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Chengchuan Chen

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Review Aug 2026

Association Between the Dietary Inflammatory Index and Cognitive Frailty in Older Adults: A Cross Sectional Analysis of NHANES Data.

BACKGROUND Cognitive frailty (CF) is a prevalent geriatric syndrome associated with increased risks of falls, hospitalization, disability, and all-cause mortality among older adults. Emerging evidence suggests that chronic inflammation may contribute to the pathophysiology of CF, while dietary patterns can modulate inflammatory responses. The Dietary Inflammatory Index (DII) is a validated tool for quantifying the inflammatory potential of diet. Although higher DII scores have been associated with physical frailty and cognitive impairment, the association between DII and CF remains unclear. AIM To investigate the association between DII and CF in older adults. METHODS We conducted a secondary analysis of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 cycles, comprising 2,386 eligible participants. Participants were categorized into tertiles according to their DII scores: T1 (n = 709), T2 (n = 763), and T3 (n = 914). Survey-weighted logistic regression analyses were performed to examine the association between DII and CF. To examine potential nonlinear relationships, restricted cubic spline (RCS) regression was performed with three knots positioned at the 10th, 50th, and 90th percentiles of the DII distribution. RESULTS The prevalence of CF in the study sample was 14.9%, and the survey-weighted prevalence increased across DII tertiles, from 4.9% in the lowest tertile to 8.1% in the middle tertile and 16.6% in the highest tertile. Participants with CF had higher DII scores than those without CF (4.3 [IQR, 1.2 to 7.1] vs 1.5 [IQR, -2.3 to 4.7]). Participants with CF were also older and had higher white blood cell (WBC) counts and neutrophil-to-lymphocyte ratio (NLR) values than those without CF (all p < 0.05). In logistic regression analyses, each 1-unit increase in DII was associated with higher odds of CF in the the unadjusted model (OR 1.096, 95% CI 1.064-1.128), after sociodemographic adjustment (OR 1.056, 95% CI 1.026-1.088), and in the fully adjusted model (OR 1.039, 95% CI 1.001-1.080). Compared with participants in the lowest tertile, those in the highest tertile had higher odds of CF in both the unadjusted (OR 3.887, 95% CI 2.820-5.358) and fully adjusted (OR 2.254, 95% CI 1.522-3.337) analyses, whereas the association for the middle tertile was not statistically significant after full adjustment. RCS models indicated a nonlinear association (p for nonlinearity = 0.020), with the odds of CF increasing more steeply at DII values above approximately 2.4. CONCLUSION Higher DII scores were associated with higher odds of CF among older adults in the United States, with a steeper increase in the odds of CF at DII values above approximately 2.4. Prospective cohort studies and dietary trials are needed to establish temporality and determine whether reducing the inflammatory potential of diet can prevent the onset or progression of CF.

Zihan Yi, Na Zhou, Zikejimu Sun et al. · Public Health Nursing · 0 citations

Open access Jul 2026

Family life-course trajectories and longitudinal changes in depressive symptoms and physical functional limitations in Chinese women from midlife to early old age: a 7-year longitudinal cohort study

Population aging and declining fertility have transformed family life courses, yet their long-term implications for women’s health remain insufficiently understood. This study examined whether distinct marital and fertility trajectories were associated with subsequent changes in depressive symptoms and physical functional limitations among Chinese women. We used data from the China Health and Retirement Longitudinal Study (CHARLS), including 5,871 women aged 45–65 years at baseline. Retrospective marital and fertility histories from ages 15 to 49 were reconstructed using sequence-based methods and grouped into trajectory typologies through Ward’s clustering. Depressive symptoms were assessed using the CES-D-10, and physical functional limitations were measured using the Nagi Disability Scale. Associations with longitudinal health outcomes were estimated using linear mixed-effects models. Robustness analyses additionally adjusted for childhood contexts, and sensitivity analyses restricted the sample to women with at least two valid outcome observations. Four trajectory groups were identified: Stable Marriage & Two-Child (40.0%), Early Marriage & High-Parity (43.3%), Stable Marriage & One-Child (15.6%), and Predominantly Married & Childless (1.2%). Compared with the Stable Marriage & Two-Child group, the Early Marriage & High-Parity group had higher baseline depressive symptoms (β = 0.858, 95% CI: 0.560 to 1.157) and higher physical functional limitations (β = 0.206, 95% CI: 0.143 to 0.269), with a faster increase in physical functional limitations over time (β = 0.025, 95% CI: 0.012 to 0.038). The Stable Marriage & One-Child group had lower baseline depressive symptoms (β = -0.858, 95% CI: -1.271 to -0.445) and lower physical functional limitations (β = -0.163, 95% CI: -0.251 to -0.076), with a marginally slower increase in physical functional limitations (β = -0.018, 95% CI: -0.036 to 0.000). The Predominantly Married & Childless group did not differ significantly from the reference group. These associations were broadly consistent in robustness and sensitivity analyses. Women’s marital and fertility trajectories were associated with later depressive symptoms and physical functional limitations from midlife to early old age. Early marriage and high parity were linked to poorer depressive and functional outcomes, whereas the Stable Marriage & One-Child trajectory was associated with relatively better depressive and functional outcomes. These findings suggest that the timing and structure of family formation may have lasting implications for women’s later-life depressive symptoms and physical functional limitations.

Chengchuan Chen, Na Zhou, Xiaowen Wu et al. · BMC Public Health · 0 citations