Individuals who consume a diet rich in nuts, fish, poultry, vegetables, fruits, and olive oil–based salad dressings but low in high-fat dairy products, red meat, organ meats, and butter have a reduced risk for Alzheimer’s disease, a new study suggests.

The finding, from a prospective community-based cohort study, warrants further exploration of food combinations in the prevention of this important public health problem, said lead study author Yian Gu, PhD, from the Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York City.

“Many studies have looked at the relationship between diet and the risk of Alzheimer’s disease, but they have tended to focus on single nutrients or dietary items, such as fruits or vegetables or intake of meats. But the reality is that people eat a variety of foods, so we wanted to determine the best combination that might prevent Alzheimer’s,” she told Medscape Neurology.

Their results were published online April 12 in the Archives of Neurology. The study will also appear in the June issue of the journal.

Dietary Patterns

Dr. Gu and her colleagues studied a cohort of 2148 elderly subjects 65 years and older living in New York City. All subjects were healthy and free of dementia at study entry. Their dietary habits were obtained via questionnaire, and they were prospectively evaluated with the same standardized neurologic and neuropsychological measures approximately every 1.5 years for an average of 4 years.

The researchers used reduced rank regression to calculate dietary patterns according to their effect on 7 nutrients previously shown in the literature to be related to Alzheimer’s disease: saturated fatty acids, monounsaturated fatty acids, ω-3 polyunsaturated fatty acids, ω-6 polyunsaturated fatty acids, vitamin E, vitamin B 12, and folate.

During the follow-up, 253 individuals developed Alzheimer’s disease. The study found that one dietary pattern — characterized by higher intakes of salad dressing, nuts, fish, tomatoes, poultry, cruciferous vegetables, fruits, and dark and green leafy vegetables and a lower intake of high-fat dairy products, red meat, organ meat, and butter — was significantly associated with a reduced risk for Alzheimer’s disease.

Compared with subjects in the lowest tertile of adherence to this pattern, the Alzheimer’s disease hazard ratio (95% confidence interval) for subjects in the highest tertile was 0.62 (0.43 – 0.89) after multivariable adjustment (P for trend = .01).

The study also found that subjects who were older, less educated, and current smokers tended to be less adherent to the protective diet. Hispanic individuals adhered less than white and black individuals (P = .02), and women tended to adhere more than men (P = .05).

“The dietary pattern that was most protective against Alzheimer’s reflected a diet rich in ω-3 and ω-6 polyunsaturated fatty acids, vitamin E, and folate but poor in saturated fatty acids and vitamin B12,” commented Dr. Gu. “The combination of nutrients in this dietary pattern reflects multiple pathways in the development of Alzheimer’s disease.

“For example, vitamin B12 and folate are homocysteine-related vitamins that may have an impact on the disease through their ability to lower circulating homocysteine levels,” she said. “Vitamin E is a strong antioxidant, and the fatty acids may be linked to dementia and cognitive function through atherosclerosis, thrombosis, or inflammation.

Fatty acids may also affect brain development and membrane functioning.”She added that the study has several limitations. “We used a single measurement of the diet, and this might not have captured the long-term dietary habits of the subjects. We also excluded subjects from the final analysis because they were lost to follow-up, and this might have introduced selection bias. We also can’t completely rule out the possibility that the reduced risk associated with this protective diet was due to residual confounding.”

Further studies are planned, Dr. Gu said. “We cannot say based on this study alone that this type of dietary pattern prevents Alzheimer’s disease, but many studies have consistently shown that fruits and vegetables andunsaturated fatty acids are associated with a lower risk. We want to repeat these findings in different populations and see if they can be confirmed in other studies.”

Array of Health Behaviors

Commenting on this study for Medscape Neurology, David Knopman, MD, professor of neurology at the Mayo Clinic and a member of the Mayo Clinic Alzheimer’s Disease Research Center in Rochester, Minnesota, said that, despite the study authors’ best efforts, it is still not clear whether diet alone makes a difference.

“Dietary habits, which often are lifelong, are certainly part of the array of health behaviors that contribute to better cognitive health in late life. However, diet and other health behaviors are intertwined. Because a healthy diet contributes to better cardiac health, lower weight, lower blood pressure and a lower risk for diabetes, there are many reasons to view the dietary habits described by Dr. Gu and colleagues as beneficial.”

The study was supported by federal National Institute on Aging grants. Dr. Gu and Dr. Knopman have disclosed no relevant financial relationships.