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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(11): 672-680
DOI: 10.1590/0004-282X20200074
Articles

Serum folate levels and cognitive performance in the ELSA-Brasil baseline assessment

Níveis séricos de folato e desempenho cognitivo na avaliação de linha de base do ELSA-Brasil

Authors

  • Itamar de Souza SANTOS 

    1   Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Clínica e Epidemiológica, São Paulo SP, Brazil.
    2   Universidade de São Paulo. Faculdade de Medicina, Departamento de Clínica Médica, São Paulo SP, Brazil.

  • Claudia Kimie SUEMOTO 

    1   Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Clínica e Epidemiológica, São Paulo SP, Brazil.
    2   Universidade de São Paulo. Faculdade de Medicina, Departamento de Clínica Médica, São Paulo SP, Brazil.

  • José Benedito Ramos VALLADÃO-JUNIOR 

    1   Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Clínica e Epidemiológica, São Paulo SP, Brazil.

  • Simin LIU 

    3   Brown University, School of Public Health, Department of Epidemiology, Providence, RI, United States of America.

  • Sandhi Maria BARRETO 

    4   Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Medicina Preventiva e Social, Belo Horizonte MG, Brazil.

  • Ligia Maria Giongo FEDELI 

    1   Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Clínica e Epidemiológica, São Paulo SP, Brazil.

  • Paulo Andrade LOTUFO 

    1   Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Clínica e Epidemiológica, São Paulo SP, Brazil.
    2   Universidade de São Paulo. Faculdade de Medicina, Departamento de Clínica Médica, São Paulo SP, Brazil.

  • Isabela Martins BENSENOR 

    1   Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Clínica e Epidemiológica, São Paulo SP, Brazil.
    2   Universidade de São Paulo. Faculdade de Medicina, Departamento de Clínica Médica, São Paulo SP, Brazil.
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ABSTRACT

Background: Most studies that analyze the association between serum folate levels and cognitive function either restrict their assessments to specific clinical scenarios or do not include middle-aged individuals, to whom strategies for preventing cognitive impairment may be more feasible. Objective: To examine the association between serum folate levels and cognitive function in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment. Methods: Data from 4,571 ELSA-Brasil participants who live in the state of São Paulo, aged 35-74 years, were analyzed. The word list learning, delayed recall, word recognition, verbal fluency, and Trail Making Test Part B consisted in the cognitive tests. For each test, age, sex, and education-specific standardized scores and a global cognitive score were calculated. Crude and adjusted linear regression models were used to examine the associations of serum folate levels with cognitive test scores. Results: In multivariable-adjusted models, serum folate was not associated with global cognitive score (β=-0.043; 95% confidence interval [95%CI] -0.135 to 0.050 for lowest vs. highest quintile group), nor with any cognitive test performance. We did not find associations between serum folate and global cognitive scores in subgroups stratified by age, sex, or use of vitamin supplements either. Conclusions: We did not find significant associations between serum folate and cognitive performance in this large sample, which is characterized by a context of food fortification policies and a consequent low frequency of folate deficiency. Positive results from previous studies may not apply to the increasingly common contexts in which food fortification is implemented, or to younger individuals.

RESUMO

Introdução: A maioria dos estudos que analisam a associação entre os níveis séricos de folato e a função cognitiva restringem suas avaliações a cenários clínicos específicos ou não incluem indivíduos de meia idade, nos quais estratégias preventivas para a função cognitiva podem ser mais viáveis. Objetivo: Examinar a associação entre os níveis séricos de folato e a função cognitiva na avaliação inicial do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). Métodos: Foram analisados dados de 4.571 participantes do ELSA-Brasil em São Paulo, com idades entre 35 e 74 anos. Os testes cognitivos foram aprendizagem, recordatório tardio e reconhecimento de lista de palavras; fluência verbal e teste de trilhas parte B. Calculamos, para cada teste e globalmente, escores padronizados para idade, sexo e educação. Foram utilizados modelos de regressão linear para examinar as associações dos níveis séricos de folato com o desempenho nos testes cognitivos. Resultados: Em modelos ajustados para múltiplas variáveis, o folato sérico não esteve associado ao escore cognitivo global (β=-0,043; intervalo de confiança de 95%: [IC95%] -0,135 a 0,050 para 1º vs. 5º quintil), ou desempenho em qualquer teste cognitivo. Também não encontramos associações entre folato sérico e escores cognitivos globais em subgrupos estratificados por idade, sexo ou uso de suplementos vitamínicos. Conclusões: Não encontramos associações significativas entre folato sérico e desempenho cognitivo nesta grande amostra, caracterizada por um cenário sob políticas de fortificação alimentar e consequente baixa frequência de deficiência de folato. Resultados positivos de estudos anteriores podem não se aplicar às situações cada vez mais comuns em que a fortificação de alimentos é implementada, ou a indivíduos mais jovens.

Keywords:

Cognition - Dietary Supplements - Epidemiology - Folic Acid - Memory

Palavras-chave:

Cognição - Suplementos Nutricionais - Epidemiologia - Ácido Fólico - Memória

Authors’ contributions:

ISS and IMB formulated the research question, designed the study, analyzed the data, interpreted the data and wrote the paper. CKS, JBRVJ, SL and LMGF interpreted the data and made important intellectual contributions to the paper. SMB and PAL participated in study design, interpreted the data and made important intellectual contributions to the paper.


Support:

The ELSA-Brasil baseline study was supported by the Brazilian Ministry of Health (Department of Science and Technology) and the Brazilian Ministry of Science and Technology (Financiadora de Estudos e Projetos and National Council for Scientific and Technological Development - CNPq) under grants [01 06 0010.00 RS, 01 06 0212.00 BA, 01 06 0300.00 ES, 01 06 0278.00 MG, 01 06 0115.00 SP, 01 06 0071.00 RJ] and by the São Paulo Research Foundation (FAPESP) under grant [2015/17013-3].




Publication History

Received: 17 April 2020

Accepted: 13 May 2020

Article published online:
07 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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