Patterns of Ultra-Processed Food Consumption and Cognitive Performance in Older Adults: A Population-Based...

Background: Given the increasing consumption of ultra-processed foods (UPFs) and the public health importance of cognitive decline in ageing, understanding how UPFs impact cognitive performance is highly relevant. However, evidence in older adults-particularly in Italy-remains scarce, despite the country's rapidly ageing population, its comparatively low UPF intake, and its distinct Mediterranean dietary context. Methods: We analysed cross-sectional data from 809 community-dwelling adults aged ≥ 65 years (59.4% women) participating in the NutBrain population-based cohort. Dietary intake was assessed using a 102-item semi-quantitative food frequency questionnaire, and daily grams of foods were classified according to the NOVA system into groups, which were analysed using a compositional data analysis approach. Global cognition and domain-specific performance were measured using standardised neuropsychological tests. Associations between NOVA groups and cognitive outcomes were estimated using multiple linear regression models adjusted for potential confounders. Gender-stratified analyses were also performed. Results: UPFs accounted for 21% of total energy intake, with bakery products as the main contributors. A relative increase of unprocessed or minimally processed foods was associated with better cognitive function (B = 0.36, p = 0.014), whereas a greater contribution of UPFs relative to the overall diet was associated with worse global cognitive function (B = -0.26, p = 0.003). The strongest associations were observed for episodic memory, particularly among women. Conclusions: A higher relative consumption of UPF was associated with worse global and memory-related cognitive performance. Longitudinal and experimental studies are warranted to clarify causality and underlying mechanisms.