Abstract
Background: Findings from animal and epidemiological research support the potential neuroprotective benefits from healthy diets. However, to establish diet-neuroprotective causal relations, evidence from dietary intervention studies is needed. NU-AGE is the first multicenter intervention assessing whether a diet targeting health in aging can counteract the age-related physiological changes in different organs, including the brain. In this study, we specifically investigated the effects of NU-AGE's dietary intervention on age-related cognitive decline.Materials and Methods: NU-AGE randomized trial (NCT01754012, clinicaltrials.gov) included 1279 relatively healthy older-adults, aged 65–79 years, from five European centers. Participants were randomly allocated into two groups: “control” (n = 638), following a habitual diet; and, “intervention” (n = 641), given individually tailored dietary advice (NU-AGE diet). Adherence to the NU-AGE diet was measured over follow-up, and categorized into tertiles (low, moderate, high). Cognitive function was ascertained at baseline and at 1-year follow-up with the Consortium to Establish a Registry for Alzheimer's Disease (CERAD)-Neuropsychological Battery and five additional domain-specific single cognitive tests. The raw scores from the CERAD subtests [excluding the Mini-Mental State Examination (MMSE)] and the single tests were standardized into Z-scores. Global cognition (measured with MMSE and CERAD-total score), and five cognitive domains (perceptual speed, executive function, episodic memory, verbal abilities, and constructional praxis) were created. Cognitive changes as a function of the intervention were analyzed with multivariable mixed-effects models.Results: After the 1-year follow-up, 571 (89.1%) controls and 573 (89.8%) from the intervention group participated in the post-intervention assessment. Both control and intervention groups showed improvements in global cognition and in all cognitive domains after 1 year, but differences in cognitive changes between the two groups were not statistically significant. However, participants with higher adherence to the NU-AGE diet showed statistically significant improvements in global cognition [β 0.20 (95%CI 0.004, 0.39), p-value = 0.046] and episodic memory [β 0.15 (95%CI 0.02, 0.28), p-value = 0.025] after 1 year, compared to those adults with lower adherence.Discussion: High adherence to the culturally adapted, individually tailored, NU-AGE diet could slow down age-related cognitive decline, helping to prevent cognitive impairment and dementia.
Highlights
Dementia has become a worldwide public health priority
A slower rate of cognitive decline and reduced risk of cognitive impairment and dementia have been associated with a higher consumption of single nutrients or of single foods
Compared to individuals in the control group with low adherence to the Food Based Dietary Guidelines (FBDG), participants with moderate-to-high adherence to the NU-AGE diet showed slight improvements in global cognition [β 0.06] and episodic memory [β 0.04] over the follow-up
Summary
Dementia has become a worldwide public health priority. About 47 million people are living today with dementia around the world and this number is expected to increase three-fold, up to 132 million cases by 2050 (Prince et al, 2015). Lifestyle modification appears to be a promising alternative strategy to slow the progression of cognitive decline and to prevent dementia (Winblad et al, 2016). Emerging evidence from observational studies suggests that healthy dietary habits could have neuroprotective benefits. People eat combinations of foods, which may have additive, synergistic, or antagonistic effects on health (Jacobs et al, 2009). Using a whole-diet approach, which emphasizes the overall dietary intake, is more important when seeking for preventive strategies targeting multifactorial disorders, such as dementia. To establish diet-neuroprotective causal relations, evidence from dietary intervention studies is needed. NU-AGE is the first multicenter intervention assessing whether a diet targeting health in aging can counteract the age-related physiological changes in different organs, including the brain. We investigated the effects of NU-AGE’s dietary intervention on age-related cognitive decline
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