Feasibility of a Dietary Intervention Using Coconut Oil on Cognition and Quality of Life in Older Adults: Randomised Controlled Pilot study.

Abstract

Background: With no effective treatments for dementia, research has addressed the efficacy of multi-dimensional interventions against dementia, mostly based on lifestyle modifications, to reduce the progression of the disease. The positive influence of adopting specific diet and nutrition-related habits on the cognitive trajectory throughout the life span has been increasingly investigated. Empirical evidence to date has demonstrated associations between nutrition and cognitive impairments in older adults specifically with the relation between glucose hypo-metabolism and neurodegeneration. Therefore, providing an alternative source of neuronal fuel could reduce neurodegeneration and consequently, dementia in older adults and adults with Mild Cognitive Impairment (MCI). Previous studies have used Medium Chain Triglycerides (MCTs) and ketogenic diets as a source of ketone bodies to improve cognitive functions in older adults with MCI or Alzheimer’s disease. However, the current study relies on the consumption of the whole food component (coconut oil) that is rich in medium chain fatty acids, to induce ketosis. Methods and analysis: The Medical Research Council’s complex intervention framework was used to design a feasibility study following a randomized controlled study design. Thirty-one individuals (mean age 74 ± 5.6, 14 men and 17 women were randomised to receive either 30 ml/day of coconut (n 18) or sunflower oil (n 13) for 6 months. Recruitment, retention, adherence, fidelity was investigated. Quantitative data consisted of anthropometric, dietary, quality of life, cognitive and blood ketone measures at baseline, three and 6 months. Qualitative data was collected through open ended questionnaires and semi- structured interviews. Results: Ninety-one percent of participants completed the study (n=28/31). Twenty-three participants (82%) adhered to consuming both oils for 3 months and 20 participants for 6 months (71%). At 3 months, 13 of the15 (87%) participants adhered to coconut oil and 11 of the15 (73%) participants for 6 months. Recruitment of MCI patients was challenging due to limitations in diagnosis, thus more older adults (n 26) than MCI patients (n 5) were recruited for the study. During the interviews at 6 months, participants reported no issues with the study processes and procedures. The participants also reported that they were able to incorporate the oil into their diet. Cohen d analysis on cognitive measures demonstrated a small effect size in the direction of benefit in cognitive measures in the coconut oil group. No change was detected in blood ketone measure, quality of life and dietary measures. Conclusion: Recruitment, retention, indicative results, and participant acceptability data suggest that the intervention is feasible for older-adults and adults with MCI. The findings support the development of a future fully powered Randomised Controlled Trial (RCT) to measure long term effects. The data will inform the design of a RCT that will be adequately powered to assess the effectiveness of the intervention on cognitive measures and quality of life. The findings from a future study, using this food-based intervention have potential to improve cognition and quality of life in older adults and adults with MCI, and in so doing reduce the risk of dementia.