The USC Leonard School of Gerontology, University of Southern California, 3715 McClintock Ave., Los Angeles, CA 90089, USA.
Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA.
Nutrients. 2021 Jun 30;13(7):2264. doi: 10.3390/nu13072264.
Alzheimer's disease (AD) and other dementias are now the seventh leading cause of death in the world and are projected to affect 115.4 million people by 2050. Delaying the onset of AD by just five years is estimated to reduce the cost and prevalence of the disease by half. There is no cure for AD nor any drug therapies to halt its progression once the disease begins. Lifestyle choices including diet are being seen as a viable complementary therapy to reduce cognitive decline, the hallmark of AD. Mediterranean, DASH (Dietary Approaches to Stop Hypertension), and MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diets have biological mechanisms supporting their potential neuroprotective benefits, but the findings of study outcomes about these benefits have been inconsistent. This paper analyzed five Randomized Clinical Trials (RCTs) (from 2000 to 2021) and 27 observational studies (from 2010 to 2021) focused on the link between cognitive health and the Mediterranean/DASH/MIND diets to identify gaps and challenges that could lead to inconsistent results. These include a lack of accuracy in assessing food intake, multiple dietary pattern scoring systems, a shifting metric among studies focused on the Mediterranean diet, a lack of standards in the tools used to assess cognitive decline, and studies that were underpowered or had follow-up periods too short to detect cognitive change. Insights from these gaps and challenges are summarized in recommendations for future RCTs, including both pragmatic and explanatory RCTs.
阿尔茨海默病（AD）和其他痴呆症现在是世界上第七大死因，预计到 2050 年将影响 1.154 亿人。如果能将 AD 的发病时间推迟五年，那么预计该病的成本和患病率将减半。目前还没有治愈 AD 的方法，也没有药物疗法可以阻止疾病的进展。包括饮食在内的生活方式选择正被视为一种可行的补充疗法，以减少认知能力下降，这是 AD 的标志。地中海、DASH（停止高血压的饮食方法）和 MIND（地中海-DASH 干预以延缓神经退行性疾病）饮食具有支持其潜在神经保护益处的生物学机制，但关于这些益处的研究结果一直不一致。本文分析了五项随机临床试验（RCT）（2000 年至 2021 年）和 27 项观察性研究（2010 年至 2021 年），重点关注认知健康与地中海/DASH/MIND 饮食之间的联系，以确定可能导致结果不一致的差距和挑战。这些差距和挑战包括：评估食物摄入量的准确性不足、多种饮食模式评分系统、以地中海饮食为重点的研究中指标的变化、用于评估认知能力下降的工具缺乏标准以及研究的效力不足或随访时间太短，无法检测到认知变化。这些差距和挑战的见解总结在未来 RCT 的建议中，包括实用型和解释型 RCT。
