Associations of Midlife Dietary Patterns with Incident Dementia and Brain Structure: Findings from the UK Biobank Study

Background: At present, the results on the associations between dietary patterns and risk of dementia are inconsistent, and studies on the associations between dietary patterns and brain structures are limited. Objectives: We aimed to investigate the associations of midlife dietary patterns with incident dementia and brain structures. Methods: On the basis of the UK Biobank Study, we investigated the 1) prospective associations of 4 healthy dietary pattern indices [healthy plant-based diet index (hPDI), Mediterranean diet score (MDS), recommended food score (RFS), and Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND)] with incident dementia (identified using linked hospital data; N = 114,684; mean age, 56.8 y; 55.5% females) using Cox proportional-hazards regressions and the 2) cross-sectional associations of these dietary pattern indices with brain structures (estimated using magnetic resonance imaging; N = 18,214; mean age, 55.9 y; 53.1% females) using linear regressions. A series of covariates were adjusted, and several sensitivity analyses were conducted. Results: A total of 481 (0.42%) participants developed dementia during the average 9.4-y follow-up. Although the associations were not statistically significant, all dietary patterns exerted protective effects against incident dementia (all HRs < 1). Furthermore, higher dietary pattern indices were significantly associated with larger regional brain volumes, including volumes of gray matter in the parietal and temporal cortices and volumes of the hippocampus and thalamus. The main results were confirmed via sensitivity analyses. Conclusions: Greater adherence to hPDI, MDS, RFS, and MIND was individually associated with larger brain volumes in specific regions. This study shows a comprehensive picture of the consistent associations of midlife dietary patterns with risk of dementia and brain health, underscoring the potential benefits of a healthy diet in the prevention of dementia.