de Wilde Martijn C, Vellas Bruno, Girault Elodie, Yavuz Aysun Cetinyurek, Sijben John W
Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands.
Gerontopole and UMR INSERM 1027 University Paul Sabatier, Toulouse University Hospital, Toulouse, France.
Alzheimers Dement (N Y). 2017 Jun 24;3(3):416-431. doi: 10.1016/j.trci.2017.06.002. eCollection 2017 Sep.
Alzheimer's disease (AD) patients are at risk of nutritional insufficiencies because of physiological and psychological factors. Recently, we showed the results of the meta-analyses indicating lower plasma levels of vitamins A, B, C, E, and folate in AD patients compared with cognitively intact elderly controls (controls). Now, additional and more extensive literature searches were performed selecting studies which compare blood and brain/cerebrospinal fluid (CSF) levels of vitamins, minerals, trace elements, micronutrients, and fatty acids in AD patients versus controls.
The literature published after 1980 in Cochrane Central Register of Controlled Trials, Medline, and Embase electronic databases was systematically analyzed using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to detect studies meeting the selection criteria. Search terms used are as follows: AD patients, Controls, vitamins, minerals, trace elements, micronutrients, and fatty acids. Random-effects meta-analyses using a linear mixed model with correction for age differences between AD patients and controls were performed when four or more publications were retrieved for a specific nutrient.
Random-effects meta-analyses of 116 selected publications showed significant lower CSF/brain levels of docosahexaenoic acid (DHA), choline-containing lipids, folate, vitamin B, vitamin C, and vitamin E. In addition, AD patients showed lower circulatory levels of DHA, eicosapentaenoic acid, choline as phosphatidylcholine, and selenium.
The current data show that patients with AD have lower CSF/brain availability of DHA, choline, vitamin B, folate, vitamin C, and vitamin E. Directionally, brain nutrient status appears to parallel the lower circulatory nutrient status; however, more studies are required measuring simultaneously circulatory and central nutrient status to obtain better insight in this observation. The brain is dependent on nutrient supply from the circulation, which in combination with nutrient involvement in AD-pathophysiological mechanisms suggests that patients with AD may have specific nutritional requirements. This hypothesis could be tested using a multicomponent nutritional intervention.
由于生理和心理因素，阿尔茨海默病（AD）患者存在营养不足的风险。最近，我们展示了荟萃分析的结果，表明与认知功能正常的老年对照组（对照组）相比，AD患者血浆中维生素A、B、C、E和叶酸水平较低。现在，我们进行了更多更广泛的文献检索，选择了比较AD患者与对照组血液和脑/脑脊液（CSF）中维生素、矿物质、微量元素、微量营养素和脂肪酸水平的研究。
使用系统评价和荟萃分析的首选报告项目指南，对1980年后发表在Cochrane对照试验中央注册库、Medline和Embase电子数据库中的文献进行系统分析，以检测符合选择标准的研究。使用的检索词如下：AD患者、对照组、维生素、矿物质、微量元素、微量营养素和脂肪酸。当针对特定营养素检索到四篇或更多出版物时，使用线性混合模型进行随机效应荟萃分析，并对AD患者和对照组之间的年龄差异进行校正。
对116篇选定出版物的随机效应荟萃分析显示，脑脊液/脑中二十二碳六烯酸（DHA）、含胆碱脂质、叶酸、维生素B、维生素C和维生素E的水平显著降低。此外，AD患者循环中DHA、二十碳五烯酸、作为磷脂酰胆碱的胆碱和硒的水平较低。
目前的数据表明，AD患者脑脊液/脑中DHA、胆碱、维生素B、叶酸、维生素C和维生素E的可利用性较低。从趋势上看，脑营养状况似乎与较低的循环营养状况平行；然而，需要更多的研究同时测量循环和中枢营养状况，以便更好地理解这一观察结果。脑依赖于循环系统的营养供应，再加上营养物质参与AD病理生理机制，这表明AD患者可能有特定的营养需求。这一假设可以通过多组分营养干预来检验。
