Associations of AD Biomarkers and Cognitive Performance with Nutritional Status: The NUDAD Project.

Astrid S Doorduijn,Ondine Van De Rest,Ellen G H M Van Den Heuvel,Marian A E De Van Der Schueren,Marjolein Visser,Jay L P Fieldhouse,Maartje I Kester,Wiesje M Van Der Flier,Francisca A De Leeuw,Philip Scheltens,Sanne Boesveldt,Charlotte E Teunissen

doi:10.3390/nu11051161

Abstract

As malnutrition is common in patients with Alzheimer’s disease (AD), we evaluated nutritional status and body composition of patients with AD, mild cognitive impairment (MCI) and controls, and studied associations of AD biomarkers and cognitive performance with nutritional status and body composition. We included 552 participants, of which 198 patients had AD, 135 patients had MCI and 219 controls. We assessed nutritional status (mini nutritional assessment (MNA)) and body composition (body mass index (BMI), fat-free mass (FFM) and waist circumference). Linear regression analyses (adjusted for age, gender and education where appropriate) were applied to test associations of AD biomarkers and cognitive performance on five domains with nutritional parameters (dependent). Patients with MCI and AD had a lower BMI and MNA score than controls. Worse performance in all cognitive domains was associated with lower MNA score, but not with body composition. AD biomarkers were associated with MNA score, BMI and waist circumference, and associations with MNA score remained after adjustment for cognitive performance. Both AD biomarkers and cognitive performance were associated with nutritional status, associations with AD biomarkers remained after adjustment for cognition. Our data suggest that malnutrition is not only related to impaired cognition but also to AD pathology.

Highlights

Unintended weight loss and protein energy malnutrition are common features in patients with moderate to severe Alzheimer’s disease (AD) dementia
The main finding of this study is that lower Aβ42 and higher tau and p-tau levels were associated with poorer nutritional status and body composition
Poorer cognitive performance in all domains was associated with poorer nutritional status, but not with body composition

Summary

Introduction

Unintended weight loss and protein energy malnutrition are common features in patients with moderate to severe Alzheimer’s disease (AD) dementia. The prevalence of malnutrition is reported to range from 0%–13% in community-dwelling patients [1,2] to 30%–60% in institutionalized patients [3,4]. Much less investigated is the prevalence of malnutrition in patients with mild cognitive impairment (MCI). The few available studies showed that patients with MCI are at higher risk of malnutrition than cognitively healthy adults, albeit at lower risk than patients with. Population-based studies in non-demented adults found that weight loss is a predictor for incident MCI and dementia [6,11,12], and may be one of the first signs of cognitive problems

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