Summary
Cognitive functions are essential for the performance of daily life activities, particularly for older adults who present a higher prevalence of cognitive disorders. Problems related to these specific brains skills can range from mild cognitive impairment (MCI) to dementia. Dementia reduces quality of life (QoL) and is related to serious economic consequences. Recently, Elsayed et al. [1] reported the results of a parallel randomized clinical trial involving sixty-eight postmenopausal women (60 to 75 years/body mass index [BMI]: 30 to 39.9 kg/m2), in order to investigate the combined impact of aerobic exercise and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet on brain cell longevity. Participants were assigned to one of two groups (the experimental and the control). The experimental group followed moderate-intensity treadmill exercise three times/week for twelve weeks plus MIND diet and the control group followed the MIND diet alone. Serum sex hormones were measured (estradiol, total testosterone [TT], free testosterone [FT], sex hormone binding globulin [SHBG]) at baseline and at 12 weeks; in addition to the assessment of cognitive function and functional activity level determined with validated scales (i.e the Rowland Universal Dementia Assessment Scale [RUDAS] and the Functional Independence Measures Scale [FIM], respectively). After intervention, the experimental group displayed significant changes in sex hormones, cognitive functions, and functional levels compared with the control group. In addition, no correlation was found between the measured variables in both groups after intervention. Authors conclude that aerobic exercise in combination with the proposed MIND diet improves cognitive and functional levels and sex hormones in postmenopausal women.
Commentary
This article that we are commenting on is interesting because so far there are no effective pharmacological treatments for the deterioration of cognitive function, which can be devastating and disabling, which emphasizes the key role of preventive strategies. As is it well known, decline in cognitive function is generally the result of the complex interaction of multiple factors. First of all, age and hormones, but also demographic, educational, genetic, socioeconomic and environmental determinants, including nutrition. There is convincing evidence for the role of diet and lifestyle on cognitive function. Therefore, dietary/nutritional approaches that help prevent or delay cognitive decline can have a significant impact on public health.
Of the total of 68 postmenopausal women that were included in this study those having diabetes mellitus, drinking alcohol, being on HRT, having any cardiovascular, orthopedic or neurological disease that affects exercise performance were excluded. Also were excluded those that were participating in any weight loss program at least six months prior to the study. The experimental group was intervened with an exercise protocol of continuous moderate-intensity aerobic exercise three times per week for three months, supervised by the study physician and physiotherapists. Both groups followed an individualized MIND-low caloric diet according to the recommendations of the American Heart Association Nutrition Committee [2], which was prescribed by dieticians. Calories were restricted by reducing 20% of the participant’s total daily energy expenditure (the total daily expenditure was determined for each participant individually according to the Harries Benedict equation) [3]. The adherence of participants to a diet was evaluated by the Perceived Dietary Adherence Questionnaire [4], that consists of a total of nine questions structured to cover the CDA Nutrition Therapy guidelines [5]. Although the authors did not find a significant correlation between hormonal findings and cognitive function, the results were still able to show a measurable improvement in cognitive ability and functional levels, despite the decrease in estrogen levels and testosterone. They attribute this to the beneficial effect that aerobic exercise and the MIND diet would have in similarity to that of estrogen and testosterone on cognitive functions. According to the researchers, aerobic exercise and the MIND diet could successfully replace sex hormone deficiency in terms of “improving cognition.” I agree with the authors that adopting a healthy lifestyle always has a significant benefit on overall health, and of course including brain function. The combination of a diet rich in antioxidants and anti-inflammatory compounds has a critical role in reducing oxidative stress and pro-inflammatory processes that are closely associated with endothelial dysfunction and the development of atherosclerotic plaques.
Health promotion through behavioral changes, such as abstinence from tobacco and alcohol use and increased physical activity, as well as a healthy diet, should be encouraged. However, it should be noted that the beneficial results that the authors point out in the article are the achievement of cognitive improvement, which is not a small thing, but we are still not facing the reality of achieving greater longevity of the brain cells. There is still so much misinformation and misreporting on this topic in the reported literature, and there is a need for more studies to further explore the correlates of many multi-morbidities among middle-aged women and non-invasive therapeutic options that can replace the decline of sex hormones during the menopausal transition.
Prof. Blanca Campostrini, MD, PhD
Full Professor of Gynecology, La Plata National University (UNLP)
Past-President of the Argentine Association for Climacteric Studies (AAPEC)
Associate Member of the International Menopause Society (IMS)
References
- Elsayed MM, Rabiee A, El Refaye GE, Elsisi HF. Aerobic Exercise with Mediterranean-DASH Intervention for Neurodegenerative Delay Diet Promotes Brain Cells’ Longevity despite Sex Hormone Deficiency in Postmenopausal Women: A Randomized Controlled Trial. Oxid Med Cell Longev. 2022;2022:4146742.
https://pubmed.ncbi.nlm.nih.gov/35419166/ - American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ, Brands M, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114(1):82-96.
https://pubmed.ncbi.nlm.nih.gov/16785338/ - Harris JA, Benedict FG. A Biometric Study of Human Basal Metabolism. Proc Natl Acad Sci U S A. 1918;4(12):370-3.
https://pubmed.ncbi.nlm.nih.gov/16576330/ - Asaad G, Sadegian M, Lau R, et al. The Reliability and Validity of the Perceived Dietary Adherence Questionnaire for People with Type 2 Diabetes. Nutrients. 2015;7(7):5484-96.
https://pubmed.ncbi.nlm.nih.gov/26198247/ - Gougeon R, Aylward N, Nichol H, Quinn K, Whitham D. Nutrition therapy. Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can. J Diabetes. 2008;32:S40–S45.
http://www.diabetesclinic.ca/en/pdf/CDA_cpg-2008.pdf
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