13.1%. The median (IQR) for total sugars intake was 44.6 g/day (26.2-68.8) or 8 tsp, and free sugars intake was 33.1 g/day (17.5-57.3) or 6 tsp. The higher intake of total sugars, free sugars, sucrose, lactose, sugar-sweetened beverages, cakes and dessert were found to be significantly associated with a lower MMSE score, after adjusting for covariates (p < 0.05 for all parameters). On the other hand, the consumption of sugars from cooked dishes and fruits were found to be significantly associated with an improved MMSE score (p < 0.05 for all parameters). The adjusted odd ratio (OR) for the risk of cognitive impairment was 3.3 (95% CI: 2.2-5.1) for total sugars and 3.6 (95% CI 2.3-5.5) for free sugars, comparing the highest with the lowest intake percentiles. The optimal cut-off value in predicting cognitive impairment was 83.1 g/day for total sugars, 44.3 g/day for free sugars, and 26.7 g/day for sucrose. The results from biomarkers analysis (n=120) indicated that higher sugar intake was associated with reduced brain-derived neurotrophic factor (BDNF) but increased in malondialdehyde (MDA), insulin, glucose and homeostatic model assessment-insulin resistance (HOMA-IR) (p < 0.05 for all parameters). MDA appeared to be the full mediator linking free sugars and sugar from sugar-sweetened beverages with the MMSE score, while BDNF was the full mediator linking sugar from fruits with the MMSE score. In conclusion, excessive sugar intake showed a notable risk for cognitive impairment, particularly global cognition and episodic memory for both visual and auditory functions.,Ph.D.
Pages:	289
Call Number:	9 Tesis Cd WM425.5.C6C548r 2020
Publisher:	UKM, Kuala Lumpur
Appears in Collections:	Faculty of Health Sciences / Fakulti Sains Kesihatan

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