Tang Lulu, Yu Xiaoli, Qiu Changcui, Lu Yu, Wang Yunlan, Liu Fei, Zhu Xiaoping
Department of Nursing, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Tongji University School of Medicine, Shanghai, China.
Int J Behav Nutr Phys Act. 2025 May 16;22(1):56. doi: 10.1186/s12966-025-01759-y.
The EAT-Lancet commission has proposed a planetary health reference diet (PHD) aiming to improve human health and global environmental sustainability. Emerging evidence suggests that high-quality diet is a modified risk factor cognitive decline. However, population-based evidence in relation to the association between this diet and cognitive decline is scarce.
This prospective cohort study examined data from the China Health and Nutrition Survey (CHNS) during 1997-2011.We included 3404 adults aged 60 years and older with normal cognition at baseline. Dietary intake was assessed using 3-day 24 h dietary recalls combined with weighing methods and cognitive function was assessed using repeated measures of the Telephone Interview for Cognitive Status-modified (TICS-m). The Planetary Health Diet Index (PHDI) was based on 14 food groups and a total score from 0 to 140. Higher scores indicated greater adherence to the PHDI. We used linear mixed model with random intercepts and slope to evaluate the association between PHDI score and cognitive decline adjusting for demographic, health, and lifestyle confounders.
During a median follow-up of 12 years, higher adherence to the PHDI was associated with a slower decline in memory and global cognition. Participants in the highest quintile of PHDI adherence had significantly slower memory decline (B = 0.025, 95%CI:0.000-0.049, P for trend = 0.019) and global cognitive decline (B = 0.020, 95%CI:0.004-0.037, P for trend = 0.029) compared to those in the lowest quintile. Stratified analyses revealed that physical activity modified these associations (P < 0.05). Among participants engaging in vigorous physical activity, those in the highest PHDI quintile exhibited an attenuated annual memory decline (B = 0.070, 95%CI:0.010-0.130, P for trend = 0.013) and global cognitive decline (B = 0.045, 95%CI:0.003-0.086, P for trend = 0.037) compared to those in the lowest quintile.
Higher adherence to the PHD was associated with slower cognitive decline in older Chinese adults. Physical activity, particularly vigorous physical activity, may enhance the cognitive benefits of this dietary pattern. These findings highlight the potential dual benefits of sustainable dietary patterns for both environmental and cognitive health.
“柳叶刀 - 饮食、健康与环境委员会”提出了一种行星健康参考饮食（PHD），旨在改善人类健康和全球环境可持续性。新出现的证据表明，高质量饮食是认知能力下降的一个可改变风险因素。然而，关于这种饮食与认知能力下降之间关联的基于人群的证据却很匮乏。
这项前瞻性队列研究分析了1997年至2011年中国健康与营养调查（CHNS）的数据。我们纳入了3404名基线时认知正常的60岁及以上成年人。饮食摄入量通过3天24小时饮食回顾结合称重法进行评估，认知功能则使用认知状态改良电话访谈（TICS - m）的重复测量进行评估。行星健康饮食指数（PHDI）基于14个食物组，总分从0到140分。分数越高表明对PHDI的依从性越高。我们使用具有随机截距和斜率的线性混合模型来评估PHDI分数与认知能力下降之间的关联，并对人口统计学、健康和生活方式混杂因素进行了调整。
在中位随访12年期间，对PHDI的更高依从性与记忆和整体认知能力下降较慢有关。与最低五分位数组相比，PHDI依从性最高五分位数组的参与者记忆下降显著较慢（B = 0.025，95%置信区间：0.000 - 0.049，趋势P值 = 0.019），整体认知能力下降也较慢（B = 0.020，95%置信区间：0.004 - 0.037，趋势P值 = 0.029）。分层分析显示，身体活动改变了这些关联（P < 0.05）。在进行剧烈身体活动的参与者中，与最低五分位数组相比，PHDI五分位数最高组的参与者每年记忆下降程度减轻（B = 0.070，95%置信区间：0.010 - 0.130，趋势P值 = 0.013），整体认知能力下降程度也减轻（B = 0.045，95%置信区间：0.003 - 0.086，趋势P值 = 0.037）。
在中国老年人中，对PHD的更高依从性与较慢的认知能力下降有关。身体活动，尤其是剧烈身体活动，可能会增强这种饮食模式对认知的益处。这些发现凸显了可持续饮食模式对环境和认知健康的潜在双重益处。
