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It is important to understand if diet is associated with brain health in midlife, when Alzheimer's disease and related dementias are known to begin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study used data from the PREVENT dementia programme. Three MedDiet scores were created (the Pyramid, Mediterranean Diet Adherence Screener [MEDAS] and MEDAS continuous) from a self\u2010reported food frequency questionnaire. Primary outcomes were hippocampal volume and cube\u2010transformed white matter hyperintensity volume. Secondary outcomes included cornu ammonis 1 and subiculum hippocampal subfield volumes, cortical thickness and measures of cognition. Sex\u2010stratified analyses were run to explore differential associations between diet and brain health by sex. An exploratory path analysis was conducted to study if any associations between diet and brain health were mediated by cardiovascular risk factors for dementia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all, 504 participants were included in this analysis, with a mean Pyramid score of 8.10 (SD 1.56). There were no significant associations between any MedDiet scoring method and any of the primary or secondary outcomes. There were no differences by sex in any analyses and no significant mediation between the Pyramid score and global cognition by cardiovascular risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Overall, this study did not find evidence for an association between the MedDiet and either neuroimaging or cognition in a midlife population study. Future work should investigate associations between the MedDiet and Alzheimer's disease and related dementias biomarkers as well as functional neuroimaging in a midlife population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.16345","type":"journal-article","created":{"date-parts":[[2024,5,25]],"date-time":"2024-05-25T10:41:54Z","timestamp":1716633714000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Mediterranean diet is not associated with neuroimaging or cognition in middle\u2010aged adults: a cross\u2010sectional analysis of the <scp>PREVENT<\/scp> dementia programme"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9864-8240","authenticated-orcid":false,"given":"Sarah","family":"Gregory","sequence":"first","affiliation":[{"name":"Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences University of Edinburgh  Edinburgh UK"},{"name":"Scottish Brain Sciences  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