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Energy and macronutrient intakes at breakfast and cognitive declines in community-dwelling older adults: a 9-year follow-up cohort study

journal contribution
posted on 2023-05-20, 22:58 authored by Shang, X, Eddy RoccatiEddy Roccati, Li, Y, He, M
Background: It is unclear whether breakfast consumption and breakfast composition are independently associated with changes in cognition over a long-term period in older adults.

Objectives: We aimed to examine the associations between energy and macronutrient intakes at breakfast and cognitive declines.

Methods: We included 2935 participants aged 55-93 y at baseline from the China Health and Nutrition Survey in our analysis. Cognition was assessed in 1997, 2000, 2004, 2006, and 2015. Dietary intake was assessed using weighing methods in combination with 24-h food records.

Results: Breakfast contributed to 25.9% of total energy intake of the day and percentages of breakfast energy intake from protein, fat, and carbohydrates were 12.8%, 11.5%, and 75.7%, respectively. During a median follow-up of 9 y, the β values for changes in global cognitive z-scores for Quintile 5 of protein and fat intakes at breakfast, with Quintile 1 as the reference, were 0.13 (95% CI: 0.01-0.25) and 0.17 (95% CI: 0.04-0.30), respectively. Substitution of 5% energy from carbohydrates with equivalent energy from protein (β, 0.06; 95% CI: 0.01-0.11) or fat (β, 0.05; 95% CI: 0.02-0.08) at breakfast was positively associated with the change in the global cognitive z-score. Energy intake at breakfast was not significantly associated with the global cognitive z-score. Similar results were found for the verbal memory z-score. The positive association of breakfast fat intake and the inverse association of breakfast carbohydrate intake with cognitive declines were stronger in urban residents.

Conclusions: Higher intakes of protein and fat and lower intake of carbohydrates at breakfast were associated with a lower rate of cognitive decline in older adults. Substitution of carbohydrates with protein or fat intake at breakfast may help to delay or prevent cognitive declines.


Publication title

American Journal of Clinical Nutrition: A Journal Reporting The Practical Application of Our World-Wide Knowledge of Nutrition




Wicking Dementia Research Education Centre


Amer Soc Clinical Nutrition

Place of publication

9650 Rockville Pike, Subscriptions, Rm L-3300, Bethesda, USA, Md, 20814-3998

Rights statement

Copyright The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition

Repository Status

  • Restricted

Socio-economic Objectives

Disease distribution and transmission (incl. surveillance and response); Health related to ageing