The global burden of cognitive decline and dementia continues to escalate, with mild cognitive impairment (MCI) representing a critical transitional stage between normal ageing and dementia. Research indicates that between 10 to 20% of individuals with MCI progress to dementia annually, with up to 50% transitioning within five years (Li et al., 2025; Manly et al., 2008). Given the absence of effective treatments to halt or reverse this progression, primary prevention strategies through modifiable lifestyle factors, particularly dietary interventions, have garnered considerable scientific attention.
Recent research published in the European Journal of Nutrition by Li et al. (2025) provides compelling evidence regarding the relationship between organic food consumption and cognitive function amongst middle-aged and older adults. This groundbreaking study, utilising data from the nationally representative Health and Retirement Study (HRS) and the Health Care and Nutrition Study (HCNS), represents the first large-scale cohort investigation to explicitly examine this association in an American population. The findings are particularly noteworthy given the growing interest in organic agriculture and its potential health implications beyond cardiovascular and metabolic benefits.
Methodology and study design
Participant selection and eligibility criteria
Li et al. (2025) employed a rigorous methodological approach, selecting 6,077 participants for cross-sectional analyses and 4,882 individuals for longitudinal analyses from the 2012 HRS wave and the 2013 HCNS. The study’s comprehensive exclusion criteria encompassed participants aged less than 45 years, those with conflicting information regarding organic food consumption, individuals with extreme daily total energy intake (>4,000 or <800 kcal per day for males and >3,500 or <500 kcal per day for females), and those with missing baseline cognitive function recordings or proxy-conducted cognitive tests (Li et al., 2025).
For the longitudinal component, additional exclusions comprised participants diagnosed with MCI or dementia at baseline, those attending fewer than one follow-up visit, or individuals with dementia as the cognitive outcome in subsequent interview waves without an MCI outcome. The median follow-up period extended to 3.7 years, providing sufficient temporal depth to observe meaningful changes in cognitive status.
Assessment of organic food consumption
The measurement of organic food consumption employed validated Food Frequency Questionnaires (FFQ) with two critical questions. The first enquired whether participants had consumed any organic food in the past year (yes/no), whilst the second identified specific categories of organic foods consumed: milk, eggs, meat, fruits, vegetables, bread or cereals, and prepared frozen meals (Li et al., 2025; Willett et al., 1985). Participants determined organic foods primarily based on certifications from the United States Department of Agriculture (USDA) and third-party certifying agencies.
Consistent with previous research methodologies (Aljahdali et al., 2022; Ludwig-Borycz et al., 2021), participants who answered affirmatively to the first question and selected at least one category in response to the second were classified as organic food consumers. The investigators constructed an Organic Diet Diversity Score (ODDS) based on the number of organic food categories consumed, ranging from 0 to 7, thereby enabling more nuanced analyses of dietary diversity effects.
Cognitive function assessment
Cognitive function was assessed using an enhanced version of the Telephone Interview for Cognitive Status (TICS), a standardised instrument renowned for its high specificity and sensitivity in distinguishing common forms of dementia, particularly Alzheimer’s disease, from normal cognitive states (Brandt et al., 1988). The assessment comprised three functional tests: immediate and delayed 10-noun free recall (measuring memory), serial sevens subtraction (assessing working memory), and counting backwards (evaluating speed of mental processing) (Li et al., 2025).
Total cognitive scores ranged from 0 to 27, with higher scores indicating superior cognitive abilities. The Langa-Weir classification method categorised participants into dementia (0-6), mild cognitive impairment (7-11), and normal cognitive function (11-27) (Crimmins et al., 2011). This well-validated classification system has been extensively employed in HRS-based research, providing robust and reproducible measurements of cognitive status.
Statistical analyses and covariate adjustment
The analytical strategy employed multivariable linear regression for cross-sectional analyses and Cox proportional hazards models for longitudinal investigations. Three progressively adjusted models were constructed: Model 1 accounted for demographic factors (age, race, marital status, educational level, and total net wealth); Model 2 additionally adjusted for health behaviours and clinical characteristics (physical activity, smoking status, alcohol consumption, body mass index, depressive symptoms, diabetes, hypertension, and other chronic diseases); Model 3 incorporated nutritional factors (total energy intake, carbohydrate intake, protein intake, fat intake, and alternative Mediterranean Diet score) (Li et al., 2025).
The investigators employed inverse probability weighting (IPTW) to generate adjusted Kaplan-Meier survival curves, illustrating variations in MCI-free probability based on organic food consumption status across different genders. This sophisticated approach minimises confounding whilst maintaining the interpretability of survival analyses (Le Borgne et al., 2016; Xie & Liu, 2005).
Principal findings and results
Cross-sectional associations with cognitive scores
The cross-sectional analyses revealed consistently positive associations between organic food consumption and baseline cognitive scores across all participants. In the fully adjusted model (Model 3), consumers of organic food exhibited higher cognitive scores compared to non-consumers (β=0.34, 95% CI 0.14, 0.53), with similar patterns observed amongst both male consumers (β=0.31, 95% CI 0.02, 0.61) and female consumers (β=0.33, 95% CI 0.07, 0.59) (Li et al., 2025). These findings remained robust across all three adjustment models, demonstrating the independence of the association from potential confounding variables.
Importantly, both organic animal foods (milk, eggs, meat) and organic plant foods (fruits, vegetables) demonstrated positive associations with cognitive function. For the overall sample, organic animal food consumption was associated with a β coefficient of 0.35 (95% CI 0.12, 0.58), whilst organic plant food consumption yielded a β coefficient of 0.38 (95% CI 0.18, 0.58). These associations persisted with similar magnitude amongst both male and female participants, suggesting universal cognitive benefits irrespective of the organic food source.
Longitudinal associations with incident mild cognitive impairment
The longitudinal analyses after a median follow-up of 3.7 years revealed striking sex-specific differences in the relationship between organic food consumption and incident MCI. Whilst the overall sample demonstrated that organic animal food consumption was associated with reduced MCI incidence (HR=0.81, 95% CI 0.67, 0.98), the most remarkable findings emerged amongst female participants (Li et al., 2025).
Female consumers of organic food exhibited a 20% reduction in MCI risk compared to non-consumers (HR=0.80, 95% CI 0.65, 0.98). This protective effect was particularly pronounced for specific organic food categories: organic animal foods conferred a 27% risk reduction (HR=0.73, 95% CI 0.58, 0.94), whilst organic plant foods provided a 20% risk reduction (HR=0.80, 95% CI 0.65, 0.98). Notably, no significant associations between organic food consumption and MCI incidence were detected amongst male consumers, underscoring the importance of considering gender perspectivesin dietary intervention research.
Specific food types and dietary diversity
Further granular analyses examining specific varieties of organic foods revealed differential effects across genders. Amongst female consumers, organic milk, eggs, fruits, and vegetables contributed significantly to better cognitive scores in cross-sectional analyses (Li et al., 2025). In longitudinal analyses, consumption of organic meat, fruits, and vegetables was associated with 39%, 27%, and 21% reductions in incident MCI, respectively, amongst female participants. Conversely, milk and fruits did not account for better cognitive scores amongst male consumers, and no specific organic food types were associated with lower incident MCI in males.
The investigation of Organic Diet Diversity Scores (ODDS) yielded compelling insights into dose-response relationships. Each one-unit increase in ODDS contributed to a 0.09 increase in cognitive scores amongst female consumers (95% CI 0.01, 0.16), whilst females with high ODDS (>3) demonstrated a 27% reduction in incident MCI risk (HR=0.73, 95% CI 0.56, 0.95) (Li et al., 2025). These findings suggest that greater diversity in organic food consumption may confer additional cognitive benefits beyond the consumption of any single organic food category.
Baseline characteristics and population demographics
The baseline characteristics revealed important differences between organic food consumers and non-consumers. Organic food consumers (n=2,533; 61% female; 73% white; mean age 66.23 years) tended to be younger, more highly educated, maintained higher frequencies of physical activities, and possessed greater total net wealth compared to non-organic food consumers (n=3,544; 57.6% female; 71.4% white; mean age 68.59 years) (Li et al., 2025). Additionally, organic food consumers reported higher daily total energy and protein intake proportions, enhanced diet quality as assessed by the alternative Mediterranean Diet Score, and demonstrated reduced prevalence of chronic diseases, depressive symptoms, diabetes, and hypertension.
Discussion and mechanistic considerations
Nutritional composition and bioactive compounds
The observed cognitive benefits of organic food consumption may be attributed to several interrelated mechanistic pathways. Research indicates that organic foods exhibit higher concentrations of beneficial nutrients and bioactive compounds compared to conventional alternatives, including elevated levels of n-3 polyunsaturated fatty acids and omega-3 fatty acids in organic animal products, and greater content of minerals, vitamins, dietary fibres, and polyphenols in organic plant products (Hurtado-Barroso et al., 2019). These compositional differences may directly influence cognitive function through multiple pathways.
Polyphenols, abundant in organic plant foods, have been identified as crucial neuroprotective agents (Faller & Fialho, 2010). These compounds exhibit positive associations with gut microbiota through reciprocal relationships, exerting prebiotic-like effects and indirectly restoring altered brain function through the brain-gut axis (BGA) pathway (Filosa et al., 2018; Ozdal et al., 2016). Furthermore, polyphenols suppress oxidative stress and modulate cell signalling transduction, promoting expression of brain-derived neurotrophic factor and directly boosting cognitive function (Pandareesh et al., 2015; Rajaram et al., 2019). Clinical studies have corroborated these mechanisms, demonstrating cognitive improvements in middle-aged participants with MCI following flavonoid supplementation (Krikorian et al., 2012).
Gut microbiota and the brain-gut axis
The brain-gut axis represents a critical mechanistic pathway through which organic food consumption may influence cognitive health. Organic foods contain lower concentrations of harmful substances such as synthetic fertilisers, residue pesticides, heavy metals, and antibiotics, which may negatively affect the composition and function of human gut microbiota compared to conventional alternatives (Hurtado-Barroso et al., 2019). Considerable scientific evidence from population studies suggests that gut microbiota eubiosis plays a critical role in brain function via the BGA (Li et al., 2021; Wang et al., 2019).
Dietary fibres contained in organic foods beneficially modify gut microbiota composition and function, thereby enhancing production of short-chain fatty acids (Sanna et al., 2019). These metabolites improve inflammation and maintain brain homeostasis through neuroprotective effects, consequently improving memory-dependent tasks (van Soest et al., 2020; Więckowska-Gacek et al., 2021). The reciprocal interactions between polyphenols and gut microbiota further contribute to cognitive benefits, with organic food consumers potentially maintaining superior gut microbiota homeostasis and experiencing beneficial effects on brain function.
Sex-specific effects and hormonal Influences
The differential impacts of organic food consumption between sexes merit particular consideration, as they may result from a constellation of biological, environmental, and behavioural factors. The study findings indicate that males exhibited greater susceptibility to diabetes, hypertension, and other chronic diseases – all confirmed risk factors for MCI (Wang et al., 2020). Additionally, males demonstrated higher burdens of heavy metal exposure from various sources, including air pollution, cigarette smoke, and contaminated food, rendering them more vulnerable to harmful effects of these metals (Song et al., 2023).
Sex hormones exert profound influences on cognitive function throughout the lifespan. Age-related decline in testosterone amongst older men correlates with higher prevalence and incidence of cognitive decline (Giannos et al., 2023; Yeap & Flicker, 2022). Conversely, higher plasma levels of estrone and estrone sulphate amongst older women associate positively with superior cognitive function (Koyama et al., 2016). Women with elevated serum estradiol levels also exhibit greater intestinal microbial diversity, potentially influencing central nervous system-related functions via the BGA (Snigdha et al., 2022). Furthermore, gut microbiota composition differs substantially between sexes even on standard diets, with female gut microbiota demonstrating higher α-diversity—a hallmark of healthy ageing (Jaggar et al., 2020).
Dietary patterns and metabolic considerations
The nutritional profile of organic animal-based products, characterised by lower levels of fat and sugar but higher quality protein (Johansson et al., 2014), may contribute to cognitive benefits through metabolic pathways. Diets low in fat and sugar associate with better cognitive function and lower dementia incidence, potentially due to reduced inflammatory responses (Hayden et al., 2017). High-fat, high-sugar diets defect gut microbiota composition and intestinal barrier integrity, triggering pro-inflammatory responses that may induce neuroinflammation and neurodegeneration by impairing the blood-brain barrier (Arnoriaga-Rodríguez & Fernández-Real, 2019; Więckowska-Gacek et al., 2021).
Dietary diversity confers additional health benefits beyond individual nutrients through synergistic effects (Milte et al., 2019). Studies indicate that dietary diversity contributes to gut microbiota stability and potential brain function benefits through the BGA (Johnson et al., 2019). The observed associations between higher Organic Diet Diversity Scores and improved cognitive outcomes amongst females support this hypothesis, suggesting that varied organic food consumption may optimise the gut microbiome’s beneficial influence on cognitive health.
Clinical implications and public health significance
Gender-specific dietary interventions
The pronounced sex-specific effects observed in this investigation underscore the critical importance of developing gender-tailored dietary interventions for cognitive health preservation. The finding that organic food consumption significantly reduced MCI risk exclusively amongst females (Li et al., 2025) challenges the ‘one-size-fits-all’ approach often adopted in nutritional recommendations.
Women experiencing cognitive decline with MCI have been reported to progress twice as rapidly as men, possibly due to population heterogeneity and different cognitive assessment tools (Gu et al., 2022). Therefore, identifying protective dietary factors that specifically benefit women represents a crucial step towards precision nutrition approaches in cognitive health.
Economic and accessibility considerations
The study revealed that organic food consumers possessed significantly higher total net wealth and educational attainment compared to non-consumers (Li et al., 2025). This socioeconomic gradient raises important questions regarding the accessibility and affordability of organic foods for vulnerable populations at greatest risk of cognitive decline. The higher cost of organic products compared to conventional alternatives may create barriers to adoption, particularly amongst older adults with fixed incomes (Aschemann-Witzel & Zielke, 2017).
Future research should investigate whether subsidised organic food programmes or community-supported agriculture initiatives could democratise access to organic foods whilst maintaining cognitive health benefits. Additionally, comparative effectiveness studies examining whether specific categories of organic foods confer disproportionate benefits could inform cost-effective recommendations prioritising those organic products with the greatest cognitive protective effects.
Primary prevention strategies
Given the absence of effective pharmaceutical treatments to halt or reverse progression from MCI to dementia (Petersen et al., 2018), primary prevention strategies through dietary modification assume paramount importance. The magnitude of risk reduction observed – with organic food consumption associated with a 20% decrease in MCI incidence amongst females, and organic animal and plant foods conferring 27% and 20% reductions respectively (Li et al., 2025) – represents clinically meaningful effects comparable to other established preventive interventions.
Integration of organic food consumption into comprehensive lifestyle modification programmes encompassing physical activity, cognitive training, and social engagement may yield synergistic benefits. The study’s findings suggest that even modest increases in organic dietary diversity could provide incremental cognitive protection, offering a practical and potentially acceptable intervention target for older adults concerned about cognitive decline.
Limitations and future research directions
Measurement limitations
The study by Li et al. (2025) acknowledges several important methodological limitations that warrant consideration. The assessment of organic food consumption relied on self-reporting without detailing consumption frequency, potentially leading to overestimation of beneficial effects by categorising occasional consumers alongside frequent consumers (Baudry et al., 2018). The absence of portion size measurements precluded calculation of the proportional contribution of organic foods to total daily dietary intake (Kesse-Guyot et al., 2020).
Future investigations should employ more sophisticated dietary assessment methodologies, including repeated 24-hour dietary recalls or detailed food diaries specifying the proportion of each food category consumed as organic. Biomarker-based approaches assessing pesticide residue levels (even in individuals, editor’s note) or nutrient profiles characteristic of organic food consumption could provide objective validation of self-reported consumption patterns, thereby strengthening causal inference.
Residual confounding and selection bias
Despite the comprehensive adjustment for potential confounders across three progressive models, the observational nature of this investigation limits definitive causal conclusions. Residual confounding from unmeasured variables, such as overall health consciousness, environmental exposures, or genetic predispositions, may partially explain the observed associations. Organic food consumers demonstrated healthier baseline profiles across multiple domains, suggesting that organic food consumption may serve as a marker for broader healthy lifestyle patterns rather than an independent causal factor (Li et al., 2025).
The substantial socioeconomic differences between organic food consumers and non-consumers introduce potential selection bias. Although analyses adjusted for educational level and total net wealth, these measures may inadequately capture the full spectrum of socioeconomic influences on cognitive health. Future research employing propensity score matching, instrumental variable analyses, or natural experiments (such as organic food voucher programmes) could strengthen causal inference by minimising confounding by indication.
Need for randomised controlled trials
Whilst the current study provides valuable epidemiological evidence, long-term randomised controlled trials (RCTs) comparing organic and conventional foods of the same variety and similar growing conditions remain necessary to establish definitive health benefits (Hurtado-Barroso et al., 2019).
Such trials face considerable practical and ethical challenges, including participant blinding, extended follow-up requirements, and substantial costs associated with providing organic foods over multi-year periods.
Pragmatic RCTs employing cluster randomisation at the community or household level might offer feasible alternatives, particularly in populations with high baseline organic food consumption.
Mechanistic investigations
Future research should elucidate the specific biological mechanisms underlying the observed associations. Longitudinal studies incorporating serial assessments of gut microbiota composition, inflammatory biomarkers, oxidative stress indicators, and neuroimaging measures could clarify the temporal sequence linking organic food consumption to cognitive preservation. Integration of metabolomics and lipidomics approaches might identify specific metabolic signatures associated with organic food consumption that mediate cognitive benefits.
Comparative studies examining differences between organic and conventional foods in bioavailability and biological activity of specific nutrients and bioactive compounds would strengthen mechanistic understanding. Such investigations could identify whether particular components of organic foods – such as higher polyphenol concentrations, superior fatty acid profiles, or absence of pesticide residues – drive the observed cognitive benefits, thereby informing targeted intervention strategies.
Interim conclusions
This comprehensive investigation by Li et al. (2025) provides compelling evidence that organic food consumption associates positively with cognitive function amongst middle-aged and older adults, with particularly pronounced protective effects against incident MCI amongst female participants. The study’s strengths include its large, nationally representative sample, longitudinal design with 3.7-year follow-up, comprehensive adjustment for potential confounders, and examination of both overall organic food consumption and specific food categories.
The findings underscore that dietary diversity in organic food consumption may confer additional cognitive benefits beyond individual food categories, with higher Organic Diet Diversity Scores associating with superior outcomes amongst females. The observed sex-specific effects highlight the critical importance of considering gender perspectives when formulating dietary interventions aimed at preserving cognitive health and preventing dementia.
Whilst methodological limitations preclude definitive causal conclusions, the consistency of findings across multiple analytical approaches and the biological plausibility of proposed mechanisms support the potential cognitive benefits of organic food consumption. The magnitude of risk reduction observed – ranging from 20% to 27% for various organic food categories amongst females – represents clinically meaningful effects warranting serious consideration by healthcare practitioners and public health policymakers.
Future research should prioritise long-term randomised controlled trials comparing organic and conventional diets, mechanistic studies elucidating biological pathways linking organic food consumption to cognitive health, and investigation of strategies to improve accessibility and affordability of organic foods for vulnerable populations. As the global burden of cognitive impairment and dementia continues to escalate, identification of modifiable dietary factors represents a crucial component of comprehensive prevention strategies.
The integration of organic food consumption into holistic lifestyle modification programmes encompassing physical activity, cognitive training, social engagement, and overall dietary quality may yield synergistic benefits for cognitive health. Recognising the sex-specific nature of organic food effects emphasises the need for personalised nutrition approaches that consider individual characteristics, preferences, and risk profiles when developing interventions to promote healthy cognitive ageing.
Dario Dongo
Photo by Ella Olsson su Unsplash
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Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
