Cardiometabolic dysregulation and cognitive decline: potential role of depressive symptoms

Abstract Background Previous studies have examined associations of cardiometabolic factors with depression and cognition separately. Aims To determine if depressive symptoms mediate the association between cardiometabolic factors and cognitive decline in two community studies. Methods Data for the analyses were drawn from the Rotterdam Study, the Netherlands (n = 2940), the Whitehall II study, UK (n = 4469) and the Canadian Longitudinal Study on Aging, Canada (n = 13,720). Results Mediation analyses suggested a direct association between cardiometabolic factors and cognitive decline and an indirect association through depression: poorer cardiometabolic status at time 1 was associated with a higher level of depressive symptoms at time 2 (standardised regression coefficient 0.07 and 0.06, respectively), which, in turn, was associated with greater cognitive decline between time 2 and time 3 (standardised regression coefficient of -0.15 and -0.41, respectively). Conclusions Evidence from three independent cohort studies suggest an association between cardiometabolic dysregulation and cognitive decline and that depressive symptoms tend to precede this decline. Key messages • Cardiometabolic dysregulation and depression might increase cognitive decline. • The association between cardiometabolic dysregulation and cognitive decline might be mediated by depression.

8Equal contribution  Skipping breakfast and late-night-eating have been associated with risk factors for type 2 diabetes (T2D). However, less is known about the link between daily timing and frequency of food intake and risk of developing T2D. The objective of the present study is to investigate the associations between circadian nutritional behaviours, defined by meal timings and frequency, and risk of T2D. 103,312 adults (79% females, mean age at baseline = 42.7) from the French NutriNet-Santé cohort were included. Participants' circadian nutritional behaviours were assessed using repeated 24 h dietary records. Associations of time of first and last meal of the day, meal frequency and of nighttime fasting duration with risk of T2D were assessed by multivariable Cox proportional hazard models adjusted for known risk factors. During a median follow-up of 7.3 years, 963 new cases of T2D were ascertained. Compared with subjects reporting on average a first meal before 8AM, those having a first meal after 9AM had a higher risk of developing T2D, HR = 1.59 (1.30 to 1.94). A late time of last meal (after 9PM) was associated with a higher risk of T2D, HR = 1.28 (1.06 to 1.54), but this association was no longer significant after adjusting for time of first meal. Each additional eating episode was associated with a reduction of the risk of T2D, HR = 0.95 (0.90 to 0.99), p-value = 0.01. Overall, nighttime fasting duration was not associated with risk of T2D, except in participants having breakfast before 8AM after a nighttime fasting duration of more than 13 hours (HR = 0.47, 0.27 to 0.82). In this large prospective study, circadian nutritional behaviours were associated with risk of T2D. Daytime nutritional behaviours and specifically an early first meal was associated with a lower risk of type 2 diabetes. If confirmed in other largescale studies, an early breakfast should be considered in preventive strategies for type 2 diabetes.

Key messages:
If confirmed in other largescale studies, an early breakfast could be considered in preventive strategies for type 2 diabetes. Beyond nutritional quality of meals, meal timing could also be a risk factor for type-2 diabetes.

Background:
Previous studies have examined associations of cardiometabolic factors with depression and cognition separately.

Aims:
To determine if depressive symptoms mediate the association between cardiometabolic factors and cognitive decline in two community studies.

Methods:
Data for the analyses were drawn from the Rotterdam Study, the Netherlands (n = 2940), the Whitehall II study, UK (n = 4469) and the Canadian Longitudinal Study on Aging, Canada (n = 13,720).

Results:
Mediation analyses suggested a direct association between cardiometabolic factors and cognitive decline and an indirect association through depression: poorer cardiometabolic status at time 1 was associated with a higher level of depressive symptoms at time 2 (standardised regression coefficient 0.07 and 0.06, respectively), which, in turn, was associated with greater cognitive decline between time 2 and time 3 (standardised regression coefficient of -0.15 and -0.41, respectively).

Conclusions:
Evidence from three independent cohort studies suggest an association between cardiometabolic dysregulation and Salt reduction policies are identified as effective; however, the assessment of their impact in European countries has been underexplored. The aim of this study is to assess the impact of salt reduction policies on hypertension in Portugal, to ultimately guide future policies. Based on national data, the top five foods contributing to salt intake, their salt content, and daily consumption were determined. Food reformulation included current policies and proposed targets for future agreements. Food availability trend from the main contributors was estimated from national food balance sheets. For this study, we considered five counterfactual scenarios (CF) to estimate salt intake variation: (1) reduction of salt content of foods targeted by current policies, while assuming stable consumption of the primary contributors; (2) proposal to extend CF 1 to other food categories; (3) change in the principal contributor's consumption based on the trend, assuming stable salt content; (4) combination of CF 2 and 3; (5) CF 4 and assuming a reduction of ''1 pinch of salt''. Relative risk was estimated from regression coefficients to then calculate the potential impact fraction (PIF) and ultimately provide the hypertension cases prevented per year for each CF. The change in salt intake expected by each CF is -11.16%, -13.57%, +0.12%, -13.40% and 23,99%, respectively. For each CF, PIF and hypertension cases avoided per year was, as follows (mean (95%CI) Sound scientific evidence is as critical to successful litigation as to effective public health policies. Increasingly, public health practitioners are asked to testify in court about the known health impacts of environmental harms. Collecting this evidence requires foresight, meticulous record-keeping, peersupport, and the courage to withstand questioning of professional capacity. In response to this need the Faculty of Public Health (UK), EUPHA-LAW, the Groningen Centre for Health Law in collaboration with Lancet Countdown, will publish a training package and toolkit for public health practitioners on public interest litigation to address climate change and environmental pollution. The workshop will review the role of litigation in advancing public health, and the outline and proposed uses for the toolkit, building on collaboration with environmental and legal organizations such as Greenpeace International and ClientEarth. Opportunities to engage with public health practitioners in regions outside Europe will also be explored.

Key messages:
Strategic alliances between public health practitioners, environmental advocates, legal experts and affected communities can use litigation and legal process to address common goals.