Associations of dietary choline, lutein and zeaxanthin with cognitive function in the Framingham Offspring Study
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Abstract
BACKGROUND: With the rapid aging of populations worldwide, cognitive impairment—including mild cognitive impairment (MCI) and dementia—has emerged as a significant public health concern. Nutritional factors such as choline, lutein, and zeaxanthin have been suggested to play a role in cognitive aging, but their long-term effects remain underexplored.
OBJECTIVES: This study aimed to investigate the prospective associations between dietary intake of choline, lutein, and zeaxanthin and cognitive functioning, including measures of verbal and visual memory, verbal learning, attention and concentration, executive function, abstract reasoning, language, reading, visual-perceptual skills, and global cognitive function among women and men in the Framingham Offspring Study (FOS). In secondary analyses, we also evaluated prospective associations of dietary choline, lutein and zeaxanthin with repeated measures of cognitive function in the FOS. Lastly, we evaluated prospective associations of dietary choline, lutein and zeaxanthin with risk of incident dementia in the FOS.
METHODS: In this prospective cohort study, I analyzed dietary intake data obtained from three-day diet records and neuropsychological test scores in the FOS. Multivariable analysis of covariance models was employed to evaluate the associations between categories of nutrient intake and cognitive performance while adjusting for confounders. The median score value within three categories of choline and lutein and zeaxanthin was used in linear regression models to test for linear trend. We also use linear mixed models to test repeated measures of cognitive outcomes associated with choline, lutein and zeaxanthin. Lastly, logistic regression models were used to estimate relative odds of developing dementia. All models were adjusted for age and sex. Potential confounders were evaluated based on their impact on the age- and sex- adjusted parameter estimates. We retained those variables in the model that changed the parameter estimates by approximately 10% or more.
RESULTS: Higher dietary intake of choline, lutein, and zeaxanthin were associated with better overall cognitive performance using a global cognitive function score. In addition, choline, lutein and zeaxanthin were positively associated with better visual memory and abstract reasoning. Lutein and zeaxanthin intake were more modestly associated with better attention and concentration, language, visuo-perceptual organization and premorbid educational achievement. Participants with moderate or higher intakes of choline, lutein and zeaxanthin (vs. lower) retained better global cognitive function over time. Lastly, higher dietary (vs. lower) choline intake was associated with lower odds of incident dementia.
CONCLUSION: The findings support the hypothesis that higher dietary intake of choline, lutein, and zeaxanthin may contribute to better cognitive function in aging populations. These results highlight the importance of dietary interventions in mitigating cognitive decline and suggest the need for further randomized trials to confirm these associations.
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2025