Dietary Supplement Intake and Its Association with Cognitive Function, Physical Fitness, Depressive Symptoms, Nutritional Status and Biochemical Indices in a 3-Year Follow-Up Among Community Dwelling Older Adults: A Longitudinal Study

Figures & data

Table 1 Baseline Characteristics of Participants [Presented as n(%) or Mean±Standard Deviation]

	Consume Vitamin and Mineral Supplements		Consume Herbal Supplement
	Yes (n=665)	No (n=1622)^†	Yes (n=389)	No (n=1880)^†
Gender
Men	284 (42.7)	812 (50.1)**	225 (57.8)	863 (45.9)***
Women	381 (57.3)	810 (49.9)	164 (42.2)	1017 (54.1)
Age, years	70.0±6.1	69.1±6.3	68.2±5.8	69.2±6.3***
Education years	6.47(4.41)	4.61(3.68)	5.88(3.75)	5.00(4.02)
Race
Malay	388 (58.3)	1043(64.3)***	293 (75.3)	1123(59.7)***
Chinese	225 (33.8)	511 (31.5)	90 (23.1)	642 (34.1)
Indian	48 (7.2)	67 (4.1)	5 (1.3)	111(5.9)
Others	4 (0.6)	1 (0.1)	1 (0.3)	4 (0.2)
Family history of dementia
Yes	49 (7.4)	115 (7.1)	35 (9.0)	128 (78.5)
No	578 (86.8)	1408 (86.8)	337 (86.6)	1631 (86.8)
Not sure	38 (5.7)	99 (6.1)	17 (12.3)	121 (87.7)
Smoking Status
Smoker	68 (10.2)	324 (20.0)***	72 (18.5)	315 (16.8)**
Ex-smoker	77 (11.6)	212 (13.1)	68 (17.5)	217 (11.5)
Non-smoker	520 (78.2)	1086 (67.0)	249 (64.0)	1348 (71.7)
Alcohol
Yes	32 (4.8)	61 (3.8)	12 (3.1)	81 (4.3)
No	633 (95.2)	1561 (96.2)	377 (96.9)	1799 (95.7)
Hip Circumference, cm	97.27±9.60	96.15±9.50*	97.4±9.8	96.3±9.5
Waist circumference, cm	88.23±11.31	88.22±11.24	89.3±11.1	88.1±11.3
Calf circumference, cm	28.49±3.63	28.39±3.43	29.0±3.4	28.3±3.5***
Hand grip, kg	22.84±7.71	23.20±7.95	24.4±7.7	22.8±7.9***
Chair stand test, count	10.34±3.20	9.77±3.12***	10.2±2.9	9.9±3.2
Chair sit and reach test, cm	1.28±11.56	1.68±11.98	0.04±11.5	1.9±12.0**
TUG, seconds	10.53±3.30	11.24±3.29***	10.8±3.0	11.1±3.4
Back Scratch Test, cm	13.63±12.55	16.01±12.81***	14.5±12.3	15.5±12.9
Digit span	7.96±2.46	7.29±2.40***	7.89±2.44	7.40±2.42***
MMSE	23.92±4.69	22.36±4.91***	23.91±4.12	22.60±5.01***
Digit symbol	5.81±2.99	4.53±2.21***	5.04±2.39	4.90±2.56
GDS	2.46±2.08	2.80±2.35**	2.40±2.09	2.74±2.29**
VR I	52.32±33.43	38.83±31.92***	46.2±32.5	42.1±33.0*
VRII	45.04±37.57	30.64±32.78**	33.9±34.5	39.4±36.3*

Notes: Significant at ***p<0.001; **p<0.01; *p<0.05. ^†Only 2287 and 2269 data were available for vitamin/mineral and herbal supplement intake respectively. Remaining were missing data. Chi-Square test employed when both variable were categorical. Independent-t-test for numerical dependent variable.

Abbreviations: TUG, timed up and go test; MMSE, Mini Mental State Examination; VRI, Visual Reproduction I; VRII, Visual Reproduction II; GDS, Geriatric Depression Scale.

Table 2 Baseline Dietary Supplementation Consumed by Participants

Type of Supplement	Number of Participants* Consuming Supplement (n)	%
Vitamin/Mineral
Multivitamin	137	20.60
B-complex	88	13.23
Calcium	99	14.89
Vitamin E	25	3.76
Zinc	3	0.45
Vitamin C	85	12.78
Selenium	1	0.15
Fish Oil	88	13.23
Lecithin	3	0.451
Evening Primrose	6	0.90
Herbal Supplement
Spirulina	17	4.37
Gamat	6	1.54
Shark Fin	1	0.26
Chinese Traditional Medicine	8	2.06
Bird Nest	1	0.26
Ginseng	7	1.80
Gingko Biloba	7	1.80
Kacip Fatimah	8	2.06
Ginger tablet	12	3.08
Garlic tablet	14	3.60
Tongkat Ali	21	5.50
Mengkudu	3	0.77
Misai Kucing	10	2.57
Majun	15	3.86
Jamun	2	0.51
Lidah Buaya	1	0.26
Habbatus Sauda	12	3.08
Manjakani	1	0.26
Not knowing the name of supplement	122	31.36

Note: *Each subject may take one or more vitamin, mineral or herbal supplement.

Table 3 Longitudinal Association Between Baseline Vitamin/Mineral Supplement Intake with Cognitive Function, Physical Fitness, Anthropometry and Biochemical Indices (N=1285)

Parameter	Vitamin/Mineral Intake		Coefficient for Time (95% CI)	p for Trend*
	Yes	No
Cognitive Function and Depressive Symptoms
MMSE
Baseline	24.74 (3.76)	23.63(4.15)	−1.22 (−1.78,0.67)	p<0.001
18th month	25.23(3.51)	24.18(3.47)	−0.74 (−1.32,0.16)	0.012
36th month	25.97(3.79)	24.92(3.61)	0
MoCA
Baseline	21.42(4.66)	19.42(5.20)	−0.25 (−1.01,0.51)	0.520
18th month	20.54(5.33)	18.47(5.63)	−1.13 (−1.92,-0.35)	0.005
36th month	21.67(5.16)	20.12(4.97)	0
Digit span
Baseline	8.16(2.29)	7.72(2.37)	−1.11(−1.56,-0.66)	p<0.001
18th month	8.11(2.45)	7.85(2.36)	−1.16 (−1.63,-0.70)	p<0.001
36th month	9.27(6.20)	8.54(2.77)	0
Digit symbol
Baseline	6.03(3.01)	4.83(2.23)	−0.22 (−0.64, 0.20)	0.297
18th month	6.14(3.40)	4.82(2.81)	−0.12 (−0.55,0.31)	0.581
36th month	6.26(3.37)	4.75(2.50)	0
VR1
Baseline	56.10(33.06)	42.60(32.63)	−1.75(−6.72,3.22)	0.489
18th month	47.56(34.96)	36.93(31.93)	−10.47(−15.41,-5.17)	<0.001
36th month	57.85(34.93)	44.12(33.51)	0
GDS
Baseline	2.28(1.99)	2.53(2.24)	−0.36(−0.69,-0.04)	0.030
18th month	2.74(2.35)	2.94(2.22)	−0.09(−0.25,0.43)	0.586
36th month	2.65(2.15)	2.93(2.25)	0
Physical Fitness
2minstep test
Baseline	65.68(26.23)	63.73(24.60)	−10.82(−14.34,-7.31)	<0.001
18th month	61.84(22.66)	61.59(21.59)	−14.66(−18.33,-11.00)	<0.001
36th month	76.50(23.05)	73.90(21.37)	0
Chair stand test
Baseline	10.52(3.17)	10.18(3.03)	−0.43(−0.86,-0.00)	<0.001
18th month	10.41(2.71)	10.03(2.82)	−0.75(−1.22,-0.74)	<0.001
36th month	11.19(2.83)	10.67(2.54)	0
Handgrip strength
Baseline	23.31(7.55)	24.43(7.77)	−0.66(−1.79, 0.47)	0.25
18th month	23.05(7.49)	23.58(7.79)	−0.92 (−2.08,0.27)	0.12
36th month	23.97(7.08)	24.86(7.26)	0
Chair Sit and Reach
Baseline	0.66(11.13)	0.36 (11.16)	−2.36(−4.04,-0.67)	0.006
18th month	2.10(10.05)	2.70(10.61)	−0.91(−2.65,0.82)	0.303
36th month	3.01(11.50)	3.74(12.51)	0
Time Up and Go
Baseline	10.09(2.95)	10.62(2.84)	−0.86(−1.31,-0.39)	<0.001
18th month	10.86(3.05)	11.38(2.92)	0.08(−0.56,0.39)	0.74
36th month	10.94(3.39)	11.53(3.37)	0
Back Scratch test
Baseline	13.08(12.71)	14.95(12.73)	−0.51 (−2.44, 1.42)	0.61
18th month	14.18(11.33)	15.85(11.65)	0.59 (−1.40, 2.58)	0.56
36th month	13.59(13.96)	16.68(14.10)	0
Anthropometry
Weight
Baseline	61.70(12.06)	61.84(11.98)	0.08(−1.90,1.73)	0.93
18th month	62.26(12.40)	61.64(12.12)	0.48(−1.39, 2.35)	0.62
36th month	61.78(12.52)	60.39(12.01)	0
Waist circumference
Baseline	88.56(11.52)	88.48(11.45)	2.88(1.08,4.67)	0.002
18th month	83.22(12.34)	82.96(12.22)	−2.47(−4.32,-0.62)	0.009
36th month	85.68(12.47)	84.31(12.21)	0
Hip Circumference
Baseline	97.60(9.59)	96.57(9.32)	1.96 (0.46,3.46)	0.01
18th month	95.65(11.05)	93.70(9.47)	0.01 (−1.54,1.56)	0.99
36th month	95.63(10.90)	93.71(10.69)	0
MUAC
Baseline	28.77(3.69)	28.72(3.25)	−0.16(−1.11,0.80)	0.75
18th month	27.80(3.74)	27.62(3.23)	−1.13(−2.12,-0.14)	0.03
36th month	28.93(3.64)	29.32(12.17)	0
Calf circumference
Baseline	34.01(3.79)	33.56(3.69)	−0.60(−1.56,0.37)	0.23
18th month	33.74(4.06)	33.31(3.60)	−0.86(−1.86,0.14)	0.09
36th month	34.60(9.55)	33.94(10.45)	0
Biochemical**
Glucose
Baseline	6.01(2.04)	6.13(2.13)	−1.14(−0.50,0.22)	0.31
36th month	6.14(2.23)	6.31(2.40)	0
Total cholesterol
Baseline	5.47(1.16)	5.49(1.12)	0.03(−0.15,0.22)	0.75
36th month	5.21(1.20)	5.24(1.06)	0
HDL cholesterol
Baseline	1.44(0.35)	1.39(0.35)	0.02(−0.04,0.07)	0.59
36th month	1.43(0.37)	1.39(0.36)	0
LDL cholesterol
Baseline	3.18(1.00)	3.41(1.01)	0.08(−0.10,0.25)	0.37
36th month	3.36(1.03)	3.10(1.11)
Triglyceride
Baseline	1.39(0.59)	1.54(0.78)	−0.14(−0.27, −0.01)	0.03
36th month	1.52(0.73)	1.62(0.86)

Notes: *p<0.05 for the longitudinal analysis between users and non-users of herbal supplements. The model is fully adjusted for covariates such as such as age, gender, education years, smoking status, calf circumference, hand grip strength, chair sit and reach test, digit span, MMSE, GDS, VRI and VRII. **For biochemical data, data were only available at baseline and 36th month for selected participants (324 for baseline and 687 for 36th month).

Abbreviations: Ref, reference group; MMSE, Mini Mental State Examination; MoCA, Montreal Cognitive Assessment; VRI, Visual Reproduction I; VRII, Visual Reproduction II; GDS, Geriatric Depression Scale; MUAC, mid-upper arm circumference; HDL, high density lipoprotein; LDL, low density lipoprotein.

Table 4 Longitudinal Association Between Baseline Herbal Supplement Intake with Cognitive Function, Physical Fitness, Anthropometry and Biochemical Indices (N=1285)

Parameter	Herbal Supplement Intake		Coefficient for Time (95% CI)	p for Trend*
	Yes	No
Cognitive Function and Depressive Symptoms
MMSE
Baseline	24.82 (3.61)	23.80(3.65)	−1.12 (−1.66,-0.58)	p<0.001
18th month	25.20(3.50)	24.12(3.52)	−0.74 (−1.30,-0.18)	0.01
36th month	25.94(3.75)	24.81(3.76)	0
MoCA
Baseline	21.44(4.66)	19.43(5.04)	−0.12 (−0.87,0.64)	0.76
18th month	20.50(5.34)	18.94(5.19)	−1.05 (−1.83,-0.27)	0.01
36th month	21.55(5.20)	19.82(5.18)	0
Digit span
Baseline	8.14(2.31)	7.70(2.38)	−1.11(−1.56,-0.66)	p<0.001
18th month	8.10(2.44)	7.81(2.37)	−1.15 (−1.62,-0.69)	p<0.001
36th month	9.25(6.14)	8.44(2.79)	0
Digit symbol
Baseline	6.04(3.02)	4.78(2.22)	−0.14 (−0.56, 0.27)	0.50
18th month	6.13(3.40)	4.75(2.80)	−0.05 (−0.48,0.37)	0.81
36th month	6.19(3.37)	4.65(2.51)	0
VR1
Baseline	56.34(33.00)	42.37(32.47)	29.92 (25.80,34.04)	0.001
18th month	47.30(35.03)	36.23(31.86)	20.88(16.62, 25.13)	<0.001
36th month	26.42(10.08)	22.70(9.87)	0
GDS
Baseline	2.30(1.98)	2.60 (2.28)	−0.39(−0.72,-0.05)	0.02
18th month	2.73(2.33)	3.00(2.27)	0.05(−0.30,0.39)	0.79
36th month	2.69(2.19)	2.90(2.24)	0
Physical Fitness
Two-minute step test
Baseline	65.30(26.31)	63.11(24.94)	−10.84(−14.36,-7.31)	<0.001
18th month	61.72(22.88)	60.99(21.91)	−14.41(−18.09,-10.74)	<0.001
36th month	76.14(23.55)	73.61(21.39)	0
Chair stand test
Baseline	10.70(3.19)	10.15(3.04)	−0.44(−0.87,-0.01)	0.04
18th month	10.41(2.71)	9.98(2.84)	−0.74(−1.19,-0.30)	0.001
36th month	11.15(2.83)	10.64(2.54)	0
Handgrip strength
Baseline	23.24(7.54)	24.27(7.85)	−0.70(−1.82, 0.43)	0.22
18th month	23.02(7.51)	23.42(7.81)	−0.92 (−2.08,0.25)	0.12
36th month	23.94(7.08)	24.69(7.31)	0
Chair Sit and Reach
Baseline	0.60(11.06)	0.76 (11.45)	−2.59(−4.28,-0.91)	0.003
18th month	2.09(10.02)	2.87(10.70)	−1.10(−2.84,0.64)	0.215
36th month	3.19(11.54)	3.94(12.50)	0
Timed Up and Go
Baseline	10.09(2.96)	10.69(2.95)	−0.93(−1.39,-0.47)	<0.001
18th month	10.86(3.04)	11.46(2.98)	−0.16(−0.64,0.32)	0.51
36th month	11.02(3.46)	11.58(3.36)	0
Back Scratch test
Baseline	13.19(12.66)	15.11(12.84)	−0.68 (−2.59, 1.26)	0.50
18th month	14.20(11.30)	15.93(11.70)	0.34 (−1.65, 2.32)	0.74
36th month	13.86(13.98)	16.68(14.23)	0
Anthropometry
Weight
Baseline	61.57(12.06)	61.78(12.05)	−0.06 (−1.87,1.74)	0.94
18th month	62.20(12.40)	61.54(12.16)	0.55(−1.31, 2.42)	0.56
36th month	61.63(12.52)	60.38(11.99)
Waist circumference
Baseline	88.55(11.44)	88.42(11.51)	2.97(1.19,4.76)	0.001
18th month	83.13(12.37)	82.88(12.20)	−2.46(−4.30,-0.61)	0.01
36th month	85.58(12.54)	84.25(12.33)	0
Hip Circumference
Baseline	97.53(9.56)	96.61(9.36)	1.97 (0.49,3.46)	0.009
18th month	95.58(11.05)	93.74(9.52)	0.20(−1.52,1.56)	0.98
36th month	95.56(10.91)	93.77(10.64)	0
MUAC
Baseline	28.74(3.69)	28.72(3.34)	−0.16(−1.10,0.78)	0.74
18th month	27.78(3.73)	27.59(3.27)	−1.12(−2.09,-0.14)	0.02
36th month	28.90(3.65)	29.28(11.94)	0
Calf circumference
Baseline	33.97(3.78)	33.58(3.69)	−0.56(−1.51,0.39)	0.25
18th month	33.73(4.05)	33.29(3.61)	−0.80(−1.78,0.19)	0.11
36th month	34.52(9.48)	33.87(10.28)	0
Biochemical**
Glucose
Baseline	6.01(2.04)	6.13(2.13)	−0.14(−0.50,0.22)	0.46
36th month	6.14(2.23)	6.31(2.34)	0
Total cholesterol
Baseline	5.24(1.06)	5.49(1.12)	0.03(−0.15,0.22)	0.75
36th month	5.21(1.20)	5.47(1.16)	0
HDL cholesterol
Baseline	1.44(0.35)	1.39(0.35)	0.02(−0.04,0.07)	0.59
36th month	1.43(0.37)	1.38(0.36)	0
LDL cholesterol
Baseline	3.18(1.00)	3.41(1.01)	0.08(−0.09,0.25)	0.37
36th month	3.10(1.11)	3.36(1.04)
Triglyceride
Baseline	1.39(0.59)	1.54(0.78)	−0.14(−0.27,-0.01)	0.03
36th month	1.53(0.73)	1.62(0.86)

Notes: *p<0.05 for the longitudinal analysis between users and non-users of herbal supplements. The model is fully adjusted for covariates such as such as age, gender, education years, smoking status, calf circumference, hand grip strength, chair sit and reach test, digit span, MMSE, GDS, VRI and VRII. **For biochemical data, data were only available at baseline and 36th month for selected participants (1011 for baseline and 870 for 36th month).

Abbreviations: Ref, reference group; MMSE, Mini Mental State Examination; MoCA, Montreal Cognitive Assessment; VRI, Visual Reproduction I; VRII, Visual Reproduction II; GDS, Geriatric Depression Scale; MUAC, mid-upper arm circumference; HDL, high density lipoprotein; LDL, low density lipoprotein.