Trinity Ulster Department Of Agriculture Research Articles

Secondary hyperparathyroidism: Predictors and relationship with vitamin D status, bone turnover markers and bone mineral density

IntroductionSecondary hyperparathyroidism (SHPT) has adverse implications for bone health but is relatively understudied. In this study we examine the prevalence and determinants of SHPT and describe the relationship of SHPT with bone turnover markers and bone mineral density (BMD) in older Irish adults. MethodEligible participants (n = 4139) were identified from the Trinity-Ulster-Department of Agriculture (TUDA) study, a cohort of Irish adults aged ≥60 years. Exclusion criteria included an estimated glomerular filtration rate (eGFR) <30 ml/min and serum calcium >2.5 mmol/l to remove hyperparathyroidism due to advanced chronic kidney disease (CKD) and primary hyperparathyroidism respectively. The relationship between SHPT and bone turnover markers and BMD (measured by densitometry) was examined in a subsample (n = 1488). Vitamin D deficiency was defined as 25-hydroxyvitamin D [25 (OH)D] <30 nmol/l. ResultsParticipants had a mean age of 73.6 ± 7.9 years, 65.1 % were female and 19.4 % were found to be vitamin D deficient. The prevalence of SHPT decreased as vitamin D increased, from 30.6 % in those deficient to 9.8 % in those with 25(OH)D ≥ 50 nmol/l and increased with declining kidney function. In non‑calcium supplement users, principal determinants of SHPT were vitamin D deficiency (OR 4.18, CI 3.05–5.73, p < 0.001), eGFR 30–44 ml/min (OR 3.69, CI 2.44–5.57, p < 0.001), loop diuretic use (OR 3.52, CI 2.59–4.79, p < 0.001) and to a lesser extent body mass index (p = 0.001), eGFR 45–59 ml/min (p < 0.001) and 25(OH)D level 30–49 nmol/l (p = 0.002). Similar findings were observed in calcium supplement users, though proton pump inhibitors were also associated with SHPT (OR 1.55, CI 1.08–2.22, p = 0.018) while vitamin D 30–49 nmol/l was not. In participants with SHPT versus those without, bone turnover markers were higher: bone alkaline phosphatase (p = 0.017) and tartrate-resistant acid phosphatase (p = 0.033), whilst there was lower BMD at the neck of femur (0.880 vs. 0.903 g/cm2, p = 0.033) and total hip (0.968 vs. 0.995 g/cm2, P = 0.017). DiscussionThe results show that up to one in six older Irish adults had SHPT and this was associated with lower BMD and higher concentrations of bone turnover markers. Both vitamin D deficiency and 25(OH)D level 30–49 nmol/l were important predictors of SHPT. Loop diuretics and PPIs may also increase the risk of SHPT, and their use may need to be carefully considered in this population. Further studies examining the potential impact of these factors on bone health in similar populations to our study sample are warranted.

Vitamin B-6 and riboflavin, their metabolic interaction, and relationship with MTHFR genotype in adults aged 18–102 years

The generation of the active form of vitamin B-6, pyridoxal 5'-phosphate (PLP), in tissues is dependent upon riboflavin as flavin mononucleotide, but whether this interaction is important for maintaining vitamin B-6 status is unclear. To investigate vitamin B-6 and riboflavin status, their metabolic interaction, and relationship with methylenetetrahydrofolate reductase (MTHFR) genotype in adulthood. Data from 5612 adults aged 18-102 y were drawn from the Irish National Adult Nutrition Survey (NANS; population-based sample) and the Trinity-Ulster Department of Agriculture (TUDA) and Genovit cohorts (volunteer samples). Plasma PLP and erythrocyte glutathione reductase activation coefficient (EGRac), as a functional indicator of riboflavin, were determined. Older (≥65 y) compared with younger (<65 y) adults had significantly lower PLP concentrations (P<0.001). A stepwise decrease in plasma PLP was observed across riboflavin categories, from optimal (EGRac ≤1.26), to suboptimal (EGRac: 1.27-1.39), to deficient (EGRac ≥1.40) status, an effect most pronounced in older adults (mean±SEM: 76.4±0.9 vs 65.0±1.1 vs 55.4±1.2nmol/L; P<0.001). In individuals with the variant MTHFR 677TT genotype combined with riboflavin deficiency, compared with non-TT (CC/CT) genotype participants with sufficient riboflavin, we observed PLP concentrations of 52.1±2.9 compared with 76.8±0.7nmol/L (P<0.001). In participants with available dietary data (i.e., NANS cohort, n = 936), PLP was associated with vitamin B-6 intake (nonstandardized regression coefficient β: 2.49; 95% CI 1.75, 3.24; P<0.001), supplement use (β: 81.72; 95% CI: 66.01, 97.43; P<0.001), fortified food (β: 12.49; 95% CI: 2.08, 22.91; P=0.019), and EGRac (β: -65.81; 95% CI: -99.08, -32.54; P<0.001), along with BMI (β: -1.81; 95% CI: -3.31, -0.30; P=0.019). These results are consistent with the known metabolic dependency of PLP on flavin mononucleotide (FMN) and suggest that riboflavin may be the limiting nutrient for maintaining vitamin B-6 status, particularly in individuals with the MTHFR 677TT genotype. Randomized trials are necessary to investigate the PLP response to riboflavin intervention within the dietary range. The TUDA study and the NANS are registered at www.ClinicalTrials.gov as NCT02664584 (27 January 2016) and NCT03374748 (15 December 2017), respectively.Clinical Trial Registry details: Trinity-Ulster-Department of Agriculture (TUDA) study, ClinicalTrials.gov no. NCT02664584 (January 27th 2016); National Adult Nutrition Survey (NANS), ClinicalTrials.gov no. NCT03374748 (December 15th 2017).

Dementia Analytics Research User Group (DARUG) - A Model for meaningful stakeholder engagement in dementia research.

The importance of involving stakeholders in research is widely recognised but few studies provide details to implementation in practice. The use of real-time technology involving patients, carers and professionals in project design, monitoring, delivery and reporting could maximise contribution. Stakeholder engagement was included as part of a Dementia Analytics Research User Group project which applied machine learning to the Trinity-Ulster-Department of Agriculture (TUDA) data set, identifying clinical and lifestyle factors associated with cognitive health in 5000 community-dwelling older Irish adults. An innovative model for engagement (ENGAGE) was used1 - a methodological and technology platform, that gains insight into group thinking and consensus. Developed by Ulster University, this produces a report in real time for sharing to all stakeholders, thus ensuring active involvement in defining the research question. Using a Personal and Public Involvement (PPI) approach, representatives from patient and carer groups (including TUDA participants ), charities (e.g., Alzheimer's UK), as well as professionals, were invited to attend one of three scoping events. Each event commenced with an overview by the project team of the value of data analytics and initial data analysis. The PPI groups were then invited to answer specific questions relating to risk factors for dementia and were asked to articulate their expectations on the potential outcomes from the project. These responses were analysed using ENGAGE and word clouds generated for discussion to help refine the project going forward. Participants (n=87) Lifestyle, Genetics, Stress and were the dominant emerging themes for risk factors of dementia. Prevention, Help and Information/ Research emerged as strong themes, with the mind maps showing stimulus, understanding and awareness as key outputs of this project. The outcomes of this engagement model were utilised to successfully inform the subsequent data analytics portion of the study2 . The model performed well, capturing discussions in real time. Feedback was positive and helped to focus and inform the research team's thinking. What was not so successful was the longer-term inclusion in the project, with engagement through remote channels tending to drift over time, somewhat exacerbated by COVID 19 restrictions. The team aim to follow up on this aspect.

130 PREDICTORS OF DRIVING STATUS IN OLDER IRISH ADULTS ATTENDING A GERIATRIC OUTPATIENT SERVICE

Abstract Background The main mode of transportation in Ireland remains travel by car. Transport mobility is important for older adults in accessing shops, healthcare, services, community and in maintaining relationships. Cessation of driving is associated with negative effects on mental health, loneliness and physical health. We aimed to explore factors associated with driving status in older adults living in an urban environment. Methods Study included adults aged greater than 65 years attending a geriatric outpatient service in an urban environment and recruited as part of the TUDA (Trinity Ulster, Department of Agriculture) study. We excluded those with a MMSE (Mini-Mental State Exam) less than 24 as we aimed to include only non-dementia patients. Physical frailty was measured with the Timed Up and Go (TUG) and depression with the Center for Epidemiological Studies Depression scale (CES-D). Factors associated with driving status were explored in multinomial regression models. Results 1978 adults, mean age 77.7 ± 7.1 years, 76.0% were female. 35.5% were current drivers but this differed by age category 45.9% (65–75 years), 25% (75–85 years) and 12.5% (85+ years). 28.1% were past drivers. Positive independent predictors of current driving were younger age (P &amp;lt; 0.001), male gender (P &amp;lt; 0.001), married status (P = 0.01), higher socioeconomic status (P &amp;lt; 0.0001) while negative predictors included physical frailty (TUG, P &amp;lt; 0.001), visual impairment (P = 0.01), stroke (P &amp;lt; 0.001), depression (P &amp;lt; 0.001) and self reported loneliness (P = 0.01). Conclusion One third of patients attending a geriatric outpatients in an urban environment were currently driving which is much lower than in the general older Irish population. However, our study included frail adults living in more deprived socioeconomic areas and had a high proportion of females who had never learned to drive. Furthermore, access to urban public transport may be a factor. Non-drivers were more likely to have depression and report loneliness independent of other factors highlighting its negative impact.

Glycated haemoglobin (HbA1c ), diabetes and neuropsychological performance in community-dwelling older adults.

Given that diabetes is associated with cognitive impairment and dementia in later life, we aimed to investigate the relationship between glycated haemoglobin (HbA1c ), diabetes and domain-specific neuropsychological performance in older adults. Cross-sectional cohort study using data from the Trinity-Ulster-Department of Agriculture (TUDA) study. Participants underwent detailed cognitive and neuropsychological assessment using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Assessment for Neuropsychological Status (RBANS). Linear regression was used to assess associations between HbA1c , diabetes status and neuropsychological performance, with adjustment for important clinical covariates. Of 4938 older adults (74.1±8.3years; 66.9% female), 16.3% (n=803) had diabetes (HbA1c ≥6.5%; 48mmol/mol), with prediabetes (HbA1c ≥5.7%-6.4%; 39-47mmol/mol) present in 28.3% (n=1395). Increasing HbA1c concentration was associated with poorer overall performance on the FAB [β: -0.01 (-0.02, -0.00); p=0.04 per % increase] and RBANS [β=-0.66 (-1.19, -0.13); p=0.02 per % increase]. Increasing HbA1c was also associated with poorer performance on immediate memory, visuo-spatial, language and attention RBANS domains. Diabetes was associated poorer performance on neuropsychological tests of immediate memory, language, visual-spatial and attention. Both increasing HbA1c and the presence of diabetes were associated with poorer cognitive and domain-specific performance in older adults. HbA1c , and not just diabetes status per se, may represent an important target in the promotion of optimal brain health in older adults.

Long-term anticholinergic, benzodiazepine and Z-drug use in community-dwelling older adults: What is the impact on cognitive and neuropsychological performance?

Long-term use of anticholinergics, benzodiazepines and related drugs (or "Z-drugs") have been associated with cognitive impairment and dementia. However, the relationship of these medications with cognitive function and domain-specific neuropsychological performance in older adults without dementia, is unclear. 5135 older adults (74.0±8.3 years; 67.4% female) without a diagnosis of dementia were recruited in Ireland to the Trinity-Ulster-Department of Agriculture (TUDA) study. Detailed cognitive and neuropsychological assessment was conducted using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS). A total of 44% (2259 of 5153) used either a potential or definite anticholinergic medication. Overall, 9.7% (n=500) used a definite anticholinergic medication. Regular benzodiazepine use was reported by 7% (n=363), whilst 7.5% (n=387) used a "Z-drug". Use of definite, but not potential anticholinergic medication was associated with poorer performance on all three assessments (β: -0.09; 95% CI: -0.14, -0.03, p=0.002 for MMSE; β: -0.04; 95% CI: -0.06, -0.02; p<0.001 for FAB; β: -4.15; 95% CI: -5.64, -2.66; p<0.001 for RBANS) in addition to all domains of the RBANS. Regular benzodiazepine use was also associated with poorer neuropsychological test performance, especially in Immediate Memory (β: -4.98; 95% CI: -6.81, -3.15; p<0.001) and Attention (β: -6.81; 95% CI: -8.60, -5.03; p<0.001) RBANS domains. Regular use of definite anticholinergic medications and benzodiazepines, but not potential anticholinergics or "Z-drugs", was associated with poorer overall and domain-specific neuropsychological performance in older adults.

Impact of food-bound malabsorption on vitamin B12 status in older adults from the TUDA Ageing Cohort Study: preliminary findings

AbstractVitamin B12 deficiency is common among older adults, even with dietary intakes well in excess of current recommendations. Severe clinical B12 deficiency (i.e. pernicious anaemia) leads to irreversible neurological damage, but once diagnosed, can be treated effectively with B12 injections. A much more common cause of low vitamin B12 status in older adults is food-bound malabsorption owing to atrophic gastritis. This in turn leads to reduced gastric acid secretion, thus limiting B12 absorption from food (given the essential role of gastric acid in releasing B12 from food proteins). Proton pump inhibitor (PPI) drugs reduce gastric acid secretion, similar to atrophic gastritis, thus there is a concern that these medications may lead to vitamin B12 malabsorption. Therefore, the aim of this study was to investigate biomarker status of vitamin B12 in relation to atrophic gastritis and PPI usage. Data were accessed from The Trinity Ulster Department of Agriculture (TUDA) Ageing Cohort Study, a cross-sectional study of community-dwelling adults (n 5186, ≥ 60 years) recruited across Northern Ireland and the Republic of Ireland (2008–2012). TUDA participants were classified into 3 groups; ‘healthy’ controls, atrophic gastritis and PPI users. Vitamin B12 status was assessed using a total of four biomarkers: serum total B12; serum holotranscobalamin, holoTC; plasma methylmalonic acid, MMA; plasma homocysteine. Atrophic gastritis was identified using pepsinogen analysis (via ELISA), with a pepsinogen I : II ratio of &lt; 3 considered indicative of atrophic gastritis. Based on results from all four biomarkers, participants with atrophic gastritis were found to have significantly lower B12 status compared to healthy controls: e.g. mean (95% CI) serum total vitamin B12, 188 (156, 218) pmol/L vs. 262 (252, 272) pmol/L P &lt; 0.001; holoTC, 46.0 (38.1, 53.8) pmol/L vs. 60.3 (57.8, 62.8) pmol/L P &lt; 0.001; plasma MMA, 0.65 (0.52, 0.78) μmol/L vs. 0.37 (0.32, 0.42) μmol/L P = 0.001. No differences in B12 biomarker concentrations were observed between PPI users and healthy controls. Regular consumption of fortified foods (i.e. ≥ 5 portions per week) compared to non-regular consumption (i.e. 0–4 portions per week) impacted positively on B12 biomarker status in all participants. This effect however appeared insufficient to restore normal vitamin B12 status in those with atrophic gastritis. These results show that older adults with atrophic gastritis have significantly lower vitamin B12 biomarker status, particularly in those who did not regularly consume fortified foods. Further investigations of the effect of atrophic gastritis and PPI usage on B12 status are warranted.

B-vitamins in Relation to Depression in Older Adults Over 60 Years of Age: The Trinity Ulster Department of Agriculture (TUDA) Cohort Study

ObjectivesMental health disorders are major contributors to disease burden in older people. Deficient status of folate and the metabolically related B vitamins may be implicated in these conditions. This study aimed to investigate folate, vitamin B12, vitamin B6, and riboflavin in relation to depression and anxiety in aging and also considered the role of fortified foods as a means of optimizing B-vitamin status and potentially reducing the risk of these mental health disorders. DesignThe Trinity Ulster Department of Agriculture (TUDA) aging study was a cross-sectional cohort study. Setting and ParticipantsCommunity-dwelling adults (n = 5186; ≥60 years) recruited from 2 jurisdictions within the island of Ireland from 2008 to 2012. MeasuresDepression and anxiety were assessed using the Centre for Epidemiological Studies Depression (CES-D) and the Hospital Anxiety and Depression (HAD) scales, respectively. The following B-vitamin biomarkers were measured: red blood cell folate, serum total vitamin B12, plasma pyridoxal-5-phosphate (PLP; vitamin B6), and erythrocyte glutathione reductase activation coefficient (EGRac; riboflavin). ResultsBiomarker values in the lowest 20% of status for folate (odds ratio [OR] 1.79; 95% CI 1.23-2.61), vitamin B6 (OR 1.45, 95% CI 1.01-2.06), or riboflavin (OR 1.56, 95% CI 1.10-2.00), but not vitamin B12, were each associated with an increased risk of depression (CES-D score ≥16). Correspondingly, B vitamin–fortified foods if consumed daily were associated with a reduced risk of depression (OR 0.54, 95% CI 0.41-0.70). A deficient status of vitamin B6 (OR 1.73, 95% CI 1.07-2.81), but not other vitamins, was associated with increased anxiety. Conclusions/ImplicationsBetter B-vitamin status may have a role in impacting positively on mental health in older adults. Regular intake of fortified foods can provide a means of optimizing B-vitamin status and thus could contribute to reducing depression. If confirmed by a randomized trial, these results may have implications for nutrition and mental health policy, and thus quality of life, in older people.

The relationship between adiposity and cognitive function in a large community-dwelling population: data from the Trinity Ulster Department of Agriculture (TUDA) ageing cohort study

Previous reports investigating adiposity and cognitive function in the population allude to a negative association, although the relationship in older adults is unclear. The aim of this study was to investigate the association of adiposity (BMI and waist:hip ratio (WHR)) with cognitive function in community-dwelling older adults (≥60 years). Participants included 5186 adults from the Trinity Ulster Department of Agriculture ageing cohort study. Neuropsychological assessment measures included the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Multi-variable linear regression models were used to assess the association between adiposity and cognitive function adjusting for insulin resistance, inflammation and cerebrovascular disease. The mean ages were 80·3 (sd 6·7), 71·0 (sd 7·3) and 70·2 (sd 6·3) years on the cognitive, bone and hypertensive cohorts, respectively. In the cognitive cohort, BMI was positively associated with immediate and delay memory, visuospatial/constructional ability, language and MMSE, and negatively with FAB (log-transformed), whereas WHR was negatively associated with attention. In the bone cohort, BMI was not associated with any cognitive domain, whereas WHR was negatively associated with visuospatial/constructional ability, attention and MMSE. In the hypertensive cohort, BMI was not associated with any cognitive domain, whereas WHR was negatively associated with immediate and delayed memory, visuospatial/constructional ability, language and MMSE and positively with FAB (log-transformed). In the cognitive and bone cohorts, the association of WHR and attention disappeared by further controlling for C-reactive protein and HbA1C. In this study of older adults, central adiposity was a stronger predictor of poor cognitive performance than BMI. Older adults could benefit from targeted public health strategies aimed at reducing obesity and obeseogenic risk factors to avoid/prevent/slow cognitive dysfunction.

Dairy Intakes in Older Irish Adults and Effects on Vitamin Micronutrient Status: Data from the TUDA Study.

Consumption of dairy products has been associated with positive health outcomes including a lower risk of hypertension, improved bone health and a reduction in the risk of type 2 diabetes. The suggested dairy intake for health in older adults is three servings per day but recent analysis of the NHANES data for older adults reported 98% were not meeting these recommendations. No studies have investigated the consequences of such declines in the dairy intakes of Irish older adults and the subsequent effects on vitamin micronutrient status. To study the daily dairy intakes of older Irish adults and to examine how the frequency of dairy food consumption affects vitamin micronutrient status. Participants (n 4,317) were from the Trinity Ulster Department of Agriculture (TUDA) Study, a large study of older Irish adults (aged >60 yrs) designed to investigate gene-nutrient interactions in the development of chronic diseases of aging. The daily intake portion for milk, cheese and yoghurt was calculated from food frequency questionnaire (FFQ) responses. Blood samples were analysed for vitamin biomarkers as follows: vitamin B12 (total serum cobalamin and holotranscobalamin (holoTC)), folate (red cell folate (RCF) and serum folate), vitamin B2 (erythrocyte glutathione reductase activation coefficient (EGRac)), vitamin B6 (serum pyridoxal phosphate) and vitamin D (serum 25(OH)D). The mean total reported dairy intake was 1.16 (SD 0.79) portions per day with males consuming significantly fewer total dairy portions compared to females (1.07 vs 1.21 respectively) (P<0.05). There was no significant difference in total daily dairy serving intakes by age decade (60-69, 70-79, >80 yrs). Overall, only 3.5% of the total population (n 151) achieved the recommended daily dairy intake of three or more servings per day. A significantly higher proportion of females (4%) compared to males (2.4%) met these dairy requirements (P=0.011). Blood concentrations of vitamin B12 biomarkers, RCF, vitamin B2 and vitamin B6 were significantly worse in those with the lowest tertile of dairy intake (0-0.71 servings) compared to those in the highest tertile (1.50-4.50 servings) (P<0.05). This study found that more than 96% of the older adults sampled did not meet current daily dairy intake recommendations. The study is the largest to-date examining dairy intakes in older Irish adults, and provides evidence that daily dairy intakes (in particular yogurt) contribute significantly to the B-vitamin and vitamin D biomarker status of older adults. These results suggest that older adults who are already vulnerable to micronutrient inadequacies, are forgoing the nutritional advantages of vitamin-rich dairy products.

The Frontal Assessment Battery: Normative Performance in a Large Sample of Older Community-Dwelling Hospital Outpatient or General Practitioner Attenders.

The Frontal Assessment Battery (FAB) is a short battery designed to assess frontal executive functioning, but data for interpretation of performance are limited. The Trinity, Ulster, Department of Agriculture (TUDA) study provided the opportunity to derive performance data from a large sample of community-dwelling hospital outpatient or general practitioner (GP) attenders. Normative analysis based on 2508 TUDA participants meeting these criteria: Mini-Mental State Examination (MMSE) >26/30, not depressed (Center for Epidemiologic Studies Depression <16) or anxious (Hospital Anxiety and Depression Scale <8), no history of stroke, or transient ischemic attack. Correlation and regression analyses were used to evaluate the effects of age, education, gender, and general cognition (MMSE). Norms for FAB were created stratified by age and education, using overlapping midpoint ranges of 10 years with a 3-year interval from age 60 to 97. Age and education accounted for 9.6% of variance in FAB score ( r2 = .096) with no significant effect of gender. The FAB and MMSE were modestly correlated ( r = .29, P < .01) with MMSE increasing the model's total explained variance in FAB score from 9.6% to 14%. This is the largest study to date to create normative data for the FAB. Age and education had the most significant impact on FAB performance, which was largely independent of global cognition (MMSE). These data may be of benefit in interpreting FAB performance in individuals with similar demographic/health status characteristics in hospital outpatient or GP settings.

Determining diagnostic markers of vitamin B12 status in older adults- Data from the Trinity Ulster Department of Agriculture Ageing cohort study

Determining diagnostic markers of vitamin B12 status in older adults- Data from the Trinity Ulster Department of Agriculture Ageing cohort study

Is Vitamin B12 status a risk factor for falling in older adults (&gt;60 yrs)?

. Currently, few studies have investigated markers of B12 status as a risk factor forfalling in large datasets from older adult populations. Therefore, the objective of this study was to assess markers of B12 status and risk offalling in a sample of Irish older adults ( n 4939) from the Trinity, Ulster, Department of Agriculture (TUDA) observational study.Participants were recruited between March 2009 and May 2012 and markers of vitamin B12 status included total serum B12 (micro-biological assay NCIB 12519, ATCC 43787) and Holo TC (Active B12) (Abbott AxSYM). Serum vitamin D was assessed by LCMS/MS(AB Sciex, USA) and fall related data were collected by health and lifestyle questionnaire.

Homocysteine and related B-vitamin status as determinants of bone mineral density in older Irish adults

Osteoporosis, a skeletal disorder characterised by compromised bone strength, results in an increased fracture risk (1) with considerable costs to both patients and the health service. While vitamin D has a well established role in bone health, evidence is emerging to support a role for the B-vitamins, and the related metabolite homocysteine (Hcy), in bone health (2,3) . The aim of this study was to investigate homocysteine and related B-vitamin status as determinants of bone mineral density (BMD). Existing data from a subset (n = 1276) of participants recruited to the Trinity Ulster Department of Agriculture (TUDA) study, a large observational cohort study of older Irish adults, were examined. Blood samples were analysed for plasma Hcy, red cell folate (RCF), serum folate and vitamin B12 at Trinity College Dublin. BMD at the total hip, femoral neck (FN) and spine were measured using dual energy X-ray absorptiometry (DXA) scans (Lunar Prodigy, GE Healthcare, UK). Of the general determinants of osteoporosis (defined as a T-Score of - 2.5 SD or lower), the following were found to be significant predictors: age ( b= 0.077, p < 0.001), female gender ( b= 1.153, p < 0.001) and BMI ( b= - 0.165, p < 0.001) (logistic regression). As expected, a higher incidence of osteoporosis was observed among women (25 %) compared with men (9 %). BMD values at the total hip and femoral neck were significantly higher in women with the highest red cell folate status compared to those with the lowest red cell folate status (Table).

B-vitamin status and cognitive function in older people

Background: Dementia is a growing public health concern; there are currently 750 000 people living with the disease in the UK. By 2025 this number is expected to rise to over a million with costs estimated at over £20 billion per annum (Alzheimer's society, 2010). Diet is considered to play an important role in the development of cognitive impairment with recent research now identifying a role for B vitamins (Kado et al., 2005). The aim of this observational study was to investigate the association between B-vitamin status (in particular, vitamin B12 and folate) and cognitive function in older people. Methods: This study was conducted as part of a larger ongoing observational study of older Irish adults; Trinity Ulster Department of Agriculture (TUDA) study. Patients who were not born in the Republic of Ireland or Northern Ireland and those with severe dementia were excluded. A non-fasting blood sample (50 mL) was collected; routine clinical markers of health were measured as well as B vitamin status [serum folate, red cell folate (RCF), serum B12 and holotranscobalamin (holoTC)]. Cognitive function was measured using various cognitive performance tests including Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Depression and anxiety were measured using the Centre of Epidemiological Studies Depression (CES-D) scale and Hospital Anxiety and Depression (HAD) scale respectively to adjust for these possible confounders of cognitive performance. Data were analysed statistically using independent t tests, chi-squared tests and Pearsons correlations. Ethical approval was granted for the recruitment of patients over the age of 60 years from outpatient clinics and GP practices within two health trusts in Northern Ireland. Results: The cohort (n = 100) was split for analysis purposes into those aged 60–69 years (n = 70) and those aged ≥70 years (n = 30). There were no significant differences between the groups in terms of cognitive scores or B vitamin status (some of the results are shown in Table 1). No significant associations were found between B vitamin status and cognitive scores in the group as a whole or in the younger age group. However, in those aged 70 years or older, folate status (RCF concentrations) was found to be significantly associated with MMSE scores (r = 0.370, P = 0.048) while the association between RCF and RBANS was approaching significance (r = 0.358, P = 0.057) in those aged 70 or older. No associations were found between vitamin B12 and cognitive scores in either of the age sub-groups. Table 1. Differences between those aged 60–69 years and those aged ≥70 years in terms of cognitive scores & B vitamin status Aged 60–69 years Aged ≥70 years P value Mean (SD) Mean (SD) RBANS 86.4 (12.8) 82.5 (14.1) 0.169 MMSE 27.5 (2.7) 27.5 (3.2) 0.822 RCF (nM) 1092.2 (96.9) 1099.0 (96.0) 0.737 Discussion: The results are in line with the current literature (Tettamanti et al., 2006). Some observational data have also found associations between vitamin B12 and cognitive impairment; however, this was not the case with the present study. These findings may suggest a possible role for folate (but not B12) in certain types of dementia, such as Alzheimer's disease, as status was not associated with FAB which is used mainly in the diagnosis of frontotemporal dementia. Conclusion: Future research is warranted to confirm these associations in larger cohort trials involving two time points which will pave the way for randomised controlled trials to examine cause-and-effect relationships between B-vitamin status and cognitive performance.