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.2019 Aug;42(8):1372-1379.
doi: 10.2337/dc19-0130. Epub 2019 May 23.

The Mediterranean Diet and 2-Year Change in Cognitive Function by Status of Type 2 Diabetes and Glycemic Control

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The Mediterranean Diet and 2-Year Change in Cognitive Function by Status of Type 2 Diabetes and Glycemic Control

Josiemer Mattei et al. Diabetes Care.2019 Aug.

Abstract

Objective: To determine associations of a Mediterranean diet score (MeDS) with 2-year change in cognitive function by type 2 diabetes and glycemic control status and contrast it against other diet quality scores.

Research design and methods: We used data from the longitudinal Boston Puerto Rican Health Study (n = 913; 42.6% with type 2 diabetes at 2 years). Glycemic control at baseline was categorized as uncontrolled (hemoglobin A1c ≥7% [53 mmol/mol]) versus controlled. Two-year change in glycemic control was defined as stable/improved versus poor/declined. We defined MeDS, Healthy Eating Index, Alternate Healthy Eating Index, and Dietary Approaches to Stop Hypertension scores. Adjusted mixed linear models assessed 2-year change in global cognitive functionz score, executive and memory function, and nine individual cognitive tests.

Results: Higher MeDS, but no other diet quality score, was associated with higher 2-year change in global cognitive function in adults with type 2 diabetes (β ± SE = 0.027 ± 0.011;P = 0.016) but not in those without (P = 0.80). Similar results were noted for Mini-Mental State Examination, word recognition, digit span, and clock drawing tests. Results remained consistent for individuals under glycemic control at baseline (0.062 ± 0.020;P = 0.004) and stable/improved over 2 years (0.053 ± 0.019;P = 0.007), but not for individuals with uncontrolled or poor/declined glycemic control. All diet quality scores were associated with higher 2-year memory function in adults without type 2 diabetes.

Conclusions: Both adhering to a Mediterranean diet and effectively managing type 2 diabetes may support optimal cognitive function. Healthy diets, in general, can help improve memory function among adults without type 2 diabetes.

© 2019 by the American Diabetes Association.

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Figures

Figure 1
Figure 1
β-Coefficients for association of baseline MeDS and 2-year change in cognitive function for Puerto Rican adults with vs. without type 2 diabetes. Repeated-measures linear mixed-effects models predicting 2-year change in each cognitive function test by continuous MeDS were adjusted for sex, age, marital status, income-to-poverty ratio, educational attainment, food security status, smoking status, psychological acculturation, physical activity score, depressive symptomatology score, hypertension status, homocysteine, CRP, BMI, baseline value, and time. Results for participants without type 2 diabetes (n = 557) (A) and for participants with type 2 diabetes (n = 356) (B), defined as having fasting plasma glucose ≥126 mg/dL (7.0 mmol/L) or self-reported use of diabetes medication (including insulin). The MeDS was assessed based on adherence to nine foods or nutrients using sex-specific population-based median cutoffs; score ranges 0–9, with a higher score indicative of better diet quality. Global cognitive function score was calculated by averaging thez scores for each of the 10 cognitive scores. Cognitive function factors were derived through principal components analysis that identified “executive” and “memory” functions. a, significant change from baseline atP < 0.05.
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