Associations Between Plant-Based Dietary Patterns and Risks of Cognitive Impairment and Dementia: A Systematic Review and Dose-Response Meta-Analysis - 22/02/26

Doi : 10.1016/j.tjpad.2026.100521

Jui-Hsiu Tsai ^a,^b,^{⁎
Tou-Yuan Tsai, Jui-Hsiu Tsai, and Hua Li contributed equally to this work}, Tou-Yuan Tsai ^b,^c,^d,^e,^f,^{⁎
Tou-Yuan Tsai, Jui-Hsiu Tsai, and Hua Li contributed equally to this work}, Hua Li ^c,^d,^{⁎
Tou-Yuan Tsai, Jui-Hsiu Tsai, and Hua Li contributed equally to this work}, Cheng-Yu Wang ^g, Yu-Kang Tu ^f,^h,ⁱ, Huei-Kai Huang ^b,^j,^k, Hsin Ma ^f,^l,^m, Yu-Lin Hsieh ^n,^o, Chuan-Sheng Hung ^p, Shih-Chieh Shao ^q, Eric H Chou ^r, Chin-Lon Lin ^b,^s, Ming-Nan Lin ^b,^g,^⁎

^a Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan

^b School of Medicine, Tzu Chi University, Hualien, Taiwan

^c Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan

^d Center for Health Data & Advanced Translational Analytics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan

^e Department of Medical Education, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan

^f Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

^g Family Medicine Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan

^h Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan

ⁱ Department of Dentistry, National Taiwan University Hospital and School of Dentistry, National Taiwan University, Taipei, Taiwan

^j Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

^k Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

^l Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

^m School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

ⁿ Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

^o Harvard Medical School, Boston, MA, USA

^p Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan

^q Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan

^r Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas, USA

^s Cardiology, Dalin Tzu Chi Hospital, Buddhist Tzu Medical Foundation, Chiayi, Taiwan

^$ Corresponding author: Dr. Ming-Nan Lin, Family Medicine Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd, Dalin Township, Chiayi County 622, Taiwan. Telephone: +886-5-2648000. Family Medicine Department Dalin Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation No. 2, Minsheng Rd, Dalin Township, Chiayi County 622 Taiwan

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ABSTRACT

Background

Evidence remains inconclusive regarding plant-based diets preventing cognitive impairment and dementia, as certain plant-based foods, including refined carbohydrates, sweets, sugar-sweetened beverages, and trans fats, may increase dementia risk.

Objectives

To quantitatively synthesize prospective cohort studies on associations between adherence to plant-based diets and the risks of cognitive impairment and dementia.

Design

Systematic review and meta-analysis. This study adhered to the PRISMA guidelines and was registered on PROSPERO (No: CRD42024501334).

Setting

Studies published until December 2025 were systematically identified using AgeLine, CINAHL, Embase, MEDLINE, PsycINFO, Scopus, and Web of Science.

Participants

The study population comprised adults aged ≥ 20 years with no cognitive impairment at baseline.

Intervention

Studies were enrolled if the participants (1) assessed dietary patterns characterized by higher plant-based food consumption and decreased or ceased consumption of animal-based foods or (2) used established dietary indices, including overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI).

Measurements

Data extraction, risk of bias assessment, and the GRADE approach for assessing certainty of evidence were performed independently by three reviewers. A random-effects model with restricted maximum likelihood was used to calculate pooled risk ratios and 95% confidence intervals. The dose-response meta-analysis used two-stage dose-response regression.

Results

The meta-analysis based on seven studies (number of participants: 221380; number of cases of incident cognitive impairment and dementia: 5668) indicated that participants with greater adherence to plant-based diets had significantly lower risks of cognitive impairment and dementia (pooled risk ratio, 0.74; 95% confidence interval, 0.56–0.97; I ²  = 92.3%) than those with lower adherence. Dose-response relationships modeled using restricted cubic splines indicated that overall PDI and hPDI were negatively associated with risks of cognitive impairment and dementia, whereas uPDI was significantly positively associated with these risks.

Conclusions

: This meta-analysis suggests that adherence to plant-based diets, particularly those rich in healthful plant foods, may be associated with a lower risk of cognitive impairment and dementia. However, given the residual heterogeneity and the inherent limitations of observational study designs, large randomised controlled trials are warranted to establish causality.

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Key Words : cognitive impairment, dementia, meta-analysis, plant-based diet, systematic review