Association of Midlife Diet With Subsequent Risk for Dementia
Association of Midlife Diet With Subsequent Risk for Dementia
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DOI：
10.1001/jama.2019.1432
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发表时间：
2019-03-12
影响因子：
120.7
通讯作者：
Sabia, Severine
中科院分区：
文献类型：
--
作者：
Akbaraly, Tasnime N.;Singh-Manoux, Archana;Sabia, Severine
观察性研究表明，饮食与认知健康有关。然而，许多研究的随访时间不足以考虑到痴呆的临床前阶段较长，并且来自介入性研究的证据也不具有结论性。目的探讨中年死亡是否与痴呆的子风险相关。设计、环境和参与者：建立于1985-1988年的基于人群的队列研究，在1991-1993年、1997-1999年和2002-2004年评估饮食摄入，并随访痴呆事件至2017年3月31日。食物频率问卷得出替代健康饮食指数（AHEI），这是一个由11个组成的饮食质量评分（得分范围为0-110），得分越高表明饮食越健康。通过与电子健康记录的联系确定痴呆事件。结果在1991-1993年无痴呆的8225名参与者中（平均年龄50.2岁[SD， 6]岁]，男性5686[69]%），在24.8年（四分位数范围24.2-25.1年）的中位随访期间，共记录了344例痴呆事件。在1991-1993年、1997-1999年（中位随访19.1年）和2002-2004年（中位随访13.5年）期间，AHEI暴露的三分位数中，痴呆发病率无显著差异。1991-1993年，AHEI最差的四分位数（饮食质量最低的四分位数）的痴呆发病率为每1000人年1.76例（95% CI, 1.47-2.12），与之相比，中间四分位数的绝对发病率差异为每1000人年0.03例（95% CI, -0.43 - 0.49），最佳四分位数的绝对发病率差异为每1000人年0.04例（95% CI, -0.42 - 0.51）。与1997-1999年最严重的AHEI组（痴呆发病率为2.06 [95% CI， 1.62至2.61]/ 1000人年）相比，中度AHEI组的绝对发病率差异为0.14 (95% CI, -0.58至0.86)/ 1000人年，最佳AHEI组的绝对发病率差异为0.14 (95% CI, -0.58至0.85)/ 1000人年。与2002-2004年最差的AHEI分群（痴呆发病率为3.12 [95% [I， 2.49至3.92]/ 1000人年）相比，中度AHEI分群的绝对发病率差异为-0.61(95% CI, -1.56至0.33)/ 1000人年，最佳AHEI分群的绝对发病率差异为-0.73 (95% CI, -1.67至0.22)/ 1000人年。在多变量分析中，每1-SD（10点）AHEI增量的痴呆校正风险比（HR）在1991-1993年（校正HR， 0.97 [95% CI， 0.87至1.08]）、1997-1999年（校正HR， 0.97 [95% CI， 0.83至1.12]）或2002-2004年（校正HR， 0.87 [95% CI， 0.75至1.00]）评估时均无显著性差异。结论和相关性在这项长期前瞻性队列研究中，中年期间评估的饮食质量与随后的痴呆风险无显著相关性。
IMPORTANCE Observational studies suggest that diet is linked to cognitive health. However, the duration of follow-up in many studies is not sufficient to take into account the long preclinical phase of dementia, and the evidence from interventional studies is not conclusive.OBJECTIVE To examine whether midlife die is associated with subsequentrisk for dementia.DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study established in 1985-1988 that had dietary intake assessed in 1991-1993, 1997-1999, and 2002-2004 and follow-up for incident dementia until March 31, 2017.EXPOSURES Food frequency questionnaire to derive the Alternate Healthy Eating Index (AHEI), an 11-component diet quality score (score range, 0-110), with higher scores indicating a healthier diet.MAIN OUTCOME AND MEASURES Incident dementia ascertained through linkage to electronic health records.RESULTS Among 8225 participants without dementia in 1991-1993 (mean age, 50.2 years [SD, 6] years]; 5686 [69]%] were men), a total of 344 cases of incident dementia were recorded during a median follow-up of 24.8 years finterquartile range, 24.2-25.1 years). No significant difference in the incidence rate for dementia was observed in tertiles of AHEI exposure during 1991-1993, 1997-1999 (median follow-up, 19.1years), and 2002-2004 (median follow-up, 13.5 years). Compared with an incidence rate for dementia of 1.76 (95% CI, 1.47-2.12) per 1000 person-years in the worst tertile of AHEI (lowest tertile of diet quality) in 1991-1993, the absolute rate difference for the intermediate tertile was 0.03 (95% CI, -0.43 to 0.49) per 1000 person-years and for the best tertile was 0.04 (95% CI, -0.42 to 0.51) per 1000 person-years. Compared with the worst AHEI tertile in 1997-1999 (incidence rate for dementia, 2.06 [95% CI, 1.62 to 2.61] per 1000 person-years), the absolute rate difference for the intermediate AHEI tertile was 0.14 (95% CI, -0.58 to 0.86) per 1000 person-years and for the best AHEI tertile was 0.14 (95% CI, -0.58 to 0.85) per 1000 person-years. Compared with the worst AHEI tertile in 2002-2004 (incidence rate for dementia, 3.12 [95% [I, 2.49 to 3.92] per 1000 person-years), the absolute rate difference for the intermediate AHEI tertile was -0.61(95% CI, -1.56 to 0.33) per 1000 person-years and for the best AHEI tertile was -0.73 (95% CI, -1.67 to 0.22) per 1000 person-years. In the multivariable analysis, the adjusted hazard ratios (HRs) for dementia per 1-SD (10-point) AHEI increment were not significant as assessed in 1991-1993 (adjusted HR, 0.97 [95% CI, 0.87 to 1.08]), in 1997-1999 (adjusted HR, 0.97 [95% CI, 0.83 to 1.12]), or in 2002-2004 (adjusted HR, 0.87 [95% CI, 0.75 to 1.00]).CONCLUSIONS AND RELEVANCE In this long-term prospective cohort study, diet quality assessed during midlife was not significantly associated with subsequent risk for dementia.