The association between the Prospective Urban Rural Epidemiology (PURE) healthy diet score and cognitive decline in Chinese older adults

The Prospective Urban Rural Epidemiology (PURE) healthy diet score emphasizes six protective food groups, yet its association with cognitive decline in aging populations remains unclear. This longitudinal analysis of 3106 participants used data from the 1997, 2000, 2004, and 2006 waves of the China Health and Nutrition Survey (CHNS). Dietary quality was measured using the PURE healthy diet score (range 0-6) based on fruits, vegetables, nuts, legumes, fish, and dairy. Cognitive function was assessed repeatedly using modified Telephone Interview for Cognitive Status-modified (TICS-m), yielding global (0-27) and standardized composite cognitive scores. Cognitive decline was defined as the annual rate of change in these scores over time. Linear mixed‑effects models evaluated the association between PURE score and cognitive decline. Over a median of 5.3 years, a higher score was associated with a slower rate of cognitive decline. Compared to a score of 0, those scoring 5-6 had an adjusted 0.42-points/year slower decline in global cognitive score (95%CI: 0.22-0.62; P < 0.001) and a 0.06-SDU/year slower decline in composite cognitive score (95%CI:0.03-0.09; P < 0.001). Higher adherence to the PURE healthy diet score was associated with a modest but statistically significant attenuation of cognitive decline in Chinese older adults, supporting its potential utility for cognitive health promotion.