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Mediterranean diet adherence and cognitive function in older UK adults: the European Prospective Investigation into Cancer and Nutrition–Norfolk (EPIC-Norfolk) Study

Lookup NU author(s): Dr Oliver Shannon, Professor Bloss Stephan, Dr Antoneta Granic, Professor Carol Brayne, Dr Stella Paddick, Professor John Mathers, Dr Mario Siervo



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Oxford University Press, 2019.

For re-use rights please refer to the publisher's terms and conditions.


Background In Mediterranean countries, adherence to a traditional Mediterranean dietary pattern (MedDiet) is associated with better cognitive function and reduced dementia risk. It is unclear if similar benefits exist in non-Mediterranean regions. Objective To examine associations between MedDiet adherence and cognitive function in an older, UK population. To investigate whether associations differed between individuals with high versus low cardiovascular disease (CVD) risk. Design We conducted an analysis in 8009 older individuals with dietary data at Health Check 1 (1993-1997) and cognitive function data at Health Check 3 (2006-2011) of the European Prospective Investigation of Cancer, Norfolk (EPIC-Norfolk). Associations were explored between MedDiet adherence and global and domain specific cognitive test scores and risk of poor cognitive performance in the entire cohort, and when stratified according to CVD risk status. Results Higher MedDiet adherence defined by the Pyramid MedDiet score was associated with better global cognition (β±SE=-0.012±0.002; P<0.001), verbal episodic memory (β±SE=-0.009±0.002; P<0.001), and simple processing speed (β±SE=-0.002±0.001; P=0.013). Lower risk of poor verbal episodic memory (OR(95%CI)=0.784 (0.641,0.959); P=0.018), complex processing speed (OR(95%CI)=0.739 (0.601,0.907); P=0.004), and prospective memory (OR(95%CI)=0.841 (0.724,0.977); P=0.023) was also observed for the highest versus lowest Pyramid MedDiet tertiles. The effect of a one-point increase in Pyramid score on global cognitive function was equivalent to 1.7 fewer years of cognitive ageing. MedDiet adherence defined by the MEDAS score (mapped using both binary and continuous scoring) showed similar, albeit less consistent, associations. In stratified analyses, associations were evident in individuals at higher CVD risk only (P<0.05). Conclusions Higher adherence to the MedDiet is associated with better cognitive function and lower risk of poor cognition in older, UK adults. This evidence underpins the development of interventions to enhance MedDiet adherence, particularly in individuals at higher CVD risk, aiming to reduce the risk of age-related cognitive decline in non-Mediterranean populations.

Publication metadata

Author(s): Shannon O, Stephan BCM, Granic A, Lentjes M, Hayat S, Mulligan A, Brayne C, Khaw KT, Bundy R, Aldred S, Hornberger M, Paddick S-M, Muniz-Tererra G, Minihane A-M, Mathers JCM, Siervo M

Publication type: Article

Publication status: Published

Journal: The American Journal of Clinical Nutrition

Year: 2019

Volume: 110

Issue: 4

Pages: 938-948

Print publication date: 01/10/2019

Online publication date: 17/06/2019

Acceptance date: 06/05/2019

Date deposited: 07/05/2019

ISSN (print): 0002-9165

ISSN (electronic): 1938-3207

Publisher: Oxford University Press


DOI: 10.1093/ajcn/nqz114


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