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Combination of healthy lifestyle traits may substantially reduce Alzheimer's disease risk & Dietary flavonols too
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Combining more healthy lifestyle behaviors was associated with substantially lower risk for Alzheimer's disease in a study that included data from nearly 3,000 research participants. Those who adhered to four or all of the five specified healthy behaviors were found to have a 60% lower risk of Alzheimer's. The behaviors were physical activity, not smoking, light-to-moderate alcohol consumption, a high-quality diet, and cognitive activities. Funded by the National Institute on Aging (NIA), part of the National Institutes of Health, this research was published in the June 17, 2020, online issue of Neurology, the medical journal of the American Academy of Neurology.
"This observational study provides more evidence on how a combination of modifiable behaviors may mitigate Alzheimer's disease risk," said NIA Director Richard J. Hodes, M.D. "The findings strengthen the association between healthy behaviors and lower risk, and add to the basis for controlled clinical trials to directly test the ability of interventions to slow or prevent development of Alzheimer's disease."
June 17, 2020
Healthy lifestyle and the risk of Alzheimer dementia
Findings from 2 longitudinal studies
In multivariable models, the HRs for Alzheimer dementia per 1 additional healthy behavior in the score were 0.70 (95% CI 0.59-0.83) in CHAP and 0.74 (95% CI 0.66-0.84) in MAP. Across the 2 cohorts, the risk of incident Alzheimer disease was 27% lower per 1 healthy behavior increase in lifestyle score (pooled HR 0.73, 95% CI 0.66-0.80). Furthermore, compared to participants with 0 or 1 healthy behavior, the HRs of Alzheimer dementia in those with 2 or 3 behaviors were 0.58 (95% CI 0.37-0.93) in CHAP and 0.66 (95% CI 0.46-0.94) in MAP, and in those with 4 or 5 healthy behaviors, the HRs were 0.33 (95% CI 0.18-0.61) in CHAP and 0.43 (95% CI 0.28-0.66) in MAP. Across the 2 cohorts, the risk of incident Alzheimer dementia was 37% lower in those with 2 or 3 healthy behaviors (pooled HR 0.63, 95% CI 0.47-0.84) and 60% lower in those with 4 or 5 healthy behaviors (pooled HR 0.40, 95% CI 0.28-0.56) compared to participants with 0 or 1 healthy behaviors (figure).

To quantify the impact of a healthy lifestyle on the risk of Alzheimer dementia.
Using data from the Chicago Health and Aging Project (CHAP; n = 1,845) and the Rush Memory and Aging Project (MAP; n = 920), we defined a healthy lifestyle score on the basis of nonsmoking, ≥150 min/wk moderate/vigorous-intensity physical activity, light to moderate alcohol consumption, high-quality Mediterranean-DASH Diet Intervention for Neurodegenerative Delay diet (upper 40%), and engagement in late-life cognitive activities (upper 40%), giving an overall score ranging from 0 to 5. Cox proportional hazard models were used for each cohort to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the lifestyle score with Alzheimer dementia, and a random-effect meta-analysis was used to pool the results.
During a median follow-up of 5.8 years in CHAP and 6.0 years in MAP, 379 and 229 participants, respectively, had incident Alzheimer dementia.
In multivariable-adjusted models, the pooled HR (95% CI) of Alzheimer dementia across 2 cohorts was 0.73 (95% CI 0.66-0.80) per each additional healthy lifestyle factor. Compared to participants with 0 to 1 healthy lifestyle factor, the risk of Alzheimer dementia was 37% lower (pooled HR 0.63, 95% CI 0.47-0.84) in those with 2 to 3 healthy lifestyle factors and 60% lower (pooled HR 0.40, 95% CI 0.28-0.56) in those with 4 to 5 healthy lifestyle factors.

A healthy lifestyle as a composite score is associated with a substantially lower risk of Alzheimer's dementia.
April 21, 2020; 94 (16) Article
Dietary flavonols and risk of Alzheimer dementia
Conclusion Higher dietary intakes of flavonols may be associated with reduced risk of developing Alzheimer dementia.
The bioactive contents of the food items were multiplied by the intake frequency and summed across all FFQ items. The top food item contributors to the individual flavonols in our cohort were kale, beans, tea, spinach, and broccoli for kaempferol; tomatoes, kale, apples, and tea for quercetin; tea, wine, kale, oranges, and tomatoes for myricetin; and pears, olive oil, wine, and tomato sauce for isorhamnetin. Energy adjustment of nutrients was computed using the regression residual method.13 Flavonol intakes were based on the first completed valid FFQ, the analytic baseline for each participant in the analyses of incident Alzheimer dementia.
In this community-based prospective study of older persons, we found evidence that higher flavonol intake through food sources, and kaempferol and isorhamnetin in particular, may be protective against the development of Alzheimer dementia. The associations were independent of many diet and lifestyle factors and cardiovascular-related conditions.
Our findings suggest that dietary intake of flavonols may reduce the risk of developing Alzheimer dementia. Confirmation of these findings is warranted through other longitudinal epidemiologic studies and clinical trials in addition to further elucidation of the biologic mechanisms. Although there is more work to be done, the associations that we observed are promising and deserve further study.
Flavonoids are a class of polyphenol representing more than 5,000 bioactive compounds that are found in a variety of fruits and vegetables.
A number of flavonoid classes, including flavonols, are known to have antioxidant and anti-inflammatory properties.1,-,4 Two previous studies reported that high levels of flavonoid intakes are associated with lower risk of Alzheimer dementia1,5 but to date, there has not been investigation of the flavonol subclass in humans, even though it is the most abundant flavonoid in foods. Animal studies have demonstrated that dietary flavonols improved memory and learning and decreased severity of Alzheimer disease neuropathology including β-amyloid, tauopathy, and microgliosis.6,7 In this study, we related dietary intakes of flavonols, including kaempferol, quercetin, myricetin, and isorhamnetin, to the development of Alzheimer dementia in a large community study.
Participants with the highest intake of total flavonols had higher levels of education and were more likely to participate in physical and cognitive activities (table 1). Spearman correlation coefficients among dietary intakes of the individual flavonols were low to moderate (range of r = 0.14 to r = 0.51), as were the correlations of flavonols to high-quality diet scores (Dietary Approaches to Stop Hypertension [DASH], Mediterranean, and Mediterranean-DASH Intervention for Neurodegenerative Delay [MIND]) (r = 0.13-0.48). Dietary intakes of total flavonols (figure 1) and the flavonol constituents were statistically significantly associated with reduced risk of Alzheimer dementia (table 2).
Participants in the highest vs lowest quintiles of total flavonol intake had a 48% lower rate of developing AD in the basic-adjusted model including the covariates age, sex, education, APOE ɛ4, late-life cognitive activity, and physical activity (table 2). Among the flavonol constituents, isorhamnetin, kaempferol (figure 2), and myricetin were each associated with a reduction in the rate of incident AD, with reductions of 38%, 50%, and 38%, respectively, for persons in the fifth vs first quintiles of intake (table 2). Dietary intake of quercetin was not associated with incident AD (hazard ratio [HR], 0.70; confidence interval [CI], 0.44-1.10). The tests for linear trend were statistically significant for total flavonols and all subclasses except for quercetin (p = 0.06).

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