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June 02, 2015; 84 (22) Article

Healthy eating and reduced risk of cognitive decline

A cohort from 40 countries

Andrew Smyth, Mahshid Dehghan, Martin O'Donnell, Craig Anderson, Koon Teo, Peggy Gao, Peter Sleight, Gilles Dagenais, Jeffrey L. Probstfield, Andrew Mente, Salim Yusuf
First published May 6, 2015, DOI: https://doi.org/10.1212/WNL.0000000000001638
Andrew Smyth
From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
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Mahshid Dehghan
From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
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Martin O'Donnell
From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
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Craig Anderson
From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
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Koon Teo
From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
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Peggy Gao
From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
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Peter Sleight
From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
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Gilles Dagenais
From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
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Jeffrey L. Probstfield
From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
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Andrew Mente
From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
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Salim Yusuf
From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
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Citation
Healthy eating and reduced risk of cognitive decline
A cohort from 40 countries
Andrew Smyth, Mahshid Dehghan, Martin O'Donnell, Craig Anderson, Koon Teo, Peggy Gao, Peter Sleight, Gilles Dagenais, Jeffrey L. Probstfield, Andrew Mente, Salim Yusuf
Neurology Jun 2015, 84 (22) 2258-2265; DOI: 10.1212/WNL.0000000000001638

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Abstract

Objective: We sought to determine the association of dietary factors and risk of cognitive decline in a population at high risk of cardiovascular disease.

Methods: Baseline dietary intake and measures of the Mini-Mental State Examination were recorded in 27,860 men and women who were enrolled in 2 international parallel trials of the ONTARGET (Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial) and TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) studies. We measured diet quality using the modified Alternative Healthy Eating Index. Cox proportional hazards regression was used to determine the association between diet quality and risk of ≥3-point decline in Mini-Mental State Examination score, and reported as hazard ratio with 95% confidence intervals with adjustment for covariates.

Results: During 56 months of follow-up, 4,699 cases of cognitive decline occurred. We observed lower risk of cognitive decline among those in the healthiest dietary quintile of modified Alternative Healthy Eating Index compared with lowest quintile (hazard ratio 0.76, 95% confidence interval 0.66–0.86, Q5 vs Q1). Lower risk of cognitive decline was consistent regardless of baseline cognitive level.

Conclusion: We found that higher diet quality was associated with a reduced risk of cognitive decline. Improved diet quality represents an important potential target for reducing the global burden of cognitive decline.

GLOSSARY

BMI=
body mass index;
CHF=
congestive heart failure;
CI=
confidence interval;
CV=
cardiovascular;
FFQ=
Food Frequency Questionnaire;
HR=
hazard ratio;
mAHEI=
modified Alternative Healthy Eating Index;
MMSE=
Mini-Mental State Examination;
ONTARGET=
Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial;
TRANSCEND=
Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease

Footnotes

  • ↵* These authors contributed equally to this work.

  • ONTARGET and TRANSCEND coinvestigators are listed on the Neurology® Web site at Neurology.org.

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Received October 2, 2014.
  • Accepted in final form February 19, 2015.
  • © 2015 American Academy of Neurology
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  • Diet, Cognition and the Microbiota
    • Robert P. Friedland, Neurologist, Univ. of Louisvile School of Medicinerobert.friedland@louisville.edu
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    Submitted July 23, 2015
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