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Original Article | Open Access

Dietary Carotenoids and Cognitive Decline: A Longitudinal Study Among Chinese Middle‐Aged and Older Adults

Liyan Huang1 , Ting Shen1, Minyu Wu1, Yiying Gong1 , Gulisiya Hailili1, Ziping Wang2, Caifeng Zhao1, Wei Chen3, Shuang Rong2 ( ), Changzheng Yuan1,4 ( )
School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
Department of Clinical Nutrition, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
Department of Food Science and Nutrition, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, United States

Liyan Huang and Ting Shen contributed equally as co‐first authors.

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Abstract

Background

This study examined the association between dietary intakes of total and specific carotenoids and cognitive decline among Chinese middle‐aged and older adults.

Methods

We included 4043 participants aged 55 years and older from the China Health and Nutrition Survey (1997–2006). Average daily dietary intakes of total carotenoids, α‐carotene, β‐carotene, β‐cryptoxanthin, lycopene, and lutein + zeaxanthin were calculated from 3‐day 24‐h dietary recalls. Cognitive function was measured repeatedly using the Telephone Interview for Cognitive Status‐Modified. Linear mixed‐effects models were utilized to estimate beta coefficients (β) and the 95% confidence intervals (CIs) for the association of energy‐adjusted carotenoid intake with changes in cognitive z‐scores.

Results

Higher intake of total dietary carotenoids was associated with slower cognitive decline. Comparing the top to bottom quintiles (median intake: 37.0 vs. 3.1 mg/day) of total carotenoids, the adjusted difference in annual decline rates (95% CI) was 0.018 (0.001–0.035, p‐trend = 0.037). The strongest association was observed for moderate intake at the fourth quintile (median intake: 23.5 mg/day, β = 0.028, 95% CI: 0.011–0.046, p‐quadratic = 0.030). Protective associations were also found for specific carotenoids, including α‐carotene (βQ5 vs. Q1 = 0.037, 95% CI: 0.020–0.055), β‐cryptoxanthin (β = 0.032, 95% CI: 0.014–0.049), lutein + zeaxanthin (β = 0.020, 95% CI: 0.002–0.037), lycopene (β = 0.018, 95% CI: 0.001–0.035) and β‐carotene (β = 0.019, 95% CI: 0.001–0.036).

Conclusions

A potential nonlinear association between dietary carotenoids and cognitive decline was observed in Chinese middle‐aged and older adults. Further research is warranted to confirm optimal intake level for dietary carotenoids and to investigate the underlying biological mechanisms.

Graphical Abstract

Higher intake of dietary carotenoids was associated with slower cognitive decline. The strongest protective association was observed for moderate carotenoid intake. Total carotenoid intake exhibited a non‐linear association with cognitive decline.

References

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Health Care Science
Pages 415-423

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Cite this article:
Huang L, Shen T, Wu M, et al. Dietary Carotenoids and Cognitive Decline: A Longitudinal Study Among Chinese Middle‐Aged and Older Adults. Health Care Science, 2026, 5(5): 415-423. https://doi.org/10.1002/hcs2.70096

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Received: 04 September 2025
Revised: 24 November 2025
Accepted: 19 December 2025
Published: 31 August 2026
© 2026 The Author(s). Tsinghua University Press.

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.