Massey Documents by Type
Permanent URI for this communityhttps://mro.massey.ac.nz/handle/10179/294
Browse
4 results
Search Results
Item Dietary patterns in the older New Zealand adult and their associations with cognitive function and metabolic syndrome : the Researching Eating, Activity, and Cognitive Health (REACH) study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Science at Massey University, Albany, New Zealand(Massey University, 2021) Mumme, KarenBackground: The global population is ageing. Ageing and poor diet are common risk factors for cognitive decline and metabolic syndrome which reduce functionality in later years. A dietary pattern approach considers the full complexity of the diet. Dietary patterns in an older New Zealand context have not been identified nor their associations with cognitive function or metabolic syndrome. Aims and objectives: This thesis, referred to as the REACH (Researching, Eating, Activity, and Cognitive Health) study, explored associations between dietary patterns and cognitive function and metabolic syndrome in older New Zealand adults. To achieve the aim a food frequency questionnaire (FFQ) was assessed for reproducibility, relative validity, and its suitability to derive robust dietary patterns. Further, associations between these dietary patterns and their nutrient and energy intake; the socio-demographic and lifestyle factors of the participants; and cognitive function and metabolic syndrome outcomes were examined. Method: Community-dwelling adults from Auckland, New Zealand were recruited (aged 65-74 years, 36% male, n 371). Dietary patterns were derived from a 109-item FFQ using 57 food groups and principal component analysis. Nutrient, energy, and alcohol intake were calculated using FOODfiles, the New Zealand Food composition database. The REACH FFQ and its derived dietary patterns were assessed for reproducibility and relative validity in a sub-set of the REACH participants (n 294). Reproducibility was assessed using an identical FFQ (FFQ2) administered one month after the initial REACH FFQ. A 4-day food record (4-DFR), collected between FFQ administrations, assessed relative validity. Cognitive function, covering six domains (global cognition, attention and vigilance, executive function, episodic memory, working memory and spatial memory), was assessed using COMPASS (Computerised Mental Performance Assessment System). Self-administered questionnaires collected health (medication and supplement intake), demographic and lifestyle [including sex, education levels, living status (alone or with someone), smoking status, physical activity levels, address (for Index of Multiple Deprivation)], and physical activity (International Physical Activity Questionnaire) data. A fasted blood sample was collected for measuring genetic [Apolipoprotein E -ε4 (APOE -ε4)] and biochemical markers (triglycerides, high- and low-density lipoprotein cholesterol). Blood pressure and anthropometric measures [weight, height, waist circumference, and body fat % (using dual X-ray absorptiometry)] were collected. Metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III. Abstract ii Statistical analyses performed: Reproducibility and relative validity of the REACH FFQ (food group intakes) and its derived dietary patterns (scores) were assessed using Spearman correlation coefficients (acceptable correlation rho=0.20-0.49), weighted kappa statistic (κw) (acceptable statistic κw=0.20-0.60), and Bland-Altman analysis including mean difference, limits of agreement, plots, and slope of bias. The similarity between dietary pattern loadings were assessed using Tucker’s congruence coefficient. Linear or logistic regression were used to examine associations between dietary patterns and their nutrients; socio-demographic and lifestyle factors; and health outcomes. Confounding adjustments included age, sex, education, index of multiple deprivation, energy intake, APOE -ε4, and physical activity. Results: In the validation study, the FFQ food groups showed good reproducibility (mean correlation coefficient = 0.69, mean κw = 0.62) and acceptable relative validity (mean correlation coefficient = 0.45, mean κw = 0.38) though Bland Altman plots showed bias and mean differences significantly different to zero in some food groups. Three similar dietary patterns were identified from each dietary assessment tool: ‘Mediterranean style’, ‘Western’, and ‘prudent’. Congruence coefficients between factor loadings ranged from 0.54 to 0.80. Correlations of dietary pattern scores ranged from 0.47 to 0.59 (reproducibility) and 0.33 to 0.43 (validity) (all P<0.001); weighted kappa scores from 0.40 to 0.48 (reproducibility) and 0.27 to 0.37 (validity); limits of agreement from ± 1.79 to ± 2.09 (reproducibility) and ± 2.09 to ± 2.27 (validity); a slope of bias was seen in the ‘prudent’ pattern for reproducibility and validity (P<0.001). From the full REACH dietary data set, three valid dietary patterns were derived explaining 18% of the variation in the diet. The ‘Mediterranean style’ pattern (salad vegetables; leafy cruciferous vegetables; other vegetables; avocados and olives; alliums; nuts and seeds; white fish and shellfish; oily fish; berries; water; salad dressings; cruciferous vegetables; eggs; cheese; tomatoes; and all other fruit) was associated with higher levels of beta-carotene equivalents, vitamin E, and folate intake (all P<0.001, all R2 ≥ 0.26), along with being female, having a higher physical activity level, and higher education (P<0.001, R2 = 0.07). The ‘Western’ pattern (processed meat; sauces and condiments; cakes, biscuits and puddings; meat pies and chips; processed fish; confectionery; vegetable oils; beer; chocolate; salad dressings; cheese; and sweetened cereal) was associated with higher daily energy intake (P<0.001, R2 = 0.43), along with being male, having a higher alcohol intake, living with others, and a secondary education (males only) (P<0.001, R2 = 0.16). The ‘prudent’ pattern (dried legumes; soy-based foods; fresh and frozen legumes; whole grains; carrots; and Abstract iii spices) was associated with a higher fibre and carbohydrate intake (both P<0.001, both R2 ≥ 0.25), along with higher physical activity and lower alcohol intake (P<0.001, R2 = 0.15). Neither the ‘Mediterranean style’ nor ‘prudent’ patterns were associated with either cognitive function or metabolic syndrome. The ‘Western’ pattern was not associated with cognitive function, but was positively associated with metabolic syndrome [odds ratio = 1 .67 (95% CI 1.08, 2.63)] (P=0.02). Being younger (P<0.05), female (P<0.001), having a higher education (P<0.01) or no APOE -ε4 allele (P<0.05) were associated with better cognitive function. Higher deprivation (P<0.001) was associated with metabolic syndrome. Conclusion: A novel and robust study with valid tools did not find any associations between dietary patterns and cognitive function in older adults living in New Zealand. Age, sex, education, and the APOE -ε4 allele were more predictive of cognitive function than the dietary patterns. A ‘Western’ dietary pattern and higher deprivation were predictive of metabolic syndrome. To reduce the odds of metabolic syndrome, actions should aim to improve deprivation, and shift people’s dietary intake away from the ‘Western’ dietary pattern.Item "Where did I park my car?" : a mixed methods investigation on mild cognitive impairment diagnosis in New Zealand : a thesis submitted in partial fulfilment of the requirements for the degree of a Doctor of Philosophy in Psychology at Massey University, Wellington, New Zealand(Massey University, 2015) McKinlay, Alison RMild cognitive impairment (MCI) is defined as an objective impairment in cognitive function which spares everyday functional ability. The syndrome is shrouded in controversy regarding definition, cut-off criteria, and clinical utility. Consequently, it is an uncertain label for the client being diagnosed by their healthcare practitioner. To date, minimal research in New Zealand has focused on MCI within specialist assessment services. Reasons for this paucity of literature will be discussed throughout this thesis. The current research aimed to identify how practitioners deliver and perceive cognitive impairment diagnosis, and examine how clients respond to receiving this diagnosis. Client experiences were framed within the common sense model (CSM). This theory originates from health psychology, where coping behaviour is said to be influenced by the cognitive representations that a person has about their condition. Although the framework is previously discussed in relation to chronic illness, international researchers have started to examine the utility of the model in explaining MCI diagnosis response. Given this context, the CSM framework guided the client-focused components of this thesis. In Study One, 57 practitioners who diagnose cognitive impairment completed a questionnaire on labels applied to MCI and beliefs about the value of diagnosis delivery. Responses were analysed using content analysis to gain an impression of professional practice. Cognitive disorder - not otherwise specified (CD-NOS), early dementia, and normal ageing were reported to additionally label the symptoms of MCI in clinical practice. In Study Two, client responses were examined in a small clinical sample (N = 9) diagnosed with MCI and CD-NOS. Participants were interviewed twice within six months of initial diagnosis. Interpretative phenomenological analysis was used to gain insight into how people cope and make sense of their diagnosis over time. Descriptive analyses were also undertaken with a subset of Study Two data to examine changes and differences in coping strategies over time. Findings suggest that participants may not see their diagnosis as an illness or significant health threat in the first six months following diagnosis. This prompts a question on the suitability of an illness model with reference to diagnosis response. Findings from this research add to the literature by highlighting practice associated with an evolving form of clinical diagnosis in NZ.Item A comparison of cognitive interference in restrained and unrestrained eaters using a modified Stroop task : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University(Massey University, 1996) Strang, Philippa MCognitive factors are thought to play a primary role in the etiology and maintenance of eating disorders. Self-report measures used to assess people with eating disorders are prone to demand characteristics due to the secrecy and denial that are that are symptomatic of eating disorders. One measure with content which is difficult to fabricate is the Stroop test. The Stroop test is a colour naming task that involves a cognitive interference effect thought to occur when the words to be colour named are emotionally relevant to the subjects' concerns or worries. All studies assessing cognitive interference with a Stroop task among eating disordered populations have reported that such subjects have delayed response times to food, weight and shape words when compared to control subjects without eating disorders, and when compared to Stroop tasks using neutral stimuli. Women who continually attempt to restrict their food intake in order to conform to cultural ideals of physical beauty may become restrained eaters. There is some evidence that suggests restrained eaters also show cognitive interference on food, weight, and shape Stroop tasks. Anxiety and depression are common symptoms among individuals with eating disorders but little is known about the relative strength of these symptoms in restrained and unrestrained eaters. It is plausible that people with eating disorders, restrained and unrestrained eaters may fall along a continuum in relation to eating related pathologies such as interference on food, weight, and shape Stroop tasks, and anxiety and depression. In the present study the performance of female restrained (n = 21) and unrestrained eaters (n = 34) were compared on two Stroop tasks, one involving food, weight, and shape words and the other involving anxiety words. They were also compared on measures of trait anxiety and depression. Contrary to expectations no group differences were found on any of these measures. The lack of significant group effects was potentially explained by very low levels of eating related symptomatology and trait anxiety in the restrained eaters group compared to control and normative comparison groups. These results suggested that the process of subject recruitment in obtaining volunteers to complete the Stroop tasks may have produced artifacts. Possible causes for the inconclusive results are discussed and recommendations for future research proposed.Item The patient competency rating scale as a measure of everyday functioning before and after traumatic brain injury : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University(Massey University, 1996) Murphy, Latesha JImpaired self awareness is a common outcome of traumatic brain injury (TBI) and is usually measured by comparing self and informant ratings of everyday functioning. The Patient Competency Rating Scale (PCRS; Prigatano et al. 1990), has often been used for this purpose. The present study compared the before and after PCRS ratings of 53 sets of TBI patients and their informants. These groups were also compared to 130 sets of self and informant ratings for a non-head injured control group. Comparison of self and informant ratings for before and after revealed that TBI subjects were very aware of their post injury difficulties. A comparison of the self ratings of TBI (before injury) and control subjects suggested that the TBI group performed better than the control group, which acknowledged some difficulty with controlling emotion. Informants generally rated TBI subjects (before injury) and control subjects as more competent than the subjects rated themselves. A comparison of informant and self ratings (after injury) demonstrated that subjects with severe head injuries underestimated their difficulties, whilst subjects in the mild and moderate groups tended to be aware of their difficulties or overestimated them. This finding suggests that degree of awareness is dependent on the severity of injury.