Objective: To investigate the impact of lifestyle, apolipoprotein E (ApoE) gene, and their interaction on the risk for cognitive frailty in the elderly population in China. Methods: The study participants were from the Chinese Longitudinal Healthy Longevity Survey. The information about their lifestyles were collected by questionnaire survey, and a weighted lifestyle score was constructed based on β coefficients associated with specific lifestyles to assess the combined lifestyle. ApoE genotypes were assessed by rs429358 and rs7412 single nucleotide polymorphisms. Cognitive frailty was assessed based on cognitive function and physical frailty. Cox proportional hazards regression model was used to analyze the association of lifestyle and ApoE gene with the risk for cognitive frailty and evaluate the multiplicative and additive interactions between lifestyle and ApoE gene. Results: A total of 5 676 elderly persons, with median age [M (Q1, Q3)] of 76 (68, 85) years, were included, in whom 615 had cognitive frailty. The analysis by Cox proportional hazards regression model indicated that moderate and high levels of dietary diversity could reduce the risk for cognitive frailty by 18% [hazard ratio (HR)=0.82, 95%CI: 0.68-1.00] and 28% (HR=0.72, 95%CI: 0.57-0.91), respectively; moderate and high levels of physical activity could reduce the risk by 31% (HR=0.69, 95%CI: 0.56-0.85) and 23% (HR=0.77, 95%CI: 0.64-0.93), respectively. Healthy lifestyle was associated with a 40% reduced risk for cognitive frailty (HR=0.60, 95%CI: 0.46-0.78). ApoE ε4 allele was associated with a 26% increased risk for cognitive frailty (HR=1.26, 95%CI: 1.02-1.56). No multiplicative or additive interactions were found between lifestyle and ApoE gene. Conclusions: Dietary diversity and regular physical activity have protective effects against cognitive frailty in elderly population. Healthy lifestyle can reduce the risk for cognitive frailty in elderly population regardless of ApoE ε4 allele carriage status.
目的： 探讨中国老年人群生活方式和载脂蛋白E（ApoE）基因及两者交互作用对认知衰弱风险的影响。 方法： 研究对象来自中国老年健康影响因素跟踪调查，基于问卷调查收集生活方式信息，基于特定生活方式与结局关联的β系数构建加权生活方式评分以评估综合生活方式，ApoE基因型由rs429358和rs7412单核苷酸多态性位点评估，认知衰弱状态基于认知功能和躯体衰弱评估。采用Cox比例风险回归模型分析生活方式、ApoE基因与认知衰弱风险的关联，并评估生活方式和ApoE基因的相乘和相加交互作用。 结果： 5 676名老年人年龄M（Q1，Q3）为76（68，85）岁，共615名发生认知衰弱。Cox比例风险回归模型显示，中等和高水平的膳食多样性可分别降低18%［风险比（HR）=0.82，95%CI：0.68~1.00］和28%（HR=0.72，95%CI：0.57~0.91）的认知衰弱风险；中等和高水平的体力活动可分别降低31%（HR=0.69，95%CI：0.56~0.85）和23%（HR=0.77，95%CI：0.64~0.93）的认知衰弱风险。整体健康的生活方式可降低40%（HR=0.60，95%CI：0.46~0.78）的认知衰弱风险。ApoE ε4等位基因可使认知衰弱风险升高26%（HR=1.26，95%CI：1.02~1.56）。生活方式和ApoE基因间不存在相乘和相加交互作用。 结论： 膳食多样化和积极参与体力活动对老年人群认知衰弱具有保护作用，无论是否携带ApoE ε4等位基因，整体健康的生活方式均可降低老年人群认知衰弱的风险。.