School of Physical Education, University of Campinas, Av. Érico Veríssimo, 701, Cidade Universitária "Zeferino Vaz", Barão Geraldo, Campinas, SP 13083-851, Brazil.
Hellenic Health Foundation, Athens, Greece; Professor Emeritus, School of Medicine, University of Athens, Greece.
Ageing Res Rev. 2021 Sep;70:101395. doi: 10.1016/j.arr.2021.101395. Epub 2021 Jun 19.
OBJECTIVES: The present study investigated the association between adherence to Mediterranean diet (MeDi) and physical performance and cognitive function in older adults. METHODS: We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated older adults aged 60+ years and assessed adherence to MeDi diet using validated composite scores. Observational studies, including cross-sectional, case-control, and longitudinal cohort studies, if crude baseline data was available, which investigated as a primary or secondary outcome the association of MeDi diet adherence with physical performance and/or cognitive function in non-demented older adults were included in the cross-sectional analysis. For the longitudinal analysis, case-control and longitudinal cohort studies that investigated the longitudinal associations between adherence to MeDi diet with the incidence of mild cognitive impairment (MCI), dementia, and/or Alzheimer's disease (AD), and/or changes in physical performance and cognition in non-demented older adults were included. Studies published in other languages than English were excluded. Studies were retrieved from MEDLINE, SCOPUS, CINAHL, and AgeLine databases until May 19, 2021. The risk of bias was evaluated using the Newcastle - Ottawa Quality Assessment Scale (NOS). A pooled effect size was calculated based on standard mean differences (SMD), log odds ratio (OR) and log risk ratio (RR). This study is registered on PROSPERO (CRD42021250254). RESULTS: Nineteen cross-sectional studies that investigated 19.734 community-dwelling and institutionalized older adults free of disability and dementia were included. A high adherence to MeDi was cross-sectionally associated with better walking speed (SMD = 0.42; 95 % Confidence Interval (CI) = 0.12-0.72, P = 0.006; I² = 65 %, P = 0.06), knee muscle strength speed (SMD = 0.26; 95 % CI = 0.17-0.36, P < 0.00001; I² = 0 %, P = 0.69), global cognition (SMD = 0.24; 95 % CI = 0.15-0.33, P < 0.00001; I² = 85 %, P < 0.00001), and memory (SMD = 0.18; 95 % CI = 0.13-0.25, P < 0.00001; I² = 100 %, P < 0.00001). The association between MeDi adherence and global cognition remained significant after stratifying the analysis by the region where the study was conducted, MeDi diet adherence composite score, and Mini Mental State Examination (MMSE). Studies had a moderate to low risk of bias. In relation to longitudinal analysis, thirty-four prospective studies with an average follow-up period that varied from 3.0 to 12.6 years and investigated 98.315 community-dwellers were included. Results indicated that older adults with high MeDi scores had a lower decline in global cognition RR = 0.26; 95 % CI = 0.23-0.29, P < 0.00001; I² = 100 %, P < 0.00001). In contrast, no significant associations between MeDi and mobility, MCI, dementia were found. A low risk of bias was found in the longitudinal studies. DISCUSSION: Findings of the present study indicated that high adherence to MeDi was cross-sectionally associated with physical performance and cognitive function. Results of the pooled analysis of longitudinal studies revealed that high adherence to MeDi reduced the risk of global cognitive decline in non-demented older adults. However, no significant associations between MeDi adherence and the incidence of mobility problems, MCI, and dementia were found. Although important, our findings should be carefully interpreted due to the presence of heterogeneity and publication bias.
目的：本研究旨在探讨地中海饮食（MeDi）依从性与老年人身体机能和认知功能之间的关系。
方法：我们进行了一项系统评价和荟萃分析，纳入了横断面和纵向研究，研究对象为年龄在 60 岁及以上的老年人，并使用经过验证的综合评分来评估 MeDi 饮食的依从性。纳入了观察性研究，包括横断面、病例对照和纵向队列研究，如果存在原始基线数据，则将其作为主要或次要结局纳入分析，以研究 MeDi 饮食依从性与非痴呆老年人的身体机能和/或认知功能之间的关系。对于纵向分析，纳入了病例对照和纵向队列研究，以研究 MeDi 饮食依从性与轻度认知障碍（MCI）、痴呆和/或阿尔茨海默病（AD）的发生率以及非痴呆老年人的身体机能和认知变化之间的纵向关联。排除了发表在英语以外其他语言的研究。从 MEDLINE、SCOPUS、CINAHL 和 AgeLine 数据库中检索研究，检索时间截至 2021 年 5 月 19 日。使用纽卡斯尔-渥太华质量评估量表（NOS）评估偏倚风险。根据标准均数差值（SMD）、对数比值（OR）和对数风险比（RR）计算合并效应量。本研究已在 PROSPERO（CRD42021250254）上注册。
结果：纳入了 19 项横断面研究，共纳入了 19734 名无残疾和痴呆的社区居住和机构居住的老年人。MeDi 高度依从性与更好的步行速度（SMD = 0.42；95%置信区间[CI]：0.12-0.72，P = 0.006；I² = 65%，P = 0.06）、膝关节肌肉力量速度（SMD = 0.26；95%CI：0.17-0.36，P < 0.00001；I² = 0%，P = 0.69）、整体认知（SMD = 0.24；95%CI：0.15-0.33，P < 0.00001；I² = 85%，P < 0.00001）和记忆（SMD = 0.18；95%CI：0.13-0.25，P < 0.00001；I² = 100%，P < 0.00001）显著相关。在按研究地点、MeDi 饮食依从性综合评分和简易精神状态检查（MMSE）进行分层分析后，MeDi 依从性与整体认知的相关性仍然显著。研究的偏倚风险为中等到低。关于纵向分析，纳入了 34 项前瞻性研究，平均随访时间从 3.0 年到 12.6 年不等，共纳入了 98315 名社区居民。结果表明，MeDi 评分较高的老年人整体认知下降的风险较低（RR = 0.26；95%CI：0.23-0.29，P < 0.00001；I² = 100%，P < 0.00001）。相比之下，MeDi 与移动能力、MCI 和痴呆之间没有显著关联。纵向研究的偏倚风险较低。
讨论：本研究的结果表明，MeDi 高度依从性与身体机能和认知功能呈横断面相关。纵向研究的汇总分析结果显示，MeDi 高度依从性可降低非痴呆老年人整体认知下降的风险。然而，MeDi 依从性与移动能力问题、MCI 和痴呆的发生率之间没有显著关联。由于存在异质性和发表偏倚，我们的研究结果虽然重要，但应谨慎解释。
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