The EAT-Lancet reference diet and cognitive function across the life course

The cross-sectional and longitudinal associations between fruit intake and cognitive performance: the Chinese Healthy Dance Study

OBJECTIVE

To analyse the association between fruit consumption and cognitive performance in middle-aged and older adults in China.

METHODS

Participants were drawn from the Chinese Square Dance Cohort. The cross-sectional dataset included 4316 individuals, with their first visit from August 2020 to August 2023. The longitudinal dataset included 1465 participants, with their first visit from August 2020 to December 2021 and follow-up visits from August 2022 to December 2023. Fruit consumption was assessed using a food frequency questionnaire. Standardised neuropsychological assessments were used to measure composite z-scores of cognitive performance, and prevalent and incident mild cognitive impairment.

RESULTS

In the cross-sectional analysis, higher quartiles of citrus fruit, drupe, berry, and tropical fruit consumption were associated with higher composite z-scores for cognitive performance and lower odds of prevalent mild cognitive impairment. In the longitudinal analysis, there was a positive association between higher quartiles of citrus fruit intake and the annual rate of change in the composite z-scores for cognitive performance; standardised regression coefficient (95 % confidence interval) for the highest compared with the lowest quartile was 0.05 (0.02-0.08). Moreover, an association between higher quartiles of citrus fruit intake and a lower risk of incident mild cognitive impairment was detected; in the comparison of the highest with the lowest quartile, the risk ratio (95 % confidence interval) was 0.56 (0.36-0.88).

CONCLUSIONS

The relationship between fruit consumption and cognition varies across the different categories of fruit. Cognitive benefits of citrus fruit consumption were found for middle-aged and older adults. Ascertaining this association might enhance comprehensive dietary recommendations for fruit consumption.

Differential impact of eicosapentaenoic acid and docosahexaenoic acid in an animal model of Alzheimer's disease

Dietary supplementation with n-3 polyunsaturated fatty acids improves cognitive performance in several animal models of Alzheimer's disease (AD), an effect often associated with reduced amyloid-beta and/or tau pathologies. However, it remains unclear to what extent eicosapentaenoic (EPA) provides additional benefits compared to docosahexaenoic acid (DHA). Here, male and female 3xTg-AD mice were fed for 3 months (13-16 months of age) the following diets: (1) control (no DHA/EPA), (2) DHA (1.1g/kg) and low EPA (0.4g/kg), or (3) DHA (0.9g/kg) with high EPA (9.2g/kg). The DHA and DHA + EPA diets respectively increased DHA by 19% and 8% in the frontal cortex of 3xTg-AD mice, compared to controls. Levels of EPA, which were below the detection limit after the control diet, reached 0.14% and 0.29% of total brain fatty acids after the DHA and DHA + EPA diet, respectively. DHA and DHA + EPA diets lowered brain arachidonic acid levels and the n-6:n-3 docosapentaenoic acid ratio. Brain uptake of free 14C-DHA measured through intracarotid brain perfusion, but not of 14C-EPA, was lower in 3xTg-AD than in NonTg mice. DHA and DHA + EPA diets in 3xTg-AD mice reduced cortical soluble phosphorylated tau (pS202) (-34% high-DHA, -34% DHA + EPA, P < 0.05) while increasing p21-activated kinase (+58% and +83%, P < 0.001; respectively). High EPA intake lowered insoluble phosphorylated tau (-31% vs. DHA, P < 0.05). No diet effect on amyloid-beta levels was observed. In conclusion, dietary intake of DHA and EPA leads to differential changes in brain PUFA while altering cerebral biomarkers consistent with beneficial effects against AD-like neuropathology.

Health outcomes, environmental impacts, and diet costs of adherence to the EAT-Lancet Diet in China in 1997-2015: a health and nutrition survey

BACKGROUND

In 2019, the EAT-Lancet Commission proposed a global reference dietary pattern. Although research on the EAT-Lancet reference diet and its associations with mortality, cardiovascular disease, type 2 diabetes, dietary environmental impacts, and cost of diets is increasing, studies done in low-income and middle-income countries remain scarce. This study aimed to assess the health outcomes, environmental impacts, and dietary costs of adherence to the EAT-Lancet reference diet in China.

METHODS

In this health and nutrition survey study, 16 029 participants from the China Health and Nutrition Survey cohort (1997-2015) were included at baseline. All-cause mortality was reported by family members and risk of cardiovascular disease and type 2 diabetes was self-reported. 3-day 24 h recall was used to assess adherence to the EAT-Lancet reference diet (Eat-Lancet Diet Index [ELDI]), diet-related environmental impacts (greenhouse-gas emissions [GHGE]), total water use (TWU), land use, and dietary costs in each survey round. Hazard ratios (HRs) for the ELDI-score were obtained by Cox models with time-varying covariates, adjusted for potential confounders. Multilevel mixed-effects linear regression was used to assess the association of environmental impacts and dietary costs to the ELDI score.

FINDINGS

During a median follow-up of 9·86 years, 803 new cases of incident type 2 diabetes, 563 new cases of cardiovascular disease, and 908 cases of all-cause mortality were recorded. At baseline, the ELDI score ranged from 9·4 points to 110·8 points on a scale of 0 to 140, with a mean of 55·3 points (SD 11·8). With each SD increase in the ELDI score, there was an 8% decreased risk of mortality (95% CI 2·2-14·1), a 16·1% decreased risk of cardiovascular disease (9·2-20·3), and a 25·3% decreased risk of type 2 diabetes (19·5- 28·4). Each SD increase in the index was associated with a decrease of 2·2% (95% CI -2·6 to -1·8) in GHGE, 2·3% (-2·6 to -2·0) in land use, no association with TWU, but an increase in diet costs of 3·3% (2·8 to 3·8).

INTERPRETATION

High adherence to the ELDI was associated with a lower risk of mortality, cardiovascular disease, and type 2 diabetes. However, the association with diet-related GHGE and land use was modest, and adherence was also linked to higher diet costs. The study advocates for the integration of sustainable indicators into future Chinese dietary guidelines. Additionally, policy measures such as agricultural subsidies on fruit and vegetable and carbon taxes on red meat are recommended to increase affordability, reduce environmental impact, and enhance the overall sustainability of dietary practices in China.

FUNDING

The China Scholarship Council and the National Natural Science Foundation of China.

Lifestyle, Environment, and Dietary Measures Impacting Cognitive Impairment: The Evidence Base for Cognitive Subtypes

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Cognition includes all phases of valid functions and processes, e.g., sensitivity, judgment, assessment, and decision-making. Thinking is also a cognitive procedure since it involves considering potential opportunities. There are various types of cognition. Hot cognition involves mental procedures where emotion plays a role, while cold cognition includes mental processes that do not include feelings or emotions. Cognitive memories of various types include sensor memory, sensing touch, smell, and sight; short-term memory allows one to recall, e.g., what one had for lunch a few days ago; working memory includes remembering telephone numbers or directions to a destination; and long-term memory comprises of major milestones in life and recalling one’s childhood events. These are further classified as episodic, e.g., the first day in primary school, and semantic memories, such as recalling the capital city of a country and filling out crossword puzzles. Declarative memories include remembering significant past events, such as global information. Cognition is affected by factors, such as nutrition, aging, addiction, environment, mental health, physical activity, smoking, and keeping the brain active. Consumption of plant- based foods plays a prominent role in the prevention of cognitive memory. Playing games and instruments, reading books, and being socially active make life more satisfying, thus assisting in the preservation of mental function and slowing mental decline.

The association between Planetary Health Diet Index and the risk of colorectal cancer: a case-control study

Background Despite the beneficial effects of a plant-based diet on colorectal cancer (CRC), no study has yet investigated the relationship between a Planetary Health Diet Index (PHDI) and CRC in the Iranian population. Therefore, the present case-control study aimed to assess the relationship between this index and CRC. Methods The current research was conducted on 71 patients with CRC (case group) and 142 (control group) admitted to hospitals in Tehran, Iran. The PHDI (0-150 points) was calculated based on a semi-quantitative food frequency questionnaire. Conditional logistic regression was applied to evaluate the association between CRC and PHDI and its sub-scores. Results After adjusting for the role of potential confounders, lower odds of CRC were observed in the second tertile of the total ratio score (odds ratio (OR) = 0.334; 95% confidence interval (CI): 0.127-0.878, P = 0.026) and the last tertile of PHDI (OR = 0.407; 95% CI: 0.183-0.907, P = 0.028), total adequacy score (OR = 0.261; 95% CI: 0.110-0.622, P = 0.002), and total moderation score (OR = 0.380; 95% CI: 0.162-0.891, P = 0.026) in comparison to the first tertile of each index. Conclusions The current study's findings indicated a reverse relationship between PHDI, total adequacy, moderation, and ratio scores with the CRC odds. However, it is suggested that more research be performed in this field in the future to confirm the results of this study.

Independent and joint role of inflammatory diet and physical activity with cognitive function in aging: Evidence from a population-based survey

OBJECTIVE

This study aims to explore the independent and joint association of physical activity (PA) and inflammatory diet with cognitive function in aging.

METHOD

Data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) was used. 2249 NHANES participants with valid data represented a weighted population of 50.5 million American residents aged 60 and older. This study separately analyzed the independent associations of PA (measured by global physical activity questionnaire) and inflammatory diet (measured by energy-adjusted dietary inflammatory index from 24-h dietary recall), and their joints (inactive & pro-inflammatory as reference) with cognitive function (assessed by three cognitive tests), and considered an individual of different status and non-linear effect by sub-group and restricted cubic splines (RCS) analysis, respectively. All analysis was multivariable-adjusted and sample-weighted.

RESULTS

The results showed that inflammatory diet was independently associated with lower cognitive function, with a 1.08, 1.29, 2.67, 0.56 lower score in the Registry for Alzheimer's Disease word list learning test (CERAD), the Animal Fluency Test (AFT), the Digit Symbol Substitution test (DSST), Z-scores, and 51 %, 62 %, 63 %, 93 % higher odds ratio (OR) of lower performance in CERAD, AFT, DSST, and p-MCI, respectively. PA was independently associated with higher cognitive function, with a 1.41, 3.37, and 0.52 higher score in AFT, DSST, Z-scores, and 28 %, 51 %, 41 % lower ORs of lower performance in CERAD and DSST and p-MCI, respectively. Active & Anti-inflammatory was always positively associated with cognitive function, with a 1.42, 2.69, 5.47, and 1.04 higher score for CERAD, AFT, DSST, and Z-score, a 58 %, 56 %, 74 %, 76 % lower ORs of lower performance in CERAT, AFT, DSST, and p-MCI, respectively, which elicited the maximum compared to other joints.

CONCLUSION

Adhering to both active PA and anti-inflammatory diet is recommended for cognitive management in older adults. Sticking to either active PA or anti-inflammatory diet also shows potential cognitive benefits, with the diet possibly playing more vital role.

Policy Actions Required to Improve Nutrition for Brain Health

Brain health is a pressing global concern. Poor diet quality is a recognized major environmental risk factor for brain disorders and one of the few that is modifiable. There is substantial evidence that nutrition impacts brain development and brain health across the life course. So why then is the full potential of nutrition not utilized to improve brain function? This commentary, which is based on discussions of the European Brain Research Area BRAINFOOD cluster, aims to highlight the most urgent research priorities concerning the evidence base in the area of nutrition and brain health and identifies 3 major issues that need to be addressed: (1) increase causal and mechanistic evidence on the link between nutrition and brain health, (2) produce effective messages/education concerning the role of food for brain health, and (3) provide funding to support collaborative working across diverse stakeholders.

Adherence to the planetary health diet and cognitive decline: findings from the ELSA-Brasil study

The EAT-Lancet Commission proposed a planetary health diet to improve human health within planetary boundaries; however, little is known about the association between adherence to this diet and cognitive decline. We used data from three waves of the Brazilian Longitudinal Study of Adult Health to evaluate the association between the planetary health diet and cognitive decline using linear mixed-effects models. Here we show that in 11,737 participants (mean (s.d.) age 51.6 (9.0) years, 54% women and 53% white), higher adherence to the planetary health diet was associated with slower memory decline (P = 0.046) and that income was a modifier in this association (P < 0.001). Adherence to the planetary health diet was associated with slower decline of memory (P = 0.040) and global cognition (P = 0.009) in high-income participants. No association was found among low-income participants. The results of our study highlight that the promotion of healthy dietary patterns should take into consideration income barriers as well as differences in dietary habits to achieve high adherence.

Association of adherence to the EAT-Lancet diet with risk of dementia according to social economic status: a prospective cohort in UK Biobank

The EAT-Lancet Commission has proposed a reference diet aiming to promote human health and environmental sustainability. Socioeconomic disadvantage and poor diet are well-known risk factors for dementia; however, whether the effect of this reference diet on dementia varies by socioeconomic status has not been investigated. The dietary habits of 190,893 participants from UK-Biobank were assessed; the association of EAT-Lancet diet with incident dementia across socioeconomic status was determined by Cox models. One thousand seven hundred twenty-eight dementia cases were identified during a median of 12.24 years follow-up. An inverse association between adherence to EAT-Lancet diet and all-cause dementia (high vs. low; hazard ratio [HR], 95% confidence interval [CI]: 0.82, 0.72-0.94) or late-onset dementia (high vs. low; HR, 95% CI: 0.78, 0.68-0.91) was observed only in individuals with high socioeconomic status. On the contrary, no protective effects of EAT-Lancet diet on early-onset dementia were observed, regardless of the socioeconomic status. Our findings indicated that adherence to an environment-friendly diet helps attenuate risk of dementia only in individuals with high socioeconomic level.

Planetary health diet and cardiovascular disease: results from three large prospective cohort studies in the USA

BACKGROUND

In 2019, the EAT-Lancet Commission on healthy diets from sustainable food systems proposed a Planetary Health Diet that seeks to optimise both chronic disease prevention as well as global environmental health. In this study, we aimed to examine the association between a dietary index based on the Planetary Health Diet and risk of cardiovascular disease.

METHODS

We included women from the Nurses' Health Study (NHS I; 1986-2016), women from the Nurses' Health Study II (NHS II; 1991-2017), and men from the Health Professionals Follow-up Study (HPFS; 1986-2016) who were free of cardiovascular disease, cancer, and diabetes at baseline. Dietary data were collected every 4 years using a validated, semi-quantitative food frequency questionnaire. The Planetary Health Diet Index (PHDI) was based on 15 food groups: whole grains, vegetables, fruit, fish and shellfish, nuts and seeds, non-soy legumes, soy foods, and unsaturated oils were scored positively; starchy vegetables, dairy, red or processed meat, poultry, eggs, saturated fats and trans fat, and added sugar received negative scores. Scores for each food group were summed to get a total score of 0-140. Higher scores indicated greater adherence to the PHDI. We used Cox proportional hazards regression with time-varying covariates to evaluate the association between PHDI score, cumulatively averaged, and incident cardiovascular disease (defined as fatal and non-fatal myocardial infarction and stroke), adjusting for demographic, health, and lifestyle confounders in all participants with available data. Cohort-specific estimates were combined using inverse variance-weighted fixed effects meta-analyses.

FINDINGS

Of the 62 919 women included from the NHS I, 88 535 women included from the NHS II, and 42 164 men included from the HPFS, a total of 9831 cases of cardiovascular disease were confirmed over 4 541 980 person-years of follow-up. Mean PHDI scores ranged from 60·7 (SD 5·1) to 90·6 (5·3) in the lowest versus highest quintile in NHS I, 55·6 (4·9) to 86·3 (6·3) in NHS II, and 59·6 (5·9) to 94 (5·9) in HPFS. In the multivariable-adjusted meta-analysis, participants in the highest quintile of PHDI score had a lower risk of incident cardiovascular disease than did those in the lowest quintile (hazard ratio [HR] 0·83 [95% CI 0·78-0·89]; p-trend <0·0001). When we examined cardiovascular disease subtypes, the highest quintile of PHDI was also associated with a lower risk of coronary heart disease (HR 0·81 [95% CI 0·74-0·88]; p-trend <0·0001) and total stroke (HR 0·86 [0·78-0·95]; p-trend=0·0004) compared with the lowest quintile.

INTERPRETATION

We found that adherence to the Planetary Health Diet, designed to be a more environmentally sustainable dietary pattern, was associated with a lower risk of cardiovascular disease in three large cohorts of men and women in the USA. These observations support the Planetary Health Diet as a promising strategy to promote both human and planetary health.

FUNDING

National Institutes of Health.

Systems Approach to Investigate the Role of Fruit and Vegetable Types on Vascular Function in Pre-Hypertensive Participants: Protocol and Baseline Characteristics of a Randomised Crossover Dietary Intervention

The evidence on the impact of fruits and vegetable types on cardiovascular risk factors remains limited. Specifically, the utilisation of biomarkers to objectively measure dietary compliance and metabolic responses is emerging. This protocol and baseline characteristics of a pilot randomised controlled, crossover, dietary intervention study aimed to examine the effects of citrus fruits, cruciferous vegetables, or common fruits and vegetables on cardiovascular risk factors. A total of 39 volunteers with untreated prehypertension was recruited and consumed a standardised, provided diet with eight daily portions of citrus fruits and cruciferous vegetables, common fruits and vegetables, or a low fruit and vegetable diet (two portions/d, control diet) in a random order for 2 weeks each, separated by a wash-out week. A targeted cohort-based recruitment strategy was utilised and resulted in 74% of participants recruited by re-contacting preselected individuals from two cohort studies with a 15% average enrolment rate. Participants had an average age of 54.4 years (±6.1 years), BMI of 27.9 kg/m2, and BP of 135/81 mmHg and were mainly male (67%). The primary outcome was office blood pressure; secondary outcomes included arterial stiffness, lipid profiles, inflammation, cognitive function, and subjective mood. Biofluids, i.e., 24 h urine, stool, and blood samples, were collected for biomarker measurements with multiple metabolomic platforms and the gut microbial composition, together with traditional dietary biomarkers.

The Association between Individual Food Groups, Limbic System White Matter Tracts, and Episodic Memory: Initial Data from the Aiginition Longitudinal Biomarker Investigation of Neurodegeneration (ALBION) Study

(1) Background: Many studies link food intake with clinical cognitive outcomes, but evidence for brain biomarkers, such as memory-related limbic white matter (WM) tracts, is limited. We examined the association between food groups, limbic WM tracts integrity, and memory performance in community-dwelling individuals. (2) Methods: We included 117 non-demented individuals (ALBION study). Verbal and visual episodic memory tests were administered, and a composite z-score was calculated. Diffusion tensor imaging tractography was applied for limbic WM tracts (fornix-FX, cingulum bundle-CB, uncinate fasciculus-UF, hippocampal perforant pathway zone-hPPZ). Food intake was evaluated through four 24-h recalls. We applied linear regression models adjusted for demographics and energy intake. (3) Results: We found significant associations between (a) higher low-to-moderate alcohol intake and higher FX fractional anisotropy (FA), (b) higher full-fat dairy intake and lower hPPZ FA, and (c) higher red meat and cold cuts intake and lower hPPZ FA. None of the food groups was associated with memory performance. (4) Conclusions: Despite non-significant associations between food groups and memory, possibly due to participants' cognitive profile and/or compensatory mechanisms, the study documented a possible beneficial role of low-to-moderate alcohol and a harmful role of full-fat dairy and red meat and cold cuts on limbic WM tracts.

Effects of Dietary Fiber, Phenolic Compounds, and Fatty Acids on Mental Health: Possible Interactions with Genetic and Epigenetic Aspects

Scientific evidence shows that dietary patterns are a key environmental determinant of mental health. Dietary constituents can modify epigenetic patterns and thus the gene expression of relevant genetic variants in various mental health conditions. In the present work, we describe some nutrigenomic effects of dietary fiber, phenolic compounds (plant secondary metabolites), and fatty acids on mental health outcomes, with emphasis on their possible interactions with genetic and epigenetic aspects. Prebiotics, through their effects on the gut microbiota, have been associated with modulation in the neuroendocrine response to stress and the facilitation of the processing of positive emotions. Some of the genetic and epigenetic mechanisms include the serotonin neurotransmitter system (TPH1 gene) and the brain-derived neurotrophic factor (inhibition of histone deacetylases). The consumption of phenolic compounds exerts a positive role in neurocognitive domains. The evidence showing the involvement of genetic and epigenetic factors comes mainly from animal models, highlighting the role of epigenetic mechanisms through miRNAs and methyltransferases as well as the effect on the expression of apoptotic-related genes. Long-chain n-3 fatty acids (EPA and DHA) have been mainly related to psychotic and mood disorders, but the genetic and epigenetic evidence is scarce. Studies on the genetic and epigenetic basis of these interactions need to be promoted to move towards a precision and personalized approach to medicine.

Functional dentition and well-being among Chilean 80-year-olds

BACKGROUND

The Decade of Healthy Aging 2021-2030 calls for a strengthening of the policies for older people in Latin America. An example of successful oral aging is the Japanese "8020" campaign, which achieved 50% of people aged 80 years having ≥20 teeth by 2016.

OBJECTIVE

To evaluate the association between having a functional dentition (≥20 teeth) and cognitive health, social participation, and quality of life in people aged ≥80 years.

METHODS

Cross-sectional data from 299 complete observations (weighted N = 436 981) of individuals aged ≥80 years from Chile's National Health Survey 2016-2017 were included (3% of the population; total = 5520 clinical observations/weighted N = 14 518 969). Generalised structural equation models (GSEM) evaluated the association between having a functional dentition and cognitive health, measured with the Mini-mental score, between having a functional dentition and social participation, and between having a functional dentition and quality of life, measured with the EQ-5D-3L. Models included the effect of mediators (daily fruit and vegetable consumption; oral health-related quality of life score) and controlled for the exposure-induced mediator-outcome variables: sex, educational level, and location. Data were analysed using the STATA-17 survey module. Statistical significance was set at P < .05 (95% confidence interval [CI]).

RESULTS

The sample was mostly female, had <8 years of education, and lived in urban areas. The prevalence of a functional dentition was 9.2% (95% CI 3.6,21.3/n = 21). GSEM demonstrated that the association between functional dentition and cognitive health was mediated by daily fruits and vegetables consumption (β = 0.12/95% CI 0.02,0.21/P = .015), with moderate strength of evidence. Additionally, there was strong evidence of an association between functional dentition and social participation frequency (β = 2.76/95% CI 0.60,4.73/P = .009). Finally, the association between functional dentition and quality of life was mediated by cognitive health (β =0.05/95% CI 0.02,0.09/P = .002) and oral health-related quality of life (β = -0.04/95% CI -0.08 to -0.01/P = .025), with strong and moderate evidence, respectively.

CONCLUSION

Given the beneficial implications of functional dentition in social participation, nutritional benefits and quality of life and well-being of individuals aged ≥80 years.

Association of aquatic food consumption, long-chain polyunsaturated n-3 fatty acid intake, and blood mercury levels with cognitive function in middle-aged and older adults

BACKGROUND & AIMS

Aquatic food is rich in nutrients which benefit the human brain and cognitive health; however, concerns about heavy metal accumulation in aquatic food remain. This study evaluated the associations between aquatic food consumption, long-chain n-3 polyunsaturated fatty acids (LC n-3 PUFAs) intake, and blood mercury levels with cognition in middle-aged and older adults.

METHODS

This cross-sectional study used baseline data from the Lifestyle and Healthy Aging of Chinese Square Dancer Study. Aquatic food consumption and LC n-3 PUFAs intake were obtained from a food frequency questionnaire. Blood mercury levels were measured using inductively coupled plasma mass spectrometry. A composite z-score was developed to represent global cognition by averaging the z-scores for each cognitive domain. Participants with mild cognitive impairment (MCI) were diagnosed according to Petersen's criteria. Multivariate linear and logistic regression models were used to examine the association between the exposure factors and cognitive performance including cognitive scores and MCI.

RESULTS

Of 2621 middle-aged and older adults, the mean (SD) age was 63.71 (5.15) years, and 85.73% were females. Compared with the lowest quartile, those in the highest quartile for aquatic food consumption were associated with higher composite z-scores (β = 0.156, 95% CI: 0.088-0.225) and lower MCI odds (OR = 0.598, 95% CI: 0.425-0.841). A similar positive relationship between LC n-3 PUFAs intake and composite z-score and an inverse association between LC n-3 PUFAs intake and MCI were also observed. In addition, the participants in the highest quartile for blood mercury levels had higher composite z-scores than those in the lowest quartile.

CONCLUSIONS

In this cross-sectional study, higher aquatic food consumption, LC n-3 PUFAs intake, and blood mercury levels were related to better cognitive function. Further studies in Chinese populations are required to confirm these findings.

Association between breakfast patterns and executive function among adolescents in Shanghai, China

Introduction

The aim of this cross-sectional study was to investigate the association between breakfast patterns and executive function among adolescents in Shanghai, China.

Methods

In 2022, we randomly recruited 3,012 adolescents aged 12-13 years from all administrative districts in Shanghai. Breakfast information was collected by parents using a one-day recall method. Executive function was measured using the Behavior Rating Inventory of Executive Function-Parent Version. Latent Class Analysis was performed to identify breakfast patterns based on the food groups in the Diet Quality Questionnaire for China.

Results

Breakfast patterns were classified into three categories: "Egg and milk foods", "Grain foods", and "Abundant foods", except for adolescents who skipped breakfast. Logistic regression was used to estimate the multivariate odds ratio (ORs) and 95% confidence intervals (95% CI) for the association between breakfast patterns and potential executive dysfunction. Adolescents in the "Abundant foods" class had a lower risk of executive dysfunction in terms of initiate (OR: 0.36; 95% CI: 0.17-0.76), and organization of materials (OR: 0.18; 95% CI: 0.04-0.94), compared to those who skipped breakfast. Similarly, the breakfast patterns of "Grain foods" and "Egg and milk foods" were associated with a lower risk of executive dysfunction, including initiate and working memory.

Discussion

Our findings suggest that breakfast patterns were associated with executive function. The improvement of breakfast patterns among adolescents should be a significant public health intervention.

Diet patterns associated with cognitive decline: methods to harmonize data from European and US cohort studies

The impact of dietary intake on cognitive outcomes and dementia prevention is a topic of increasing interest. Meta-analyses of observational studies, mostly conducted within US and European populations, have reported benefits of healthy diet patterns on cognitive performance, but results from individual studies have been inconsistent. These inconsistencies are likely due to the diverse methodology used in studies, including different diet and cognitive function assessment instruments, follow-up periods, and analytical methods, which make drawing conclusions relevant to dietary guidance challenging. The objective of this project is to describe a protocol to conduct a retrospective harmonization study on dietary intake and cognitive health using data from European and US studies. The recommendations resulting from the project can be used to support evidence-based synthesis for future iterations of the Dietary Guidelines for Americans or other population-based dietary guidance. Additionally, this study will serve as a harmonization guide for future research on the relationship between diet patterns and cognition. The approach outlined ultimately aims to optimize resources and expedite research efforts for dementia prevention.

Adherence to the Eatwell Guide and population and planetary health: A Rank Prize Forum report

This report summarises a Forum conducted in June 2023 to explore the current state of the knowledge around the Eatwell Guide, which is the UK government's healthy eating tool, in relation to population and planetary health. The 1.5-day Forum highlighted the limited, albeit promising evidence linking higher adherence to the Eatwell Guide with favourable health outcomes, including reduced overall mortality risk, lower abdominal obesity in post-menopausal women and improved cardiometabolic health markers. Similarly, evidence was presented to suggest that higher adherence to the Eatwell Guide is associated with reduced greenhouse gas emissions. Presentations were given around cultural adaptations of the Eatwell Guide, including African Heritage and South Asian versions, which are designed to increase the acceptability and uptake of the Eatwell Guide in these communities in the United Kingdom. Presentations highlighted ongoing work relevant to the applications of the Eatwell Guide in randomised controlled trials and public health settings, including the development of a screening tool to quantify Eatwell Guide adherence. The Forum ended with a World Café-style event, in which the strengths and limitations of the Eatwell Guide were discussed, and directions for future research were identified. This Forum report serves as a primer on the current state of the knowledge on the Eatwell Guide and population and planetary health and will be of interest to researchers, healthcare professionals and public health officials.

A Scoping Review on the Opportunities for Social Engagement and Cognitive Frailty in Older Adults

Cognitive frailty (CF) is defined as the clinical syndrome of the combination of physical frailty and cognitive impairment, without dementia. Numerous risk factors for CF have been previously identified but this scoping review focusses on the critical need for social engagement and the association with cognition. The focus of this scoping review on the opportunity for social engagement rather than on perception or experience of loneliness. Based on the results of 55 studies were synthesised into four social engagement categories, namely participation, household, network, and habitat. Social engagement is associated with maintaining or improving cognition, particularly through active participation in social roles. Habitat (i.e., rural or urban settings) also influences cognition and the challenge is to enable social participation.

Effect of Fiber-Rich Diet and Rope Skipping on Memory, Executive Function, and Gut Microbiota in Young Adults: A Randomized Controlled Trial

SCOPE

To investigate the effects of fiber-rich diets (FDs), rope skipping (RS), and the combination of these two interventions (fiber-rich diet with rope skipping [FD-RS]) on memory, executive function in young adults, and to explore their relationship with gut microbiota.

MATERIALS AND RESULTS

The study is a 12-week parallel-design randomized controlled trial in which 120 undergraduates (19 ± 1 years) are randomized to FD (fiber ≥ 20 g day-1 ), RS (3 × 2000 times per week), FD-RS or control group (n = 30 per group). Memory and executive function are assessed by scales, and stool samples are collected at baseline and after the intervention. FD group and FD-RS group show fewer prospective and retrospective subjective memory impairments than the control group, but there is no significant difference between FD-RS and the intervention alone (FD or RS). No obvious change in executive function is observed throughout the trial. In terms of the gut microbiota, the α-diversity does not increase, but the microbial community evenness improves after the RS and FD intervention. Additionally, the relative abundance of phylum Firmicutes and genera Faecalibacterium, Eubacterium_coprostanoligenes_group in the RS group and NK4A214_group in the FD group significantly increase. In the RS group, a correlation is found between the increase in microbial evenness and the improvement in retrospective memory.

CONCLUSION

The FD and FD-RS have beneficial effects on memory in young adults. Meanwhile, FD and RS can improve the microbial evenness and increase several beneficial genera of phylum Firmicutes.

Global trends and research hotspots of EAT-Lancet diet: a bibliometric analysis

The EAT-Lancet diet is a groundbreaking and comprehensive dietary framework that has garnered significant attention in the fields of nutrition, sustainability, and public health. We aimed to conduct a bibliometric study to investigate current status and hotspots in the field of EAT-Lancet diet based on the Web of Science Core Collection (WOSCC) database, and the documents of EAT-Lancet diet published from Jan 1, 2019 to Sep 1.2023 were extracted. The bibliometric and visualized analysis were performed by VOSviewer 1.6.16 and WOSCC Online Analysis Platform. In total, 155 documents from 62 journals were included, and 735 authors from 389 institutions and 53 countries/regions contributed to the field of EAT-Lancet diet. The most productive countries/regions, institutions, authors, and journals were the USA, Wageningen University & Research, Johan Rockström, and Nutrients, respectively. The first high-cited document was published in Lancet and authored by Willett et al. in 2019. This is also the first study about EAT-Lancet diet. The article firstly proposed the "EAT-Lancet Diet" emphasizing balanced, plant-based eating to improve human health while addressing environmental concerns. In conclusion, in the field of EAT-Lancet diet, the main research hotspots and frontiers are the adaptation of EAT-Lancet diet, the composition of EAT-Lancet diet, and the benefits of EAT-Lancet diet for human health. The number of research on the EAT-Lancet diet is currently limited. There is a pressing need for further studies to broaden our understanding of the EAT-Lancet diet and its potential to enhance human health.

Dietary (Poly)phenols and Cognitive Decline: A Systematic Review and Meta-Analysis of Observational Studies

SCOPE

This study aims to systematically review observational studies investigating the relation between dietary (poly)phenol consumption and various cognitive outcomes.

METHODS AND RESULTS

Embase and PubMed databases are searched from inception to April 2023 for observational studies investigating the relation between dietary (poly)phenol intake and cognitive outcomes. For quantitative analyses, random effects models, subgroup analyses, and dose-response analyses are performed. A total of 37 studies are included in the systematic review. Among (poly)phenols, a higher intake of flavonoids is associated with better cognitive function and lower odds of cognitive decline (although with some exceptions). A quantitative meta-analysis shows an overall inverse association with cognitive impairment and reduced association with the incidence of dementia or related disorders for total flavonoids (relative risk (RR) = 0.83, 95% confidence interval (CI): 0.76, 0.89), anthocyanins (RR = 0.73, 95% CI: 0.60, 0.89), flavones (RR = 0.77, 95% CI: 0.63, 0.94), flavan-3-ols (RR = 0.86, 95% CI: 0.82, 0.91), and flavonols (RR = 0.88, 95% CI: 0.80, 0.96). Data on other (poly)phenolic compounds (i.e., phenolic acids) are promising but too preliminary.

CONCLUSION

Habitual inclusion of flavonoids in the diet may play a preventive role against cognitive disorders.

High-Fat Diets in Animal Models of Alzheimer's Disease: How Can Eating Too Much Fat Increase Alzheimer's Disease Risk?

High dietary intake of saturated fatty acids is a suspected risk factor for neurodegenerative diseases, including Alzheimer's disease (AD). To decipher the causal link behind these associations, high-fat diets (HFD) have been repeatedly investigated in animal models. Preclinical studies allow full control over dietary composition, avoiding ethical concerns in clinical trials. The goal of the present article is to provide a narrative review of reports on HFD in animal models of AD. Eligibility criteria included mouse models of AD fed a HFD defined as > 35% of fat/weight and western diets containing > 1% cholesterol or > 15% sugar. MEDLINE and Embase databases were searched from 1946 to August 2022, and 32 preclinical studies were included in the review. HFD-induced obesity and metabolic disturbances such as insulin resistance and glucose intolerance have been replicated in most studies, but with methodological variability. Most studies have found an aggravating effect of HFD on brain Aβ pathology, whereas tau pathology has been much less studied, and results are more equivocal. While most reports show HFD-induced impairment on cognitive behavior, confounding factors may blur their interpretation. In summary, despite conflicting results, exposing rodents to diets highly enriched in saturated fat induces not only metabolic defects, but also cognitive impairment often accompanied by aggravated neuropathological markers, most notably Aβ burden. Although there are important variations between methods, particularly the lack of diet characterization, these studies collectively suggest that excessive intake of saturated fat should be avoided in order to lower the incidence of AD.

APOE Genotype Modifies the Association between Midlife Adherence to the Planetary Healthy Diet and Cognitive Function in Later Life among Chinese Adults in Singapore

BACKGROUND

It remains unclear if adherence to the planetary healthy diet (PHD), designed to improve human and environmental health, is associated with better cognitive function in aging, and if this association differs by apolipoprotein E (APOE) genotype.

OBJECTIVES

We aimed to examine the association between the PHD pattern and risk of poor cognitive function, and to further assess whether the APOE ε4 allele could modify this association.

METHODS

The study included 16,736 participants from the Singapore Chinese Health Study. The PHD score was calculated using data from a validated 165-item food frequency questionnaire at baseline (1993-1998), with higher scores indicating greater adherence to the PHD. Cognitive function was assessed by the Singapore-modified Mini-Mental State Examination at follow-up 3 visits (2014-2016). A subset of 9313 participants had APOE genotype data. Logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs), with adjustment for potential confounders.

RESULTS

We identified 2397 (14.3%) cases of poor cognitive function. In the total population, OR (95% CI) of poor cognitive function for each one-SD increment in the PHD score was 0.89 (0.85, 0.93). Carriers of APOE ε4 allele had increased risk of poor cognitive function (OR: 1.36, 95% CI: 1.15, 1.61). There was a significant interaction between the PHD score and the APOE ε4 allele (P-interaction = 0.042). Each one-SD increment in the PHD score was significantly associated with lower risk of poor cognitive function (OR: 0.89; 95% CI: 0.83, 0.96) in non-carriers of APOE ε4 allele, but not in APOE ε4 allele carriers (OR: 1.04, 95% CI: 0.89, 1.23).

CONCLUSIONS

Midlife adherence to the PHD was associated with reduced risk of poor cognitive function in later life. However, this was not observed in carriers of APOE ε4 allele who had higher risk of poor cognitive function.

China's dietary changes would increase agricultural blue and green water footprint

Agriculture accounts for 61 % of fresh water consumption in China. Although population and diet have a significant impact on water consumption, little is known about the reasons for and extent of their influence. Changes in the blue and green water footprint of 20 agricultural sectors in 31 Chinese provinces were estimated in 5 scenarios by applying the environmentally expanded multi-regional input-output model. The water footprint network is strongly interconnected, with over 50 % of the provinces characterized as net importers of the blue water footprint, 70 % of the total blue and green water footprint imports in developed provinces, and 65 % of the total blue and green water footprint exports in developing provinces, with the flow distribution driven and dominated by economically developed provinces. The findings also highlighted that the impact of population change on the water footprint is insignificant, contributing 0.51 % and 5.78 % to the reduction of the water footprint in 2030 and 2050, respectively. The impact of simultaneous changes in the population and dietary structure on the water footprint was higher than population changes and lower than dietary structure changes. The main force driving changes in the water footprint was changes in the dietary structure, which resulted in a two-fold effect on the water footprint. First, it has increased the blue and green water footprint by 33 % and 12 %, respectively, thus aggravating the coercive impact on water resources on the production side. Second, it has led to a change in the main contributing sectors for the blue and green water footprint from cereals to fruits, vegetables, and potatoes. Therefore, when the population is changing and optimizing its dietary structures, a greater focus must be placed on threats and pressures to water resources. This will result in better scientific management and more efficient use of water resources.

APOE-Genotype and Insulin Modulate Estimated Effect of Dietary Macronutrients on Cognitive Performance: Panel Analyses in Nondiabetic Older Adults at Risk of Dementia

BACKGROUND

The apolipoprotein E gene (APOE ε-2/3/4, combined as 6 different genotypes: ε-22/23/24/33/34/44) and insulin status modulate dementia risk and play a role in the metabolism of macronutrients.

OBJECTIVES

We aimed to examine APOE-genotype and fasting insulin as effect modifiers of the slopes between dietary macronutrients and cognitive performance among older adults at risk of dementia.

METHODS

Panel analyses-with diet and cognition measured at baseline and follow-up at years 1 and 2-were performed in a sub-sample from the FINGER (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) trial (n = 676, 60-77 y, 46% females, all nondiabetics). The associations between macronutrients (3-d food records, z-scores) and global cognition (modified Neuropsychological Test Battery, z-score) were analyzed in mixed regression models adjusted for confounders selected a priori. After a gradient was implied by the point estimates in categorical APOE analyses, we investigated a continuous APOE variable [APOE-gradient, coded -1 (for ε-23), -0.5 (ε-24), 0 (ε-33), 1 (ε-34), 2 (ε-44)] as an effect-modifier.

RESULTS

At increasing levels of the APOE-gradient, a relatively more favorable slope between diet and cognition was observed for a lower carbohydrate/fat ratio [β = -0.040, 95% confidence interval (CI): -0.074, -0.006; P = 0.020 for interaction diet × APOE-gradient), and higher protein (β = 0.075, 95% CI: 0.042, 0.109; P = 9.4 × 10-6). Insulin concentration (log-linear) modulated the association between the carbohydrate/fat ratio and cognition by a quadratic interaction (β = -0.016, P = 0.039). Coherent findings for exploratory predictors (fiber, fat subtypes, composite score, metabolic biomarkers) were compatible with published hypotheses of differential dietary adaptation by APOE, with cognition among ε-33 being relatively independent of dietary parameters-implying "metabolic flexibility." Antagonistic slopes to cognition for ε-23 (positive) compared with ε-34 and ε-44 (negative) were found for a Higher-carbohydrates-fiber-Lower-fat-protein composite score, even as within-subjects effects.

CONCLUSIONS

APOE-based precision nutrition appears conceptually promising, but replications in wider samples are warranted, as well as support from trials. Both relative hyper- and hypoinsulinemia might modulate the effect of diet on cognition.

The Association between the EAT-Lancet Diet and Diabetes: A Systematic Review

Several studies have explored the association between diabetes and the EAT-Lancet diet. Thus, the objective of our study was to conduct a systematic review to analyze and summarize all clinical studies concerning the association between diabetes and the EAT-Lancet diet. We undertook a comprehensive search of the Embase, Cochrane, and PubMed databases up to 15 August 2023. All clinical studies concerning the association between diabetes and the EAT-Lancet diet were summarized and analyzed. In total, our systematic review included five studies of four prospective studies and one cross-sectional study, encompassing 259,315 participants. All the included studies were evaluated as high quality. The outcomes from all studies indicated that adherence to the EAT-Lancet diet was correlated with a reduced risk of diabetes. In conclusion, the EAT-Lancet diet may be an effective dietary intervention for diabetes. Nevertheless, the number of studies examining the association between diabetes and the EAT-Lancet diet is limited. Further high-quality studies are required to expand our understanding of the benefits of the EAT-Lancet diet for patients with diabetes.

Role of fruit and vegetables in sustaining healthy cognitive function: evidence and issues

Modifiable lifestyle factors, such as improved nutrition, are crucial in maintaining cognitive health in older age. Fruit and vegetables represent healthy and sustainable sources of nutrients with the potential to prevent age-related cognitive decline. The aim of this review is to synthesise the available evidence, from epidemiological and randomised controlled trials (RCT), regarding the role of fruit and vegetables in sustaining healthy cognitive function. Epidemiological studies of combined fruit and vegetable intake suggest that increased consumption may sustain cognition in later life. The evidence appears to be stronger for an association between vegetables and cognition, particularly for green leafy and cruciferous vegetables. Specific benefits shown for berries, citrus fruits, avocado and nuts suggest fruit is worthy of further investigation in relation to cognition. Data from RCT indicate benefits to differing aspects of cognition following citrus and berry fruits, cocoa and peanuts, but the data are limited and there are a lack of studies exploring effects of vegetables. There is growing evidence for an association between fruit and vegetable intake and cognitive function, but this is not always consistent and the data from RCT are limited. Issues in previous research are highlighted, such as strict exclusion criteria, absence of baseline nutritional status data and lack of consideration of individual differences, which may explain the weaker findings from RCT. Inclusion of those most at risk for cognitive decline is recommended in future nutrition and cognition research.

Higher versus lower nut consumption and changes in cognitive performance over two years in a population at risk of cognitive decline: a cohort study

BACKGROUND

Tree nuts and peanuts (henceforth, nuts) are nutrient-dense foods rich in neuroprotective components; thus, their consumption could benefit cognitive health. However, evidence to date is limited and inconsistent regarding the potential benefits of nuts for cognitive function.

OBJECTIVE

To prospectively evaluate the association between nut consumption and 2-y changes in cognitive performance in older adults at cognitive decline risk.

METHODS

A total of 6,630 participants aged 55 to 75 y (mean age 65.0±4.9 y, 48.4% women) with overweight/obesity and metabolic syndrome completed a validated semi-quantitative food frequency questionnaire and a comprehensive battery of neuropsychological tests at baseline and a 2-y follow-up. Composite cognitive scores were used to assess global, general, attention, and executive function domains. Nut consumption was categorized as <1, ≥1 to <3, ≥3 to <7, and ≥7 servings/wk (1 serving=30 g). Multivariable-adjusted linear regression models were fitted to assess associations between baseline nut consumption and 2-y cognitive changes.

RESULTS

Nut consumption was positively associated with 2-y changes in general cognitive function (P-trend <0.001). Compared with participants consuming <1 serving/wk of nuts, those categorized as consuming ≥3 to <7 and ≥7 servings/wk showed more favorable changes in general cognitive performance (β z-score [95% CI] = 0.06 [0.00,0.12] and 0.13 [0.06,0.20], respectively). No significant changes were observed in the multivariable-adjusted models for other cognitive domains assessed.

CONCLUSION

Frequent nut consumption was associated with a smaller decline in general cognitive performance over 2 y in older adults at risk of cognitive decline. Randomized clinical trials to verify our findings are warranted.

Effects of Desert Olive Tree Pearls Containing High Hydroxytyrosol Concentrations on the Cognitive Functions of Middle-Aged and Older Adults

The Japanese population has the world's longest life expectancy but faces the challenge of extending the healthy life expectancy without developing chronic diseases. Therefore, the effectiveness of products derived from olives used in the Mediterranean diet as a potential dietary solution has attracted attention. This study examined the effects of desert olive tree pearls (DOTPs), which contain 162 times more polyphenol hydroxytyrosol than olive oil, on the cognitive function of middle-aged and older adults using the Cognitrax test. Participants (aged 51-82 years) were assigned to the DOTP intake (n = 36) or placebo group (n = 36) in a randomized, double-blind, placebo-controlled, parallel-group study. The participants received 3 g of DOTPs or placebo in olive oil twice daily for 12 weeks. Among cognitive domains, complex attention had a significant time × group interaction effect (p = 0.049) between the DOTP and placebo groups. The simple main effect for this item was significantly different (p < 0.001 and p = 0.572, respectively). Time effects were significant (p < 0.05) for the psychomotor speed, reaction time, cognitive flexibility, processing speed, and executive function domains. Therefore, DOTPs have the potential to alleviate cognitive problems faced by middle-aged and older adults in Japan.

Perspectives on Neuronutrition in Prevention and Treatment of Neurological Disorders

The term neuronutrition has been proposed as part of nutritional neuroscience, studying the effects of various dietary components on behavior and cognition. Other researchers underline that neuronutrition includes the use of various nutrients and diets to prevent and treat neurological disorders. The aim of this narrative review was to explore the current understanding of the term neuronutrition as the key concept for brain health, its potential molecular targets, and perspectives of its nutritional approach to the prevention and treatment of Alzheimer's and Parkinson's diseases, multiple sclerosis, anxiety, depressive disorders, migraine, and chronic pain. Neuronutrition can be defined as a part of neuroscience that studies the influence of various aspects of nutrition (nutrients, diet, eating behavior, food environment, etc.) on the development of nervous disorders and includes nutrition, clinical dietetics, and neurology. There is evidence that the neuronutritional approach can influence neuroepigenetic modifications, immunological regulation, metabolic control, and behavioral patterns. The main molecular targets in neuronutrition include neuroinflammation, oxidative/nitrosative stress and mitochondrial dysfunction, gut-brain axis disturbance, and neurotransmitter imbalance. To effectively apply neuronutrition for maintaining brain health, a personalized approach is needed, which includes the adaptation of the scientific findings to the genetic, biochemical, psycho-physiological, and environmental features of each individual.

Decoding the physiological response of plants to stress using deep learning for forecasting crop loss due to abiotic, biotic, and climatic variables

This paper presents a simple method for detecting both biotic and abiotic stress in plants. Stress levels are measured based on the increase in nutrient uptake by plants as a mechanism of self-defense when under stress. A continuous electrical resistance measurement was used to estimate the rate of change of nutrients in agarose as the growth medium for Cicer arietinum (Chickpea) seeds. To determine the concentration of charge carriers in the growth medium, Drude's model was used. For identifying anomalies and forecasting plant stress, two experiments were conducted and outliers were found in electrical resistance and relative changes in carrier concentration. Anomaly in the first iteration was detected by applying k-Nearest Neighbour, One Class Support Vector Machine and Local Outlier Factor in unsupervised mode on electrical resistance data. In the second iteration, the neural network-based Long Short Term Memory method was used on the relative change in the carrier concentration data. As a result of the change in resistance of growth media during stress, nutrient concentrations shifted by 35%, as previously reported. Farmers who cater to small communities around them and are most affected by local and global stress factors can use this method of forecasting.

The Effect of a Planetary Health Diet on the Human Gut Microbiome: A Descriptive Analysis

In 2019, researchers from the EAT-Lancet Commission developed the 'Planetary Health (PH) diet'. Specifically, they provided recommendations pertaining to healthy diets derived from sustainable food systems. Thus far, it has not been analysed how such a diet affects the human intestinal microbiome, which is important for health and disease development. Here, we present longitudinal genome-wide metagenomic sequencing and mass spectrometry data on the gut microbiome of healthy volunteers adhering to the PH diet, as opposed to vegetarian or vegan (VV) and omnivorous (OV) diets. We obtained basic epidemiological information from 41 healthy volunteers and collected stool samples at inclusion and after 2, 4, and 12 weeks. Individuals opting to follow the PH diet received detailed instructions and recipes, whereas individuals in the control groups followed their habitual dietary pattern. Whole-genome DNA was extracted from stool specimens and subjected to shotgun metagenomic sequencing (~3 GB per patient). Conventional bacterial stool cultures were performed in parallel and bacterial species were identified with matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. We analysed samples from 16 PH, 16 OV, and 9 VV diet patterns. The α-diversity remained relatively stable for all dietary groups. In the PH group, we observed a constant increase from 3.79% at inclusion to 4.9% after 12 weeks in relative abundance of Bifidobacterium adolescentis. Differential PH abundance analysis highlighted a non-significant increase in possible probiotics such as Paraprevotella xylaniphila and Bacteroides clarus. The highest abundance of these bacteria was observed in the VV group. Dietary modifications are associated with rapid alterations to the human gut microbiome, and the PH diet led to a slight increase in probiotic-associated bacteria at ≥4 weeks. Additional research is required to confirm these findings.

Association between Changes in Protein Intake and Risk of Cognitive Impairment: A Prospective Cohort Study

Little is known about the role of change in protein intake in affecting cognitive function among older adults. Therefore, we aimed to investigate the associations between the change in protein intake from various food groups and cognitive impairment among older adults in a prospective cohort study. A total of 6951 participants without cognitive impairment or dementia were included in this study. The frequency of protein intake from various food groups was measured by a food frequency questionnaire at baseline and follow-up. Multivariable Cox hazard models with time as the underlying time metric applied to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). During the 37,535 person-years of follow-up, 1202 (17.3%) participants developed cognitive impairment. The improvement in overall protein intake was negatively associated with cognitive impairment with multivariable-adjusted HR of 0.98 (95% CI = 0.97-0.99). Compared with participants with stable change, those with an extreme decline in animal-based protein intake had a 48% higher risk of cognitive impairment. The associations of changes in protein from six food groups with cognitive impairment were in a similar direction to the main result. Protective associations between improving protein intake and a reduced risk of cognitive impairment were observed.