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      Serum high‐density lipoprotein cholesterol is a protective predictor of executive function in older patients with diabetes mellitus

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          Abstract

          Aims/Introduction

          Older people with diabetes mellitus are at high risk for cognitive impairment or dementia. The clinical predictors for cognitive decline in older people with diabetes mellitus were elucidated.

          Materials and Methods

          This was a secondary analysis of a vitamin B 12 intervention trial in older people with diabetes mellitus. A total of 271 non‐demented individuals were followed up at 9‐month intervals for 27 months. We explored the association between baseline clinical features with changes in cognitive measures (Clinical Dementia Rating scale, Neuropsychological Test Battery including executive function z‐scores, psychomotor speed z‐scores and memory z‐scores).

          Results

          A total of 152 participants had normal cognition (Clinical Dementia Rating 0) and 119 had cognitive impairment (Clinical Dementia Rating 0.5) at baseline. After 27 months, 41 participants had cognitive decline, 36 of whom were cognitively normal at baseline. Multiple logistic regression showed no significant clinical predictor of global cognitive decline. Higher high‐density lipoprotein cholesterol ( HDL‐C) was associated with better executive performance at month 27 (β = 0.359, P < 0.001). Multilevel modeling showed that the highest tertile of HDL‐C was associated with better executive function z‐scores than the lowest tertile of HDL‐C at all time‐points.

          Conclusions

          Among older people with diabetes mellitus, higher serum HDL‐C was associated with better executive function.

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          Most cited references30

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          National Lipid Association recommendations for patient-centered management of dyslipidemia: part 1 - executive summary.

          Various organizations and agencies have issued recommendations for the management of dyslipidemia. Although many commonalities exist among them, material differences are present as well. The leadership of the National Lipid Association (NLA) convened an Expert Panel to develop a consensus set of recommendations for patient-centered management of dyslipidemia in clinical medicine. The current Executive Summary highlights the major conclusions in Part 1 of the recommendations report of the NLA Expert Panel and includes: (1) background and conceptual framework for formulation of the NLA Expert Panel recommendations; (2) screening and classification of lipoprotein lipid levels in adults; (3) targets for intervention in dyslipidemia management; (4) atherosclerotic cardiovascular disease risk assessment and treatment goals based on risk category; (5) atherogenic cholesterol-non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol-as the primary targets of therapy; and (6) lifestyle and drug therapies intended to reduce morbidity and mortality associated with dyslipidemia.
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            Comparison of effects of dietary saturated, monounsaturated, and polyunsaturated fatty acids on plasma lipids and lipoproteins in man.

            Twenty patients consumed a liquid diet in which the predominant fatty acids were either saturated (Sat), monounsaturated (Mono), or polyunsaturated (Poly). The fats in these three diets comprised 40% of total calories and consisted of palm oil, high-oleic safflower oil, and high-linoleic safflower oil, respectively. During the third and fourth week of each dietary period, multiple samples of blood were taken and were analyzed for plasma total cholesterol (TC), triglycerides (TG), and cholesterol in lipoprotein fractions (VLDL-C, LDL-C, and HDL-C). Twelve of the patients had normal TG levels; in these patients, both Mono and Poly diets caused statistically significant and equal lowerings of plasma LDL-C, but the Poly diet lowered HDL-C levels more frequently than did the Mono diet. Neither diet changed the level of plasma TG. The proportions of total protein and the various lipid components in isolated fractions (VLDL, IDL, LDL, HDL) were not altered by the two diets. Eight patients had hypertriglyceridemia; these individuals showed considerable variability in response to Mono and Poly diets. Although there was a trend towards reductions in TC and LDL-C levels by both types of unsaturated fats, the changes were inconsistent; furthermore, HDL-C concentrations were low on the Sat diet and were unaffected by either the Mono or the Poly diet. The results of this study show that oleic acid is as effective as linoleic acid in lowering LDL-C levels in normo-triglyceridemic patients, and oleic acid seemingly reduces HDL-C levels less frequently than does linoleic acid. Neither type of unsaturated fat had striking effects on lipoprotein levels of hypertriglyceridemic patients.
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              Severe hypoglycemia and cognitive decline in older people with type 2 diabetes: the Edinburgh type 2 diabetes study.

              People with type 2 diabetes are at increased risk of age-related cognitive decline and dementia. Hypoglycemia is a candidate risk factor, but the direction of association between episodes of severe hypoglycemia and cognitive decline in type 2 diabetes remains uncertain. In the Edinburgh Type 2 Diabetes Study, cognitive function was assessed in 831 adults with type 2 diabetes (aged 60-75 years) at baseline and after 4 years. Scores on seven neuropsychological tests were combined into a standardized general ability factor g. Self-reported history of severe hypoglycemia at baseline (history of hypoglycemia) and at follow-up (incident hypoglycemia) was recorded. A history of hypoglycemia was reported by 9.3% of subjects, and 10.2% reported incident hypoglycemia. Incident hypoglycemia was associated with poorer cognitive ability at baseline (age- and sex-adjusted odds ratio for lowest tertile of g 2.04 [95% CI 1.25-3.31], P = 0.004). Both history of hypoglycemia and incident hypoglycemia were also associated with greater cognitive decline during follow-up (mean follow-up g adjusted for age, sex, and baseline g -0.25 vs. 0.03 [P = 0.02] and -0.28 vs. 0.04 [P = 0.01], respectively), including after addition of vascular risk factors and cardiovascular and microvascular disease to the models (-0.23 vs. 0.03 [P = 0.04] and -0.21 vs. 0.05 [P = 0.03], respectively). The relationship between cognitive impairment and hypoglycemia appeared complex, with severe hypoglycemia associated with both poorer initial cognitive ability and accelerated cognitive decline.
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                Author and article information

                Contributors
                tkwok@cuhk.edu.hk
                Journal
                J Diabetes Investig
                J Diabetes Investig
                10.1111/(ISSN)2040-1124
                JDI
                Journal of Diabetes Investigation
                John Wiley and Sons Inc. (Hoboken )
                2040-1116
                2040-1124
                30 June 2018
                January 2019
                : 10
                : 1 ( doiID: 10.1111/jdi.2019.10.issue-1 )
                : 139-146
                Affiliations
                [ 1 ] Department of Medicine and Therapeutics the Chinese University of Hong Kong Prince of Wales Hospital Shatin Hong Kong
                [ 2 ] Department of Medicine Alice Ho Miu Ling Nethersole Hospital Taipo Hong Kong
                [ 3 ] Department of Medicine & Geriatrics Tai Po Hospital Taipo Hong Kong
                Author notes
                [*] [* ] Correspondence

                Timothy Kwok

                Tel.: +852‐2632‐3173

                Fax: +852‐2632‐3173

                E‐mail address: tkwok@ 123456cuhk.edu.hk

                Author information
                http://orcid.org/0000-0002-2416-7601
                http://orcid.org/0000-0002-1227-803X
                Article
                JDI12865
                10.1111/jdi.12865
                6319476
                29777621
                42c2bc0b-0746-45fe-b59a-8bc08330ce0b
                © 2018 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 06 March 2018
                : 25 April 2018
                : 15 May 2018
                Page count
                Figures: 1, Tables: 4, Pages: 8, Words: 6949
                Funding
                Funded by: Hong Kong Research Grant Council
                Award ID: CUHK468110
                Categories
                Original Article
                Articles
                Clinical Science and Care
                Custom metadata
                2.0
                jdi12865
                January 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.4 mode:remove_FC converted:04.01.2019

                cognitive function,diabetes mellitus,high‐density lipoprotein cholesterol

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