The Paradox of Overnutrition in Aging and Cognition

The Paradox of Overnutrition in Aging and Cognition

Tuesday, December 4, 2012

The New York Academy of Sciences

This conference is aimed at presenting cutting-edge research on linking overnutrition, aging and cognition. While overnutrition and cognition must be well defined and appropriately measured for the elderly population, they may also serve as indicators for accelerated aging and for assessing potential risk factors. Various strategies including the use of imaging and metabolic markers, as well as the identification of predictors in the aging process such as aging-related physical impairment need to be employed to understand the linkages between overnutrition and the aging process especially its cognitive aspects. This symposium will explore these linkages from a clinical and epidemiological perspective. The audience includes students and scientists working on aging and nutrition research and their application in preventive and curative medicine.

Reception to follow.

Registration Pricing

 By 11/1/2012After 11/1/2012Onsite
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Student/Postdoc Member$20$30$30
Nonmember (Academia)$40$50$50
Nonmember (Corporate)$65$75$75
Nonmember (Non-profit)$40$50$50
Nonmember (Student / Postdoc / Fellow)$40$50$50

 

Presented by

  • Sackler"

Agenda

* Presentation times are subject to change.


December 4, 2012

8:00 AM

Registration

9:00 AM

Introduction and Welcome
Mandana Arabi, MD, PhD, The Sackler Institute for Nutrition Science
Deborah Gustafson, PhD, SUNY Downstate
Medical Center; University of Gothenburg

Session I: Chaired by John G. Kral, MD, PhD, SUNY Downstate Medical Center

9:15 AM

Systems Biology Approaches to Overnutrition and Aging
Josef Penninger, MD, IMBA-Institute of Molecular Biotechnology of the Austrian Academy of Sciences

9:45 AM

Precursors and Secular Trends in Metabolic Disease - A Global Perspective
David Phillips, PhD, University of Southampton

10:15 AM

Body Composition Over the Lifecyle — Sarcopenia, Normal vs. Pathologic
Steven B. Heymsfield, MD, Pennington Biomedical Research Center,  Louisiana State University

10:45 AM

Skeletal Muscle Power: A Critical Determinant of Physical Functioning in Older Adults.
Roger A. Fielding, PhD, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University

11:15 AM

Discussion

11:35 AM

Coffee Break

Session II: Chaired by Deborah R. Gustafson, PhD, SUNY Downstate Medical Center; University of Gothenburg, Sweden

11:50 AM

Cognitive Reserve and Aging: Observations of Epidemiologic and Imaging Studies
Yaakov Stern, PhD, Columbia University College of Physicians and Surgeons

12:10 PM

Diabetes, Cognition and Dementia
Lenore J. Launer, PhD, National Institute on Aging, National Institutes of Health

12:40 PM

Discussion

1:00 PM

Networking Lunch

Session III: Chaired by John G. Kral, MD, PhD, SUNY Downstate Medical Center

2:15 PM

The Paradox of Anthropometric Indicators in Aging, Cognition and Dementia
Deborah Gustafson, PhD, SUNY Downstate Medical Center; University of Gothenburg

2:45 PM

Nutrition and Cognition: Limitations, Complexities and Interpretations
Nikos Scarmeas, MD, University of Athens; Columbia University

3:15 PM

Bariatric Surgery, Cognitive Function and Alzheimer's Disease
John Gunstad, PhD, Kent State University

3:45 PM

Panel Discussion: Realistic Plans
Facilitator: John G. Kral, MD, PhD, SUNY Downstate Medical Center

4:30 PM

Meeting Close — Networking reception

Speakers

Organizers

Deborah Gustafson, PhD

SUNY Downstate Medical Center; University of Gothenburg

Deborah Gustafson is a Professor at the State University of New York-Downstate Medical Center, Departments of Neurology and Medicine, Section for NeuroEpidemiology, as well as the University of Gothenburg, Sahlgrenska Academy, Neuropsychiatric Epidemiology Research Unit, in Sweden. She is the Swedish Research Council Senior Researcher in Psychiatric Epidemiology. Dr. Gustafson was the first to report on a relationship between overweight and risk of Alzheimer's disease based on population-based studies in Sweden. She continues to explore potential mechanisms of adipose tissue, as well as vascular and metabolic factors, in relationship to mental disorders and brain structure. She has a global research focus and collaborates with research teams in Europe, South America and Asia. In New York City, she is Co-PI of the Women’s Interagency HIV Study (WIHS), a multi-center study across the US, in which she is exploring the role of anthropometric indices, adipose tissue hormones, and genetic susceptibility in relation to cognition in a diverse sample of women with HIV. Deborah is the recipient of grants from the National Institutes of Health (NIH, USA), the European Union, and the Swedish Research Council. Dr. Gustafson has over 100 peer-reviewed or invited publications. She is an invited speaker at international meetings on the topics of adiposity, vascular factors, and prevention of dementia and other mental disorders in the elderly. Deborah received her educational training from the University of Minnesota and held an NIH postdoctoral fellowship.

John G. Kral MD, PhD

SUNY Downstate Medical Center

With an MA in Behavioral Neuroscience, Dr. Kral attended medical school at the University of Göteborg, Sweden, where he completed residencies in Surgery and Medicine and PhD studies on adipose tissue and lipid and carbohydrate metabolism. He initiated the program for obesity surgery there and, in 1981, the Division of Surgical Metabolism at St. Luke’s-Roosevelt Hospital Center, Columbia University, as a member of the first NIH Obesity Research Center. Apart from studies of body composition, adipose tissue receptors and lipid and carbohydrate metabolism his career-long interests have included ingestive behavior and determinants of the chronic inflammatory insulin resistant over-nutrition syndrome. In 1983 he co-founded the American Society for Bariatric Surgery and co-organized the 1991 NIH Consensus Development Conference: Gastrointestinal Surgery for Severe Obesity. Dr Kral has investigated the effects of intestinal diversion on hyperinsulinemia, gastric emptying, intestinal adaptation, microflora and mucosal immunity and performed the first clinical studies of vagotomy for the treatment of obesity. His most recent research concerns early-life stress as a precursor of insulin resistance in monkeys as well as effects of gestational stress on urban health, gene polymorphisms associated with human appetite regulation and the importance of the intrauterine environment and epigenetic changes for the development of adolescent human obesity and insulin resistance. He is a member of the steering committee on Overnutrition of the Sackler Institute for Nutrition Science founded in 2011 at the New York Academy of Sciences.

Mandana Arabi MD, PhD

The Sackler Institute for Nutrition Science

Speakers

Roger A. Fielding, PhD

Tufts University

Roger A. Fielding is Director and Senior Scientist of the Nutrition, Exercise Physiology, and Sarcopenia (NEPS) Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. He is also Professor of Nutrition at the Friedman School of Nutrition Science and Policy, Professor of Medicine at Tufts University School of Medicine, and Lecturer of Physical Medicine and Rehabilitation at Harvard Medical School. Currently, he also serves as the Associate Director of the Boston Claude D. Pepper Older Americans Independence Center.

After graduating from Boston University with a BS in Health Sciences, Dr. Fielding received a Master of Arts in Physical Education from Ball State University in 1985. In 1993, he graduated with his PhD from Tufts University after researching the modulation of skeletal muscle protein metabolism and the effect of exercise-induced muscle injury. Thereafter, he began his research career in the Department of Health Sciences at Boston University, initiating studies that examined the role of skeletal muscle power output on physical function and disability in older adults, as well as parallel studies examining the influence of aging on intracellular signaling events in contracting skeletal muscle. In 2004, Dr. Fielding was recruited to the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and has since conducted numerous clinical studies of exercise and muscle function in older adults. As a Senior Scientist, he has explored the effects of nutritional, pharmacological, and exercise therapies on changes in skeletal muscle structure and function with advancing age, and has examined the role of nutrition and exercise on muscle performance in older animals and humans. Dr. Fielding is an internationally known researcher who studies the underlying mechanisms contributing to the age-associated decline in skeletal muscle mass, the resultant impact on function, and the potential role of exercise, nutrition, and physical activity on attenuating this process.

Dr. Fielding has a strong record of extramural funding including support from the NIH, USDA, foundations and industry. He serves on the editorial boards of the Journal of Nutrition, Health and Aging, and the Journal of Nutrition and Metabolism and the Journal of Gerontology for Medical Sciences. He has also served as a reviewer on numerous NIH study sections and was recently elected to the NIH/CSR College of Reviewers.

John Gunstad, PhD

Kent State University

John Gunstad obtained a BA in Psychology from Moorhead State University (Moorhead, MN). He attended graduate school at Ohio University and earned a PhD in Clinical Psychology, with concentrations in Clinical Neuropsychology and Health Psychology. Dr. Gunstad completed his internship and postdoctoral fellowship in Clinical Neuropsychology at Brown Medical School (Providence, RI). He worked under the supervision of Dr. Ronald Cohen and Dr. Robert Paul, where he began a line of programmatic work in the neurocognitive effects of medical conditions including obesity and cardiovascular disease. He joined the faculty of Kent State University in the Fall of 2005 and is now Associate Professor in the Department of Psychology and leads the neuropsychology training program.

Deborah Gustafson, PhD

SUNY Downstate Medical Center; University of Gothenburg

Steven B. Heymsfield, MD

Pennington Biomedical Research Center

Steven B. Heymsfield, MD is the Executive Director of Pennington Biomedical Research Center of the Louisiana State University System and he holds the George A. Bray, Jr. Chair in Nutrition. Previously he was the Global Director of Scientific Affairs for the obesity franchise at Merck & Co. where he oversaw scientific aspects of the Company's obesity drug development program. Dr. Heymsfield received a degree in medicine from Mount Sinai School of Medicine, and he completed his internship and residency at Emory University, continuing on to become a Fellow in Medicine prior to his Columbia University appointment as Professor of Medicine and Deputy Director, New York Obesity Research Center, in 1986.

Dr. Heymsfield has published more than 450 peer-reviewed papers covering topics such as obesity, anorexia nervosa, bulimia nervosa, malnutrition, pregnancy, body composition, and caloric expenditure. His contributions to the study of human nutrition led to the TOPS Award from NAASO, the Rhoads Award of the American Society of Parenteral and Enteral Nutrition, and the Forbes Memorial Award Lecture, International Society of Body Composition Research. He was honored for his role in the FDA ban on ephedra, receiving the 2004 NYC Mayor's Award for Science and Technology. Dr. Heymsfield was elected Fellow of the American Society for Nutrition in 2009 and Fellow of the American Society of Parental and Enteral Nutrition in 2012.

In addition to his strong interest in biological method development, Dr. Heymsfield maintains an active clinical research program, extending his earlier research at Columbia University. Dr. Heymsfield is past President of the American Society of Clinical Nutrition and of the American Society of Parenteral and Enteral Nutrition.

Lenore J. Launer, PhD

National Institute on Aging, National Institutes of Health

Dr. Launer received her PhD in epidemiology and nutrition from Cornell University. From 1990 to 1999 she held academic appointments in the Netherlands (Erasmus University Medical School, Free University, National Institute for Public Health) where she collaborated in many epidemiologic studies of neurologic diseases including dementia and migraine headache. Dr. Launer joined the National Institute on Aging Intramural Research Program as Chief of the Neuroepidemiology Section in February 1999.

Dr. Launer’s research interests include studies focused on understanding the contribution of genetic, inflammatory, metabolic, vascular, and hormonal factors to sub-clinical and clinical outcomes in brain disease and investigating the links between brain disease and other common diseases of old age. Research is conducted using large epidemiologic studies, which allow testing in the general population, hypotheses on risk/protective factors and mechanisms identified at a more basic science level.

Josef Penninger, MD

IMBA-Institute of Molecular Biotechnology of the Austrian Academy of Sciences

Josef Penninger was born in 1964 in Gurten, Austria. He received a High School education in classical humanities and studied Medicine, Immunology, and History of Arts in Innsbruck, Austria. After his graduation in 1990, he left Austria to pursue postgraduate studies at the Ontario Cancer Institute in Toronto. From 1994 to 2002, Josef Penninger worked as a lead researcher at the Amgen Research Institute in Toronto affiliated with the University of Toronto and the Ontario Cancer Institute. In 2002, he accepted the appointment as director of the newly established Institute of Molecular Biotechnology of the Austrian Academy of Sciences, IMBA, and moved back to Vienna. Currently, Josef Penninger is Full Professor in the Departments of Immunology and Medical Biophysics at the University of Toronto, Professor of Genetics at the University of Vienna, Austria, and Honorary Professor of the Chinese Academy of Sciences/Peking Union Medical College.

Scientifically, his basic approach is to genetically manipulate and change genes in mice and to determine the effects of these mutations in the development of the whole organism and in diseases. Through these mutations, he tries to establish basic principles of development and basic mechanisms of disease pathogenesis. The main focus of his laboratory lies on heart and lung diseases, autoimmune diseases and cancer, as well as bone metabolism disorders.

Josef Penninger has received various prizes and honors, such as the EU Excellence Award (2004), Elected Young Global Leader by the World Economic Forum (2005), Ernst Jung Prize for Medicine (highest endowed medicine prize in Europe, 2007), Descartes Prize (highest EU research prize, 2007), Carus Medal (2008), ESCI Award for Excellence in Biomedical Investigation, ASMR-Medal of the Australian Society for Medical Research (2009), the Award as Elected Fellow of the American Association for the Advancement of Science (2011) and the Innovator Award, Era of Hope by the US Department of Defense (2012).

David Phillips, PhD

University of Southampton

David Phillips is Professor of Endocrine and Metabolic Programming at the University of Southampton, UK. He is also an Honorary Consultant Physician in Endocrinology and Diabetes for the Southampton University Hospitals NHS Trust. He trained at the University of Cambridge and St Thomas’ Hospital, London, and following junior hospital appointments was awarded a Wellcome Trust Research Training Fellowship at the University of Southampton, where he completed a PhD thesis on the epidemiology of thyroid disease. This work subsequently took him to Zaïre, Central Africa, where he carried out a trial of iodine supplementation on behalf of the UK Charity, OXFAM. On his return he was appointed Lecturer in Endocrinology at the University of Wales College of Medicine, Cardiff. He was appointed to his current position in 1991. In Southampton his research programme has centred on the developmental origins of type 2 diabetes, the metabolic syndrome and related conditions. The work has been funded by the Medical Research Council, The Wellcome Trust, The National Institutes of Health and several UK-based charities. He collaborates extensively with research groups in other universities both in the UK and abroad and holds professorial appointments at the University of Toronto, Canada, and The University of Adelaide, South Australia.

Nikos Scarmeas, MD

University of Athens; Columbia University

Dr. Nikos Scarmeas was born and raised in Athens, Greece. After obtaining an MD degree from the University of Athens he moved to the United States for a neurology residency training, followed by a 2-year clinical fellowship in Aging and Dementia at Columbia University Medical Center. He also completed a Masters degree in Biostatistics – Epidemiology at the Mailman School of Public Health at Columbia University. Dr Scarmeas joined the faculty of Columbia University in 2002. He is currently an Associate Professor of Neurology and shares his time between research and clinical work at Columbia University and at the University of Athens. His clinical work includes seeing elderly patients with dementias and cognitive dysfunction and supervising and teaching medical students and neurology residents.

His research interests began with the topic of cognitive reserve (i.e. how higher IQ, education, more demanding occupational attainments, or more engagement in cognitive-social-physical leisure - lifestyle activities can help elderly cope better with the damage caused to their brains by Alzheimer’s disease and aging, and therefore reduce their risk for dementia and slow down their rates of cognitive and functional decline). More recently, he has developed a special interest in the contribution of diet (in particular composite dietary patterns such as a Mediterranean-type diet and others) and physical activity in dementias and healthy aging. Dr Scarmeas is the Principal Investigator in studies funded by either the Alzheimer's Association or the NIH-NIA and a Co-Investigator in multiple others. His research work has resulted in more than 100 original publications in highly esteemed journals and multiple presentations in internationally acclaimed scientific conferences - meetings. He reviews for multiple international scientific journals and international funding agencies including the Alzheimer’s Association, the US National Institute of Health, the European Union Marie Curie programs etc.

Yaakov Stern, PhD

Columbia University College of Physicians and Surgeons

Dr. Stern earned his BA in Psychology at Touro College in New York City. He earned his PhD at the Experimental Cognition program of City University of the City of New York. Dr. Stern directs the Cognitive Neuroscience Division of the Department of Neurology at Columbia University College of Physicians and Surgeons, where he is Professor of Clinical Neuropsychology in the Departments of Neurology, Psychiatry, and Psychology, as well as in the Sergievsky Center and the Taub Institute for the Research on Alzheimer’s Disease and the Aging Brain. He is Associate Director of the Alzheimer’s Disease Research Center and directs the post-doctoral training program “Neuropsychology and Cognition in Aging.” He is on the Medical and Scientific Advisory Council of the Alzheimer's Association and associate editor of JINS. Dr. Stern’s research focuses on cognition in normal aging and in diseases of aging, particularly Alzheimer’s disease. Dr. Stern’s research approach includes classic neuropsychological and cognitive experimental techniques, with a strong focus on functional imaging. He has published over 400 peer-reviewed papers, numerous chapters, and edited a book on cognitive reserve.

 

Abstracts

Systems Biology Approaches to Overnutrition and Aging
Josef Penninger, MD, IMBA-Institute of Molecular Biotechnolgy of the Austrian Academy of Sciences, Vienna, Austria

Over 1 billion people are estimated to be overweight placing them at risk for diabetes, cardiovascular disease and cancer. We performed a systems level genetic dissection of adiposity regulation using genome-wide RNAi-screening in adult Drosophila. Candidate obesity genes were further functionally classified using muscle-, oenocyte-, fat body- and neuronal-specific drivers. Among multiple known and novel candidate genes revealed, hedgehog signaling scored as the most prominent fat-body specific obesity pathway. To translate these findings into mammals, we generated adipose tissue specific Sufu mutant mice. Intriguingly, these aP2-SufuKO mice displayed near total loss of white-, but not brown-, adipose tissue compartments. Mechanistically, activation of hedgehog signaling blocked differentiation of white adipocytes through direct dysregulation of early adipogenic factors. These findings link in vivo RNAi-based scanning of the Drosophila genome to regulation of adipocyte cell fate in mammals.

Precursors and Secular Trends in Metabolic Disease - A Global Perspective
David Phillips, PhD, Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

Type 2 diabetes and related metabolic diseases have now become epidemic in resource-poor countries that have undergone rapid westernization and where the consumption of energy-rich diets with reduced physical activity have led to the development of obesity. These conditions together with their greatly increased risk of cardiovascular disease pose a major challenge to the often poorly developed health services. Recent research has suggested that these trends could result from the process of developmental plasticity. Populations adapt to poor living conditions and chronic undernutrition by developing non-genetic, phenotypic alterations in their body composition and metabolism, processes that originate during fetal life and extend into infancy. The mechanisms underlying these alterations are still obscure but seem to involve permanent endocrine changes, especially in the biological response to stress, and changes in related physiological systems that are in turn thought to result from altered epigenetic regulation. The phenotypic alterations are lifelong and appropriate or adaptive if these populations continue to live in poor conditions. However, they are inappropriate or maladaptive if the populations experience overnutrition predisposing to metabolic disorders and the accompanying accelerated mortality from cardiovascular disease. An important consequence of this model of disease is the suggestion that improving the nutrition of pregnant women and infants may be one of best ways of tacking this serious emerging problem in global health.

Body Composition Over the Life Cycle - Sarcopenia, Normal vs. Pathologic
Steven B. Heymsfield, MD, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA

Skeletal muscle is that largest body compartment in children and adults except for those with severe obesity in whom excess adiposity predominates. Peak skeletal muscle mass is reached by the beginning of the second decade and begins a gradual decline thereafter starting around the fourth and fifth decade. Race and sex differences are present in peak skeletal muscle mass and declines in mass with aging are moderated by activity levels, senescence-related hormonal effects, and other as yet not-well defined environmental and genetic factors. Sarcopenia represents the pathological manifestation of normal age-related loss of skeletal muscle mass and associated metabolic and mechanical functions leading to increased morbidity and mortality. Sarcopenia is an important component of closely related “frailty” that also commutes greater health risks. Recent studies support the existence of obesity-sarcopenia in which skeletal muscle mass loss is masked by an enlarged adipose tissue compartment with synergistic adverse clinical effects. The presentation will review development of the skeletal muscle compartment, including moderating factors along with our current understanding of pathologic sarcopenia.

Skeletal Muscle Power: A Critical Determinant of Physical Functioning in Older Adults
Roger A. Fielding, PhD, Tufts University, Boston MA

Muscle power declines earlier and more precipitously with advancing age compared to muscle strength. Peak muscle power has also emerged as an important predictor of functional limitations in older adults. Our current working hypothesis is focused on examining lower extremity muscle power as a more critical variable in understanding the relationship between impairments, functional limitations, and resultant disability with aging.

Cognitive Reserve and Aging: Observations of Epidemiologic and Imaging Studies
Yaakov Stern, PhD, Columbia University College of Physicians and Surgeons, New York, NY

The concept of reserve emerged from observations of a disjunction between the degree of brain damage or pathology and the clinical manifestation of that damage. For example, two individuals with the same amount of Alzheimer's disease pathology can have widely divergent severity of clinical dementia. In addition, many studies indicate that a set of life experiences such as educational and occupational exposure and leisure activities are associated with reduced risk of developing dementia and with a slower rate of memory decline in normal aging. This talk will provide a theoretical account of reserve. It will review epidemiologic research that has lent support to the concept of cognitive reserve, and present imaging studies intended to elucidate the neural underpinnings of cognitive reserve.

Diabetes, Cognition and Dementia
Lenore J. Launer, PhD, National Institute on Aging, National Institutes of Health, Bethesda, MD

One of the more serious consequences of overnutrition is the development of Type 2 Diabetes (T2D). Studies report robust findings of increased cognitive impairment and possibly dementia in persons with T2D. Evidence for the underlying structural functional changes will be presented. Specifically we will discuss changes in brain MRI and cognition that have been reported from observational studies as well as the first prevention trial, ACCORD MIND, designed to mitigate adverse brain changes in persons with T2D. Studies suggest there is a gradient in cognitive function associated with diabetes-related characteristics, such as disease duration and glycemic control, and that there is a strong association of T2D with total brain atrophy and a weaker association with white matter small vessel disease. These data will then be discussed in the context of the conference theme on overnutrition.

The Paradox of Anthropometric Indicators in Aging, Cognition and Dementia
Deborah R. Gustafson, PhD, State University of New York Downstate Medical Center, Brooklyn, New York, University of Gothenburg, Sweden

Anthropometric indicators of overnutrition are linked to clinical dementia and Alzheimer’s Disease (AD), as well as overall mortality. Epidemiological studies show that higher levels of body mass index (BMI), waist circumference or waist-to-hip ratio (WHR), in mid- and late-life may increase risk for dementia, whereas decline in body weight or BMI, and subsequent underweight in the years preceding and at the time of a dementia diagnosis also relate to increased risk of dementia. Also observed is that a higher BMI at age 70 years and older is positively related to survival. The role of adipose tissue during different periods of life in relation to later and concurrent risk for cognitive decline and dementia, as well as overall aging, is not understood. Biological mechanisms relating adipose tissue to the ageing brain and neurocognitive symptoms are unclear, however effects on both peripheral and central metabolism are hypothesized. Hypotheses relating adipose tissue to cognitive decline and dementia may involve effects on the peripheral and cerebral vasculature, adipose tissue hormones (adipokines) and adipose tissue-related hormones interacting with brain nuclei that are important for neurocognition, effects on energy metabolism, change in adipose tissue morphology over time, and genetic susceptibility based on adipose tissue-related systems and the brain. Given the ubiquity of adipose tissue and its multi-functionality, metabolic implications over the life course on health of the brain and other ageing processes are large.

Nutrition and Cognition: Limitations, Complexities and Interpretations
Nikos Scarmeas, MD, University of Athens, Greece; Columbia University, New York, NY

Previous studies have related different aspects of cognitive performance and risk for Alzheimer’s disease or other dementias with a series of micronutrients, macronutrients, foods and dietary patterns. Overall, this literature is quite extensive. However, at the same time it is also very conflicting since noted associations are often not replicated or confirmed in subsequent studies. As a result no clear recommendations can be articulated regarding nutritional habits that may optimize cognitive performance or protect from dementia/cognitive impairment. This state of scientific uncertainty can be related to a series of reasons including variability in subjects’ baseline levels of each nutrient or food, limitations of observational epidemiological approaches (vs. advantages of clinical trials), inherent inaccuracies in measurements of both the outcome (cognition) and exposure (nutrition), complexity of diet coupled with a reductionistic consideration of limited nutritional elements (vs. a more holistic one of dietary patterns), limited information on central nervous system nutrient biomarkers, and multiplicity of cerebral biological mechanisms with potential nutritional effects of interacting and even opposing directionality. We will review examples of the above and will discuss attempts to partially address some of these issues.

Bariatric Surgery, Cognitive Function, and Alzheimer's Disease
John Gunstad, PhD, Kent State University

More than two-thirds of American adults have an elevated body mass index (BMI) and obesity is a leading preventable cause of death. In addition to its many other health consequences, obesity is now recognized as an independent risk factor for adverse neurocognitive outcomes, including Alzheimer’s disease, stroke, and accelerated cognitive decline. Recent work demonstrates that structural brain abnormalities and cognitive dysfunction can also be identified long prior to the onset of these conditions. Bariatric surgery is an effective treatment for severe obesity, though its neurocognitive effects are poorly understood. All surgeries confer some risk of post-operative cognitive impairment and the vitamin deficiencies associated with bariatric surgery may increase this risk. However, these procedures improve or even resolve many medical conditions with known adverse effects on the brain and may thus ultimately reduce risk for conditions like Alzheimer’s disease. Our findings indicate that uncomplicated bariatric surgery has cognitive benefits at 12 weeks and 12 months post-operatively. Further studies are needed to clarify the mechanisms for these cognitive gains and the potential for reducing long-term risk of pathological cognitive decline.

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