International Journal of Clinical Research
International Journal of Clinical Research. 2025; 9: (10) ; 10.12208/j.ijcr.20250464 .
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1 国家康复辅具研究中心，中国老年保健协会营养代谢分会认知学组 北京
2 福建医科大学附属协和医院 福建福州
3 广州医科大学附属第二医院 广东广州
4 深圳前海泰康医院 广东深圳
5 浙江大学医学院附属邵逸夫医院 浙江杭州
6 内蒙古医科大学附属医院 内蒙古呼和浩特
7 上海市精神卫生中心，上海交通大学医学院 上海
8 吉林大学第二医院 吉林长春
9 河北省人民医院 河北石家庄
10 四川大学华西医院 四川成都
11 空军军医大学第二附属医院 陕西西安
12 新疆医科大学第一附属医院 新疆乌鲁木齐
13 天津医科大学总医院 天津
14 重庆医科大学附属大学城医院 重庆
15 哈尔滨医科大学第一附属医院 黑龙江哈尔滨
16 山东省立第三医院 山东济南
17 山西白求恩医院 山西太原
18 首都医科大学附属北京天坛医院 北京
*通讯作者： 魏鹏绪,单位： 国家康复辅具研究中心，中国老年保健协会营养代谢分会认知学组 北京；
包括营养/饮食模式在内的健康生活方式能够降低阿尔茨海默病和其他痴呆的风险。基于相关证据，本专家共识基于GRADE方法及3轮德尔菲法形成，对将健康饮食模式作为AD一级预防和早期干预的核心策略做出强推荐，并为预防和干预阿尔茨海默病及相关痴呆提供以饮食为核心的营养建议。营养干预应该作为健康生活方式中不可或缺的一部分，主要聚焦于健康的饮食模式而非特定的营养素。其目标人群涵盖从认知未受损至痴呆阶段的成人，尤其是风险程度较高的个体（如有AD家族史或为APOE ε4携带者）。实施营养干预需要为认知障碍未受损的个体、轻度认知障碍或痴呆患者提供营养计划，例如饮食指南、健康饮食模式建议或营养处方。估计能量需要量和其他膳食参考摄入量应根据年龄、性别、体重、营养状况、身体活动水平和其他现有健康状况进行个体化调整。应通过各种食物均衡摄入营养素。采用的健康饮食模式应考虑与阿尔茨海默病及相关痴呆预防相关的特定需求，并监测营养干预的效果。此外，实施阿尔茨海默病和相关痴呆症的预防和干预策略不能仅依赖于医疗机构。
A healthy lifestyle, including nutritional/dietary patterns, can reduce the risk of Alzheimer's disease and other dementias. Based on relevant evidence, this expert consensus, developed using the GRADE approach and a three-round Delphi process, strongly recommends a healthy dietary pattern as a core strategy for primary prevention and early intervention of Alzheimer's disease. It also provides dietary-focused nutritional recommendations for the prevention and intervention of Alzheimer's disease and related dementias. Nutritional intervention should be an integral part of a healthy lifestyle, focusing primarily on healthy dietary patterns rather than specific nutrients. The target population ranges from adults with intact cognitive function to those with dementia, particularly those at higher risk (such as those with a family history of AD or APOE ε4 carriers). Nutritional interventions require providing nutritional plans, such as dietary guidelines, recommendations for healthy eating patterns, or nutritional prescriptions, for individuals with intact cognitive function, mild cognitive impairment, or dementia. Estimated energy requirements and other dietary reference intakes should be individualized based on age, sex, weight, nutritional status, physical activity level, and other existing health conditions. Nutrient intake should be balanced across a variety of foods. The adoption of a healthy eating pattern should take into account specific needs related to the prevention of Alzheimer's disease and related dementias, and the effectiveness of nutritional interventions should be monitored. Furthermore, the implementation of prevention and intervention strategies for Alzheimer's disease and related dementias cannot rely solely on medical institutions.
[1] Alzheimer's Disease International. World Alzheimer Report 2015-The Global Impact of Dementia[M]. London: Alzheimer's Disease International, 2015.
[2] WHO. Global status report on the public health response to dementia [M]. Geneva: World Health Organization. 2021.
[3] GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019[J]. Lancet Public Health,2022,7(2):e105-105e125.
[4] Alzheimer's Association. 2020 Alzheimer's disease facts and figures[J]. Alzheimers Dement,2020,16:391–460.
[5] Han J, Du Z, Lim MH. Mechanistic Insight into the Design of Chemical Tools to Control Multiple Pathogenic Features in Alzheimer's Disease[J]. Acc Chem Res,2021,54(20): 3930-3940.
[6] Brito D, Esteves F, Rajado AT, et al. Assessing cognitive decline in the aging brain: lessons from rodent and human studies[J]. NPJ Aging,2023,9(1):23.
[7] Dolgin E. How to defeat dementia[J]. Nature,2016,539 (7628): 156-158.
[8] Jack CR Jr, Bennett DA, Blennow K, et al. NIA-AA Research Framework: Toward a biological definition of Alzheimer's disease[J]. Alzheimers Dement,2018,14(4): 535-562.
[9] Talboom JS, Håberg A, De Both MD, et al. Family history of Alzheimer's disease alters cognition and is modified by medical and genetic factors[J]. Elife,2019,8
[10] Bloss CS, Delis DC, Salmon DP, et al. Decreased cognition in children with risk factors for Alzheimer's disease[J]. Biol Psychiatry,2008,64(10):904-906.
[11] Mantovani E, Zucchella C, Schena F, et al. Towards a Redefinition of Cognitive Frailty[J]. J Alzheimers Dis,2020, 76(3): 831-843.
[12] Morris MC, Evans DA, Bienias JL, et al. Dietary fats and the risk of incident Alzheimer disease[J]. Arch Neurol,2003, 60(2):194-200.
[13] Morris MC, Evans DA, Tangney CC, et al. Associations of vegetable and fruit consumption with age-related cognitive change[J]. Neurology,2006,67(8):1370-1376.
[14] Yu JT, Xu W, Tan CC, et al. Evidence-based prevention of Alzheimer's disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials[J]. J Neurol Neurosurg Psychiatry,2020,91(11):1201-1209.
[15] Shannon OM, Ranson JM, Gregory S, et al. Mediterranean diet adherence is associated with lower dementia risk, independent of genetic predisposition: findings from the UK Biobank prospective cohort study[J]. BMC Med,2023,21(1):81.
[16] WHO. Risk reduction of cognitive decline and dementia: WHO guidelines[M]. Geneva: World Health Organization, 2019.
[17] Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission[J]. Lancet,2024,404(10452): 572-628.
[18] Thomas A, Baillet M, Proust-Lima C, et al. Blood polyunsaturated omega-3 fatty acids, brain atrophy, cognitive decline, and dementia risk[J]. Alzheimers Dement, 2020
[19] Agarwal P, Leurgans SE, Agrawal S, et al. Association of Mediterranean-DASH Intervention for Neurodegenerative Delay and Mediterranean Diets With Alzheimer Disease Pathology[J]. Neurology,2023,100(22):e2259-2259e2268.
[20] Glans I, Sonestedt E, Nägga K, et al. Association Between Dietary Habits in Midlife With Dementia Incidence Over a 20-Year Period[J]. Neurology,2023,100(1):e28-28e37.
[21] Gomes Gonçalves N, Vidal Ferreira N, Khandpur N, et al. Association Between Consumption of Ultraprocessed Foods and Cognitive Decline[J]. JAMA Neurol,2023,80(2): 142-150.
[22] Townsend RF, Logan D, O'Neill RF, et al. Whole Dietary Patterns, Cognitive Decline and Cognitive Disorders: A Systematic Review of Prospective and Intervention Studies[J]. Nutrients,2023, 15: 333.
[23] Liu YH, Gao X, Na M, et al. Dietary Pattern, Diet Quality, and Dementia: A Systematic Review and Meta-Analysis of Prospective Cohort Studies[J]. J Alzheimers Dis,2020, 78(1): 151-168.
[24] Chen H, Dhana K, Huang Y, et al. Association of the Mediterranean Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) Diet With the Risk of Dementia[J]. JAMA Psychiatry,2023, 80(6):630-638.
[25] R Cardoso B, Machado P, Steele EM. Association between ultra-processed food consumption and cognitive performance in US older adults: a cross-sectional analysis of the NHANES 2011-2014[J]. Eur J Nutr,2022,61(8): 3975-3985.
[26] Rong L, Peng Y, Shen Q, et al. Effects of ketogenic diet on cognitive function of patients with Alzheimer's disease: a systematic review and meta-analysis[J]. J Nutr Health Aging,2024,28(8):100306.
[27] Yeung LK, Alschuler DM, Wall M, et al. Multivitamin Supplementation Improves Memory in Older Adults: A Randomized Clinical Trial[J]. Am J Clin Nutr,2023, 118(1):273-282.
[28] Ornish D, Madison C, Kivipelto M, et al. Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer's disease: a randomized, controlled clinical trial[J]. Alzheimers Res Ther,2024,16(1):122.
[29] Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables[J]. J Clin Epidemiol,2011,64(4):383-394.
[30] WHO. Total fat intake for the prevention of unhealthy weight gain in adults and children: WHO guideline[M]. Geneva: World Health Organization, 2023.
[31] National Academies of Sciences, Engineering, and Medicine. Dietary Reference Intakes for Energy. Washington, DC: The National Academies Press.2023.
[32] Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Editors: A Catharine Ross, Christine L Taylor, Ann L Yaktine, and Heather B Del Valle. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US). 2011.
[33] Chinese Nutrition Society. Dietary reference intakes for China (2023 edition)[M]. Beijing: People's Medical Publishing House, 2023.
[34] Heymsfield SB, Shapses SA. Guidance on Energy and Macronutrients across the Life Span[J]. N Engl J Med,2024,390(14):1299-1310.
[35] Dominguez LJ, Barbagallo M. Nutritional prevention of cognitive decline and dementia[J]. Acta Biomed,2018, 89(2):276-290.
[36] U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary guidelines for Americans, 2020–2025. 9th edition[M]. Washington, DC: US Government Publishing Office.2020.
[37] Akbaraly TN, Singh-Manoux A, Dugravot A, et al. Association of Midlife Diet With Subsequent Risk for Dementia[J]. JAMA,2019,321(10):957-968.
[38] Ngandu T, Lehtisalo J, Solomon A, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial[J]. Lancet,2015, 385(9984):2255-2263.
[39] Dhana K, Franco OH, Ritz EM, et al. Healthy lifestyle and life expectancy with and without Alzheimer's dementia: population based cohort study[J]. BMJ,2022,377:e068390.
[40] Pugazhenthi S, Qin L, Reddy PH. Common neurodegenerative pathways in obesity, diabetes, and Alzheimer's disease[J]. Biochim Biophys Acta Mol Basis Dis,2017,1863(5):1037-1045.
[41] Fraser GE, Singh PN, Bennett H. Variables associated with cognitive function in elderly California Seventh-day Adventists[J]. Am J Epidemiol,1996,143(12):1181-1190.
[42] Wang DD, Li Y, Bhupathiraju SN, et al. Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies[J]. Circulation,2021,143(17):1642-1654.
[43] WHO. Carbohydrate intake for adults and children: WHO guideline[M]. Geneva: World Health Organization, 2023.
[44] Reynolds A, Mann J, Cummings J, et al. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses[J]. Lancet,2019,393(10170):434-445.
[45] Gill SK, Rossi M, Bajka B, et al. Dietary fibre in gastrointestinal health and disease[J]. Nat Rev Gastroenterol Hepatol,2021,18(2):101-116.
[46] Agricultural Research Service. Dietary Guidelines Advisory Committee. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. Washington DC: U.S. Department of Agriculture, Agricultural Research Service. 2020.
[47] Morris MC, Wang Y, Barnes LL, et al. Nutrients and bioactives in green leafy vegetables and cognitive decline: Prospective study[J]. Neurology,2018,90(3):e214-214e222.
[48] Wang K, Tang W, Hao X, et al. Ultra-processed food consumption and risk of dementia and Alzheimer's disease: Long-term results from the Framingham Offspring Study[J]. Alzheimers Dement,2023,19(12):5988.
[49] Zhang H, Greenwood DC, Risch HA, et al. Meat consumption and risk of incident dementia: cohort study of 493,888 UK Biobank participants[J]. Am J Clin Nutr,2021,114(1):175-184.
[50] Sala-Vila A, Fleming J, Kris-Etherton P, et al. Impact of α-Linolenic Acid, the Vegetable ω-3 Fatty Acid, on Cardiovascular Disease and Cognition[J]. Adv Nutr,2022, 13(5):1584-1602.
[51] Liu Y, Gu X, Li Y, et al. Changes in fatty acid intake and subsequent risk of all-cause and cause-specific mortality in males and females: a prospective cohort study[J]. Am J Clin Nutr,2024
[52] Tessier AJ, Cortese M, Yuan C, et al. Consumption of Olive Oil and Diet Quality and Risk of Dementia-Related Death[J]. JAMA Netw Open,2024,7(5):e2410021.
[53] Villoz F, Filippini T, Ortega N, et al. Dairy Intake and Risk of Cognitive Decline and Dementia: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies[J]. Adv Nutr,2024,15(1):100160.
[54] Pase MP, Himali JJ, Beiser AS, et al. Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia: A Prospective Cohort Study[J]. Stroke,2017, 48(5):1139-1146.
[55] Daviet R, Aydogan G, Jagannathan K, et al. Associations between alcohol consumption and gray and white matter volumes in the UK Biobank[J]. Nat Commun,2022, 13(1):1175.
[56] Genuis SJ, Kelln KL. Toxicant exposure and bioaccumulation: a common and potentially reversible cause of cognitive dysfunction and dementia[J]. Behav Neurol, 2015,2015:620143.
[57] Domingo-Relloso A, McGraw KE, Heckbert SR, et al. Urinary Metal Levels, Cognitive Test Performance, and Dementia in the Multi-Ethnic Study of Atherosclerosis[J]. JAMA Netw Open,2024,7(12):e2448286.
[58] Tang C, Shen M, Hong H. Uncovering the relationship between trace element exposure, cognitive function, and dietary inflammation index in elderly americans from the National Health and Nutrition Examination Survey 2011-2014[J]. BMC Public Health,2024,24(1):2516.
[59] American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc. 2013.
[60] Jack CR Jr, Andrews JS, Beach TG, et al. Revised criteria for diagnosis and staging of Alzheimer's disease: Alzheimer's Association Workgroup[J]. Alzheimers Dement,2024,20(8):5143-5169.