Response to important considerations when assessing the effect of essential fatty acids on cognitive performance
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LETTER TO THE EDITOR
Open Access
Response to important considerations when assessing the effect of essential fatty acids on cognitive performance Xue Dong and Dongfeng Zhang* Abstract In this letter, we respond to the comments raised by Visaria et al. in their letter to the editor about the publication “Association of dietary ω-3 and ω-6 fatty acids intake with cognitive performance in older adults: National Health and Nutrition Examination Survey (NHANES) 2011–2014”. We have further adjusted for some key covariates as the authors mentioned in the letter and performed sensitivity analysis by excluding vegetarians considering the bioavailability of fatty acids from different sources. In conclusion, the results were basically consistent with our previous results, which showed that the results were stable and reliable. We hope that our study could be helpful in further studies delineating the various intricacies of fatty acid nutrition and metabolism and control for covariates. Keywords: ω-3 fatty acids, ω-6 fatty acids, Nutrition, Cognitive performance, NHANES To the Editor: We would like to thank you for the opportunity to respond to the comments raised by Visaria et al. in their letter to the editor about the publication “Association of dietary ω-3 and ω-6 fatty acids intake with cognitive performance in older adults: National Health and Nutrition Examination Survey (NHANES) 2011–2014”. We would also like to thank Visaria et al. for their interest in our paper and for taking the time to express their views. We will answer the questions in detail about covariates and methodological considerations raised by the authors. Visaria and colleagues’ first comment pertains to the control of covariates. They contend that while we have appropriately controlled for demographic, socioeconomic, physical activity, and cardiometabolic comorbidity factors, there are several other covariates that need to be accounted for, such as vitamin, mineral and other dietary consumption, sociobehavioral risk factors and physical & mental * Correspondence: [email protected] Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, No. 308 Ningxia Road, Qingdao 266021, China
comorbidities. According to their suggestion and our sample size (2496 participants), we further adjusted for vitamin D [1], niacin [2], vitamin B6 [3], vitamin B12, folic acid, zinc [4], iron, copper, selenium, protein [5], total saturated fatty acids [6], and depression [7] in Model 2. Table 1 presents the characteristics of the study population across cognitive status. There were no significant differences between people with low cognitive performance and normal cognitive performance in the distribution of pre-diabetes, gastrointestinal disorders, and smoking among three tests. So, we did not put them into the overall analysis. Table 2 shows the associations of ω-3 fatty acids, ω-6 fatty acids, and ω-6: ω-3 ratio with three tests. In the full-adjusted model, the odds ratios (ORs) with 95% confidence interval (CI) of the Cons
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