Abstract
OBJECTIVE: The evidence regarding adherence to dietary patterns and Parkinson's disease (PD) risk is inconsistent. Because of the long prodromal PD phase, reverse causation represents a major threat to investigations of diet in relation to PD. We examined whether adherence to the Mediterranean (MED) and Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diets is associated with PD incidence, while considering reverse causation, in a large cohort of women with a 25-year follow-up. METHODS: Participants from the E3N (Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l'Education Nationale) study were prospectively followed-up from 1993 to 2018. PD diagnoses were validated using medical records and drug claim databases. Baseline MED and MIND scores were computed using a validated food questionnaire. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using multivariable Cox regression models. Exposures were lagged by 5 years in main analyses and longer lags in sensitivity analyses. We performed age-stratified analyses and adjusted for prodromal symptoms. RESULTS: Analyses (5-year-lag) are based on 71,542 women (845 PD patients). Higher adherence to MED and MIND diets was not associated with PD overall, but was associated with lower PD incidence in women <71 years old (MED, HR(high vs. low+medium) = 0.76 [0.58-1.00], p-Age × MED interaction = 0.038; MIND, HR(high vs. low+medium) = 0.75 [0.58-0.97], p-Age × MIND interaction = 0.035). Legumes and high unsaturated to saturated fat ratio had the strongest contribution for the MED diet, while beans and olive oil had the strongest contribution for the MIND diet. Results were consistent after adjustment for constipation/depression and in analyses with lags up to 20 years. INTERPRETATION: Adherence to the MED and MIND diets was associated with lower PD incidence <71 years in women. These findings are important for planning preventative interventions. ANN NEUROL 2026;99:1014-1029.