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Cross-sectional and longitudinal associations between adherence to Mediterranean diet with physical performance and cognitive function in older adults: A systematic review and meta-analysis.
Ageing Res Rev. 2021 09; 70:101395.AR

Abstract

OBJECTIVES

The present study investigated the association between adherence to Mediterranean diet (MeDi) and physical performance and cognitive function in older adults.

METHODS

We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated older adults aged 60+ years and assessed adherence to MeDi diet using validated composite scores. Observational studies, including cross-sectional, case-control, and longitudinal cohort studies, if crude baseline data was available, which investigated as a primary or secondary outcome the association of MeDi diet adherence with physical performance and/or cognitive function in non-demented older adults were included in the cross-sectional analysis. For the longitudinal analysis, case-control and longitudinal cohort studies that investigated the longitudinal associations between adherence to MeDi diet with the incidence of mild cognitive impairment (MCI), dementia, and/or Alzheimer's disease (AD), and/or changes in physical performance and cognition in non-demented older adults were included. Studies published in other languages than English were excluded. Studies were retrieved from MEDLINE, SCOPUS, CINAHL, and AgeLine databases until May 19, 2021. The risk of bias was evaluated using the Newcastle - Ottawa Quality Assessment Scale (NOS). A pooled effect size was calculated based on standard mean differences (SMD), log odds ratio (OR) and log risk ratio (RR). This study is registered on PROSPERO (CRD42021250254).

RESULTS

Nineteen cross-sectional studies that investigated 19.734 community-dwelling and institutionalized older adults free of disability and dementia were included. A high adherence to MeDi was cross-sectionally associated with better walking speed (SMD = 0.42; 95 % Confidence Interval (CI) = 0.12-0.72, P = 0.006; I² = 65 %, P = 0.06), knee muscle strength speed (SMD = 0.26; 95 % CI = 0.17-0.36, P < 0.00001; I² = 0 %, P = 0.69), global cognition (SMD = 0.24; 95 % CI = 0.15-0.33, P < 0.00001; I² = 85 %, P < 0.00001), and memory (SMD = 0.18; 95 % CI = 0.13-0.25, P < 0.00001; I² = 100 %, P < 0.00001). The association between MeDi adherence and global cognition remained significant after stratifying the analysis by the region where the study was conducted, MeDi diet adherence composite score, and Mini Mental State Examination (MMSE). Studies had a moderate to low risk of bias. In relation to longitudinal analysis, thirty-four prospective studies with an average follow-up period that varied from 3.0 to 12.6 years and investigated 98.315 community-dwellers were included. Results indicated that older adults with high MeDi scores had a lower decline in global cognition RR = 0.26; 95 % CI = 0.23-0.29, P < 0.00001; I² = 100 %, P < 0.00001). In contrast, no significant associations between MeDi and mobility, MCI, dementia were found. A low risk of bias was found in the longitudinal studies.

DISCUSSION

Findings of the present study indicated that high adherence to MeDi was cross-sectionally associated with physical performance and cognitive function. Results of the pooled analysis of longitudinal studies revealed that high adherence to MeDi reduced the risk of global cognitive decline in non-demented older adults. However, no significant associations between MeDi adherence and the incidence of mobility problems, MCI, and dementia were found. Although important, our findings should be carefully interpreted due to the presence of heterogeneity and publication bias.

Authors+Show Affiliations

School of Physical Education, University of Campinas, Av. Érico Veríssimo, 701, Cidade Universitária "Zeferino Vaz", Barão Geraldo, Campinas, SP 13083-851, Brazil. Electronic address: coelhojunior@hotmail.com.br.Hellenic Health Foundation, Athens, Greece; Professor Emeritus, School of Medicine, University of Athens, Greece. Electronic address: atrichopoulou@hhf-greece.gr.National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy. Electronic address: f_panza@hotmail.com.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

34153553

Citation

Coelho-Júnior, Hélio José, et al. "Cross-sectional and Longitudinal Associations Between Adherence to Mediterranean Diet With Physical Performance and Cognitive Function in Older Adults: a Systematic Review and Meta-analysis." Ageing Research Reviews, vol. 70, 2021, p. 101395.
Coelho-Júnior HJ, Trichopoulou A, Panza F. Cross-sectional and longitudinal associations between adherence to Mediterranean diet with physical performance and cognitive function in older adults: A systematic review and meta-analysis. Ageing Res Rev. 2021;70:101395.
Coelho-Júnior, H. J., Trichopoulou, A., & Panza, F. (2021). Cross-sectional and longitudinal associations between adherence to Mediterranean diet with physical performance and cognitive function in older adults: A systematic review and meta-analysis. Ageing Research Reviews, 70, 101395. https://doi.org/10.1016/j.arr.2021.101395
Coelho-Júnior HJ, Trichopoulou A, Panza F. Cross-sectional and Longitudinal Associations Between Adherence to Mediterranean Diet With Physical Performance and Cognitive Function in Older Adults: a Systematic Review and Meta-analysis. Ageing Res Rev. 2021;70:101395. PubMed PMID: 34153553.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cross-sectional and longitudinal associations between adherence to Mediterranean diet with physical performance and cognitive function in older adults: A systematic review and meta-analysis. AU - Coelho-Júnior,Hélio José, AU - Trichopoulou,Antonia, AU - Panza,Francesco, Y1 - 2021/06/19/ PY - 2021/04/22/received PY - 2021/06/14/revised PY - 2021/06/17/accepted PY - 2021/6/22/pubmed PY - 2021/9/11/medline PY - 2021/6/21/entrez KW - Cognition KW - Dementia KW - Dietary patterns KW - Frailty KW - Physical function KW - Sarcopenia SP - 101395 EP - 101395 JF - Ageing research reviews JO - Ageing Res Rev VL - 70 N2 - OBJECTIVES: The present study investigated the association between adherence to Mediterranean diet (MeDi) and physical performance and cognitive function in older adults. METHODS: We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated older adults aged 60+ years and assessed adherence to MeDi diet using validated composite scores. Observational studies, including cross-sectional, case-control, and longitudinal cohort studies, if crude baseline data was available, which investigated as a primary or secondary outcome the association of MeDi diet adherence with physical performance and/or cognitive function in non-demented older adults were included in the cross-sectional analysis. For the longitudinal analysis, case-control and longitudinal cohort studies that investigated the longitudinal associations between adherence to MeDi diet with the incidence of mild cognitive impairment (MCI), dementia, and/or Alzheimer's disease (AD), and/or changes in physical performance and cognition in non-demented older adults were included. Studies published in other languages than English were excluded. Studies were retrieved from MEDLINE, SCOPUS, CINAHL, and AgeLine databases until May 19, 2021. The risk of bias was evaluated using the Newcastle - Ottawa Quality Assessment Scale (NOS). A pooled effect size was calculated based on standard mean differences (SMD), log odds ratio (OR) and log risk ratio (RR). This study is registered on PROSPERO (CRD42021250254). RESULTS: Nineteen cross-sectional studies that investigated 19.734 community-dwelling and institutionalized older adults free of disability and dementia were included. A high adherence to MeDi was cross-sectionally associated with better walking speed (SMD = 0.42; 95 % Confidence Interval (CI) = 0.12-0.72, P = 0.006; I² = 65 %, P = 0.06), knee muscle strength speed (SMD = 0.26; 95 % CI = 0.17-0.36, P < 0.00001; I² = 0 %, P = 0.69), global cognition (SMD = 0.24; 95 % CI = 0.15-0.33, P < 0.00001; I² = 85 %, P < 0.00001), and memory (SMD = 0.18; 95 % CI = 0.13-0.25, P < 0.00001; I² = 100 %, P < 0.00001). The association between MeDi adherence and global cognition remained significant after stratifying the analysis by the region where the study was conducted, MeDi diet adherence composite score, and Mini Mental State Examination (MMSE). Studies had a moderate to low risk of bias. In relation to longitudinal analysis, thirty-four prospective studies with an average follow-up period that varied from 3.0 to 12.6 years and investigated 98.315 community-dwellers were included. Results indicated that older adults with high MeDi scores had a lower decline in global cognition RR = 0.26; 95 % CI = 0.23-0.29, P < 0.00001; I² = 100 %, P < 0.00001). In contrast, no significant associations between MeDi and mobility, MCI, dementia were found. A low risk of bias was found in the longitudinal studies. DISCUSSION: Findings of the present study indicated that high adherence to MeDi was cross-sectionally associated with physical performance and cognitive function. Results of the pooled analysis of longitudinal studies revealed that high adherence to MeDi reduced the risk of global cognitive decline in non-demented older adults. However, no significant associations between MeDi adherence and the incidence of mobility problems, MCI, and dementia were found. Although important, our findings should be carefully interpreted due to the presence of heterogeneity and publication bias. SN - 1872-9649 UR - https://www.unboundmedicine.com/medline/citation/34153553/Cross_sectional_and_longitudinal_associations_between_adherence_to_Mediterranean_diet_with_physical_performance_and_cognitive_function_in_older_adults:_A_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1568-1637(21)00142-2 DB - PRIME DP - Unbound Medicine ER -