Abstract
The association of dietary patterns, or the combinations of different foods that people eat, with cognitive change and dementia is unclear. To examine the association of dietary patterns in midlife with cognitive function in later life in a US population without dementia. Observational cohort study with analysis of data collected from 1987 to 2017. Analysis was completed in January to February 2019. Community-dwelling black and white men and women from Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and suburban Minneapolis, Minnesota, participating in the Atherosclerosis Risk in Communities (ARIC) study were included. Two dietary pattern scores were derived from a 66-item food frequency questionnaire using principal component analysis. A Western, or unhealthy, dietary pattern was characterized by higher consumption of meats and fried foods. A so-called prudent, or healthier, dietary pattern was characterized by higher amounts of fruits and vegetables. Results of 3 cognitive tests (Digit Symbol Substitution Test, Word Fluency Test, and Delayed Word Recall) performed at 3 points (1990-1992, 1996-1998, and 2011-2013) were standardized and combined to represent global cognitive function. The 20-year change in cognitive function was determined by tertile of diet pattern score using mixed-effect models. The risk of incident dementia was also determined by tertile of the diet pattern score. A total of 13 588 participants (7588 [55.8%] women) with a mean (SD) age of 54.6 (5.7) years at baseline were included; participants in the top third of Western and prudent diet pattern scores were considered adherent to the respective diet. Cognitive scores at baseline were lower in participants with a Western diet (z score for tertile 3 [T3], -0.17 [95% CI, -0.20 to -0.14] vs T1, 0.17 [95% CI, 0.14-0.20]) and higher in participants with a prudent diet (z score for T3, -0.09 [95% CI, -0.12 to -0.06] vs T1, -0.09 [95% -0.12 to -0.06]). Estimated 20-year change in global cognitive function did not differ by dietary pattern (difference of change in z score for Western diet, T3 vs T1: -0.01 [95% CI, -0.05 to 0.04]; and difference of change in z score for prudent diet, T3 vs T1: 0.02 [95% CI, -0.02 to 0.06]). The risk of incident dementia did not differ by dietary pattern (Western hazard ratio for T3 vs T1, 1.06 [95% CI, 0.92-1.22]; prudent hazard ratio for T3 vs T1, 0.99 [95% CI, 0.88-1.12]). This study found that the dietary pattern of US adults at midlife was not associated with processing speed, word fluency, memory, or incident dementia in later life.
Highlights
Healthy dietary patterns may protect against dementia and mild cognitive impairment.[1,2] Prior studies demonstrate that healthy dietary patterns are associated with increased brain volumes and reduced atrophy compared with less healthy dietary patterns.[3,4] the mechanism behind a healthy diet and improved brain health are not well understood, 2 plausible mechanisms include reduced vascular injury and a reduction in Alzheimer pathology.[5]
Cognitive scores at baseline were lower in participants with a Western diet (z score for tertile 3 [T3], −0.17 [95% CI, −0.20 to −0.14] vs T1, 0.17 [95% CI, 0.14-0.20]) and higher in participants with a prudent diet (z score for T3, −0.09 [95% CI, −0.12 to −0.06] vs T1, −0.09 [95% −0.12 to −0.06])
Estimated 20-year change in global cognitive function did not differ by dietary pattern
Summary
Healthy dietary patterns may protect against dementia and mild cognitive impairment.[1,2] Prior studies demonstrate that healthy dietary patterns are associated with increased brain volumes and reduced atrophy compared with less healthy dietary patterns.[3,4] the mechanism behind a healthy diet and improved brain health are not well understood, 2 plausible mechanisms include reduced vascular injury and a reduction in Alzheimer pathology.[5]. Midlife dietary pattern, compared with dietary pattern in later life, may have a stronger association with cognitive decline and dementia because chronic disease or the concern for chronic disease in later life may motivate individuals to improve their diet,[9] making it appear that a healthy diet is associated with poor health outcomes. At least 10 prior studies examined associations of dietary patterns later in life with cognitive decline, but far fewer prospectively investigated associations for midlife dietary patterns.[9,10] In this study, we examine the association between midlife dietary patterns and cognitive change and incident dementia over 20 years. We hypothesized that a healthy diet at midlife would be associated with less cognitive decline and a lower risk of dementia
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