Associations Between Healthy and Plant-Based Dietary Patterns and Cognitive Reserve: A Cross-Sectional Analysis of the 1946 British Birth Cohort

Kelly C Cara; Tammy M Scott; Paul F Jacques; Mei Chung

doi:10.1016/j.cdnut.2025.107599

Associations Between Healthy and Plant-Based Dietary Patterns and Cognitive Reserve: A Cross-Sectional Analysis of the 1946 British Birth Cohort

Curr Dev Nutr. 2025 Nov 12;9(12):107599. doi: 10.1016/j.cdnut.2025.107599. eCollection 2025 Dec.

Authors

Kelly C Cara^{1

2}, Tammy M Scott¹, Paul F Jacques^{1

3}, Mei Chung¹

Affiliations

¹ Division of Nutrition Epidemiology and Data Science, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States.
² Department of Population Science, American Cancer Society, Atlanta, GA, United States.
³ Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, MA, United States.

Abstract

Background: Cognitive reserve (CR) is the ability to compensate for brain changes, injury, and disease, and it is measured by acquired knowledge and experiences. Genes and environmental factors influence CR, but the role of diet is unclear.

Objectives: This study examined associations between CR and alignment with different dietary patterns and investigated diet's unique contribution to variability in CR.

Methods: We applied cross-sectional methods to data from the National Survey of Health and Development's 1946 British Birth Cohort. National Adult Reading Test (NART) scores at age 53 identified CR levels. Scores for the Healthy Eating Index (HEI)-2020 and Plant-Based Diet Indexes (PDIs overall, healthful [hPDI], and unhealthful [uPDI]) were calculated from diet recalls and diaries at ages 4, 36, 43, and 53. Multiple linear regression models identified associations between NART and cumulative mean dietary index scores while adjusting for key confounders. Owen value R ² decomposition determined variance explained by covariate groups.

Results: Participants with complete data were analyzed (n = 2514, 48% male). In regression models, NART was positively associated with HEI, PDI, and hPDI but inversely associated with uPDI. Compared with the lowest quintile, those in the highest quintile for HEI, PDI, and hPDI had significantly higher NART [adjusted mean difference (95% CI) for HEI: 2.25 (1.19, 3.30); PDI: 1.17 (0.19, 2.15); hPDI: 1.42 (0.51, 2.33)], whereas the highest quintile for uPDI showed lower NART (-1.55 [-2.55, -0.54]). Associations weakened but remained significant in models additionally adjusted for childhood cognitive ability. Among dietary patterns, HEI explained the most variation in NART (HEI 2.84%, uPDI 1.51%, hPDI 1.05%, PDI 0.51%).

Conclusions: CR was positively associated with healthy dietary patterns and inversely associated with unhealthful plant-based dietary patterns. Diet uniquely explained variations in CR and should be considered among influential lifestyle factors in future research. Longitudinal analyses are needed to confirm these findings.

Keywords: Healthy Eating Index; cognition; cognitive reserve; cohort studies; diet, healthy; diet, plant-based.