Dementia: WHO guidelines on minimising risk

According to the World Health Organisation (WHO), there are nearly 10 million new cases of dementia worldwide every year, with the figure set to triple by 2050.

The WHO evaluated 12 modifiable risk factors and offered advice on how to tackle them. It provides evidence-based recommendations on lifestyle behaviours and interventions to delay or prevent cognitive decline and dementia.

 

What is dementia?

Dementia is not a single disease, but rather an umbrella term that describes a group disorders. It’s a term used to describe a progressive deterioration of intellect and social functioning as a consequence of brain disease. Dementia is usually progressive and eventually severe.

There are over 100 different types of dementia, and any progressive brain disease (including e.g. multiple sclerosis) can include dementia later.

Alzheimer’s accounts for 70% of all dementias, affecting 20% of individuals over 85.

In practice, the term dementia is usually used for patients presenting with symptoms such as problems with memory, speech and understanding, where a general medical cause such as infection or a metabolic disturbance can’t be identified.

 

Who’s at risk?

Dementia can develop at any age from adolescence onwards, but is strongly age related, rare under the age of 60, and very rare under the age of 45.

The incidence increases from 6.7 per 1,000 persons, years 65–69, to 68.5 per 1,000 persons at age 85 years and above. About 5% of the population over 65 has dementia at any one time, and around 163,000 new cases of dementia occur in England and Wales each year.

Thus, as people get older and live longer, it is increasingly common and not unusual for patients to know others who have suffered, or have a family history of the condition. Although there are some genetic types of dementia, these usually present at a younger age.

 

Reducing risk

The WHO has launched its first ever guidelines on how people can reduce their risk of getting dementia.

The main takeaways in the guidelines are to exercise more and maintain a healthy diet, with an emphasis on the benefits of the Mediterranean diet – simple plant-based cooking, little or no meat and a healthy dose of olive oil.

Interestingly, supplementation with vitamins B and E, polyunsaturated fats and multi-complex supplements did not make a difference.

People should be looking for these nutrients through food; not through supplements.

 

Other notable factors

There is now ‘extensive evidence’ that smoking and alcohol are risk factors for dementia and cognitive decline.

In terms of other risk factors, the guidelines note the following may be offered to help reduce cognitive decline or dementia:

  • Cognitive training to older adults with normal cognition and mild cognitive impairment.
  • Weight management with interventions for overweight and/or obesity at mid-life
  • Management of dyslipidaemia at mid-life
  • Management of hypertension and diabetes for adults with these conditions

The WHO did not endorse games and other activities aimed at boosting thinking skills. These can be considered for people with normal capacities or mild impairment, but there’s little evidence of benefit.

 

Conclusion

While there is no cure for dementia, there is hope that having better overall health could help prevent it.

In summary, the WHO recommends staying away from tobacco, limiting your alcohol consumption, and maintaining a healthy blood pressure through a good diet and exercise.

It seems that what’s good for your heart is probably good for your brain too.

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Eating more fibre and whole grains lowers risk of death and disease, major study finds

Observational studies and clinical trials conducted over nearly 40 years reveal the health benefits of eating at least 25g or more of dietary fibre a day, according to research commissioned by the World Health Organization.

 

People who had higher intakes of dietary fibre and whole grains had lower rates of chronic diseases, such as heart disease, cancer and diabetes, compared to those with diets low in fibre and whole grains.

 

Main findings

Current UK guidelines recommend that people eat 30g a day, yet only 9 per cent of British adults meet the target. Fibre consumption is even worse in the US, with the average adult eating just 15g of fibre a day.

 

Higher fibre diets were associated with a 15 to 31 percent reduction in the risk of death and disease. That meant 13 fewer deaths and six fewer cases of coronary heart disease, per 1,000 participants in the studies.

 

People with diets high in whole grains saw similar benefits, with up to 33 percent reduction in risk, translating to 26 fewer deaths and seven fewer cases of coronary heart disease.

 

The study, published in The Lancet, one of the most prestigious and oldest medical journals, suggests eating at least 25 to 29 grams of dietary fibre per day to achieve these health benefits. Higher intakes could produce more benefits; however, the authors note that consuming copious amounts of it could have ill-effects for people with low iron or mineral levels.

 

The research consisted of analysing 185 observational studies and 58 clinical trials that were conducted over nearly 40 years.

 

The importance

This landmark study is important and timely because the Internet is a wasteland of deranged dietary advice. Quack ‘doctors’, self-proclaimed nutritionists, and – excuse my French – broscience baloney have infiltrated forums, social media and YouTube. In particular, there is a growing trend advocating the carnivore diet. This consists of consuming only animal foods. No fruits. No vegetables. But all the burgers, steaks and pork chops you want, which are often eaten raw by enthusiasts.

 

This dangerous and stupid dietary advice is gaining popularity, despite it being diametrically opposed to the robust, high quality empirical evidence that continues to emerge in the scientific literature.

 

Supporting evidence

For instance, another recent study, also published in The Lancet, showed that Tsimane people (forager-horticulturalist population of the Bolivian Amazon) have the lowest reported levels of vascular ageing of all populations yet studied. It turns out that their diet is largely carbohydrate-based (72%) and includes high fibre foods such as rice, plantain, corn, nuts and fruits. Protein constitutes only 14% of their diet, and they consume very low levels of fat. So much for the carnivore diet.

 

Conclusion

In summary, recent studies confirm that fibre and whole grain intakes are vitally important for longer term health. If your current diet is low in fibre, increase it gradually to help avoid bowel upset.

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