Adherence to a healthy lifestyle and brain structural imaging markers
Authors: Pan Yuesong , Shen Jie , Cai Xueli , Chen Hui , Zong Geng , Zhu Wanlin , Jing Jing , Liu Tao , Jin Aoming , Wang Yilong , Meng Xia , Yuan Changzheng , Wang Yongjun 
Published: August 2022

Objective

To investigate the association of adherence to a healthy lifestyle with a panel of brain structural markers in middle-aged and older adults.

Design

Cross-sectional and prospective study design.

Setting

PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study in China and UK Biobank (UKB).

Participants

2,413 participants in PRECISE and 19,822 participants in UKB.

Exposures

A healthy lifestyle score (0-5) was constructed based on five modifiable lifestyle factors: healthy diet, physically active, non-current-smoking, non-alcohol consumption (in PRECISE)/moderate alcohol consumption (in UKB), and healthy body weight.

Main Outcomes

Validated multimodal neuroimaging markers were derived from brain magnetic resonance imaging (MRI).

Results

In the cross-sectional analysis of PRECISE, participants who adopted four or five low-risk lifestyle factors had larger total brain volume (TBV; β= 0.12, 95%CI: - 0.02, 0.26; p-trend = 0.048) and gray matter volume (GMV; β= 0.16, 95%CI: 0.01, 0.30; p-trend = 0.047), smaller white matter hyperintensity volume (WMHV; β= -0.35, 95%CI: -0.50, -0.20; p-trend <0.001) and lower odds of lacune (Odds Ratio [OR]=0.48, 95%CI: 0.22, 1.08; p-trend = 0.03), compared to those with zero or one low-risk factors. Meanwhile, in the prospective analysis in UKB (with a median of 7.7 years’ follow-up), similar associations were observed between the number of low-risk lifestyle factors (4-5 vs 0-1) and TBV (β= 0.22, 95%CI: 0.16, 0.28; p-trend <0.001), GMV (β= 0.26, 95%CI: 0.21, 0.32; p-trend < 0.001), white matter volume (WMV; β= 0.08, 95%CI: 0.01, 0.15; p-trend = 0.001), hippocampus volume (β= 0.15, 95%CI: 0.08, 0.22; p-trend = <0.001), and WMHV burden (β= -0.23, 95%CI: -0.29, -0.17; p-trend < 0.001). Those with four or five low-risk lifestyle factors showed approximately 2.0-5.8 years of delay in aging of brain structure.

Conclusion

Adherence to a healthier lifestyle was associated with a lower degree of neurodegeneration-related brain structural markers in middle-aged and older adults.

What is already known on this topic

Previous research has linked specific modifiable lifestyle factors to age-related cognitive decline in adults.

Little is known about the potential role of an overall healthy lifestyle in brain structure.

What this study adds

In the cross-sectional analysis of 2,413 participants in China and the prospective analysis of 19,822 participants in UK, participants who adopted 4-5 low-risk lifestyle factors had larger total brain volume and gray matter volume and lower white matter hyperintensity volume, compared to those with 0-1 factors.

The association estimates were equivalent to approximately 2.0-5.8 years of delay in aging of brain structure.

Adherence to a healthier lifestyle was associated with a lower degree of neurodegeneration-related brain structural markers in middle-aged and older adults.