Journal Article

Dietary patterns and cardiorespiratory fitness in midlife and subsequent all-cause dementia: findings from the Cooper Center Longitudinal Study

Gerber, Yariv, Pavlovic, Andjelka, Leonard, David, Eilat-Adar, Sigal, DeFina, Laura F., Byker Shanks, Carmen, Shuval, Kerem, Pettee Gabriel, Kelley, Tesler, Riki, Meernik, Clare, Barlow, Carolyn E.

2024

Overview

Background Identifying lifestyle factors that independently or jointly lower dementia risk is a public health priority given the limited treatment options available to patients. In this cohort study, we examined the associations between Mediterranean or Dietary Approaches to Stop Hypertension (DASH) diet adherence and cardiorespiratory fitness (CRF) with later-life dementia, and assessed whether the associations between dietary pattern and dementia are modified by CRF. Methods Data are from 9,095 adults seeking preventive care at the Cooper Clinic (1987–1999) who completed a 3-day dietary record and a maximal exercise test. Alzheimer’s disease and related disorders or senile dementia (i.e., all-cause dementia) was identified from Medicare administrative claims (1999–2019). Illness-death models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between Mediterranean or DASH diet adherence (primary exposure), CRF (secondary exposure), and all-cause dementia, adjusted for demographic and clinical factors. An interaction term was included between diet score and CRF to assess effect modification by CRF. Results The mean age at baseline was 50.6 (standard deviation [SD]: 8.4) years, and a majority of the study sample were men (77.5%) and White (96.4%). 1449 cases of all-cause dementia were identified over a mean follow-up of 9.2 (SD: 5.8) years. Neither Mediterranean nor DASH diet adherence was associated with dementia risk in fully adjusted models (HR per SD of Mediterranean diet score: 1.00, 95% CI: 0.94, 1.05; HR per SD of DASH diet score: 1.02, 95% CI: 0.96, 1.08). However, participants with higher CRF had a decreased hazard of dementia (HR, per metabolic equivalent of task [MET] increase, Mediterranean model: 0.95, 95% CI: 0.92, 0.98; HR, per MET increase, DASH model: 0.96, 95% CI: 0.92, 0.97). No effect modification by CRF was observed in the association between diet and dementia. Conclusions In this sample of apparently healthy middle-aged adults seeking preventive care, higher CRF at midlife was associated with a lower risk of all-cause dementia, though adherence to a Mediterranean or DASH diet was not, and CRF did not modify the diet-dementia association. CRF should be emphasized in multimodal interventions for dementia prevention and investigated among diverse samples.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Aged / Alzheimer's disease / Analysis / Behavioral Sciences / Cardiopulmonary system / Cardiorespiratory Fitness / Cardiovascular system / Care and treatment / Clinical Nutrition / cohort studies / DASH diet / Dementia / Diet / Diet, Mediterranean - statistics & numerical data / Dietary Approaches To Stop Hypertension / Dietary Approaches to Stop Hypertension diet / eating habits / Exercise / exercise test / Female / Food and nutrition / Health aspects / Health Promotion and Disease Prevention / Humans / Hypertension / Life style / lifestyle / Longitudinal Studies / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Medicine, Preventive / Mediterranean diet / Middle age / Middle Aged / Physical fitness / Prevention / Preventive health services / primary contact / Psychological aspects / public health / Respiratory organs / risk / Risk Factors / secondary contact / standard deviation