Highlight
– Greater intake of anti-inflammatory foods associates with significantly lower all-cause mortality.
– A trend toward reduced Alzheimer’s disease (AD) mortality is observed with higher anti-inflammatory diet adherence.
– Protective effects are pronounced in men and non-Hispanic White populations.
– Even modest dietary shifts (≥10% calories) toward anti-inflammatory foods may yield mortality risk reduction.
Study Background and Disease Burden
Alzheimer’s disease (AD) remains the leading cause of dementia globally, posing a substantial clinical and socioeconomic burden. Chronic neuroinflammation is increasingly recognized as a critical driver of AD pathogenesis, contributing to neurodegeneration and cognitive decline. Modifiable lifestyle factors—including diet—may influence systemic and central nervous system inflammatory states. Notably, diets rich in anti-inflammatory components have the potential to attenuate neuroinflammation. However, direct evidence linking adherence to anti-inflammatory dietary patterns with AD-specific mortality has been limited. Understanding this relationship is imperative to identify accessible preventive strategies for at-risk populations.
Study Design
This investigation analyzed data from 18,795 adults aged 18 years and older participating in the 2007-2014 National Health and Nutrition Examination Survey (NHANES), a representative cohort of the U.S. population. Adherence to an anti-inflammatory diet was quantified as the percentage of total caloric intake derived from foods with anti-inflammatory properties, categorized into four groups: 0%, <5%, 5-9.99%, and ≥10%. Mortality outcomes included AD-specific mortality and all-cause mortality, ascertained via linkage to the National Death Index through 2019.
The analysis utilized Cox proportional hazards models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting for demographic factors (age, sex, race/ethnicity), lifestyle variables (smoking, physical activity), and clinical covariates (comorbidities). Subgroup stratification by sex, race/ethnicity, and for AD mortality, age ≥45 years, were conducted to examine differential associations.
Key Findings
Participants with 0% anti-inflammatory dietary intake exhibited a markedly elevated all-cause mortality risk compared to those with ≥10% intake (HR 3.82; 95% CI 1.18-12.33). This underscores the substantial survival benefit conferred by even a modest proportion of anti-inflammatory foods in the diet.
Regarding AD-specific mortality, the overall cohort demonstrated a non-significant trend toward increased risk with zero anti-inflammatory intake after full adjustments (HR 3.04; 95% CI 0.74-12.46; p>0.05). However, significant associations emerged upon subgroup analyses:
– Male participants with 0% anti-inflammatory intake had dramatically higher AD mortality risk compared to those with ≥10% (HR 12.83).
– Similarly, non-Hispanic White adults with no anti-inflammatory intake faced elevated AD mortality hazards (HR 3.77).
In contrast, no statistically significant associations were noted for female or non-White subpopulations, suggesting potential biological, behavioral, or environmental modifiers.
Importantly, adherence to even minimal anti-inflammatory intake (≥10% of calories) correlated with lower AD-specific and all-cause mortality risks for these susceptible subgroups. These findings highlight that achievable dietary modifications could translate into meaningful clinical benefits.
Expert Commentary
The study by Hsu et al. provides compelling epidemiologic evidence linking dietary inflammation modulation to mortality outcomes pertinent to AD. Neuroinflammation is a recognized pathomechanism in AD, fueled by systemic pro-inflammatory states influenced by diet. Anti-inflammatory foods — including fruits, vegetables, whole grains, omega-3-rich fish, and nuts — confer antioxidants and bioactive compounds that may reduce neuroinflammatory cascades via multiple pathways such as inhibition of microglial activation and modulation of gut microbiota.
The differential impact observed by sex and race/ethnicity warrants further investigation. Potential explanations include genetic differences in inflammatory responses, disparities in dietary patterns or metabolic traits, and interactions with other social determinants of health. Future research integrating molecular biomarkers and intervention trials is essential to elucidate mechanisms and optimize personalized nutrition strategies.
Limitations include reliance on self-reported dietary data subject to recall bias, observational design precluding causal inference, and residual confounding despite multivariable adjustments. Nonetheless, the nationally representative sample enhances generalizability within the U.S. adult population.
Conclusion
The association between higher adherence to an anti-inflammatory diet and reduced mortality highlights a promising, practical avenue for AD risk mitigation. Particularly for men and non-Hispanic Whites, even modest consumption of anti-inflammatory foods appears to confer protective effects on survival and neurodegenerative outcomes. Incorporating dietary recommendations targeting inflammation reduction could form part of comprehensive public health strategies to diminish AD burden.
Ongoing research should aim to clarify underlying mechanisms, explore effectiveness in diverse populations, and establish evidence-based dietary guidelines tailored for neuroprotection. Clinicians are encouraged to discuss anti-inflammatory dietary patterns with patients as a low-cost, accessible intervention with potential multifaceted benefits.
References
Hsu CC, Wang SI, Yu S, Lin ES, Wei JC. Adherence to an anti-inflammatory diet is associated with lower Alzheimer’s disease mortality: A modifiable risk factor in a national cohort. J Prev Alzheimers Dis. 2025 Sep;12(8):100221. doi: 10.1016/j.tjpad.2025.100221. Epub 2025 Jun 13. PMID: 40517083.
Additional supporting literature:
– Heneka MT, et al. Neuroinflammation in Alzheimer’s disease. Lancet Neurol. 2015 Apr;14(4):388-405.
– Liu S, et al. Dietary patterns and risk of dementia: a systematic review and meta-analysis. Nutrients. 2020;12(12):3867.
– Grosso G, et al. Mediterranean Diet and Cardiovascular Risk: Epidemiological Evidence and Mechanistic Insights. Curr Pharm Des. 2014;20(31):5037-5046.
