地中海式饮食和运动降低阿尔茨海默病的患病风险.doc

地中海式饮食和运动降低阿尔茨海默病的患病风险Physical activity, diet, and risk of Alzheimer disease. 出处：JAMA 2009Aug302(6) :627-37 作者：Scarmeas N;Luchsinger JA;Schupf N;Brickman AM;Cosentino S;Tang MX;Stern YPMID：19671904相 关 文 章坚持地中海饮食在中年人中与循环IL-6呈负相关：双胞胎研究Aph1亚基分泌酶的异质性：与阿尔茨海默病的相关性亲环蛋白D缺陷减弱了阿尔茨海默病的线粒体和神经元扰动并改善学习和记忆能力临床前阿尔茨海默病的新证据：认知障碍老龄化的神经病理学改变 家庭型饮食和运动疗法对长期患有癌症且超重的老年生存患者器官功能的疗效： RENEW：一项随机对照试验 背景：高度坚持地中海式饮食以及大量运动与阿兹海默病患病风险降低具有独立相关性，然而，饮食与运动结合起来对AD的影响尚未被研究过。目的：研究饮食与运动结合起来对AD患病风险的影响。设计、背景及病人：这项前瞻性队列研究包括2组来自纽约市的1880名老年居民，受试者在研究开始时均未患老年痴呆症，且均可获取有关饮食和运动的有关资讯。此外，在1992年至2006年期间，大约每隔1.5年均会接受标准的神经内科和神经心理学评估。接受的评估有：对地中海式饮食的坚持程度（0-9级，划分为低、中或高度）以及运动（即每周参加不同运动的总和，用运动类型 轻度、中度、剧烈 进行加权；划分为：不运动、少量运动或大量运动；再分别分为低度或高度）；进行单独和综合性评估，上述指标是Cox模型的主要预测指标。对受试者队列、年龄、性别、种族、教育程度、载脂蛋白E基因型、热量摄入情况、体重指数、吸烟状况、是否患有抑郁、休闲活动、合并症指数以及临床痴呆评定量表基线值进行调整。主要检测结果：发生AD的时间。结果：个人平均随访时间为5.4(3.3)年，在这期间有282名受试者患有AD。当同时考虑坚持地中海式饮食和运动这两个因素时，发现它们与AD发病率降低有显著相关性：与低度坚持地中海式饮食的受试者相比，中度坚持者的危险比HR为0.98 95%的可信区间CI为0.72-1.33；高度坚持者的危险比为0.60 95% 的可信区间为0.42-0.87；P值趋向于.008；与不参加运动的受试者相比，少量运动者的危险比为0.75 95%的可信区间为0.54-1.04; 大量运动者的危险比为0.67 95%的可信区间为0.47-0.95；P值趋向于.03。与既不坚持地中海式饮食又不参加运动的受试者(即低度坚持地中海式饮食且不运动；AD的绝对患病风险为19%)相比，那些既坚持地中海式饮食又参加运动的受试者(即高度坚持地中海式饮食且参加大量运动)AD的患病风险降低(绝对患病风险为12%；危险比为0.65 95%的可信区间为0.44-0.96；P值趋向于 .03)。结论：在这项研究中，我们发现，对地中海式饮食的坚持程度越高，运动量越大，AD的患病风险就越小，且这两者与AD患病风险降低独立相关。CONTEXT: Both higher adherence to a Mediterranean-type diet and more physical activity have been independently associated with lower Alzheimer disease (AD) risk but their combined association has not been investigated. OBJECTIVE: To investigate the combined association of diet and physical activity with AD risk. DESIGN, SETTING, AND PATIENTS: Prospective cohort study of 2 cohorts comprising 1880 community-dwelling elders without dementia living in New York, New York, with both diet and physical activity information available. Standardized neurological and neuropsychological measures were administered approximately every 1.5 years from 1992 through 2006. Adherence to a Mediterranean-type diet (scale of 0-9; trichotomized into low, middle, or high; and dichotomized into low or high) and physical activity (sum of weekly participation in various physical activities, weighted by the type of physical activity light, moderate, vigorous; trichotomized into no physical activity, some, or much; and dichotomized into low or high), separately and combined, were the main predictors in Cox models. Models were adjusted for cohort, age, sex, ethnicity, education, apolipoprotein E genotype, caloric intake, body mass index, smoking status, depression, leisure activities, a comorbidity index, and baseline Clinical Dementia Rating score. MAIN OUTCOME MEASURE: Time to incident AD. RESULTS: A total of 282 incident AD cases occurred during a mean (SD) of 5.4 (3.3) years of follow-up. When considered simultaneously, both Mediterranean-type diet adherence (compared with low diet score, hazard ratio HR for middle diet score was 0.98 95% confidence interval CI, 0.72-1.33; the HR for high diet score was 0.60 95% CI, 0.42-0.87; P = .008 for trend) and physical activity (compared with no physical activity, the HR for some physical activity was 0.75 95% CI, 0.54-1.04; the HR for much physical activity was 0.67 95% CI, 0.47-0.95; P = .03 for trend) were associated with lower AD risk. Compared with individuals neither adhering to the diet nor participating in physical activity (low diet score and no physical activity; absolute AD risk of 19%), those both adhering to the diet and participating in physical activity (high diet score and high physical activity) had a lower risk of AD (absolute risk, 12%; HR, 0.65 95% CI, 0.44-0.96; P = .03 for trend). CONCLUSION: In this study, both higher Mediterranean-type diet adherence and higher physical activity were independently associated with reduced risk for AD.专家评价：Mikael FogelholmAcademy of Finland, FinlandDiabetes & EndocrinologyThe study is an important confirmation of the hypothesis that the risk for Alzheimer disease (AD) can be prevented by both prudent dietary habits (in this study, Mediterranean diet) and higher physical activity. The effects of dietary and physical activity habits were independent of each other.The incidence and prevalence of neurodegenerative diseases, including AD in particular, will increase as a consequence of the changing age distribution. Decreasing the risk or at least postponing the onset of AD is therefore important both from an individual and a population perspective. The present study addressed an important question, namely whether physical activity and diet are associated with lower incidence of AD in an ageing population. The participants were 1880 community-dwelling elderly individuals, mean age 77 years. Data on baseline physical activity and diet were collected using questionnaires. A total of 282 new AD cases occurred during a mean of 5.4 years (SD 3.3) follow-up. High levels of physical activity decreased the risk by 33%. High levels in this study corresponded to approximately 1.3h of vigorous, 2.4h of moderate, or 4h of light physical activity per week. Those who scored high whilst also on a Mediterranean diet (plenty of fruit, vegetables, legumes, cereals, fish; lower intake of meat and dairy products; high ratio of monounsaturated fats to saturated fats; mild to moderate alcohol consumption) had 40% lower incidence of AD. The associations found between physical activity/diet and AD were independent of each other. The publ