Weight and health-related quality of life: The moderating role of weight discrimination and internalized weight bias

ObjectivesObesity is an increasingly prevalent public health concern, with associated medical comorbidities and impairment in health-related quality of life (HRQoL). Obese women are frequently victims of weight-related discrimination. The HRQoL impairments among obese people could be related to this discrimination and to internalized weight bias.DesignWe examined the potential moderating role of discrimination (from others) and self-directed (internalized) weight-based discrimination in the association between body mass index (BMI) and HRQoL.MethodsEighty-one women (mean age = 41.1 years; mean BMI = 43.40 kg/m², 97% Caucasian) completed valid and reliable measures of weight bias internalization (weight bias internalization scale), perceived discrimination by others (everyday discrimination scale) and both physical and mental HRQoL (SF-36 Health Survey). Multiple regression analysis was used to test whether internalized weight bias or discrimination moderated the association between BMI and the summary scores for physical and mental HRQoL, controlling for age.ResultsSignificant associations were found between BMI and discrimination (r = .36, p = .002), between internalized weight bias and both mental (r = .61, p < .001) and physical HRQoL (r = .45, p < .001), and between discrimination and physical HRQoL (r = .29, p = .014). A statistically significant interaction was found between BMI and internalized weight bias (b = − .21, SE = .10, p < 0.05) in accounting for the variance in physical HRQoL.ConclusionsThe association between higher BMI and poorer physical HRQoL was found only in individuals reporting high levels of internalized weight bias. Self-discrimination among overweight individuals may be a critical factor in their physical health impairment.     

Disability,more than multimorbidity,was predictive of mortality among older persons aged 80 years and older

ObjectiveIn this study, we evaluate the impact of disability and multimorbidity on the risk of all-cause death in a population of frail older persons living in community.Study Design and SettingWe analyzed data from the Aging and Longevity Study in the Sirente geographic area, a prospective cohort study that collected data on all subjects aged 80 years and older (n = 364). The main outcome measure was all-cause mortality over 4-year follow-up.ResultsA total of 150 deaths occurred. Sixty-seven subjects (44.6%) died in the nondisabled group compared with 83 subjects (55.3%) in the disabled group (P < 0.01). Thirty-nine subjects (31.7%) died among subjects without multimorbidity compared with 111 subjects (46.0%) with two or more diseases (P < 0.01). When examining the combined effect of multimorbidity and disability, the effect of disability on the risk of death was higher than that of multimorbidity. After adjusting for potential confounders, relative to those without disability and multimorbidity, disabled subjects showed an increased risk of death when multimorbidity was associated (hazard ratio [HR] = 3.91; 95% confidence interval [CI] = 1.53–10.00) and in absence of multimorbidity (HR = 2.36; 95% CI = 0.63–8.83).ConclusionOur results show that disability exerts an important influence on mortality, independently of age and other clinical and functional variables.     

Proxy reports of physical activity were valid in older people with and without cognitive impairment

ObjectiveTo determine the validity of proxy reports of physical activity in people with symptoms of cognitive impairment.Study Design and SettingIn the Canadian Study of Health and Aging, a multicenter prospective cohort study, someone close to the participant (proxy) reported exercise levels for people who screened positive for cognitive impairment or were institutionalized (n = 2421), some of whom were subsequently diagnosed with cognitive impairment (n = 1612) and some of whom were diagnosed as having no cognitive impairment (n = 809). The reliability and validity of proxy reports of physical activity were examined by agreement with self-reports of physical activity (intraclass correlation coefficient) and by association with adverse health markers (Mantel–Haenzel χ²) and survival time (Cox proportional hazards).ResultsProxy reports of physical activity had moderate interrater reliability (0.55, 95% confidence interval: 0.49–0.61, P < 0.001). People in higher physical activity group had fewer adverse health outcomes than those in lower physical activity groups. Predictive validity was confirmed as people who had higher proxy-reported physical activity survived longer that those with lower physical activity.ConclusionProxy-reported physical activity appears to be a valid estimate of physical activity in people with symptoms or a diagnosis of cognitive impairment.     

Self-determined motivation and physical activity in children and adolescents: A systematic review and meta-analysis

ObjectiveSelf-determination theory is used as a framework for examining the relation between motivation and physical activity. The purpose of this review was to systematically review studies that assessed the association between self-determined motivation and physical activity levels in children and adolescents.MethodWe searched electronic databases in April 2013. Included studies assessed the relation between motivation (as outlined in self-determination theory) and physical activity in children and adolescents.ResultsForty-six studies (n = 15,984 participants) met the inclusion criteria. Meta-analysis indicated that overall levels of self-determined motivation had a weak to moderate, positive associations with physical activity (ρ = .21 to .31). Autonomous forms of motivation (i.e., intrinsic motivation and identified regulation) had moderate, positive associations with physical activity (ρ = .27 to .38), whereas controlled forms of motivation (i.e., introjection and external regulation) had weak, negative associations with physical activity (ρ = − .03 to −.17). Amotivation had a weak, negative association with physical activity (ρ = − .11 to − .21).ConclusionsEvidence provides some support for self-determination theory tenets. However, there was substantial heterogeneity in most associations and many studies had methodological shortcomings.     

Impacto sobre el cuidador principal de una intervención realizada a personas mayores dependientes

ObjectiveTo evaluate the impact of joining a home care program on primary caregivers of dependent elderly people.DesignNon-randomised “before-after” intervention study.SettingPrimary Care.ParticipantsPrimary carers of elderly dependent people included in a home care program (n = 156; 7.8% loss to follow up).InterventionsInclusion in a home care program for chronically dependent elderly and the assessment of the primary carer in the same year.Variables assessedperceived health, frequency of visits, questionnaires of quality of life (Nottingham questionnaire), psychological health (Goldberg questionnaire), social support (Duke-UNC scale) and overburden of caregivers (Zarit questionnaire) and satisfaction with care received.ResultsThere were no significant changes in perceived health. Improvement in the areas of energy, sleep, emotional and social relationship of the quality of life. Decreased attendance (8.4 vs. 7.5, p < 0.05) and the percentage of overusers (30.1 vs 6.9%, P < .01). A reduced percentage of caregivers expressed low social support (8.3 vs 2.8%, P < .05) and caregiver overburden (56.4 vs 44.4%, P < .05). 90.3% of caregivers believed that care had improved at the end of intervention, with a significant improvement of satisfaction of overall medical and nursing care received (7.6 vs 8, 4, 7.9 vs 8.5 and 7 vs 8.5; P < .05).ConclusionsJoining a home care program for dependents has a positive impact on their primary caregiver and improves their perception of care received, reducing their use of health services, reducing the level of overburden and their perceived lack of social support.     

Perceived social and physical environmental correlates of physical activity in older adolescents and the moderating effect of self-efficacy

ObjectiveTo determine if perceptions of the social and physical environment are associated with active transport and leisure-time sports among Belgian youth and to investigate if this relationship is moderated by self-efficacy.MethodsIn February–May 2008, 1445 adolescents (17.4 ± 0.6 yrs) were recruited in 20 randomly selected Belgian schools. Physical activity, psychosocial, and environmental factors were assessed using validated questionnaires. Moderated multilevel regression analysis was used to examine the association between physical activity and possible correlates.ResultsSocial environmental variables (modeling and social support) were positively associated with active transportation and leisure-time sports (p < 0.05). Higher land use mix diversity, higher street connectivity, more attractive environments, better access to recreational facilities, and higher emotional satisfaction with the neighborhood were associated with more active transportation (p < 0.05). Higher perceived safety from traffic, better access to recreational facilities, more physical activity equipment at home, and fewer electronic devices in the bedroom were associated with more leisure-time sports (p < 0.05). Lower perceived safety and poorer access to (recreational) facilities were only associated with lower active transport among youth with lower self-efficacy (p < 0.05).ConclusionCreating more supportive environments could have the potential to affect the physical activity levels of Belgian adolescents with both high and low self-efficacy.     

Évaluation de la qualité de l’alimentation d’adolescents algériens par le score d’adéquation aux recommandations nutritionnelles du PNNS (France)

ObjectiveTo assess the diet quality of Algerian adolescents by an adequacy score derived of the Programme National Nutrition Santé-Guideline Score (PNNS-GS) witch the maximum value 8 signed an adequacy with French PNNS recommendations.Materials and methodsA food frequency questionnaire survey was conducted among 327 teenagers (11–19 years) in two towns in eastern Algeria. Adolescent's anthropometric data were recorded as occupation and education level of their parents. The analyzes were performed with respect to terciles (T) score (T1 representing the most distant subjects of PNNS objectives). Student's test and Chi² test were used.ResultsThe average score was 3.19 ± 1.10. It differed by gender (3.1 ± 1.0 vs 3.3 ±  girls and boys 1.2, P = 0.03). Teenagers T1 group represented 19.6% of the population vs 9.2% for the T3 group (P = 0.0001). The ratings by food group showed that the recommendations concerning fish and seafood's were the least affected (77% of adolescents consumed less than once/week). Sugary products were consumed more than 3 times/day by 67% of subjects and fruits and vegetables less than 3 times/day by 59% of them.ConclusionFood quality of investigated Algerians teenagers does not meet the nutritional recommendations. Nutrition education actions are needed to guide food choices adolescents towards healthy eating.     

Progression of quality of life in patients with grade 3 obesity after a 36 months care pathway with and without bariatric surgery

ObjectivesBeyond somatic consequences, excess weight affects quality of life. In the literature this has markedly improved in the first 6 months, but has decreased later. The originality of our work in that is based on the comparison of two groups of patients, surgical and non-surgical ones, monitored by a multi-professional team for 3 years.MethodsThe sample is comprised of 32 subjects divided into two groups: 17 subjects from the non-surgical pathway and 15 from the surgical one. The Quality of Life, Obesity, and Dietetics questionnaire (QOLOD), the Hospital Anxiety and Depression Scale (HADS) and the Dutch Eating Behaviour Questionnaire (DEBQ), age, BMI, and sex were recorded.ResultsAt baseline, age was significantly different between two groups (surgery vs. non-surgery). BMI and QOLOD improvement were significantly more important in surgical group (?13.6 kg [?19.2; ?10.8] vs. 0.0 kg [?2.8; 3.0] P < 0.001 and 16.9 [8.5; 32.2 vs. 2.1 [?9.4; 16.2], P = 0.004). The progression of the QOLOD score correlated negatively with the progression of BMI (r = ?0.5, P = 0.005)ConclusionThere is a link between post-surgery weight loss and improved quality of life at 36 months. We suggest a qualitative follow-up survey for surgical and non-surgical obese patients.     

The FTO rs9939609 polymorphism and obesity risk in teens: Evidence-based meta-analysis

ObjectiveThis meta-analysis aims evaluate the association of the polymorphism rs9939609 of FTO with the risk of obesity among children and adolescents, based on the assessment of four genetic models: codominant, dominant, recessive alleles model.MethodsCase-control studies, published between the years 2011–2015, were selected from tree available databases (PubMed, Scopus and Web of Science) and were analysed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Thirteen studies were included totalling 15,613 participants, divided into 7311 cases and 8302 controls.ResultsThe FTO rs9939609 polymorphism was significantly associated with increased risk of obesity in children and adolescents for homozygous genotypes AA and heterozygous AT (TT vs. AT + AA: OR = 0.723, 95% CI 0.629 to 0.832; p < 0.0001).ConclusionThis meta-analysis shows that the FTO rs9939609 polymorphism in the gene is a risk factor for obesity in children and adolescents with the presence of the A allele, both homozygous genotype AA situation, as heterozygous AT.     

Pedometer-assessed physical activity of Singaporean youths

ObjectiveThe aim of the study was to investigate the pedometer-assessed physical activity of Singaporean youths using an objective measurement of physical activity.Methods and resultsPedometer step count was monitored over the entire week in 877 participants aged 9–18 years in three schooling cohorts [primary (age, 9–12 years; n = 150 males; 156 females), secondary (age, 13–16 years; n = 137 males; 138 females) and junior college (age, 17–18 years; n = 140 males; 156 females)] in Singapore during July to September 2009. Analyses identified significant main effects for step count taken outside of school compared to within school (mean (SD): 5568 (4796) vs. 3881 (3149), p < 0.05). However, no significant difference was found for steps accumulated within or outside school in boys and girls across the schooling levels (steps × sex × level interaction, p > 0.05). Step counts were not significantly different between weekdays or weekends (9719 (6063) vs. 9483 (8056), p > 0.05), across schooling levels and between male and female participants (sex × level and steps × level × sex interactions, all p > 0.05).ConclusionStep count decline is drastic for male adolescents after primary school but remains low across the schooling levels for female participants. Aggregated daily step count fell short by up to 35% of the 16,000 and 13,000 steps recommended respectively for male and female youths.     

Risk factors for overweight and obesity in French adolescents: Physical activity,sedentary behavior and parental characteristics

ObjectiveWe determined the prevalence by age and sex and associated factors of overweight and obesity in French adolescents.MethodsWe conducted a cross-sectional study of 2385 adolescents aged 11–18 y (1213 boys and 1172 girls) from middle and high schools in the Aquitaine region (southwest France) in 2004–2005. Weight and height were measured, and adolescents filled in a questionnaire about their characteristics and those of their parents. Overweight and obesity were defined according to the age- and sex-specific body mass index cutoff points of the International Obesity Task force.ResultsPrevalence of overweight (obesity included) was greater in boys and younger children. The odds ratio (OR) for an adolescent being overweight increased with parents' being overweight (at least one parent overweight, OR 1.97, 1.48–2.62, P < 0.0001), low paternal socioeconomic status (OR 1.78, 1.22–2.60, P < 0.01) and sedentary behavior (22 h/wk, OR 1.33, 1.02–1.74, P < 0.05), and decreased with physical activity of parents (at least one parent active, OR 0.67, 0.51–0.89, P = 0.01).ConclusionOur data support the hypothesis that parental overweight and low socioeconomic status and adolescents' sedentary behavior are strong risk factors for adolescent overweight and obesity, and that parents active lifestyle is associated with a lower risk of overweight in their adolescents.     

A single Epley manoeuvre can improve self-perceptions of disability (quality of life) in patients with pc-BPPV: A randomised controlled trial in primary care

Posterior canal benign paroxysmal positional vertigo (pc-BPPV) causes physical, functional, and emotional impairment. The treatment is the Epley manoeuvre (EM).ObjectiveThe purpose of the study was to compare the impact of the EM and a sham manoeuvre in primary care on self-perceived disability.DesignRandomised, double-blind, sham-controlled clinical trial conducted in primary care with a follow-up of 1 year.ParticipantsPatients aged ≥18 years old diagnosed with pc-BPPV according to the Dix–Hallpike test (DHT) were randomised to:InterventionsIntervention (EM) group or a control (sham manoeuvre) group.Main measurementsThe main study covariates were age, sex, history of depression and anxiety, presence of nystagmus in the DHT, patient-perceived disability assessed with the Dizziness Handicap Inventory – screening version (DHI-S). Data were analyzed using bivariate and multivariate mixed Tobit analyses.ResultsOverall, 134 patients were studied: 66 in the intervention group and 68 in the control group. Median age was 52 years (interquartile range [IQR], 38.25–68.00 years. standard deviation, 16.98) and 76.12% of the patients were women. The DHT triggered nystagmus in 40.30% of patients. The median total DHI-S score for the overall sample at baseline was 16 (IQR, 8.00–22.00); 16 [IQR, 10.5–24.0] vs 10 [6.0–14.0] for women vs men (P < .001). Patients treated with the EM experienced a mean reduction of 2.03 points in DHI-S score over the follow-up period compared with patients in the sham group.ConclusionsPc-BPPV affects the quality of life of primary care patients. A single EM can improve self-perceptions of disability by around 2 points on the DHI-S scale.     

Effects of clustering of multiple lifestyle-related behaviors on blood pressure in adolescents from two observational studies

BackgroudSeveral lifestyle-related behaviors are associated with cardiovascular health outcomes in adolescents. To examine the associations between clustered lifestyle-related behaviors and blood pressure (BP) levels in adolescents.MethodsParticipants were recruited by multistage random cluster in two cross-sectional studies; one conducted in 2006 and 2007 in ten cities from nine European countries: Athens and Heraklion in Greece, Dortmund in Germany, Ghent in Belgium, Lille in France, Pécs in Hungary, Rome in Italy, Stockholm in Sweden, Vienna in Austria, and Zaragoza in Spain; and another conducted in 2007 one city in Brazil (Maringá/PR). Systolic BP (SBP) and diastolic BP (DBP) (outcomes) and clustered behaviors (weekly consumption of fruits and vegetables, weekly consumption of sugar-sweetened beverages, sleep duration, screen time and physical activity) were analyzed.ResultsThe Healthy Eating cluster was negatively associated with DBP in European girls, β = − 2.46 (− 4.62; − 0.30), and with SBP in Brazilian boys, β = − 2.79 (− 3.10; − 0.15). Furthermore, the Unhealthy Eating cluster was associated with increased SBP in European girls, β = 4.54 (1.29; 7.79), and in Brazilian boys, β = 4.10 (0.80; 7.40).ConclusionThe Healthy Eating cluster was associated with lower blood pressure, whereas the Unhealthy Eating cluster was associated with increased SBP in adolescents.     

Assessment of energy expenditure,physical activity and sleep pattern in patients with frequent symptomatic ventricular ectopic beats

BackgroundVentricular ectopic beats (VEBs) are considered as benign ventricular arrhythmias in patients without structural heart disease. However, symptomatic frequent VEBs can adversely affect energy metabolism. The present study aimed to determine the effect of symptomatic frequent VEBs on energy expenditure, physical activity and sleep pattern.MethodsThirty-seven patients with symptomatic frequent VEBs and no structural heart diseases were enrolled. Patients underwent simultaneous 24-hour-ambulatory Holter electrocardiogram monitoring and the BodyMedia armband device monitoring which measures energy expenditure. Data acquired from both devices were compared with the data acquired from healthy volunteers in the control group.ResultsTotal energy expenditure (TEE) was higher in the patient group than the control group (1470 ± 353 kcal vs 1125 ± 275 kcal, P < 0.001). Average metabolic equivalence (aMETs) (1.1 ± 0.2 vs. 1.3 ± 0.2, P = 0.028), physical activity duration (PAD) (0.35 vs. 0.48, P = 0.007) and sleep duration (SDN) (3.15 vs. 4.31, P = 0.004) were significantly lower in the patient group than control group. VEBs frequency was inversely correlated with only SDN (r = −0.374, P = 0.027).ConclusionTotal energy expenditure (TEE) is increased in patients with symptomatic frequent VEBs in comparison with healthy subjects while PAD, average metabolic equivalence (aMETs) and SDN are decreased. VEBs frequency was inversely correlated with SDN.     

Determining the risk of diabulimia and its relationship with diet quality and nutritional status of adolescents with type 1 diabetes

IntroductionDiabulimia is known as an eating disorder specific to individuals with diabetes.ObjectivesIn this study, it was aimed to determine the diabulimia risk and to evaluate the possible relationships between diabulimia risk and diet quality, anthropometric measurements, and biochemical parameters of adolescents with type 1 diabetes.Material and methodsIn total, 110 adolescents (male: 51.8%, female: 48.2%) with type 1 diabetes between 10–19 years were included in the study. Sociodemographic characteristics and information about diabetes of adolescents were collected using a questionnaire prepared by the researchers through face-to-face interview technique. Anthropometric measurements and 3-day food consumption records were obtained to evaluate their nutritional status, and their biochemical parameters were obtained from hospital files to evaluate their metabolic status. The diet quality was evaluated using the Healthy Eating Index-2015. Diabetes Eating Problem Survey was administered to individuals and it was accepted that diabetics with a total score of ≥ 20 were at risk of diabetes-related eating disorders.Results/ConclusionAmong the 110 adolescents included in this study, 31.8% were found to be at risk of diabulimia. There was a significant relationship between the groups with and without diabulimia risk in terms of diet quality scores (P < 0.05). All individuals with a risk of diabulimia as well as 86.8% of individuals without a risk of diabulimia had high HbA1c levels (P < 0.05). Diet quality, some anthropometric measurements and biochemical parameters of adolescents at risk of diabulimia should be improved. It is important to periodically evaluate the risk of diabulimia, the diet quality, and the nutritional status of adolescents with type 1 diabetes to reduce the occurrence of short and long-term complications.     

Impact of the 13-valent pneumococcal conjugate vaccine on Streptococcus pneumoniae multiple serotype carriage

IntroductionPneumococcal multiple serotype carriage is important for evolution of the species and to understand how the pneumococcal population is changing with vaccination. We aimed to determine the impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on multiple serotype carriage.Methods and materialsNasopharyngeal samples from fully vaccinated pneumococcal carriers (4 doses of PCV13, n = 141, aged 18–72 months) or from non-vaccinated pneumococcal carriers (0 doses of any PCV, n = 140, same age group) were analyzed. Multiple serotype carriage was evaluated by DNA hybridization with a molecular serotyping microarray that detects all known serotypes.ResultsVaccinated children had a lower prevalence of multiple serotype carriage than the non-vaccinated group (20.6% vs 29.3%, p = 0.097), and a significantly lower proportion of PCV13 serotypes (6.4% vs 38.5%, p = 0.0001). PCV13 serotypes found among vaccinated children were mostly detected as a minor serotype in co-colonization with a more abundant non-vaccine serotype. Vaccinated children were colonized by a significantly higher proportion of commensal non-pneumococcal Streptococcus spp. (58.2% vs 42.8%, p = 0.012). In vaccinated children there were significantly less non-vaccine type (NVT) co-colonization events than expected based on the distribution of these serotypes in non-vaccinated children.ConclusionsThe results suggest that vaccinated children have lower pneumococcal multiple serotype carriage prevalence due to higher competitive abilities of non-vaccine serotypes expanding after PCV13 use. This might represent an additional benefit of PCV13, as decreased co-colonization rates translate into decreased opportunities for horizontal gene transfer and might have implications for the evolution and virulence of pneumococci.     

Temps devant les écrans,sport et sommeil d’une population d’adolescents algériens – Influence du genre et de l’indice de masse corporelle

ObjectiveThis article analyses the influence of gender and body mass index (BMI) on the usual physical activities of a population of Algerian adolescents.Material and methodsData on sleep durations, studying at home, being in front of a screen (television, computer, smartphone, playing console) were collected using a questionnaire. Information on sporting activity was also collected. International references from the World Health Organization have been used to classify subjects by ponderal status.ResultsA total of 501 adolescents (10–19 years old) schooled in primary, middle and secondary cycles participated in the study. A negative correlation was found between the duration of sleep and their age (r = ?12%). The normal weight adolescents were predominant (65.5%; P < 0.0001). For sporting activity, 8.2% of those surveyed did not practise it (neither at school, nor in the gym, nor outdoors). Positive correlations were observed between age and BMI (r = 36%), duration of use smartphone and BMI (r = 50%) and with age (r = 48%). For the three school levels, the average duration of using a smartphone was positively and significantly correlated with BMI (primary: r = 29%; middle: r = 35%; secondary: r = 45%).ConclusionThis study highlights the importance of promoting a healthy lifestyle during adolescence through the capacity for self-regulation by avoiding a health risk behaviours, including the use of digital technologies and the lack of practice of sport.     

Gender differences in the longitudinal associations of depressive symptoms and leisure-time physical activity with cognitive decline in ≥ 57 year-old Taiwanese

ObjectiveThis study investigates the role of gender in the associations of long-term depressive symptoms and leisure-time physical activity (LTPA) with the risk of cognitive decline in elderly Taiwanese.MethodWe analyzed 3679 subjects (age ≥ 57) in the 2003 and 2007 datasets of the Taiwan Longitudinal Survey on Aging, of which data were collected via face-to-face interviews by trained interviewers. We excluded proxy respondents. Multivariable logistic regression analysis examined the associations of long-term depressive symptoms (increased symptoms: CES-D10 scores from < 10 to ≥ 10; decreased symptoms: from ≥ 10 to < 10) and LTPA (frequency, duration, and intensity) with cognitive decline (a decrease of two or more SPMSQ scores).ResultsWomen had significant higher percentages of cognitive impairment, compared to men, at the baseline (5.9 vs. 1.5%; χ² = 51.24, p < 0.001) and end-point (10.8 vs. 5.2%;χ² = 39.5, p < 0.001). Men with long-term depressive symptoms had 5.28 greater odds of cognitive decline (OR = 5.28, 95%CI = 2.84–9.82, p < 0.001) and men with increased depressive symptoms had 2.09 greater odds (2.09, 1.24–3.51, p = 0.006). No such association was observed in women. Men with consistently high LTPA had 65% (0.35, 0.19–0.65, p = 0.001) and women with increased LTPA had 43% (0.57, 0.34–0.93, p = 0.024) reduction in odds of developing cognitive decline.ConclusionWe found gender differences in the longitudinal association between depressive symptoms and cognitive decline. Long-term LTPA may loosen the association between long-term depressive symptoms and cognitive decline. These findings are useful in the identification of vulnerable elderly in the Taiwanese population and public health interventions should focus on assisting their cognitive aging.