School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
Am J Clin Nutr. 2022 Jan 11;115(1):232-243. doi: 10.1093/ajcn/nqab326.
Evidence regarding the role of diet quality, especially its change, in subjective cognitive decline (SCD) is scarce.
We aimed to examine associations of long-term diet quality scores, including the Alternate Mediterranean Diet (AMED), Dietary Approaches to Stop Hypertension (DASH), and Alternate Healthy Eating Index 2010 (AHEI-2010), with SCD in the Nurses' Health Study.
We followed 49,493 female registered nurses (mean age in 1984: 48 y) from 1984 to 2014. Diet scores were derived from 7 repeated FFQs in 1984, 1986, and every 4 y afterward until 2006. Self-reported SCD was assessed in 2012 and 2014 by a 7-item questionnaire on memory and cognition changes. Categorical SCD score was classified as "none" (0 points, 40.8%), "moderate" (0.5-2.5 points, 46.9%), and "severe" (3-7 points, 12.3%).
Multinomial and linear regression models were adjusted for total calorie intake, demographic characteristics, lifestyle, and clinical factors. Comparing the top with the bottom quintiles of AMED, DASH, and AHEI-2010, multivariable-adjusted ORs (95% CIs) for severe SCD compared with none were 0.57 (0.51, 0.64), 0.61 (0.55, 0.68), and 0.81 (0.73, 0.90), respectively. Similar associations remained for the 3 diet indexes evaluated 28 y before SCD assessment. Compared with participants with the lowest diet quality tertiles in both remote and recent years, the lowest odds of severe SCD were observed among those who maintained the highest diet quality tertiles over time, with 40%, 32%, and 20% lower odds of severe SCD for AMED, DASH, and AHEI-2010, respectively. Moreover, the odds of severe SCD were lower among those with improved diets over time; for each SD higher in diet quality change, the reductions in risk were 11% for AMED, 5% for DASH, and 3% for AHEI-2010, respectively.
Our findings support beneficial roles of long-term adherence to, and improvement in, healthy dietary patterns for the maintenance of subjective cognition in women.
关于饮食质量（尤其是其变化）在主观认知下降（SCD）中的作用的证据很少。
我们旨在研究长期饮食质量评分（包括交替地中海饮食（AMED）、停止高血压的饮食方法（DASH）和替代健康饮食指数 2010（AHEI-2010））与护士健康研究中 SCD 的关联。
我们随访了 49493 名女性注册护士（1984 年平均年龄：48 岁），随访时间从 1984 年到 2014 年。饮食评分来自 1984 年、1986 年和之后每 4 年的 7 次重复 FFQ，直到 2006 年。通过关于记忆和认知变化的 7 项问卷在 2012 年和 2014 年评估自我报告的 SCD。分类 SCD 评分分为“无”（0 分，40.8%）、“中度”（0.5-2.5 分，46.9%）和“重度”（3-7 分，12.3%）。
多变量和线性回归模型调整了总热量摄入、人口统计学特征、生活方式和临床因素。与 AMED、DASH 和 AHEI-2010 的最高五分位与最低五分位相比，重度 SCD 的多变量调整比值比（95%CI）分别为 0.57（0.51，0.64）、0.61（0.55，0.68）和 0.81（0.73，0.90）。在评估 SCD 前 28 年，对 3 种饮食指数进行评估，仍然存在类似的关联。与近年来饮食质量最低三分位的参与者相比，长期保持最高饮食质量三分位的参与者中，重度 SCD 的几率最低，AMED、DASH 和 AHEI-2010 的重度 SCD 几率分别降低 40%、32%和 20%。此外，随着时间的推移，饮食改善的参与者中重度 SCD 的几率较低；饮食质量变化每增加 1 个标准差，风险降低 11%（AMED）、5%（DASH）和 3%（AHEI-2010）。
我们的研究结果支持长期坚持和改善健康饮食模式对女性主观认知的维持有益。
