Eating Fish Can Help Prevent Alzheimer's

Older New Yorkers who eat a Mediterranean-type diet have a reduced risk of developing
Alzheimer's disease (about half the risk, in fact). This seems to have a different mechanism of
action from the known beneficial effects of the diet on cardiovascular conditions.

Older New Yorkers who eat a Mediterranean-type diet have a reduced risk of developing
Alzheimer's disease (about half the risk, in fact). This seems to have a different mechanism of
action from the known beneficial effects of the diet on cardiovascular conditions.

Summary

A Mediterranean-type diet reduces the risk of developing Alzheimer's disease by about 50%.
This is a separate effect from the known benefits of the diet on cardiovascular conditions.

Introduction

The Mediterranean Diet (MD) has been credited with lower risks for several forms of cancer,
obesity, high cholesterol levels, high blood pressure, high blood sugar, coronary heart disease,
and overall mortality. Most recently the diet has been linked with a lower risk of developing
Alzheimer's disease. All this is quite a burden for a diet to bear, and obviously calls for efforts
to discover the 'secret ingredients' that bring the most benefits. Two recent studies published
in the Archives of Neurology have addressed possible ways in which the MD can help prevent
Alzheimer's. We summarize the first one here; the second will be the subject of a subsequent
article on this site.

People living in New York City were studied by researchers from the Taub Institute for
Research on Alzheimer's Disease and the Aging Brain. Dietary patterns were analyzed and
associations sought with Alzheimer's, once the possible role of vascular conditions (such as
stroke, diabetes, high blood pressure and so on) had been discounted. The intent was to
determine if vascular disease(s) represented a link between diet and Alzheimer's. This might
allow interruption of the process by non-dietary means; e.g. antihypertensive medication.

What was done

Two groups of volunteers living in Manhattan were recruited in 1992 and 1999. At baseline a
full medical work-up was done, along with a Clinical Dementia Rating (CDR) test, to assess
the presence of dementia. Apolipoprotein E genotype was determined for each volunteer.

A 61-item food frequency questionnaire was administered by a trained interviewer. A MD

score was constructed using the daily gram intake of beneficial foods in 7 categories: dairy,
meat, fruits, vegetables, legumes, cereals, and fish; fat and alcohol intake were built into the
final MD score. The score ranged theoretically from 0 to 9, with a higher score indicating
higher adherence to a Mediterranean-type diet. The subjects were classified into three groups
(tertiles), according to their MD scores.
Information was gathered on race, level of education, total calorie intake, smoking, body mass
index (BMI), and comorbidities (stroke, diabetes, high blood pressure, heart disease, high
lipid levels).

What was found

The original sample size was over 4100 people, but roughly half were eliminated from the
analysis: those who had no dementia at baseline but developed it during the study, uncertainty
about the CDR score, missing dietary information, and non-calculation of the MD score. This
left 1984 volunteers for analysis. Their average age was 76, and 68% of them were women.

There were 194 subjects with Alzheimer's in the final group analyzed. Compared with non-
demented volunteers, they were older, less well educated, and had lower BMIs. There were
fewer men and more Hispanics in the subjects with Alzheimer's, and they had a higher
incidence of stroke.

As expected, higher adherence to the MD was associated with a reduced risk for Alzheimer's
disease. The average MD score for non-demented subjects was 4.4, and for Alzheimer's
subjects it was 3.8; this difference was statistically significant i.e. it could not have occurred
by chance alone. Those subjects in the highest tertile (the one-third of volunteers with a high
MD score) had 32% of the chance of getting Alzheimer's as those in the lowest (worst) MD
tertile; the middle tertile group were 47% as likely to develop Alzheimer's.

The above risks (odds ratios) were calculated after adjustment for age, sex, race, education,
apolipoprotein E genotype, calorie intake, smoking and BMI. In another calculation,
adjustments were made for co-existing vascular conditions: history of stroke, diabetes, high
blood pressure, heart disease, and lipid abnormalities. When these adjustments were made, the
risk levels were virtually unchanged: 31% for the high tertile, and 48% for the middle tertile
volunteers.

What these findings mean

The main finding - a clear relationship between a high MD intake and a decreased risk of
Alzheimer's - was a confirmation of previous studies. More importantly, the analyses in which
adjustments were made for vascular conditions showed no differences from those for the
whole population. This clearly demonstrates that vascular disease is not the chief factor in the
causation of Alzheimer's disease, as some have thought.

It's possible that the measurement of vascular conditions was not exact enough to have picked
up an important role in the development of Alzheimer's. For instance, measurement of
atherosclerotic plaque in the carotid arteries or coronary artery calcification might have
provided different results; however, this seems unlikely.

One must look for other reasons for the beneficial effects of a Mediterranean diet. These can
be sought either by analyses of specific components of the diet, or by looking at 'markers' in
the body for the action of different components (e.g. a specific omega-3 fatty acid in the
plasma). This latter approach will be the subject of the next article in this series. In the
meantime, eat more fish!