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INTRODUCTION Resistance training has been well established as an effective treatment strategy to increase skeletal muscle mass and strength in the elderly . We assessed whether dietary protein supplementation can further augment the adaptive response to prolonged resistance-type exercise training in healthy elderly men and women . METHODS Healthy elderly men ( n = 31 , 70 ± 1 yr ) and women ( n = 29 , 70 ± 1 yr ) were r and omly assigned to a progressive , 24-wk resistance-type exercise training program with or without additional protein supplementation ( 15 g·d-1 ) . Muscle hypertrophy was assessed on a whole-body Dual-energy X-ray absorptiometry ( DXA ) , limb ( computed tomography ) , and muscle fiber ( biopsy ) level . Strength was assessed regularly by 1-repetition maximum ( RM ) strength testing . Functional capacity was assessed with a sit-to-st and and h and grip test . RESULTS One-RM strength increased by 45 % ± 6 % versus 40 % ± 3 % ( women ) and 41 % ± 4 % versus 44 % ± 3 % ( men ) in the placebo versus protein group , respectively ( P < 0.001 ) , with no differences between groups . Leg muscle mass ( women , 4 % ± 1 % vs 3 % ± 1 % ; men , 3 % ± 1 % vs 3 % ± 1 % ) and quadriceps cross-sectional area ( women , 9 % ± 1 % vs 9 % ± 1 % ; men , 9 % ± 1 % vs 10 % ± 1 % ) increased similarly in the placebo versus protein groups ( P < 0.001 ) . Type II muscle fiber size increased over time in both placebo and protein groups ( 25 % ± 13 % vs 30 % ± 9 % and 23 % ± 12 % vs 22 % ± 10 % in the women and men , respectively ) . Sit-to-st and improved by 18 % ± 2 % and 19 % ± 2 % in women and men , respectively ( P < 0.001 ) . CONCLUSION Prolonged resistance-type exercise training increases skeletal muscle mass and strength , augments functional capacity , improves glycemia and lipidemia , and reduces blood pressure in healthy elderly men and women .  Additional protein supplementation ( 15 g·d-1 ) does not further increase muscle mass , strength , and /or functional capacity Background There is emerging evidence of the role of certain nutrients as risk factors for frailty . However , people eat food , rather than nutrients , and no previous study has examined the association between dietary patterns empirically derived from food consumption and the risk of frailty in older adults . Methods This is a prospect i ve cohort study of 1,872 non-institutionalized individuals aged ≥60 years recruited between 2008 and 2010 . At baseline , food consumption was obtained with a vali date d diet history and , by using factor analysis , two dietary patterns were identified : a ‘ prudent ’ pattern , characterized by high intake of olive oil and vegetables , and a ‘ Westernized ’ pattern , with a high intake of refined bread , whole dairy products , and red and processed meat , as well as low consumption of fruit and vegetables . Participants were followed-up until 2012 to assess incident frailty , defined as at least three of the five Fried criteria ( exhaustion , weakness , low physical activity , slow walking speed , and unintentional weight loss ) . Results Over a 3.5-year follow-up , 96 cases of incident frailty were ascertained . The multivariate odds ratios ( 95 % confidence interval ) of frailty among those in the first ( lowest ) , second , and third tertile of adherence to the prudent dietary pattern were 1 , 0.64 ( 0.37–1.12 ) , and 0.40 ( 0.2–0.81 ) , respectively ; P-trend = 0.009 . The corresponding values for the Westernized pattern were 1 , 1.53 ( 0.85–2.75 ) , and 1.61 ( 0.85–3.03 ) ; P-trend = 0.14 . Moreover , a greater adherence to the Westernized pattern was associated with an increasing risk of slow walking speed and weight loss . Conclusions In older adults , a prudent dietary pattern showed an inverse dose-response relationship with the risk of frailty while a Westernized pattern had a direct relationship with some of their components . Clinical trials should test whether a prudent pattern is effective in preventing or delaying frailty Adherence to a Mediterranean-style diet is associated with a lower risk for mortality , cognitive decline , and dementia . Whether adherence to a Mediterranean-style diet protects against age-related frailty is unclear . Therefore , our objective was to examine the association between a Mediterranean-style diet with the risk of frailty in community-dwelling older persons . We conducted longitudinal analyses using data from 690 community-living persons ( ≥65 y ) who were r and omly selected from a population registry in Tuscany , Italy . Participants of the Invecchiare in Chianti study of aging completed the baseline examination in 1998 - 2000 and were re-examined at least once over 6 y. Adherence to a Mediterranean-style diet ( scored 0 - 9 , modeled categorically as ≤3 , 4 - 5 , and ≥6 ) was computed from the European Prospect i ve Investigation into Cancer and nutrition FFQ previously vali date d in this cohort . Frailty was defined as having at least 2 of the following criteria : poor muscle strength , feeling of exhaustion , low walking speed , and low physical activity . After a 6-y follow-up , higher adherence ( score ≥6 ) to a Mediterranean-style diet was associated with lower odds of developing frailty [ OR = 0.30 ( 95 % CI : 0.14 , 0.66 ) ] compared with those with lower adherence ( score ≤3 ) . A higher adherence to a Mediterranean-style diet at baseline was also associated with a lower risk of low physical activity ( OR = 0.62 ; 95 % CI : 0.40 , 0.96 ) and low walking speed [ OR = 0.48 ( 95 % CI : 0.27 , 0.86 ) ] but not with feelings of exhaustion and poor muscle strength . In community-dwelling older adults , higher adherence to a Mediterranean-style diet was inversely associated with the development of frailty OBJECTIVE To determine the validity and reliability of a rapidly administered neurocognitive screening battery consisting of 4 brief tests ( Enhanced Cued Recall , Temporal Orientation , Verbal Fluency , and Clock Drawing ) to distinguish between patients with probable Alzheimer 's disease ( AD ) and healthy control subjects . SUBJECTS Sixty successive referrals to the Memory Disorders Clinic at Southwestern Vermont Medical Center , Bennington , who were diagnosed as having probable AD and 60 community-dwelling volunteers of comparable age , sex distribution , and education . DESIGN Interrater and test-retest reliability , intergroup comparisons between patients with AD and control subjects on the 4 individual tests , and determination of probability of dementia for patients with AD and control subjects using the entire battery of tests . SETTING Outpatient care . MAIN OUTCOME MEASURE Comparison of the probability of dementia on the 7 Minute Screen  with the criterion st and ard of clinical diagnosis established by examination and laboratory studies . SECONDARY OUTCOME MEASURES Test-retest and interrater reliability ( correlation coefficients ) , time for administration . RESULTS Mean time of administration was 7 minutes 42 seconds . Mean scores for patients with AD and control subjects on all 4 individual tests were significantly different ( for each , P<.001 ) . When the 4 tests were combined in a logistic regression , the battery had a sensitivity of 100 % and a specificity of 100 % . A series of 1000 repeated r and om sample s of 30 patients with AD and 30 control subjects taken from the overall sample of 60 patients with AD and 60 control subjects had a mean sensitivity of 92 % and a mean specificity of 96 % . The battery was equally sensitive to patients with mild AD as demonstrated by correctly classifying all 13 patients with AD using Mini-Mental State Examination scores of 24 or higher . Neither age nor education was a statistically significant factor when added as a covariate . Test-retest reliabilities for individual tests ranged from 0.83 to 0.93 . Test-retest reliability for the entire battery was 0.91 . Interrater reliability for the entire battery was 0.92 . CONCLUSIONS The 7 Minute Screen appears highly sensitive to AD and may be useful in helping to make initial distinctions between patients experiencing cognitive changes related to the normal aging process and those experiencing cognitive deficits related to dementing disorders such as AD . It has reasonable interrater and test-retest reliability , can be administered in a brief period , and requires no clinical judgment and minimal training BACKGROUND Adherence to a Mediterranean diet may improve longevity , but relevant data are limited . METHODS We conducted a population -based , prospect i ve investigation involving 22,043 adults in Greece who completed an extensive , vali date d , food-frequency question naire at base line .  Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean-diet scale that incorporated the salient characteristics of this diet ( range of scores , 0 to 9 , with higher scores indicating greater adherence ) . We used proportional-hazards regression to assess the relation between adherence to the Mediterranean diet and total mortality , as well as mortality due to coronary heart disease and mortality due to cancer , with adjustment for age , sex , body-mass index , physical-activity level , and other potential confounders . RESULTS During a median of 44 months of follow-up , there were 275 deaths . A higher degree of adherence to the Mediterranean diet was associated with a reduction in total mortality ( adjusted hazard ratio for death associated with a two-point increment in the Mediterranean-diet score , 0.75 [ 95 percent confidence interval , 0.64 to 0.87 ] ) . An inverse association with greater adherence to this diet was evident for both death due to coronary heart disease ( adjusted hazard ratio , 0.67 [ 95 percent confidence interval , 0.47 to 0.94 ] ) and death due to cancer ( adjusted hazard ratio , 0.76 [ 95 percent confidence interval , 0.59 to 0.98 ] ) . Associations between individual food groups contributing to the Mediterranean-diet score and total mortality were generally not significant . CONCLUSIONS Greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality CONTEXT Higher adherence to a Mediterranean-type diet is linked to lower risk for mortality and chronic diseases , but its association with cognitive decline is unclear . OBJECTIVE To investigate the association of a Mediterranean diet with change in cognitive performance and risk for dementia in elderly French persons . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 1410 adults ( > or = 65 years ) from Bordeaux , France , included in the Three-City cohort in 2001 - 2002 and reexamined at least once over 5 years .  Adherence to a Mediterranean diet ( scored as 0 to 9 ) was computed from a food frequency question naire and 24-hour recall . MAIN OUTCOME MEASURES Cognitive performance was assessed on 4 neuropsychological tests : the Mini-Mental State Examination ( MMSE ) , Isaacs Set Test ( IST ) , Benton Visual Retention Test ( BVRT ) , and Free and Cued Selective Reminding Test ( FCSRT ) . Incident cases of dementia ( n = 99 ) were vali date d by an independent expert committee of neurologists . RESULTS Adjusting for age , sex , education , marital status , energy intake , physical activity , depressive symptomatology , taking 5 medications/d or more , apolipoprotein E genotype , cardiovascular risk factors , and stroke , higher Mediterranean diet score was associated with fewer MMSE errors ( beta = -0.006 ; 95 % confidence interval [ CI ] , -0.01 to -0.0003 ; P = .04 for 1 point of the Mediterranean diet score ) . Performance on the IST , BVRT , or FCSRT over time was not significantly associated with Mediterranean diet adherence . Greater adherence as a categorical variable ( score 6 - 9 ) was not significantly associated with fewer MMSE errors and better FCSRT scores in the entire cohort , but among individuals who remained free from dementia over 5 years , the association for the highest compared with the lowest group was significant ( adjusted for all factors , for MMSE : beta = -0.03 ; 95 % CI , -0.05 to -0.001 ; P = .04 ; for FCSRT : beta = 0.21 ; 95 % CI , 0.008 to 0.41 ; P = .04 ) . Mediterranean diet adherence was not associated with the risk for incident dementia ( fully adjusted model : hazard ratio , 1.12 ; 95 % CI , 0.60 to 2.10 ; P = .72 ) , although power to detect a difference was limited . CONCLUSIONS Higher adherence to a Mediterranean diet was associated with slower MMSE cognitive decline but not consistently with other cognitive tests . Higher adherence was not associated with risk for incident dementia Fighting against inactivity and inadequate nutritional intake are of utmost importance in the elderly . To our knowledge , the few studies which have been performed were conducted for only a short period and the results do not permit formal conclusions to be drawn . We therefore tried to fill this gap in our knowledge by determining whether an intervention combining an acceptable progressive exercise programme and nutritional supplements would be feasible for a long-term period in the very frail elderly , and would bring about concomitant benefits in body composition and muscle power . Accordingly , this exercise and nutritional combination was assessed in the frail elderly in a 9-month r and omised trial with a factorial design . Fifty-seven elderly volunteers over 72 years , from sixteen retirement homes in Lyon , France participated in the study .  Dietary supplements were compared with placebo , and physical exercise was compared with memory training . Main outcome measures were fat-free mass ( FFM ) and muscle power . FFM was determined by labelled water , and muscle power was measured by a leg-extensor machine . At 9 months , the compliance was 63 % for exercise sessions , and 54 % for nutritional supplements . In patients with dietary supplements , muscle power increased by 57 % at 3 months ( P=0.03 ) , and showed only a tendency at 9 months ; although FFM increased by 2.7 % at 9 months , the difference was not significant ( P=0.10 ) . Exercise did not improve muscle power at 9 months , but improved functional tests ( five-time-chair rise , P=0.01 ) . BMI increased with supplements ( + 3.65 % ) , but decreased with placebo ( -0.5 % ) at 9 months ( P=0.007 ) . A long-term combined intervention is feasible in frail elderly individuals with a good rate of compliance . Nutritional supplements and exercise may improve muscle function . Despite no significant results on FFM , due to the limited number of volunteers , combined intervention should be suggested to counteract muscle weakness in the frail elderly Background : Prospect i ve evidence of associations of dietary patterns with cognitive decline is limited and inconsistent . We examined how cognitive changes among Chinese older adults relate to either an adapted Mediterranean diet score or factor analysis -derived dietary patterns . Methods : This prospect i ve cohort study comprised 1,650 adults ≥55 years of age , who completed a cognitive screening test at two or more waves of the China Health and Nutrition Survey in 1997 , 2000 , or 2004 . Outcomes were repeated measures of global cognitive scores , composite cognitive z scores ( st and ardized units [ SU ] ) , and st and ardized verbal memory scores ( SU ) . Baseline diet was measured by 24-hour recalls over 3 days . We used linear mixed effects models to evaluate how changes in cognitive scores were associated with adapted Mediterranean diet score and two dietary pattern scores derived from factor analysis . Results : Among adults ≥65 years of age , compared with participants in the lowest tertile of adapted Mediterranean diet , those in the highest tertile had a slower rate of cognitive decline ( difference in mean SU change/year & bgr ; = 0.042 ; 95 % confidence interval [ CI ] : 0.002 , 0.081 ) . A wheat-based diverse diet derived by factor analysis shared features of the adapted Mediterranean diet , with the top tertile associated with slower annual decline in global cognitive function ( & bgr ; = 0.069 SU/year ; 95 % CI : 0.023 , 0.114 ) . We observed no associations among adults < 65 years of age . Conclusions : Our findings suggest that an adapted Mediterranean diet or a wheat-based , diverse diet with similar components may reduce the rate of cognitive decline in later life in the Chinese population IMPORTANCE Oxidative stress and vascular impairment are believed to partly mediate age-related cognitive decline , a strong risk factor for development of dementia . Epidemiologic studies suggest that a Mediterranean diet , an antioxidant-rich cardioprotective dietary pattern , delays cognitive decline , but clinical trial evidence is lacking . OBJECTIVE To investigate whether a Mediterranean diet supplemented with antioxidant-rich foods influences cognitive function compared with a control diet . DESIGN , SETTING , AND PARTICIPANTS Parallel-group r and omized clinical trial of 447 cognitively healthy volunteers from Barcelona , Spain ( 233 women [ 52.1 % ] ; mean age , 66.9 years ) , at high cardiovascular risk were enrolled into the Prevención con Dieta Mediterránea nutrition intervention trial from October 1 , 2003 , through December 31 , 2009 . All patients underwent neuropsychological assessment at inclusion and were offered retesting at the end of the study . INTERVENTIONS Participants were r and omly assigned to a Mediterranean diet supplemented with extravirgin olive oil ( 1 L/wk ) , a Mediterranean diet supplemented with mixed nuts ( 30 g/d ) , or a control diet ( advice to reduce dietary fat ) . MAIN OUTCOMES AND MEASURES Rates of cognitive change over time based on a neuropsychological test battery : Mini-Mental State Examination , Rey Auditory Verbal Learning Test ( RAVLT ) , Animals Semantic Fluency , Digit Span subtest from the Wechsler Adult Intelligence Scale , Verbal Paired Associates from the Wechsler Memory Scale , and the Color Trail Test . We used mean z scores of change in each test to construct 3 cognitive composites : memory , frontal ( attention and executive function ) , and global . RESULTS Follow-up cognitive tests were available in 334 participants after intervention ( median , 4.1 years ) . In multivariate analyses adjusted for confounders , participants allocated to a Mediterranean diet plus olive oil scored better on the RAVLT ( P = .049 ) and Color Trail Test part 2 ( P = .04 ) compared with controls ; no between-group differences were observed for the other cognitive tests . Similarly adjusted cognitive composites ( mean z scores with 95 % CIs ) for changes above baseline of the memory composite were 0.04 ( -0.09 to 0.18 ) for the Mediterranean diet plus olive oil , 0.09 ( -0.05 to 0.23 ; P = .04 vs controls ) for the Mediterranean diet plus nuts , and -0.17 ( -0.32 to -0.01 ) for the control diet . Respective changes from baseline of the frontal cognition composite were 0.23 ( 0.03 to 0.43 ; P = .003 vs controls ) , 0.03 ( -0.25 to 0.31 ) , and -0.33 ( -0.57 to -0.09 ) . Changes from baseline of the global cognition composite were 0.05 ( -0.11 to 0.21 ; P = .005 vs controls ) for the Mediterranean diet plus olive oil , -0.05 ( -0.27 to 0.18 ) for the Mediterranean diet plus nuts , and -0.38 ( -0.57 to -0.18 ) for the control diet .  All cognitive composites significantly ( P < .05 ) decreased from baseline in controls . CONCLUSIONS AND RELEVANCE In an older population , a Mediterranean diet supplemented with olive oil or nuts is associated with improved cognitive function . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N35739639 BACKGROUND Poor nutrient intake is conceptualized to be a component of frailty , but this hypothesis has been little investigated . We examined the association between low energy and nutrient intake and frailty . METHODS We used data from 802 persons aged 65 years or older participating to the InCHIANTI ( Invecchiare in Chianti , aging in the Chianti area ) study . Frailty was defined by having at least two of the following criteria : low muscle strength , feeling of exhaustion , low walking speed , and reduced physical activity . The European Prospect i ve Investigation into Cancer and nutrition ( EPIC ) question naire was used to estimate the daily intake of energy and nutrients .  Low intake was defined using the value corresponding to the lowest sex-specific intake quintile of energy and specific nutrients . Adjusted logistic regression analyses were used to study the association of frailty and frailty criteria with low intakes of energy and nutrients . RESULTS Daily energy intake < or = 21 kcal/kg was significantly associated with frailty ( odds ratio [ OR ] : 1.24 ; 95 % CI : 1.02 - 1.5 ) . After adjusting for energy intake , a low intake of protein ( OR : 1.98 ; 95 % CI : 1.18 - 3.31 ) ; vitamins D ( OR : 2.35 ; 95 % CI : 1.48 - 3.73 ) , E ( OR : 2.06 ; 95 % CI : 1.28 - 3.33 ) , C ( OR : 2.15 ; 95 % CI : 1.34 - 3.45 ) , and folate ( OR : 1.84 ; 95 % CI : 1.14 - 2.98 ) ; and having a low intake of more than three nutrients ( OR : 2.12 ; 95 % CI : 1.29 - 3.50 ) were significantly and independently related to frailty . CONCLUSIONS This study provides evidence that low intakes of energy and selected nutrients are independently associated with frailty Purpose Mediterranean-type dietary pattern has been associated with lower risk of cardiovascular ( CVD ) and other chronic diseases , primarily in Southern European population s. We examined whether Mediterranean diet score ( MDS ) is associated with total , CVD , coronary heart disease ( CHD ) and stroke mortality in a prospect i ve cohort study in three Eastern European population s. Methods A total of 19,333 male and female participants of the Health Alcohol and Psychosocial factors in Eastern Europe ( HAPIEE ) study in the Czech Republic , Pol and and the Russian Federation were included in the analysis . Diet was assessed by food frequency question naire , and MDS was derived from consumption of nine groups of food using absolute cut-offs .  Mortality was ascertained by linkage with death registers . Results Over the median follow-up time of 7 years , 1314 participants died .  The proportion of participants with high adherence to Mediterranean diet was low ( 25 % ) . One st and ard deviation ( SD ) increase in the MDS ( equivalent to 2.2 point increase in the score ) was found to be inversely associated with death from all causes ( HR , 95 % CI 0.93 , 0.88–0.98 ) and CVD ( 0.90 , 0.81–0.99 ) even after multivariable adjustment . Inverse but statistically not significant link was found for CHD ( 0.90 , 0.78–1.03 ) and stroke ( 0.87 , 0.71–1.07 ) . The MDS effects were similar in each country cohort . Conclusion Higher adherence to the Mediterranean diet was associated with reduced risk of total and CVD deaths in these large Eastern European urban population s. The application of MDS with absolute cut-offs appears suitable for non-Mediterranean population Background Hypertension can be prevented by adopting healthy dietary patterns . Our aim was to assess the 4-year effect on blood pressure ( BP ) control of a r and omized feeding trial promoting the traditional Mediterranean dietary pattern . Methods The PREDIMED primary prevention trial is a r and omized , single-blinded , controlled trial conducted in Spanish primary healthcare centers . We recruited 7,447 men ( aged 55 to 80 years ) and women ( aged 60 to 80 years ) who had high risk for cardiovascular disease . Participants were assigned to a control group or to one of two Mediterranean diets . The control group received education on following a low-fat diet , while the groups on Mediterranean diets received nutritional education and also free foods ; either extra virgin olive oil , or nuts . Trained personnel measured participants ’ BP at baseline and once yearly during a 4-year follow-up . We used generalized estimating equations to assess the differences between groups during the follow-up . Results The percentage of participants with controlled BP increased in all three intervention groups ( P-value for within-group changes : P<0.001 ) . Participants allocated to either of the two Mediterranean diet groups had significantly lower diastolic BP than the participants in the control group ( −1.53 mmHg ( 95 % confidence interval ( CI ) −2.01 to −1.04 ) for the Mediterranean diet supplemented with extra virgin olive oil , and −0.65 mmHg ( 95 % CI -1.15 to −0.15 ) mmHg for the Mediterranean diet supplemented with nuts ) . No between-group differences in changes of systolic BP were seen . Conclusions Both the traditional Mediterranean diet and a low-fat diet exerted beneficial effects on BP and could be part of advice to patients for controlling BP . However , we found lower values of diastolic BP in the two groups promoting the Mediterranean diet with extra virgin olive oil or with nuts than in the control group . Trial registration Current Controlled Trials IS RCT BACKGROUND The etiology of the geriatric syndrome frailty is multifactorial . Besides hormonal and inflammatory processes , nutritional influences may be of major relevance . In this cross-sectional study , the association between dietary quality and frailty was investigated . METHODS In 192 community-dwelling older volunteers ( > 75 years ) , an interview-based food frequency question naire was used to assess nutritional data . A Mediterranean diet ( MED ) score ( maximum 9 points ) was used to evaluate dietary quality . Frailty was defined as the presence of at least three and prefrailty as the presence of one or two of the following criteria : weight loss , exhaustion , low physical activity , low h and grip strength , and slow walking speed . Older adults without any of these attributes were defined as " nonfrail " Binomial logistic regression analysis was used to assess the risk of being frail ( vs prefrail and nonfrail ) in each quartile ( vs lowest quartile ) of the MED score . RESULTS The mean ( SD ) age of the participants was 83 ( 4 ) years ; 41.1 % were prefrail and 15.1 % were frail . The risk of being frail was significantly reduced in the highest quartile of the MED score ( OR 0.26 ; 95 % CI 0.07 - 0.98 ) . CONCLUSIONS A healthy dietary pattern is associated with a lower risk of being frail . Larger , prospect i ve and interventional studies are needed to clarify the association between dietary quality and frailty PURPOSE To assess the effects of a one year nutritional supplementation and resistance training program on muscle strength and walking capacity in the elderly . MATERIAL AND METHODS Elderly subjects from two outpatient clinics received a nutritional supplement , that provided 400 Kcal , 15 g/protein and 50 % of vitamin DRVs per day . Half the subjects receiving and not receiving the supplement were r and omly assigned to a resistance exercise training program with two sessions per week . Every six months , body composition using DEXA , limb muscle strength , maximal inspiratory and expiratory pressures and walking capacity were assessed . RESULTS One hundred forty nine subjects were considered eligible and 101 ( 31 supplemented and trained , 28 supplemented , 16 trained and 26 without supplementation nor training ) completed the year of follow up . Overall compliance with the supplement was 48 22 % and trained subjects attended 56 21 % of programmed sessions . No changes in fat free mass were observed in any of the groups , but fat mass increased from 22.5 7.3 to 23.2 7.3 kg in all groups ( p < 0.001 ) . Upper and lower limb strength and walking capacity increased significantly in trained subjects whether supplemented or not . Maximal inspiratory pressure and right h and grip strength increased only in the supplemented and trained group . CONCLUSIONS Resistance training improved muscle strength and walking capacity To examine the association between dietary habits , cognitive functioning and brain volumes in older individuals , data from 194 cognitively healthy individuals who participated in the Prospect i ve Investigation of the Vasculature in Uppsala Seniors cohort were used . At age 70 , participants kept diaries of their food intake for 1week . These records were used to calculate a Mediterranean diet ( MeDi ) score ( comprising dietary habits traditionally found in Mediterranean countries , e.g. high intake of fruits and low intake of meat ) , with higher scores indicating more pronounced MeDi-like dietary habits . Five years later , participants ' cognitive capabilities were examined by the seven minute screening ( 7MS ) ( a cognitive test battery used by clinicians to screen for dementia ) , and their brain volumes were measured by volumetric magnetic resonance imaging . Multivariate linear regression analyses were constructed to examine the association between the total MeDi score and cognitive functioning and brain volumes . In addition , possible associations between MeDi 's eight dietary features and cognitive functioning and brain volumes were investigated . From the eight dietary features included in the MeDi score , pertaining to a low consumption of meat and meat products was linked to a better performance on the 7MS test ( P=0.001 ) and greater total brain volume ( i.e. the sum of white and gray matter , P=0.03 ) when controlling for potential confounders ( e.g. BMI ) in the analysis . Integrating all dietary features into the total MeDi score explained less variance in cognitive functioning and brain volumes than its single dietary component meat intake . These observational findings suggest that keeping to a low meat intake could prove to be an impact-driven public health policy to support healthy cognitive aging , when confirmed by longitudinal studies . Further , they suggest that the MeDi score is a construct that may mask possible associations of single MeDi features with brain health domains in elderly population Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES Protein supplementation has been proposed as an effective dietary strategy to increase skeletal muscle mass and improve physical performance in frail elderly people . Our objective was to assess the impact of 24 weeks of dietary protein supplementation on muscle mass , strength , and physical performance in frail elderly people . DESIGN / SETTING / PARTICIPANTS A total of 65 frail elderly subjects were included and r and omly allocated to either daily protein or placebo supplementation ( 15 g protein at breakfast and lunch ) . MEASUREMENTS Skeletal muscle mass ( DXA ) , muscle fiber size ( muscle biopsy ) , strength ( 1-RM ) , and physical performance ( SPPB ) were assessed at baseline , and after 12 and 24 weeks of dietary intervention . RESULTS Skeletal muscle mass did not change in the protein- ( from 45.8 ± 1.7 to 45.8 ± 1.7 kg ) or placebo-supplemented group ( from 46.7 ± 1.7 to 46.6 ± 1.7 kg ) following 24 weeks of intervention ( P > .05 ) . In accordance , type I and II muscle fiber size did not change over time ( P > .05 ) . Muscle strength increased significantly in both groups ( P < .01 ) , with leg extension strength tending to increase to a greater extent in the protein ( 57 ± 5 to 68 ± 5 kg ) compared with the placebo group ( 57 ± 5 to 63 ± 5 kg ) ( treatment × time interaction effect : P = .059 ) . Physical performance improved significantly from 8.9 ± 0.6 to 10.0 ± 0.6 points in the protein group and did not change in the placebo group ( from 7.8 ± 0.6 to 7.9 ± 0.6 points ) ( treatment × time interaction effect : P = .02 ) . CONCLUSION Dietary protein supplementation improves physical performance , but does not increase skeletal muscle mass in frail elderly people Background Frailty is a well known and accepted term to clinicians working with older people . The study aim was to determine whether an intervention could reduce frailty and improve mobility . Methods We conducted a single center , r and omized , controlled trial among older people who were frail in Sydney , Australia . One group received an intervention targeting the identified characteristics of frailty , whereas the comparison group received the usual health care and support services . Outcomes were assessed by raters masked to treatment allocation at 3 and 12 months after study entry . The primary outcomes were frailty as assessed by the Cardiovascular Health Study criteria , and mobility as assessed by the Short Physical Performance Battery . Secondary outcome measures included disability , depressive symptoms and health-related quality of life . Results A total of 216 participants ( 90 % ) completed the study . Overall , 68 % of participants were women and the mean age was 83.3 years ( st and ard deviation , 5.9 ) . In the intention-to-treat analysis , the between-group difference in frailty was 14.7 % at 12 months ( 95 % confidence interval : 2.4 % , 27.0 % ; P = 0.02 ) . The score on the Short Physical Performance Battery , in which higher scores indicate better physical status , was stable in the intervention group and had declined in the control group ; with the mean difference between groups being 1.44 ( 95 % confidence interval , 0.80 , 2.07 ; P < 0.001 ) at 12 months . There were no major differences between the groups with respect to secondary outcomes . The few adverse events that occurred were exercise-associated musculoskeletal symptoms . Conclusions Frailty and mobility disability can be successfully treated using an interdisciplinary multifaceted treatment program . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : Although diet quality is implicated in cardiovascular disease ( CVD ) risk , few studies have investigated the relation between diet quality and the risks of  CVD and mortality in older adults . This study examined the prospect i ve associations between dietary scores and risk of CVD and all-cause mortality in older British men . A total of 3328 men ( aged 60–79 y ) from the British Regional Heart Study , free from CVD at baseline , were followed up for 11.3 y for CVD and mortality . Baseline food-frequency question naire data were used to generate 2 dietary scores :  the Healthy Diet Indicator ( HDI ) , based on WHO dietary guidelines , and the Elderly Dietary Index ( EDI ) , based on a Mediterranean-style dietary intake , with higher scores indicating greater compliance with dietary recommendations . Cox proportional hazards regression analyses assessed associations between quartiles of HDI and EDI and risk of all-cause mortality , CVD mortality , CVD events , and coronary heart disease ( CHD ) events . During follow-up , 933 deaths , 327 CVD deaths , 582 CVD events , and 307 CHD events occurred . Men in the highest compared with the lowest EDI quartile had significantly lower risks of all-cause mortality ( HR : 0.75 ; 95 % CI : 0.60 , 0.94 ; P-trend = 0.03 ) , CVD mortality ( HR : 0.63 ; 95 % CI : 0.42 , 0.94 ; P-trend = 0.03 ) , and CHD events ( HR : 0.66 ; 95 % CI : 0.45 , 0.97 ; P-trend = 0.05 ) but not CVD events ( HR : 0.79 ; 95 % CI : 0.60 , 1.05 ; P-trend = 0.16 ) after adjustment for sociodemographic , behavioral , and cardiovascular risk factors . The HDI was not significantly associated with any of the outcomes . The EDI appears to be more useful than the HDI for assessing diet quality in relation to CVD and morality risk  in older men . Encouraging older adults to adhere to the guidelines inherent in the EDI criteria may have public health benefits Purpose Maintenance of cognitive abilities is important for elderly to stay independent . With the aging of the population , the call for modifiable factors is emerging . Dietary protein might improve cognitive performance ; however , this has hardly been studied . Therefore , we studied the impact of 24-week dietary protein supplementation on cognitive performance in pre-frail and frail elderly people . Methods Pre-frail and frail elderly subjects , according to the Fried criteria , r and omly received a protein drink containing 15 g protein or a placebo drink twice a day . Cognitive performance was measured at baseline and after 24 weeks by means of a sensitive neuropsychological test battery . In addition , reaction time was assessed after both 12 and 24 weeks of intervention . Domain scores were calculated for the domains episodic memory , attention and working memory , information processing speed , and executive functioning . Analyses of covariance were used to determine differences between groups . Linear mixed models were used to determine differences in reaction time over time and per treatment . Results In total , 65 subjects ( 79 ± 8 years ) with a median Mini-Mental State Examination score of 28 ( interquartile range 26–30 ) were included . Reaction time improved more in the protein group ( 68 ms ) than in the placebo group ( 18 ms , P = 0.03 ) . Dietary protein had no significant effect on any of the cognitive domain scores . Conclusions Protein supplementation might improve reaction time performance in pre-frail and frail elderly , but did not improve other cognitive functions There is evidence from a population -based study of an inverse relationship between monounsaturated fatty acids ( MUFA ) energy intake and age-related cognitive decline ( ARCD ) , while high polyunsaturated fatty acids ( PUFA ) intake was positively associated with cognitive impairment in elderly subjects . We investigated the possible role of MUFA and PUFA on age-related cognitive changes . A population -based , prospect i ve study was carried out on 278 , 186 , and 95 nondemented elderly subjects ( 65 - 84 years ) evaluated for global cognitive functions ( Mini-Mental State Examination , MMSE ) at the first ( 1992 - 1993 ) , second ( 1995 - 1996 ) , and third survey ( 2000 - 2001 ) , respectively , from the r and omized cohort of Casamassima , Bari , Italy ( n=704 ) , one of the eight centers of the Italian Longitudinal Study on Aging ( ILSA ) .  MUFA and PUFA intakes were assessed at baseline with a semi-quantitative food frequency question naire . High MUFA and PUFA energy intakes and total energy intake were significantly associated with a better cognitive performance in a 8.5-year follow-up . In this prospect i ve population -based study on older nondemented subjects with a typical Mediterranean diet , high MUFA and PUFA intakes appeared to be protective against ARCD OBJECTIVES To evaluate the association between protein intake and incident frailty . DESIGN Prospect i ve cohort study . SETTING Subset of the Women 's Health Initiative Observational Study conducted at 40 clinical centers . PARTICIPANTS Twenty-four thous and four hundred seventeen women aged 65 to 79 who were free of frailty at baseline with plausible self-reported energy intakes ( 600 - 5,000 kcal/day ) according to the Food Frequency Question naire ( FFQ ) . MEASUREMENTS Baseline protein intake was estimated from the FFQ . Calibrated estimates of energy and protein intake were corrected for measurement error using regression calibration equations estimated from objective measures of total energy expenditure ( doubly labeled water ) and dietary protein ( 24-hour urinary nitrogen ) . After 3 years of follow-up , frailty was defined as having at least three of the following components : low physical function ( measured using the R and -36 question naire ) , exhaustion , low physical activity , and unintended weight loss . Multinomial logistic regression models estimated associations for uncalibrated and calibrated protein intake . RESULTS Of the 24,417 eligible women , 3,298 ( 13.5 % ) developed frailty over 3 years . After adjustment for confounders , a 20 % increase in uncalibrated protein intake ( % kcal ) was associated with a 12 % ( 95 % confidence interval (CI)=8 - 16 % ) lower risk of frailty , and a 20 % increase in  calibrated protein intake  was associated with a 32 % ( 95 % CI=23 - 50 % ) lower risk of frailty . CONCLUSION Higher protein consumption , as a fraction of energy , is associated with a strong , independent , dose-responsive lower risk of incident frailty in older women . Using uncalibrated measures underestimated the strength of the association . Incorporating more protein into the diet may be an intervention target for frailty prevention Background / objectives : A few previous studies indicate that protein supplementation increases gains in muscle mass and strength during a resistance exercise program . The purpose of this study was to investigate whether whey protein supplementation results in greater increases in lean body mass , muscle strength and physical function in elderly individuals during 12 weeks of resistance exercise when compared to isocaloric carbohydrate supplementation . Subjects/ Methods : A total of 161 men and women , 65–91 years old , participated in a r and omized , controlled , double-blind intervention study , involving dietary supplementation and a 12-week resistance exercise program , design ed to increase muscle mass and strength of all major muscle groups . Participants exercised three times a week and received either 20 g of whey protein ( n=83 ) or isocaloric carbohydrate ( n=78 ) in liquid form immediately after each workout . Data were obtained at baseline and end point . Results : The primary outcomes , lean body mass , strength and physical function increased significantly during the course of the study . Type of dietary supplementation did not influence gains in lean body mass ( P=0.365 ) , quadriceps strength ( P=0.776 ) or performance during a 6-min walk ( P=0.726 ) or a timed up- and -go test ( P=0.151 ) . Twenty participants discontinued the intervention . Conclusions : Ingestion of 20 g of whey protein immediately after resistance exercise three times per week , does not lead to greater gains in lean body mass , strength and physical function in elderly people with sufficient energy and protein intakes when compared to isocaloric carbohydrate Objective Previous observational studies reported beneficial effects of the Mediterranean diet ( MedDiet ) on cognitive function , but results were inconsistent . We assessed the effect on cognition of a nutritional intervention using MedDiets in comparison with a low-fat control diet . Methods We assessed 522 participants at high vascular risk ( 44.6 % men , age 74.6 ± 5.7 years at cognitive evaluation ) enrolled in a multicentre , r and omised , primary prevention trial ( PREDIMED ) , after a nutritional intervention comparing two MedDiets ( supplemented with either extra-virgin olive oil ( EVOO ) or mixed nuts ) versus a low-fat control diet . Global cognitive performance was examined by  Mini-Mental State Examination ( MMSE ) and  Clock Drawing Test ( CDT ) after 6.5 years of nutritional intervention . Research ers who assessed the outcome were blinded to group assignment . We used general linear models to control for potential confounding . Results After adjustment for sex , age , education , Apolipoprotein E genotype , family history of cognitive impairment/dementia , smoking , physical activity , body mass index , hypertension , dyslipidaemia , diabetes , alcohol and total energy intake , participants allocated to the MedDiet+EVOO showed higher mean MMSE and CDT scores with significant differences versus control ( adjusted differences : + 0.62 95 % CI + 0.18 to + 1.05 , p=0.005 for MMSE , and + 0.51 95 % CI + 0.20 to + 0.82 , p=0.001 for CDT ) . The adjusted means of MMSE and CDT scores were also higher for participants allocated to the MedDiet+Nuts versus control ( adjusted differences : + 0.57 ( 95 % CI + 0.11 to + 1.03 ) , p=0.015 for MMSE and + 0.33 ( 95 % CI + 0.003 to + 0.67 ) , p=0.048 for CDT ) . These results did not differ after controlling for incident depression . Conclusions An intervention with MedDiets enhanced with either EVOO or nuts appears to improve cognition compared with a low-fat diet . IS RCT BACKGROUND Healthy dietary patterns have been linked positively with health and longevity . However , prospect i ve studies in diverse population s in the United States addressing dietary patterns and mortality are limited . OBJECTIVE We assessed the ability of the following 4 diet- quality indexes [ the Healthy Eating Index-2010 ( HEI-2010 ) , the Alternative HEI-2010 ( AHEI-2010 ) , the alternate Mediterranean diet score ( aMED ) , and the Dietary Approaches to Stop Hypertension ( DASH ) ] to predict the reduction in risk of mortality from all causes , cardiovascular disease ( CVD ) , and cancer . DESIGN White , African American , Native Hawaiian , Japanese American , and Latino adults ( n = 215,782 ) from the Multiethnic Cohort completed a quantitative food-frequency question naire . Scores for each dietary index were computed and divided into quintiles for men and women .  Mortality was documented over 13 - 18 y of follow-up . HRs and 95 % CIs were computed by using adjusted Cox models . RESULTS High HEI-2010 , AHEI-2010 , aMED , and DASH scores were all inversely associated with risk of mortality from all causes , CVD , and cancer in both men and women ( P-trend < 0.0001 for all models ) . For men , the HEI-2010 was consistently associated with a reduction in risk of mortality for all causes ( HR : 0.75 ; 95 % CI : 0.71 , 0.79 ) , CVD ( HR : 0.74 ; 95 % CI : 0.69 , 0.81 ) , and cancer ( HR : 0.76 ; 95 % CI : 0.70 , 0.83 ) when lowest and highest quintiles were compared . In women , the AHEI and aMED showed large reductions for all-cause mortality ( HR : 0.78 ; 95 % CI : 0.74 , 0.82 ) , the AHEI showed large reductions for CVD ( HR : 0.76 ; 95 % CI : 0.69 , 0.83 ) , and the aMED showed large reductions for cancer ( HR : 0.84 ; 95 % CI : 0.76 , 0 . 92 ) . CONCLUSION These results , in a US multiethnic population , suggest that consuming a dietary pattern that achieves a high diet- quality index score is associated with lower risk of mortality from all causes , CVD , and cancer in adult men and women BACKGROUND Healthy dietary patterns may protect against age-related  cognitive decline , but results of studies have been inconsistent . OBJECTIVE We examined associations between Dietary Approaches to Stop Hypertension (DASH)- and Mediterranean-style dietary patterns and age-related cognitive change in a prospect i ve , population -based study . DESIGN Participants included 3831 men and women ≥65 y of age who were residents of Cache County , UT , in 1995 . Cognitive function was assessed by using the Modified Mini-Mental State Examination ( 3MS ) ≤4 times over 11 y. Diet-adherence scores were computed by summing across the energy-adjusted rank-order of individual food and nutrient components and categorizing participants into quintiles of the distribution of the diet accordance score . Mixed-effects repeated- measures models were used to examine 3MS scores over time across increasing quintiles of dietary accordance scores and individual food components that comprised each score . RESULTS The range of rank-order DASH and Mediterranean diet scores was 1661 - 25,596 and 2407 - 26,947 , respectively . Higher DASH and Mediterranean diet scores were associated with higher average 3MS scores . People in quintile 5 of DASH averaged 0.97 points higher than those in quintile 1 ( P = 0.001 ) . The corresponding difference for Mediterranean quintiles was 0.94 ( P = 0.001 ) . These differences were consistent over 11 y. Higher intakes of whole grains and nuts and legumes were also associated with higher average 3MS scores [ mean quintile 5 compared with 1 differences : 1.19 ( P < 0.001 ) , 1.22 ( P < 0.001 ) , respectively ] . CONCLUSIONS Higher levels of accordance with both the DASH and Mediterranean dietary patterns were associated with consistently higher levels of cognitive function in elderly men and women over an 11-y period . Whole grains and nuts and legumes were positively associated with higher cognitive functions and may be core neuroprotective foods common to various healthy plant-centered diets around the globe BACKGROUND Whey protein supplementation may augment resistance exercise-induced increases in muscle strength and mass . Further studies are required to determine whether this effect extends to mobility-limited older adults . The objectives of the study were to compare the effects of whey protein concentrate ( WPC ) supplementation to an isocaloric control on changes in whole-body lean mass , mid-thigh muscle cross-sectional area , muscle strength , and stair-climbing performance in older mobility-limited adults in response to 6 months of resistance training ( RT ) . METHODS Eighty mobility-limited adults aged 70 - 85 years were r and omized to receive WPC ( 40g/day ) or an isocaloric control for 6 months . All participants also completed a progressive high-intensity RT intervention . Sample sizes were calculated based on the primary outcome of change in whole-body lean mass to give 80 % power for a 0.05-level , two-sided test . RESULTS Lean mass increased 1.3 % and 0.6 % in the WPC and control groups , respectively . Muscle cross-sectional area was increased 4.6 % and 2.9 % in the WPC and control groups , respectively , and muscle strength increased 16%-50 % in WPC and control groups . Stair-climbing performance also improved in both groups . However , there were no statistically significant differences in the change in any of these variables between groups . CONCLUSIONS These data suggest that WPC supplementation at this dose does not offer additional benefit to the effects of RT in mobility-limited older adults Background Despite many studies on cognitive function and its influential factors among old population , relatively little research has been design ed to study the relationship between  dietary intake  and cognitive function in elderly . Objective We conducted a population -based , prospect i ve nested case-control study to investigate the association between  dietary habits  and declines in cognitive function over three years among Chinese illiterate elderly . Design and methods This study was part of the Chinese Longitudinal Health Longevity Study ( CLHLS ) . Six thous and nine hundred and eleven illiterate residents aged 65 or older were investigated . Socio-demographic and dietary habits data were collected at baseline . The cognitive function of illiterate elderly persons was assessed using Chinese revised  Mini Mental State Examination ( MMSE-r ) in 2002 and 2005 . Cognitive decline was defined as MMSE-r score dropped to less than 18 at follow-up among those with normal cognitive function ( MMSE-r≥18 at baseline ) . Odds ratios ( OR ) were calculated via logistic regression models . Results Five thous and six hundred and ninety one elderly were included in the current analysis . In bivariate analysis , cognitive decline was associated with gender , marital status , financial status , smoking , drinking alcohol , drinking tea , eating fruits , vegetables , legumes , fishes , meat , egg and sugar . Multivariate logistic regression analysis found that always eating vegetable ( Adjusted OR : 0.66 ; 95 % confidence intervals , CI : 0.58 , 0.75 ) , always consuming legumes ( AOR:0.78 ; 95 % CI : 0.64 , 0.96 ) were inversely associated with cognitive decline . Conclusions Lower intakes of vegetables and legumes were associated with cognitive decline  among illiterate elderly Chinese . Dietary factors may be important for prevention cognitive decline BACKGROUND Cardiovascular disease and vascular risk factors increase rates of cognitive impairment , but very little is known regarding prevention in this high-risk group . The heart-healthy Mediterranean-type dietary pattern may beneficially influence both vascular and cognitive outcomes . OBJECTIVES We examined the association between Mediterranean-style diet and cognitive decline in women with prevalent vascular disease or ≥3 coronary risk factors . DESIGN / PARTICIPANTS / SETTING Prospect i ve cohort study among 2,504 women participants in the Women 's Antioxidant Cardiovascular Study ( WACS ) , a cohort of female health professionals . Adherence to a Mediterranean-style diet was determined at WACS baseline ( 1995 - 1996 ) using a 0- to 9-point scale with higher scores indicating higher adherence . In 1998 - 2000 , participants aged ≥65 years underwent a telephone cognitive battery including five tests of global cognition , verbal memory , and category fluency . Tests were administered three additional times across 5.4 years . STATISTICAL ANALYSES PERFORMED We used multivariable-adjusted generalized linear models for repeated measures to compare the annual rates of cognitive score changes across tertiles of Mediterranean diet score , as assessed at WACS baseline . RESULTS In both basic- and multivariable-adjusted models , consuming a Mediterranean-style diet was not related to cognitive decline . No effect modification was detected by age , education , depression , cardiovascular disease severity at WACS baseline , or level of cognition at initial assessment . CONCLUSIONS In women at higher risk of cognitive decline due to vascular disease or risk factors , adherence to a Mediterranean-style diet was not associated with subsequent 5-year cognitive change OBJECTIVES Protein supplementation has been proposed as an effective dietary strategy to augment the skeletal muscle adaptive response to prolonged resistance-type exercise training in elderly people . Our objective was to assess the impact of protein supplementation on muscle mass , strength , and physical performance during prolonged resistance-type exercise training in frail elderly men and women . DESIGN / SETTING / PARTICIPANTS A r and omized , double-blind , placebo-controlled trial with 2 arms in parallel among 62 frail elderly subjects ( 78 ± 1 year ) . These elderly subjects participated in a progressive resistance-type exercise training program ( 2 sessions per week for 24 weeks ) during which they were supplemented twice daily with either protein ( 2 * 15 g ) or a placebo .  MEASUREMENTS Lean body mass ( DXA ) , strength ( 1-RM ) , and physical performance ( SPPB ) were assessed at baseline , and after 12 and 24 weeks of intervention . RESULTS Lean body mass increased from 47.2 kg ( 95 % CI , 43.5 - 50.9 ) to 48.5 kg ( 95 % CI , 44.8 - 52.1 ) in the protein group and did not change in the placebo group ( from 45.7 kg , 95 % CI , 42.1 - 49.2 to 45.4 kg , 95 % CI , 41.8 - 48.9 ) following the intervention ( P value for treatment × time interaction = .006 ) . Strength and physical performance improved significantly in both groups ( P = .000 ) with no interaction effect of dietary protein supplementation . CONCLUSIONS Prolonged resistance-type exercise training represents an effective strategy to improve strength and physical performance in frail elderly people  . Dietary protein supplementation is required to allow muscle mass gain during exercise training in frail elderly people . TRIAL REGISTRATION clinical trials.gov identifier : NCT01110369 BACKGROUND Physical inactivity , inadequate dietary protein , and low- grade systemic inflammation contribute to age-related muscle loss , impaired function , and disability . OBJECTIVE We assessed the effects of progressive resistance training ( PRT ) combined with a protein-enriched diet facilitated through lean red meat on lean tissue mass ( LTM ) , muscle size , strength and function , circulating inflammatory markers , blood pressure , and lipids in elderly women . DESIGN In a 4-mo cluster r and omized controlled trial , 100 women aged 60 - 90 y who were residing in 15 retirement villages were allocated to receive PRT with lean red meat ( ∼160 g cooked ) to be consumed 6 d/wk [ resistance training plus lean red meat ( RT+Meat ) group ; n = 53 ] or control PRT [ 1 serving pasta or rice/d ; control resistance training ( CRT ) group ; n = 47 ) ] . All women undertook PRT 2 times/wk and received 1000 IU vitamin D3/d . RESULTS The mean ( ± SD ) protein intake was greater in the RT+Meat group than in the CRT group throughout the study ( 1.3 ± 0.3 compared with 1.1 ± 0.3 g · kg⁻¹ · d⁻¹ , respectively ; P < 0.05 ) . The RT+Meat group experienced greater gains in total body LTM ( 0.45 kg ; 95 % CI : 0.07 , 0.84 kg ) , leg LTM ( 0.22 kg ; 95 % CI : 0.02 , 0.42 kg ) , and muscle strength ( 18 % ; 95 % CI : 0.03 , 0.34 ) than did the CRT group ( all P < 0.05 ) . The RT+Meat group also experienced a 10 % greater increase in serum insulin-like growth factor I ( P < 0.05 ) and a 16 % greater reduction in the proinflammatory marker interleukin-6 ( IL-6 ) ( P < 0.05 ) after 4 mo . There were no between-group differences for the change in blood lipids or blood pressure . CONCLUSION A protein-enriched diet equivalent to ∼1.3 g · kg⁻¹ · d⁻¹ achieved through lean red meat is safe and effective for enhancing the effects of PRT on LTM and muscle strength and reducing circulating IL-6 concentrations in elderly women . This trial was registered at the Australian Clinical Trials Registry as ACTRN12609000223235 Objective : To examine the association between rates of cognitive change and dietary consumption of fruits and vegetables among older persons . Methods : The authors conducted a prospect i ve cohort study of 3,718 participants , aged 65 years and older of the Chicago Health and Aging Project . Participants completed a food frequency question naire and were administered at least two of three cognitive assessment s at baseline , 3-year , and 6-year follow-ups . Cognitive function was measured using the average z-score of four tests : the East Boston Tests of immediate memory and delayed recall , the Mini-Mental State Examination , and the Symbol Digit Modalities Test . Results : The mean cognitive score at baseline for the analyzed cohort was 0.18 ( range : –3.5 to 1.6 ) , and the overall mean change in score per year was a decline of 0.04 st and ardized units . In mixed effects models adjusted for age , sex , race , and education , compared with the rate of cognitive decline among persons in the lowest quintile of vegetable intake ( median of 0.9 servings/day ) , the rate for persons in the fourth quintile ( median , 2.8 servings/day ) was slower by 0.019 st and ardized units per year ( p = 0.01 ) , a 40 % decrease , and by 0.018 st and ardized units per year ( p = 0.02 ) for the fifth quintile ( median , 4.1 servings/day ) , or a 38 % decrease in rates . The association remained significant ( p for linear trend = 0.02 ) with further control of cardiovascular-related conditions and risk factors . Fruit consumption was not associated with cognitive change . Conclusion : High vegetable but not fruit consumption may be associated with slower rate of cognitive decline with older age We examined the relationship between dietary intake and cognitive performance in Korean elderly people . Data for dietary intake , anthropometric measurements and cognitive function tests were collected and the relationships of the variables were analyzed . A r and om sample of 210 men and 239 women in Korea , aged 60 and over , was selected . Subjects were free-living elderly people who had not experienced major cognitive function impairment . Main outcome measures ,  24 h dietary recall method , food behaviour variables , anthropometrics indices , health variables , and Kwon 's Mini-Mental State Examination for Koreans ( MMSE-K ) for cognitive function test . The prevalence rate of poor cognitive function ( MMSE-K score < or = 19 ) of Korean elderly was 22.3 % : women with poor cognitive function had a higher rate ( 31.0 % ) than that in men ( 12.3 % ) . Cognitive ability was related negatively with age and positively with school education level . Female subjects of poor cognitive function had significantly lower intakes of total amount of foods , cereals , vegetables , fruits , milk , spices , and also , energy , protein , fat , carbohydrate , Ca , P , Fe , vitamin A , thiamin , riboflavin , and niacin  than those of the normal cognitive score ( > or = 24 ) group ( P < 0.05 ) . Male subjects of poor cognitive function had significantly lower intakes of fruits , fiber , and vitamin C than the normal subjects ( P < 0.05 ) . The MMSE-K score of female subjects showed a significant positive correlation with total amount of foods , cereals , beans , fruits , milk , oil , spices , and energy , protein , fat , carbohydrate , Ca , Fe , P , riboflavin and niacin intakes . The consumption of adequate nutrients , by taking sufficient amounts and variety of foods , may be important in maintaining adequate cognitive function in elderly Koreans Objectives : We examined whether accordance to the DASH ( Dietary Approach to Stop Hypertension ) and Mediterranean diets is associated with slower cognitive decline in a prospect i ve Chicago cohort study of older persons , the Memory and Aging Project . Methods : The sample comprised 826 Memory and Aging Project participants ( aged 81.5 ± 7.1 years ) who completed a 144-item food frequency question naire at baseline and 2 or more cognitive assessment s over 4.1 years .  Dietary scores were computed for accordance to the DASH diet ( 0–10 ) and the Mediterranean diet ( MedDietScore ) ( 0–55 ) . For both , higher scores reflect greater accordance . Both patterns share at least 3 common food components . Cognitive function was assessed annually with 19 cognitive tests from which global cognitive scores and summary measures are computed . Results : The mean global cognitive score at baseline was 0.12 ( range , −3.23 to 1.60 ) with an overall mean annual change in score of −0.08 st and ardized units . Only 13 participants had possible dementia .  The mean  DASH score was 4.1 ( range , 1.0–8.5 ) and the MedDietScore was 31.3 ( range , 18–46 ) . In mixed models adjusted for covariates , a 1-unit difference in DASH score was associated with a slower rate of global cognitive decline by 0.007 st and ardized units ( st and ard error of estimate = 0.003 , p = 0.03 ) . Similarly , a 1-unit-higher MedDietScore was associated with a slower rate of global cognitive decline by 0.002 st and ardized units ( st and ard error of estimate = 0.001 , p = 0.01 ) . Conclusions : These findings support the hypothesis that both the DASH and Mediterranean diet patterns are associated with slower rates of cognitive decline in the same cohort of older persons OBJECTIVE To examine the clinical utility of the Clock Test for identifying dementia . DESIGN Group comparisons . SETTING A hospital-based out-patient diagnostic clinic . PATIENTS Volunteer sample of elderly individuals ( normal elderly , NE , n = 62 ) and a referred sample of probable Alzheimer Disease ( AD , n = 58 ) patients meeting NINCDS-ADRDA criteria . MAIN OUTCOME MEASURE The  Clock Test  is composed of three components :  Clock Drawing , Clock Setting , and Clock Reading .  A detailed scoring system for qualitative as well as quantitative evaluation of Clock Drawing errors was used . Five time setting s , varying in level of complexity , were used to evaluate Clock Setting and Clock Reading .  RESULTS The groups differed significantly on  Clock Drawing , Clock Setting , and Clock Reading ( P less than 0.001 ) . On Clock Drawing , the AD group made significantly more errors of omission and misplacement of numbers than the NE group ( P less than 0.001 ) . Using cut-off scores derived to maximize separation between the groups to define deficits in performance , the sensitivity and specificity for the diagnosis of AD of Clock Drawing , Clock Setting , and Clock Reading were 92 % and 86 % , 87 % and 97 % , 92 % and 85 % , respectively . Using a criterion of deficits on two or more of the three components , sensitivity and specificity increased to 94 % and 93 % , respectively . CONCLUSIONS Deficits on clock drawing in AD may be reflective of a generalized disturbance in the conceptualization of time rather than constructional apraxia , per se . The functionally relevant components of Clock Setting and Clock Reading combined with Clock Drawing make the Clock Test particularly useful as a screening and research tool for AD Physical activity has been proposed as one of the most effective strategies to prevent cognitive decline .  Protein supplementation may exert an additive effect . The effect of resistance-type exercise training with or without protein supplementation on cognitive functioning in frail and pre-frail elderly people was assessed in a secondary analysis . Two 24-week , double-blind , r and omized , placebo-controlled intervention studies were carried out in parallel . Subjects performed a  resistance-type exercise program of two sessions per week ( n=62 ) or no exercise program ( n=65 ) . In both studies , subjects were r and omly allocated to either a protein ( 2 × 15 g daily ) or a placebo drink . Cognitive functioning was assessed with a neuropsychological test battery focusing on the cognitive domains episodic memory , attention and working memory , information processing speed , and executive functioning . In frail and pre-frail elderly  , resistance-type exercise training in combination with protein supplementation  improved information processing speed ( changes in domain score 0.08±0.51 versus -0.23±0.19 in the non-exercise group , p=0.04 ) . Exercise training without protein supplementation was beneficial for attention and working memory ( changes in domain scores 0.35±0.70 versus -0.12±0.69 in the non-exercise group , p=0.02 ) . There were no significant differences among the intervention groups on the other cognitive tests or domain scores In this large-scale prospect i ve epidemiological study , we examined associations of long-term adherence to the Mediterranean diet ( MeDi ) and subsequent cognitive function and decline .  We included 16,058 women from the Nurses ' Health Study , aged ≥70 y , who underwent cognitive testing by telephone 4 times during 6 y , beginning in 1995 - 2001 , and provided repeated information on diet between 1984 and the first cognitive exam . Primary outcomes were the Telephone Interview for Cognitive Status ( TICS ) and composite scores of verbal memory and global cognition .  MeDi adherence was based on intakes of : vegetables , fruits , legumes , whole grains , nuts , fish , red and processed meats , moderate alcohol , and the ratio of monounsaturated : saturated fat . Long-term MeDi exposure was estimated by averaging all repeated measures of diet ( > 13 y , on average ) . In primary analyses of cognitive change , the MeDi was not associated with decline in global cognition or verbal memory . In a secondary approach examining cognitive status in older age , determined by averaging all 4 repeated measures of cognition , each higher quintile of long-term MeDi score was linearly associated with better multivariable-adjusted mean cognitive scores [ differences in mean Z-scores between extreme quintiles of MeDi = 0.06 ( 95 % CI : 0.01 , 0.11 ) ; = 0.05 ( 95 % CI : 0.01 , 0.08 ) ; and = 0.06 ( 95 % CI : 0.03 , 0.10 ) st and ard units ; P-trends = 0.004 , 0.002 , and < 0.001 for TICS , global cognition , and verbal memory , respectively ] . These associations were similar to those observed in women 1 - 1.5 y apart in age . In summary , long-term MeDi adherence was related to moderately better cognition but not with cognitive change in this very large cohort of older women
Objectives There has been little evaluation of the evidence relating dietary factors to functional capacity in older adults .
The aims were to i ) conduct a systematic review of studies assessing dietary factors in relation to six key functional indicators which impact on quality of life in adults ≥65 yrs : non-fatal cardiovascular events , cognition , mental health , falls and fractures , physical health ( muscle mass , strength ) and frailty ; and ii ) assess if there was sufficient evidence to devise food-based dietary recommendations .