Skip to main content

Dietary patterns: a novel approach to examine the link between nutrition and cognitive function in older individuals

  • B. Allès (a1) (a2) (a3) (a4), C. Samieri (a1) (a2), C. Féart (a1) (a2), M.-A. Jutand (a1) (a2), D. Laurin (a3) (a4) and P. Barberger-Gateau (a1) (a2)...

Cognitive decline may lead to dementia whose most frequent cause is Alzheimer's disease (AD). Among the many potential risk factors of cognitive decline and AD, diet raises increasing interest. Most studies considered diet in the frame of a single nutrient approach with inconsistent results. A novel approach to examine the link between nutrition and cognitive function is the use of dietary patterns. The aim of the present review was to update and complete the body of knowledge about dietary patterns in relationship with various cognitive outcomes in the elderly. Two approaches can be used: a priori and a posteriori patterns. A priori patterns are defined by the adhesion to a pre-defined healthy diet using a score such as the Mediterranean diet (MeDi) score, the Healthy Eating Index, the Canadian Healthy Eating Index, the French National Nutrition and Health Programme (Programme National Nutrition Santé) Guideline Score (PNNS-GS), the Recommended Food Score (RFS) and Dietary Approaches to Stop Hypertension (DASH). MeDi score, RFS, PNNS-GS and DASH have been associated with lower risks of cognitive impairment, cognitive decline, and dementia or AD. Principal components analysis, reduced rank regression and clustering methods allow the identification of ‘healthy’ patterns associated with lower risk of cognitive decline. However, some studies did not report any associations with cognitive outcomes and results are discordant especially regarding MeDi and the risk of dementia. Several methodological challenges should be overcome to provide a higher level of evidence supporting the development of nutritional policies to prevent cognitive decline and AD.

    • 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. 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.

      Dietary patterns: a novel approach to examine the link between nutrition and cognitive function in older individuals
      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 <service> account. Find out more about sending content to Dropbox.

      Dietary patterns: a novel approach to examine the link between nutrition and cognitive function in older individuals
      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 <service> account. Find out more about sending content to Google Drive.

      Dietary patterns: a novel approach to examine the link between nutrition and cognitive function in older individuals
      Available formats
Corresponding author
*Corresponding author: B. Allès, fax +33 5 57 57 14 86, email
Hide All
1Daviglus, ML, Bell, CC, Berrettini, W, et al. (2010) National Institutes of Health State-of-the-Science Conference statement: preventing Alzheimer disease and cognitive decline. Ann Intern Med 153, 176181.
2Daviglus, ML, Plassman, BL, Pirzada, A, et al. (2011) Risk factors and preventive interventions for Alzheimer disease: state of the science. Arch Neurol 68, 11851190.
3Plassman, BL, Williams, JW Jr, Burke, JR, et al. (2010) Systematic review: factors associated with risk for and possible prevention of cognitive decline in later life. Ann Intern Med 153, 182193.
4Filley, CM & Anderson, CA (2011) Dementia: five new things. Neurology 76, Suppl. 2, S26S30.
5Wald, DS, Kasturiratne, A & Simmonds, M (2010) Effect of folic acid, with or without other B vitamins, on cognitive decline: meta-analysis of randomized trials. Am J Med 123, 522527.
6van de Rest, O, Geleijnse, JM, Kok, FJ, et al. (2008) Effect of fish oil on cognitive performance in older subjects: a randomized, controlled trial. Neurology 71, 430438.
7Dangour, AD, Allen, E, Elbourne, D, et al. (2010) Effect of 2-y n-3 long-chain polyunsaturated fatty acid supplementation on cognitive function in older people: a randomized, double-blind, controlled trial. Am J Clin Nutr 91, 17251732.
8Jia, X, McNeill, G & Avenell, A (2008) Does taking vitamin, mineral and fatty acid supplements prevent cognitive decline? A systematic review of randomized controlled trials. J Hum Nutr Diet 21, 317336.
9Gu, Y & Scarmeas, N (2011) Dietary patterns in Alzheimer's disease and cognitive aging. Curr Alzheimer Res 8, 510519.
10Jacobs, DR, Gross, MD & Tapsell, LC (2009) Food synergy: an operational concept for understanding nutrition. Am J Clin Nutr 89, 1543S1548S.
11Jacobs, DR & Steffen, LM (2003) Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. Am J Clin Nutr 78, 508S513S.
12Jacobs, DR & Tapsell, LC (2007) Food, not nutrients, is the fundamental unit in nutrition. Nutr Rev 65, 439450.
13Trichopoulou, A, Kouris-Blazos, A, Wahlqvist, ML, et al. (1995) Diet and overall survival in elderly people. BMJ 311, 14571460.
14Huijbregts, P, Feskens, E, Räsänen, L, et al. (1997) Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and The Netherlands: longitudinal cohort study. BMJ 315, 1317.
15Kennedy, ET, Ohls, J, Carlson, S, et al. (1995) The Healthy Eating Index: design and applications. J Am Diet Assoc 95, 11031108.
16Shatenstein, B, Ferland, G, Belleville, S, et al. (2012) Diet quality and cognition among older adults from the NuAge study. Exp Gerontol 47, 353360.
17Estaquio, C, Kesse-Guyot, E, Deschamps, V, et al. (2009) Adherence to the French Programme National Nutrition Santé Guideline Score is associated with better nutrient intake and nutritional status. J Am Diet Assoc 109, 10311041.
18Kant, AK, Schatzkin, A, Graubard, BI, et al. (2000) A prospective study of diet quality and mortality in women. JAMA 283, 21092115.
19Folstein, MF, Folstein, SE & McHugh, PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12, 189198.
20Teng, EL & Chui, HC (1987) The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry 48, 314318.
21Ballard, C, Gauthier, S, Corbett, A, et al. (2011) Alzheimer's disease. Lancet 377, 10191031.
22Querfurth, HW & LaFerla, FM (2010) Alzheimer's disease. N Engl J Med 362, 329344.
23Mudher, A & Lovestone, S (2002) Alzheimer's disease – do tauists and baptists finally shake hands? Trends Neurosci 25, 2226.
24Lim, GP, Calon, F, Morihara, T, et al. (2005) A diet enriched with the omega-3 fatty acid docosahexaenoic acid reduces amyloid burden in an aged Alzheimer mouse model. J Neurosci 25, 30323040.
25Green, KN, Martinez-Coria, H, Khashwji, H, et al. (2007) Dietary docosahexaenoic acid and docosapentaenoic acid ameliorate amyloid-β and tau pathology via a mechanism involving presenilin 1 levels. J Neurosci 27, 43854395.
26Florent, S, Malaplate-Armand, C, Youssef, I, et al. (2006) Docosahexaenoic acid prevents neuronal apoptosis induced by soluble amyloid-β oligomers. J Neurochem 96, 385395.
27Boudrault, C, Bazinet, RP & Ma, DWL (2009) Experimental models and mechanisms underlying the protective effects of n-3 polyunsaturated fatty acids in Alzheimer's disease. J Nutr Biochem 20, 110.
28Lukiw, WJ, Cui, J-G, Marcheselli, VL, et al. (2005) A role for docosahexaenoic acid-derived neuroprotectin D1 in neural cell survival and Alzheimer disease. J Clin Invest 115, 27742783.
29Freund-Levi, Y, Basun, H, Cederholm, T, et al. (2008) Omega-3 supplementation in mild to moderate Alzheimer's disease: effects on neuropsychiatric symptoms. Int J Geriatr Psychiatry 23, 161169.
30Freund-Levi, Y, Hjorth, E, Lindberg, C, et al. (2009) Effects of omega-3 fatty acids on inflammatory markers in cerebrospinal fluid and plasma in Alzheimer's disease: the OmegAD study. Dement Geriatr Cogn Disord 27, 481490.
31Innis, SM (2007) Dietary (n-3) fatty acids and brain development. J Nutr 137, 855859.
32Calder, PC (2012) Mechanisms of action of (n-3) fatty acids. J Nutr 142, 592S599S.
33Devore, EE, Kang, JH, Stampfer, MJ, et al. (2010) Total antioxidant capacity of diet in relation to cognitive function and decline. Am J Clin Nutr 92, 11571164.
34Young, IS & Woodside, JV (2001) Antioxidants in health and disease. J Clin Pathol 54, 176186.
35Gillette-Guyonnet, S, Andrieu, S, Dantoine, T, et al. (2009) Commentary on “A roadmap for the prevention of dementia II. Leon Thal Symposium 2008.” The Multidomain Alzheimer Preventive Trial (MAPT): a new approach to the prevention of Alzheimer's disease. Alzheimers Dement 5, 114121.
36Annweiler, C, Schott, AM, Rolland, Y, et al. (2010) Dietary intake of vitamin D and cognition in older women: a large population-based study. Neurology 75, 18101816.
37Cunnane, SC, Plourde, M, Pifferi, F, et al. (2009) Fish, docosahexaenoic acid and Alzheimer's disease. Prog Lipid Res 48, 239256.
38Mazereeuw, G, Lanctôt, KL, Chau, SA, et al. (2012) Effects of omega-3 fatty acids on cognitive performance: a meta-analysis. Neurobiol Aging 33, 1482.e171482.e29.
39Barberger-Gateau, P, Raffaitin, C, Letenneur, L, et al. (2007) Dietary patterns and risk of dementia: the Three-City cohort study. Neurology 69, 19211930.
40Willett, WC, Sacks, F, Trichopoulou, A, et al. (1995) Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr 61, 1402S1406S.
41Sofi, F, Abbate, R, Gensini, GF, et al. (2010) Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 92, 11891196.
42Trichopoulou, 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.
43Sofi, F, Macchi, C, Abbate, R, et al. (2010) Effectiveness of the Mediterranean diet: can it help delay or prevent Alzheimer's disease? J Alzheimers Dis 20, 795801.
44Solfrizzi, V, Frisardi, V, Seripa, D, et al. (2011) Mediterranean diet in predementia and dementia syndromes. Curr Alzheimer Res 8, 520542.
45Trichopoulou, A, Orfanos, P, Norat, T, et al. (2005) Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330, 991.
46Scarmeas, N, Luchsinger, JA, Schupf, N, et al. (2009) Physical activity, diet, and risk of Alzheimer disease. JAMA 302, 627637.
47Scarmeas, N, Stern, Y, Mayeux, R, et al. (2006) Mediterranean diet, Alzheimer disease, and vascular mediation. Arch Neurol 63, 17091717.
48Scarmeas, N, Stern, Y, Mayeux, R, et al. (2009) Mediterranean diet and mild cognitive impairment. Arch Neurol 66, 216225.
49Psaltopoulou, T, Kyrozis, A, Stathopoulos, P, et al. (2008) Diet, physical activity and cognitive impairment among elders: the EPIC-Greece cohort (European Prospective Investigation into Cancer and Nutrition). Public Health Nutr 11, 10541062.
50Féart, C, Samieri, C, Rondeau, V, et al. (2009) Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA 302, 638648.
51Féart, C, Samieri, C & Barberger-Gateau, P (2010) Mediterranean diet and cognitive function in older adults. Curr Opin Clin Nutr Metab Care 13, 1418.
52Tangney, CC, Kwasny, MJ, Li, H, et al. (2011) Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. Am J Clin Nutr 93, 601607.
53Cherbuin, N & Anstey, KJ (2011) The Mediterranean diet is not related to cognitive change in a large prospective investigation: the PATH through life study. Am J Geriatr Psychiatry (epublication ahead of print version 20 September 2011).
54Barnes, DE (2011) The Mediterranean diet: good for the heart = good for the brain? Ann Neurol 69, 226228.
55Scarmeas, N, Stern, Y, Tang, M-X, et al. (2006) Mediterranean diet and risk for Alzheimer's disease. Ann Neurol 59, 912921.
56Huijbregts, 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.
57Corrêa Leite, ML, Nicolosi, A, Cristina, S, et al. (2001) Nutrition and cognitive deficit in the elderly: a population study. Eur J Clin Nutr 55, 10531058.
58Shatenstein, B, Nadon, S, Godin, C, et al. (2005) Diet quality of Montreal-area adults needs improvement: estimates from a self-administered food frequency questionnaire furnishing a dietary indicator score. J Am Diet Assoc 105, 12511260.
59Kesse-Guyot, E, Amieva, H, Castetbon, K, et al. (2011) Adherence to nutritional recommendations and subsequent cognitive performance: findings from the prospective Supplementation with Antioxidant Vitamins and Minerals 2 (SU.VI.MAX 2) study. Am J Clin Nutr 93, 200210.
60Kaluza, J, Hakansson, N, Brzozowska, A, et al. (2007) Diet quality and mortality: a population-based prospective study of men. Eur J Clin Nutr 63, 451457.
61Wengreen, HJ, Neilson, C, Munger, R, et al. (2009) Diet quality is associated with better cognitive test performance among aging men and women. J Nutr 139, 19441949.
62Román-Viñas, B, Ribas Barba, L, Ngo, J, et al. (2009) Validity of dietary patterns to assess nutrient intake adequacy. Br J Nutr 101, S12S20.
63Remig, V, Franklin, B, Margolis, S, et al. (2010) Trans fats in America: a review of their use, consumption, health implications, and regulation. J Am Diet Assoc 110, 585592.
64Monteiro, CA, Levy, RB, Claro, RM, et al. (2011) Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil. Public Health Nutr 14, 513.
65Waijers, PMCM, Feskens, EJM & Ocké, MC (2007) A critical review of predefined diet quality scores. Br J Nutr 97, 219231.
66Svetkey, LP, Sacks, FM, Obarzanek, E, et al. (1999) The DASH Diet, Sodium Intake and Blood Pressure Trial (DASH-sodium): rationale and design. DASH-Sodium Collaborative Research Group. J Am Diet Assoc 99, S96S104.
67Smith, PJ, Blumenthal, JA, Babyak, MA, et al. (2010) Effects of the Dietary Approaches to Stop Hypertension diet, exercise, and caloric restriction on neurocognition in overweight adults with high blood pressure. Hypertension 55, 13311338.
68Bayer-Carter, JL, Green, PS, Montine, TJ, et al. (2011) Diet intervention and cerebrospinal fluid biomarkers in amnestic mild cognitive impairment. Arch Neurol 68, 743752.
69Panagiotakos, D (2008) A priori versus a posterior methods in dietary pattern analysis: a review in nutrition epidemiology. Nutr Bull 33, 311315.
70Tinsley, HEA & Tinsley, DJ (1987) Uses of factor analysis in counseling psychology research. J Couns Psychol 34, 414424.
71Kleinbaum, DG, Kupper, LL & Muller, KE (1997) Applied Regression Analysis and Other Multivariable Methods, 3rd revised ed. Belmont, CA: Wadsworth Publishing Co., Inc.
72Akbaraly, TN, Archana, S-M, Marmot, MG, et al. (2009) Education attenuates the association between dietary patterns and cognition. Dement Geriatr Cogn Disord 27, 147154.
73Newby, PK, Muller, D, Hallfrisch, J, et al. (2003) Dietary patterns and changes in body mass index and waist circumference in adults. Am J Clin Nutr 77, 14171425.
74Smith, ADAC, Emmett, PM, Newby, PK, et al. (2011) A comparison of dietary patterns derived by cluster and principal components analysis in a UK cohort of children. Eur J Clin Nutr 65, 11021109.
75Samieri, C, Jutand, M-A, Féart, C, et al. (2008) Dietary patterns derived by hybrid clustering method in older people: association with cognition, mood, and self-rated health. J Am Diet Assoc 108, 14611471.
76Corrêa Leite, ML, Nicolosi, A, Cristina, S, et al. (2003) Dietary and nutritional patterns in an elderly rural population in Northern and Southern Italy: (I). A cluster analysis of food consumption. Eur J Clin Nutr 57, 15141521.
77James, DCS (2009) Cluster analysis defines distinct dietary patterns for African-American men and women. J Am Diet Assoc 109, 255262.
78Pryer, JA, Cook, A & Shetty, P (2001) Identification of groups who report similar patterns of diet among a representative national sample of British adults aged 65 years of age or more. Public Health Nutr 4, 787795.
79Pryer, JA & Rogers, S (2009) Dietary patterns among a national sample of British children aged 1 1/2–4 1/2 years. Public Health Nutr 12, 957966.
80Reedy, J, Wirfält, E, Flood, A, et al. (2010) Comparing 3 dietary pattern methods – cluster analysis, factor analysis, and index analysis – with colorectal cancer risk: The NIH-AARP Diet and Health Study. Am J Epidemiol 171, 479487.
81Hoffmann, K, Schulze, MB, Schienkiewitz, A, et al. (2004) Application of a new statistical method to derive dietary patterns in nutritional epidemiology. Am J Epidemiol 159, 935944.
82Schulze, MB, Hoffmann, K, Manson, JE, et al. (2005) Dietary pattern, inflammation, and incidence of type 2 diabetes in women. Am J Clin Nutr 82, 675684.
83DiBello, JR, Kraft, P, McGarvey, ST, et al. (2008) Comparison of 3 methods for identifying dietary patterns associated with risk of disease. Am J Epidemiol 168, 14331443.
84Drogan, D, Hoffmann, K, Schulz, M, et al. (2007) A food pattern predicting prospective weight change is associated with risk of fatal but not with nonfatal cardiovascular disease. J Nutr 137, 19611967.
85Hoffmann, K, Zyriax, B-C, Boeing, H, et al. (2004) A dietary pattern derived to explain biomarker variation is strongly associated with the risk of coronary artery disease. Am J Clin Nutr 80, 633640.
86Liu, L, Nettleton, JA, Bertoni, AG, et al. (2009) Dietary pattern, the metabolic syndrome, and left ventricular mass and systolic function: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr 90, 362368.
87McCann, SE, McCann, WE, Hong, C-C, et al. (2007) Dietary patterns related to glycemic index and load and risk of premenopausal and postmenopausal breast cancer in the Western New York Exposure and Breast Cancer Study. Am J Clin Nutr 86, 465471.
88McNaughton, SA, Mishra, GD & Brunner, EJ (2009) Food patterns associated with blood lipids are predictive of coronary heart disease: the Whitehall II study. Br J Nutr 102, 619624.
89Nettleton, JA, Steffen, LM, Schulze, MB, et al. (2007) Associations between markers of subclinical atherosclerosis and dietary patterns derived by principal components analysis and reduced rank regression in the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr 85, 16151625.
90Nöthlings, U, Murphy, SP, Wilkens, LR, et al. (2008) A food pattern that is predictive of flavonol intake and risk of pancreatic cancer. Am J Clin Nutr 88, 16531662.
91Weikert, C, Hoffmann, K, Dierkes, J, et al. (2005) A homocysteine metabolism-related dietary pattern and the risk of coronary heart disease in two independent German study populations. J Nutr 135, 19811988.
92Gu, Y, Nieves, JW, Stern, Y, et al. (2010) Food combination and Alzheimer disease risk: a protective diet. Arch Neurol 67, 699706.
93Bountziouka, V, Tzavelas, G, Polychronopoulos, E, et al. (2011) Validity of dietary patterns derived in nutrition surveys using a priori and a posteriori multivariate statistical methods. Int J Food Sci Nutr 62, 617627.
94Slattery, ML (2010) Analysis of dietary patterns in epidemiological research. Appl Physiol Nutr Metab 35, 207210.
95Bowman, GL, Shannon, J, Ho, E, et al. (2011) Reliability and validity of food frequency questionnaire and nutrient biomarkers in elders with and without mild cognitive impairment. Alzheimer Dis Assoc Disord 25, 4957.
96Debette, S, Seshadri, S, Beiser, A, et al. (2011) Midlife vascular risk factor exposure accelerates structural brain aging and cognitive decline. Neurology 77, 461468.
97Luchsinger, JA & Gustafson, DR (2009) Adiposity and Alzheimer's disease. Curr Opin Clin Nutr Metab Care 12, 1521.
98Xu, WL, Atti, AR, Gatz, M, et al. (2011) Midlife overweight and obesity increase late-life dementia risk: a population-based twin study. Neurology 76, 15681574.
99Eskelinen, MH, Ngandu, T, Tuomilehto, J, et al. (2011) Midlife healthy-diet index and late-life dementia and Alzheimer's disease. Dement Geriatr Cogn Dis Extra 1, 103112.
100Imamura, F & Jacques, PF (2011) Invited Commentary: dietary pattern analysis. Am J Epidemiol 173, 11051108.
101Kaaks, R, Riboli, E, Estève, J, et al. (1994) Estimating the accuracy of dietary questionnaire assessments: validation in terms of structural equation models. Stat Med 13, 127142.
Recommend this journal

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

Nutrition Research Reviews
  • ISSN: 0954-4224
  • EISSN: 1475-2700
  • URL: /core/journals/nutrition-research-reviews
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed