Skip to main content
SpringerLink
Log in

Are a healthy diet and physical activity synergistically associated with cognitive functioning in older adults?

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

Previous research has demonstrated that being both physically active and adhering a healthy diet is associated with improved cognitive functioning; however, it remains unclear whether these factors act synergistically. We investigated the synergistic association of a healthy diet and being physically active with cognitive functioning.

Design

Cross-sectional study.

Setting and participants

Data from the Longitudinal Aging Study Amsterdam (LASA) were used. We analyzed data from 2,165 community dwelling adults who were aged 55-85 years, 56% of whom were female. Cognitive functioning was assessed by the Mini-Mental State Examination (MMSE), an MMSE score of >26 indicates good cognitive functioning. Physical activity was assessed by the LASA Physical Activity Questionnaire and was considered sufficient if the person engaged in moderately intense physical activity ≥ 20 min/day. A healthy diet score was based on the intake of fruit, vegetables and fish. Each of the food groups was assigned a score that ranged from 1 (well below the Dutch guideline for a healthy diet) to 4 (well above the Dutch guideline for a healthy diet), and the scores were aggregated to determine a healthy diet (healthy ≥ 9 points). Multiple logistic and linear regression analyses were used to examine the (synergistic) association among physical activity, a healthy diet and cognitive functioning. All analyses were adjusted for potential chronic diseases and lifestyle confounders.

Results

Of all of the participants, 25% were diagnosed with a cognitive impairment (MMSE ≤26), 80% were physically active and 41% had a healthy diet. Sixty three percent of the participants both adhered to a healthy diet and were physically active. Sufficient daily physical activity (OR=2.545 p<.001) and adherence to a healthy diet (OR=1.766 p=.002) were associated with good cognitive functioning. After adjusting for confounding factors, sufficient physical activity was not significantly related to cognitive functioning (p=.163); however adherence to a healthy diet remained significantly associated with good cognitive functioning (p=.017). No interaction among sufficient physical activity, healthy diet adherence and good cognitive functioning was observed (crude: p=.401, adjusted: p=.216).

Conclusion

The results of this cross-sectional study indicate that adherence to a healthy diet is independently related to cognitive functioning. Being physically active does not modify this association. Furthermore, these two lifestyle factors do not synergistically relate to cognitive functioning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table 1
Table 2
Table 3
Figure 1
Table 4

Similar content being viewed by others

References

  1. de Lange J. Dementie samengevat [dementia in a nutshell]. 2007; Available at: http://www.nationaalkompas.nl/gezondheid-en-ziekte/ziekten-en-aandoeningen/psychische-stoornissen/dementie/dementie-samengevat. Accessed 02-13, 2013.

    Google Scholar 

  2. Alzheimer’s disease international. Policy brief for heads of government: the global impact of dementia 2013-2015. Londons Alzheimer’s disease international 2013.

    Google Scholar 

  3. World Health Organization. Dementia: a public health priority.: World Health Organization; 2012.

    Google Scholar 

  4. Angevaren M, Aufdemkampe G, Verhaar H, Aleman A, Vanhees L. Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. Cochrane Database Syst Rev 2008;3(3).

    Google Scholar 

  5. Angevaren M, Vanhees L, Nooyens AC, Wendel-Vos C, Verschuren W. Physical activity and 5-year cognitive decline in the Doetinchem cohort study. Ann Epidemiol 2010;20(6):473–479.

    Article  PubMed  Google Scholar 

  6. Féart C, Samieri C, Rondeau V, Amieva H, Portet F, Dartigues J, et al. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA 2009;302(6):638–648.

    Article  PubMed  PubMed Central  Google Scholar 

  7. González-Gross M, Marcos A, Pietrzik K. Nutrition and cognitive impairment in the elderly. Br J Nutr 2001;86(03):313–321.

    Article  PubMed  Google Scholar 

  8. Kramer AF, Erickson KI, Colcombe SJ. Exercise, cognition, and the aging brain. J Appl Physiol (1985) 2006 Oct;101(4):1237–1242.

    Article  Google Scholar 

  9. Peneau S, Galan P, Jeandel C, Ferry M, Andreeva V, Hercberg S, et al. Fruit and vegetable intake and cognitive function in the SU.VI.MAX 2 prospective study. Am J Clin Nutr 2011 Nov;94(5):1295–1303.

    Article  CAS  PubMed  Google Scholar 

  10. Scarmeas N, Stern Y, Mayeux R, Luchsinger JA. Mediterranean diet, Alzheimer disease, and vascular mediation. Arch Neurol 2006;63(12):1709–1717.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Scarmeas N, Luchsinger JA, Schupf N, Brickman AM, Cosentino S, Tang MX, et al. Physical activity, diet, and risk of Alzheimer disease. JAMA 2009;302(6):627–637.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Scarmeas N, Stern Y, Mayeux R, Manly J, Schupf N, Luchsinger JA. Mediterranean diet and mild cognitive impairment. Archives of Neurology 2009;66(2):216–225.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Voss MW, Nagamatsu LS, Liu-Ambrose T, Kramer AF. Exercise, brain, and cognition across the life span. J Appl Physiol (1985) 2011 Nov;111(5):1505–1513.

    Article  Google Scholar 

  14. Yaffe K, Barnes D, Nevitt M, Lui L, Covinsky K. A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med 2001;161(14):1703–1708.

    Article  CAS  PubMed  Google Scholar 

  15. Crichton G, Elias M, Davey A, Alkerwi A, Dore G. Higher cognitive performance is prospectively associated with healthy dietary choices: the Maine Syracuse Longitudinal Study. The journal of prevention of Alzheimer’s disease 2015(01).

    Google Scholar 

  16. Mosconi L, Murray J, Tsui W, Li Y, Davies M, Williams S, et al. Mediterranean Diet and Magnetic Resonance Imaging-Assessed Brain Atrophy in Cognitively Normal Individuals at Risk for Alzheimer’s Disease. The journal of prevention of Alzheimer’s disease 2014;1(1):23.

    PubMed  PubMed Central  Google Scholar 

  17. van de Rest O, Berendsen AA, Haveman-Nies A, de Groot LC. Dietary patterns, cognitive decline, and dementia: a systematic review. Adv Nutr 2015 Mar 13;6(2):154–168.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Eggermont LH, Milberg WP, Lipsitz LA, Scherder EJ, Leveille SG. Physical activity and executive function in aging: the MOBILIZE Boston Study. J Am Geriatr Soc 2009;57(10):1750–1756.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kang JH, Ascherio A, Grodstein F. Fruit and vegetable consumption and cognitive decline in aging women. Ann Neurol 2005;57(5):713–720.

    Article  PubMed  Google Scholar 

  20. Nooyens AC, Bueno-de-Mesquita HB, van Boxtel MP, van Gelder BM, Verhagen H, Verschuren W. Fruit and vegetable intake and cognitive decline in middle-aged men and women: the Doetinchem Cohort Study. Br J Nutr 2011;106(05):752–761.

    Article  CAS  PubMed  Google Scholar 

  21. Solfrizzi V, Panza F, Capurso A. The role of diet in cognitive decline. J Neural Transm 2003;110(1):95–110.

    CAS  PubMed  Google Scholar 

  22. Kalmijn S, Feskens EJ, Launer LJ, Kromhout D. Polyunsaturated fatty acids, antioxidants, and cognitive function in very old men. Am J Epidemiol 1997 Jan 1;145(1):33–41.

    Article  CAS  PubMed  Google Scholar 

  23. Arab L, Sabbagh MN. Are certain lifestyle habits associated with lower Alzheimer’s disease risk? J Alzheimer’s Dis 2010;20(3):785–794.

    Google Scholar 

  24. Panza F, Solfrizzi V, Colacicco A, D’introno A, Capurso C, Torres F, et al. Mediterranean diet and cognitive decline. Public Health Nutr 2004;7(07):959–963.

    Article  CAS  PubMed  Google Scholar 

  25. Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr 1995 Jun;61(6 Suppl):1402S–1406S.

    CAS  PubMed  Google Scholar 

  26. Knopman DS. Mediterranean diet and late-life cognitive impairment: a taste of benefit. JAMA 2009;302(6):686–687.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. van Praag H. Exercise and the brain: something to chew on. Trends Neurosci 2009;32(5):283–290.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wu A, Ying Z, Gomez-Pinilla F. Docosahexaenoic acid dietary supplementation enhances the effects of exercise on synaptic plasticity and cognition. Neuroscience 2008;155(3):751–759.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Elmadfa I, Meyer A, Nowak V, Hasenegger V, Putz P, Verstraeten R, et al. European Nutrition and Health Report 2009. Ann Nutr Metab 2009 Oct;55 Suppl 2:1–40.

    Article  PubMed  Google Scholar 

  30. The Netherlands Nutrition Centre Foundation. Schijf van vijf [Dutch disc of five for nutrition]. 2013; Available at: http://www.voedingscentrum.nl/nl/schijf-van-vijf/eetveel-groente-fruit-en-brood.aspx. Accessed 02-26, 2012.

    Google Scholar 

  31. Health Council of the Netherlands. Richtlijnen goede voeding 2006 [Guidelines for a healthy diet 2006]. The Hague: Health Council of the Netherlands 2006;2006/21.

    Google Scholar 

  32. Huisman M, Poppelaars J, van der Horst M, Beekman AT, Brug J, van Tilburg TG, et al. Cohort profile: the Longitudinal Aging Study Amsterdam. Int J Epidemiol 2011 Aug;40(4):868–876.

    Article  PubMed  Google Scholar 

  33. Visser M. Diet and food consumption. 2012; Available at: http://lasa-vu.nl/themes/physical/dietandfoodconsumption.htm. Accessed 04-16, 2014.

    Google Scholar 

  34. Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992.

    Google Scholar 

  35. Van den Berg, Gerard J, Deeg DJ, Lindeboom M, Portrait F. The Role of Early-Life Conditions in the Cognitive Decline due to Adverse Events Later in Life*. The Economic Journal 2010;120(548):F411-F428.

    Article  Google Scholar 

  36. Williams JW, Plassman BL, Burke J, Holsinger T, Benjamin S. Preventing Alzheimer’s disease and cognitive decline. 2010.

    Google Scholar 

  37. Balash Y, Mordechovich M, Shabtai H, Giladi N, Gurevich T, Korczyn A. Subjective memory complaints in elders: depression, anxiety, or cognitive decline? Acta Neurológica Scandinavica 2013;127(5):344–350.

    Article  CAS  PubMed  Google Scholar 

  38. Comijs HC, Deeg DJH. Vroege predictoren van dementie [early predictors of dementia]. Longitudinal Aging Study Amsterdam (LASA) 2006.

    Google Scholar 

  39. Dik MG, Jonker C, Comijs HC, Bouter LM, Twisk JW, van Kamp GJ, et al. Memory complaints and APOE-epsilon4 accelerate cognitive decline in cognitively normal elderly. Neurology 2001 Dec 26;57(12):2217–2222.

    Article  CAS  PubMed  Google Scholar 

  40. Monsch AU, Foldi N, Ermini-Fünfschillin D, Berres M, Taylor K, Seifritz E, et al. Improving the diagnostic accuracy of the Mini-Mental State Examination. Acta Neurol Scand 1995;92(2):145–150.

    Article  CAS  PubMed  Google Scholar 

  41. Hu FB, Rimm E, Smith-Warner SA, Feskanich D, Stampfer MJ, Ascherio A, et al. Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am J Clin Nutr 1999 Feb;69(2):243–249.

    CAS  PubMed  Google Scholar 

  42. Jia X, Craig LC, Aucott LS, Milne AC, McNeill G. Repeatability and validity of a food frequency questionnaire in free-living older people in relation to cognitive function. J Nutr Health Aging 2008;12(10):735–741.

    CAS  PubMed  Google Scholar 

  43. Smith W, Mitchell P, Reay EM, Webb K, Harvey PW. Validity and reproducibility of a self-administered food frequency questionnaire in older people. Aust N Z J Public Health 1998;22(4):456–463.

    Article  CAS  PubMed  Google Scholar 

  44. Willett WC, Sampson L, Stampfer MJ, Rosner B, Bain C, Witschi J, et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 1985 Jul;122(1):51–65.

    CAS  PubMed  Google Scholar 

  45. Stel VS, Smit JH, Pluijm SM, Visser M, Deeg DJ, Lips P. Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer. J Clin Epidemiol 2004;57(3):252–258.

    Article  PubMed  Google Scholar 

  46. Wendel-Vos G. Wat zijn redenen om veel, weinig of niet te bewegen? [reasons for limitation or avoidance of leasure time physical activity]. 2012; Available at: http://www.nationaalkompas.nl/gezondheidsdeterminanten/leefstijl/lichamelijke-activiteit/wat-zijn-de-mogelijke-oorzaken-van-onvoldoende-lichamelijke-activiteit/. Accessed 02-19, 2013.

    Google Scholar 

  47. Beekman AT, Deeg D, Van Limbeek J, Braam A, De Vries M, Van Tilburg W. Criterion validity of the Center for Epidemiologic Studies Depression scale (CESD): results from a community-based sample of older subjects in The Netherlands. Psychol Med 1997;27(1):231–236.

    Article  CAS  PubMed  Google Scholar 

  48. Dutch malnutrition steering group. What is malnutrition? 2010; Available at: http://www.stuurgroepondervoeding.nl/index.php?id=171. Accessed 02/28, 2013.

    Google Scholar 

  49. van Gelder BM, Tijhuis M, Kalmijn S, Kromhout D. Fish consumption, n-3 fatty acids, and subsequent 5-y cognitive decline in elderly men: the Zutphen Elderly Study. Am J Clin Nutr 2007 Apr;85(4):1142–1147.

    PubMed  Google Scholar 

  50. Beydoun MA, Kaufman JS, Sloane PD, Heiss G, Ibrahim J. n–3 Fatty acids, hypertension and risk of cognitive decline among older adults in the Atherosclerosis Risk in Communities (ARIC) study. Public Health Nutr 2008;11(01):17–29.

    Article  PubMed  Google Scholar 

  51. Dullemeijer C, Durga J, Brouwer IA, van de Rest O, Kok FJ, Brummer RJ, et al. N 3 Fatty Acid Proportions in Plasma and Cognitive Performance in Older Adults. Am J Clin Nutr 2007 Nov;86(5):1479–1485.

    CAS  PubMed  Google Scholar 

  52. Morris MC, Evans DA, Tangney CC, Bienias JL, Wilson RS. Fish consumption and cognitive decline with age in a large community study. Arch Neurol 2005;62(12):1849–1853.

    Article  PubMed  Google Scholar 

  53. Morris MC, Evans DA, Tangney CC, Bienias JL, Wilson RS. Associations of vegetable and fruit consumption with age-related cognitive change. Neurology 2006 Oct 24;67(8):1370–1376.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Royston P, Altman DG, Sauerbrei W. Dichotomizing continuous predictors in multiple regres-sion: a bad idea. Stat Med 2006;25(1):127–141.

    Article  PubMed  Google Scholar 

  55. Smith PJ, Blumenthal JA, Hoffman BM, Cooper H, Strauman TA, Welsh-Bohmer K, et al. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med 2010 Apr;72(3):239–252.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Laurin D, Verreault R, Lindsay J, MacPherson K, Rockwood K. Physical activity and risk of cognitive impairment and dementia in elderly persons. Arch Neurol 2001;58(3):498–504.

    Article  CAS  PubMed  Google Scholar 

  57. Gil A, Martinez de Victoria E, Olza J. Indicators for the evaluation of diet quality. Nutr Hosp 2015 Feb 26;31 Suppl 3:128–144.

    PubMed  Google Scholar 

  58. Guenther PM, Kirkpatrick SI, Reedy J, Krebs-Smith SM, Buckman DW, Dodd KW, et al. The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans. J Nutr 2014 Mar;144(3):399–407.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Schwingshackl L, Hoffmann G. Diet Quality as Assessed by the Healthy Eating Index, the Alter-nate Healthy Eating Index, the Dietary Approaches to Stop Hypertension Score, and Health Outcomes: A Systematic Review and Meta-Analysis of Cohort Studies. Journal of the Academy of Nutrition and Dietetics 2015;115(5):780–800. e5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied, Sciences, Groningen, Netherlands

    Willemke Nijholt, H. Jager-Wittenaar, C. P. Van Der Schans & J. S. M. Hobbelen

  2. Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical, Center Groningen, Groningen, Netherlands

    H. Jager-Wittenaar

  3. Department of Health Sciences, VU University Amsterdam, Amsterdam, Netherlands

    M. Visser

  4. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands

    M. Visser

  5. Department of Rehabilitation Medicine, University of Groningen, University Medical Center, Groningen, Netherlands

    C. P. Van Der Schans

Authors
  1. Willemke Nijholt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Jager-Wittenaar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Visser
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. P. Van Der Schans
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. S. M. Hobbelen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Willemke Nijholt.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nijholt, W., Jager-Wittenaar, H., Visser, M. et al. Are a healthy diet and physical activity synergistically associated with cognitive functioning in older adults?. J Nutr Health Aging 20, 525–532 (2016). https://doi.org/10.1007/s12603-015-0610-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-015-0610-0

Key words

Search

Navigation