Women have a greater lifetime risk of developing Alzheimer’s disease (AD) dementia than men, a sex/gender disparity that cannot be explained by female longevity alone. There is substantial evidence for sex differences in the effects of APOE £4 on risk for AD. While APOE e4 increases AD risk in both sexes, women who carry APOE e4 are disproportionately vulnerable to cognitive impairment and AD compared to their counterpart men. In contrast to APOE e4, APOE £2 is associated with slower cognitive decline and a lower risk of AD. Although a less robust literature, APOE e2 may also have sex-specific effects. Because APOE e2 is the rarest major APOE allele, well-powered studies are needed to examine sex-specific effects. The objective of the present study was to examine sex-specific associations of APOE e2 carriage with longitudinal cognitive decline in a large cohort of clinically unimpaired adults.

We used observational data from two sources: the National Alzheimer’s Coordinating Center (NACC) and the Rush Alzheimer’s Disease Center (ROS/MAP/MARS) studies. We included data from clinically unimpaired adults who were >50 years old at baseline who self-identified as non-Hispanic White (NHW) or non-Hispanic Black (NHB). Participants were categorized as APOE £2, £4, or £3/e3 carriers. APOE e2/e4 carriers were excluded. The same battery of neuropsychological tests was used to assess global cognition in participants from both data sources. Linear mixed models examined interactive associations of genotype (£2 or £4 vs. £3/£3), sex, and time on longitudinal cognition in NHW and NHB participants separately. Analyses were first performed in a pooled sample of NACC and ROS/MAP/MARS participants and if significant they were repeated separately in each data source.

Across both data sources, 9,766 NHW (mean (SD) age=73.0(9.00) years, mean (SD) education=16.3(2.83) years, n(%) women=6,344(65.0)) and 2,010 NHB participants (mean(SD) age=71.3(7.59) years, mean(SD) education=14.9(3.10) years, n(%) women=1,583(78.8)) met inclusion criteria. Sex modified the association between APOE £2 and cognitive decline in NHW (ß=0.097, 95% CI: 0.023-0.172, pint=.01) but not NHB participants (ß=-0.011, 95% CI: -0.153-0.131, pint=.9). In sex-stratified analyses of NHW participants, APOE £2 (vs. £3/£3) carriage was associated with attenuated cognitive decline in men (ß=0.096, 95% CI: 0.037-0.155, p=.001), but not women (ß=-0.001, 95% CI: -0.044-0.043, p=.97). In analyses comparing men and women APOE £2 carriers, men exhibited slower cognitive decline than women (ß=0.120, 95% CI: 0.051-0.190, p=.001). Analyses performed separately in NACC and ROS/MAP revealed the same pattern of male-specific APOE £2 protection in NHW participants in both data sources.

In light of the longstanding view that APOE £2 protects against AD and dementia, our results provide evidence that APOE £2 is associated with attenuated cognitive decline in men but not women among NHW adults. This male-specific protection may contribute to sex differences in AD-related cognitive decline. Our findings have important implications for understanding the biological drivers of sex differences in AD risk, which is crucial for developing sex-specific strategies to prevent and treat AD dementia.

While plant-based dietary practices (PBDPs) have been recommended to improve both population health and environmental sustainability outcomes, no nationally representative Canadian studies have described the prevalence or correlates of excluding animal source foods. The current study therefore: (1) created operationalised definitions of PBDPs based on animal source food exclusions to estimate the prevalence of Canadians who adhere to PBDPs and (2) examined key correlates of PBDPs.

Population representative, cross-sectional data were from the 2015 Canadian Community Health Survey–Nutrition. Respondents’ PBDPs were categorised as: (1) vegan (excluded red meat, poultry, fish, eggs and dairy); (2) vegetarian (excluded red meat, poultry and fish); (3) pescatarian (excluded red meat and poultry) and (4) red meat excluder (excluded red meat). Descriptive statistics and multivariable regression analyses were used to examine the prevalence and correlates of these PBDP categories.

All ten provinces in Canada.

Canadians aged 2 years and above (n 20 477).

In 2015, approximately 5 % of Canadians reported adhering to any PBDP (all categories combined) with the majority (2·8 %) categorised as a red meat excluder, 1·3 % as vegetarian, 0·7 % as pescatarian and 0·3 % as vegan. South Asian cultural identity (OR 19·70 (95 % CI 9·53, 40·69)) and higher educational attainment (OR 1·97 (95 % CI 1·02, 3·80)) were significantly associated with reporting a vegetarian/vegan PBDP.

Despite growing public discourse around PBDPs, only 5 % of Canadians reported PBDPs in 2015. Understanding the social and cultural factors that influence PBDPs is valuable for informing future strategies to promote environmentally sustainable dietary practices.

The present study aimed to: (i) evaluate changes in Canadian children’s dietary quality during school hours and on school days between 2004 and 2015; and (ii) explore whether changes in dietary quality over time were moderated by sociodemographic characteristics.

Nationally representative 24 h dietary recall data were obtained from the 2004 (n 4827) and 2015 (n 2447) Canadian Community Health Surveys. Dietary quality was measured using the Canadian Healthy Eating Index (C-HEI) which evaluates respondents’ compliance with 2007 national dietary recommendations, and the school-HEI which assesses respondents’ dietary quality during school hours. Multivariable regression models compared differences in dietary quality between 2004 and 2015. Interaction effects were used to test whether changes over time were moderated by sociodemographic characteristics (sex, age group, ethnicity, residential location, province of residence, parental education, food security status).

Canada.

Children aged 6–17 years.

Mean school-HEI score rose from 51.3 to 58.0 points (maximum = 100) from 2004 to 2015 (P < 0.001). School-HEI sub-scores for total vegetables and fruit, whole fruit, dark green and orange vegetables, milk and alternatives, and meat and alternatives improved over time, but remained well below recommendations. Decreased energy from minimally nutritious foods accounted for 39 % of the improvement in mean school-HEI scores. Mean whole day C-HEI scores also improved (60.8 to 66.4 points, P < 0.001). There was no evidence of a moderating effect for any of the sociodemographic variables examined.

Mean dietary quality of Canadian children during school hours and on school days improved modestly for all age and sex groups but remained below 2007 national dietary recommendations.

The Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort study of the Canadian Consortium on Neurodegeneration in Aging (CCNA) is a national initiative to catalyze research on dementia, set up to support the research agendas of CCNA teams. This cross-country longitudinal cohort of 2310 deeply phenotyped subjects with various forms of dementia and mild memory loss or concerns, along with cognitively intact elderly subjects, will test hypotheses generated by these teams.

The COMPASS-ND protocol, initial grant proposal for funding, fifth semi-annual CCNA Progress Report submitted to the Canadian Institutes of Health Research December 2017, and other documents supplemented by modifications made and lessons learned after implementation were used by the authors to create the description of the study provided here.

The CCNA COMPASS-ND cohort includes participants from across Canada with various cognitive conditions associated with or at risk of neurodegenerative diseases. They will undergo a wide range of experimental, clinical, imaging, and genetic investigation to specifically address the causes, diagnosis, treatment, and prevention of these conditions in the aging population. Data derived from clinical and cognitive assessments, biospecimens, brain imaging, genetics, and brain donations will be used to test hypotheses generated by CCNA research teams and other Canadian researchers. The study is the most comprehensive and ambitious Canadian study of dementia. Initial data posting occurred in 2018, with the full cohort to be accrued by 2020.

Availability of data from the COMPASS-ND study will provide a major stimulus for dementia research in Canada in the coming years.

To examine factors that influence decision-making, preferences, and plans related to advance care planning (ACP) and end-of-life care among persons with dementia and their caregivers, and examine how these may differ by race.

Cross-sectional survey.

13 geographically dispersed Alzheimer’s Disease Centers across the United States.

431 racially diverse caregivers of persons with dementia.

Survey on “Care Planning for Individuals with Dementia.”

The respondents were knowledgeable about dementia and hospice care, indicated the person with dementia would want comfort care at the end stage of illness, and reported high levels of both legal ACP (e.g., living will; 87%) and informal ACP discussions (79%) for the person with dementia. However, notable racial differences were present. Relative to white persons with dementia, African American persons with dementia were reported to have a lower preference for comfort care (81% vs. 58%) and lower rates of completion of legal ACP (89% vs. 73%). Racial differences in ACP and care preferences were also reflected in geographic differences. Additionally, African American study partners had a lower level of knowledge about dementia and reported a greater influence of religious/spiritual beliefs on the desired types of medical treatments. Notably, all respondents indicated that more information about the stages of dementia and end-of-life health care options would be helpful.

Educational programs may be useful in reducing racial differences in attitudes towards ACP. These programs could focus on the clinical course of dementia and issues related to end-of-life care, including the importance of ACP.

The present study assessed systematic bias and the effects of data set error on the validity of food environment measures in two municipal and two commercial secondary data sets.

Sensitivity, positive predictive value (PPV) and concordance were calculated by comparing two municipal and two commercial secondary data sets with ground-truthed data collected within 800 m buffers surrounding twenty-six schools. Logistic regression examined associations of sensitivity and PPV with commercial density and neighbourhood socio-economic deprivation. Kendall’s τ estimated correlations between density and proximity of food outlets near schools constructed with secondary data sets v. ground-truthed data.

Vancouver, Canada.

Food retailers located within 800 m of twenty-six schools

All data sets scored relatively poorly across validity measures, although, overall, municipal data sets had higher levels of validity than did commercial data sets. Food outlets were more likely to be missing from municipal health inspections lists and commercial data sets in neighbourhoods with higher commercial density. Still, both proximity and density measures constructed from all secondary data sets were highly correlated (Kendall’s τ>0·70) with measures constructed from ground-truthed data.

Despite relatively low levels of validity in all secondary data sets examined, food environment measures constructed from secondary data sets remained highly correlated with ground-truthed data. Findings suggest that secondary data sets can be used to measure the food environment, although estimates should be treated with caution in areas with high commercial density.

To describe the development and application of the School Food Environment Assessment Tools and a novel scoring system to assess the integration of healthy and environmentally sustainable food initiatives in elementary and secondary schools.

The cross-sectional study included direct observations of physical food environments and interviews with key school personnel regarding food-related programmes and policies. A five-point scoring system was then developed to assess actions across six domains: (i) food gardens; (ii) composting systems; (iii) food preparation activities; (iv) food-related teaching and learning activities; and availability of (v) healthy food; and (vi) environmentally sustainable food.

Vancouver, Canada.

A purposive sample of public schools (n 33) from all six sectors of the Vancouver Board of Education.

Schools scored highest in the areas of food garden and compost system development and use. Regular integration of food-related teaching and learning activities and hands-on food preparation experiences were also commonly reported. Most schools demonstrated rudimentary efforts to make healthy and environmentally sustainable food choices available, but in general scored lowest on these two domains. Moreover, no schools reported widespread initiatives fully supporting availability or integration of healthy or environmentally sustainable foods across campus.

More work is needed in all areas to fully integrate programmes and policies that support healthy, environmentally sustainable food systems in Vancouver schools. The assessment tools and proposed indicators offer a practical approach for researchers, policy makers and school stakeholders to assess school food system environments, identify priority areas for intervention and track relevant changes over time.

To examine associations between students’ socio-economic status (SES) and school-day dietary intake, and the roles of parents and peers in shaping these associations.

A cross-sectional survey measured school-day intake of vegetables, whole grains, low-fat milk, packaged snack foods and sugar-sweetened beverages. Logistic regression models examined associations between SES (parental education and food insecurity status) and dietary outcomes during or en route to or from school, and examined whether peer modelling or parental norms potentially mediated the associations between SES and dietary outcomes.

Twenty-six public schools in Vancouver, Canada in 2012.

Nine hundred and fifty students in grades 5–8.

Students whose parents completed some college, compared with those completing high school or less, were significantly more likely to consume vegetables daily (unadjusted OR=1·85; 95 % CI 1·06, 3·22) and students whose parents completed college or university were significantly less likely to consume sugar-sweetened beverages daily (unadjusted OR=0·67; 95 % CI 0·47, 0·94). Food secure students were also significantly less likely to consume sugar-sweetened beverages daily compared with food insecure students (unadjusted OR=0·52; 95 % CI 0·29, 0·92). Parental norms, but not peer modelling, emerged as a potential mediator of the association between SES and vegetable intake. SES was not significantly associated with the remaining dietary outcomes.

Higher SES was significantly associated with two of five school-day dietary outcomes and predicted higher likelihood of daily nutritious food choices at school. The present study suggests that there is room for improvement in school-day dietary quality for students from all SES backgrounds in Vancouver.