Abstract
BackgroundAdherence to the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet has been linked to a decreased risk of dementia, but reverse causality and residual confounding by lifestyle may partly account for this link. We aimed to address these issues by studying the associations over cumulative time periods, which may provide insight into possible reverse causality, and by using both historical and more contemporary dietary data as this could give insight into confounding since historical data may be less affected by lifestyle factors.MethodsIn the population-based Rotterdam Study, dietary intake was assessed using validated food frequency questionnaires in 5375 participants between 1989 and 1993 (baseline I) and in a largely non-overlapping sample in 2861 participants between 2009 and 2013 (baseline II). We calculated the MIND diet score and studied its association with the risk of all-cause dementia, using Cox models. Incident all-cause dementia was recorded until 2018.ResultsDuring a mean follow-up of 15.6 years from baseline I, 1188 participants developed dementia. A higher MIND diet score at baseline I was associated with a lower risk of dementia over the first 7 years of follow-up (hazard ratio (HR) [95% confidence interval (CI)] per standard deviation (SD) increase, 0.85 [0.74, 0.98]), but associations disappeared over longer follow-up intervals. The mean follow-up from baseline II was 5.9 years during which 248 participants developed dementia. A higher MIND diet score at baseline II was associated with a lower risk of dementia over every follow-up interval, but associations slightly attenuated over time (HR [95% CI] for 7 years follow-up per SD increase, 0.76 [0.66, 0.87]). The MIND diet score at baseline II was more strongly associated with the risk of dementia than the MIND diet score at baseline I.ConclusionBetter adherence to the MIND diet is associated with a decreased risk of dementia within the first years of follow-up, but this may in part be explained by reverse causality and residual confounding by lifestyle. Further research is needed to unravel to which extent the MIND diet may affect the risk of dementia.
Highlights
Diet has gained increasing interest as a target for developing preventive opportunities against dementia, as it impacts several mechanisms underlying dementia, including oxidative stress, inflammation, and vascular abnormalities
In Additional file 1, characteristics of the study population are presented stratified by tertiles of the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet score
A higher MIND diet score at baseline II was associated with a lower risk of dementia and so were the Dutch dietary guidelines and Mediterranean diet score (model 2 adjusted hazard ratios (HRs) [95% confidence intervals (95% CIs)] per Baseline II (N = 2861)
Summary
Diet has gained increasing interest as a target for developing preventive opportunities against dementia, as it impacts several mechanisms underlying dementia, including oxidative stress, inflammation, and vascular abnormalities. The average follow-up time in previous studies was 4.5 to 6.6 years, which corresponds largely to the prodromal stage of dementia [14]. During this phase of incremental cognitive impairment, dietary habits may deteriorate [15, 16], for instance, due to depressive symptoms [17] and olfactory impairment [18]. We aimed to address these issues by studying the associations over cumulative time periods, which may provide insight into possible reverse causality, and by using both historical and more contemporary dietary data as this could give insight into confounding since historical data may be less affected by lifestyle factors
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