Habitual sugar intake and cognitive impairment among multi-ethnic Malaysian older adults

Figures & data

Figure 1 Prevalence of SA, UA, and MCI according to total population and gender. p>0.1 for chi-square analysis of the association between gender and cognitive status.

Abbreviations: SA, successful aging; UA, usual aging; MCI, mild cognitive impairment.

Table 1 Socio-demography characteristic and self-reported medical history of subjects

Parameters	SA (n=192)	UA (n=859)	MCI (n=158)	Total (n=1209)	p-value
Age (years)	66.48±4.92	68.67±5.82	66.66±4.76	68.08±5.63	0.000***
Ethnicity
Malay	116 (60.4)	572 (66.6)	83 (52.5)	771 (63.8)	0.007**
Non-Malay	76 (39.6)	287 (33.4)	150 (47.5)	438 (36.2)
Gender
Men	104 (54.2)	413 (48.1)	87 (55.1)	604 (50.0)	0.121
Women	88 (45.8)	446 (51.9)	71 (44.9)	605 (50.0)
Religion
Muslim	116 (60.4)	572 (66.6)	83 (52.5)	771 (63.8)
Non-Muslim	76 (39.6)	287 (33.4)	150 (47.5)	438 (36.2)	0.000***
Education level (years)	7.07±3.96	5.00±3.88	6.28±4.24	5.54±3.94
Education level
Primary (<6 years)	109 (56.8)	511 (59.5)	88 (55.7)	708 (58.6)	0.000***
Secondary (6–13 years)	62 (33.3)	153 (17.8)	44 (27.9)	259 (21.4)
Tertiary (>13 years)	8 (4.1)	16 (1.7)	5 (3.2)	29 (2.4)
No formal schooling	13 (6.8)	179 (20.8)	21 (13.3)	213 (17.6)
Marital status
Married	147 (76.6)	604 (70.3)	121 (76.6)	872 (72.1)	0.177
Single/divorced/widow	45 (23.4)	255 (70.0)	37 (75.6)	337 (27.9)
Household income (MYR)	1,614 (2000)	1,199 (2397)	1,260 (1899)	1,272 (2281)	0.077
Living status
Staying alone	18 (9.4)	94 (10.9)	22 (13.9)	134 (11.1)	0.391
Staying with others	174 (90.6)	765 (89.1)	136 (86.1)	1,075 (88.9)
Smoking status
Smoker	43 (22.4)	154 (17.9)	69 (15.2)	221 (18.3)	0.139
Non-smoker/ex-smoker	179 (77.6)	1,225 (82.1)	246 (74.8)	988 (81.7)
Alcohol consumption					0.909
Yes	7 (3.6)	7 (4.3)	37 (4.3)	51 (4.2)
No	185 (96.4)	822 (95.7)	151 (95.6)	1,158 (95.8)
Hypertension
Yes	0 (0.0)	553 (64.4)	117 (74.1)	670 (55.4)	0.000***
No	192 (100.0)	306 (35.6)	41 (25.9)	539 (44.6)
Diabetes mellitus
Yes	0 (0.0)	263 (30.6)	70 (44.30)	333 (27.5)	0.000***
No	192 (100.0)	596 (69.4)	88 (55.7)	876 (72.5)
Hyperlipidemia
Yes	45 (23.4)	406 (47.3)	96 (60.8)	547 (45.2)	0.000***
No	147 (76.6)	453 (52.7)	62 (39.2)	662 (54.8)
Stroke
Yes	0 (0)	19 (2.2)	5 (3.2)	24 (2.0)	0.073
No	192 (100.0)	840 (97.8)	153 (96.8)	1185 (98.0)
Osteoarthritis
Yes	41 (21.4)	251 (29.2)	57 (36.1)	349 (28.9)	0.009**
No	151 (78.6)	608 (70.8)	101 (63.9)	860 (71.1)
Heart disease
Yes	0 (0)	76 (8.8)	20 (12.7)	96 (7.9)	0.000***
No	192 (100.0)	783 (91.2)	138 (87.3)	1113 (92.1)

Notes: ***p<0.001; **p<0.01 significant at two-tailed using one-way ANOVA for the continuous independent variable and Pearson chi-square for categorical variable. Data presented as n (%) or mean ± SD.

Abbreviations: SA, successful aging; UA, usual aging; MCI, mild cognitive impairment.

Table 2 Types of sugar intake and aging category

Parameters (g/day)	Total (n=1,209)	SA (n=192)	UA (n=859)	MCI (n=158)	p-value
Total sugar intake^a	44.60 (26.21-68.81)	45.35 (26.60-69.91)	44.64 (25.43-68.84)	43.19 (28.35-66.31)	0.892
Free sugar intake^a	33.08 (17.48-57.26)	34.16 (16.63-56.10)	33.97 (18.10-58.31)	30.29 (16.68-49.54)	0.313
Fructose^a	3.12 (1.23-6.00)	2.86 (1.16-5.67)	3.76 (1.30-7.30)	3.97 (1.42-6.43)	0.004**
Glucose^a	3.16 (1.25-6.33)	3.75 (1.36-6.98)	2.92 (1.19-6.01)	3.91 (1.46-7.23)	0.032*
Sucrose^a	29.67 (14.72-51.71)	30.89 (13.90-51.24)	29.81 (14.87-52.78)	25.64 (14.63-47.62)	0.357
Maltose^a	1.41 (0.61-2.76)	1.64 (0.65-2.96)	1.35 (0.60-2.67)	1.46 (0.61-2.61)	0.245
Lactose^a	0.93 (0.13-4.83)	1.30 (0.24-4.58)	0.86 (0.13-4.84)	0.96 (0.10-5.41)	0.367
Sugar from cooked dishes^a	1.43 (0-3.40)	1.70 (0-3.71)	1.36 (0-3.16)	2.50 (0.73-4.31)	0.000***
Sugar from cakes and dessert^a	1.24 (0-5.02)	0.68 (0-4.43)	1.41 (0-5.25)	0.90 (0-4.90)	0.247
Sugar from processed foods^a	0.99 (0-3.22)	1.44 (0-3.56)	0.96 (0-2.91)	0.97 (0-3.87)	0.239
Sugar from sweetened beverages^a	29.42 (12.61-51.28)	29.18 (12.49-50.52)	24.32 (13.40-52.26)	29.72 (10.64-44.00)	0.108
Sugar from fruits^a	4.26 (0-11.07)	6.72 (0-13.10)	6.54 (0-13.42)	3.77 (0-9.92)	0.011**
Daily calorie intake^b	1,550.20 (430.54)	1,564.19 (388.82)	1,539.52 (435.64)	1,583.05 (450.09)	0.338
Carbohydrate^b	199.50 (64.23)	204.84 (71.20)	197.52 (63.42)	203.75 (59.30)	0.243
Protein^b	60.46 (38.02)	63.88 (62.23)	59.63 (33.20)	60.81 (19.30)	0.373
Fat^b	59.97 (40.77)	64.62 (64.80)	58.97 (36.13)	59.73 (22.65)	0.222
% of energy from total sugar^a	11.51 (8.25-15.21)	11.60 (8.29-15.23)	11.60 (8.08-15.38)	10.91 (8.67-14.22)	0.197
% of energy from free sugar^a	8.53 (5.51-12.66)	8.74 (5.52-12.22)	8.83 (5.75-13.03)	7.65 (5.10-10.63)	0.069

Notes: ***p<0.001; **p<0.01; *p<0.05 significant at two-tailed using one-way ANOVA or Kruskal–Wallis. ^aResult presented as median (IQR) and analyzed using Kruskal–Wallis; IQR=Q₁-Q₃. ^bResult presented as mean (SD) and analyzed using one-way ANOVA.

Abbreviations: SA, successful aging; UA, usual aging; MCI, mild cognitive impairment.

Table 3 Mean ± SD cognitive functions tests according to the percentile of total sugar intake

Cognitive function test	25th percentile<6 teaspoons (<26.22 g)	50th percentile6–9 teaspoons (26.22–44.61)	75th percentile 9–14 teaspoons (44.62–68.82 g)	100th percentile>14 teaspoons (>68.82 g)	η^2	p-value
Digit span	8.43 (2.93)	8.66 (2.89)	8.84 (4.72)	8.94 (6.29)	0.001	0.986
RAVLT immediate	49.49 (9.76)	49.69 (9.76)	49.79 (9.77)	48.27 (9.75)	0.002	0.354
RAVLT delayed	49.99 (9.65)	50.37 (10.16)	49.65 (10.32)	48.25 (9.85)	0.005	0.085
MMSE	25.47 (3.47)^c	25.30 (3.73)^b,c	25.18 (3.57)^b	24.07 (4.09)^a	0.033	0.000***
MoCA	21.50 (5.06)^b	20.90 (5.15)^a	21.37 (4.97)^a,b	20.40 (5.73)^a	0.016	0.000***
Digit symbol	10.88 (71.92)	5.01 (2.84)	8.09 (50.82)	7.50 (50.92)	0.002	0.668
VR-I	48.10 (34.22)^b	45.46 (34.18)^a,b	49.54 (34.91)^a,b	42.26 (33.91)^a	0.011	0.011*
VR-II	60.30 (35.19)	56.70 (35.73)	71.17 (35.68)	52.16 (36.81)	0.003	0.261

Notes: ***p<0.001; **p<0.01; *p<0.05 significant at two-tailed using ANCOVA, adjusted for covariates: gender, age, years of education, BMI, marital status, smoking status, alcohol consumption status, physical activity, geriatric depression scale. Different letters (a,b,c) in the same row indicate significant differences (p<0.001) based on Tukey post-hoc test.

Abbreviations: RAVLT, Rey’s auditory verbal learning test; MMSE, Mini-Mental State Examination; MoCA, Montreal Cognitive Assessment.

Table 4 Mean ± SD cognitive functions tests according to the percentile of free sugar intake

Cognitive function test	25th percentile <4 teaspoons (<17.49 g)	50th percentile 4–7 teaspoons (17.49–33.18)	75th percentile 7–12 teaspoons (33.19–57.12 g)	100th percentile >12 teaspoons (>57.12 g)	η^2	p-value
Digit span	8.78 (3.04)	8.51 (4.84)	8.88 (2.71)	8.71 (6.24)	0	0.835
RAVLT immediate	50.40 (10.08)^b	50.07 (9.87)^b	49.22 (9.55)^a,b	47.55 (9.35)^a	0.008	0.016*
RAVLT delayed	51.04 (10.21)^b	50.36 (10.15)^b	49.33 (9.85)^a,b	47.52 (9.55)^a	0.013	0.002**
MMSE	25.87 (3.44)^c	25.29 (3.72)^b,c	25.02 (3.54)^b	23.84 (4.03)^a	0.048	0.000***
MoCA	21.86 (5.08)^c	20.85 (5.28)^a,b,c	21.40 (4.88)^b,c	19.97 (5.54)^a	0.02	0.000***
Digit symbol	11.23 (71.76)	4.96 (2.85)	8.09 (50.90)	7.19 (50.92)	0.002	0.491
VR-I	51.98 (34.44)^c	44.38 (34.19)^a,b	49.36 (34.41)^b,c	39.59 (34.38)^a	0.019	0.000***
VR-II	63.90 (35.05)	55.23 (35.61)	72.18 (222.58)	48.93 (36.17)	0.005	0.177

Notes: ***p<0.001; **p<0.01; *p<0.05 significant at two-tailed using ANCOVA, adjusted for covariates: gender, age, years of education, BMI, marital status, smoking status, alcohol consumption status, physical activity, geriatric depression scale. Different letters (a,b,c) in the same row indicate significant differences (p<0.001) based on Tukey post-hoc test.

Abbreviations: RAVLT, Rey’s auditory verbal learning test; MMSE, Mini-Mental State Examination; MoCA, Montreal Cognitive Assessment.

Table 5 Multivariate-adjusted OR and 95% CI for cognitive impairment (MMSE <24) according to quintile of various sugar intake

Various sugar intake	25th percentile	50th percentile	75th percentile	100th percentile
Total sugar	1.0	1.64 (1.08–2.51)*	2.04 (1.34–3.10)**	3.30 (2.15–5.08)***
Free sugar	1.0	1.48 (0.968–2.28)	2.37 (1.54–3.65)***	3.58 (2.32–5.52)***
Fructose	1.0	0.83 (0.54–1.27)	0.86 (0.57–1.29)	0.73 (0.48–1.12)
Glucose	1.0	1.14 (0.77–1.69)	1.24 (0.82–1.87)	1.32 (0.87–2.00)
Sucrose	1.0	1.51 (0.98–2.33)	2.89 (1.87–4.44)***	3.33 (2.16–5.15)***
Maltose	1.0	1.09 (0.73–1.63)	0.93 (0.61–1.40)	1.36 (0.90–2.04)
Lactose	1.0	1.17 (0.78–1.76)	1.26 (0.85–1.89)	1.63 (1.09–2.43)*
SSB	1.0	1.66 (1.07–2.56)*	2.75 (1.78–4.22)***	3.69 (2.39–5.71)***
Cakes and dessert	1.0	0.78 (0.42–1.48)	1.70 (1.19–2.44)**	1.77 (1.23–2.55)**
Processed foods	1.0	0.81 (0.54–1.21)	1.08 (0.74–1.58)	0.75 (0.51–1.11)
Cooked dishes	1.0	1.34 (0.87–2.06)	0.90 (0.62–1.31)	0.69 (0.47–0.94)*
Fruits	1.0	1.19 (0.80–1.78)	0.86 (0.58–1.25)	0.65 (0.43–0.94)*

Notes: ***p<0.001; **p<0.01; *p<0.05 significant using binary logistic regression, adjusted for covariates: gender, age, years of education, BMI, marital status, smoking status, alcohol consumption status, physical activity, geriatric depression scale.