Adherence to High Dietary Diversity and Incident Cognitive Impairment for the Oldest-Old: A Community-Based, Nationwide Cohort Study

Background and aims: Dietary diversity change is associated with cognitive function, however, whether the effect still exists among the oldest-old (80+) is unclear. Our aim was to examine the effect of dietary diversity changes on cognitive impairment for the oldest-old in a large prospective cohort. Methods: Within the Chinese Longitudinal Healthy Longevity Study, 6237 adults older than 80 years were included. The dietary diversity score (DDS) was assessed by a simplified food frequency questionnaire (FFQ). Cognitive impairment was defined as a Mini-Mental State Examination (MMSE) score lower than 18 points. Cognitive decline was defined as a reduction of total MMSE score >= 3 points, and cognitive decline of different subdomains was defined as a reduction of >= 15% in the corresponding cognitive domain. The multivariate-adjusted Cox proportional hazard model evaluated the effects of DDS change on cognitive decline. The linear mixed-effect model was used to test subsequent changes in MMSE over the years. Results: During 32,813 person-years of follow-up, 1829 participants developed cognitive impairment. Relative to the high-high DDS change pattern, participants in the low-low and high-low patterns were associated with an increased risk of cognitive impairment with a hazard ratio (95% confidential interval, CI) of 1.43 (1.25, 1.63) and 1.44 (1.24, 1.67), and a faster decline in the MMSE score over the follow-up year. Participants with the low-high pattern had a similar incidence of cognitive impairment with HRs (95% CI) of 1.03 (0.88, 1.20). Compared with the stable DDS status group (-1-1), the risk of cognitive impairment was higher for those with large declines in DDS (<=-5) and the HR was 1.70 (95% CI: 1.44, 2.01). Conclusions: Even for people older than 80, dietary diversity change is a simple method to identify those who had a high risk of cognitive decline. Keeping high dietary diversity is beneficial for cognitive function and its subdomain even in the final phase of life, especially for females and the illiterate oldest-old.

Automated summary

The aim of this study was to examine the effects of dietary diversity changes on cognitive impairment in adults aged 80 and older. The results showed that compared to individuals with consistent high dietary diversity, those with consistent low dietary diversity and those with a change from high to low dietary diversity had an increased risk of cognitive impairment. These individuals also experienced a faster decline in cognitive function during the follow-up period. Participants who had a change from low to high dietary diversity had a similar incidence of cognitive impairment as those with consistent high dietary diversity. Furthermore, individuals with a large decline in dietary diversity had a higher risk of cognitive impairment. Maintaining a high dietary diversity is beneficial for cognitive function in the oldest-old, especially for females and those with lower education levels.