Low-fat dietary pattern and global cognitive function: Exploratory analyses of the Women's Health Initiative (WHI) randomized Dietary Modification trial

Rowan T Chlebowski; Steve Rapp; Aaron K Aragaki; Kathy Pan; Marian L Neuhouser; Linda G Snetselaar; JoAnn E Manson; Jean Wactawski-Wende; Karen C Johnson; Kathleen Hayden; Laura D Baker; Victor W Henderson; Lorena Garcia; Lihong Qi; Ross L Prentice

doi:10.1016/j.eclinm.2019.100240

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Low-fat dietary pattern and global cognitive function: Exploratory analyses of the Women's Health Initiative (WHI) randomized Dietary Modification trial

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Low-fat dietary pattern and global cognitive function: Exploratory analyses of the Women's Health Initiative (WHI) randomized Dietary Modification trial

Rowan T Chlebowski, Steve Rapp, Aaron K Aragaki, Kathy Pan, Marian L Neuhouser, Linda G Snetselaar, JoAnn E Manson, Jean Wactawski-Wende, Karen C Johnson, Kathleen Hayden, …

EClinicalMedicine, Vol.18, pp.100240-100240

01/2020

DOI: 10.1016/j.eclinm.2019.100240

PMCID: PMC6953641

PMID: 31938786

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Abstract

Meta-analyses of observational studies associate adherence to several dietary patterns with cognitive health. However, limited evidence from full scale, randomized controlled trials precludes causal inference regarding dietary effects on cognitive function. The Women's Health Initiative (WHI) Dietary Modification (DM) randomized trial, in 48,835 postmenopausal women, included a subset of 1,606 WHI Memory Study (WHIMS) participants >= 65 years old, to assess low-fat dietary pattern influence on global cognitive function, evaluated with annual screening (Modified Mini–Mental State Examinations [3MSE]). Participants were randomized by a computerized, permuted block algorithm, stratified by age group and center, to a dietary intervention (40%) to reduce fat intake to 20% of energy and increase fruit, vegetable and grain intake or usual diet comparison groups (60%). The study outcome was possible cognition impairment (failed cognitive function screening) through the 8.5 year (median) dietary intervention. Those failing screening received a comprehensive, multi-phase cognitive function assessment to classify as: no cognitive impairment, mild cognitive impairment, or probable dementia. Exploratory analyses examined the composite endpoint of death after possible cognitive impairment through 18.7 years (median) follow-up. The WHI trials are registered at ClinicalTrials.gov:NCT00000611. Among the 1,606 WHIMS participants, the dietary intervention statistically significantly reduced the incidence of possible cognitive impairment (n = 126; hazard ratio [HR] 0.59 95% confidence interval [CI] 0.38–0. 91, P = 0.01) with HR for dietary influence on subsequent mild cognitive impairment of 0.65 (95% CI 0.35–1.19) and HR of 0.63 (95% CI 0.19–2.10) for probable dementia (PD). Through 18.7 years, deaths from all-causes after possible cognitive impairment were non-significantly lower in the dietary intervention group (0.56% vs 0.77%, HR 0.83 95% CI 0.35 to 2.00, P = 0.16). Adoption of a low-fat eating pattern, representing dietary moderation, significantly reduced risk of possible cognitive impairment in postmenopausal women. Several Institutes of the US National Institutes of Health.

Cognition

Dietary modification

Low-fat dietary pattern

Randomized clinical trial

Women's Health Initiative

Details

Title: Subtitle: Low-fat dietary pattern and global cognitive function: Exploratory analyses of the Women's Health Initiative (WHI) randomized Dietary Modification trial
Creators: Rowan T Chlebowski - Lundquist Institute for Biomedical Innovation and Harbor-UCLA, Torrance, CA, United States
Steve Rapp - Wake Forest School of Medicine, Winston-Salem, NC, United States
Aaron K Aragaki - Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Kathy Pan - Lundquist Institute for Biomedical Innovation and Harbor-UCLA, Torrance, CA, United States
Marian L Neuhouser - Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Linda G Snetselaar - University of Iowa, Iowa City, IA, United States
JoAnn E Manson - Brigham and Women's Hospital, Boston, MA, United States
Jean Wactawski-Wende - University of Buffalo, Buffalo, NY, United States
Karen C Johnson - University of Tennessee, Memphis, TN, United States
Kathleen Hayden - Wake Forest School of Medicine, Winston-Salem, NC, United States
Laura D Baker - Wake Forest School of Medicine, Winston-Salem, NC, United States
Victor W Henderson - Stanford University, Stanford, CA, United States
Lorena Garcia - UC Davis Health, Davis, CA, United States
Lihong Qi - UC Davis Health, Davis, CA, United States
Ross L Prentice - Wake Forest School of Medicine, Winston-Salem, NC, United States
Resource Type: Journal article
Publication Details: EClinicalMedicine, Vol.18, pp.100240-100240
Publisher: Elsevier Ltd
DOI: 10.1016/j.eclinm.2019.100240
PMID: 31938786
PMCID: PMC6953641
ISSN: 2589-5370
eISSN: 2589-5370
Grant note: DOI: 10.13039/100000050, name: National Heart, Lung and Blood Institute, award: N01WH22110; DOI: 10.13039/100000002, name: National Institutes of Health; name: Department of Health and Human Services, award: 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, 44221
Language: English
Date published: 01/2020
Academic Unit: Epidemiology; Fraternal Order of Eagles Diabetes Research Center; Internal Medicine
Record Identifier: 9984215047502771

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