An Anti-Inflammatory Signature Across Pain and Cognition: Not All Mediterranean Diets Are Equal

Background: Chronic pain and early cognitive vulnerability frequently co-occur in older women and may share inflammatory mechanisms. Objective: We examined whether dietary inflammatory load, assessed using the dietary inflammatory index (DII), and Mediterranean-derived dietary patterns (Mediterranean diet (MED), Dietary Approaches to Stop Hypertension (DASH), Mediterranean–DASH Intervention for Neurodegenerative Delay (MIND) and anti-inflammatory Mediterranean Diet (AnMED)) are associated with pain and early cognitive outcomes. Methods: We conducted a cross-sectional study among women aged ≥50 years recruited from community pharmacies and healthcare centers in the Comunidad Valenciana (Spain). Dietary intake was assessed using the PREDIMED Food Frequency Questionnaire to derive DII and dietary pattern scores. Outcomes included pain intensity, subjective memory complaints (SMC) and semantic verbal fluency (SVF). Analyses were adjusted for sociodemographic, clinical and lifestyle covariates, with false discovery rate correction. Results: Complete case samples comprised 470 women for SMC and SVF, with 328 also included for pain. Higher DII was consistently associated with greater pain intensity, increased odds of SMC, and lower SVF scores. No dietary pattern was associated with pain after correction. AnMED was associated with lower odds of SMC and higher SVF, while DASH was also positively associated with SVF. Bridge analysis showed that lower DII was associated with both MIND and AnMED, with a stronger association for AnMED. Conclusions: Dietary inflammatory load showed the most consistent associations with pain and early cognitive vulnerability, whereas Mediterranean-derived patterns differed in their inflammatory and cognitive relevance.