Association between changes in diet quality from mid-life to late-life and healthy ageing: the Singapore Chinese Health Study

Abstract

Background Few studies have evaluated the association between changes in diet quality from mid-life to late-life and healthy ageing. Methods We included 12,316 Chinese adults aged 45–74 years at baseline (1993–1998) from the Singapore Chinese Health Study. Diet quality was measured using the Dietary Approaches to Stop Hypertension (DASH) scores at baseline and follow-up 3 interviews (2014–2016). Healthy ageing was assessed at follow-up 3 interviews, and was defined as absence of specific chronic diseases, good mental and overall self-perceived health, good physical functioning and absence of cognitive impairment, limitations in instrumental activities of daily living or function-limiting pain. Multivariable-adjusted logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between changes in DASH scores and healthy ageing. Results Compared with participants who maintained relatively stable DASH scores, a >10% decrease in DASH score was associated with a 16% (95% CI, 4–26%) lower likelihood of healthy ageing, whereas a >10% increase in DASH score was associated with a 19% (95% CI, 3–37%) higher likelihood of healthy ageing. Compared with participants who were in the low-score group consistently, participants who increased their DASH scores from moderate-score at baseline to high-score at follow-up 3 had a 53% (95% CI, 21–92%) higher likelihood of healthy ageing, whereas those who were in the high-score group consistently had 108% (95% CI, 71–152%) higher likelihood of healthy ageing. Conclusions Improving diet quality from mid- to late-life was associated with a higher likelihood of healthy ageing.

Nutrition and Healthy Ageing in Asia: A Systematic Review

“…Three studies [ 7 , 14 , 15 ], which included 17,244 participants in two cohorts, investigated the multidimensional concept of healthy ageing. In the SCHS, healthy ageing was defined as the absence of specific chronic diseases; good mental and overall self-perceived health; good physical functioning; and a lack of adverse outcomes of cognitive impairment, limitations in instrumental activities of daily living (IADL), or function-limiting pain [ 14 , 15 ].…”

“…Three studies [ 7 , 14 , 15 ], which included 17,244 participants in two cohorts, investigated the multidimensional concept of healthy ageing. In the SCHS, healthy ageing was defined as the absence of specific chronic diseases; good mental and overall self-perceived health; good physical functioning; and a lack of adverse outcomes of cognitive impairment, limitations in instrumental activities of daily living (IADL), or function-limiting pain [ 14 , 15 ]. Data from the SCHS reported that a greater adherence to various healthy dietary patterns at midlife, defined by the alternate Mediterranean diet (aMED), the Dietary Approaches to Stop Hypertension (DASH) diet, the Alternative Healthy Eating Index (AHEI)-2010, the overall plant-based diet index (PDI), and the healthful plant-based diet index (hPDI), was associated with a higher likelihood of healthy ageing in late life, with the odds ratio (OR) comparing the highest with the lowest quartile of diet quality scores ranging from 34% to 53% for healthy ageing [ 14 ].…”

Longitudinal Dietary Trajectories With Cognitive and Psychosocial Well-Being in Chinese Adults Aged 85 Years and Older in Singapore

“…However, only limited studies on longitudinal diet have focused on these outcomes in individuals aged ≥85 years. Previously in the SCHS cohort, we have taken an a priori approach to categorize participants into groups of changes in diet quality scores, and showed that those with consistently high diet quality from mid- to late life had a lower risk of cognitive impairment ( Tong et al, 2021 ) and a higher likelihood of healthy aging ( Zhou et al, 2022 ). However, such categorization is subjectively defined and does not capture the distinct diet trajectories presently occurring in the population understudied ( Nagin & Odgers, 2010 ).…”

“…Studies in Asian populations are critical as dietary patterns differ across cultures and countries ( Luo et al, 2020 ). We have previously shown that maintaining adherence to a high diet quality (defined as above median diet quality scores at two time points) from mid- to late life (aged ≥45–≥65 years) was associated with a lower risk of cognitive impairment ( Tong et al, 2021 ) and a higher likelihood of healthy aging ( Zhou et al, 2022 ) in late life in a cohort of Chinese men and women in Singapore. This study will add on to previous evidence by (a) deriving diet quality trajectories using dietary intakes from three time points spanning from ages 60 to 74 years (late life) to ages 85 to 97 years (very late life), and (b) examining the associations between these trajectories and cognitive impairment, depressive symptoms, social engagement, and self-rated health among those aged ≥85 years of this cohort.…”

Composition of healthy diets for older persons

“…Over 20-year follow-up in the Singapore Chinese Health Study, those with consistent or improved adherence to the Dietary Approaches to Stop Hypertension (DASH) diet (i.e. high intake of whole grains, fruits and vegetables, nuts and legumes, and low-fat dairy; and limited intake of sugar-sweetened beverages and fruit juice, red and processed meat, and sodium) had a higher likelihood of achieving better outcomes in physical, functional, cognitive, and mental domains in aging [50 ▪ ].…”