The Relationship between Alternative Healthy Diet Index and Cognitive Function in the Older Adults: The Mediating Effect of Depressive Symptoms
Zhonghai Lu, Chen Chen, Jiesong Zhang, Xueyan Wang, Dongfeng Zhang, Suyun Li
Abstract
This study aimed to investigate the association between the alternative healthy eating index-2010 (AHEI-2010) with cognitive function and the mediating role of depressive symptoms in older adults using the data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). The AHEI-2010 was calculated from NHANES individual food data and Food Patterns Equivalents Database (FPED) diet data. Cognitive function was assessed by the Consortium to Establish a Registry for Alzheimer's disease (CERAD, memory function indicator), Word Learning sub-test, digital symbol substitution test (DSST, processing speed indicator), animal fluency test (AFT, executive function indicator), and the comprehensive z-score (global cognition indicator). A weighted multiple linear regression model was used to explore the relationship between AHEI-2010 and cognitive function, and Karlson-Holm-Breen (KHB) method was used to explore the mediating effect of depressive symptoms. A total of 2644 participants were included in this study. Participants with higher AHEI-2010 scores were more likely to have higher scores in DSST, AFT, and comprehensive z-score compared with the lowest quartile. Depressive symptoms play a significant mediating role between AHEI-2010 and cognitive function. The proportion of mediating in CERAD, DSST, AFT, and comprehensive z-score was 14.14%, 9.10%, 9.15%, and 10.47%, respectively. This study found that higher dietary quality was associated with better cognitive function. In addition, depressive symptoms may be an important pathway linking diet and cognitive function.