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Reference: Laurin, 2004
Cohort: Honolulu-Asia Aging Study
Risk Factor: Nutritional Antioxidants


Average Follow-up Time Detail
Range of follow-up time was 25.7 to 33.0 years.

Exposure Detail
Dietary vitamin E intake was evaluated using a 24-hour recall and a 26-item survey in midlife (1965-1968). Data was only used if participants described their 24-hour recall as a “typical” diet; 6.4% of participants were excluded from the analysis as a result. Nutrient intake was calculated using a modified Nutritionist IV. For their analyses, the investigators used total calorie-adjusted vitamin E intake, computed using the regression residual method (Willett W, Stampfer MJ. Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 1986; 124:17-27).

"A 24-hour dietary recall was administered to all subjects as part of examination 1 (1965-1968)... Dietitians trained in standardized procedures used appropriate food models and serving utensils to establish food consumption (30). According to predefined rules, the dietitians tallied foods eaten during the previous 24 hours on a precoded interview form (31). Subjects were asked whether the 24-hour recall was fairly typical or unusual (i.e., major difference due to under- or overeating or drinking). In addition, questions related to the frequencies of consumption of 26 selected food and drink items characteristic of Western or traditional Japanese diets, including tea, were asked at examinations 1 and 3. In 1996, the nutritional information (beta-carotene, vitamin C, vitamin E, and total energy intake) from the 24-hour recall was recoded and estimated for subjects with a typical diet (93.6 percent) using a modified Nutritionist IV (version 3.0) software program (N-Squared Computing, Salem, Oregon) that included over 9,700 food items with 75 nutrients. Nutrient estimates were calculated using the US Department of Agriculture nutrition data bank (32), the Canadian nutrition data bank (33), the Composition of Malaysian Foods (34), and other recipe and cookbook files (Dr. Kamal Masaki, Pacific Health Research Institute (Honolulu, Hawaii), personal communication, 2002). Food items specific to Hawaii and to the Japanese population were added directly from data provided by the Cancer Research Center of Hawaii and the Standard Tables of Food Composition in Japan (35) or were based on the recipes provided by the US Department of Agriculture Recipe File or Hawaiian cookbooks created using the software. Important sources of antioxidants in the Hawaiian diet include sweet potato, taro, bok choy, konbu, nori, and wakame for beta-carotene; breadfruit, sweet potato, turnip, guava, lychee, mango, and pineapple for vitamin C; and macadamia nuts, sweet potato, and mango for vitamin E.”

“Only subjects with recalls typical of their usual diet were considered.”

"Associations between intakes of specific antioxidants and outcomes were assessed after adjustment for total energy intake using the residual method."

Ethnicity Detail
Japanese men living in Hawaii.

Screening and Diagnosis Detail
Screening Method:
CASICognitive Abilities Screening Instrument (Teng 1994)
MMSEMini-Mental State Examination (Folstein 1975)
3MSEModified Mini-Mental State Examination (Teng 1987)

AD Diagnosis:
NINCDS ADRDA National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association Criteria (McKhann 1984)

Total Dementia Definition: Dementia via DSM IIIR.

“At baseline and at follow-up, subjects were first screened for dementia using the 100-point Cognitive Abilities Screening Instrument, a combination of the Hasegawa Dementia Screening Scale, the Folstein Mini-Mental State examination, and the Modified Mini-Mental State Test (24). Case-finding at examination 4 was conducted according to a multistep procedure using the Cognitive Abilities Screening Instrument score to determine subgroups for evaluation, a process described in detail elsewhere (22, 25). The dementia evaluation included a neurologic examination, neuropsychological testing, and an informant interview about changes in cognitive function and behavior. In subjects with dementia, a brain image was made and routine blood tests were conducted. On the basis of these data, a consensus diagnosis for dementia was given by the study neurologist and two physicians with expertise in dementia, according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (26). Probable of possible Alzheimer’s disease was diagnosed according to the National Institute of Neurological and Communicative Disorders and Stroke-Alzeheimer’s Disease and Related Disorders Association criteria (27).”

Covariates & Analysis Detail
Analysis Type:
Cox proportional hazards regression

Cox proportional hazards regression with delayed entry and with age as the time scale was used.

In addition to the the regression residual method (Willett W, Stampfer MJ. Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 1986; 124:17-27), total caloric intake was also used as a covariate in the analysis of calorie-adjusted vitamin E intake and AD.

AD Covariates:
Aage
Ggender
ALCalcohol intake
APOE4APOE e4 genotype
BMIbody mass index
Kcalcaloric intake
CVDcardiovascular disease
DBPdiastolic blood pressure
PAphysical activity
SMsmoking status
VITSsupplemental vitamin intake
SBPsystolic blood pressure
TCtotal cholesterol
YOByear of birth

TD Covariates:
Aage
Ggender
ALCalcohol intake
APOE4APOE e4 genotype
BMIbody mass index
Kcalcaloric intake
CVDcardiovascular disease
DBPdiastolic blood pressure
PAphysical activity
SMsmoking status
VITSsupplemental vitamin intake
SBPsystolic blood pressure
TCtotal cholesterol
YOByear of birth