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Plasma folate levels in relation to cognitive impairment: a community-based cohort of older adults in China

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Abstract

Purpose

Lower plasma level of folate has been associated with an increased risk of age-related cognitive impairment. However, studies that examined this relation have yielded mixed results. We aimed to examine the prospective association of plasma folate level with risk of cognitive impairment in a community-based prospective cohort of older adults in China.

Methods

This study included 615 participants (mean age: 76.3 years) without baseline cognitive impairment from the Rugao Longevity and Ageing Study (RuLAS). We used logistic regression to examine the prospective association between baseline plasma folate and risk of cognitive impairment in the next two years. Fasting blood samples were collected and assayed for plasma folate level at baseline. Cognitive impairment was defined as Hasegawa Dementia Scale (HDS) score ≤ 21.5 points.

Results

During two years’ follow-up, 20.7% of the participants developed cognitive impairment. After controlled for age, gender, and plasma homocysteine, a higher level of plasma folate was associated with lower odds of cognitive impairment. The corresponding odds ratio (OR) with 95% confidence interval was 0.41 (0.19–0.89) comparing participants at extreme quintiles of plasma folate (median level 17.2 vs. 6.3 nmol/L). The associations were similar after further adjustment for major demographic and lifestyle factors (OR = 0.42, 0.18–0.98). Moreover, the inverse association was particularly stronger among males (OR = 0.12, 0.03–0.52) but was non-significant among females.

Conclusion

Our findings support a potential beneficial role of higher plasma folate levels in cognitive function in older Chinese adults, particularly among males. Future studies with larger sample size and longer follow-up are warranted to confirm these findings and to identify the optimal plasma folate level for cognitive function.

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Availability of data and material

The datasets used and analyzed for the current study are available from the corresponding author on reasonable request.

Code availability

Analysis codes used in this analysis are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors acknowledge the support from the Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province (2020E10004).

Funding

This work was supported by the National Key R&D Program of China (2018YFC2000400/2018YFC2000400-3), the Shanghai Municipal Science and Technology Major Project (Grant No. 2017SHZDZX01).

Author information

Authors and Affiliations

  1. School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

    Xiao Chen, Yuhui Huang, Shiyu Yan & Changzheng Yuan

  2. Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Jiaxi Yang

  3. Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Jiaxi Yang

  4. Human Phenome Institute, Fudan University, Shanghai, China

    Hui Zhang & Xiaofeng Wang

  5. National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China

    Hui Zhang & Xiaofeng Wang

  6. CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China

    Yaying Cao & Geng Zong

  7. State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China

    Yan Zheng

  8. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Changzheng Yuan

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  1. Xiao Chen
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  2. Jiaxi Yang
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  3. Hui Zhang
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  8. Yan Zheng
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  9. Xiaofeng Wang
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  10. Changzheng Yuan
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Contributions

XW and CY designed the analysis; XC and JY performed the statistical analyses; CY, XC, JY, and HZ interpreted the data and drafted and revised the manuscript; CY supervised the data analysis and interpretation; CY, XW had the primary responsibility for the study final content; all authors critically reviewed the manuscript and approved the final draft.

Corresponding authors

Correspondence to Xiaofeng Wang or Changzheng Yuan.

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Conflict of interest

None.

Ethics approval

This study was approved by the Human Ethics Committee of the School of Life Sciences of Fudan University, Shanghai, China (Ethical Approval No. BE1815).

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Informed consent was obtained from all participants before participation.

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All the authors have approved the submitted version.

Supplementary Information

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394_2022_2825_MOESM1_ESM.docx

Supplementary Table 1 Multivariable-adjusted ORs (95% CIs) for cognitive impairment comparing top to bottom quintile of plasma folate levels across subgroups

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Chen, X., Yang, J., Zhang, H. et al. Plasma folate levels in relation to cognitive impairment: a community-based cohort of older adults in China. Eur J Nutr 61, 2837–2845 (2022). https://doi.org/10.1007/s00394-022-02825-y

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