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April 02, 2019; 92 (14) Article

Dietary patterns during adulthood and cognitive performance in midlife

The CARDIA study

View ORCID ProfileClaire T. McEvoy, Tina Hoang, View ORCID ProfileStephen Sidney, View ORCID ProfileLyn M. Steffen, View ORCID ProfileDavid R. Jacobs, View ORCID ProfileJames M. Shikany, View ORCID ProfileJohn T. Wilkins, Kristine Yaffe
First published March 6, 2019, DOI: https://doi.org/10.1212/WNL.0000000000007243
Claire T. McEvoy
From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA.
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Tina Hoang
From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA.
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Stephen Sidney
From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA.
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Lyn M. Steffen
From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA.
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David R. Jacobs Jr
From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA.
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James M. Shikany
From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA.
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John T. Wilkins
From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA.
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Kristine Yaffe
From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA.
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Citation
Dietary patterns during adulthood and cognitive performance in midlife
The CARDIA study
Claire T. McEvoy, Tina Hoang, Stephen Sidney, Lyn M. Steffen, David R. Jacobs, James M. Shikany, John T. Wilkins, Kristine Yaffe
Neurology Apr 2019, 92 (14) e1589-e1599; DOI: 10.1212/WNL.0000000000007243

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Abstract

Objective To investigate whether dietary patterns (Mediterranean diet [MedDiet], Dietary Approaches to Stop Hypertension [DASH], and A Priori Diet Quality Score [APDQS]) during adulthood are associated with midlife cognitive performance.

Methods We studied 2,621 Coronary Artery Risk Development in Young Adults (CARDIA) participants; 45% were black, 57% were female, and mean age was 25 ± 3.5 years at baseline (year 0). Mean diet scores were calculated from diet history at baseline, year 7, and year 20 (mean age 25, 32, and 45 years, respectively). Cognitive function was assessed at years 25 and 30 (mean age 50 and 55 years, respectively). Linear models were used to examine association between tertiles of diet score and change in composite cognitive function and cognitive z scores (verbal memory [Rey Auditory Verbal Learning Test], processing speed [Digit Symbol Substitution Test], and executive function [Stroop Interference test]) and the Montreal Cognitive Assessment (MoCA) at year 30.

Results DASH was not associated with change in cognitive performance. Higher MedDiet and APDQS scores were associated with less decline in cognitive function (MedDiet: low −0.04, middle 0.03, high 0.03, p = 0.03; APDQS: low −0.04, middle −0.00, high 0.06, p < 0.01) and Stroop Interference (MedDiet: low 0.09, middle −0.06, high −0.03; APDQS: low 0.10, middle 0.01, high −0.09, both p < 0.01). Odds ratios (95% confidence interval) for poor global cognitive function (≥1 SD below mean MoCA score) comparing extreme tertiles of diet scores were 0.54 (0.39–0.74) for MedDiet, 0.48 (0.33–0.69) for APDQS, and 0.89 (0.68–1.17) for DASH.

Conclusion Greater adherence to MedDiet and APDQS dietary patterns during adulthood was associated with better midlife cognitive performance. Additional studies are needed to define the combination of foods and nutrients for optimal brain health across the life course.

Glossary

APDQS=
A Priori Diet Quality Score;
BMI=
body mass index;
CARDIA=
Coronary Artery Risk Development in Young Adults;
CES-D=
Center for Epidemiologic Studies Depression;
CI=
confidence interval;
DASH=
Dietary Approaches to Stop Hypertension;
DSST=
Digit Symbol Substitution Test;
MedDiet=
Mediterranean diet;
MoCA=
Montreal Cognitive Assessment;
OR=
odds ratio;
RAVLT=
Rey Auditory Verbal Learning Test

Footnotes

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

  • Editorial, page 645

  • CME Course: NPub.org/cmelist

  • Received April 13, 2018.
  • Accepted in final form November 28, 2018.
  • © 2019 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence

  • Author response: Dietary patterns during adulthood and cognitive performance in midlife: The CARDIA study
    • Claire McEvoy, Assistant Professor, Queen's University Belfast
    Submitted December 17, 2019
  • Reader response: Dietary patterns during adulthood and cognitive performance in midlife The CARDIA study
    • Mariana I. Muñoz-Garcia, PhD Student, University of Navarra
    • Estefanía Toledo, Associate professor, University of Navarra
    • Miguel A. Martinez-Gonzalez, Professor & Chair Preventive Medicine & Public Health, University of Navarra
    Submitted April 01, 2019
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