Department of Nutrition, Faculty of Public Health, University of São Paulo, São Paulo, Brazil.
Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil.
Clin Nutr ESPEN. 2023 Jun;55:332-339. doi: 10.1016/j.clnesp.2023.04.013. Epub 2023 Apr 19.
BACKGROUND & AIMS: Folate (vitamin B9) is an essential co-factor for one-carbon metabolism. Controversial evidence has emerged regarding the association between folate and cognitive performance. The aim of the study was to investigate the association between baseline dietary folate intake and cognitive decline in a population exposed to mandatory fortification during a median follow-up of 8 years.
Multicenter, prospective cohort study involving 15,105 public servants aged 35-74 years old, both sexes, from The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Baseline dietary intake was assessed by a Food Frequency Questionnaire (FFQ). Six cognitive tests were performed in the three waves to assess memory, executive function and global cognition. Linear mixed-effects models were used to assess the association between dietary folate intake at baseline and changes in cognition over time.
Data from 11,276 participants were analyzed. The mean (SD) age was 51.7 (9) years, 50% were women, 63% were overweight/obese, and 56% had graduated from college or more. Overall dietary folate intake was not associated with cognitive decline; neither vitamin B12 intake was a modifier of this association. General dietary supplements and specifically multivitamins use did not affect these findings. Natural food folate group was associated with a slower rate of global cognitive decline (β (95% CI): 0.001 (0.000; 0.002), P = 0.015). There was no association between fortified food group and cognition scores.
Overall dietary folate intake was not associated with cognitive function in this Brazilian population. However, folate naturally occurring in food sources may slow global cognitive decline.
叶酸（维生素 B9）是一碳代谢的必需辅助因子。关于叶酸与认知表现之间的关系，出现了有争议的证据。本研究的目的是调查在中位随访 8 年期间暴露于强制性强化食品的人群中，基线饮食叶酸摄入量与认知能力下降之间的关联。
多中心前瞻性队列研究，纳入了 15105 名年龄在 35-74 岁之间的公共服务人员，包括男性和女性，来自巴西成人健康纵向研究（ELSA-Brasil）。基线饮食摄入量通过食物频率问卷（FFQ）进行评估。在三个时间点进行了六项认知测试，以评估记忆、执行功能和整体认知。使用线性混合效应模型评估基线饮食叶酸摄入量与随时间变化的认知之间的关联。
分析了 11276 名参与者的数据。平均（SD）年龄为 51.7（9）岁，50%为女性，63%超重/肥胖，56%大学毕业或以上。总体饮食叶酸摄入量与认知能力下降无关；维生素 B12 摄入量也不是这种关联的调节剂。一般膳食补充剂，特别是多种维生素的使用并没有影响这些发现。天然食物叶酸组与整体认知下降的速度较慢相关（β（95%CI）：0.001（0.000；0.002），P=0.015）。强化食品组与认知评分之间没有关联。
在巴西人群中，总体饮食叶酸摄入量与认知功能无关。然而，天然存在于食物来源中的叶酸可能会减缓整体认知能力下降。
