the mind diet & brain health · purpose: to study the correlations between the mind diet,...

The MIND Diet & Brain HealthJessica Goble

Outline

● Overview of the MIND diet● Study 1: The MIND diet and Alzheimer’s disease● Study 2: The MIND diet and psychological disorders● Study 3: The MIND diet and cognitive decline after stroke● Compare and contrast these studies● Conclusions based on this research● Implications for RD practice

Objectives

● Understand the components of the MIND diet in comparison to the Mediterranean and DASH diets

● Review three different research articles on the MIND diet as it relates to brain and mental health

● Make conclusions about the effectiveness of the MIND diet and potential implications of its use in RD practice

What is the MIND Diet?

MIND = Mediterranean-DASH Intervention for Neurodegenerative Delay

15 components make up the MIND diet:

2,5

General Guidelines

Daily: 3 servings of whole grains, a salad, one other vegetable, and 1 glass of wine

Most days: Nuts as a snack and beans

Weekly: At least 2 servings of poultry and berries and at least 1 serving of fish

Limits: Items in the “unhealthy” list, specifically 1 tbsp butter/margarine per day, and less than 1 serving per week each for cheese, fried food, and fast food

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MIND Diet

● Does not specify high fruit consumption

● Does not specify high potato consumption

● Does not specify high dairy consumption

● Not high in fish consumption

Mediterranean Diet DASH Diet

● Specifies 3-4 servings of fruit per day

● Specifies 2 servings of potatoes per day

● Specifies 6 or more servings of fish meals per week

● Specifies 3-4 servings of fruit per day

● Specifies 2 or more servings of low-fat dairy per day

Comparison to the Mediterranean and DASH diets

5

MIND Diet Associated with Reduced Risk of Alzheimer’s Disease

Study #1

Morris, M. C., Tangney, C. C., Wang, Y., Sacks, F. M., Bennett, D. A., & Aggarwal, N. T. (2015). MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimer’s & Dementia, 11(9), 1007–1014. doi: 10.1016/j.jalz.2014.11.009

About the Study

Prospective observational study

Purpose: To study the correlations between the MIND diet, Mediterranean diet, and DASH diet and Alzheimer’s disease.

1,306 participants from the Rush Memory and Aging Project entered the study. They were invited to completed annual food frequency questionnaires and annual neuropsychological assessments for this study.

No intervention was used.

Study #1

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Dietary Evaluation

● Modified Harvard semi-quantitative food frequency questionnaire (FFQ)○ Validated for use with these older participants

● Participants had to report the usual frequency of consumption of 144 food items over the past 12 months

● Participants were then given a score for each of the three diets

7

Study #1

DASH Components MAX score

Mediterranean Diet Components

MAX score

MIND Components MAX score

Total Grains ≥ 7/d 1 Non-refined Grains > 4/d 5 Whole Grains ≥ 3/d 1

Vegetables ≥ 4/d 1 Vegetables > 4/d 5 Green Leafy ≥ 6/wk 1

Fruits ≥ 4/d 1 Potatoes > 2/d 5 Other Vegetables ≥ 1/d 1

Dairy ≥ 2/d 1 Fruits > 3/d 5 Berries ≥ 2/wk 1

Meat, Poultry, & Fish 1 Full-Fat Dairy ≤ 10/wk 5 Red Meats and Products < 4/wk 1

Nuts, Seeds, & Legumes ≥ 4/wk 1 Red Meat ≤ 1/wk 5 Fish ≥ 1/wk 1

Total Fat ≤ 27% of kcal 1 Fish > 6/wk 5 Poultry ≥ 2/wk 1

Saturated Fat ≤ 6% of kcal 1 Poultry ≤ 3/wk 5 Beans > 3/wk 1

Sweets ≤ 5/wk 1 Legumes, Nuts, & Beans > 6/wk 5 Nuts ≥ 5/wk 1

Sodium ≤ 2400 mg/d 1 Olive oil ≥ 1/d 5 Fast/Fried Food < 1/wk 1

Alcohol <300 mL/d but >0 5 Olive oil is primary oil 1

Butter, Margarine < 1 T/d 1

Cheese < 1/wk 1

Pastries/sweets < 5/wk 1

Alcohol/Wine 1/d 1

TOTAL DASH Score 10 TOTAL MedDiet Score 55 TOTAL MIND Score 15

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Cognitive Evaluation and Other Variables

● Cognitive evaluation● Alzheimer’s diagnosis

○ National Institute of Neurological and Communicative Disorders and Stroke

○ Alzheimer’s Disease and Related Disorders Association.

● Non-dietary variables were also obtained for use in analyses○ APOE-genotype

6,7

Study #1

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MODEL Tertile 1 Tertile 2 Tertile 3 P for Linear Trend

MIND DIET SCORE

Score Range 2.5-6.5 7-8 8.5-12.5

Age-adjusted 1.0 (ref) 0.64 0.48 0.003

Basic Adjusted 1.0 (ref) 0.75 0.47 0.002

Basic + Condition Adjusted

1.0 (ref) 0.65 0.47 0.0006

DASH DIET SCORE

Score Range 1.0-3.5 4.0-4.5 5.0-8.5

Age-adjusted 1.0 (ref) 0.98 0.60 0.06



1.0 (ref) 0.98 0.61 0.07

MEDITERRANEAN DIET SCORE

Score Range 18-29 30-34 35-46

Age-adjusted 1.0 (ref) 0.81 0.49 0.01



1.0 (ref) 0.81 0.46 0.006

Conclusions

● Provides evidence that even a mild to moderate adherence to the overall MIND diet pattern may protect against the development of Alzheimer’s disease

● These results were also observed in previous studies between the MIND diet and cognitive decline

● Higher DASH diet scores had a lower protective association● The Mediterranean diet has had a protective association in

some, but not all studies

7

Study #1

Strengths and Limitations

Strengths:● Study design minimizes selection bias● Diagnosis was based on annual testing

and structured evaluations and blinding was used

● Diet pattern scores were based on a comprehensive food frequency questionnaire, validated for use

Study #1

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Limitations:● Study design cannot determine a

causal relationship● Reliance on limited information from

the food frequency questionnaire● Relatively short average period from

initial diet assessment to disease onset

Adherence to the MIND diet and the prevalence of psychological disorders in adults

Study #2

Salari-Moghaddam, A., Keshteli, A. H., Mousavi, S. M., Afshar, H., Esmaillzadeh, A., & Adibi, P. (2019). Adherence to the MIND diet and prevalence of psychological disorders in adults. Journal of Affective Disorders, 256, 96–102. doi: 10.1016/j.jad.2019.05.056

About the Study

Cross-sectional observational study

Purpose: To examine the association between adherence to the MIND diet and psychological disorders.

This Iranian study used 3,176 participants from the Study on the Epidemiology of Psychological, Alimentary Health and Nutrition (SEPAHAN) project. The participants were asked to complete demographic and medical history questionnaires, food frequency questionnaires, and psychological assessments for this study.

No intervention or blinding was used.

Study #2

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Dietary Evaluation

● Willett-format dish-based semi-quantitative food frequency questionnaire○ Validated for use with Iranian adults

● Participants had to report their intakes of 106 foods and mixed dishes based on 6 to 9 multiple choice responses varying from “never or less than once per month” to “12 or more times per day”.

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Study #2

MIND Diet Score

● This study’s MIND diet score was based on the 15 dietary components minus olive oil and wine due to a lack of information

● Participants were classified into three tertiles based on brain healthy foods and unhealthy foods

● The total MIND diet score was calculated by adding the scores for each component

Study #2

10

Psychological Evaluation and Other Variables● Psychological Evaluation

○ Hospital Anxiety and Depression Scale (HADS)○ General Health Questionnaire (GHQ)

■ Iranian validated versions of both

● Non-dietary variables were also obtained for use in analyses

10

Study #2

10

Quartiles of the MIND diet score

Q1 Q2 Q3 Q4

MENDepression - Non-adjusted 1.00 (ref) 1.42 0.96 0.85

Model 1 1.00 (ref) 1.52 0.99 0.95

Model 2 1.00 (ref) 1.44 1.11 0.98

Model 3 or Fully Adjusted 1.00 (ref) 1.28 1.11 0.92 (0.58-1.47)

Anxiety - Non-adjusted 1.00 (ref) 1.24 0.42 0.50

Model 1 1.00 (ref) 1.69 0.36 0.63

Model 2 1.00 (ref) 1.53 0.35 0.63


Psychological Distress - Non-adjusted 1.00 (ref) 0.80 0.58 0.76

Model 1 1.00 (ref) 0.87 0.50 0.74

Model 2 1.00 (ref) 0.77 0.52 0.76


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Quartiles of the MIND diet score

Q1 Q2 Q3 Q4

WOMENDepression - Non-adjusted 1.00 (ref) 1.16 0.89 0.64

Model 1 1.00 (ref) 1.17 0.89 0.65

Model 2 1.00 (ref) 1.20 0.90 0.64


Anxiety - Non-adjusted 1.00 (ref) 1.09 0.89 0.75

Model 1 1.00 (ref) 1.10 0.89 0.74

Model 2 1.00 (ref) 1.17 0.96 0.83


Psychological Distress - Non-adjusted 1.00 (ref) 0.99 0.83 0.65

Model 1 1.00 (ref) 1.04 0.87 0.67

Model 2 1.00 (ref) 1.13 0.89 0.69


Conclusions

● Adherence to the MIND diet was significantly associated with a lower chance of depression and psychological distress, but not with anxiety in the whole population

● Due to a lack of studies on the MIND diet and anxiety, these findings need to be reproduced in other populations to come to a solid conclusion

Study #2

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Strengths:● One of the first studies of its kind● Large sample size● Control of confounding variables

Study #2

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causal relationship● This data only represents the

initial step in identifying this relationship

● No data on menopausal status, olive oil, and wine

Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diet Slows Cognitive Decline After Stroke

Study #3

Cherian, L., Wang, Y., Fakuda, K., Leurgans, S., Aggarwal N., & Morris M. (2019). Mediterranean-Dash Intervention for Neurodegenerative Delay (MIND) Diet Slows Cognitive Decline After Stroke. The Journal of Prevention of Alzheimer's Disease, 6, 267–273. Doi: 10.14283/jpad.2019.28

About the StudyCommunity cohort observational study

Purpose: To determine if the MIND diet is effective in preventing cognitive decline after stroke.

Data on 106 participants from the Rush Memory and Aging Project was used. The participants were invited to complete annual food frequency questionnaires and annual neuropsychological assessments.

No intervention was used.

Study #3

2

Dietary Evaluation

● Modified Harvard semi-quantitative food frequency questionnaire (FFQ)○ Validated for use with these older participants

● Participants had to report the usual frequency of consumption of 144 food items over the past 12 months

● Participants were then given a score for each of the three diets

2

Study #3

DASH Components MAX score

Mediterranean Diet Components

MAX score

MIND Components MAX score

Total Grains ≥ 7/d 1 Non-refined Grains > 4/d 5 Whole Grains ≥ 3/d 1

Vegetables ≥ 4/d 1 Vegetables > 4/d 5 Green Leafy ≥ 6/wk 1

Fruits ≥ 4/d 1 Potatoes > 2/d 5 Other Vegetables ≥ 1/d 1

Dairy ≥ 2/d 1 Fruits > 3/d 5 Berries ≥ 2/wk 1

Meat, Poultry, & Fish 1 Full-Fat Dairy ≤ 10/wk 5 Red Meats and Products < 4/wk 1

Nuts, Seeds, & Legumes ≥ 4/wk 1 Red Meat ≤ 1/wk 5 Fish ≥ 1/wk 1

Total Fat ≤ 27% of kcal 1 Fish > 6/wk 5 Poultry ≥ 2/wk 1

Saturated Fat ≤ 6% of kcal 1 Poultry ≤ 3/wk 5 Beans > 3/wk 1

Sweets ≤ 5/wk 1 Legumes, Nuts, & Beans > 6/wk 5 Nuts ≥ 5/wk 1

Sodium ≤ 2400 mg/d 1 Olive oil ≥ 1/d 5 Fast/Fried Food < 1/wk 1

Alcohol <300 mL/d but >0 5 Olive oil is primary oil 1

Butter, Margarine < 1 T/d 1

Cheese < 1/wk 1

Pastries/sweets < 5/wk 1

Alcohol/Wine 1/d 1

TOTAL DASH Score 10 TOTAL MedDiet Score 55 TOTAL MIND Score 15

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Cognitive Evaluation and Other Variables● Cognitive evaluation● 5 domains: episodic memory, semantic memory, working

memory, visuospatial memory, and perceptual speed● Global cognitive function

● Non-dietary variables were also obtained for use in analyses

2,3,9

Study #3

2

Domains: Global Cognition Episodic Memory Semantic Memory

Working Memory Visuospatial Memory

Perceptual Speed

MIND diet

Tertile 1 Ref Ref Ref Ref Ref Ref

Tertile 2 0.058 0.025 0.030 0.023 0.062 0.047

Tertile 3 0.083 0.041 0.070 0.033 0.061 0.071

Linear p-value 0.034 0.300 0.043 0.386 0.129 0.059

Med diet


Tertile 2 0.039 -0.004 0.032 0.013 0.015 -0.034

Tertile 3 0.062 0.028 0.065 0.034 0.062 0.041

Linear p-value 0.113 0.551 0.070 0.341 0.072 0.392

DASH diet


Tertile 2 0.017 0.022 0.055 0.0048 0.028 -0.00057

Tertile 3 0.043 0.036 0.052 0.030 0.031 0.027

Linear p-value 0.263 0.367 0.123 0.377 0.359 0.462

Conclusions

● The MIND diet significantly slows the rate of decline in global cognition, semantic memory, and perceptual speed after stroke

● The Mediterranean and DASH diets were not associated with slowing cognitive decline after stroke

● This study suggests that the estimated effect on stroke survivors was double of that observed in the overall MAP cohort

● Further studies are necessary to explore the role of the MIND diet in preventing cognitive decline in stroke survivors

Study #3

2


Study #3

2

Strengths:● Use of validated food frequency

questionnaires● Measurement of cognitive change with

a large number of standardized tests● Statistical control of confounding

factors


causal relationship● Small sample size● History of stroke was determined by

self-report or by diagnosis during neurologic exams

● Findings cannot be generalized to other populations

● Reliance on limited information from the food frequency questionnaire

Comparison of Research

● These three studies all found that adherence to the MIND diet is beneficial to brain health○ Other research articles

● Strengths and Limitations of these research articles

● Studies were all completed within the past 5 years

1,2,4,7,8,10

Implications for RD Practice and Conclusions

● These research studies show some promising evidence that the MIND diet can slow decline in cognition and possibly ease psychological distress

● This new research could give dietitians a new diet or at least information to educate clients who are asking for a diet to promote brain health

Questions?

References1. Berendsen, A. M., Kang, J. H., Feskens, E. J. M., C. P. G. M. De Groot, Grodstein, F., & Rest, O. V. D.

(2017). Association of long-term adherence to the mind diet with cognitive function and cognitive decline in American women. The Journal of Nutrition, Health & Aging, 22(2), 222–229. doi: 10.1007/s12603-017-0909-0

2. Cherian, L., Wang, Y., Fakuda, K., Leurgans, S., Aggarwal N., & Morris M. (2019). Mediterranean-Dash Intervention for Neurodegenerative Delay (MIND) Diet Slows Cognitive Decline After Stroke. The Journal of Prevention of Alzheimers Disease, 6, 267–273. Doi: 10.14283/jpad.2019.28

3. Harvey, P. (2019). Domains of cognition and their assessment. Dialogues in Clinical Neuroscience Cognition in Mental Health, 21(3), 227–237. doi: 10.31887/dcns.2019.21.3/pharvey

4. Hosking, D. E., Eramudugolla, R., Cherbuin, N., & Anstey, K. J. (2019). MIND not Mediterranean diet related to 12-year incidence of cognitive impairment in an Australian longitudinal cohort study. Alzheimers & Dementia, 15(4), 581–589. doi: 10.1016/j.jalz.2018.12.011

5. Marcason, W. (2015). What Are the Components to the MIND Diet? Journal of the Academy of Nutrition and Dietetics, 115(10), 1744. doi: 10.1016/j.jand.2015.08.002

References6. Mayo Clinic Staff. (2019, April 19). The role of genes in your Alzheimer's risk. Retrieved April 8,

2020, from https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-genes/art-20046552

7. Morris, M. C., Tangney, C. C., Wang, Y., Sacks, F. M., Bennett, D. A., & Aggarwal, N. T. (2015). MIND diet associated with reduced incidence of Alzheimers disease. Alzheimers & Dementia, 11(9), 1007–1014. doi: 10.1016/j.jalz.2014.11.009

8. Morris, M. C., Tangney, C. C., Wang, Y., Sacks, F. M., Barnes, L. L., Bennett, D. A., & Aggarwal, N. T. (2015). MIND diet slows cognitive decline with aging. Alzheimers & Dementia, 11(9), 1015–1022. doi: 10.1016/j.jalz.2015.04.011

9. Nikolova, A., & Macken, B. (2016). The objects of visuospatial short-term memory: Perceptual organization and change detection. Quarterly Journal of Experimental Psychology, 69(7), 1426–1437. doi: 10.1080/17470218.2015.1083595

10. Salari-Moghaddam, A., Keshteli, A. H., Mousavi, S. M., Afshar, H., Esmaillzadeh, A., & Adibi, P. (2019). Adherence to the MIND diet and prevalence of psychological disorders in adults. Journal of Affective Disorders, 256, 96–102. doi: 10.1016/j.jad.2019.05.056

the mind diet & brain health · purpose: to study the correlations between the mind diet,...

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