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Martha Clara Morris

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Alzheimer Scotland Annual Conference 2017 slides.

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Martha Clara Morris

  1. 1. MIND Diet and Dementia Prevention Martha Clare Morris, Sc.D. Director, Section on Nutrition and Nutritional Epidemiology, Rush University Medical Center Alzheimer Scotland Annual Conference, June 2, 2017 Edinburgh, Scotland
  2. 2. Summary: Nutrition for a Healthy Brain NUTRIENT FOOD SOURCES Evidence Strong Dietary tocopherols – low deleterious Nuts, oils, seeds, green leafy vegetables, whole grains DHA – low deleterious Fish – 1 meal /week Folate – low deleterious Vegetables, whole grains Saturate Fat –high deleterious U/S Fats – high beneficial Commercial products, baked goods, red meats, high fat dairy Moderate / Limited Evidence Carotenoids (β-carotene, luteine, lycopene) Green leafy vegetables, bright colored fruit, vegetables Flavonoids Berries Vitamin D Fish, dairy Trans fats Commercial products, baked goods Monounsaturated fat Olive oil Polyphenols Olive oil, red wine, teas, vegs, fruits
  3. 3. DASH Mediterranean MIND Total Grains 42+/wk Nonrefined Grains >32/wk Whole Grains >28/wk Vegetables 28+/wk Vegetables >33/wk Potatoes >18/wk Green Leafy 7+/wk Other Vegetables 14+/wk Fruits 28+/wk Fruits >22/wk Berries (1/2 c /d) Dairy ≥14/wk Full-fat Dairy .≤10/wk Regular Cheese ≤1/d Butter <1T/d Nuts, seeds & legumes ≥4/wk Legumes, nuts & beans >6/wk Beans 3+/wk Nuts 1/8 c/d Lean meat, poultry fish ≤6/wk Red meat ≤ 1/wk Fish >6/wk Poultry ≤3/wk Lean Red Meats <4/wk Fish 1+/wk Poultry 2+/wk Total Fat ≤ 27% of kcal Saturated Fat ≤ 6% of kcal Sweets ≤ 5/wk Commercial Pastries, sweets <5/wk Sodium ≤ 2400mg/d Olive oil 3-4 T/d Olive Oil>1 T/d Alcohol < 300mL/d but >0 Alcohol/wine 1/d
  4. 4. Mediterranean-DASH Intervention for Neurodegenerative Delay  MIND Component   0     0.5   1 Green Leafy Vegetables ≤2 servings/wk > 2 to <6/wk 6+ servings/wk Other Vegetables <5 serving/wk 5 - <7 wk 7+ servings/wk Berries <1 serving/wk 1 /wk 2+ servings/wk Nuts <1/mo 1/mo - <5/wk 5+ servings/wk Olive Oil Not primary oil Primary oil used Butter, Cream >2 servings/d 1-2 /d <1 serving/d Regular Cheese 7+ servings/wk 1-6 /wk < 1 serving/wk Whole Grains <1 serving/d 1-2 /d 3+ servings/d Fish (not fried, not shell) Rarely 1-3 /mo 1+ meals/wk Beans <1 meal/wk 1-3/wk >3 meals/wk Poultry (not fried) <1 meal/wk 1 /wk 2+ meals/wk Red Meat 7+ meals/wk 4-6 /wk < 4 meals/wk Fast Foods 4+ times/wk 1-3 /wk <1 time/wk Pastries & Sweets 7+ servings/wk 5 -6 /wk <5 servings/wk Wine >1 glass/d or never 1/mo – 6/wk 1 glass/d
  5. 5. MAP NUTRITION STUDY • Food Frequency Questionnaires – 144 food items – 2004 to present – Self-administered at yearly evaluations – 75 % to 80% response – Validated in biracial sample of Chicago community residents 65+ years old
  6. 6. Bennett DA, et al. Neuroepidemiology. 2005;25:163–175. MAP STUDY DESIGN
  7. 7. MAP NUTRITION ANALYTIC SAMPLES • Cognitive Decline: – 994 with baseline FFQ and 2 cognitive assessments; mean of 4.5 years follow-up; range 2-10 years – Mixed effects models • Incident AD – 923 with FFQ and free of dementia at baseline – 114 incident AD cases – Proportional Hazard Models
  8. 8. MIND Diet Score and Cognitive Decline -0.7 -0.6 -0.5 -0.4 -0.3 -0.2 -0.1 0 0.1 0.2 0.3 0 1 2 3 4 5 6 7 8 9 10 GlobalCognivtiveScore Years on study Mindscore_tertile1 Mindscore_tertile2 Mindscore_tertile3 Adjusted for age, sex, education, participation in cognitive activities, energy intake
  9. 9. MIND Diet Score and Global Cognitive Change MIND Score Age- Adjusted Basic- Adjusted* Basic *+ CVD Beta 0.0090 0.0095 0.0095 SE (0.0023) (0.0023) (0.0023) P-value 0.0001 <0.0001 <0.0001 *Age, sex, education, participation in cognitive activities, APOE-ε4, smoking history, physical activity hours per week, total energy intake
  10. 10. Comparison to MedDi and DASH Standardized Betas For Diet Pattern Effects on Decline in Global Score MIND MedDi DASH β/SE* 4.4 2.44 2.76 P-Value 0.003 0.01 0.02 *Adjusted for age, sex, education, cognitive activities, caloric intake
  11. 11. MIND Diet Score and Cognitive Domains Episodic Memory Semantic Memory Perceptual Organization Perceptual Speed Working Memory Beta 0.0080 0.0105 0.0077 0.0084 0.0050 P- value 0.004 0.0001 0.002 0.0003 0.04 † Adjusted for age, sex, education, participation in cognitive activities, APOE-ε4, smoking history, physical activity hours per week, total energy intake
  12. 12. MIND Diet and Incident AD Tertile 1 Tertile 2 Tertile 3 MIND Score HR 1.0 0.65* 0.47* 95% CI (referent) (0.44, 0.98) (0.26, 0.76) DASH HR 1.0 0.98 0.61* 95% CI (referent) (0.66, 1.46) (0.38,0.97) Mediterranean HR 1.0 0.81 0.46* 95% CI (referent) (0.54, 1.24) (0.27, 0.79) Adjusted for age, sex, education, cognitive activities, physical activity, calories
  13. 13. MIND Diet and Incident AD with CVD Factors MODELS HR for Linear MIND Score P-value Basic Model* 0.84 0.004 + Physical Activity, Smoking 0.85 0.008 + Stroke, MI, Diabetes, Hypertension 0.85 0.007 + BMI<20, BMI>30, depressive symptoms 0.86 0.01 Basic Model – deleting cases within 2 years 0.84 0.008 *Adjusted for age, sex, education, cognitive activities, calories
  14. 14. MIND Diet, Mortality, Disability & Motor Decline MODELS MIND Score HR DASH HR MedDiet HR Death (n=234) 0.92* 0.89* 0.97* Help with ADL (n=192) 0.90** 0.89* 0.97 Parkinsonism (top 10%) 0.88** 0.88 0.88 Bradykinesia (top 10%) 0.89** 0.88* 0.97 Gait, top 25% (n=152) 0.89** 0.89* 0.96* Tremor (n=126) 0.83 0.86* 0.98 Rigidity (n=60) 0.85* 0.84 0.94* Adjusted for age and sex
  15. 15. CONCLUSION • MIND diet associated with 53% reduced risk of developing Alzheimer’s disease – Slower decline in cognitive abilities • Even moderate scores on the MIND diet were associated with neuroprotection • MIND diet appears to be more neuroprotective than DASH and Mediterranean diets

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