Association of the Mediterranean Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) Diet With the Risk of Dementia

Abstract

Importance: Dementia threatens the well-being of older adults, making efforts toward prevention of great importance.

Objective: To evaluate the association of the Mediterranean-Dietary Approaches to Stop Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND) diet with the risk of dementia in 3 prospective studies and a meta-analysis.

Design, setting, and participants: Cohort analyses included the Whitehall II study (WII), the Health and Retirement Study (HRS), and the Framingham Heart Study Offspring cohort (FOS), and the meta-analysis included 11 cohort studies. Participants were middle-aged and older women and men from WII in 2002 to 2004, HRS in 2013, and FOS in 1998 to 2001 without dementia at the study baseline. Data were analyzed from May 25 to September 1, 2022.

Exposures: MIND diet score was measured using food frequency questionnaires, and scores ranged from 0 to 15, with a higher score indicating higher adherence to the MIND diet.

Main outcome and measures: Incident all-cause dementia, with cohort-specific definitions.

Results: Included in this study were 8358 participants (mean [SD] age, 62.2 [6.0] years; 5777 male [69.1%]) from WII, 6758 participants (mean [SD] age, 66.5 [10.4] years; 3965 female [58.7%]) from HRS, and 3020 participants (mean [SD] age, 64.2 [9.1] years; 1648 female [54.6%]) from FOS. The mean (SD) baseline MIND diet score was 8.3 (1.4) in WII, 7.1 (1.9) in HRS, and 8.1 (1.6) in FOS. Over 166 516 person-years, a total of 775 participants (220 in WII, 338 in HRS, and 217 in FOS) developed incident dementia. In the multivariable-adjusted Cox proportional hazard model, higher MIND diet score was associated with lower risk of dementia (pooled hazard ratio [HR] for every 3-point increment, 0.83; 95% CI, 0.72-0.95; P for trend = .01; I2 = 0%). The associations were consistently observed in subgroups defined by sex, age, smoking status, and body mass index. In the meta-analysis of 11 cohort studies with 224 049 participants (5279 incident dementia cases), the highest tertile of MIND diet score was associated with lower risk of dementia compared with the lowest tertile (pooled HR, 0.83; 95% CI, 0.76-0.90; I2 = 35%).

Conclusions and relevance: Results suggest that adherence to the MIND diet was associated with lower risk of incident dementia in middle-aged and older adults. Further studies are warranted to develop and refine the specific MIND diet for different populations.

Figure 1.. Flowcharts of Participant Inclusion in the Cohort Analyses and Study Inclusion in the Meta-analysis

The median (IQR) follow-up durations were 12.9 (12.2-13.8) years in the Whitehall II study (A), 5.0 (3.0-5.0) years in the Health and Retirement Study (B), and 10.7 (7.5-14.3) years in Framingham Heart Study Offspring cohort (C). D, Search strategy used for the meta-analysis. FFQ indicates food frequency questionnaire.

Figure 2.. Meta-analysis of Multivariable-Adjusted Hazard Ratio (HR) and 95% CI for Incident Dementia Comparing the Highest vs Lowest Tertile of Mediterranean–Dietary Approaches to Stop Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND) Diet Score

HR below 1.00 indicates a lower risk of dementia. We used random-effects models to pool the risk estimates comparing highest vs lowest MIND diet tertiles. CHAP indicates Chicago Health and Aging Project; FOS, Framingham Heart Study Offspring cohort; HRS, Health and Retirement Study; MAP, Memory and Aging Project; RS, Rotterdam Study; 3C, Three-City Study; UKB, UK Biobank; WHI-MS, Women’s Health Initiative Memory Study; WII, Whitehall II study.