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Mediterranean diet adherence is associated with better cognitive status and less depressive symptoms in a Greek elderly population

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Abstract

Purpose

To evaluate the Mediterranean diet (MD) adherence of an elderly Greek population, and its association with the grade of cognitive decline and psychological status.

Methods

Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Mediterranean diet score (MedDietScore) questionnaires were used to assess the impact of MD adherence on cognitive abilities and psychological state of a Greek elderly population.

Participants

2092 men and women over 65 years old (mean age 74.97 ± 8.41 years) from seven different Greek cities

Results

34.4% of the study population showed cognitive impairment, while 32.3% of the participants had depressive symptoms. More than half of the participants (52.1%) showed very low or low MD adherence. Higher MD adherence was significantly associated with better MMSE and GDS scores. Moreover, higher MD adherence was significantly associated with younger age, female gender, higher educational level, and better anthropometric parameters. MD adherence was independently associated with cognitive and psychological status, and gender after adjustment for potential confounders.

Conclusion

Higher MD adherence is strongly associated with better cognitive status and less depressive symptomatology. Public health policies are recommended to focus on the promotion of the MD, as a crucial strategy to reduce the risk of cognitive impairment and depression.

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References

  1. Gotsis E, Anagnostis P, Mariolis A et al (2015) Health benefits of the Mediterranean diet: an update of research over the last 5 years. Angiology 66:304–318

    PubMed  Google Scholar 

  2. Trichopoulou A, Naska A, Orfanos P et al (2005) Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek European Prospective Investigation into Cancer and Nutrition Study. Am J Clin Nutr 82:935–940

    CAS  PubMed  Google Scholar 

  3. Dinu M, Pagliai G, Sofi F (2017) A heart-healthy diet: recent insights and practical recommendations. Curr Cardiol Rep 19:95

    PubMed  Google Scholar 

  4. Schwingshackl L, Hoffmann G (2015) Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis of observational studies. Cancer Med 4:1933–1947

    PubMed  PubMed Central  Google Scholar 

  5. Esposito K, Giugliano D (2014) Mediterranean diet and type 2 diabetes. Diabetes Metab Res Rev 30:34–40

    CAS  PubMed  Google Scholar 

  6. Schwingshackl L, Missbach B, Konig J et al (2015) Adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis. Public Health Nutr 18:1292–1299

    Google Scholar 

  7. Deary IJ, Corley J, Gow AJ et al (2009) Age-associated cognitive decline. Br Med Bull 92:135–152

    PubMed  Google Scholar 

  8. World Health Organization, Alzheimer’s Disease International Dementia: a public health priority. https://www.who.int/mental_health/publications/dementia_report_2012/en/. Accessed Oct 2019

  9. Barua A, Ghosh MK, Kar N et al (2011) Prevalence of depressive disorders in the elderly. Ann Saudi Med 31:620–624

    PubMed  PubMed Central  Google Scholar 

  10. Rosenvinge BH, Rosenvinge JH (2003) Occurrence of depression in the elderly–a systematic review of 55 prevalence studies from 1990–2001. Tidsskr Nor Laegeforen. 123:928–929. [Article in Norwegian]  

    Google Scholar 

  11. Bjørkløf GH, Engedal K, Selbæk G et al (2013) Coping and depression in old age: a literature review. Dement Geriatr Cogn Disord 35:121–154

    PubMed  Google Scholar 

  12. Sivertsen H, Bjørkløf GH, Engedal K et al (2015) Depression and quality of life in older persons: a review. Dement Geriatr Cogn Disord 40:311–339

    PubMed  Google Scholar 

  13. Van der Weele GM, Gussekloo J, De Waal MW et al (2009) Co-occurrence of depression and anxiety in elderly subjects aged 90 years and its relationship with functional status, quality of life and mortality. Int J Geriatr Psychiatry 24:595–601

    PubMed  Google Scholar 

  14. Garcia-Pena C, Wagner FA, Sanchez-Garcia S et al (2008) Depressive symptoms among older adults in Mexico City. J Gen Intern Med 23:1973–1980

    PubMed  PubMed Central  Google Scholar 

  15. Bennett S, Thomas AJ (2014) Depression and dementia: cause, consequence or coincidence? Maturitas 79:184–190

    PubMed  Google Scholar 

  16. Mantzorou M, Vadikolias K, Pavlidou E et al (2020) Nutritional status is associated with the degree of cognitive impairment and depressive symptoms in a Greek elderly population. Nutr Neurosci 23:201–209. https://doi.org/10.1080/1028415X.2018.1486940

    Article  Google Scholar 

  17. Shimada H, Park H, Makizako H et al (2014) Depressive symptoms and cognitive performance in older adults. J Psychiatr Res 57:149–156

    PubMed  Google Scholar 

  18. Psaltopoulou T, Kyrozis A, Stathopoulos P et al (2008) Diet, physical activity and cognitive impairment among elders: the EPIC-Greece cohort (European Prospective Investigation into Cancer and Nutrition). Public Health Nutr 11:1054–1062

    CAS  PubMed  Google Scholar 

  19. Gabryelewicz T, Styczynska M, Luczywek E et al (2006) The rate of conversion of mild cognitive impairment to dementia: predictive role of depression. Int J Geriatr Psychiatry 22:563–567

    Google Scholar 

  20. Byers AL, Yaffe K (2011) Depression and risk of developing dementia. Nat Rev Neurol 7:323–331

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Nyaradi A, Foster JK, Hickling S et al (2014) Prospective associations between dietary patterns and cognitive performance during adolescence. J Child Psychol Psychiatry 55:1017–1024

    PubMed  Google Scholar 

  22. Lee J, Pase M, Pipingas A et al (2015) Switching to a 10-day Mediterranean-style diet improves mood and cardiovascular function in a controlled crossover study. Nutrition 31:647–652

    PubMed  Google Scholar 

  23. McMillan L, Owen L, Kras M (2011) Behavioural effects of a 10-day Mediterranean diet. Results from a pilot study evaluating mood and cognitive performance. Appetite 56:143–147

    PubMed  Google Scholar 

  24. Martinez-Lapiscina EH, Clavero P et al (2013) Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. J Neurol Neurosurg Psychiatry 84:1318–1325

    PubMed  Google Scholar 

  25. Mosconi L, Walters M, Sterling J et al (2018) Lifestyle and vascular risk effects on MRI-based biomarkers of Alzheimer's disease: a cross-sectional study of middle-aged adults from the broader New York City area. BMJ Open 8:e019362

    PubMed  PubMed Central  Google Scholar 

  26. Mosconi L, Murray J, Tsui WH et al (2014) Mediterranean diet and magnetic resonance imaging-assessed brain atrophy in cognitively normal individuals at Risk for Alzheimer's disease. J Prev Alzheimers Dis 1:23–32

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Galbete C, Toledo E, Toledo JB et al (2015) Mediterranean diet and cognitive function: the SUN project. J Nutr Health Aging 19:305–312

    CAS  PubMed  Google Scholar 

  28. Psaltopoulou T, Sergentanis TN, Panagiotakos DB et al (2013) Mediterranean diet, stroke, cognitive impairment, and depression: a meta-analysis. Ann Neurol 74:580–591

    PubMed  Google Scholar 

  29. Tsivgoulis G, Judd S, Letter AJ et al (2013) Adherence to a Mediterranean diet and risk of incident cognitive impairment. Neurology 80:1684–1692

    PubMed  PubMed Central  Google Scholar 

  30. Gu Y, Luchsinger JA, Stern Y, Scarmeas N (2010) Mediterranean diet, inflammatory and metabolic biomarkers, and risk of Alzheimer's disease. J Alzheimers Dis JAD 22:483–492

    CAS  PubMed  Google Scholar 

  31. Scarmeas N, Stern Y, Tang MX et al (2006) Mediterranean diet and risk for Alzheimer's disease. Ann Neurol 59:912–921

    PubMed  PubMed Central  Google Scholar 

  32. Scarmeas N, Stern Y, Mayeux R et al (2009) Mediterranean diet and mild cognitive impairment. Arch Neurol 66:216–225

    PubMed  PubMed Central  Google Scholar 

  33. Ye X, Scott T, Gao X et al (2013) Mediterranean diet, healthy eating index 2005, and cognitive function in middle-aged and older Puerto Rican adults. J Acad Nutr Diet 113:276-81.e1-3. https://doi.org/10.1016/j.jand.2012.10.014

    Article  PubMed  PubMed Central  Google Scholar 

  34. Feart C, Samieri C, Rondeau V et al (2009) Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA 302:638–648

    CAS  PubMed  PubMed Central  Google Scholar 

  35. McEvoy CT, Hoang T, Sidney S et al (2019) Dietary patterns during adulthood and cognitive performance in midlife: the CARDIA study. Neurology 92:e1589–e1599

    PubMed  PubMed Central  Google Scholar 

  36. Tangney CC, Kwasny MJ, Li H et al (2011) Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. Am J Clin Nutr 93:601–607

    CAS  PubMed  Google Scholar 

  37. Cooper C, Sommerlad A, Lyketsos CG et al (2015) Modifiable predictors of dementia in mild cognitive impairment: a systematic review and meta-analysis. Am J Psychiatry 172:323–334

    PubMed  Google Scholar 

  38. Molendijk M, Molero P, Ortuno Sanchez-Pedreno F et al (2018) Diet quality and depression risk: a systematic review and dose-response meta-analysis of prospective studies. J Affect Disord 226:346–354

    Google Scholar 

  39. Opie RS, Itsiopoulos C, Parletta N et al (2017) Dietary recommendations for the prevention of depression. Nutr Neurosci 20:161–171

    CAS  Google Scholar 

  40. Quirk SE, Williams LJ, O’Neil A et al (2013) The association between diet quality, dietary patterns and depression in adults: a systematic review. BMC Psychiatry 13:175

    PubMed  PubMed Central  Google Scholar 

  41. Bountziouka V, Polychronopoulos E, Zeimbekis A et al (2009) Long-term fish intake is associated with less severe depressive symptoms among elderly men and women: the MEDIS (MEDiterranean ISlands Elderly) epidemiological study. J Aging Health 21:864–880

    PubMed  Google Scholar 

  42. Mamplekou E, Bountziouka V, Psaltopoulou T et al (2010) Urban environment, physical inactivity and unhealthy dietary habits correlate to depression among elderly living in eastern Mediterranean islands: the MEDIS (MEDiterranean ISlands Elderly) study. J Nutr Health Aging 14:449–455

    CAS  PubMed  Google Scholar 

  43. Carlos S, De La Fuente-Arrillaga C, Bes-Rastrollo M et al (2018) Mediterranean diet and health outcomes in the SUN Cohort. Nutrients 10:439. https://doi.org/10.3390/nu10040439

    Article  CAS  PubMed Central  Google Scholar 

  44. Sanchez-Villegas A, Delgado-Rodriguez M, Alonso A et al (2009) Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Arch Gen Psychiatry 66:1090–1098

    PubMed  Google Scholar 

  45. Parletta N, Zarnowiecki D, Cho J et al (2017) A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: a randomized controlled trial (HELFIMED). Nutr Neurosci 22:474–487. https://doi.org/10.1080/1028415X.2017.1411320

    Article  Google Scholar 

  46. Adjibade M, Assmann KE, Andreeva VA et al (2018) Prospective association between adherence to the Mediterranean diet and risk of depressive symptoms in the French SU.VI.MAX cohort. Eur J Nutr 57:1225–1235

    PubMed  Google Scholar 

  47. Veronese N, Stubbs B, Noale M et al (2016) Adherence to the Mediterranean diet is associated with better quality of life: data from the Osteoarthritis Initiative. Am J Clin Nutr 104:1403–1409

    CAS  PubMed  PubMed Central  Google Scholar 

  48. Fountoulakis KN, Tsolaki M, Chantzi H et al (2000) Mini Mental State Examination (MMSE): a validation study in Greece. Am J Alzheimers Dis 15:342–345

    Google Scholar 

  49. Fountoulakis KN, Tsolaki M, Iacovides A et al (1999) The validation of the short form of the Geriatric Depression Scale (GDS) in Greece. Aging (Milan, Italy) 11:367–372

    CAS  Google Scholar 

  50. Arvaniti F, Panagiotakos DB (2008) Healthy indexes in public health practice and research: a review. Crit Rev Food Sci Nutr 48:317–327

    PubMed  Google Scholar 

  51. Panagiotakos DB, Pitsavos C, Stefanadis C (2006) Dietary patterns: a Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk. Nutr Metab Cardiovasc Dis NMCD 16:559–568

    PubMed  Google Scholar 

  52. Panagiotakos DB, Pitsavos C, Arvaniti F et al (2007) Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore. Prev Med 44:335–340

    PubMed  Google Scholar 

  53. World Health Organization (1985) Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization technical report series 854:1–452

  54. Valls-Pedret C, Sala-Vila A, Serra-Mir M et al (2015) Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA Int Med 175:1094–1103

    Google Scholar 

  55. Hernandez-Galiot A, Goni I (2017) Adherence to the Mediterranean diet pattern, cognitive status and depressive symptoms in an elderly non-institutionalized population. Nutr Hosp 34:338–344

    PubMed  Google Scholar 

  56. Gardener S, Gu Y, Rainey-Smith SR et al (2012) Adherence to a Mediterranean diet and Alzheimer's disease risk in an Australian population. Transl Psychiatry 2:e164

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Trichopoulou A, Costacou T, Bamia C et al (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348:2599–2608

    PubMed  Google Scholar 

  58. Trichopoulou A, Kyrozis A, Rossi M et al (2015) Mediterranean diet and cognitive decline over time in an elderly Mediterranean population. Eur J Nutr 54:1311–1321

    CAS  PubMed  Google Scholar 

  59. Kyrozis A, Psaltopoulou T, Stathopoulos P et al (2009) Dietary lipids and geriatric depression scale score among elders: the EPIC-Greece cohort. J Psychiatr Res 43:763–769

    CAS  PubMed  Google Scholar 

  60. Skarupski KA, Tangney CC, Li H et al (2013) Mediterranean diet and depressive symptoms among older adults over time. J Nutr Health Aging 17:441–445

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Darmon N, Drewnowski A (2008) Does social class predict diet quality? Am J Clin Nutr 87:1107–1117

    CAS  PubMed  Google Scholar 

  62. Grosso G, Marventano S, Giorgianni G et al (2014) Mediterranean diet adherence rates in Sicily, southern Italy. Public Health Nutr 17:2001–2009

    PubMed  Google Scholar 

  63. Vercambre M-N, Grodstein F, Berr C, Kang JH (2012) Mediterranean diet and cognitive decline in women with cardiovascular disease or risk factors. J Acad Nutr Diet 112:816–823

    PubMed  PubMed Central  Google Scholar 

  64. Katsarou A, Tyrovolas S, Psaltopoulou T et al (2010) Socio-economic status, place of residence and dietary habits among the elderly: the Mediterranean islands study. Public Health Nut 13:1614–1621

    Google Scholar 

  65. Scali J, Richard A, Gerber M (2007) Diet profiles in a population sample from Mediterranean southern France. Public Health Nutr 4:173–182

    Google Scholar 

  66. Muñoz M-A, Fíto M, Marrugat J et al (2008) Adherence to the Mediterranean diet is associated with better mental and physical health. Br J Nutr 101:1821–1827

    PubMed  Google Scholar 

  67. Bonaccorsi G, Lorini C, Santomauro F et al (2018) Adherence to Mediterranean diet and nutritional status in a sample of nonagenarians. Exp Gerontol 103:57–62

    PubMed  Google Scholar 

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Funding

C.T. is recipient of a Grant (YPATIA) from the University of the Aegean (3030-16.1).

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Authors and Affiliations

  1. Department of Food Science and Nutrition, School of Environment, University of Aegean, Myrina, Mitropoliti Ioakim 2, 81440, Myrina, Lemnos, Greece

    Maria Mantzorou, Eleni Pavlidou, Christina Tryfonos, Georgios Vasios & Constantinos Giaginis

  2. Department of Neurology, School of Medicine, Democritus University of Thrace, Alexandroupoli, Thrace, Greece

    Konstantinos Vadikolias

  3. Department of Psychiatry and Child Psychiatry, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupoli, Thrace, Greece

    Aspasia Serdari

Authors
  1. Maria Mantzorou
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  2. Konstantinos Vadikolias
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  3. Eleni Pavlidou
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  4. Christina Tryfonos
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  5. Georgios Vasios
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  6. Aspasia Serdari
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  7. Constantinos Giaginis
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Contributions

CG, VK, and SA designed the study. MM, EP, and CT carried out the study. CG and GV analysed the data. MM and CG wrote the article.

Corresponding authors

Correspondence to Maria Mantzorou or Constantinos Giaginis.

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There is no conflict of interest.

Ethical approval

The study was approved by the Bioethics Comittee of the University of the Aegean and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki.

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All participants were informed about the purpose of the study and signed a consent form.

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Mantzorou, M., Vadikolias, K., Pavlidou, E. et al. Mediterranean diet adherence is associated with better cognitive status and less depressive symptoms in a Greek elderly population. Aging Clin Exp Res 33, 1033–1040 (2021). https://doi.org/10.1007/s40520-020-01608-x

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  • DOI: https://doi.org/10.1007/s40520-020-01608-x

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