Diet Quality from Midlife to Later Life Relates to Late-Life Brain Health and Verbal Memory in the SG70 Cohort

Healthy diet across adulthood is associated with better late-life cognition, but how life-course diet quality relates to brain integrity, and whether brain measures mediate diet-cognition associations, remains unclear as studies with long-term diet records and detailed neurocognitive measures are lacking. We studied 892 participants from the SG70 study, nested within the Singapore Chinese Health Study, with adherence to the Dietary Approaches to Stop Hypertension diet (DASH) assessed between 1993--2025. Dietary quality during midlife, ages 44--55 years, and early elderhood, ages 61--73 years, was examined in relation to seven cognitive domains, brain morphometry, white matter hyperintensities and free-water MRI markers in late life, ages 68--82 years. Higher DASH adherence at both life stages was significantly associated with better late-ife verbal memory, and remained so when both life stages were modelled jointly. Higher midlife DASH adherence was associated with greater white matter volume in association tracts, whereas higher early-elderhood DASH adherence was associated with lower white matter hyperintensity (deep basal ganglia and anterior periventricular regions) and lower frontal and occipital grey matter free water, suggesting lower neurovascular and inflammatory burden. Mediation analyses indicated that white matter volume accounted for 12.3% in mediating the midlife DASH--verbal memory association, while cortical free water accounted for 12.5% in mediating the early-elderhood DASH--verbal memory association. Importantly, participants whose DASH adherence improved from lower adherence in midlife to better adherence in later life showed better verbal memory and more favourable brain integrity than those with persistently low adherence. These findings identify midlife and post-midlife diet quality as modifiable life-course exposures associated with late-life cognitive resilience through differences in macrostructural and microstructural brain integrity.