The journal of nutrition, health & aging

, Volume 17, Issue 9, pp 757–765

A cross sectional study to examine the association between dietary patterns and cognitive impairment in older Chinese people in Hong Kong




Dietary patterns can be identified using a priori and a posterior approaches. Few studies have related dietary patterns with cognitive impairment in Chinese population. This study examined the risk of cognitive impairment associated with dietary patterns identified by both approaches.


Baseline data on 1,926 Chinese men and 1,744 Chinese women aged > 65 years participating in a cohort study examining the risk factors for osteoporosis in Hong Kong were analyzed. Dietary data were collected using a validated food frequency questionnaire. Adherence to a priori dietary patterns, namely the Mediterranean Diet Score (MDS) was assessed. Factor analysis (FA) identified three a posterior dietary patterns: “vegetables-fruits” pattern which was rich in vegetables, fruits, soy products and legumes, “snacks-drinks-milk products” pattern which was a mixture of healthy and unhealthy food groups including fast food, sweets and desserts, nuts, milk products and whole grains, and “meat-fish” pattern which included frequent intake of meat, fish and seafood. Cognitive function was assessed by the Community Screening Instrument for Dementia (CSI-D). Multivariate logistic regression examined the risk of cognitive impairment with adjustment for potential confounders.


A total of 221 men and 656 women was classified as cognitive impaired. Neither the MDS nor the dietary patterns identified by FA were associated with risk of cognitive impairment in men. In women, higher “vegetables-fruits” pattern score was associated with reduced risk of cognitive impairment [Adjusted OR=0.73 (95% CI: 0.54–1.00) of the highest quartile of “vegetables-fruits” pattern score compared with the lowest quartile, ptrend=0.018]. Similar inverse trend was observed for “snacks-drinks-milk products” pattern score [Adjusted OR=0.65 (95% CI: 0.47–0.90) of the highest quartile of “snacks-drinks-milk products” pattern score compared with the lowest quartile, ptrend=0.003]. There was no association of “meat-fish” pattern or the MDS with risk of cognitive impairment in women.


Higher “vegetables-fruits” and “snacks-drinks-milk products” pattern scores were associated with reduced risk of cognitive impairment in Chinese older women in Hong Kong.

Key words

Dietary pattern cognitive impairment chinese mediterranean diet 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Solfrizzi V, Panza F, Frisardi V, Seripa D, Logroscino G, Imbimbo BP, Pilotto A. Diet and Alzheimer’s disease risk factors or prevention: the current evidence. Expert Rev Neurother. 2011;11:677–708.PubMedCrossRefGoogle Scholar
  2. 2.
    Gonzalez S, Huerta JM, Fernandez S, Patterson AM, Lasheras C. The relationship between dietary lipids and cognitive performance in an elderly population. Int J Food Sci Nutr. 2010;61:217–225.PubMedCrossRefGoogle Scholar
  3. 3.
    Ye X, Gao X, Scott T, Tucker KL. Habitual sugar intake and cognitive function among middle-aged and older Puerto Ricans without diabetes. Br J Nutr. 2011;106:1423–1432.PubMedCrossRefGoogle Scholar
  4. 4.
    Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13:3–9.PubMedCrossRefGoogle Scholar
  5. 5.
    van Dam RM. New approaches to the study of dietary patterns. Br J Nutr. 2005;93:573–574.PubMedCrossRefGoogle Scholar
  6. 6.
    Schulze MB, Hoffmann K. Methodological approaches to study dietary patterns in relation to risk of coronary heart disease and stroke. Br J Nutr. 2006;95:860–869.PubMedCrossRefGoogle Scholar
  7. 7.
    Waijers PM, Feskens EJ, Ocke MC. A critical review of predefined diet quality scores. Br J Nutr. 2007;97:219–231.PubMedCrossRefGoogle Scholar
  8. 8.
    Gu Y, Nieves JW, Stern Y, Luchsinger JA, Scarmeas N. Food combination and Alzheimer disease risk: a protective diet. Arch Neurol. 2010;67:699–706.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Tangney CC, Kwasny MJ, Li H, Wilson RS, Evans DA, Morris MC. Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. Am J Clin Nutr. 2011;93:601–607.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Scarmeas N, Stern Y, Tang MX, Mayeux R, Luchsinger JA. Mediterranean diet and risk for Alzheimer’s disease. Ann Neurol. 2006;59:912–921.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Scarmeas N, Stern Y, Mayeux R, Manly JJ, Schupf N, Luchsinger JA. Mediterranean diet and mild cognitive impairment. Arch Neurol. 2009;66:216–225.PubMedCentralPubMedGoogle Scholar
  12. 12.
    Chen X, Huang Y, Cheng HG. Lower intake of vegetables and legumes associated with cognitive decline among illiterate elderly Chinese: a 3-year cohort study. J Nutr Health Aging. 2012;16:549–552.PubMedCrossRefGoogle Scholar
  13. 13.
    Wang Z, Dong B, Zeng G, Li J, Wang W, Wang B, Yuan Q. Is there an association between mild cognitive impairment and dietary pattern in Chinese elderly? Results from a cross-sectional population study. BMC Public Health 2010;10:595.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Yao YH, Xu RF, Tang HD, Jiang GX, Wang Y, Wang G, Chen SD, Cheng Q. Cognitive impairment and associated factors among the elderly in the Shanghai suburb: findings from a low-education population. Neuroepidemiology 2010;34:245–252.PubMedCrossRefGoogle Scholar
  15. 15.
    Wong SY, Kwok T, Woo J, Lynn H, Griffith JF, Leung J, Tang YY, Leung PC. Bone mineral density and the risk of peripheral arterial disease in men and women: results from Mr. and Ms Os, Hong Kong. Osteoporos Int. 2005;16:1933–1938.PubMedCrossRefGoogle Scholar
  16. 16.
    Census and Statistics Department. Hong Kong 2006 Population By-census Thematic Report: Older Persons. Hong Kong: Census and Statistics Department, 2006.Google Scholar
  17. 17.
    Marmot M, Wilkinson RG. Psychosocial and material pathways in the relation between income and health: a response to Lynch et al. BMJ 2001;322:1233–1236.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Woo J, Lynn H, Leung J, Wong SY. Self-perceived social status and health in older Hong Kong Chinese women compared with men. Women & Health 2008;48:209–234.CrossRefGoogle Scholar
  19. 19.
    Washburn RA, Smith KW, Jette AM, Janney CA. The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol. 1993;46:153–162.PubMedCrossRefGoogle Scholar
  20. 20.
    Prince M, Acosta D, Chiu H, Scazufca M, Varghese M, Dementia Research G. Dementia diagnosis in developing countries: a cross-cultural validation study. Lancet 2003;361:909–917.PubMedCrossRefGoogle Scholar
  21. 21.
    Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale. A preliminary report. J Psychiatr Res. 1983;17:37–49.CrossRefGoogle Scholar
  22. 22.
    Lee HB, Chiu HFK, Kwok WY, Leung CM, Kwong PK, Chung DWS. Chinese elderly and the GDS short form: a preliminary study. Clin Gerontologist. 1993;14:37–39.Google Scholar
  23. 23.
    Woo J, Leung SSF, Ho SC, Lam TH, Janus ED. A food frequency questionnaire for use in the Chinese population in Hong Kong: Description and examination of validity. Nutr Res. 1997;17:1633–1641.CrossRefGoogle Scholar
  24. 24.
    Paul AA, Southgate DAT. McCance & Widdowson’s: The Composition of Foods. 4th ed. London: HMSO, 1978.Google Scholar
  25. 25.
    Yang Y, Wang G, Pan X. China Food Composition 2002. 2002 ed. Peking: University Medical Press, 2002.Google Scholar
  26. 26.
    Chan R, Chan D, Woo J. Associations between dietary patterns and demographics, lifestyle, anthropometry and blood pressure in Chinese community-dwelling older men and women. J Nutr Sci. 2012 (in press).Google Scholar
  27. 27.
    Reedy J, Wirfalt E, Flood A, Mitrou PN, Krebs-Smith SM, Kipnis V, Midthune D, Leitzmann M, Hollenbeck A, et al. Comparing 3 dietary pattern methods—cluster analysis, factor analysis, and index analysis—With colorectal cancer risk: The NIHAARP Diet and Health Study. Am J Epidemiol. 2010;171:479–487.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Field A. Discovering Statistics Using SPSS. London: Sage Publications, 2005.Google Scholar
  29. 29.
    Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. New Engl J Med. 2003;348:2599–2608.PubMedCrossRefGoogle Scholar
  30. 30.
    Osler M, Schroll M. Diet and mortality in a cohort of elderly people in a north European community. Int J Epidemiol. 1997;26:155–159.PubMedCrossRefGoogle Scholar
  31. 31.
    Lee J, Lam L, Woo J, Kwok T. Lower fluid and fruits/vegetable intake in questionable dementia among older Hong Kong Chinese. J Nutr Health Aging. 2010;14:45–49.PubMedCrossRefGoogle Scholar
  32. 32.
    Roberts RO, Geda YE, Cerhan JR, Knopman DS, Cha RH, Christianson TJ, Pankratz VS, Ivnik RJ, Boeve BF, et al. Vegetables, unsaturated fats, moderate alcohol intake, and mild cognitive impairment. Dement Geriatr Cogn Disord. 2010;29:413–423.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Loef M, Walach H. Fruit, vegetables and prevention of cognitive decline or dementia: a systematic review of cohort studies. J Nutr Health Aging. 2012;16:626–630.PubMedCrossRefGoogle Scholar
  34. 34.
    Peneau S, Galan P, Jeandel C, Ferry M, Andreeva V, Hercberg S, Kesse-Guyot E, SU.VI.MAX 2 Research Group. Fruit and vegetable intake and cognitive function in the SU.VI.MAX 2 prospective study. Am J Clin Nutr. 2011;94:1295–1303.PubMedCrossRefGoogle Scholar
  35. 35.
    Kesse-Guyot E, Amieva H, Castetbon K, Henegar A, Ferry M, Jeandel C, Hercberg S, Galan P, SU.VI.MAX 2 Research Group. Adherence to nutritional recommendations and subsequent cognitive performance: findings from the prospective Supplementation with Antioxidant Vitamins and Minerals 2 (SU.VI.MAX 2) study. Am J Clin Nutr. 2011;93:200–210.PubMedCrossRefGoogle Scholar
  36. 36.
    Gomez-Pinilla F. Brain foods: the effects of nutrients on brain function. Nat Rev Neurosci. 2008;9:568–578.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Gillette Guyonnet S, Abellan Van Kan G, Andrieu S, Barberger Gateau P, Berr C, Bonnefoy M, Dartigues JF, de Groot L, Ferry M, et al. IANA task force on nutrition and cognitive decline with aging. J Nutr Health Aging. 2007;11:132–152.PubMedGoogle Scholar
  38. 38.
    Rahman A, Sawyer Baker P, Allman RM, Zamrini E. Dietary factors and cognitive impairment in community-dwelling elderly. J Nutr Health Aging. 2007;11:49–54.PubMedGoogle Scholar
  39. 39.
    Requejo AM, Ortega RM, Robles F, Navia B, Faci M, Aparicio A. Influence of nutrition on cognitive function in a group of elderly, independently living people. Eur J Clin Nutr. 2003;57Suppl 1:S54–57.PubMedCrossRefGoogle Scholar
  40. 40.
    Stephan BC, Wells JC, Brayne C, Albanese E, Siervo M. Increased fructose intake as a risk factor for dementia. J Gerontol A Bio Sci Med Sci. 2010;65:809–814.CrossRefGoogle Scholar
  41. 41.
    Ho RC, Niti M, Yap KB, Kua EH, Ng TP. Metabolic syndrome and cognitive decline in chinese older adults: results from the singapore longitudinal ageing studies. Am J Geriatr Psychiatry. 2008;16:519–522.PubMedCrossRefGoogle Scholar
  42. 42.
    Razay G, Vreugdenhil A, Wilcock G. The metabolic syndrome and Alzheimer disease. Arch Neurol. 2007;64:93–96.PubMedCrossRefGoogle Scholar
  43. 43.
    Camfield DA, Owen L, Scholey AB, Pipingas A, Stough C. Dairy constituents and neurocognitive health in ageing. Br J Nutr. 2011;106:159–174.PubMedCrossRefGoogle Scholar
  44. 44.
    Feart C, Samieri C, Barberger-Gateau P. Mediterranean diet and cognitive function in older adults. Curr Opin Clin Nutr Metab Care. 2010;13:14–18.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Feart C, Samieri C, Rondeau V, Amieva H, Portet F, Dartigues JF, Scarmeas N, Barberger-Gateau P. Adherence to a Mediterranean Diet, Cognitive Decline, and Risk of Dementia. JAMA 2009;302:638–648.PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Woo J, Woo KS, Leung SS, Chook P, Liu B, Ip R, Ho SC, Chan SW, Feng JZ, et al. The Mediterranean score of dietary habits in Chinese populations in four different geographical areas. Eur J Clin Nutr. 2001;55:215–220.PubMedCrossRefGoogle Scholar
  47. 47.
    Kouris-Blazos A, Gnardellis C, Wahlqvist ML, Trichopoulos D, Lukito W, Trichopoulou A. Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia. Br J Nutr. 1999;82:57–61.PubMedGoogle Scholar
  48. 48.
    Speed C. The transposability of the Mediterranean-type diet in non-Mediterranean regions: application to the physician/allied health team. Eur J Cancer Prev. 2004;13:529–534.PubMedCrossRefGoogle Scholar
  49. 49.
    Prince M, Acosta D, Ferri CP, Guerra M, Huang Y, Jacob KS, Libre Rodriguez JJ, Salas A, Sosa AL, et al. A brief dementia screener suitable for use by non-specialists in resource poor settings—the cross-cultural derivation and validation of the brief Community Screening Instrument for Dementia. Int J Geriatr Psychiatry. 2011;26:899–907.PubMedCentralPubMedCrossRefGoogle Scholar
  50. 50.
    Chan TS, Lam LC, Chiu HF, Prince M. Validity and applicability of the Chinese version of community screening instrument for dementia. Dement Geriatr Cogn Disord. 2003;15:10–18.PubMedCrossRefGoogle Scholar
  51. 51.
    Hamer M, McNaughton SA, Bates CJ, Mishra GD. Dietary patterns, assessed from a weighed food record, and survival among elderly participants from the United Kingdom. Eur J Clin Nutr. 2010;64:853–861.PubMedCentralPubMedCrossRefGoogle Scholar
  52. 52.
    Butler LM, Wang R, Koh WP, Yu MC. Prospective study of dietary patterns and colorectal cancer among Singapore Chinese. Br J Cancer. 2008;99:1511–1516.PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Waijers PM, Ocke MC, van Rossum CT, Peeters PH, Bamia C, Chllptsios Y, van der Schouw YT, Slimani N, Bueno-de-Mesquita HB. Dietary patterns and survival in older Dutch women. Am J Clin Nutr. 2006;83:1170–1176.PubMedGoogle Scholar
  54. 54.
    Mishra GD, McNaughton SA, Ball K, Brown WJ, Giles GG, Dobson AJ. Major dietary patterns of young and middle aged women: results from a prospective Australian cohort study. Eur J Clin Nutr. 2010;64:1125–1133.PubMedCrossRefGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Department of Medicine and TherapeuticsThe Chinese University of Hong KongShatin, Hong KongChina
  2. 2.Jockey Club Centre for Osteoporosis Care and ControlThe Chinese University of Hong KongShatin, Hong KongChina
  3. 3.Prince of Wales HospitalShatin, New Territories, Hong Kong SARChina

Personalised recommendations