Skip to main content

Cognitive performance among the elderly in relation to the intake of plant foods. The Hordaland Health Study

  • Eha Nurk (a1) (a2), Helga Refsum (a1) (a3), Christian A. Drevon (a1), Grethe S. Tell (a4), Harald A. Nygaard (a4) (a5), Knut Engedal (a6) and A. David Smith (a3)...

Fruits and vegetables are among the most nutritious and healthy of foods, and are related to the prevention of many chronic diseases. The aim of the study was to examine the relationship between intake of different plant foods and cognitive performance in elderly individuals in a cross-sectional study. Two thousand and thirty-one elderly subjects (aged 70–74 years; 55 % women) recruited from the general population in Western Norway underwent extensive cognitive testing and completed a comprehensive FFQ. The cognitive test battery covered several domains (Kendrick Object Learning Test, Trail Making Test – part A, modified versions of the Digit Symbol Test, Block Design, Mini-Mental State Examination and Controlled Oral Word Association Test). A validated and self-reported FFQ was used to assess habitual food intake. Subjects with intakes of>10th percentile of fruits, vegetables, grain products and mushrooms performed significantly better in cognitive tests than those with very low or no intake. The associations were strongest between cognition and the combined intake of fruits and vegetables, with a marked dose-dependent relationship up to about 500 g/d. The dose-related increase of intakes of grain products and potatoes reached a plateau at about 100–150 g/d, levelling off or decreasing thereafter, whereas the associations were linear for mushrooms. For individual plant foods, the positive cognitive associations of carrots, cruciferous vegetables, citrus fruits and high-fibre bread were most pronounced. The only negative cognitive association was with increased intake of white bread. In the elderly, a diet rich in plant foods is associated with better performance in several cognitive abilities in a dose-dependent manner.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Cognitive performance among the elderly in relation to the intake of plant foods. The Hordaland Health Study
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Cognitive performance among the elderly in relation to the intake of plant foods. The Hordaland Health Study
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Cognitive performance among the elderly in relation to the intake of plant foods. The Hordaland Health Study
      Available formats
Corresponding author
*Corresponding author: Professor A. David Smith, fax +44 1865 272420, email
Hide All
1 Key TJ, Thorogood M, Appleby PN, et al. (1996) Dietary habits and mortality in 11 000 vegetarians and health conscious people: results of a 17 year follow up. BMJ 313, 775779.
2 Steinmetz KA & Potter JD (1996) Vegetables, fruit, and cancer prevention: a review. J Am Diet Assoc 96, 10271039.
3 Dauchet L, Amouyel P & Dallongeville J (2005) Fruit and vegetable consumption and risk of stroke: a meta-analysis of cohort studies. Neurology 65, 11931197.
4 He FJ, Nowson CA & MacGregor GA (2006) Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet 367, 320326.
5 He FJ, Nowson CA, Lucas M, et al. (2007) Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies. J Hum Hypertens 21, 717728.
6 Lock K, Pomerleau J, Causer L, et al. (2005) The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet. Bull World Health Organ 83, 100108.
7 Knekt P, Kumpulainen J, Järvinen R, et al. (2002) Flavonoid intake and risk of chronic diseases. Am J Clin Nutr 76, 560568.
8 McKeever TM & Britton J (2004) Diet and asthma. Am J Respir Crit Care Med 170, 725729.
9 Arts ICW & Hollman PCH (2005) Polyphenols and disease risk in epidemiologic studies. Am J Clin Nutr 81, 317S325S.
10 Nestle M (1999) Animal v. plant foods in human diets and health: is the historical record unequivocal? Proc Nutr Soc 58, 211218.
11 Weisburger JH (2002) Lifestyle, health and disease prevention: the underlying mechanisms. Eur J Cancer Prev 11, Suppl. 2, S1S7.
12 Kang JH, Ascherio A & Grodstein F (2005) Fruit and vegetable consumption and cognitive decline in aging women. Ann Neurol 57, 713720.
13 Joseph JA, Shukitt-Hale B & Lau FC (2007) Fruit polyphenols and their effects on neuronal signaling and behavior in senescence. Ann N Y Acad Sci 1100, 470485.
14 Knopman DS (2009) Mediterranean diet and late-life cognitive impairment: a taste of benefit. JAMA 302, 686687.
15 Galli RL, Shukitt-Hale B, Youdim KA, et al. (2002) Fruit polyphenolics and brain aging: nutritional interventions targeting age-related neuronal and behavioral deficits. Ann N Y Acad Sci 959, 128132.
16 Ortega RM, Requejo AM, Andres P, et al. (1997) Dietary intake and cognitive function in a group of elderly people. Am J Clin Nutr 66, 803809.
17 Huijbregts PP, Feskens EJ, Räsänen L, et al. (1998) Dietary patterns and cognitive function in elderly men in Finland, Italy and The Netherlands. Eur J Clin Nutr 52, 826831.
18 Lee L, Kang SA, Lee HO, et al. (2001) Relationships between dietary intake and cognitive function level in Korean elderly people. Public Health 115, 133138.
19 Polidori MC, Pratico D, Mangialasche F, et al. (2009) High fruit and vegetable intake is positively correlated with antioxidant status and cognitive performance in healthy subjects. J Alzheimers Dis 17, 921927.
20 Sabia S, Nabi H, Kivimaki M, et al. (2009) Health behaviors from early to late midlife as predictors of cognitive function: The Whitehall II study. Am J Epidemiol 170, 428437.
21 Morris MC, Evans DA, Tangney CC, et al. (2006) Associations of vegetable and fruit consumption with age-related cognitive change. Neurology 67, 13701376.
22 Hughes TF, Andel R, Small BJ, et al. (2010) Midlife fruit and vegetable consumption and risk of dementia in later life in Swedish twins. Am J Geriatr Psychiatry 18, 413420.
23 Refsum H, Nurk E, Smith AD, et al. (2006) The Hordaland Homocysteine Study: a community-based study of homocysteine, its determinants, and associations with disease. J Nutr 136, Suppl. 6, 1731S1740S.
24 Hordaland Health Study '97-'99 (HUSK) (2008) Recruitment into the Cognitive Sub-study of the Hordaland Homocysteine Study. (accessed 14 October 2008).
25 Bjartveit K, Foss OP, Gjervig T, et al. (1979) The cardiovascular disease study in Norwegian counties: background and organization. Acta Med Scand 634, Suppl., 170.
26 Nurk E, Drevon CA, Refsum H, et al. (2007) Cognitive performance among the elderly and dietary fish intake: the Hordaland Health Study. Am J Clin Nutr 86, 14701478.
27 Kendrick DC (1985) Kendrick Cognitive Tests for the Elderly. Windsor, UK: The NFER-NELSON Publishing Company Ltd.
28 Reitan RM (1958) Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills 8, 271276.
29 Wechsler D (1981) Wechsler Adult Intelligence Scale-Revised. New York, NY: The Psychological Corporation.
30 Folstein MF, Folstein SE & McHugh PR (1975) ‘Mini-mental state’. A practical method for grading the cognitive state of patients for clinician. J Psychiatr Res 12, 189198.
31 Benton A & Hamsher K (1989) Multilingual Aphasia Examination. Iowa City, IA: AJA Associates.
32 Andersen LF, Solvoll K & Drevon CA (1996) Very-long-chain n-3 fatty acids as biomarkers for intake of fish and n-3 fatty acid concentrates. Am J Clin Nutr 64, 305311.
33 Nes M, Andersen LF, Solvoll K, et al. (1992) Accuracy of a quantitative food frequency questionnaire applied in elderly Norwegian women. Eur J Clin Nutr 46, 809821.
34 Nurk E, Tell GS, Vollset SE, et al. (2002) Plasma total homocysteine and hospitalizations for cardiovascular disease: the Hordaland Homocysteine Study. Arch Intern Med 162, 13741381.
35 Fiskerstrand T, Refsum H, Kvalheim G, et al. (1993) Homocysteine and other thiols in plasma and urine: automated determination and sample stability. Clin Chem 39, 263271.
36 Molloy AM & Scott JM (1997) Microbiological assay for serum, plasma, and red cell folate using cryopreserved, microtiter plate method. Methods Enzymol 281, 4353.
37 Zigmond AS & Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67, 361370.
38 Bjelland I, Dahl AA, Haug TT, et al. (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52, 6977.
39 Grant WB (1999) Dietary links to Alzheimer's disease: 1999 update. J Alzheimers Dis 1, 197201.
40 Smith AP, Clark R & Gallagher J (1999) Breakfast cereal and caffeinated coffee: effects on working memory, attention, mood, and cardiovascular function. Physiol Behav 67, 917.
41 Rahman A, Baker P, Allman RM, et al. (2007) Dietary factors and cognitive impairment in community-dwelling elderly. J Nutr Health Aging 11, 4954.
42 Jacobs DR Jr, Meyer HE & Solvoll K (2001) Reduced mortality among whole grain bread eaters in men and women in the Norwegian County Study. Eur J Clin Nutr 55, 137143.
43 Prättälä R, Helasoja V & Mykkänen H (2001) The consumption of rye bread and white bread as dimensions of health lifestyles in Finland. Public Health Nutr 4, 813819.
44 Abu-Saad K, Shai I, Kaufman-Shriqui V, et al. (2009) Bread type intake is associated with lifestyle and diet quality transition among Bedouin Arab adults. Br J Nutr 102, 15131522.
45 Mori K, Inatomi S, Ouchi K, et al. (2009) Improving effects of the mushroom Yamabushitake (Hericium erinaceus) on mild cognitive impairment: a double-blind placebo-controlled clinical trial. Phytother Res 23, 367372.
46 Kris-Etherton PM, Hu FB, Ros E, et al. (2008) The role of tree nuts and peanuts in the prevention of coronary heart disease: multiple potential mechanisms. J Nutr 138, 1746S1751S.
47 Ovesen LF (2005) Øget indtag af grøntsager og frugt nedsœtter risikoen for iskœmisk hjertesygdom (Increased consumption of fruits and vegetables reduces the risk of ischemic heart disease). Ugeskr Laeger 167, 27422747.
48 Trichopoulou A, Costacou T, Bamia C, et al. (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348, 25992608.
49 Smith AD (2008) The worldwide challenge of the dementias: a role for B vitamins and homocysteine? Food Nutr Bull 29, Suppl. 2, S143S172.
50 Pratico D (2008) Evidence of oxidative stress in Alzheimer's disease brain and antioxidant therapy: lights and shadows. Ann N Y Acad Sci 1147, 7078.
51 Nurk E, Refsum H, Drevon CA, et al. (2009) Intake of flavonoid-rich wine, tea, and chocolate by elderly men and women is associated with better cognitive test performance. J Nutr 139, 120127.
52 Brevik A, Vollset SE, Tell GS, et al. (2005) Plasma concentration of folate as a biomarker for the intake of fruit and vegetables: the Hordaland Homocysteine Study. Am J Clin Nutr 81, 434439.
53 Lee Y, Kim J & Back JH (2009) The influence of multiple lifestyle behaviors on cognitive function in older persons living in the community. Prev Med 48, 8690.
54 Burns A & Iliffe S (2009) Alzheimer's disease. BMJ 338, b158.
55 Nurk E, Refsum H, Tell GS, et al. (2005) Plasma total homocysteine and memory in the elderly: the Hordaland Homocysteine Study. Ann Neurol 58, 847857.
56 Launer LJ (2005) The epidemiologic study of dementia: a life-long quest? Neurobiol Aging 26, 335340.
57 Whalley LJ, Dick FD & McNeill G (2006) A life-course approach to the aetiology of late-onset dementias. Lancet Neurol 5, 8796.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary Materials

Nurk supplementary material
Supplementary tabel S1

 PDF (38 KB)
38 KB


Altmetric attention score

Full text views

Total number of HTML views: 49
Total number of PDF views: 254 *
Loading metrics...

Abstract views

Total abstract views: 388 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd November 2017. This data will be updated every 24 hours.