Energy and macronutrient intakes at breakfast and cognitive declines in community-dwelling older adults: a 9-year follow-up cohort study

Abstract

Background: It is unclear whether breakfast consumption and breakfast composition are independently associated with changes in cognition over a long-term period in older adults.

Objectives: We aimed to examine the associations between energy and macronutrient intakes at breakfast and cognitive declines.

Methods: We included 2935 participants aged 55-93 y at baseline from the China Health and Nutrition Survey in our analysis. Cognition was assessed in 1997, 2000, 2004, 2006, and 2015. Dietary intake was assessed using weighing methods in combination with 24-h food records.

Results: Breakfast contributed to 25.9% of total energy intake of the day and percentages of breakfast energy intake from protein, fat, and carbohydrates were 12.8%, 11.5%, and 75.7%, respectively. During a median follow-up of 9 y, the β values for changes in global cognitive z-scores for Quintile 5 of protein and fat intakes at breakfast, with Quintile 1 as the reference, were 0.13 (95% CI: 0.01-0.25) and 0.17 (95% CI: 0.04-0.30), respectively. Substitution of 5% energy from carbohydrates with equivalent energy from protein (β, 0.06; 95% CI: 0.01-0.11) or fat (β, 0.05; 95% CI: 0.02-0.08) at breakfast was positively associated with the change in the global cognitive z-score. Energy intake at breakfast was not significantly associated with the global cognitive z-score. Similar results were found for the verbal memory z-score. The positive association of breakfast fat intake and the inverse association of breakfast carbohydrate intake with cognitive declines were stronger in urban residents.

Conclusions: Higher intakes of protein and fat and lower intake of carbohydrates at breakfast were associated with a lower rate of cognitive decline in older adults. Substitution of carbohydrates with protein or fat intake at breakfast may help to delay or prevent cognitive declines.

Keywords: breakfast; cognitive decline; dietary carbohydrates; dietary fat; dietary protein; energy.

FIGURE 1

Substitution of the carbohydrate intake with equivalent energy from the protein and fat intakes and the change in cognition. Changes in cognitive scores associated with substitution of 5% energy (breakfast) from the carbohydrate intake with equivalent energy from the protein and fat intakes were estimated using GLM. We simultaneously included energy intake at breakfast and percentages of energy (breakfast) from carbohydrates and other specific macronutrients at breakfast (continuous), as well as other potential confounders in the GLM. The differences in coefficients and 95% CIs for the 2 macronutrients of interest were then computed. The change in cognitive scores was computed as the scores at baseline subtracted from those at follow-up. Model 1 was adjusted for age and gender; Model 2 was adjusted for the same variables in Model 1 plus education, urbanicity, years of follow-up, smoking, alcohol intake, physical activity, global cognitive score, BMI, and systolic and diastolic blood pressure at baseline; and Model 3 was adjusted for the same variables in Model 2 plus intakes of total energy, breakfast energy, fiber, sodium, potassium, grains, vegetables, fruits, red meat, processed meat, fish, and poultry at baseline. Abbreviation: GLM, general linear regression model.