Nutritional Status Is Associated With Clinical Progression in Alzheimer's Disease: The NUDAD Project.

Astrid S Doorduijn,Heleen M.A Hendriksen,Francisca A De Leeuw,Wiesje M Van Der Flier,Marian A.E De Van Der Schueren,Charlotte E Teunissen,Marjolein Visser,Philip Scheltens,Ondine Van De Rest

doi:10.1016/j.jamda.2020.10.020

Abstract

In cognitively normal adults, nutritional parameters are related to cognitive decline and incidence of dementia. Studies on the role of nutrition in predementia stages subjective cognitive decline and mild cognitive impairment, and mild stages of Alzheimer's disease (AD) dementia in a clinical setting are lacking. In the absence of a curative treatment, this evidence is important for targeting nutritional factors to potentially prevent or delay further cognitive decline. Our aim is to investigate associations of nutritional parameters with clinical progression in patients ranging from those who are cognitively normal to those who have AD dementia. Longitudinal. Memory clinic, 551 patients (219 with subjective cognitive decline, 135 with mild cognitive impairment, and 197 with AD dementia), mean age 64±8years. We assessed body mass index, fat-free mass, Mini-Nutritional Assessment, and dietary intake with the Dutch Healthy Diet food frequency questionnaire and the 238-item healthy life in an urban setting (HELIUS) food frequency questionnaire at baseline. Cox proportional hazard models were used to evaluate associations of nutritional parameters with clinical progression. Additional analyses were restricted to patients who were amyloid positive. We observed clinical progression in 170 patients (31%) over 2.2±0.9years. Poorer Mini-Nutritional Assessment score [hazard ratio (95% confidence interval) 1.39 (1.18-1.64)], lower body mass index [1.15 (0.96-1.38)], lower fat-free mass [1.40 (0.93-2.10)], and a less healthy dietary pattern [1.22 (1.01-1.48)] were associated with a higher risk of clinical progression. Similar effect sizes were found in patients who were amyloid positive. Poorer nutritional status and a less healthy dietary pattern are associated with a higher risk of clinical progression. This study provides support for investigating whether improving nutritional status can alter the clinical trajectory of AD.

Highlights

This study provides support for investigating whether improving nutritional status can alter the clinical trajectory of Alzheimer’s disease (AD)
The main finding of this study is that poorer nutritional status and less healthy dietary pattern were associated with a higher risk of clinical progression in a memory clinic cohort
In line with and in addition to former studies in patients with moderate AD dementia,7,8,18e20 we showed that a poorer Mini-Nutritional Assessment (MNA) score, indicative of a poorer nutritional status, was associated with a higher risk of clinical progression across the complete spectrum of AD.15e17 a lower body mass index (BMI) tended to be associated with a higher risk of clinical progression

Summary

Objective

Nutritional parameters are related to cognitive decline and incidence of dementia. Studies in cognitively normal samples show that nutritional parameters are related to cognitive decline and incidence of dementia.[1] Weight loss often precedes the onset of Alzheimer’s disease (AD) dementia2e6 and older adults with poorer nutritional status [ie, lower body mass index (BMI)] show more cognitive decline and have a higher risk of dementia.[7,8] dietary intake has been related to cognition [eg, a dietary pattern with relatively high caloric intake from carbohydrates and low caloric intake from fat and proteins may increase the risk of mild cognitive impairment (MCI) or dementia in older adults].9. We investigated the associations of nutritional status as well as dietary intake with clinical progression in a memory clinic cohort of patients with subjective cognitive decline (SCD), MCI, and AD dementia

Methods

Results

Discussion

Conclusions and Implications