Diet, physical activity and cognitive impairment among elders: the EPIC–Greece cohort (European Prospective Investigation into Cancer and Nutrition)

Ψαλτοπούλου, Θεοδώρα; Kyrozis, Andreas; Stathopoulos, Panos; Trichopoulos, Dimitrios; Vassilopoulos, Demetrios; Trichopoulou, Antonia

doi:10.1017/s1368980007001607

Cited by 152 publications

(127 citation statements)

References 70 publications

(86 reference statements)

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“…Finally, we agree with the conclusion of Psaltopoulou et al (41) that, based on current evidence, adoption of the MD as part of preventive measures to reduce the risk of cognitive decline and dementia is recommended in both clinical practice and public health settings.…”

Section: Resultssupporting

confidence: 90%

Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review of the Evidence

Petersson

Philippou

2016

Advances in Nutrition

345

212

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A growing body of evidence suggests that adherence to the Mediterranean diet (MD) may protect against cognitive decline and dementia. Many epidemiologic studies and several randomized controlled trials (RCTs) have found positive effects of the MD on cognitive function, but findings remain inconsistent. The aim of this systematic review was to provide an update on the current knowledge of the effects of the MD on cognitive function, cognitive impairment, Alzheimer disease (AD), and all-type dementia. Five databases were searched-PubMed, Embase, CINAHL, CENTRAL, and PsycINFO (1806 to 25 May 2015)-with the use of prespecified criteria. Human studies that were published in English without any restriction on study type, population assessed, intervention period, follow-up time, or publication date, and that examined the association between adherence to the MD and cognitive function or dementia symptoms (as measured by cognitive function tests), were included. Only primary publication types were included. Thirty-two studies from 25 unique cohorts, including 5 RCTs and 27 observational studies, met the inclusion criteria. The majority of studies showed that the MD was associated with improved cognitive function, a decreased risk of cognitive impairment or decreased risk of dementia, or AD. Three studies found no correlation between the MD and AD, 3 further studies found no association between the MD and cognitive impairment, and 5 studies found no association between the MD and cognitive function. There was large heterogeneity, and studies differed with regard to quality. Based on the findings and the limitations in study design, we conclude that adherence to the MD is associated with better cognitive performance. However, it should be noted that the majority of findings come from epidemiologic studies that provide evidence for a correlation between the MD and cognition but not for a cause-and-effect relation. More controlled trials are required to establish a causational relation. Adv Nutr 2016;7:889-904.

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Section: Resultssupporting

confidence: 90%

Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review of the Evidence

Petersson

Philippou

2016

Advances in Nutrition

345

212

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“…Contrarily to the hypothesis of reverse causation that would predict an attenuation of the association after the exclusion of early cases, the inverse associations for the two upper categories of conformity to the MeDiet were not attenuated, but they even exhibited stronger inverse associations with RR = 0·42 (95% CI 0·27, 0·66) and R = 0·50 (95% CI 0·33, 0·74) for MDS = 5 and MDS ≧ 6, respectively. Nevertheless, it should be pointed out that a smaller cohort study in Greece, did not find any significant advantage of the MeDiet (34) . However, it is necessary to highlight that the present study was based on a sample of only 732 elders.…”

Section: Available Longitudinal Evidence On Food Patterns and The Rismentioning

confidence: 72%

“…In the largest of them (the SUN study) a reduced risk of depression associated with closer (30) Meat-livestock DASH-Na type 95 14 weeks POMS Reduction with intervention and control diet (NS) Observational cohort studies Sanchez-Villegas et al (31) SUN MeDiet 10 094 4·4 years Medical Dx Significant reduction Skarupski et al (32) CHAP MeDiet 3502 7·2 years CES-D Significant reduction Psaltopoulou et al (34) EPIC-GREECE MeDiet 732 10 years GDS No significant association Shatenstein et al (35) NuAge HEI 1488 3 years GDS No significant association Akbaraly et al (36) WHITEHALL II aHEI 4215 5 years CES-D Reduction in women, NS in men Sanchez-Villegas et al (37) SUN aHEI, PDP 15 093 8·5 Years Medical Dx Significant reduction with both indexes Rienks et al (38) Australian LSW conformity to the traditional MeDiet was found (31) . The conformity to the MeDiet was operationally defined using the MDS proposed by Trichopoulou et al 33 The MDS assigned 1 point to subjects whose consumption was at or above the sex-specific median of six components in agreement with the traditional MeDiet (vegetables, fruits/nuts, legumes, fish/seafood, cereals and MUFA:SFA lipid ratio).…”

Section: Available Longitudinal Evidence On Food Patterns and The Rismentioning

confidence: 99%

Food patterns and the prevention of depression

Martínez‐González

Sánchez‐Villegas

2016

Proc. Nutr. Soc.

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An emerging field of research in nutritional epidemiology is the assessment of several links between nutritional quality and mental health. Specifically, some studies have pointed out that several food patterns could be associated with a reduced risk of depression among adults. This association seems to be consistent across countries, cultures and populations according to several systematic reviews and meta-analyses of observational studies. Some previously described food patterns, specifically the Mediterranean Food Pattern, the Alternative Healthy Eating Index, the Prudent diet or the Provegetarian Food Pattern may be effective to reduce the future risk of depression. Among them, only the Mediterranean Food Pattern has been tested for primary prevention in a large randomised trial, but the inverse association found was not statistically significant. The scientific report of the 2015 Dietary Guidelines for Americans Advisory Committee concluded that current evidence is still limited. Notwithstanding, this field is promising and, according to large and well-conducted observational studies, food patterns potentially associated with reduced risk of depression are those emphasising seafood, vegetables, fruits and nuts. There is a need to assess whether differences in the intake of some micro or macronutrients between these dietary patterns can make a difference in their association with a lower risk of depression. Moreover, the shape of the dose–response curve and the potential existence of a nonlinear threshold effect have not yet been established.

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“…Parallel with these studies, there is accruing evidence about the benefits in cognition of lifestyle-related habits such as physical and cognitive and social activities (Hamer and Chida 2009; Kareholt et al 2011;Morgan et al 2012;Niti et al 2008;Sattler et al 2012) and nutrition in terms of nutrients and foods with conflicting results (Coley et al 2008). Regarding dietary patterns as a whole, a protective effect of MedDiet on cognitive function (Kesse-Guyot et al 2013), cognitive decline (Tsivgoulis et al 2013;Tangney et al 2011;Feart et al 2009;Scarmeas et al 2006) and development of mild cognitive impairment (Scarmeas et al 2009b;Roberts et al 2010) and dementia (Roberts et al 2010;Gu et al 2010;Scarmeas et al 2006Scarmeas et al , 2009a has been found in several observational studies but not in other cohort studies (Psaltopoulou et al 2008; Samieri et al Table 4 Multivariable-adjusted means and differences (95 % CI) for the association between each of the SNPs and cognitive assessment (Clock Drawing Test) according to intervention status Overall CLU (rs11136000) CLU ( (Martinez-Lapiscina et al 2013a, b). This is important since some observational studies may not find a protective association between the MedDiet and cognitive function because their MedDiet-like dietary pattern did not truly represent the traditional MedDiet due to sociocultural factors (Cherbuin and Anstey 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Compelling evidence worldwide supports a benefit effect of this emerging nutritional pattern on health (Roman et al 2008). The MedDiet has provided favorable results on cognitive function, cognitive decline and dementia prevention along several observational studies (Scarmeas et al 2006;Psaltopoulou et al 2008;Gu et al 2010;Feart et al 2009;Scarmeas et al 2009a, b;Roberts et al 2010;Tangney et al 2011;Kesse-Guyot et al 2013;Samieri et al 2013;Tsivgoulis et al 2013). Recently, the PREDIMED-NAVARRA primary prevention trial has confirmed the benefit on cognitive function and mild cognitive impairment development (MCI) of a nutritional intervention with MedDiet supplemented with extra-virgin olive oil (EVOO) or nuts compared with a low-fat control diet (Martinez-Lapiscina et al 2013a, b).…”

Section: Introductionmentioning

confidence: 99%

Genotype patterns at CLU, CR1, PICALM and APOE, cognition and Mediterranean diet: the PREDIMED-NAVARRA trial

et al. 2014

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The traditional Mediterranean diet (MedDiet) has shown beneficial effects on cognitive decline. Nevertheless, diet-gene interactions have been poorly evaluated. We aimed to investigate diet-gene interaction in the PREDIMED-NAVARRA randomized trial. A total of 522 participants (67 ± 6 years at baseline) enrolled in the PREDIMED-NAVARRA trial were randomly allocated to one of three diets: two MedDiets (supplemented with either extra-virgin olive oil or nuts) or a low-fat diet. They were evaluated with the Mini-Mental State Examination (MMSE) and the Clock Drawing Test (CDT) after 6.5 years of intervention. Subjects were genotyped for CR1-rs3818361, CLU-rs11136000, PICALM-rs3851179 and Apolipoprotein E (ApoE) genes. We studied MedDietgene interactions for cognition and assessed the effect of the MedDiet on cognition across different genetic profiles. A significant interaction (p = 0.041) between CLUrs11136000 and the MedDiet intervention on the MMSE was found with a beneficial effect of MedDiet among carriers of the T minor allele (B = 0.97, 95 % CI 0.45-1.49). Similar effect was observed for CR1-rs3818361, but no significant interaction was observed (p = 0.335). For PICALM-rs3851179, the MedDiet intervention showed a beneficial effect in both genotype groups. No apparent interaction was found for the CDT between intervention and gene variants. Similarly, participants randomly allocated to MedDiet groups, with favorable 123Genes Nutr (2014) 9:393 DOI 10.1007/s12263-014-0393-7 profiles of CR1, CLU and PICALM genes, significantly improved CDT scores compared to controls with the same genetic profile. Cognitive performance was better for nonApoE4 and for ApoE4 carriers of MedDiet groups compared to controls, but for CDT performance, we only found statistical significant differences for non-ApoE4 carriers. A MedDiet intervention modulates the effect of genetic factors on cognition. The effect of MedDiet might be greater for subjects with a more favorable genetic profile.

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Diet, physical activity and cognitive impairment among elders: the EPIC–Greece cohort (European Prospective Investigation into Cancer and Nutrition)

Abstract: Objectives: To identify dietary and lifestyle variables that may affect cognitive function in the elderly. Design: Population-based prospective cohort study. Setting: General community residing in Athens and the surrounding Attica region of Greece.

Cited by 152 publications

References 70 publications

Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review of the Evidence

Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review of the Evidence

Food patterns and the prevention of depression

Genotype patterns at CLU, CR1, PICALM and APOE, cognition and Mediterranean diet: the PREDIMED-NAVARRA trial

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