Neighborhood Food Environment and Dementia Incidence: the Japan Gerontological Evaluation Study Cohort Survey

Abstract

Introduction Interventions targeting built environmental factors may encourage older people to engage in favorable behaviors and decrease dementia risk, but epidemiologic evidence is limited. This study investigated the association between neighborhood food environment and dementia incidence. Methods A 3-year follow-up (2010–2013) was conducted among participants in the Japan Gerontological Evaluation Study, a population-based cohort study of older adults aged ≥65 years. Dementia incidence for 49,511 participants was assessed through the public long-term care insurance system. Availability of food stores (defined as the number of food stores selling fruits and vegetables within 500 meters or 1 kilometer of residence) was assessed for each participant using objective (GIS-based) and subjective (participant-reported) measurements. Data were analyzed from 2017 to 2018. Results A total of 3,162 cases of dementia occurred during the follow-up. Compared with the highest quartile for objective availability of food stores, the hazard ratio adjusting for age and sex was 1.60 (95% CI=1.43, 1.78) for the second-lowest quartile. Compared with the highest subjective availability of food stores, the hazard ratio was 1.74 (95% CI=1.49, 2.04) for the lowest category. After successive adjustment for sociodemographic characteristics, health status, and other geographic neighborhood factors (availability of restaurants, convenience stores, and community centers), the hazard ratio remained statistically significant. Conclusions Lower food store availability was associated with increased dementia incidence. Given that food shopping is a routine activity and a main motive for going out among older adults, increasing the availability of food stores may contribute to dementia prevention.

Neighbourhood environment and dementia in older people from high-, middle- and low-income countries: results from two population-based cohort studies

“…This study used 400 m and 800 m buffers as a proximate activity space for older people in their daily life. Although most existing studies also generated buffers based on participants’ residences [ 11 , 12 ], whether older people visited these green and blue spaces or travelled outside of local areas is not known. Although physical distances to the nearest amenities were measured in this study, other features of built environment such as availability of public transport, pavement conditions and street network might also affect the accessibility to amenities including those that might be at a distance [ 27 , 28 ].…”

“…The findings of this study echo the complexity of relationships reported from earlier studies. Research from US, Japan and Hong Kong has included different measures related to local amenities, with inconclusive results for cognitive health in later life [11][12][13]. Here, living in an area with poor access to daily life amenities (post offices or convenience stores) was found to be associated with higher odds of dementia in both cohorts.…”

“…In recent years, the environmental impact on dementia, including air pollution, noise and features of the built environment, have been investigated in public health research [6,7]. For the built environment, existing studies have mainly focused on two aspects: availability of green spaces [8][9][10] and local amenities such as food stores, libraries, community centres and recreational facilities [11][12][13][14][15]. Availability of these environmental features are thought to reduce stress and depressive symptoms and encourage physical activity and social interaction, creating a complex and stimulating environment that could increase cognitive reserve and reduce the risk of cognitive decline and dementia [16].…”

“…For example, cross-sectional results from the Multi-Ethnic Study of Atherosclerosis (MESA), a US-based cohort of 4716 older adults from six states, reported negative associations between cognitive function and the density of social and walking destinations such as postal offices, restaurants and beauty shops in local areas [ 13 ]. On the contrary, low availability of local food stores and restaurants was found to be associated with an increased risk of developing dementia over a three-year follow-up period in a population-based cohort of 49,511 older adults living in Japan [ 12 ]. These inconsistencies could be related to variation in research methods across studies, such as cross-sectional or longitudinal designs, sampling approaches, assessment methods for exposures, outcomes or other covariates and the availability of data for local amenities at different time points.…”

Association between Food Store Availability and the Incidence of Functional Disability among Community-Dwelling Older Adults: Results from the Japanese Gerontological Evaluation Cohort Study

“…Previous studies have shown that the food environment might impact incidence of mortality and dementia in older people [10,11]. If one’s main reason for going out is to shop at a neighborhood grocery store, food store availability might influence the incidence of functional disability in many older adults.…”