Charisis Sokratis, Yannakoulia Mary, Scarmeas Nikolaos
Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA.
Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
Nat Rev Neurol. 2025 Jan;21(1):5-16. doi: 10.1038/s41582-024-01036-9. Epub 2024 Nov 21.
Diet is a modifiable lifestyle factor with a proven role in cardiovascular disease risk reduction that might also play an important part in cognitive health. Evidence from observational studies has linked certain healthy dietary patterns to cognitive benefits. However, clinical trials of diet interventions have demonstrated either null or, at best, small effects on cognitive outcomes. In this Review, we summarize the currently available evidence from observational epidemiology and clinical trials regarding the potential role of diet in the prevention of cognitive decline and dementia. We further discuss possible methodological limitations that might have hindered the ability of previous diet intervention trials to capture potential neuroprotective effects. Considering the overwhelming and continuously expanding societal, economic and health-care burden of Alzheimer disease and other dementias, future nutritional research must address past methodological challenges to accurately and reliably inform clinical practice guidelines and public health policies. Within this scope, we provide a roadmap for future diet intervention trials for dementia prevention. We discuss study designs involving both intensive personalized interventions - to evaluate pharmacokinetic and pharmacodynamic properties, establish neuroprotective thresholds, and test hypothesized biological mechanisms and effects on brain health and cognition through sensitive and precise biomarker measures - and large-scale, pragmatic public health interventions to study population-level benefits.
饮食是一种可改变的生活方式因素，已证实其在降低心血管疾病风险方面发挥作用，并且可能在认知健康中也起到重要作用。观察性研究的证据已将某些健康饮食模式与认知益处联系起来。然而，饮食干预的临床试验表明，对认知结果要么没有影响，要么至多只有微小影响。在本综述中，我们总结了目前来自观察性流行病学和临床试验的证据，这些证据涉及饮食在预防认知衰退和痴呆方面的潜在作用。我们进一步讨论了可能阻碍既往饮食干预试验捕捉潜在神经保护作用能力的方法学局限性。鉴于阿尔茨海默病和其他痴呆症给社会、经济和医疗保健带来的巨大且不断扩大的负担，未来的营养研究必须应对过去的方法学挑战，以便准确、可靠地为临床实践指南和公共卫生政策提供依据。在此范围内，我们为未来预防痴呆的饮食干预试验提供了一个路线图。我们讨论了研究设计，包括强化个性化干预（以评估药代动力学和药效学特性、确定神经保护阈值，并通过灵敏且精确的生物标志物测量来测试假设的生物学机制以及对大脑健康和认知的影响）以及大规模、实用的公共卫生干预，以研究人群层面的益处。
