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【medical-news】补充叶酸可提高认知功能

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http://www.medpagetoday.com/Neurology/AlzheimersDisease/tb/4888
Cognitive Function Boosted by Folic Acid Supplements

WAGENINGEN, The Netherlands, Jan. 19 -- Folic acid supplementation appears to improve cognitive function, particularly memory, among older adults with poor folate status, Dutch researchers said. Action Points

Explain to interested patients that folic acid supplementation may benefit cognitive function among older adults who have poor folate status.

Inform interested patients that in the United States, where grain is fortified with folic acid, less than 1% of the population may have inadequate folate status.
Three years of daily 800 μg folic acid orally bestowed on patients the equivalent of a 4.7- to 6.9 years of younger memory, reported Jane Durga, Ph.D., of Wageningen University here, and colleagues, in the Jan. 20 issue of The Lancet.

These results follow on the heels of an observational study in New York that found a weak link between higher folate levels and a lowered risk of Alzheimer's disease in older Americans.

However, Dr. Durga and colleagues said it is unclear whether the cognitive benefits they found would yield a similar end result.

"Whereas some have argued that cognitive decline is the beginning of a continuum leading to dementia," they wrote, "others have argued that the cause of age-related cognitive decline differs from that of dementia and that age-related cognitive decline is not an early state of mild cognitive impairment or dementia."

They added, "Although folic acid improved performance on tests of memory, including delayed recall, additional research is needed to determine whether folic acid supplementation can reduce the risk of mild cognitive impairment or Alzheimer's disease."

Their study encompassed a secondary endpoint analysis of the Folic Acid and Carotid Intimamedia Thickness (FACIT) trial, which is looking at folic acid's effect on atherosclerosis in men and women ages 50 to 70.

The study evaluated persons with elevated plasma total homocysteine (13 μmol/L or more) who could be expected to benefit from homocysteine-lowering folic acid. All 818 participants also had normal serum vitamin B12 at baseline.

Selecting individuals with high homocysteine (in the absence of other potentially accountable factors) focused the study on those with inadequate folate status, according to an accompanying editorial by Martha Clare Morris, Sc.D., and Christine C. Tangney, Ph.D., both of the Rush Institute for Healthy Aging in Chicago.

Participants were randomly assigned to three years of double-blind treatment with placebo or 800 μg/day folic acid, which the authors said "is regarded as a low dose for a clinical trial." Treatment was effective with serum folate concentrations increasing by 576% and plasma homocysteine falling by 26% for the folic acid group compared with placebo.

At baseline, both groups had similar scores on a battery of cognitive tests for memory, sensorimotor speed, complex speed, information processing speed, and word fluency.

Three years later, the results were significantly different comparing the folic acid versus placebo groups. The findings were (mean Z score difference):

A significantly better mean change in global cognitive function (0.050, 95% CI 0.004 to 0.096, P=0.033).
A significant comparative improvement in memory (0.132, 95% confidence interval 0.032 to 0.233, P=0.010).
A significant difference in information processing speed (0.087, 95% CI 0.016 to 0.158, P= 0.016),
A significantly better sensorimotor speed for the folic acid than the placebo group (0.064, 95% CI -0.001 to 0.129, P=0·055).
Similar information processing speeds between groups (0.037, 95% CI -0.049 to 0.122, P=0.40).
No significant difference in word fluency between groups (-0.070, 95% CI -0.188 to 0.048, P=0.245).

On the basis of these findings, the researchers said, folic acid appeared to affect age-related aspects of cognitive function.

"The effect of folic acid might be restricted to basic aspects of speed and information processing, rather than high order information processing," Dr. Durga and colleagues wrote. "Word fluency was not affected by folic acid supplementation, perhaps not surprisingly, because encyclopaedic memory is a component of crystallised intelligence that stays relatively intact as one grows older."

Folic acid conferred the mental performance of a younger person for the older adults, even after adjusting for sex and education. These findings were:

4.7 years younger for memory overall (95% CI 1.1 to 8.3).
6.9 years younger for delayed-recall memory (95% CI 2.1 to 11.8).
1.7 years younger for sensorimotor speed (95% CI -0.04 to 3.4).
2.1 years younger for information processing speed (95% CI 0.4-3.7).
1.5 years younger for global cognitive function (95% CI 0.1 to 2.8).

Performance on the Mini-Mental State Examination used to screen for possible dementia (less than 24 points) were not affected by folic acid treatment (P=0.63). Mean scores were similar between groups at 29 points after three years for both.

The results were not modified by initial folate status, MTHFR C677T genotype, dyslipidemia, or self-reported vascular disease. Compliance was high, there was no difference between groups in the proportion of patients who discontinued treatment or were lost to follow-up (P=0.25), and only five patients in the folic acid group reported adverse events (forgetfulness, sun allergies, weight gain, tinnitus, and dark urine).

The researchers said the magnitude of effect seen in the trial would likely not be as great in populations, such as that in the United States, where homocysteine concentrations are lower overall.

"Dietary intakes of folate in the trial participants were far lower than the U.S. recommended dietary allowance (RDA) of 400 μg a day, and also lower than the RDA for The Netherlands (300 μg a day)," wrote Dr. Morris and Dr. Tangney in their commentary. "After the introduction of fortification, fewer than 1% of the U.S. population had an inadequate serum folate status."

The results need to be confirmed by other investigators and repeated in other populations, such as those with mild cognitive impairment and dementia, the researchers concluded.

Dr. Durga currently works at the Nestle Research Center in Lausanne, Switzerland, and another author now works at the Unilever Food and Health Research Institute in Vlaardingen, Netherlands. However, the study was finished prior to either author's move, and none of the authors declared conflicts of interest.

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2007-01-20 10:33 浏览 : 1978 回复 : 3

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ldguan 编辑于 2007-01-22 07:52

• 院外心脏骤停15次，台上再停3次，好在活了过来

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本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领

2007-01-20 10:43

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• 其他医生用我的工号出报告

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Cognitive Function Boosted by Folic Acid Supplements 叶酸可提高认知能力

WAGENINGEN, The Netherlands, Jan. 19 -- Folic acid supplementation appears to improve cognitive function, particularly memory, among older adults with poor folate status, Dutch researchers said. Action Points WAGENINGEN，荷兰，1月19。荷兰研究人员指出：叶酸补体能够改善认知能力，尤其是叶酸缺乏状态的老年人的记忆能力。

Explain to interested patients that folic acid supplementation may benefit cognitive function among older adults who have poor folate status. 向目标病人解释，叶酸补体可能有益于叶酸缺乏状态的老年人的认知能力。

Inform interested patients that in the United States, where grain is fortified with folic acid, less than 1% of the population may have inadequate folate status. Three years of daily 800 μg folic acid orally bestowed on patients the equivalent of a 4.7- to 6.9 years of younger memory, reported Jane Durga, Ph.D., of Wageningen University here, and colleagues, in the Jan. 20 issue of The Lancet. 告知美国病人，那里的谷物富含叶酸，所以不足1%的总人口缺乏叶酸。 Wageningen University的Jane Durga博士及其同事于The Lancet的1月20日期刊上报道，三年中每天口服800μg叶酸的病人的记忆力等同于年轻4.7-6.9年的个体。

These results follow on the heels of an observational study in New York that found a weak link between higher folate levels and a lowered risk of Alzheimer's disease in older Americans. 这些结果紧跟在一项New York的观察性研究之后，发现在美国老年人的高叶酸水平和阿尔茨海默氏病的低风险之间存在一种较弱的联系。

However, Dr. Durga and colleagues said it is unclear whether the cognitive benefits they found would yield a similar end result. 但是，Durga博士及其同事指出，他们发现的认知能力的改善并不一定产生相同的结果。

"Whereas some have argued that cognitive decline is the beginning of a continuum leading to dementia," they wrote, "others have argued that the cause of age-related cognitive decline differs from that of dementia and that age-related cognitive decline is not an early state of mild cognitive impairment or dementia." 他们写道：“尽管很多人认为认知能力下降是导致老年痴呆症的开始，另一些人认为年龄相关的认知能力下降的起因不同于痴呆症，也不是轻微认知损伤或痴呆症的早期阶段。”

They added, "Although folic acid improved performance on tests of memory, including delayed recall, additional research is needed to determine whether folic acid supplementation can reduce the risk of mild cognitive impairment or Alzheimer's disease." 他们补充：“尽管叶酸改善了记忆力测试（包括延迟回忆在内）中的行为，还需要进一步的研究来确定叶酸补体是否能够降低轻微认知损伤或阿尔茨海默氏病的风险。”

Their study encompassed a secondary endpoint analysis of the Folic Acid and Carotid Intimamedia Thickness (FACIT) trial, which is looking at folic acid's effect on atherosclerosis in men and women ages 50 to 70. 他们的研究包含叶酸和颈动脉内中膜厚度（FACIT）试验分析的另一种结果，FACIT试验的目的是研究50-70岁之间的男性和女性中叶酸对于动脉粥样硬化的影响。

The study evaluated persons with elevated plasma total homocysteine (13 μmol/L or more) who could be expected to benefit from homocysteine-lowering folic acid. All 818 participants also had normal serum vitamin B12 at baseline. 这项研究评价了具有提高了的质膜总高半胱氨酸的人群，他们被认为受益于高半胱氨酸降低的叶酸。总的818名参与者也有正常的血清维生素B12。

Selecting individuals with high homocysteine (in the absence of other potentially accountable factors) focused the study on those with inadequate folate status, according to an accompanying editorial by Martha Clare Morris, Sc.D., and Christine C. Tangney, Ph.D., both of the Rush Institute for Healthy Aging in Chicago. 选择的高水平高半胱氨酸（缺乏其他潜在促进因子）的个体促使研究集中于那些叶酸不足状态的个体，与Chicago的Rush Institute for Healthy Aging的Martha Clare Morris博士和Christine C. Tangney博士发表的社论一致。

Participants were randomly assigned to three years of double-blind treatment with placebo or 800 μg/day folic acid, which the authors said "is regarded as a low dose for a clinical trial." Treatment was effective with serum folate concentrations increasing by 576% and plasma homocysteine falling by 26% for the folic acid group compared with placebo. 参加者被随机分配3年的镇定剂或800μg/day叶酸的本人不知情的药物处理，800μg/day叶酸被作者称为临床试验的很低的剂量。

At baseline, both groups had similar scores on a battery of cognitive tests for memory, sensorimotor speed, complex speed, information processing speed, and word fluency. 起初，两组人具有相同的记忆、感觉运动速度、综合速度、信息处理速度和文字流利的认知测验的分数。

Three years later, the results were significantly different comparing the folic acid versus placebo groups. The findings were (mean Z score difference): A significantly better mean change in global cognitive function (0.050, 95% CI 0.004 to 0.096, P=0.033). A significant comparative improvement in memory (0.132, 95% confidence interval 0.032 to 0.233, P=0.010). A significant difference in information processing speed (0.087, 95% CI 0.016 to 0.158, P= 0.016). A significantly better sensorimotor speed for the folic acid than the placebo group (0.064, 95% CI -0.001 to 0.129, P=0•055). Similar information processing speeds between groups (0.037, 95% CI -0.049 to 0.122, P=0.40). No significant difference in word fluency between groups (-0.070, 95% CI -0.188 to 0.048, P=0.245). 3年之后，叶酸和镇定剂组的结果明显不同。发现是（平均Z分数差异）：总体认知能力的明显改善的平均变化（0.050, 95% CI 0.004 to 0.096, P=0.033）。记忆力的明显比较的改善（0.132, 95% confidence interval 0.032 to 0.233, P=0.010）。信息处理速度的明显差异（0.087, 95% CI 0.016 to 0.158, P= 0.016）。叶酸比镇定剂组明显改善的感觉运动速度（0.064, 95% CI -0.001 to 0.129, P=0•055）。两组间的相似的信息处理速度（0.037, 95% CI -0.049 to 0.122, P=0.40）。两组间的文字流利度没有明显差异（-0.070, 95% CI -0.188 to 0.048, P=0.245）。

On the basis of these findings, the researchers said, folic acid appeared to affect age-related aspects of cognitive function. 在这些发现的基础上，研究人员指出叶酸影响认知能力的年龄相关方面。

"The effect of folic acid might be restricted to basic aspects of speed and information processing, rather than high order information processing," Dr. Durga and colleagues wrote. "Word fluency was not affected by folic acid supplementation, perhaps not surprisingly, because encyclopaedic memory is a component of crystallised intelligence that stays relatively intact as one grows older." Durga博士及其同事写道：“叶酸可能限制速度和信息处理过程的基础方面，而不是更高状态的信息处理过程。文字流利度并没有被叶酸补体所影响，也许只是不明显，因为百科全书式的记忆是明确智力（它作为一个生长顺序而相对完整）的一个组成部分”。

Folic acid conferred the mental performance of a younger person for the older adults, even after adjusting for sex and education. These findings were: 4.7 years younger for memory overall (95% CI 1.1 to 8.3). 6.9 years younger for delayed-recall memory (95% CI 2.1 to 11.8). 1.7 years younger for sensorimotor speed (95% CI -0.04 to 3.4). 2.1 years younger for information processing speed (95% CI 0.4-3.7). 1.5 years younger for global cognitive function (95% CI 0.1 to 2.8). 叶酸使老年人具有年轻人一般的精神表现，甚至是在性别和教育程度校正之后。这些发现使：记忆力整体年轻4.7年（95% CI 1.1 to 8.3）。延迟取消记忆年轻6.9年（95% CI 2.1 to 11.8）。感觉运动速度年轻1.7年（95% CI -0.04 to 3.4）。信息处理速度年轻2.1年（95% CI 0.4-3.7）。整体认知功能年轻1.5年（95% CI 0.1 to 2.8）。

Performance on the Mini-Mental State Examination used to screen for possible dementia (less than 24 points) were not affected by folic acid treatment (P=0.63). Mean scores were similar between groups at 29 points after three years for both. 用于筛选可能的痴呆症（少于24个百分点）的Mini-Mental State检测没有被叶酸的施用（P=0.63）所影响。3年后，29个百分点的组之间的平均值相似。

The results were not modified by initial folate status, MTHFR C677T genotype, dyslipidemia, or self-reported vascular disease. Compliance was high, there was no difference between groups in the proportion of patients who discontinued treatment or were lost to follow-up (P=0.25), and only five patients in the folic acid group reported adverse events (forgetfulness, sun allergies, weight gain, tinnitus, and dark urine). 结果没有被最初的叶酸状况、MTHFR C677T基因型、脂血或self-reported血管疾病所修饰。依从很高，在不连续施用或失去重复性（P=0.25）的病人组之间并没有差异，并且在施用叶酸的组中只有5个病人被报道具有相反的事件（健忘、光敏感、增重、耳鸣和黑尿）。

The researchers said the magnitude of effect seen in the trial would likely not be as great in populations, such as that in the United States, where homocysteine concentrations are lower overall. 研究人员指出在试验中观察到的效果的意义在人群中可能并不如此重要，比如在美国，那里高半胱氨酸浓度整体水平很低。

"Dietary intakes of folate in the trial participants were far lower than the U.S. recommended dietary allowance (RDA) of 400 μg a day, and also lower than the RDA for The Netherlands (300 μg a day)," wrote Dr. Morris and Dr. Tangney in their commentary. "After the introduction of fortification, fewer than 1% of the U.S. population had an inadequate serum folate status." Morris博士和Tangney博士在他们的注释中写道：“试验的病人中叶酸的饮食摄取，远少于美国推荐饮食量（RDA）的每天400μg，也低于荷兰PDA的每天300μg。推荐强化之后，少于1%的美国人口具有不足的血清叶酸状态”。

The results need to be confirmed by other investigators and repeated in other populations, such as those with mild cognitive impairment and dementia, the researchers concluded. 研究人员推断，这些结果被其他调查者确认，并且在其他的人群中（比如那些轻微认知损伤和痴呆症病人）重复。

Dr. Durga currently works at the Nestle Research Center in Lausanne, Switzerland, and another author now works at the Unilever Food and Health Research Institute in Vlaardingen, Netherlands. However, the study was finished prior to either author's move, and none of the authors declared conflicts of interest. Durga博士最近工作于瑞士Lausanne的Nestle Research Center，其他的作者现在工作于荷兰Vlaardingen的Unilever Food and Health Research Institute。但是，这项研究在作者们调动之前即告完成，没有一位作者声称这里存在利益冲突。

字数：1604

叶酸可提高认知能力

WAGENINGEN，荷兰，1月19。荷兰研究人员指出：叶酸补体能够改善认知能力，尤其是叶酸缺乏状态的老年人的记忆能力。

向目标病人解释，叶酸补体可能有益于叶酸缺乏状态的老年人的认知能力。
告知美国病人，那里的谷物富含叶酸，所以不足1%的总人口缺乏叶酸。 Wageningen University的Jane Durga博士及其同事于The Lancet的1月20日期刊上报道，三年中每天口服800μg叶酸的病人的记忆力等同于年轻4.7-6.9年的个体。

这些结果紧跟在一项New York的观察性研究之后，发现在美国老年人的高叶酸水平和阿尔茨海默氏病的低风险之间存在一种较弱的联系。但是，Durga博士及其同事指出，他们发现的认知能力的改善并不一定产生相同的结果。他们写道：“尽管很多人认为认知能力下降是导致老年痴呆症的开始，另一些人认为年龄相关的认知能力下降的起因不同于痴呆症，也不是轻微认知损伤或痴呆症的早期阶段。”他们补充：“尽管叶酸改善了记忆力测试（包括延迟回忆在内）中的行为，还需要进一步的研究来确定叶酸补体是否能够降低轻微认知损伤或阿尔茨海默氏病的风险。”

他们的研究包含叶酸和颈动脉内中膜厚度（FACIT）试验分析的另一种结果，FACIT试验的目的是研究50-70岁之间的男性和女性中叶酸对于动脉粥样硬化的影响。这项研究评价了具有提高了的质膜总高半胱氨酸的人群，他们被认为受益于高半胱氨酸降低的叶酸。总的818名参与者也有正常的血清维生素B12。选择的高水平高半胱氨酸（缺乏其他潜在促进因子）的个体促使研究集中于那些叶酸不足状态的个体，与Chicago的Rush Institute for Healthy Aging的Martha Clare Morris博士和Christine C. Tangney博士发表的社论一致。参加者被随机分配3年的镇定剂或800μg/day叶酸的本人不知情的药物处理，800μg/day叶酸被作者称为临床试验的很低的剂量。

起初，两组人具有相同的记忆、感觉运动速度、综合速度、信息处理速度和文字流利的认知测验的分数。3年之后，叶酸和镇定剂组的结果明显不同。发现是（平均Z分数差异）：总体认知能力的明显改善的平均变化（0.050, 95% CI 0.004 to 0.096, P=0.033）。记忆力的明显比较的改善（0.132, 95% confidence interval 0.032 to 0.233, P=0.010）。信息处理速度的明显差异（0.087, 95% CI 0.016 to 0.158, P= 0.016）。叶酸比镇定剂组明显改善的感觉运动速度（0.064, 95% CI -0.001 to 0.129, P=0•055）。两组间的相似的信息处理速度（0.037, 95% CI -0.049 to 0.122, P=0.40）。两组间的文字流利度没有明显差异（-0.070, 95% CI -0.188 to 0.048, P=0.245）。

在这些发现的基础上，研究人员指出叶酸影响认知能力的年龄相关方面。Durga博士及其同事写道：“叶酸可能限制速度和信息处理过程的基础方面，而不是更高状态的信息处理过程。文字流利度并没有被叶酸补体所影响，也许只是不明显，因为百科全书式的记忆是明确智力（它作为一个生长顺序而相对完整）的一个组成部分”。叶酸使老年人具有年轻人一般的精神表现，甚至是在性别和教育程度校正之后。这些发现使：记忆力整体年轻4.7年（95% CI 1.1 to 8.3）。延迟取消记忆年轻6.9年（95% CI 2.1 to 11.8）。感觉运动速度年轻1.7年（95% CI -0.04 to 3.4）。信息处理速度年轻2.1年（95% CI 0.4-3.7）。整体认知功能年轻1.5年（95% CI 0.1 to 2.8）。用于筛选可能的痴呆症（少于24个百分点）的Mini-Mental State检测没有被叶酸的施用（P=0.63）所影响。3年后，29个百分点的组之间的平均值相似。结果没有被最初的叶酸状况、MTHFR C677T基因型、脂血或self-reported血管疾病所修饰。依从很高，在不连续施用或失去重复性（P=0.25）的病人组之间并没有差异，并且在施用叶酸的组中只有5个病人被报道具有相反的事件（健忘、光敏感、增重、耳鸣和黑尿）。

研究人员指出在试验中观察到的效果的意义在人群中可能并不如此重要，比如在美国，那里高半胱氨酸浓度整体水平很低。Morris博士和Tangney博士在他们的注释中写道：“试验的病人中叶酸的饮食摄取，远少于美国推荐饮食量（RDA）的每天400μg，也低于荷兰PDA的每天300μg。推荐强化之后，少于1%的美国人口具有不足的血清叶酸状态”。研究人员推断，这些结果被其他调查者确认，并且在其他的人群中（比如那些轻微认知损伤和痴呆症病人）重复。

Durga博士最近工作于瑞士Lausanne的Nestle Research Center，其他的作者现在工作于荷兰Vlaardingen的Unilever Food and Health Research Institute。但是，这项研究在作者们调动之前即告完成，没有一位作者声称这里存在利益冲突。

2007-01-20 17:23

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1.题目：Cognitive Function Boosted by Folic Acid Supplements
叶酸补体可提高认知能力

Folic Acid Supplements 不是叶酸补体，而是叶酸补充剂，或叶酸添加剂
题目应译为：补充叶酸可提高认知功能

2. Folic acid supplementation appears to improve cognitive function, particularly memory, among older adults with poor folate status,
叶酸补体能够改善认知能力，尤其是叶酸缺乏状态的老年人的记忆能力。

对叶酸缺乏的老年人补充叶酸可改善其认知功能，对记忆力的改善尤为明显。

3. The study evaluated persons with elevated plasma total homocysteine (13 μmol/L or more) who could be expected to benefit from homocysteine-lowering folic acid.
这项研究评价了具有提高了的质膜总高半胱氨酸的人群，他们被认为受益于高半胱氨酸降低的叶酸。

plasma total homocysteine 应译为：血浆同型半胱氨酸

该句译为：这项研究评估了高同型半胱氨酸血症(大于13 μmol/L ) 的患者，预计这些患者将受益于叶酸对同型半胱氨酸的降低作用。

4. Participants were randomly assigned to three years of double-blind treatment with placebo or 800 μg/day folic acid,
参加者被随机分配3年的镇定剂或800μg/day叶酸的本人不知情的药物处理

在为期三年的双盲治疗研究中，参加者被随机分配为服用安慰剂或服用叶酸800 μg/天。

5. Treatment was effective with serum folate concentrations increasing by 576% and plasma homocysteine falling by 26% for the folic acid group compared with placebo.

这句话没翻译。试译：叶酸治疗组与安慰剂组比较，血清叶酸浓度增加576％且血浆同型半胱氨酸水平下降26％视为治疗有效。

6. Word fluency was not affected by folic acid supplementation, perhaps not surprisingly, because encyclopaedic memory is a component of crystallised intelligence that stays relatively intact as one grows older."
文字流利度并没有被叶酸补体所影响，也许只是不明显，因为百科全书式的记忆是明确智力（它作为一个生长顺序而相对完整）的一个组成部分”。

语言流畅并未受到补充叶酸的影响，或许这并不让人感到意外，因为随着年龄增长，形成的智能也相对完整，而百科辞典式的记忆只是这些智能的一部分。

7. adverse events
相反的事件

应译为：不良事件（不良反应事件）

2007-01-21 23:15

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