Mediterranean Diet and Cognitive FunctionALYSSA PETERS
UWGB DIETETIC INTERN 2018-19
Peters, A (2014, 2015). Grandma [Photographs]. Retrieved from personal camera
Progression
Mild Cognitive Impairment
Mild Dementia
Moderate Dementia
Severe Dementia
Medical Care Corporation (2016). MCI and Dementia [Infograph]. Retrieved from https://www.mccare.com/education/mcidementia.html.
Does not interfere with activities of
daily living
Interferes with activities of daily living
Reactive oxygen species
OxidativeStress
Antioxidant properties
Adherence to a Mediterranean diet and Alzheimer’s disease risk in an Australian population. Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2 0 1 2
Oldways Preservation and Exchange Trust (2009). Mediterranean Diet Pyramid [Photograph]. Retrieved from https://oldwayspt.org/traditional-diets/mediterranean-diet
Mediterranean diet improves cognition: the
PREDIMED-NAVARRA randomized trial
Martínez-Lapiscina E, Clavero P, Toledo E, et al. Journal of Neurology, Neurosurgery, and
Psychiatry. 2013
Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomized trial
PurposeAssess the effects of MedDiet on cognition and dementia incidence
Design• Randomized control trial
• 6.5 years
• 522 participants
Martínez-Lapiscina E, Clavero P, Toledo E, et al. Journal of Neurology, Neurosurgery and Psychiatry. 2013
Community-dwelling men and women residing in Spain
Inclusion
• Age > 55 years
• High vascular risk d/t T2D or 3 of the following:
• Current smoking
• Hypertension
• Dyslipidemia
• Overweight
• Family history of premature CVD
Exclusion
• Current CVD or previous history
• Severe chronic illness
• Illiteracy
Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomized trial. Martínez-Lapiscina E, Clavero P, Toledo E, et al. Journal of Neurology, Neurosurgery and Psychiatry. 2013
Intervention◦ MedDiet + EVOO (1L/week)
◦ MedDiet + Mixed Nuts (30g of raw, unprocessed/day)
◦ Low-Fat Control Diet: education given on low-fat diet (diet plan)
137-item FFQ
14-item adherence questionnaireUSDA (n.d.). Olive Oil [Photograph]. Retrieved from https://www.flickr.com/photos/usdagov/6896388410
Shutterstock (n.d.). Walnuts [Photograph]. Retrieved from https://theconversation.com/its-good-to-eat-walnuts-but-is-it-true-that-they-prevent-heart-disease-57439
Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomized trial. Martínez-Lapiscina E, Clavero P, Toledo E, et al. Journal of Neurology, Neurosurgery and Psychiatry. 2013
Clock Drawing Test (CDT)•Language comprehension
•Visuospatial abilities
•Working memory
•Attention and abstract thinking
Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomized trial. Martínez-Lapiscina E, Clavero P, Toledo E, et al. Journal of Neurology, Neurosurgery and Psychiatry. 2013
Frontiers in Neuroscience (n.d.). Progressive Deterioration [Photograph]. Retrieved from https://curiosity.com/topics/screen-for-dementia-with-the-stroke-of-a-clock-curiosity/
Mini mental state exam (MMSE)
•Orientation to time and place
•Attention and calculation
•Recall
•Language and visual construction
Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomized trial. Martínez-Lapiscina E, Clavero P, Toledo E, et al. Journal of Neurology, Neurosurgery and Psychiatry. 2013
MedWorks Media (n.d.). Mini-Mental State Examination [Infograph]. Retrieved from https://medworksmedia.com/product/mini-mental-state-examination-mmse/
MedDiet + EVOO (n=244)
MedDiet + Nuts(n=166)
Control/Low-fat(n=132)
MMSE27.73 (27.27 to
28.19)27.68 (27.20 to
28.16)27.11 (26.61 to 27.61)
Adjusted diff. versus control
(95% CI)
+0.62 (+0.18 to +1.05
0.005+0.57 (+0.11 to
+1.03)0.015 0 (reference)
CDT 5.31 (4.98-5.64) 5.13 (4.78-5.47) 4.80 (4.44-5.16)
Adjusted diff. versus control
(95% CI)+0.51 (+0.20 to
+0.82)0.001
+0.33 (+0.003 to +0.67)
0.048 0 (reference)
Adjusted for sex, age, education, family history of cognitive impairment or dementia, Apoe4 genotype, hypertension, dyslipidemia, diabetes, smoking
Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomized trial. Martínez-Lapiscina E, Clavero P, Toledo E, et al. Journal of Neurology, Neurosurgery and Psychiatry. 2013
Mediterranean diet improves cognition:
the PREDIMED-NAVARRA
randomized trial
Diagnosis
• EVOO: 18
• Nuts: 19
• Low-fat/Control: 23
60 cases of MCI
• EVOO: 12
• Nuts: 6
• Low-fat/Control: 17
35 cases of Dementia
Martínez-Lapiscina E, Clavero P, Toledo E, et al. Journal of Neurology, Neurosurgery and Psychiatry. 2013
Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomized trial
Strengths
• Long-term, Randomized
• Foods with strong antioxidant and anti-inflammatory properties
• Several confounders were controlled
Limitations
• Sample size
• Single blinded
• High risk of CVD
• FFQ-self reported
• Intervention done at home
Martínez-Lapiscina E, Clavero P, Toledo E, et al. Journal of Neurology, Neurosurgery and Psychiatry. 2013
/
Conclusion
I-A (strong)
Overall, MedDiet with EVOO or mixed nuts
showed better cognitive performance
over 6.5 years
Evidence for protective effects of
MedDiet on cognitive function
Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomized trial
Martínez-Lapiscina E, Clavero P, Toledo E, et al. Journal of Neurology, Neurosurgery and Psychiatry. 2013
Adherence to a Mediterranean-type dietary pattern and
cognitive decline in a community population
Tangney C, Kwasny M, Li H, et al. The American Journal of Clinical Nutrition. 2011
Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population
PurposeAssess association between adherence to a Mediterranean diet and cognitive change in older adults
Design• Observational-Prospective Cohort
• 7.6 years
• 3,790 participants
Tangney C, Kwasny M, Li H, et al. The American Journal of Clinical Nutrition. 2011
Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population
Inclusion
• Age > 65 years
• 2 or more cognitive assessments (4 possible) during home interview
Exclusion
• History of
• Heart Disease
• Stroke
Tangney C, Kwasny M, Li H, et al. The American Journal of Clinical Nutrition. 2011
Participants of the Chicago Health and Aging Project (CHAP)
Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population
• Non-refined cereals (3 items)
• Potatoes (3 items)
• Fruit (11 items)
• Vegetable (16 items)
• Legumes, nuts and beans (7 items)
• Fish (3 items)
• Olive oil (2 items)
Tangney C, Kwasny M, Li H, et al. The American Journal of Clinical Nutrition. 2011
• Red meat/meat products (11 items)
• Poultry (4 items)
• Full-fat cheese and other dairy (6 items)
MedDiet FFQ
MedDiet ScoreMAX OF 55
Tangney C, Kwasny M, Li H, et al. The American Journal of Clinical Nutrition. 2011
Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population
Components Servings per week for max score of 5
Nonrefined cereals and breads
>32
Potatoes >18
Fruit >22
Vegetables >33
Legumes, nuts, beans >6
Fish >6
Olive Oil ≥7
Red meats ≤1
Poultry ≤3
Full-fat dairy ≤10
Wine only (mL) <300
Alcohol (mL) <300
Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population
Tangney C, Kwasny M, Li H, et al. The American Journal of Clinical Nutrition. 2011
Results
Type of Test All (n=3790)
Lowest 12-25(n=1163)
Middle 26-29(n=1251)
Highest 30-45(n=1376)
Global Cognitive Score 0.18 ± 0.73 0.04 ± 0.75 0.13 ± 0.74 0.36 ± 0.65
Mini-Mental State Exam
26.5 ± 4.1 25.9 ± 4.3 26.2 ± 4.3 27.3 ± 3.3
Global Cognitive Score
Rate of Change
Solid + Dashed: Middle tertile
B = -0.0171, P = 0.0002
B = -0.0079, P = 0.075
Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population Tangney C, Kwasny M, Li H, et al. The American Journal of Clinical Nutrition. 2011
Solid Line: Highest tertile
Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population
Strengths
• Long-term, prospective design
• Biracial community sample
• FFQ’s assessed at baseline and next interview cycle (3 y)
• Several confounders controlled
Limitations
• FFQ self-administered
• MedDiet scoring
• APOE4 genotype
Tangney C, Kwasny M, Li H, et al. The American Journal of Clinical Nutrition. 2011
Conclusion
II-B (fair)
Highest tertilesignificantly
associated with slower rate of Global
Cognitive Score
Adherence to MedDiet, may afford
some protection against cognitive
decline
Tangney C, Kwasny M, Li H, et al. The American Journal of Clinical Nutrition. 2011
Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population
Adherence to a Mediterranean diet and Alzheimer’s disease risk
in an Australian population
Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2012
Adherence to a Mediterranean diet and Alzheimer’s disease risk in an Australian population
PurposeInvestigate the association between adherence to a Mediterranean diet (MeDi) and risk for Alzheimer’s disease (AD) and mild cognitive impairment (MCI).
Design• Cross-Sectional Study
• 970 participants
Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2 0 1 2
Volunteers of the Australian Imaging, Biomarkers and Lifestyle Study of Ageing (AIBL)
Inclusion
• Age > 60 years
• Volunteers of study
Exclusion
• History of…
• Insulin Dependent DM
• Uncontrolled DM
• Regular alcohol use
Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2 0 1 2
Adherence to a Mediterranean diet and Alzheimer’s disease risk in an Australian population
MeDi Score (0-9)
1 point for mild to moderate alcohol consumption
>5 to <25 g per day for females >10 to <50g per day for males
1 point for ratio of MUFA: SFA (above median)
1 point for detrimental components (below median)
Meat, Dairy Products
1 point for each beneficial component (above median)
Fruits, Vegetables, Legumes, Cereals, Fish
Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2 0 1 2
Adherence to a Mediterranean diet
and Alzheimer’s disease risk in an
Australian population
Neuropsychological Test BatteryMMSE
Logical Memory
Verbal Fluency
Attention and Working Memory
Executive Function
Language
Visuospatial Function
Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2 0 1 2
Adherence to a Mediterranean diet and Alzheimer’s disease risk in an Australian population
Adherence to a Mediterranean diet and Alzheimer’s disease risk in an Australian population
Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2 0 1 2
All (n=970) AD (n=149) MCI (n=98) HC (n=723) P-value
MMSE 27.07 19.10 26.16 28.86 <0.05
MeDi 4.40 3.79 4.02 4.57 <0.001
Results
Adherence to a Mediterranean diet and Alzheimer’s disease risk in an Australian population. Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2 0 1 2
Adherence to a Mediterranean diet and Alzheimer’s disease risk in an Australian population
Strengths
• Large sample, ethnicity
• Cognition tests
• Several confounders controlled
Limitations
• FFQ
• MedDiet scoring
• Australian population
Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2 0 1 2
Conclusion
II-D (fair)
AD and MCI subjects had a lower mean
MeDi score compared to HC
Lower adherence to MeDi is associated with MCI and AD.
Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2 0 1 2
Adherence to a Mediterranean diet and Alzheimer’s disease risk in an Australian population
ReviewEvidence for protective effects of MedDiet on cognitive function
Adherence to MedDiet may afford some protection against cognitive decline
Lower adherence to MeDi is associated with MCI and AD
Gardener S, Gu Y, Rainey-Smith SR et al. Adherence to a Mediterranean diet and Alzheimer's disease risk in an Australian population. Translational Psychiatry. 2012 Oct; 2(10): e164. Doi: 10.1038/tp.2012.91Tangney C, Kwasny M, Li H, et al. Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. The American Journal of Clinical Nutrition. 2011; 93(3): 601-607. Doi: 10.3945/ajcn.110.007369 Martínez-Lapiscina E, Clavero P, Toledo E, et al. Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. Journal of Neurology, Neurosurgery, and Psychiatry. 2013; 00: 1-8. Doi: 10.1136/jnnp-2012-304792.
Nutrition Relevance
Oxidative stress increases cognitive impairment
Antioxidants inhibit effects of oxidative stress
Mediterranean Diet plentiful in antioxidants
Adherence to a Mediterranean diet and Alzheimer’s disease risk in an Australian population. Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2 0 1 2
Thoughts
Limited Research
Whole Diet Approach
Other Factors
-Genotype
Peters, A (2014, 2015). Grandma [Photographs]. Retrieved from personal camera
References➢Diagnosis Of Alzheimer's Disease - Neuropsychological Testing (n.d). Retreived from https://www.mentalhelp.net/articles/diagnosis-of-alzheimer-s-disease-neuropsychological-testing/
➢Frontiers in Neuroscience (n.d.). Progressive Deterioration [Photograph]. Retrieved from https://curiosity.com/topics/screen-for-dementia-with-the-stroke-of-a-clock-curiosity/
➢Gardener S, Gu Y, Rainey-Smith SR et al. Adherence to a Mediterranean diet and Alzheimer's disease risk in an Australian population. Translational Psychiatry. 2012 Oct; 2(10): e164. Doi: 10.1038/tp.2012.91
➢Harrison J, Minassian SL, Jenkins L, Black RS, Koller M, Grundman M. A Neuropsychological Test Battery for Use in Alzheimer Disease Clinical Trials. Arch Neurol. 2007;64(9):1323–1329. doi:10.1001/archneur.64.9.1323
➢Martínez-Lapiscina E, Clavero P, Toledo E, et al. Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. Journal of Neurology, Neurosurgery, and Psychiatry. 2013; 00: 1-8. Doi: 10.1136/jnnp-2012-304792.
References➢Medical Care Corporation (2016). MCI and Dementia [Infograph]. Retrieved from https://www.mccare.com/education/mcidementia.html.
➢MedWorks Media (n.d.). Mini-Mental State Examination [Infograph]. Retrieved from https://medworksmedia.com/product/mini-mental-state-examination-mmse/
➢Oldways Preservation and Exchange Trust (2009). Mediterranean Diet Pyramid [Photograph]. Retrieved from https://oldwayspt.org/traditional-diets/mediterranean-diet
➢Shutterstock (n.d.). Walnuts [Photograph]. Retrieved from https://theconversation.com/its-good-to-eat-walnuts-but-is-it-true-that-they-prevent-heart-disease-57439
➢Tangney C, Kwasny M, Li H, et al. Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. The American Journal of Clinical Nutrition. 2011; 93(3): 601-607. Doi: 10.3945/ajcn.110.007369
➢USDA (n.d.). Olive Oil [Photograph]. Retrieved from https://www.flickr.com/photos/usdagov/6896388410
➢https://www.alz.org/alzheimers-dementia/what-is-alzheimers
Thank You!
Alyssa PetersMediterranean Diet and Cognitive Function
uwgbresearchreviews.weebly.com
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