Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston.
Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston.
JAMA Netw Open. 2021 May 3;4(5):e2113020. doi: 10.1001/jamanetworkopen.2021.13020.
Gluten avoidance has been suggested as having a benefit to cognitive health among the general population, given the link between gluten and cognitive impairment in patients with celiac disease. However, data are lacking in individuals without celiac disease.
To examine whether gluten intake is associated with cognitive function in women without celiac disease.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included US women who participated in the longitudinal, population-based Nurses' Health Study II and had not previously or subsequently been diagnosed with celiac disease. Dietary data were collected from 1991 to 2015, and data on cognitive function were collected from 2014 to 2019. Data analysis was conducted from October 2020 to April 2021.
Energy-adjusted gluten intake, cumulatively averaged across questionnaire cycles prior to cognitive assessment.
Three standardized cognitive scores assessed by the validated Cogstate Brief Battery: (1) psychomotor speed and attention score, (2) learning and working memory score, and (3) global cognition score. Higher scores indicated better performance.
The cohort included 13 494 women (mean [SD] age, 60.6 [4.6] years). The mean (SD) gluten intake was 6.3 (1.6) g/d. After controlling for demographic and lifestyle risk factors in linear regression, no significant differences in standardized cognitive scores (mean [SD], 0 [1]) by quintile of gluten intake were found across highest and lowest quintiles of gluten intake (psychomotor speed and attention: -0.02; 95% CI, -0.07 to 0.03; P for trend = .22; learning and working memory: 0.02; 95% CI, -0.03 to 0.07; P for trend = .30; global cognition: -0.002; 95% CI, -0.05 to 0.05; P for trend = .78). The null associations persisted after additional adjustment for major sources of dietary gluten (ie, refined grains or whole grains), comparing decile categories of gluten intake, using gluten intake updated at each previous questionnaire cycle, or modeling changes in gluten intake. Similarly, these associations were not materially altered in sensitivity analyses that excluded women who had reported cancer or dementia diagnosis or had not completed all dietary assessments.
In this study, long-term gluten intake was not associated with cognitive scores in middle-aged women without celiac disease. Our results do not support recommendations to restrict dietary gluten to maintain cognitive function in the absence of celiac disease or established gluten sensitivity.
鉴于乳糜泻患者的麸质与认知障碍之间存在关联，因此有人提出避免食用麸质可能对普通人群的认知健康有益。然而，在没有乳糜泻的人群中，相关数据仍然缺乏。
研究在没有乳糜泻的女性中，麸质摄入与认知功能之间是否存在关联。
设计、地点和参与者：这项队列研究纳入了参加纵向、基于人群的护士健康研究 II 的美国女性，且这些女性在研究开始前或此后均未被诊断为乳糜泻。从 1991 年至 2015 年收集饮食数据，从 2014 年至 2019 年收集认知功能数据。数据分析于 2020 年 10 月至 2021 年 4 月进行。
在认知评估前的问卷周期中，经能量调整后的累积平均麸质摄入量。
采用经验证的 Cogstate 简明电池评估的三个标准化认知评分：（1）精神运动速度和注意力评分，（2）学习和工作记忆评分，以及（3）整体认知评分。得分越高表示表现越好。
该队列包括 13494 名女性（平均[标准差]年龄为 60.6[4.6]岁）。平均（标准差）麸质摄入量为 6.3（1.6）g/d。在校正人口统计学和生活方式风险因素后，在最高和最低麸质摄入五分位数中，未发现标准化认知评分（平均值[标准差]为 0[1]）存在显著差异（精神运动速度和注意力评分：-0.02；95%CI，-0.07 至 0.03；趋势 P 值=0.22；学习和工作记忆评分：0.02；95%CI，-0.03 至 0.07；趋势 P 值=0.30；整体认知评分：-0.002；95%CI，-0.05 至 0.05；趋势 P 值=0.78）。这些关联在进一步调整主要膳食麸质来源（即精制谷物或全谷物）、比较麸质摄入的十分位数类别、使用每个先前问卷周期更新的麸质摄入数据或模拟麸质摄入变化后仍然存在。同样，在敏感性分析中，当排除报告癌症或痴呆诊断或未完成所有饮食评估的女性时，这些关联也没有实质性改变。
在这项研究中，长期摄入麸质与中年女性的认知评分无关，这些女性没有乳糜泻。我们的结果不支持为了在没有乳糜泻或已确定的麸质敏感性的情况下维持认知功能而限制膳食麸质摄入的建议。
