Dietary B-complex vitamins and sleep quality in relation to cognitive impairment among older adults - non-linear associations and evidence of additive interaction

Sep 28, 2026

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Global dementia is projected to rise sharply, and modifiable factors such as B-complex vitamin intake and sleep quality may influence cognitive health. This population-based cross-sectional study analyzed 8,806 adults aged 65+ from the Shanghai Aging and Retirement Evaluation Survey (Jan–May 2024). Dietary B-complex intake was measured via a validated Food Frequency Questionnaire and sleep quality via PSQI, while cognition was assessed by MMSE. L-shaped associations for B6, B12, and folate and J-shaped sleep relationships were observed, with significant additive interactions indicating synergistic effects on cognitive impairment risk.

LanguageEnglish

CategoryHealthcare

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Pages14

Reading Time35 min

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Background

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Introduction

TYPE Original Research PUBLISHED 19 December 2025 DOI 10. 3389/fnut.2025.1694999 OPEN ACCESS EDITED BY Gizem Özata Uyar, Kirikkale Universitesi, Türkiye REVIEWED BY Ciro Gaona, Alzheimer’s Foundation of Venezuela, Venezuela Changjiang Liu, Wuhan University, China Ça˘gla Pınarlı Falakacıla,˙Istanbul Gedik University, Türkiye *CORRESPONDENCE Yong Cai [caiyong202028@hotmail.com](caiyong202028@hotmail.com)[ ](caiyong202028@hotmail.com)Chunhai Shao [2257139538@qq.com](2257139538@qq.com)[ ](2257139538@qq.com)Ying Wang [yingwangxun@163.com](yingwangxun@163.com)[ ](yingwangxun@163.com)Fan Hu [joyking2003@163.com](joyking2003@163.com) †These authors have contributed equally to this work RECEIVED 29 August 2025 REVISED 07 November 2025 ACCEPTED 30 November 2025 PUBLISHED 19 December 2025 CITATION Zhang M, Wang Y, Zhang Y, Gao Q, Hu F, Wang Y, Shao C and Cai Y (2025) Dietary B-complex vitamins and sleep quality in relation to cognitive impairment among older adults: non-linear associations and evidence of additive interaction. Front. Nutr. 12:1694999 . doi: 10.3389/fnut.2025.1694999 COPYRIGHT © 2025 Zhang, Wang, Zhang, Gao, Hu, Wang, Shao and Cai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Dietary B-complex vitamins and sleep quality in relation to cognitive impairment among older adults: non-linear associations and evidence of additive interaction Meihui Zhang1,2†, Yuxuan Wang1,2†, Yinghuan Zhang1,2 , Quyige Gao1,2 , Fan Hu2*, Ying Wang2*, Chunhai Shao3,4* and Yong Cai2,5* 1 School of Public Health, Shanghai Jiao Tong University, Shanghai, China, 2 Public Health Research Center, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 3 Department of Clinical Nutrition, Huashan Hospital, Fudan University, Shanghai, China, 4 Department of Clinical Nutrition, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China, 5 Center of Community Healthcare, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China Background: Global dementia cases are projected to reach 152 .8 million by 2050, with China accounting for approximately 25% of cases. While B-complex vitamins and sleep quality are established modiﬁable determinants of cognitive health, their potential synergistic effects on cognitive function remain unexplored, particularly in rapidly aging populations. Methods: In this population-based cross-sectional study, we analyzed baseline data from 8,806 adults aged ≥65 years in the Shanghai Aging and Retirement Evaluation Survey (January-May 2024) . Dietary B-complex vitamins intake was assessed using a validated Food Frequency Questionnaire. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) . Cognitive function was measured using the Mini-Mental State Examination, with scores ≤24 indicating cognitive impairment. We examined non-linear relationships using restricted cubic splines analysis and assessed independent associations using multivariate logistic regression. Both multiplicative and additive interactions were evaluated using cross-product terms and three additive interaction indices. Findings: Among 8,806 participants, 677 (7 .69%) had cognitive impairment. Higher intake of vitamin B6, B12, and folate showed L-shaped associations with reduced cognitive impairment risk, while PSQI scores demonstrated J-shaped relationships. Compared with lowest quartiles, participants in highest quartilesof vitamin B6, B12, and folate intake had lower odds of cognitive impairment (adjusted OR 0

FAQs

What data and tools were used to evaluate dietary B-complex vitamin intake, sleep quality, and cognitive impairment?

Dietary B-complex vitamin intake was assessed using a validated Food Frequency Questionnaire. Sleep quality was evaluated with the Pittsburgh Sleep Quality Index (PSQI), and cognitive function was measured using the Mini-Mental State Examination (MMSE), where scores ≤24 indicated cognitive impairment.

How were non-linear associations between vitamins, sleep quality, and cognitive impairment analyzed?

Non-linear relationships were examined using restricted cubic splines, and independent associations were estimated with multivariate logistic regression.

What did the study find about interactions between low B-complex vitamin intake and poor sleep quality?

Significant additive interactions were observed between low B-complex intake and poor sleep quality, with Relative Excess Risk Due to Interaction, Attributable Proportion, and Synergy Index all indicating a synergistic association with cognitive impairment risk.

Sep 28, 2026

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