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Adherence to the planetary health diet and cognitive decline: findings from the ELSA-Brasil study – Nature.com

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Abstract

The EAT–Lancet Commission proposed a planetary health diet to improve human health within planetary boundaries; however, little is known about the association between adherence to this diet and cognitive decline. We used data from three waves of the Brazilian Longitudinal Study of Adult Health to evaluate the association between the planetary health diet and cognitive decline using linear mixed-effects models. Here we show that in 11,737 participants (mean (s.d.) age 51.6 (9.0) years, 54% women and 53% white), higher adherence to the planetary health diet was associated with slower memory decline (P = 0.046) and that income was a modifier in this association (P < 0.001). Adherence to the planetary health diet was associated with slower decline of memory (P = 0.040) and global cognition (P = 0.009) in high-income participants. No association was found among low-income participants. The results of our study highlight that the promotion of healthy dietary patterns should take into consideration income barriers as well as differences in dietary habits to achieve high adherence.

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Fig. 1: Association of quintiles of the PHDI and cognitive decline.
Fig. 2: Association of quintiles of the PHDI adherence score at the study baseline with cognitive decline in participants with high and low income.
Fig. 3: Histogram of the PHDI adherence scores for participants with high and low income at the study baseline.
Fig. 4: Association between individual components of the PHDI adherence and global cognitive decline.
Fig. 5: Association between individual components of the PHDI adherence and global cognitive decline stratified for high and low income.

Data availability

Data from the ELSA-Brasil study were used under license for the current study due to privacy reasons, therefore the data are not publicly available. Researchers can apply for data access at http://elsabrasil.org/. This study complies with the GATHER statement.

Code availability

The code used for the main analysis of this paper is available at https://github.com/NattyGG/EAT-Lancet.

References

  1. Willett, W. et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. Lancet 393, 447–492 (2019).

    Article 
    PubMed 

    Google Scholar     

  2. Bramorska, A., Zarzycka, W., Podolecka, W., Kuc, K. & Brzezicka, A. Age-related cognitive decline may be moderated by frequency of specific food products consumption. Nutrients 13, 2504 (2021).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar     

  3. Alsaffar, A. A. Sustainable diets: the interaction between food industry, nutrition, health and the environment. Food Sci. Technol. Int. 22, 102–111 (2016).

    Article 
    PubMed 

    Google Scholar     

  4. Cacau, L. T. et al. Development and validation of an index based on EAT–Lancet Recommendations: the Planetary Health Diet Index. Nutrients 13, 1698 (2021).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar     

  5. Rajaram, S., Jones, J. & Lee, G. J. Plant-based dietary patterns, plant foods, and age-related cognitive decline. Adv. Nutr. 10, S422–S436 (2019).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar     

  6. Gomez‐Pinilla, F., Vaynman, S. & Ying, Z. Brain‐derived neurotrophic factor functions as a metabotrophin to mediate the effects of exercise on cognition. Eur. J. Neurosci. 28, 2278–2287 (2008).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar     

  7. Dalile, B. et al. The EAT–Lancet reference diet and cognitive function across the life course. Lancet Planet Health 6, e749–e759 (2022).

    Article 
    PubMed 

    Google Scholar     

  8. Colizzi, C. et al. Adherence to the EAT–Lancet healthy reference diet in relation to risk of cardiovascular events and environmental impact: results from the EPIC‐NL Cohort. J. Am. Heart Assoc. 12, e026318 (2023).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar     

  9. Rost, N. S. et al. Post-stroke cognitive impairment and dementia. Circ. Res. 130, 1252–1271 (2022).

    Article 
    CAS 
    PubMed 

    Google Scholar     

  10. Prince, M. et al. World Alzheimer Report 2015. The Global Impact of Dementia: An Analysis of Prevalence, Incidence, Cost and Trends https://www.alzint.org/resource/world-alzheimer-report-2015/ (Alzheimer’s Disease International, 2015).

  11. Parrott, M. D. et al. Relationship between diet quality and cognition depends on socioeconomic position in healthy older adults. J. Nutr. 143, 1767–1773 (2013).

    Article 
    CAS 
    PubMed 

    Google Scholar     

  12. Hirvonen, K., Bai, Y., Headey, D. & Masters, W. A. Affordability of the EAT–Lancet reference diet: a global analysis. Lancet Glob. Health 8, e59–e66 (2020).

    Article 
    PubMed 

    Google Scholar     

  13. Cacau, L. T. et al. Adherence to the EAT–Lancet sustainable reference diet and cardiometabolic risk profile: cross-sectional results from the ELSA-Brasil cohort study. Eur. J. Nutr. 62, 807–817 (2022).

    PubMed 

    Google Scholar     

  14. Xu, C. et al. Association between the EAT–Lancet diet pattern and risk of type 2 diabetes: a prospective cohort study. Front. Nutr. 8, 784018 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar     

  15. Young, H. A. Adherence to the EAT–Lancet diet: unintended consequences for the brain? Nutrients 14, 4254 (2022).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar     

  16. Marchioni, D. M. et al. Low adherence to the EAT–Lancet sustainable reference diet in the Brazilian population: findings from the national dietary survey 2017–2018. Nutrients 14, 1187 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar     

  17. Verly Junior, E., Carvalho, A. M. D., Fisberg, R. M. & Marchioni, D. M. L. Adesao ao guia alimentar para populacao brasileira. Rev. Saúde. Pública 47, 1021–1027 (2013).

    Article 
    PubMed 

    Google Scholar     

  18. FNDE. Painel de Preços Praticados pelo PNAE https://www.fnde.gov.br/painelprecospnae/ (2023).

  19. Hiza, H. A. B., Casavale, K. O., Guenther, P. M. & Davis, C. A. Diet quality of americans differs by age, sex, race/ethnicity, income, and education level. J. Acad. Nutr. Diet. 113, 297–306 (2013).

    Article 
    PubMed 

    Google Scholar     

  20. Turrell, G., Hewitt, B., Patterson, C., Oldenburg, B. & Gould, T. Socioeconomic differences in food purchasing behaviour and suggested implications for diet-related health promotion. J. Hum. Nutr. Diet. 15, 355–364 (2002).

    Article 
    CAS 
    PubMed 

    Google Scholar     

  21. Berthy, F. et al. Higher adherence to the EAT–Lancet reference diet is associated with higher nutrient adequacy in the NutriNet-Santé cohort: a cross-sectional study. Am. J. Clin. Nutr. 117, 1174–1185 (2023).

    Article 
    CAS 
    PubMed 

    Google Scholar     

  22. Beal, T., Ortenzi, F. & Fanzo, J. Estimated micronutrient shortfalls of the EAT–Lancet planetary health diet. Lancet Planet Health 7, e233–e237 (2023).

    Article 
    PubMed 

    Google Scholar     

  23. Ferreira, N. V. et al. Association between adherence to the MIND diet and cognitive performance is affected by income: the ELSA-Brasil study. Alzheimer Dis. Assoc. Disord. 36, 133–139 (2022).

    Article 
    CAS 
    PubMed 

    Google Scholar     

  24. Ylilauri, M. P. T. et al. Associations of dairy, meat, and fish intakes with risk of incident dementia and with cognitive performance: the Kuopio ischaemic heart disease risk factor study (KIHD). Eur. J. Nutr. 61, 2531–2542 (2022).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar     

  25. Gomes Gonçalves, N., Suemoto, C. K. & Ferreira, N. V. Different sources of sugar consumption and cognitive performance in older adults: data from the national health and nutrition examination survey 2011–2014. J. Gerontol. Ser. B 78, 620–628 (2023).

    Article 

    Google Scholar     

  26. Ludwig, D. S. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA 287, 2414 (2002).

    Article 
    CAS 
    PubMed 

    Google Scholar     

  27. Ekstrand, B. et al. Brain foods – the role of diet in brain performance and health. Nutr. Rev. 79, 693–708 (2021).

    Article 
    PubMed 

    Google Scholar     

  28. Yassine, H. N. et al. Nutritional metabolism and cerebral bioenergetics in Alzheimer’s disease and related dementias. Alzheimers Dement. 19, 1041–1066 (2023).

    Article 
    CAS 

    Google Scholar     

  29. Molina del, M. C. B. et al. Reprodutibilidade e validade relativa do questionário de frequência alimentar do ELSA-Brasil. Cad. Saúde. Pública 29, 379–389 (2013).

    Article 

    Google Scholar     

  30. Sperling, R. A. et al. Toward defining the preclinical stages of Alzheimer’s disease: recommendations from the National Institute on Aging‐Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 7, 280–292 (2011).

    Article 
    PubMed 

    Google Scholar     

  31. Schmidt, M. I. et al. Cohort profile: longitudinal study of adult health (ELSA-Brasil). Int J. Epidemiol. 44, 68–75 (2015).

    Article 
    PubMed 

    Google Scholar     

  32. Aquino, E. M. L. et al. Brazilian longitudinal study of adult health (ELSA-Brasil): objectives and design. Am. J. Epidemiol. 175, 315–324 (2012).

    Article 
    PubMed 

    Google Scholar     

  33. Cacau, L. T. & Marchioni, D. M. The Planetary Health Diet Index scores proportionally and considers the intermediate values of the EAT–Lancet reference diet. Am. J. Clin. Nutr. 115, 1237 (2022).

    Article 
    CAS 
    PubMed 

    Google Scholar     

  34. Bertolucci, P. H. F., Okamoto, I. H., Toniolo Neto, J., Ramos, L. R. & Brucki, S. M. D. Desempenho da populacao Brasileira na bateria neuropsicologica do Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) [Performance of Brazilian population in neuropsychological battery of Consortium to Establish a Registry for Alzheimer’s Disease]. Rev. Psiquiatr. Clin. 25, 80–83 (1998).


    Google Scholar     

  35. Strauss, E., Sherman, E. & Spreen, O. A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary 3rd edn, (Oxford University Press, 2006).

  36. Bertola, L. et al. Longitudinal measurement invariance of neuropsychological tests in a diverse sample from the ELSA-Brasil study. Braz. J. Psychiatry 43, 254–261 (2021).

    Article 
    PubMed 

    Google Scholar     

  37. Greenlief, C. L., Margolis, R. B. & Erker, G. J. Application of the trail-making test in differentiating neuropsychological impairment of elderly persons. Percept. Mot. Skills 61, 1283–1289 (1985).

    Article 
    CAS 
    PubMed 

    Google Scholar     

  38. Nunes, M. A., de Mello Alves, M. G., Chor, D., Schmidt, M. I. & Duncan, B. Adaptação transcultural do CIS-R (Clinical Interview Schedule—Revised Version) para o português no Estudo Longitudinal De Saúde Do Adulto (ELSA). Rev. HCPA 31, 487–490 (2012).


    Google Scholar     

  39. Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ)—Short and Long Forms (IPAQ, 2005).

  40. Hernan, M. A. Estimating causal effects from epidemiological data. J. Epidemiol. Community Health 60, 578–586 (2006).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar     

Download references

Acknowledgements

The ELSA-Brasil study was supported by the Brazilian Ministry of Health, the Ministry of Science Technology and Innovation and the National Council for Scientific and Technological Development (CNPq). Drs Barreto, Bensenor, Goulart, Marchioni and Suemoto receive support from CNPq, Brazil (research productivity fellowship). The funders had no role in the study design, data collection, management, analysis, interpretation, writing of the manuscript and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil

    Natalia Gomes Gonçalves & Claudia Kimie Suemoto

  2. Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil

    Leandro Teixeira Cacau & Dirce Maria Marchioni

  3. Amazônia Adventist College, Pará, Brazil

    Naomi Vidal Ferreira

  4. Center for Clinical and Epidemiological Research, Hospital Universitario, University of São Paulo, São Paulo, Brazil

    Paulo Andrade Lotufo, Alessandra Carvalho Goulart & Isabela Martins Bensenor

  5. Department of Social Medicine, Federal University of Espírito Santo, Vitória, Brazil

    Maria Carmen Viana

  6. Preventive and Social Medicine Department, Clinical Hospital/ EBSERH, Federal University of Minas Gerais, Belo Horizonte, Brazil

    Sandhi Maria Barreto

Authors

  1. Natalia Gomes Gonçalves
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  2. Leandro Teixeira Cacau
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  3. Naomi Vidal Ferreira
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  4. Paulo Andrade Lotufo
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  5. Alessandra Carvalho Goulart
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  6. Maria Carmen Viana
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  7. Sandhi Maria Barreto
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  8. Isabela Martins Bensenor
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  9. Dirce Maria Marchioni
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  10. Claudia Kimie Suemoto
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Contributions

N.G.G., C.K.S., D.M.M. and L.T.C. conceptualized the study. N.G.G., C.K.S. and L.T.C. curated data. N.G.G. conducted the formal analysis. P.A.L., S.M.B. and I.M.B. acquired funding. C.K.S. supervised the study. N.G.G. was responsible for data visualization. N.G.G., L.T.C. and N.V.F. wrote the original draft. L.T.C., N.V.F., P.A.L., A.C.G., M.C.V., S.M.B., I.M.B., D.M.M. and C.K.S. reviewed and edited the manuscript. N.G.G. and C.K.S. directly accessed and verified the underlying data reported in the manuscript. All authors had full access to all the data in the study and had the final responsibility to submit it for publication.

Corresponding author

Correspondence to
Claudia Kimie Suemoto.

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Competing interests

The authors declare no competing interests.

Peer review

Peer review information

Nature Aging thanks Weili Xu, Changzheng Yuan and the other, anonymous, reviewer(s) for their contributions to the peer review of this work.

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Extended data

Extended Data Table 1 Association between quintiles of the Planetary Health Diet Index adherence score at the study baseline and annual cognitive decline (n = 11,737)
Full size table
Extended Data Table 2 Association between quintiles of the Planetary Health Diet Index adherence score at the study baseline and annual cognitive decline stratified according to participants’ age (n = 11,737)
Full size table

Extended Data Fig. 1

Flowchart of the study participants during the follow-up period.

Extended Data Fig. 2 Association of quintiles of the Planetary Health Index (PHDI) adherence score at the study baseline with (A) memory, (B) verbal fluency, (C) executive function, and (D) global cognition trajectories over a median of eight years of follow-up in participants < 60 years (n = 9,382) and ≥ 60 years (n = 2,355).

Linear mixed-effects models adjusted for age, sex, education, income, race, alcohol consumption, smoking, diabetes, hypertension, cardiovascular disease, physical activity, depressive symptoms, BMI, and total calories. We used inverse probability weighting to correct for attrition bias related to mortality and missing participation at each wave. PHDI score ranged from 0 to 150 and was categorized into quintiles (1st quintile: 26.22–50.53, 2nd quintile 2: 50.54–57.00, 3rd quintile: 57.01–62.96, 4th quintile: 62.98–69.90, 5th quintile: 69.91–109.98). Data are presented as mean values for each quintile. P values represent the interaction terms among quintiles of PHDI, age, and the timescale calculated using the Wald test (two-sided). Exact p values: (A) 1.1 × 10−8, (D) 1.0 × 10−6.

Extended Data Fig. 3 Brazilian map indicating where ELSA-Brasil recruitment centers were located.

The number of participants in each center was Salvador: 2,025 participants; Belo Horizonte: 3,115 participants; Vitória: 1,055 participants; Rio de Janeiro: 1,784 participants; São Paulo: 5,061 participants; Porto Alegre: 2,061 participants.

Supplementary information

Supplementary Information

Supplementary Tables 1–7 and Supplementary References.

Reporting Summary

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Gomes Gonçalves, N., Cacau, L.T., Ferreira, N.V. et al. Adherence to the planetary health diet and cognitive decline: findings from the ELSA-Brasil study.
Nat Aging (2024). https://doi.org/10.1038/s43587-024-00666-4

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  • Received: 26 October 2023

  • Accepted: 13 June 2024

  • Published: 28 June 2024

  • DOI: https://doi.org/10.1038/s43587-024-00666-4

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