Malnutrition and Risk of Structural Brain Changes Seen on Magnetic Resonance Imaging in Older Adults

Marian A E de van der Schueren; Sabine Lonterman-Monasch; Wiesje M van der Flier; Mark H Kramer; Andrea B Maier; Majon Muller

doi:10.1111/jgs.14385

Malnutrition and Risk of Structural Brain Changes Seen on Magnetic Resonance Imaging in Older Adults

J Am Geriatr Soc. 2016 Dec;64(12):2457-2463. doi: 10.1111/jgs.14385. Epub 2016 Oct 28.

Authors

Marian A E de van der Schueren^{1

2}, Sabine Lonterman-Monasch³, Wiesje M van der Flier⁴, Mark H Kramer⁵, Andrea B Maier⁶, Majon Muller⁶

Affiliations

¹ Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
² Department of Nutrition, Sports and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
³ Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands.
⁴ Alzheimer Centre, Departments of Neurology and Epidemiology and Biostatistics, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
⁵ Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
⁶ Section of Gerontology and Geriatrics, Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands.

PMID: 27792245
DOI: 10.1111/jgs.14385

Abstract

Objectives: To study the associations between protein energy malnutrition, micronutrient malnutrition, brain atrophy, and cerebrovascular lesions.

Design: Cross-sectional.

Setting: Geriatric outpatient clinic.

Participants: Older adults (N = 475; mean age 80 ± 7).

Measurements: Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and according to serum micronutrient levels (vitamins B1, B6, B12, D; folic acid). White matter hyperintensities (WMHs), global cortical brain atrophy, and medial temporal lobe atrophy on magnetic resonance imaging (MRI) were rated using visual rating scales. Logistic regression analyses were performed to assess associations between the three MNA categories (<17, 17-23.5, ≥23.5) and micronutrients (per SD decrease) and WMHs and measures of brain atrophy.

Results: Included were 359 participants. Forty-eight participants (13%) were malnourished (MNA <17), and 197 (55%) were at risk of malnutrition (MNA = 17-23.5). Participants at risk of malnutrition (odds ratio (OR) = 1.93, 95% confidence interval (CI) = 1.01-3.71) or who were malnourished (OR = 2.80, 95% CI = 1.19-6.60) had a greater probability of having severe WMHs independent of age and sex than those with adequate nutritional status. Results remained significant after further adjustments for cognitive function, depressive symptoms, cardiovascular risk factors, history of cardiovascular disease, smoking and alcohol use, and micronutrient levels. Lower vitamin B1 (OR = 1.51, 95% CI = 1.11-2.08) and B12 (OR = 1.45, 95% CI = 1.02-2.04) levels were also related to greater risk of severe WMHs, independent of age and sex. Results remained significant after additional adjustments. MNA and vitamin levels were not associated with measures of brain atrophy.

Conclusion: Malnutrition and lower vitamin B1 and B12 levels were independently associated with greater risk of WMHs. Underlying mechanisms need to be further clarified, and whether nutritional interventions can modify these findings also needs to be studied.

Keywords: Mini Nutritional Assessment; brain atrophy; malnutrition; nutritional status; older adults; white matter hyperintensities.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged, 80 and over
Atrophy
Brain / pathology*
Cross-Sectional Studies
Female
Geriatric Assessment
Humans
Magnetic Resonance Imaging / methods*
Male
Malnutrition / pathology*
Micronutrients / blood
Nutrition Assessment
Nutritional Status*
Risk Factors

Substances

Micronutrients