Joint association of dietary fatty acid patterns identified by Gaussian graphical models and cognitive impairment status with all-cause mortality in U.S. adults: A prospective cohort study.

BACKGROUND: The association between dietary fatty acid patterns (DFAPs) and cognitive function jointly affecting long-term survival remains poorly understood. Network-based methods addressing conditional dependencies among fatty acids may reveal novel patterns, yet the joint association of DFAPs derived from Gaussian Graphical Models (GGMs) and cognitive status with all-cause mortality (ACM) risk has not been examined in nationally representative U.S. adults. METHODS: GGMs were applied to 24-hour recall data for 19 fatty acids from 2446 adults aged ≥18 years in the NHANES 2011-2014 cycles. Psychometric mild cognitive impairment (pMCI) was defined as a composite cognitive score >1 standard deviation below the mean. Survey-weighted Cox proportional hazards models estimated joint associations of DFAP quartiles and pMCI with ACM. RESULTS: Three DFAPs were found, including a mixed long-chain fatty acid (MLCFA) pattern, a dairy-derived saturated fatty acid (DSFA) pattern, and a marine omega-enriched fatty acid (MOEFA) pattern. In fully adjusted models, U.S. adults with high adherence to MLCFA, DSFA, and MOEFA patterns with pMCI indicated a 66%, 76%, and 69% increase risk of ACM compared with cognitively normal adults in the lowest pattern quartile (MLCFA: Hazard ratio (HR)Q4 pMCI(+) vs Q1 pMCI(-):1.66, 95% confidence interval (CI): 1.06-2.60; DSFA: HRQ4 pMCI(+) vs Q1 pMCI(-):1.76, 95% CI: 1.12-2.76; MOEFA: HRQ4 pMCI(+) vs Q1 pMCI(-):1.69, 95% CI: 1.11-2.56). Based on subgroup analysis, the joint association of adherence to the MLCFA and concurrent pMCI was associated with a 22% mortality reduction in U.S. females (HR: 0.78, 95% CI: 0.64-0.94) and a 33% reduction in U.S. adults without diabetes (HR: 0.67, 95% CI: 0.45-0.98). CONCLUSION: Greater adherence to the MLCFA pattern combined with pMCI may be associated with ACM risk reduction among U.S. females and adults without diabetes.