Filippini T, Garuti C, Adani G, Vineti G, Galli C, Zamboni G, Tondelli M, Costa M, Malavolti M, Vinceti M, Chiari A
Oral presentation at the I Edition of “Le giornate della ricerca scientifica e delle esperienze professionali dei giovani”. December 19-21, 2019. Rome. Journal of Preventive Medicine and Hygiene
Background and aim: Early onset dementia (EOD) is a condition characterized by the onset of severe cognitive impairment before 65 years (Rossor et al., 2010). There is a general agreement that clinical presentation and consequences on daily life are different than late-onset dementia, due to the occurrence when subjects are still involved within occupational activities as well as familiar responsibilities (Vraamark Elberling et al., 2002). Previous studies have raised the possibility that the risk factors may also differ between the two forms, including the role of environmental and life-style determinants such as diet (Killin et al, 2016). There is some epidemiologic evidence of an association between dietary habits and protective relations to cognitive decline and incident dementia (Martinez-Lapiscina et al., 2013; Scarmeas et al., 2006). The aim of this study is to evaluate, for the first time to our knowledge, the association between diet and EOD risk.
Methods: Using a case-control design, we recruited newly-diagnosed EOD cases from 2016 to 2019 in Modena province, Northern Italy. We recruited controls from care-givers of dementia patients referring the Neurology Units of Modena-Baggiovara and Carpi Hospitals. We investigated dietary habits through a self-administered semi-quantitative food frequency questionnaire, designed and validated to capture eating behaviors in Italy, and specifically developed as part of the European Prospective Investigation into Cancer and Nutrition (EPIC) study for the Northern Italy population (Pala et al., 2003). Participants were asked to respond to 248 questions about 188 different food items, in order to assess frequency and quantity of daily consumption for each food item. We specifically focused on consumption of fruits and vegetables that were categorized into major and sub-group categories as previously reported (Filippini et al., 2018). We computed the odds ratios (ORs) of EOD risk, and the corresponding 95% confidence intervals (CIs), according to increasing tertile of intake using an unconditional logistic regression model and we also modeled the relation using restricted cubic splines with three knots (10, 50 and 90%). We implemented a model adjusted for sex, age (years), educational attainment (years), and total energy intake (kcal/day).
Results: We recruited 56 (men/women: 22/34) and 53 (men/women: 24/29) controls who agreed to participate and returned study material. Regarding food intake, cases showed a lower intake than controls of vegetables (119 g/day versus 148 g/day), pulses (19 g/day versus 22 g/day), potatoes (15 g/day versus 23 g/day), and dry fruits (2.6 g/day versus 4.0 g/day). Conversely cases showed a higher intake than controls of fresh fruits (256 g/day versus 240 g/day). In the analysis of EOD risk according to increasing tertile we found an inverse association with all vegetables overall considered and also for individual subgroup, particularly leafy vegetables and other vegetables (e.g. eggplant, zucchini or sweet pepper). Also, an inverse association was found for potatoes and slightly for legumes. Conversely, the higher tertile of intake of fresh fruits was associated with no difference in EOD risk, but in the stratified analysis for non-citrus and citrus fruits we found inverse association for the latter. Interestingly, for non-citrus fruits we found inverse association in the second tertile of consumption, and an opposite positive association in the third tertile. Finally, with increasing tertile of dry fruits intake, we found a strong inverse association with EOD risk. Similarly in the spline analysis, the increasing consumption of vegetables, particularly leafy vegetables showed a strong inverse association, as similarly also increased pulse intake. Regarding fruit consumption, fresh fruit overall considered showed ambivalent relation, while higher consumption of citrus fruits only, as well as dry fruits, showed a negative association with EOD risk.
Conclusions: In this study, we found an association of consumption of vegetables and to some extent fruit with EOD risk in an Italian population. Despite the study limitations, such as the possible occurrence of selection bias, our findings suggest that dietary habits may influence EOD etiology and onset.