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Nutrients in Alzheimer’s Disease: The Interaction of Diet, Drugs and Disease

  • S. Imindu Liyanage (a1), Prachi Vilekar (a1) and Donald F. Weaver (a1) (a2)

Abstract

In recent decades, clinical trials in Alzheimer’s disease (AD) have failed at an unprecedented rate. The etiology of AD has since come under renewed scrutiny, both to elucidate the underlying pathologies and to identify novel therapeutic strategies. Here, diet has emerged as a potential causative/protective agent. A variety of nutrients, including lipids, minerals, vitamins, antioxidants and sugars as well as broader dietary patterns and microbiotal interactions have demonstrated associations with AD. Although clinical trials have yet to definitively implicate any singular dietary element as therapeutic or causative, it is apparent that dietary preferences, likely in complex synergies, may influence the risk, onset and course of AD. This review catalogs the impact of major dietary elements on AD. It further examines an unexplored reciprocal association where AD may modulate diet, as well as how potential therapeutics may complicate these interactions. In doing so, we observe diet may have profound effects on the outcome of a clinical trial, either as a confounder of a drug/disease interaction or as a generally disruptive covariate. We therefore conclude that future clinical trials in AD should endeavor to control for diet, either in study design or subsequent analyses.

Les interactions entre l’alimentation et la prise de médicaments dans le cas de la maladie d’Alzheimer. Au cours des dernières décennies, les essais cliniques liés à la maladie d’Alzheimer (MA) ont échoué à un rythme sans précédent. Depuis, l’étiologie de cette maladie a fait l’objet d’un examen plus attentif à la fois pour mieux comprendre les troubles sous-jacents de la MA et pour identifier de nouvelles stratégies thérapeutiques. À cet égard, l’alimentation est apparue au fil des années comme un agent potentiellement causal/protecteur dans le cas de la MA. On a ainsi pu démontrer qu’une variété de nutriments, ce qui inclut des lipides, des minéraux, des vitamines, des antioxydants et des sucres, de même que des habitudes alimentaires plus variées et des interactions propres à la flore intestinale, pouvaient être associées à l’évolution de la MA. Bien que l’on doive encore établir de façon définitive au moyen d’essais cliniques le rôle causal et thérapeutique de quelque élément nutritif que ce soit, il est clair que les choix alimentaires que l’on fait, probablement dans le cadre de synergies complexes, pourraient avoir une influence sur le risque d’être atteint de la MA, sur son apparition et son évolution. Cette étude entend donc se pencher sur l’impact des principaux éléments nutritifs en ce qui a trait à la MA. Elle examinera en outre les associations réciproques peu abordées en vertu desquelles il est possible que la MA ait un impact sur l’alimentation ; elle cherchera aussi à savoir dans quelle mesure d’éventuelles options thérapeutiques peuvent affecter ces interactions. Ce faisant, nous sommes d’avis que l’alimentation pourrait avoir de profonds effets sur les résultats d’essais cliniques, que ce soit à titre d’élément perturbant les interactions entre un médicament et la maladie ou, le plus souvent, à titre de covariable perturbatrice. En somme, nous sommes amenés à conclure que les essais cliniques du futur portant sur la MA devraient s’efforcer de tenir compte de l’alimentation, que ce soit dans leur méthodologie ou lors d’analyses ultérieures.

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Corresponding author

Correspondence to: Donald F. Weaver, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Email: donald.weaver@uhnresearch.ca

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Keywords

Nutrients in Alzheimer’s Disease: The Interaction of Diet, Drugs and Disease

  • S. Imindu Liyanage (a1), Prachi Vilekar (a1) and Donald F. Weaver (a1) (a2)

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