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Cited by 124Nutritional Studies and DietDementia and Cognitive Impairment ResearchFatty Acid Research and Health

Association of midlife diet with subsequent risk for dementia

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Akbaraly, Tasnime N., Singh-Manoux, Archana, Dugravot, Aline, Brunner, Eric J., Kivimäki, Mika, Sabia, Séverine·2019·JAMA
DOI 10.1001/jama.2019.1432PMC PMC6436698
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Abstract

Importance: Observational studies suggest that diet is linked to cognitive health. However, the duration of follow-up in many studies is not sufficient to take into account the long preclinical phase of dementia, and the evidence from interventional studies is not conclusive. Objective: To examine whether midlife diet is associated with subsequent risk for dementia. Design, Setting, and Participants: Population-based cohort study established in 1985-1988 that had dietary intake assessed in 1991-1993, 1997-1999, and 2002-2004 and follow-up for incident dementia until March 31, 2017. Exposures: Food frequency questionnaire to derive the Alternate Healthy Eating Index (AHEI), an 11-component diet quality score (score range, 0-110), with higher scores indicating a healthier diet. Main Outcome and Measures: Incident dementia ascertained through linkage to electronic health records. Results: Among 8225 participants without dementia in 1991-1993 (mean age, 50.2 years [SD, 6.1 years]; 5686 [69.1%] were men), a total of 344 cases of incident dementia were recorded during a median follow-up of 24.8 years (interquartile range, 24.2-25.1 years). No significant difference in the incidence rate for dementia was observed in tertiles of AHEI exposure during 1991-1993, 1997-1999 (median follow-up, 19.1 years), and 2002-2004 (median follow-up, 13.5 years). Compared with an incidence rate for dementia of 1.76 (95% CI, 1.47-2.12) per 1000 person-years in the worst tertile of AHEI (lowest tertile of diet quality) in 1991-1993, the absolute rate difference for the intermediate tertile was 0.03 (95% CI, -0.43 to 0.49) per 1000 person-years and for the best tertile was 0.04 (95% CI, -0.42 to 0.51) per 1000 person-years. Compared with the worst AHEI tertile in 1997-1999 (incidence rate for dementia, 2.06 [95% CI, 1.62 to 2.61] per 1000 person-years), the absolute rate difference for the intermediate AHEI tertile was 0.14 (95% CI, -0.58 to 0.86) per 1000 person-years and for the best AHEI tertile was 0.14 (95% CI, -0.58 to 0.85) per 1000 person-years. Compared with the worst AHEI tertile in 2002-2004 (incidence rate for dementia, 3.12 [95% CI, 2.49 to 3.92] per 1000 person-years), the absolute rate difference for the intermediate AHEI tertile was -0.61 (95% CI, -1.56 to 0.33) per 1000 person-years and for the best AHEI tertile was -0.73 (95% CI, -1.67 to 0.22) per 1000 person-years. In the multivariable analysis, the adjusted hazard ratios (HRs) for dementia per 1-SD (10-point) AHEI increment were not significant as assessed in 1991-1993 (adjusted HR, 0.97 [95% CI, 0.87 to 1.08]), in 1997-1999 (adjusted HR, 0.97 [95% CI, 0.83 to 1.12]), or in 2002-2004 (adjusted HR, 0.87 [95% CI, 0.75 to 1.00]). Conclusions and Relevance: In this long-term prospective cohort study, diet quality assessed during midlife was not significantly associated with subsequent risk for dementia.

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  • Diet might influence dementia risk by protecting against the excess risk of cardiovascular risk factors.

    “from dementia, except in those with cardiovascular disease, suggesting that diet might influence dementia risk by protecting from the excess risk of cardiovascular risk factors.147”

    From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [147]

    The Results (Post-hoc Sensitivity Analyses; page unavailable) report one exception to generally nonsignificant findings: a higher healthy-food score was associated with reduced dementia risk among people with a history of cardiovascular disease. The paper does not say that diet protects against excess risk from cardiovascular risk factors or establish that proposed mechanism. (LLM, conf=0.83)

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Authors
Akbaraly, T. N., Singh-Manoux, A., Dugravot, A., Brunner, E. J., Kivimäki, M., & Sabia, S.
Affiliations
  • Inserm (FR)
  • Department of Epidemiology and Public Health, University College London, London, England
  • University College London (GB)
Corresponding author
Akbaraly, Tasnime N.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2019-03-12
Volume
321
Issue
10
Pages
957
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2019.1432
PMC
PMC6436698
OpenAlex
W2921906072
Cited by
121
References
38
Citations by year
2026: 12 · 2025: 12 · 2024: 20 · 2023: 19 · 2022: 18 · 2021: 13 · 2020: 16 · 2019: 11
FWCI
13.35
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • British Heart Foundation (RG/16/11/32334, PG/11/63/29011, RG/13/2/30098)
  • Economic and Social Research Council (ES/J023299/1)
  • National Institute on Aging (R01AG056477)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
Keywords
dementia risk, Alternative Healthy Eating Index, diet quality, cognitive health, incident dementia, preclinical dementia, dietary intake, food frequency questionnaire, long-term follow-up, cognitive aging, Alzheimer's disease, vascular dementia, dementia subtypes, sex differences, neuroimaging biomarkers, neurodegeneration biomarkers, neuroinflammation
MeSH terms
Diet, Healthy, Energy Intake, Dementia, Diet, Diet Surveys, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Risk, Socioeconomic Factors, Cohort Studies, Health Behavior, Incidence, Multivariate Analysis

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