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Cited by 170Nutritional Studies and DietDementia and Cognitive Impairment ResearchFatty Acid Research and Health

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Mediterranean diet adherence is associated with lower dementia risk, independent of genetic predisposition: findings from the UK Biobank prospective cohort study

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Shannon, Oliver M., Ranson, Janice M., Gregory, Sarah, Macpherson, Helen, Milte, Catherine, Lentjes, Marleen, Mulligan, Angela, McEvoy, Claire, Griffiths, Alex, Matu, Jamie, Hill, Tom R., Adamson, Ashley, Siervo, Mario, Minihane, Anne Marie, Muniz-Tererra, Graciela, Ritchie, Craig, Mathers, John C., Llewellyn, David J., Stevenson, Emma·2023·BMC Medicine
DOI 10.1186/s12916-023-02772-3PMC PMC10012551
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Abstract

Background: The identification of effective dementia prevention strategies is a major public health priority, due to the enormous and growing societal cost of this condition. Consumption of a Mediterranean diet (MedDiet) has been proposed to reduce dementia risk. However, current evidence is inconclusive and is typically derived from small cohorts with limited dementia cases. Additionally, few studies have explored the interaction between diet and genetic risk of dementia. Methods: We used Cox proportional hazard regression models to explore the associations between MedDiet adherence, defined using two different scores (Mediterranean Diet Adherence Screener [MEDAS] continuous and Mediterranean diet Pyramid [PYRAMID] scores), and incident all-cause dementia risk in 60,298 participants from UK Biobank, followed for an average 9.1 years. The interaction between diet and polygenic risk for dementia was also tested. Results: Higher MedDiet adherence was associated with lower dementia risk (MEDAS continuous: HR = 0.77, 95% CI = 0.65–0.91; PYRAMID: HR = 0.86, 95% CI = 0.73–1.02 for highest versus lowest tertiles). There was no significant interaction between MedDiet adherence defined by the MEDAS continuous and PYRAMID scores and polygenic risk for dementia. Conclusions: Higher adherence to a MedDiet was associated with lower dementia risk, independent of genetic risk, underlining the importance of diet in dementia prevention interventions.

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Crossref · 10.1186/s12916-023-02772-3

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Figures

Fig. 1 Association between MedDiet adherence and risk of dementia (n = 60,298, including 882 dementia cases). MedDiet adherence level was split into tertiles, with the dashed line reflecting the low MedDiet adherence reference group for each MedDiet score
Fig. 1 Association between MedDiet adherence and risk of dementia (n = 60,298, including 882 dementia cases). MedDiet adherence level was split into tertiles, with the dashed line reflecting the low MedDiet adherence reference group for each MedDiet scoreCC BY · PubMed Central
Fig. 2 Association between MedDiet adherence and risk of dementia in sub-group and sensitivity analyses. MedDiet adherence level was split into tertiles, with the dashed line reflecting the low MedDiet adherence reference group for each MedDiet score. Analyses include: A) Primary analyses for the MEDAS, MEDAS continuous and PYRAMID scores (n = 60,298, including 882 dementia cases); B) Including participants with a minimum of 2 dietary reports (n = 38,794, including 479 dementia cases); C) After excluding participants with extreme energy intakes (n = 59,627, including 867 dementia cases); D) Excluding participants with less than 2 years (n = 59,594, including 843 dementia cases) and 5 years (n = 58,196, including 698 dementia cases) follow up; E) Adjusting for potential mediators, including BMI (n = 60,163, including 876 dementia cases), history of depression (n = 58,837, including 851 dementia cases), or stroke (n = 60,298, including 882 dementia cases); F) Stratified into low (n = 21,009, including 261 dementia cases), medium (n = 20,000, including 313 dementia cases) and high (n = 19,273, including 308 dementia cases) genetic risk categories; G) Stratified into APOE4 carriers (n = 16,644, including 467 dementia cases) and non-carriers (n = 43,651, including 415 dementia cases); H) With imputed missing data (n = 196,335, including 5001 dementia cases); I) Restricted to fatal (n = 59,627, including 260 dementia cases) and non-fatal (n = 60,038, including 622 dementia cases) dementia cases; and J) Stratified into higher (n = 33,281, including 430 dementia cases) and lower (n = 27,007, including 452 dementia cases) education status groups
Fig. 2 Association between MedDiet adherence and risk of dementia in sub-group and sensitivity analyses. MedDiet adherence level was split into tertiles, with the dashed line reflecting the low MedDiet adherence reference group for each MedDiet score. Analyses include: A) Primary analyses for the MEDAS, MEDAS continuous and PYRAMID scores (n = 60,298, including 882 dementia cases); B) Including participants with a minimum of 2 dietary reports (n = 38,794, including 479 dementia cases); C) After excluding participants with extreme energy intakes (n = 59,627, including 867 dementia cases); D) Excluding participants with less than 2 years (n = 59,594, including 843 dementia cases) and 5 years (n = 58,196, including 698 dementia cases) follow up; E) Adjusting for potential mediators, including BMI (n = 60,163, including 876 dementia cases), history of depression (n = 58,837, including 851 dementia cases), or stroke (n = 60,298, including 882 dementia cases); F) Stratified into low (n = 21,009, including 261 dementia cases), medium (n = 20,000, including 313 dementia cases) and high (n = 19,273, including 308 dementia cases) genetic risk categories; G) Stratified into APOE4 carriers (n = 16,644, including 467 dementia cases) and non-carriers (n = 43,651, including 415 dementia cases); H) With imputed missing data (n = 196,335, including 5001 dementia cases); I) Restricted to fatal (n = 59,627, including 260 dementia cases) and non-fatal (n = 60,038, including 622 dementia cases) dementia cases; and J) Stratified into higher (n = 33,281, including 430 dementia cases) and lower (n = 27,007, including 452 dementia cases) education status groupsCC BY · PubMed Central
Fig. 3 Association between MedDiet adherence defined by the MEDAS (A), MEDAS continuous (B) and PYRAMID (C) scores and risk of dementia (n = 60,298, including 882 dementia cases) after sequentially removing each MedDiet component from the total score. Hazard ratios and 95% CIs were estimated per point increased in MedDiet score
Fig. 3 Association between MedDiet adherence defined by the MEDAS (A), MEDAS continuous (B) and PYRAMID (C) scores and risk of dementia (n = 60,298, including 882 dementia cases) after sequentially removing each MedDiet component from the total score. Hazard ratios and 95% CIs were estimated per point increased in MedDiet scoreCC BY · PubMed Central

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  1. World Health Organization. Risk Reduction of Cognitive Decline and Dementia. Geneva: World Health Organization; 2019.

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Metadata

Authors
Shannon, O. M., Ranson, J. M., Gregory, S., Macpherson, H., Milte, C., Lentjes, M., Mulligan, A., McEvoy, C., Griffiths, A., Matu, J., Hill, T. R., Adamson, A., Siervo, M., Minihane, A. M., Muniz-Tererra, G., Ritchie, C., Mathers, J. C., Llewellyn, D. J., & Stevenson, E.
Affiliations
  • Newcastle University (GB)
  • University of Exeter (GB)
  • University of Edinburgh (GB)
  • Deakin University (AU)
  • Örebro University (SE)
  • University of Cambridge (GB)
  • Queen's University Belfast (GB)
  • Leeds Beckett University (GB)
  • University of Nottingham (GB)
  • University of East Anglia (GB)
Corresponding author
Mathers, John C.
ORCID
Venue
BMC Medicine
Publisher
Springer Science and Business Media LLC
Published
2023-03-14
Volume
21
Issue
1
Pages
81-81
ISSN
1741-7015 (ISSN-L)
DOI
10.1186/s12916-023-02772-3
PMC
PMC10012551
OpenAlex
W4324029343
Cited by
167
References
44
Citations by year
2026: 43 · 2025: 49 · 2024: 62 · 2023: 13
FWCI
42.75
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (Queen's University Belfast) (publishedVersion, cc-by)
  • Leeds Beckett Repository (Leeds Beckett University) (acceptedVersion, other-oa)
  • UEA Digital Repository (University of East Anglia) (acceptedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Open Research Exeter (University of Exeter) (submittedVersion, cc-by)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Apollo
Funders
Medical Research Council (MR/T001852/1)
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
Mediterranean diet, dietary adherence, dementia risk, dementia prevention, polygenic risk, genetic susceptibility, Mediterranean Diet Adherence Screener, Mediterranean diet pyramid, UK Biobank
MeSH terms
Dementia, United Kingdom, Humans, Prospective Studies, Biological Specimen Banks, Genetic Predisposition to Disease, Diet, Mediterranean

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