title: Healthy eating and reduced risk of cognitive decline: A cohort from 40 countries.
abstract: OBJECTIVE
  We sought to determine the association of dietary factors and risk of cognitive decline in a population at high risk of cardiovascular disease.
  
  
  METHODS
  Baseline dietary intake and measures of the Mini-Mental State Examination were recorded in 27,860 men and women who were enrolled in 2 international parallel trials of the ONTARGET (Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial) and TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) studies. We measured diet quality using the modified Alternative Healthy Eating Index. Cox proportional hazards regression was used to determine the association between diet quality and risk of ≥3-point decline in Mini-Mental State Examination score, and reported as hazard ratio with 95% confidence intervals with adjustment for covariates.
  
  
  RESULTS
  During 56 months of follow-up, 4,699 cases of cognitive decline occurred. We observed lower risk of cognitive decline among those in the healthiest dietary quintile of modified Alternative Healthy Eating Index compared with lowest quintile (hazard ratio 0.76, 95% confidence interval 0.66-0.86, Q5 vs Q1). Lower risk of cognitive decline was consistent regardless of baseline cognitive level.
  
  
  CONCLUSIONS
  We found that higher diet quality was associated with a reduced risk of cognitive decline. Improved diet quality represents an important potential target for reducing the global burden of cognitive decline.
authors.affiliation: From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA. andrew.smyth@phri.ca.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smyth
authors.affiliation: From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
authors.forename: Mahshid
authors.initials: M
authors.lastname: Dehghan
authors.affiliation: From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Donnell
authors.affiliation: From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
authors.forename: Craig
authors.initials: C
authors.lastname: Anderson
authors.affiliation: From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
authors.forename: Koon
authors.initials: K
authors.lastname: Teo
authors.affiliation: From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
authors.forename: Peggy
authors.initials: P
authors.lastname: Gao
authors.affiliation: From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
authors.forename: Peter
authors.initials: P
authors.lastname: Sleight
authors.affiliation: From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
authors.forename: Gilles
authors.initials: G
authors.lastname: Dagenais
authors.affiliation: From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Probstfield
authors.affiliation: From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mente
authors.affiliation: From the Population Health Research Institute (A.S., M.D., M.O.D., K.T., P.G., A.M., S.Y.), McMaster University, Hamilton, Canada; Health Research Board Clinical Research Facility (A.S., M.O.D.), National University of Ireland, Galway; The George Institute for Global Health (C.A.), Australia; Nuffield Department of Medicine (P.S.), John Radcliffe Hospital, Oxford, UK; Laval University Heart and Lung Institute (G.D.), Quebec, Canada; and University of Washington (J.L.P.), School of Medicine, Seattle, WA.
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D003072:Cognition Disorders / Q000178:diet therapy / Q000517:prevention & control / Q000523:psychology; D015331:Cohort Studies; D004311:Double-Blind Method; D005247:Feeding Behavior; D005500:Follow-Up Studies; D006304:Health Status; D038622:Internationality; D012307:Risk Factors; D040242:Risk Reduction Behavior; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic