title: Adherence to a Mediterranean diet and risk of incident cognitive impairment.
abstract: OBJECTIVE
  We sought to determine the relationship of greater adherence to Mediterranean diet (MeD) and likelihood of incident cognitive impairment (ICI) and evaluate the interaction of race and vascular risk factors.
  
  
  METHODS
  A prospective, population-based, cohort of individuals enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study 2003-2007, excluding participants with history of stroke, impaired cognitive status at baseline, and missing data on Food Frequency Questionnaires (FFQ), was evaluated. Adherence to a MeD (scored as 0-9) was computed from FFQ. Cognitive status was evaluated at baseline and annually during a mean follow-up period of 4.0 ± 1.5 years using Six-item-Screener.
  
  
  RESULTS
  ICI was identified in 1,248 (7%) out of 17,478 individuals fulfilling the inclusion criteria. Higher adherence to MeD was associated with lower likelihood of ICI before (odds ratio [lsqb]OR[rsqb] 0.89; 95% confidence interval [lsqb]CI[rsqb] 0.79-1.00) and after adjustment for potential confounders (OR 0.87; 95% CI 0.76-1.00) including demographic characteristics, environmental factors, vascular risk factors, depressive symptoms, and self-reported health status. There was no interaction between race (p = 0.2928) and association of adherence to MeD with cognitive status. However, we identified a strong interaction of diabetes mellitus (p = 0.0134) on the relationship of adherence to MeD with ICI; high adherence to MeD was associated with a lower likelihood of ICI in nondiabetic participants (OR 0.81; 95% CI 0.70-0.94; p = 0.0066) but not in diabetic individuals (OR 1.27; 95% CI 0.95-1.71; p = 0.1063).
  
  
  CONCLUSIONS
  Higher adherence to MeD was associated with a lower likelihood of ICI independent of potential confounders. This association was moderated by presence of diabetes mellitus.
authors: Second Department of Neurology, School of Medicine, Attikon Hospital, University of Athens, Greece. tsivgoulisgiorg@yahoo.gr
authors: Georgios
authors: G
authors: Tsivgoulis
authors: Suzanne
authors: S
authors: Judd
authors: Abraham J
authors: AJ
authors: Letter
authors: Andrei V
authors: AV
authors: Alexandrov
authors: George
authors: G
authors: Howard
authors: Fadi
authors: F
authors: Nahab
authors: Frederick W
authors: FW
authors: Unverzagt
authors: Claudia
authors: C
authors: Moy
authors: Virginia J
authors: VJ
authors: Howard
authors: Brett
authors: B
authors: Kissela
authors: Virginia G
authors: VG
authors: Wadley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data*; D003072:Cognition Disorders / Q000208:ethnology*; D003920:Diabetes Mellitus / Q000208:ethnology; D038441:Diet, Mediterranean / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D015144:Southeastern United States / Q000453:epidemiology; D011795:Surveys and Questionnaires; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American
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