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December 14, 2021; 97 (24) Research Article

Diet Inflammatory Index and Dementia Incidence

A Population-Based Study

Sokratis Charisis, Eva Ntanasi, View ORCID ProfileMary Yannakoulia, Costas A. Anastasiou, Mary H. Kosmidis, View ORCID ProfileEfthimios Dardiotis, Antonios N. Gargalionis, View ORCID ProfileKostas Patas, Stylianos Chatzipanagiotou, Ioannis Mourtzinos, Katerina Tzima, View ORCID ProfileGeorgios Hadjigeorgiou, Paraskevi Sakka, View ORCID ProfileDimitrios Kapogiannis, Nikolaos Scarmeas
First published November 10, 2021, DOI: https://doi.org/10.1212/WNL.0000000000012973
Sokratis Charisis
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Eva Ntanasi
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Mary Yannakoulia
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Costas A. Anastasiou
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Mary H. Kosmidis
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Efthimios Dardiotis
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Antonios N. Gargalionis
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Kostas Patas
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Stylianos Chatzipanagiotou
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Ioannis Mourtzinos
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Katerina Tzima
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Georgios Hadjigeorgiou
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Paraskevi Sakka
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Dimitrios Kapogiannis
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Nikolaos Scarmeas
From the 1st Department of Neurology (S.C., E.N., N.S.) and Department of Medical Biopathology and Clinical Microbiology (A.N.G., K.P., S.C.), Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurology (S.C.), University of Texas Health Science Center at San Antonio; Department of Nutrition and Dietetics (E.N., M.Y., C.A.A.), Harokopio University, Athens; Lab of Cognitive Neuroscience (M.H.K.), School of Psychology, and Department of Food Science and Technology (I.M.), Faculty of Agriculture, Aristotle University of Thessaloniki; School of Medicine (E.D.), University of Thessaly, Larissa, Greece; Department of Food BioSciences (K.T.), Teagasc Food Research Centre Ashtown, Dublin, Ireland; Department of Neurology (G.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (P.S.), Greece; National Institute on Aging/NIH (D.K.), Baltimore, MD; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Diet Inflammatory Index and Dementia Incidence
A Population-Based Study
Sokratis Charisis, Eva Ntanasi, Mary Yannakoulia, Costas A. Anastasiou, Mary H. Kosmidis, Efthimios Dardiotis, Antonios N. Gargalionis, Kostas Patas, Stylianos Chatzipanagiotou, Ioannis Mourtzinos, Katerina Tzima, Georgios Hadjigeorgiou, Paraskevi Sakka, Dimitrios Kapogiannis, Nikolaos Scarmeas
Neurology Dec 2021, 97 (24) e2381-e2391; DOI: 10.1212/WNL.0000000000012973

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Abstract

Background and Objectives Aging is characterized by a functional shift of the immune system toward a proinflammatory phenotype. This derangement has been associated with cognitive decline and has been implicated in the pathogenesis of dementia. Diet can modulate systemic inflammation; thus, it may be a valuable tool to counteract the associated risk for cognitive impairment and dementia. The present study aimed to explore the associations between the inflammatory potential of diet, assessed with an easily applicable, population-based, biomarker-validated diet inflammatory index (DII), and the risk for dementia in community-dwelling older adults.

Methods Individuals from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) were included in the present cohort study. Participants were recruited through random population sampling and were followed up for a mean of 3.05 (standard deviation 0.85) years. Dementia diagnosis was based on standard clinical criteria. Those with baseline dementia or missing cognitive follow-up data were excluded from the analyses. The inflammatory potential of diet was assessed through a DII score that considers literature-derived associations of 45 food parameters with levels of proinflammatory and anti-inflammatory cytokines in the blood; higher values indicated a more proinflammatory diet. Consumption frequencies were derived from a detailed food frequency questionnaire and were standardized to representative dietary intake normative data from 11 different countries. Analysis of dementia incidence as a function of baseline DII scores was performed by Cox proportional hazards models.

Results Analyses included 1,059 individuals (mean age 73.1 years, 40.3% male, mean education 8.2 years), 62 of whom developed incident dementia. Each additional unit of DII score was associated with a 21% increase in the risk for dementia incidence (hazard ratio 1.21 [95% confidence interval 1.03–1.42]; p = 0.023). Compared to participants in the lowest DII score tertile, participants in the highest one (maximal proinflammatory diet potential) were 3 (95% confidence interval 1.2–7.3; p = 0.014) times more likely to develop incident dementia. The test for trend was also significant, indicating a potential dose-response relationship (p = 0.014).

Discussion In the present study, higher DII scores (indicating greater proinflammatory diet potential) were associated with an increased risk for incident dementia. These findings might avail the development of primary dementia preventive strategies through tailored and precise dietary interventions.

Glossary

AD=
Alzheimer disease;
BMR=
basal metabolic rate;
CI=
confidence interval;
CRP=
C-reactive protein;
DII=
diet inflammatory index;
DSM-IV-TR=
Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision;
FFQ=
food frequency questionnaire;
HELIAD=
Hellenic Longitudinal Investigation of Aging and Diet;
HR=
hazard ratio;
IL=
interleukin;
MCI=
mild cognitive impairment;
TNF=
tumor necrosis factor;
VaD=
vascular dementia

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.

  • Received May 18, 2021.
  • Accepted in final form September 29, 2021.
  • © 2021 American Academy of Neurology
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Letters: Rapid online correspondence

  • Author Response: Diet Inflammatory Index and Dementia Incidence: A Population-Based Study
    • Nikolaos Scarmeas, Neurologist, National and Kapodistrian University of Athens, Greece and Columbia University, New York, USA
    • Sokratis Charisis, Neurologist, National and Kapodistrian University of Athens, Greece
    Submitted December 08, 2021
  • Reader Response: Diet Inflammatory Index and Dementia Incidence: A Population-Based Study
    • Timothy Daly, Philosophy of Science, Sorbonne Université
    Submitted November 21, 2021
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    • Discussion
    • Study Funding
    • Disclosure
    • Appendix Authors
    • Footnotes
    • References
  • Figures & Data
  • Info & Disclosures
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