超加工食品消费与不良脑健康结局之间的关联。
Associations Between Ultra-Processed Food Consumption and Adverse Brain Health Outcomes.
作者信息
Bhave Varun M, Oladele Carol R, Ament Zsuzsanna, Kijpaisalratana Naruchorn, Jones Alana C, Couch Catharine A, Patki Amit, Garcia Guarniz Ana-Lucia, Bennett Aleena, Crowe Michael, Irvin Marguerite R, Kimberly W Taylor
机构信息
From the Harvard Medical School (V.M.B., W.T.K.), Boston, MA; Equity Research and Innovation Center (C.R.O.), Yale School of Medicine, New Haven, CT; Center for Genomic Medicine (Z.A., N.K., W.T.K.) and Department of Neurology (Z.A., N.K., A.-L.G.G., W.T.K.), Massachusetts General Hospital, Boston; Division of Neurology (N.K.), Department of Medicine and Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Departments of Epidemiology (A.C.J., C.A.C., A.P., M.R.I.) and Biostatistics (A.B.), School of Public Health, and Department of Psychology (M.C.), University of Alabama at Birmingham.
出版信息
Neurology. 2024 Jun 11;102(11):e209432. doi: 10.1212/WNL.0000000000209432. Epub 2024 May 22.
BACKGROUND AND OBJECTIVES
Ultra-processed foods (UPFs) are linked to cardiometabolic diseases and neurologic outcomes, such as cognitive decline and stroke. However, it is unclear whether food processing confers neurologic risk independent of dietary pattern information. We aimed to (1) investigate associations between UPFs and incident cognitive impairment and stroke and (2) compare these associations with other commonly recommended dietary patterns in the REasons for Geographic and Racial Differences in Stroke study. This prospective, observational cohort study enrolled Black and White adults in the United States from 2003 to 2007.
METHODS
The NOVA system was used to categorize items from a baseline food frequency questionnaire according to the level of processing. Participants with incomplete or implausible self-reported dietary data were excluded. Consumption for each category (grams) was normalized to total grams consumed. Scores quantifying adherence to a Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet were also calculated. Incident cognitive impairment was defined using performance relative to a normative sample on memory and fluency assessments. Incident stroke was identified through adjudicated review of medical records.
RESULTS
The cognitive impairment cohort (n = 14,175) included participants without evidence of impairment at baseline who underwent follow-up testing. The stroke cohort (n = 20,243) included participants without a history of stroke. In multivariable Cox proportional hazards models, a 10% increase in relative intake of UPFs was associated with higher risk of cognitive impairment (hazard ratio [HR] = 1.16, 95% CI 1.09-1.24, = 1.01 × 10) and intake of unprocessed or minimally processed foods with lower risk of cognitive impairment (HR = 0.88, 95% CI 0.83-0.94, = 1.83 × 10). Greater intake of UPFs (HR = 1.08, 95% CI 1.02-1.14, = 1.12 × 10) and unprocessed or minimally processed foods (HR = 0.91, 95% CI 0.86-0.95, = 2.13 × 10) were also associated with risk of stroke in multivariable Cox models. The effect of UPFs on stroke risk was greater among Black than White participants (UPF-by-race interaction HR = 1.15, 95% CI 1.03-1.29, = 1.50 × 10). Associations between UPFs and both cognitive impairment and stroke were independent of adherence to the Mediterranean, DASH, and MIND diets.
DISCUSSION
Food processing may be important to brain health in older adults independent of known risk factors and adherence to recommended dietary patterns.
背景与目的
超加工食品（UPF）与心血管代谢疾病及神经学结局相关，如认知衰退和中风。然而，尚不清楚食品加工是否会带来独立于饮食模式信息之外的神经学风险。我们旨在：（1）研究超加工食品与新发认知障碍及中风之间的关联；（2）在“中风地理和种族差异原因”（REGARDS）研究中，将这些关联与其他常用的推荐饮食模式进行比较。这项前瞻性观察队列研究于2003年至2007年在美国招募了黑人和白人成年人。
方法
使用NOVA系统根据加工水平对基线食物频率问卷中的项目进行分类。排除自我报告饮食数据不完整或不可信的参与者。将每个类别（克）的摄入量标准化为总摄入量克数。还计算了量化对地中海饮食、得舒饮食（DASH）以及地中海-得舒神经退行性延迟干预饮食（MIND）的依从性得分。新发认知障碍通过在记忆和流畅性评估中相对于正常样本的表现来定义。通过对医疗记录的裁定性审查确定新发中风。
结果
认知障碍队列（n = 14,175）包括基线时无损伤证据且接受随访测试的参与者。中风队列（n = 20,243）包括无中风病史的参与者。在多变量Cox比例风险模型中，超加工食品相对摄入量增加10%与认知障碍风险升高相关（风险比[HR]=1.16，95%置信区间1.09 - 1.24，P = 1.01×10⁻⁴），而未加工或最低加工食品的摄入与认知障碍风险降低相关（HR = 0.88，95%置信区间0.83 - 0.94，P = 1.83×10⁻⁵）。在多变量Cox模型中，超加工食品摄入量增加（HR = 1.08，95%置信区间1.02 - 1.14，P = 1.12×10⁻³）以及未加工或最低加工食品摄入量增加（HR = 0.91，95%置信区间0.86 - 0.95，P = 2.13×10⁻⁴）也与中风风险相关。超加工食品对中风风险的影响在黑人参与者中比白人参与者更大（超加工食品与种族交互作用HR = 1.15，95%置信区间1.03 - 1.29，P = 1.50×10⁻³）。超加工食品与认知障碍和中风之间的关联独立于对地中海饮食、得舒饮食和MIND饮食的依从性。
讨论
食品加工可能对老年人的大脑健康很重要，独立于已知风险因素以及对推荐饮食模式的依从性。
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