Mediterranean Diet and Risk of Dementia and Alzheimer’s Disease in the EPIC-Spain Dementia Cohort Study

Abstract

The Mediterranean diet (MD) has shown to reduce the occurrence of several chronic diseases. To evaluate its potential protective role on dementia incidence we studied 16,160 healthy participants from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Spain Dementia Cohort study recruited between 1992–1996 and followed up for a mean (±SD) of 21.6 (±3.4) years. A total of 459 incident cases of dementia were ascertained through expert revision of medical records. Data on habitual diet was collected through a validated diet history method to assess adherence to the relative Mediterranean Diet (rMED) score. Hazard ratios (HR) of dementia by rMED levels (low, medium and high adherence levels: ≤6, 7–10 and ≥11 points, respectively) were estimated using multivariable Cox models, whereas time-dependent effects were evaluated using flexible parametric Royston-Parmar (RP) models. Results of the fully adjusted model showed that high versus low adherence to the categorical rMED score was associated with a 20% (HR = 0.80, 95%CI: 0.60–1.06) lower risk of dementia overall and HR of dementia was 8% (HR = 0.92, 0.85–0.99, p = 0.021) lower for each 2-point increment of the continuous rMED score. By sub-types, a favorable association was also found in women for non-AD (HR per 2-points = 0.74, 95%CI: 0.62–0.89), while not statistically significant in men for AD (HR per 2-points = 0.88, 0.76–1.01). The association was stronger in participants with lower education. In conclusion, in this large prospective cohort study MD was inversely associated with dementia incidence after accounting for major cardiovascular risk factors. The results differed by dementia sub-type, sex, and education but there was no significant evidence of effect modification.

Roles and Mechanisms of Gut Microbiota in Patients With Alzheimer’s Disease

“…Epidemiological findings are consistent in showing that adherence to a Mediterranean diet characterized by high intake of fruit, vegetables, cereals, and legumes, and low intake of meat, high-fat dairy, and sweets, is consistently associated with a lower risk of AD (Yusufov et al, 2017). In a Mediterranean study involving over 16,000 middle-aged and elderly participants followed up for over 20 years, Andreu-Reinón et al (2021) found that adherence to the MedDiet was associated with a 20% lower risk of AD overall in the EPIC-Spain Dementia Cohort. Adherence to the MedDiet increases the diversity of microbiota after 1 year of intervention, with higher ratio of Firmicutes/Bacteroidetes and higher levels of SCFAs, which is negatively associated with inflammatory markers.…”

Association Between Egg Consumption and Dementia Risk in the EPIC-Spain Dementia Cohort

“…Moreover, legumes and vegetal oils could improve insulin sensitivity, which could, in turn, influence cognitive function ( 34 ). Indeed, in the EPIC-Spain Dementia Cohort, a recent investigation observed that a high rMED adherence score was associated with a 20% lower risk of dementia ( 35 ).…”

Metabolic Syndrome, Cognitive Impairment and the Role of Diet: A Narrative Review

“…Findings from large-scale cohort studies and long-term intervention trials support the protective effect of this pattern against several neurodegenerative disorders [74]. Among the largest prospective observational studies are the Singapore Chinese Health Study (16,948 men and women followed for an average of 20 years) [75], the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk, 8009 older individuals with an average of 13 years of follow-up) [76], the EPIC-Spain study (16,169 adults followed for approximately 22 years) [77] and the Coronary Artery Risk Development in Young Adults (CARDIA, with follow-up for up to 20 years) [78]. These studies found that higher adherence to a Mediterranean diet was associated with a significantly lower risk of developing all-cause dementia, AD or mild cognitive impairment.…”