vitamin-b-12 and Folic-Acid-Deficiency

This review delves into the intricate relationship between excess folate (vitamin B9) intake, especially its synthetic form, namely, folic acid, and its implications on health and disease. While folate plays a pivotal role in the one-carbon cycle, which is essential for DNA synthesis, repair, and methylation, concerns arise about its excessive intake. The literature underscores potential deleterious effects, such as an increased risk of carcinogenesis; disruption in DNA methylation; and impacts on embryogenesis, pregnancy outcomes, neurodevelopment, and disease risk. Notably, these consequences stretch beyond the immediate effects, potentially influencing future generations through epigenetic reprogramming. The molecular mechanisms underlying these effects were examined, including altered one-carbon metabolism, the accumulation of unmetabolized folic acid, vitamin-B12-dependent mechanisms, altered methylation patterns, and interactions with critical receptors and signaling pathways. Furthermore, differences in the effects and mechanisms mediated by folic acid compared with natural folate are highlighted. Given the widespread folic acid supplementation, it is imperative to further research its optimal intake levels and the molecular pathways impacted by its excessive intake, ensuring the health and well-being of the global population.

Topics: Dietary Supplements; DNA Methylation; Female; Folic Acid; Folic Acid Deficiency; Humans; Pregnancy; Vitamin B 12

Anemia and depression are common in the elderly and they are important medical, social and economic problems for the world. Both disorders are associated with a lower quality of life, multimorbidity and a higher risk of death. The connections between anemia and depression have been reported, but the mechanism and clinical consequences of their co-existence are not fully understood. Several links can be found between anemia and depression in the elderly: common etiological factors, low socioeconomic status of patients, poor education and less physical activity. Both conditions are associated with the occurrence of the same pathological changes: age-related (especially with the presence of inflammation, oxidative stress, degenerative changes in organs and tissues), nutritional deficiencies (iron, vitamin B12, folic acid) and hormonal disorders (especially thyroid gland disorders, sex hormone deficiencies). Anemia and depression are not sufficiently diagnosed in the elderly and, as a result, are often left untreated. The diagnosis and treatments of these conditions in the elderly differ from those in other age groups. The study provides an overview of the literature regarding the co-existence of anemia and depression in elderly patients and clinical recommendations.

Topics: Aged; Anemia; Depression; Folic Acid Deficiency; Humans; Quality of Life; Vitamin B 12; Vitamin B 12 Deficiency

In this review of megaloblastic anemia (MA), an overview of vitamin B

Topics: Anemia, Megaloblastic; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infant, Newborn; Vitamin B 12; Vitamin B 12 Deficiency

Mood disorders affect more than 500 million people around the world. In the last decade, their prevalence has increased, and many people suffer from nervousness, anxiety, and stress at least once in their lives. The incidence of mood disorders and anxiety increases during perimenopause or under stressful conditions. The social restrictions introduced during the COVID-19 pandemic have significantly increased the normal burden of psychological and psychic disorders. In moderate to severe cases, pharmacological treatment is currently recommended, while in mild disorders, especially in the initial phase, psychological therapy is preferable. It is known that several nutrients are crucial for brain function. Among them, folate (vitamin B9), cyanocobalamin (vitamin B12), and S-adenosyl-L-methionine (SAMe) have been shown to influence various neurobiological processes. Overall, the available evidence suggests that dietary supplementation with folic acid, vitamin B12, and SAMe can be beneficial for people with mild mood disorders.

Topics: COVID-19 Drug Treatment; Female; Folic Acid; Folic Acid Deficiency; Humans; Mood Disorders; Pandemics; Vitamin B 12; Vitamin B 12 Deficiency

Folic acid, referred to as vitamin B9, is a water-soluble substance, which participates in the synthesis of nucleic acids, amino acids, and proteins. Similarly to B12 and B6, vitamin B9 is involved in the metabolism of homocysteine, which is associated with the

Topics: Anemia; Dietary Supplements; Folic Acid; Folic Acid Deficiency; Gastrointestinal Microbiome; Humans; Hyperhomocysteinemia; Inflammatory Bowel Diseases; Methylenetetrahydrofolate Reductase (NADPH2); Vitamin B 12; Vitamin B 6

COVID-19 exacts a disproportionate toll on both the elderly and those with diabetes; these patients are more likely to require costly intensive care, longer hospitalisation, and die from complications. Nations would thus find it extremely difficult to either lift or sustain socially, economically, and politically damaging restrictions that keep this group of people safe. Without a vaccine, there is thus an urgent need to identify potential modifiable risk factors which can help manage overall fatality or recovery rates. Case fatality rates are highly variable between (and even within) nations; nutritional differences have been proposed to account significantly for this disparity. Indeed, vitamin B12 deficiency is a common denominator between the elderly and those with diabetes. The question on hand thus lies on whether managing B12 deficiencies will impact COVID-19 fatality outcome or recovery rates. Herein, we review the latest evidence that shows that B12 deficiency associates in multiple areas very similar to where COVID-19 exerts its damaging effects: immunologically; microbiologically; haematologically; and through endothelial cell signalling-supporting the hypothesis that B12 deficiency is a potential modifiable risk factor in our fight against COVID-19.

Topics: Aged; Comorbidity; COVID-19; Critical Care; Diabetes Complications; Folic Acid Deficiency; Gastrointestinal Microbiome; Homocysteine; Humans; Models, Biological; Obesity; Pandemics; Risk Factors; SARS-CoV-2; Severity of Illness Index; Vitamin B 12; Vitamin B 12 Deficiency

Neural tube defects (NTDs) are birth defects that arise during embryogenesis when normal neural tube closure fails to occur. According to the World Health Organization, NTDs are detected annually in approximately 300,000 neonates worldwide. The exact etiology of NTDs remains complex and poorly understood. It is generally agreed that most NTD cases are of multifactorial origin, having a combination of multiple genes and a number of environmental risk factors. The role of folic acid, vitamin B12 deficiency, genetics and other risk factors, in the etiology of NTDs, has also been extensively studied. This knowledge synthesis brings together different types of evidence to update the role of vitamin B12 deficiency, genetics and other risk factors, in the etiology of NTDs. Following a PubMed search and screening for relevant articles, we included 40 studies in our review (30 case-control studies, 3 cross-sectional studies, 5 cohort studies, and 2 case reports). The available data showed that vitamin B12 levels were decreased in mothers and infants in NTD groups compared with control groups. Holo-transcobalamin, the active form of vitamin B12, was also found in lower levels in mothers with NTD-affected infants. Several studies reported elevated homocysteine levels in mothers and infants in NTD groups. Additionally, numerous studies reported links between genetic variants and increased NTD risk. These genes include GIF, LRP2, CUBN, TCb1R, MTHFR, and others. Several maternal factors have also been linked with significant NTD risk such as BMI, maternal diet, air pollutants, low maternal age, and many others. The majority of studies on NTDs have focused on the role of folic acid, hence there is a need for well-designed studies on the role of other risk factors like vitamin B12 deficiency in the etiology of NTDs.

Topics: Adult; Animals; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infant, Newborn; Neural Tube Defects; Pregnancy; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

One-carbon metabolism is crucial for the maintenance of healthy pregnancy and alterations in this pathway have been associated with various pregnancy-related complications. Therefore, the present study was conducted to test the hypothesis that the altered folic acid, vitamin B12 and homocysteine levels are associated with the risk of early pregnancy loss (EPL). Plasma folic acid, vitamin B12 and homocysteine levels were analyzed in 83 females with EPL and 70 healthy pregnant females in their first trimester. Further, meta-analyses of folic acid, vitamin B12 and homocysteine were also performed involving various eligible studies. Results from our case-control study and meta-analysis showed that folic acid deficiency is not associated with the risk of EPL. On the other hand, low vitamin B12 and hyperhomocysteinemia were individually found to be significant risk factors for EPL in the present study (P < .01, P < .05, respectively) and meta-analysis as well (P < .001, P < .05, respectively). Vitamin B12 deficiency in combination with hyperhomocysteinemia was a more serious risk factor for EPL (Odds Ratio = 4.98, P = 0.002). Therefore, we conclude that vitamin B12 deficiency and elevated homocysteine levels are independent risk factors for EPL, and of higher risk when combined. The assessment of vitamin B12 and homocysteine levels may serve as a good screening marker for EPL risk.

Topics: Abortion, Spontaneous; Adult; Case-Control Studies; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Maternal Nutritional Physiological Phenomena; Meta-Analysis as Topic; Nutritional Status; Odds Ratio; Pregnancy; Pregnancy Complications; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Vitamin B12 is a fascinating nutrient in that it is made by microbes but is essential for human metabolism. Humans can get it only from animal origin foods. Dietary deficiency rather than an absorption defect (Pernicious anemia, intrinsic factor defect) is the commonest cause of deficiency in the world, contributed by cultural and economic imperatives. Indians have a large prevalence of subclinical B12 deficiency due to vegetarianism. Birth cohort with long-term serial follow-up (Pune Maternal Nutrition Study) has helped reveal the life-course evolution of B12 deficiency: genetics, transplacental and lactational transfer from the mother, influence of family environment, rapid childhood and adolescent growth, and low consumption of milk all made a contribution. A novel association of low maternal B12 status was with fetal growth restriction and increased risk factors of diabetes in the baby. After demonstrating adequate absorption of small (2 μg) dose of vitamin B12, and a noticeable improvement of metabolic parameters in a pilot trial, we planned a supplementation trial in adolescents to improve outcomes in their babies (a primordial prevention called Pune Rural Intervention in the Young Adolescent). The results are awaited. The long-term effects in the babies born in the trial will contribute to a better understanding of the Developmental Origins of Health and Disease.

Topics: Adolescent; Adult; Animals; Diet; Diet, Vegetarian; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Gastrointestinal Microbiome; Humans; India; Male; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency

Megaloblastic anemia causes macrocytic anemia from ineffective red blood cell production and intramedullary hemolysis. The most common causes are folate (vitamin B

Topics: Adolescent; Aged; Anemia, Megaloblastic; Avitaminosis; Diagnosis, Differential; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Severity of Illness Index; Vitamin B 12; Vitamin B 12 Deficiency

Immune dysfunction, including severe combined immunodeficiency, has been described in genetic disorders affecting the metabolism of the vitamins cobalamin (vitamin B12) and folate. We have reviewed reports of clinical findings in patients with a number of inborn errors of cobalamin or folate metabolism, specifically looking for immune problems.. There is little evidence that immune function is affected in most of the disorders. Exceptions are Imerslund-Gräsbeck syndrome and hereditary folate malabsorption (affecting intestinal absorption of cobalamin and folate, respectively), transcobalamin deficiency (affecting transport of cobalamin in blood and cellular cobalamin uptake), and methylenetetrahydrofolate dehydrogenase 1 deficiency (catalyzing cytoplasmic interconversion of reduced folate coenzyme derivatives).. Although some inborn errors of cobalamin or folate can be associated with immune dysfunction, the degree and type of immune dysfunction vary with no obvious pattern.

Topics: Anemia, Megaloblastic; Folic Acid; Folic Acid Deficiency; Humans; Malabsorption Syndromes; Methylenetetrahydrofolate Dehydrogenase (NADP); Minor Histocompatibility Antigens; Nutritional Physiological Phenomena; Primary Immunodeficiency Diseases; Proteinuria; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Vitamins B9 (folate) and B12 are essential water-soluble vitamins that play a crucial role in the maintenance of one-carbon metabolism: a set of interconnected biochemical pathways driven by folate and methionine to generate methyl groups for use in DNA synthesis, amino acid homeostasis, antioxidant generation, and epigenetic regulation. Dietary deficiencies in B9 and B12, or genetic polymorphisms that influence the activity of enzymes involved in the folate or methionine cycles, are known to cause developmental defects, impair cognitive function, or block normal blood production. Nutritional deficiencies have historically been treated with dietary supplementation or high-dose parenteral administration that can reverse symptoms in the majority of cases. Elevated levels of these vitamins have more recently been shown to correlate with immune dysfunction, cancer, and increased mortality. Therapies that specifically target one-carbon metabolism are therefore currently being explored for the treatment of immune disorders and cancer. In this review, we will highlight recent studies aimed at elucidating the role of folate, B12, and methionine in one-carbon metabolism during normal cellular processes and in the context of disease progression.

Topics: Folic Acid; Folic Acid Deficiency; Humans; One-Carbon Group Transferases; Polymorphism, Genetic; Vitamin B 12; Vitamin B 12 Deficiency

Homocysteine (Hcy) is methylated by methionine synthase to form methionine with methyl-cobalamin as a cofactor. The reaction demethylates 5-methyltetrahydrofolate to tetrahydrofolate, which is required for DNA and RNA synthesis. Deficiency of either of the cobalamin (Cbl) and/or folate cofactors results in elevated Hcy and megaloblastic anemia. Elevated Hcy is a sensitive biomarker of Cbl and/or folate status and more specific than serum vitamin assays. Elevated Hcy normalizes when the correct vitamin is given. Elevated Hcy is associated with alcohol use disorder and drugs that target folate or Cbl metabolism, and is a risk factor for thrombotic vascular disease. Elevated methionine and cystathionine are associated with liver disease. Elevated Hcy, cystathionine, and cysteine, but not methionine, are common in patients with chronic renal failure. Higher cysteine predicts obesity and future weight gain. Serum S-adenosylhomocysteine (AdoHcy) is elevated in Cbl deficiency and chronic renal failure. Drugs that require methylation for catabolism may deplete liver S-adenosylmethionine and raise AdoHcy and Hcy. Deficiency of Cbl or folate or perturbations of their metabolism cause major changes in sulfur amino acids.

Topics: Alcoholism; Amino Acids, Sulfur; Anemia, Megaloblastic; Biomarkers; Cardiovascular Diseases; Folic Acid; Folic Acid Deficiency; Humans; Hyperhomocysteinemia; Kidney Failure, Chronic; Liver Diseases; Nutritional Status; Obesity; S-Adenosylhomocysteine; Vitamin B 12; Vitamin B 12 Deficiency

Atrophic glossitis (AG) is characterized by the partial or complete absence of filiform papillae on the dorsal surface of the tongue. AG may reflect the significant deficiencies of some major nutrients including riboflavin, niacin, pyridoxine, vitamin B12, folic acid, iron, zinc, and vitamin E. Moreover, protein-calorie malnutrition, candidiasis, Helicobacter pylori colonization, xerostomia, and diabetes mellitus are also the etiologies of AG. Our previous study found the serum gastric parietal cell antibody (GPCA), thyroglobulin antibody (TGA), and thyroid microsomal antibody (TMA) positivities in 26.7%, 28.4%, and 29.8% of 1064 AG patients, respectively. We also found anemia, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia in 19.0%, 16.9%, 5.3%, 2.3%, and 11.9% of 1064 AG patients, respectively. Moreover, GPCA-positive AG patients tended to have relatively higher frequencies of hemoglobin, iron, and vitamin B12 deficiencies and hyperhomocysteinemia than GPCA-negative AG patients. Supplementations with vitamin BC capsules plus corresponding deficient hematinics for those AG patients with hematinic deficiencies can achieve complete remission of oral symptoms and AG in some AG patients. Therefore, it is very important to examine the complete blood count, serum hematinic, homocysteine, and autoantibody levels in AG patients before we start to offer treatments for AG patients.

Topics: Anemia; Atrophy; Autoantibodies; Erythrocyte Indices; Folic Acid; Folic Acid Deficiency; Glossitis; Hemoglobins; Humans; Hyperhomocysteinemia; Iron; Parietal Cells, Gastric; Vitamin B 12; Vitamin B 12 Deficiency

Vitamin B

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Animals; Folic Acid; Folic Acid Deficiency; Humans; Methylmalonyl-CoA Mutase; Vitamin B 12; Vitamin B 12 Deficiency

This review gives an overview of clinical characteristics, treatment and outcome of nutritional and acquired cobalamin (Cbl; synonym: vitamin B12) deficiencies, inborn errors of Cbl absorption and intracellular trafficking, as well as methylenetetrahydrofolate dehydrogenase (MTHFD1) and methylene tetrahydrofolate reductase (MTHFR) deficiencies, which impair Cbl-dependent remethylation. Acquired and inborn Cbl-related disorders and MTHFR deficiency cause multisystem, often severe disease. Failure to thrive, neurocognitive or psychiatric symptoms, eye disease, bone marrow alterations, microangiopathy and thromboembolic events are characteristic. The recently identified MTHFD1 defect additionally presents with severe immune deficiency. Deficient Cbl-dependent enzymes cause reduced methylation capacity and metabolite toxicity. Further net-effects of perturbed Cbl function or reduced Cbl supply causing oxidative stress, altered cytokine regulation or immune functions are discussed.

Topics: Folic Acid; Folic Acid Deficiency; Homocystinuria; Humans; Infant, Newborn; Metabolic Networks and Pathways; Methylenetetrahydrofolate Dehydrogenase (NADP); Methylenetetrahydrofolate Reductase (NADPH2); Muscle Spasticity; Psychotic Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Vitamin B12 and folic acid deficiencies are particularly frequent conditions in older people. Since these metabolic disorders represent relevant dyscognitive factors, the assessment of vitamin B12 and folic acid levels is essential in the diagnostic approach of cognitive disorders, such as mild cognitive impairment and dementia in an outpatient memory clinic. This article summarizes the relevant diagnostic and therapeutic aspects of vitamin B12 and folic acid deficiencies and their effects on cognition. The literature review is supplemented by a data analysis of a naturalistic cohort of 250 patients from this outpatient memory clinic.

Topics: Aged; Aged, 80 and over; Cognition; Cognition Disorders; Data Analysis; Folic Acid; Folic Acid Deficiency; Humans; Outpatients; Universities; Vitamin B 12; Vitamin B 12 Deficiency

Micronutrient deficiencies are common in pregnant women due to low dietary intake and increased requirements for fetal development. Low maternal micronutrient status is associated with a range of pregnancy pathologies involving placental dysfunction, including fetal growth restriction (FGR), small-for-gestational age (SGA), pre-eclampsia and preterm birth. However, clinical trials commonly fail to convincingly demonstrate beneficial effects of supplementation of individual micronutrients, attributed to heterogeneity and insufficient power, potential interactions and lack of mechanistic knowledge of effects on the placenta. We aimed to provide current evidence of relationships between selected micronutrients (vitamin D, vitamin A, iron, folate, vitamin B12) and adverse pregnancy outcomes, combined with understanding of actions on the placenta. Following a systematic literature search, we reviewed data from clinical,

Topics: Animals; Dietary Supplements; Female; Fetal Development; Folic Acid; Folic Acid Deficiency; Humans; Infant, Newborn; Iron; Iron Deficiencies; Iron, Dietary; Micronutrients; Models, Animal; Placenta; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Randomized Controlled Trials as Topic; Trophoblasts; Vitamin A; Vitamin A Deficiency; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin D; Vitamin D Deficiency

Inflammatory bowel disease (IBD) patients may be at risk of vitamin B12 and folate insufficiencies, as these micronutrients are absorbed in the small intestine, which is affected by IBD. However, a consensus has not been reached on the association between IBD and serum folate and vitamin B12 concentrations.. In this study, a comprehensive search of multiple databases was performed to identify studies focused on the association between IBD and serum folate and vitamin B12 concentrations. Studies that compared serum folate and vitamin B12 concentrations between IBD and control patients were selected for inclusion in the meta-analysis.. The main outcome was the mean difference in serum folate and vitamin B12 concentrations between IBD and control patients. Our findings indicated that the average serum folate concentration in IBD patients was significantly lower than that in control patients, whereas the mean serum vitamin B12 concentration did not differ between IBD patients and controls. In addition, the average serum folate concentration in patients with ulcerative colitis (UC) but not Crohn's disease (CD) was significantly lower than that in controls. This meta-analysis identified a significant relationship between low serum folate concentration and IBD.. Our findings suggest IBD may be linked with folate deficiency, although the results do not indicate causation. Thus, providing supplements of folate and vitamin B12 to IBD patients may improve their nutritional status and prevent other diseases.

Topics: Colitis, Ulcerative; Crohn Disease; Dietary Supplements; Folic Acid; Folic Acid Deficiency; Humans; Inflammatory Bowel Diseases; Intestinal Absorption; Intestinal Mucosa; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency

Moderate hyperhomocysteinemia-induced low folate status is an independent risk factor for cardiovascular disease, dementia, and depression. Folate is an essential cofactor in the one-carbon metabolism pathway and is necessary in amino acid metabolism, purine and thymidylate synthesis, and DNA methylation. In the folate cycle and homocysteine metabolism, folate, vitamin B12, vitamin B6, and vitamin B2 are important cofactors. Many enzymes are involved in folate transport and uptake, the folate pathway, and homocysteine (Hcy) metabolism, and various polymorphisms have been documented in these enzymes. Serum folate and total Hcy (tHcy) levels are influenced by folate intake and genetic polymorphisms in 5,10-methylenetertahydrofolate reductase (MTHFR) such as C677T. The prevalence of the MTHFR 677TT genotype varies across ethnic groups and regions, with a frequency of approximately 15% in Japanese populations. Individuals with the TT genotype have significantly higher tHcy levels and lower folate levels in serum than those with the CT and TT genotypes. However, administration of folic acid has been shown to eliminate these differences. Moreover, data have suggested that interventions based on genotype may be effective for motivating individuals to change their lifestyle and improve their nutrition status. Accordingly, in this review, we discuss the effects of MTHFR C677T polymorphisms on serum tHcy and folate levels with folic acid intervention and evaluate approaches for overcoming folic acid deficiency and related symptoms.

Topics: Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Gene Expression; Genotype; Humans; Hyperhomocysteinemia; Male; Metabolic Networks and Pathways; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Polymorphism, Genetic; Vitamin B 12

Although a low serum folate concentration is a useful biomarker of pure folate deficiency, the presence of vitamin B12 deficiency or hemolysis or both in individuals with low folate status predictably raises serum folate levels. Therefore, in resource-limited settings where dietary folate deficiency can coexist with vitamin B12 deficiency or malaria or both, the serum folate concentration can range from normal to high, leading to serious underestimation of tissue folate status. This review traces the genesis of an inappropriate overreliance on the serum folate concentration to rule out folate deficiency in vulnerable populations of women and children. Of significance, without due consideration of a chronically inadequate dietary folate intake, authors of influential studies have likely wrongly judged these populations to have an adequate folate status. Through repetition, this error has led to a dangerous entry into the contemporary medical literature that folate deficiency is rare in women and children. As a consequence, many millions of under-resourced women and children with mild to moderate tissue folate deficiency may have been deprived of folate replacement. This review uses historical documents to challenge earlier conclusions and re-emphasizes the need for contextual integration of clinical information in resource-limited settings.

Topics: Biomarkers; Developing Countries; Diet; Environment; False Negative Reactions; Female; Folic Acid; Folic Acid Deficiency; Hematologic Tests; Humans; Malaria; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency; Vulnerable Populations

Diabetes mellitus is an acutely debilitating ailment affecting a large population of the world. At present, over 415 million people around the world including 7 million people in Pakistan suffering from diabetes. Homocysteine is an amino acid that is inversely related to vitamin B12 and folate, and raised level of homocysteine is implicated in many adverse health conditions. In this study, the potential role of homocysteine in diabetes and the epidemiology of hyperhomocysteinaemia, and vitamin B12 and folate deficiency is reviewed along with the impact of folate and vitamin B12 in regulation of homocysteine level. Deficiency of vitamin B12 and folate is rare in developed countries and the countries which adopted fortification programs, but deficiency of these vitamins is found to be highly prevalent in developing world, particularly in Pakistan. Several studies have found an association of high homocysteine levels and diabetes, but a few studies found contrary results. Hence, further epidemiological studies are recommended for homocysteine involvement in diabetes and vitamin B12 and folate deficiency, so that an urgent action can be taken to control the hyperhomocysteinaemia and consequently the ever increasing burden of disease and specifically diabetes.

Topics: Diabetes Mellitus; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Prevalence; Vitamin B 12

Anemia of pregnancy, an important risk factor for fetal and maternal morbidity, is considered a global health problem, affecting almost 50% of pregnant women. In this article, diagnosis and management of iron, cobalamin, and folate deficiencies, the most frequent causes of anemia in pregnancy, are discussed. Three clinical cases are considered. Iron deficiency is the most common cause. Laboratory tests defining iron deficiency, the recognition of developmental delays and cognitive abnormalities in iron-deficient neonates, and literature addressing the efficacy and safety of IV iron in pregnancy are reviewed. An algorithm is proposed to help clinicians diagnose and treat iron deficiency, recommending oral iron in the first trimester and IV iron later. Association of folate deficiency with neural tube defects and impact of fortification programs are discussed. With increased obesity and bariatric surgery rates, prevalence of cobalamin deficiency in pregnancy is rising. Low maternal cobalamin may be associated with fetal growth retardation, fetal insulin resistance, and excess adiposity. The importance of treating cobalamin deficiency in pregnancy is considered. A case of malarial anemia emphasizes the complex relationship between iron deficiency, iron treatment, and malaria infection in endemic areas; the heightened impact of combined etiologies on anemia severity is highlighted.

Topics: Adult; Anemia; Anemia, Iron-Deficiency; Erythrocyte Transfusion; Female; Folic Acid; Folic Acid Deficiency; Hematinics; Humans; Iron; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Vitamin deficiency is one of the major causes of treatable dementia. Specifically, patients suffering from dementia frequentry display low serum levels of vitamin B(12). There is a close metabolic interaction between folate and vitamin B(12). Folate deficiency causes various neuropsychiatric symptoms, which resemble those observed in vitamin B(12) deficiency. This review summarizes, the basic pathophysiology of vitamin B(12) and folate deficiency, its clinical diagnosis, associated neuropsychiatric symptoms such as subacute combined degeneration and dementia, and epidemiological studies of cognitive decline and brain atrophy.

Topics: Aged; Brain; Dementia; Female; Folic Acid Deficiency; Humans; Spinal Cord; Vitamin B 12; Vitamin B 12 Deficiency

Anemia is a common problem in primary care. Classification based on mean cell volume narrows the differential diagnosis and directs testing. A marked macrocytosis is characteristic of vitamin B12 and folate deficiencies, certain medications, and primary bone marrow disorders. The three most common causes of microcytic anemia are iron deficiency, thalassemia trait, and anemia of inflammation. Additional laboratory testing is required for diagnosis. Determination of the rate of development of anemia and examination of a blood smear may provide diagnostic clues to guide more specialized testing. Diagnosis of iron, vitamin B12, or folate deficiency mandates determination of the underlying cause.

Topics: Alcohol Drinking; Anemia, Iron-Deficiency; Anemia, Macrocytic; Blood Cell Count; Diagnosis, Differential; Drug-Related Side Effects and Adverse Reactions; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Humans; Liver Diseases; Myeloproliferative Disorders; Predictive Value of Tests; Primary Health Care; United States; Vitamin B 12; Vitamin B 12 Deficiency; Women's Health

Topics: Algorithms; Diagnosis, Differential; Folic Acid; Folic Acid Deficiency; Guideline Adherence; Humans; Methylmalonic Acid; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Background: The current magnitude of folate and vitamin B12 deficiency in Latin America and the Caribbean is uncertain.. To summarize data on plasma or serum vitamin B12 and folate concentrations in Latin America and the Caribbean reported since 1990, a period that covers the era before and after the introduction of folic acid fortification.. A systematic review was conducted in 2012 and updated in 2014. Studies and surveys using biochemical biomarkers and conducted in apparently healthy individuals were identified.. Folate deficiency in Latin America and the Caribbean appears not to be a public health problem (prevalence < 5%) after the introduction of folic acid fortification. However, there is some indication that high rates of low or marginal vitamin B12 status remain in most locations and across population groups.. Adding vitamin B12 as a fortificant with folic acid may be the best strategy in areas where vitamin B12 deficiency is an established concern.

Topics: Adolescent; Adult; Aged; Caribbean Region; Child; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Latin America; Male; Nutritional Status; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency

Adequate choline intake during pregnancy is essential for proper fetal development. Nowadays studies suggest that even in high income countries regular pregnant women diet does not provide the satisfactory amount of choline. Choline demand during pregnancy is high and it seems to exceed present choline intake recommendations. Moreover lactation period also demands choline supplementation because of its high concentration in female milk. Numerous studies on animal model proved correlation between choline supplementation during pregnancy and proper fetal cognitive function development. Despite increased synthesis in maternal liver during pregnancy choline demand is much higher than common dietary uptake. Nowadays studies as to the nutritional recommendations during pregnancy concern also vitamin B12 supplementation. Vitamin B12 deficiency may be an important risk factor of neural tube defects development. Presented article contains a review of data on proper choline and vitamin B12 uptake during pregnancy and lactation and potential results of choline and vitamin B12 poor maternal status.

Topics: Choline; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Humans; Maternal Nutritional Physiological Phenomena; Pregnancy; Pregnancy Complications; Prenatal Nutritional Physiological Phenomena; Vitamin B 12; Vitamin B 12 Deficiency

This systematic review evaluated micronutrient intake inadequacy of ten micronutrients for adult ethnic minority populations residing in Europe. Pubmed was searched for studies, related references were checked and experts consulted. Ten studies were identified and six were included in the final analysis representing Albanian, Roma, Sub-Saharan African, South Asian and African-Caribbean minority groups. The Estimated Average Requirement cut point was applied to estimate inadequate intake. With the exception of a sub-Saharan African study, of seven micronutrients analysed, inadequate intakes were markedly elevated (>50 % of the population in most cases) in both genders for folate, vitamin B(12), calcium and iron (the latter in females only). A pressing need exists for intake adequacy studies with sound methodologies addressing ethnic minority groups in Europe. These populations constitute a vulnerable population for inadequate intakes and results substantiate the need for further investigation, interventions and policy measures to reduce their nutritional risk.

Topics: Calcium; Ethnicity; Europe; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Iron Deficiencies; Male; Micronutrients; Minority Groups; Vitamin B 12; Vitamin B 12 Deficiency

Vitamin B12 deficiency is common in certain populations, such as in India, where there is also a rising prevalence of Type 2 diabetes, obesity and their complications. Human cohorts and animal models provide compelling data suggesting the role of the one-carbon cycle in modulating the risk of diabetes and adiposity via developmental programming. Early mechanistic studies in animals suggest that alterations to the cellular provision of methyl groups (via the one-carbon cycle) in early developmental life may disrupt DNA methylation and induce future adverse phenotypic changes. Furthermore, replacement of micronutrient deficits at suitable developmental stages may modulate this risk. Current human studies are limited by a range of factors, including the accuracy and availability of methods to measure nutritional components in the one-carbon cycle, and whether its disruptions exert tissue-specific effects. A greater understanding of the causal and mechanistic role of the one-carbon cycle is hoped to generate substantial insights into its role in the developmental origins of complex metabolic diseases and the potential of targeted and population-wide prevention strategies.

Topics: Adiposity; Carbon Cycle; Diabetes Mellitus, Type 2; Environmental Exposure; Female; Fetal Development; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Infant, Newborn; Insulin Resistance; Male; Maternal Nutritional Physiological Phenomena; Methylmalonic Acid; Obesity; Pregnancy; Prenatal Exposure Delayed Effects; Vitamin B 12; Vitamin B 12 Deficiency

Genome-wide association studies have mainly relied on common HapMap sequence variations. Recently, sequencing approaches have allowed analysis of low frequency and rare variants in conjunction with common variants, thereby improving the search for functional variants and thus the understanding of the underlying biology of human traits and diseases. Here, we used a large Icelandic whole genome sequence dataset combined with Danish exome sequence data to gain insight into the genetic architecture of serum levels of vitamin B(12) (B12) and folate. Up to 22.9 million sequence variants were analyzed in combined samples of 45,576 and 37,341 individuals with serum B(12) and folate measurements, respectively. We found six novel loci associating with serum B(12) (CD320, TCN2, ABCD4, MMAA, MMACHC) or folate levels (FOLR3) and confirmed seven loci for these traits (TCN1, FUT6, FUT2, CUBN, CLYBL, MUT, MTHFR). Conditional analyses established that four loci contain additional independent signals. Interestingly, 13 of the 18 identified variants were coding and 11 of the 13 target genes have known functions related to B(12) and folate pathways. Contrary to epidemiological studies we did not find consistent association of the variants with cardiovascular diseases, cancers or Alzheimer's disease although some variants demonstrated pleiotropic effects. Although to some degree impeded by low statistical power for some of these conditions, these data suggest that sequence variants that contribute to the population diversity in serum B(12) or folate levels do not modify the risk of developing these conditions. Yet, the study demonstrates the value of combining whole genome and exome sequencing approaches to ascertain the genetic and molecular architectures underlying quantitative trait associations.

Topics: Alzheimer Disease; Denmark; Exome; Folic Acid; Folic Acid Deficiency; Genome-Wide Association Study; Genome, Human; Humans; Iceland; Methylenetetrahydrofolate Reductase (NADPH2); Quantitative Trait Loci; Vitamin B 12

During the past decade the role of folate and vitamin B12 in human nutrition have been under constant re-examination. Basic knowledge on the metabolism and interactions between these essential nutrients has expanded and multiple complexities have been unraveled. These micronutrients have shared functions and intertwined metabolic pathways that define the size of the "methyl donor" pool utilized in multiple metabolic pathways; these include DNA methylation and synthesis of nucleic acids. In Chile, folate deficiency is virtually nonexistent, while vitamin B12 deficiency affects approximately 8.5-51% depending on the cut-off value used to define deficiency. Folate is found naturally mainly in vegetables or added as folic acid to staple foods. Vitamin B12 in its natural form is present only in foods of animal origin, which is why deficit is more common among strict vegetarians and populations with a low intake of animal foods. Poor folate status in vulnerable women of childbearing age increases the risk of neural tube birth defects, so the critical time for the contribution of folic acid is several months before conception since neural tube closure occurs during the first weeks of life. The absorption of vitamin B12 from food is lower in older adults, who are considered to have higher risk of gastric mucosa atrophy, altered production of intrinsic factor and acid secretion. Deficiency of these vitamins is associated with hematological disorders. Vitamin B12 deficiency can also induce clinical and sub-clinical neurological and of other disorders. The purpose of this review is to provide an update on recent advances in the basic and applied knowledge of these vitamins relative to human health.

Topics: Diet; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Folate plays a critical role in the prevention of uracil incorporation into DNA and hypomethylation of DNA. This activity is compromised when vitamin B12 concentration is low because methionine synthase activity is reduced, lowering the concentration of S-adenosyl methionine (SAM) which in turn may diminish DNA methylation and cause folate to become unavailable for the conversion of dUMP to dTMP. The most plausible explanation for the chromosome-breaking effect of low folate is excessive uracil misincorporation into DNA, a mutagenic lesion that leads to strand breaks in DNA during repair. Both in vitro and in vivo studies with human cells clearly show that folate deficiency causes expression of chromosomal fragile sites, chromosome breaks, excessive uracil in DNA, micronucleus formation, DNA hypomethylation and mitochondrial DNA deletions. In vivo studies show that folate and/or vitamin B12 deficiency and elevated plasma homocysteine (a metabolic indicator of folate deficiency) are significantly correlated with increased micronucleus formation and reduced telomere length respectively. In vitro experiments indicate that genomic instability in human cells is minimised when folic acid concentration in culture medium is greater than 100nmol/L. Intervention studies in humans show (a) that DNA hypomethylation, chromosome breaks, uracil incorporation and micronucleus formation are minimised when red cell folate concentration is greater than 700nmol/L and (b) micronucleus formation is minimised when plasma concentration of vitamin B12 is greater than 300pmol/L and plasma homocysteine is less than 7.5μmol/L. These concentrations are achievable at intake levels at or above current recommended dietary intakes of folate (i.e. >400μg/day) and vitamin B12 (i.e. >2μg/day) depending on an individual's capacity to absorb and metabolise these vitamins which may vary due to genetic and epigenetic differences.

Topics: Animals; Cells, Cultured; Dietary Supplements; DNA Damage; DNA Methylation; Folic Acid; Folic Acid Deficiency; Gene-Environment Interaction; Genome, Mitochondrial; Genomic Instability; Humans; Nutritional Requirements; Vitamin B 12; Vitamin B 12 Deficiency

It is now 30 years since the first publications stating that supplementation with folate could prevent neural tube defects appeared and 20 years since the definitive data, including prevention of other birth defects. Since then epidemiological studies and animal experiments have identified folate as a molecule at the crossroads of neural development. Fortification of food has greatly reduced the incidence of spina bifida. Much interest has focussed on long-term sequelae in children born to mothers severely deprived of folate (and other nutrients) such as during the Dutch Hunger Winter of 1944 and in poor parts of the world. In addition, deficiency in folate and B12 are increasingly discussed as a possible contributing factor in dementia and congenital orofacial and heart malformations. The year 2011 saw the publication of a study that implicated low folate intake in poorer school performance of adolescents as judged by school marks. This has enormous social implications but needs confirmation from other settings. This review assesses the current state of evidence and sets the data in context of whether folate has a role in the development and plasticity of the nervous system even after birth, with particular emphasis on childhood and adolescence.

Topics: Adolescent; Cardiovascular Diseases; Child; Child, Preschool; Cognition Disorders; Educational Status; Embryonic Development; Folic Acid; Folic Acid Deficiency; Humans; Nervous System; Neural Tube Defects; Socioeconomic Factors; Vitamin B 12

Deficiencies of folate or of vitamin B-12 are widespread and constitute a major global burden of morbidity that affect all age groups. Detecting or confirming the presence of folate or vitamin B-12 deficiency and distinguishing one from the other depends, ultimately, on laboratory testing. Tests to determine the presence of folate or vitamin B-12 deficiency are used singly or in combination to establish the nutritional status and prevalence of deficiencies of the vitamins in various populations. The efficacy of interventions through the use of fortification or supplements is monitored by using the same laboratory tests. Tests currently in use have limitations that can be either technical or have a biological basis. Consequently, each single test cannot attain perfect sensitivity, specificity, or predictive value. Laboratory indicators of vitamin B-12 or folate status involve the measurement of either the total or a physiologically relevant fraction of the vitamin in a compartment such as blood. Thus, assays to measure vitamin B-12 or folate in plasma or serum as well as folate in red blood cells are in widespread use, and more recently, methods to measure vitamin B-12 associated with the plasma binding protein transcobalamin (holotranscobalamin) have been developed. Alternatively, concentrations of surrogate biochemical markers that reflect the metabolic function of the vitamin can be used. Surrogates most commonly used are plasma homocysteine, for detection of either vitamin B-12 or folate deficiency, and methylmalonic acid for detection of vitamin B-12 deficiency. The general methods as well as their uses, indications, and limitations are presented.

Topics: Folic Acid; Folic Acid Deficiency; Humans; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency

This two-part review highlights micronutrients for which either public health policy has been established or for which new evidence provides guidance as to recommended intakes during pregnancy. One pivotal micronutrient is folate, the generic name for different forms of a water-soluble vitamin essential for the synthesis of thymidylate and purines and, hence, DNA. For non-pregnant adult women the recommended intake is 400 μg/day dietary folate equivalent. For women capable of becoming pregnant an additional 400 μg/day of synthetic folic acid from supplements or fortified foods is recommended to reduce the risk of neural tube defects (NTD). The average amount of folic acid received through food fortification (grains) in the US is only 128 μg/day, emphasising the need for the supplemental vitamin for women of reproductive age. Vitamin B12 (cobalamin) is a cofactor required for enzyme reactions, including generation of methionine and tetrahydrofolate. B12 is found almost exclusively in foods of animal origin (meats, dairy products); therefore, vegetarians are at greatest risk for dietary vitamin B12 deficiency and should be supplemented. Vitamin B6 is required for many reactions, primarily in amino acid metabolism. Meat, fish and poultry are good dietary sources. Supplementation beyond routine prenatal vitamins is not recommended.

Topics: Animals; Congenital Abnormalities; Dairy Products; Diet; Dietary Supplements; Edible Grain; Female; Fishes; Folic Acid; Folic Acid Deficiency; Humans; Meat; Nutrition Policy; Nutritional Requirements; Poultry; Pregnancy; Reproduction; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6; Vitamin B 6 Deficiency

There has been a great interest in the last decades about the clinical significance of elevated total plasma homocysteine (tHcy), and especially its possible association with an increased cardiovascular risk. Measurement of tHcy is clearly indicated when homocystinuria is suspected in young or adult patients (in the presence of a severe, atypical or progressive myopia with ectopia lentis and/or venous thromboembolism and/or severe, premature or atypical atherosclerotic vascular disease) and in the evaluation of vitamin B12 and/or folic acid deficiencies. The current evidence does not support either the screening measurement of tHcy or the treatment with vitamin B12 and/or folic acid supplementation in patients with cardiovascular disease. It is important to remember that it remains to be proved whether the long-term administration of folic acid at pharmacological doses is safe.

Topics: Adolescent; Adult; Cardiovascular Diseases; Child; Child, Preschool; Ectopia Lentis; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Homocystinuria; Humans; Hyperhomocysteinemia; Infant; Infant, Newborn; Life Style; Male; Middle Aged; Myopia; Pregnancy; Randomized Controlled Trials as Topic; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

In recent years, there has been growing interest in the association between national diet and the possibility of developing various mental disorders, as well as between deficiency of such vitamins as, e.g. folic acid, vitamin B12, B6, and others (e.g., omega-3 fatty acids), elevated serum homocysteine level and the functioning of human brain as well as the occurrence of such disorders as dementia, central nervous system vascular disorders and depression.. was to present the current state of knowledge about the role of folic acid and homocysteine in the human organism as well as the significance of vitamin deficiency, mainly folic acid and hyperhomocysteinemy for the occurrence of mood disorders.. The authors conducted the search of the Internet database Medline (www.pubmed.com) using as key words: depression, mood, homocysteine, vitamin deficiencies: folic acid, B6 and 812 and time descriptors: 1990-2007.. In depression, folate, vitamins B12 and B6, as well as unsaturated omega-3 fatty acids deficiency affects the biochemical processes in the CNS, as folic acid and vitamin B12, participate in the metabolism of S-adenosylmethionine (SAM), a donator of methyl groups, which play a decisive role in the functioning of the nervous system; they are, among others, active in the formation of neurotransmitters (e.g. serotonin), phospholipids that are a component of neuronal myelin sheaths, and cell receptors. The deficiency of the vitamins in question results in hyperhomocysteinemia (the research shows that approximately 45-55% of patients with depression develop significantly elevated serum homocysteine), which causes a decrease in SAM, followed by impaired methylation and, consequently, impaired metabolism of neurotransmitters, phospholipids, myelin, and receptors. Hyperhomocysteinemia also leads to activation of NMDA receptors, lesions in vascular endothelium, and oxidative stress. All this effects neurotoxicity and promotes the development of various disorders, including depression. Vitamins B12 and B6, folic acid and omega-3 fatty acids supplementation is thus important in patients suffering from their deficiency; national diet as a significant factor in prevention of numerous CNS disorders, including depression, is also worth consideration.

Topics: Affect; Dietary Supplements; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Mood Disorders; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6; Vitamin B 6 Deficiency

Cobalamin deficiency can lead to several adverse health consequences: folate trapping in the methylation cycle and subsequent impaired DNA biosynthesis; pernicious anemia hematologically, similar to that caused by folate deficiency; elevated blood homocysteine (tHcy) (risk factor for cardiovascular disease and adverse pregnancy outcomes); and neural tube defects (NTDs). Population-wide folate status is expected to improve where folic acid fortification policies for reducing NTD occurrence are established. However, there is concern that cobalamin deficiency and its characteristic neuropathy could be masked when hematological abnormalities in risk groups such as the elderly and vegetarians are reversed through folic acid supplementation. Folate-cobalamin interactions and their impact on health are reviewed here.

Topics: Adult; Aged; Cardiovascular Diseases; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Homocysteine; Humans; Neural Tube Defects; Nutritional Requirements; Nutritional Status; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

There has been increasing research into the role of nutritional factors in mood and cognitive disorders in later life. This review evaluates findings from recent research for the role and effect of n-3 polyunsaturated fatty acids (PUFAs) and B vitamins in mood and cognitive disorders in later life.. Epidemiological studies, including genetic epidemiological ones, continue to provide support for the role of folate and/or vitamin B12 in mood disorders in later life. However, evidence from recent randomized controlled trials for the effect of these B vitamins and n-3 PUFAs is modest. There is little robust evidence for the effect of these nutrients on cognitive disorders in later life.. Larger randomized controlled trials allowing more appropriate meta-analyses are required to further evaluate current findings. Additionally, methods derived from research in geriatric medicine may assist in conceptualizing a role for these nutrients.

Topics: Aged; Animals; Cognition Disorders; Diet; Dietary Fats; Fatty Acids, Unsaturated; Fishes; Folic Acid; Folic Acid Deficiency; Geriatric Psychiatry; Humans; Mental Disorders; Mood Disorders; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

This review describes current knowledge of the main causes of vitamin B12 and folate deficiency. The most common explanations for poor vitamin B12 status are a low dietary intake of the vitamin (i.e., a low intake of animal-source foods) and malabsorption. Although it has long been known that strict vegetarians (vegans) are at risk for vitamin B12 deficiency, evidence now indicates that low intakes of animal-source foods, such as occur in some lacto-ovo vegetarians and many less-industrialized countries, cause vitamin B12 depletion. Malabsorption of the vitamin is most commonly observed as food-bound cobalamin malabsorption due to gastric atrophy in the elderly, and probably as a result of Helicobacter pylori infection. There is growing evidence that gene polymorphisms in transcobalamins affect plasma vitamin B12 concentrations. The primary cause of folate deficiency is low intake of sources rich in the vitamin, such as legumes and green leafy vegetables, and the consumption of these foods may explain why folate status can be adequate in relatively poor populations. Other situations in which the risk of folate deficiency increases include lactation and alcoholism.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biological Availability; Child; Child, Preschool; Developing Countries; Diet; Diet, Vegetarian; Female; Folic Acid; Folic Acid Deficiency; Helicobacter Infections; Helicobacter pylori; Humans; Infant; Intestinal Absorption; Male; Middle Aged; Nutritional Requirements; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Deficiencies of folate or of vitamin B12 are widespread and constitute a major global burden of morbidity affecting all age groups. Detecting or confirming the presence of folate or vitamin B12 deficiency and distinguishing one from the other depends, ultimately, on laboratory testing. Tests to determine the presence of folate or vitamin B12 deficiency are used singly or in combination to establish the nutritional status and prevalence of deficiencies of the vitamins in various populations. The efficacy of interventions through the use of fortification or supplements is monitored using the same laboratory tests. Tests currently in use have limitations that can be either technical or have a biological basis. Consequently, each single test cannot attain perfect sensitivity, specificity, or predictive value. Laboratory indicators of vitamin B12 or folate status involve measurement of either the total or a physiologically relevant fraction of the vitamin in a compartment such as the blood. Thus, assays to measure vitamin B12 or folate in plasma or serum as well as folate in red blood cells are in widespread use, and more recently, methods to measure vitamin B12 associated with the plasma binding protein transcobalamin (holotranscobalamin) have been developed. Alternatively, levels of surrogate biochemical markers that reflect the metabolic function of the vitamin can be used. Surrogates most commonly used are plasma homocysteine, for detection of either vitamin B12 or folate deficiency and methylmalonic acid for detection of vitamin B12 deficiency. The general methods as well as their uses, indications, and limitations are presented.

Topics: Biomarkers; Diagnosis, Differential; Erythrocyte Indices; Erythrocytes; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Nutrition Assessment; Nutritional Status; Sensitivity and Specificity; Sentinel Surveillance; Transcobalamins; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

In recent years there has been growing interest in the vitamins folic acid and vitamin B12 because of the realization that the status of these vitamins in populations is less than adequate, and that such inadequacy may be linked to adverse public health outcomes. This concern has prompted the United States, Canada, and other countries to fortify grain products with folic acid, while additional countries are considering doing so in the near future. This presentation provides a new approach which relies on the combination of the concentrations in blood of vitamins and their respective functional indicators to establish cutoff points for assessing folate and vitamin B12 status in populations. The premise is based on the fact that the relationship between plasma vitamin concentrations and their respective functional indicators is inverse and biphasic, with a steep slope at low concentrations of the vitamin and a more moderate slope at higher plasma vitamin concentrations. We propose that the intersection of these two slopes be used as a guideline for assessing the status of these vitamins and the adequacy of fortification programs. The cutoff would be 10 nmol/L for serum folate and 340 nmol/L for red blood cell folate, based on lowest plasma homocysteine. For serum vitamin B12, the cutoff would be 150 pmol/L based on lowest methylmalonic acid and 300 pmol/L based on lowest homocysteine.

Topics: Biomarkers; Erythrocytes; Folic Acid; Folic Acid Deficiency; Food, Fortified; Homocysteine; Humans; Methylmalonic Acid; Nutrition Assessment; Nutritional Status; Reference Standards; Reference Values; Vitamin B 12; Vitamin B 12 Deficiency

Based on biochemical evidence, a high prevalence of biochemical evidence of vitamin B12 or folate deficiency has been reported in a number of areas in the world. The evidence that these biochemical abnormalities lead to a comparable prevalence of anemia is reviewed. The overall contribution of vitamin B12 deficiency to the global burden of anemia is probably not significant, except perhaps in women and their infants and children in vegetarian communities. In developed countries, folate-deficiency anemia is uncommon. In some developing countries, this anemia is still seen, but there are no comprehensive data on the relative prevalence compared with anemia due to malaria, iron-deficiency, hemoglobinopathy, and HIV disease. It seems unlikely that folate deficiency makes a major contribution to the burden of anemia in developing countries. Iron-deficiency anemia may coexist with vitamin B12 and especially folate deficiency, and may confound the hematological features of the vitamin deficiencies whose prevalence would then be underestimated. Supplementation of the diet of pregnant women with folic acid can virtually eliminate folate-deficiency anemia in these women. There are very few data on the hematological effect of vitamin B12 supplementation or fortification at the population level. The addition of vitamin B12 to the supplementation of the diet of pregnant women with iron and folic acid does not produce an increased hematological response, at least in nonvegetarian populations. There are numerous reports of the effect of folic acid fortification of food on tests of folate status, but only a single published report on the hematological response was found.

Topics: Anemia; Comorbidity; Developing Countries; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Nutrition Assessment; Nutritional Requirements; Nutritional Status; Pregnancy; Pregnancy Complications; Prevalence; Vitamin B 12; Vitamin B 12 Deficiency

The importance of folate in reproduction can be appreciated by considering that the existence of the vitamin was first suspected from efforts to explain a potentially fatal megaloblastic anemia in young pregnant women in India. Today, low maternal folate status during pregnancy and lactation remains a significant cause of maternal morbidity in some communities. The folate status of the neonate tends to be protected at the expense of maternal stores; nevertheless, there is mounting evidence that inadequate maternal folate status during pregnancy may lead to low infant birthweight, thereby conferring risk of developmental and long-term adverse health outcomes. Moreover, folate-related anemia during childhood and adolescence might predispose children to further infections and disease. The role of folic acid in prevention of neural tube defects (NTD) is now established, and several studies suggest that this protection may extend to some other birth defects. In terms of maternal health, clinical vitamin B12 deficiency may be a cause of infertility or recurrent spontaneous abortion. Starting pregnancy with an inadequate vitamin B12 status may increase risk of birth defects such as NTD, and may contribute to preterm delivery, although this needs further evaluation. Furthermore, inadequate vitamin B12 status in the mother may lead to frank deficiency in the infant if sufficient fetal stores of vitamin B12 are not laid down during pregnancy or are not available in breastmilk. However, the implications of starting pregnancy and lactation with low vitamin B12 status have not been sufficiently researched.

Topics: Abortion, Spontaneous; Child Development; Child Nutritional Physiological Phenomena; Child, Preschool; Congenital Abnormalities; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Maternal Nutritional Physiological Phenomena; Neural Tube Defects; Nutritional Status; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Nutritional Physiological Phenomena; Vitamin B 12; Vitamin B 12 Deficiency; Women's Health

Topics: Aged; Aged, 80 and over; Aging; Cognition; Cognition Disorders; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Nutritional Requirements; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency

Folate deficiency in the periconceptional period contributes to neural tube defects; deficits in vitamin B12 (cobalamin) have negative consequences on the developing brain during infancy; and deficits of both vitamins are associated with a greater risk of depression during adulthood. This review examines two mechanisms linking folate and vitamin B12 deficiency to abnormal behavior and development in infants: disruptions to myelination and inflammatory processes. Future investigations should focus on the relationship between the timing of deficient and marginal vitamin B12 status and outcomes such as infant growth, cognition, social development, and depressive symptoms, along with prevention of folate and vitamin B12 deficiency.

Topics: Adolescent; Adult; Aged; Brain; Child; Child, Preschool; Depression; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infant, Newborn; Male; Middle Aged; Neural Tube Defects; Nutritional Status; Pregnancy; Prenatal Exposure Delayed Effects; Vitamin B 12; Vitamin B 12 Deficiency

Folate and vitamin B12 deficiencies represent important and evolving global health challenges that contribute to the global burden of anemia, neurologic conditions, neurodevelopmental disorders, and birth defects. We present a review of population-based programs designed to increase consumption of folates and vitamin B12. A folic acid supplementation program targeting couples prior to marriage in China has led to optimal consumption of supplements containing folic acid and a significant reduction of neural tube defects (NTD). Supplementation programs that use mass community education show some promise, but have not been shown to be as effective as targeted education. The success of supplementation programs hinges on a strong and persistent educational component and access to the supplements. Fortification with folic acid has been shown to reduce the prevalence of NTD in the countries where it has been implemented. Challenges to fortification programs include identifying the appropriate delivery vehicles, setting the optimal fortification level, sustaining the quality assurance of the fortification level, and addressing regulatory challenges and trade barriers of commercially fortified flours. Supplementation and fortification are cost-effective and viable approaches to reducing the burden of NTD, anemia, and other conditions resulting from folate deficiency. The experience with interventions involving folic acid could provide a model for the subsequent development of supplementation and fortification programs involving vitamin B12.

Topics: Cost-Benefit Analysis; Dietary Supplements; Folic Acid; Folic Acid Deficiency; Food, Fortified; Health Promotion; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Folate deficiency can result in congenital neural tube defects and megaloblastic anaemia. Low folate levels may be due to insufficient dietary intake or inefficient absorption, but impaired metabolic utilization also occurs.Because B12 deficiency can produce a similar anaemia to folate deficiency, there is a risk that folate supplementation can delay the diagnosis of B12 deficiency, which can cause irreversible neurological damage. Folic acid supplements may sometimes therefore include vitamin B12 supplements with simultaneous administration of vitamin B12.Lesser degrees of folate inadequacy are associated with high blood levels of the amino acid homocysteine which has been linked with the risk of arterial disease, dementia and Alzheimer's disease. There is therefore interest in whether dietary supplementation can improve cognitive function in the elderly.However, any apparent benefit from folic acid which was given in combination with B12 needs to be "corrected" for any effect of vitamin B12 alone. A separate Cochrane review of vitamin B12 and cognitive function has therefore been published.. To examine the effects of folic acid supplementation, with or without vitamin B12, on elderly healthy or demented people, in preventing cognitive impairment or retarding its progress.. Trials were identified from a search of the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 10 October 2007 using the terms: folic acid, folate, vitamin B9, leucovorin, methyltetrahydrofolate, vitamin B12, cobalamin and cyanocobalamin. This Register contains references from all major health care databases and many ongoing trials databases. In addition MEDLINE, EMBASE, CINAHL, PsychINFO and LILACS were searched (years 2003-2007) for additional trials of folate with or without vitamin B12 on healthy elderly people.. All double-blind, placebo-controlled, randomized trials, in which supplements of folic acid with or without vitamin B12 were compared with placebo for elderly healthy people or people with any type of dementia or cognitive impairment.. The reviewers independently applied the selection criteria and assessed study quality. One reviewer extracted and analysed the data. In comparing intervention with placebo, weighted mean differences and standardized mean difference or odds ratios were estimated.. Eight randomized controlled trials fulfilled the inclusion criteria for this review. Four trials enrolled healthy older people, and four recruited participants with mild to moderate cognitive impairment or dementia with or without diagnosed folate deficiency. Pooling the data was not possible owing to heterogeneity in sample selections, outcomes, trial duration, and dosage. Two studies involved a combination of folic acid and vitamin B12.There is no adequate evidence of benefit from folic acid supplementation with or without vitamin B12 on cognitive function and mood of unselected healthy elderly people. However, in one trial enrolling a selected group of healthy elderly people with high homocysteine levels, 800 mcg/day folic acid supplementation over three years was associated with significant benefit in terms of global functioning (WMD 0.05, 95% CI 0.004 to 0.096, P = 0.033); memory storage (WMD 0.14, 95% CI 0.04 to 0.24, P = 0.006) and information-processing speed (WMD 0.09, 95% CI 0.02 to 0.16, P = 0.016).Four trials involved people with cognitive impairment. In one pilot trial enrolling people with Alzheimer's disease, the overall response to cholinesterase inhibitors significantly improved with folic acid at a dose of 1mg/day (odds ratio: 4.06, 95% CI 1.22 to 13.53; P = 0.02) and there was a significant improvement in scores on the Instrumental Activities of Daily Living and the Social Behaviour subscale of the Nurse's Observation Scale for Geriatric Patients (WMD 4.01, 95% CI 0.50 to 7.52, P = 0.02). Other trials involving people with cognitive impairment did not show any benefit in measures of cognitive function from folic acid, with or without vitamin B12.Folic acid plus vitamin B12 was effective in reducing serum homocysteine concentrations (WMD -5.90, 95% CI -8.43 to -3.37, P < 0.00001). Folic acid was well tolerated and no adverse effects were reported.. The small number of studies which have been done provide no consistent evidence either way that folic acid, with or without vitamin B12, has a beneficial effect on cognitive function of unselected healthy or cognitively impaired older people. In a preliminary study, folic acid was associated with improvement in the response of people with Alzheimer's disease to cholinesterase inhibitors. In another, long-term use appeared to improve the cognitive function of healthy older people with high homocysteine levels. More studies are needed on this important issue.

Topics: Cognition; Cognition Disorders; Dementia; Dietary Supplements; Drug Therapy, Combination; Folic Acid; Folic Acid Deficiency; Humans; Randomized Controlled Trials as Topic; Vitamin B 12

Hyperhomocysteinemia (HHCY) has been suggested as a new risk factor for osteoporosis. Recent epidemiological, clinical and experimental studies provide a growing body of data, which is reviewed in this article. Epidemiological and (randomized) clinical trials suggest that HHCY increases fracture risk, but has minor effects on bone mineral density. Measurement of biochemical bone turnover markers indicates a shift of bone metabolism towards bone resorption. Animal studies confirm these observations showing a reduced bone quality and stimulation of bone resorption in hyperhomocysteinemic animals. Homocysteine (HCY) has been found to accumulate in bone by collagen binding. Cell culture studies demonstrate that high HCY levels stimulate osteoclasts but not osteoblasts, indicating again a shift of bone metabolism towards bone resorption. Regarding B-vitamins, only a few in vivo studies with equivocal results have been published. However, two large cell culture studies confirm the results obtained with exogenous HCY administration. In addition, HHCY seems to have adverse affects on extracellular bone matrix by disturbing collagen crosslinking. In conclusion, existing data suggest that HHCY (and possibly B-vitamin deficiencies) adversely affects bone quality by a stimulation of bone resorption and disturbance of collagen crosslinking.

Topics: Animals; Bone Density; Folic Acid Deficiency; Fractures, Bone; Humans; Hyperhomocysteinemia; Osteoporosis; Vitamin B 12; Vitamin B 6; Vitamin B Deficiency

Hyperhomocysteinemia, considered "the cholesterol of nineties", is an established risk factor for cardiovascular diseases and premature atherosclerosis. Hyperhomocysteinemia is due to genetic and acquired factors (unhealthy lifestyle with poor diet in folate and vitamin B, elderly, renal impairment, thyroid diseases, malignancies). More recently, hyperhomocysteinemia was associated with venous thrombosis. Several studies found a correlation with a usual site of thrombosis (central retinal vein, mesenterical level, cerebral veins, Budd-Chiari syndrome). Other studies showed the association between hyperhomocysteinemia and recurrent venous thrombosis. This condition is of high interest because homocysteine may represent a potentially reversible cause of thrombophilia. Although methylenetetrahydrofolate reductase (MTHFR) C677T genotype and deficits of folic acid, vitamin B12 lead to hyperhomocysteinemia, in cases with a thrombotic event the correlations between homocysteine level and folic acid as well as between homocysteinemia and vitamin B12 were found to be weak and no significant correlation between homocysteinemia and MTHFR was identified. Recently, some authors reported an independent association between low levels of folic acid or vitamin B12 and venous thrombosis. Regarding the MTHFR genotype, the risk for venous thrombosis is increased only in patients with factor V Leiden. A recent meta-analysis of 24 retrospective and 3 prospective studies published in electronic literature showed that a 5 micromol/L higher homocysteine level was associated with a 27% (95% CI: 1-59) higher risk of venous thrombosis in prospective studies and a 60% (95% CI: 10-134) higher risk in retrospective studies. A meta-analysis of the short-term trials of therapy with folic acid showed a reduction of 25% of homocysteinemia and a further reduction of 7% when vitamin B12 was associated. This situation may be associated with a 10% to 20% decreased risk of venous thrombosis. Further trials are required to estimate if this is worthwhile from the clinical point of view. In medical practice the measurement of homocysteinemia may be indicated in unexplained idiopathic venous thrombosis, or recurrent episodes or venous thrombosis occurred at an early age or at an uncommon site.

Topics: Folic Acid; Folic Acid Deficiency; Humans; Hyperhomocysteinemia; Risk Factors; Venous Thromboembolism; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

The mechanism by which Vitamin B12 prevents demyelination of nerve tissue is still not known. The evidence indicates that the critical site of B12 function in nerve tissue is in the enzyme, methionine synthase, in a system which requires S-adenosylmethionine. In recent years it has been recognized that S-adenosylmethionine gives rise to the deoxyadenosyl radical which catalyzes many reactions including the rearrangement of lysine to beta-lysine. Evidence is reviewed which suggests that there is an analogy between the two systems and that S-adenosyl methionine may catalyze a rearrangement of homocysteine on methionine synthase giving rise to iso- or beta-methionine. The rearranged product is readily degraded to CH3-SH, providing a mechanism for removing toxic homocysteine.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Animals; Biological Transport; Bone Marrow; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Methionine; Methylation; Myelin Sheath; Nerve Tissue; S-Adenosylmethionine; Tetrahydrofolates; Vitamin B 12; Vitamin B 12 Deficiency

Cobalamin deficiency in the newborn usually results from cobalamin deficiency in the mother. Megaloblastic anaemia, pancytopenia and failure to thrive can be present, accompanied by neurological deficits if the diagnosis is delayed. Most cases of spina bifida and other neural tube defects result from maternal folate and/or cobalamin insufficiency in the periconceptual period. Polymorphisms in a number of genes involved in folate and cobalamin metabolism exacerbate the risk. Inborn errors of cobalamin metabolism affect its absorption, (intrinsic factor deficiency, Imerslund-Gräsbeck syndrome) and transport (transcobalamin deficiency) as well as its intracellular metabolism affecting adenosylcobalamin synthesis (cblA and cblB), methionine synthase function (cblE and cblG) or both (cblC, cblD and cblF). Inborn errors of folate metabolism include congenital folate malabsorption, severe methylenetetrahydrofolate reductase deficiency and formiminotransferase deficiency. The identification of disease-causing mutations in specific genes has improved our ability to diagnose many of these conditions, both before and after birth.

Topics: Diet; Folic Acid; Folic Acid Deficiency; Humans; Infant, Newborn; Metabolism, Inborn Errors; Neural Tube Defects; Vitamin B 12; Vitamin B 12 Deficiency

Anaemia is a serious complication of Crohn's disease that triggers hospitalization and, if not interfered with, may lead to death.. To systematically summarize and compare the literature on anaemia in Crohn's disease.. For this systematic review the literature was searched for English-language articles using anaemia, Crohn* and IBD as key words. 144 articles were identified and sorted according to the following topics: prevalence, aetiology, diagnostic tests and therapy.. The reported prevalence of anaemia varied between 6.2% and 73.7%, with higher reported frequencies in older studies and in in-patients. Iron deficiency is the most common underlying condition. Vitamin B12 deficiency is related to the extent of ileal resection but has rarely impact on anaemia. Diagnostic criteria are not established and treatment guidelines are missing. Oral iron supplementation seems effective for short periods but intolerance leads to discontinuation in up to 21%. Eleven of 11 studies show that oral iron enhances intestinal inflammation and colon carcinogenesis in animal models of colitis. Intravenous iron supplementation with iron sucrose has been tested in over 250 Crohn's disease patients, is safe, effective and does not carry such hazards.. As disease activity is determining the degree of anaemia in Crohn's disease, implementation of more effective therapy for Crohn's disease will lower its incidence. However, further studies regarding the safety and effectiveness of iron supplementation are needed.

Topics: Anemia; Crohn Disease; Ferric Compounds; Folic Acid; Folic Acid Deficiency; Genetic Predisposition to Disease; Humans; Vitamin B 12; Vitamin B 12 Deficiency

We review the findings in major depression of a low plasma and particularly red cell folate, but also of low vitamin B12 status. Both low folate and low vitamin B12 status have been found in studies of depressive patients, and an association between depression and low levels of the two vitamins is found in studies of the general population. Low plasma or serum folate has also been found in patients with recurrent mood disorders treated by lithium. A link between depression and low folate has similarly been found in patients with alcoholism. It is interesting to note that Hong Kong and Taiwan populations with traditional Chinese diets (rich in folate), including patients with major depression, have high serum folate concentrations. However, these countries have very low life time rates of major depression. Low folate levels are furthermore linked to a poor response to antidepressants, and treatment with folic acid is shown to improve response to antidepressants. A recent study also suggests that high vitamin B12 status may be associated with better treatment outcome. Folate and vitamin B12 are major determinants of one-carbon metabolism, in which S-adenosylmethionine (SAM) is formed. SAM donates methyl groups that are crucial for neurological function. Increased plasma homocysteine is a functional marker of both folate and vitamin B12 deficiency. Increased homocysteine levels are found in depressive patients. In a large population study from Norway increased plasma homocysteine was associated with increased risk of depression but not anxiety. There is now substantial evidence of a common decrease in serum/red blood cell folate, serum vitamin B12 and an increase in plasma homocysteine in depression. Furthermore, the MTHFR C677T polymorphism that impairs the homocysteine metabolism is shown to be overrepresented among depressive patients, which strengthens the association. On the basis of current data, we suggest that oral doses of both folic acid (800 microg daily) and vitamin B12 (1 mg daily) should be tried to improve treatment outcome in depression.

Topics: Brain; Depressive Disorder, Major; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Methylenetetrahydrofolate Reductase (NADPH2); Nutritional Status; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

For more than 50 years, the Food and Nutrition Board of the National Academy of Sciences has been reviewing nutrition research and defining nutrient requirements for healthy people, referred to as the recommended dietary allowances (RDA). As new nutrition research is published, the importance of vitamins as vital nutrients is underscored, and new physiologic roles and applications to human health are examined and considered with regard to updating the RDA. Each year a substantial amount of research is published on vitamins. This article examines and summarizes noteworthy research published on individual water-soluble vitamins (excluding vitamin C) in the past 12 months, provides relevant background information on these vitamins, and offers critical reviews as appropriate.

Topics: Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Neural Tube Defects; Niacinamide; Nutritional Requirements; Pregnancy; Riboflavin; Riboflavin Deficiency; Solubility; Thiamine; Thiamine Deficiency; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6; Vitamin B 6 Deficiency; Vitamin B Complex; Vitamin B Deficiency

Growing epidemiological evidence of associations between mildly elevated plasma homocysteine with age-related cognitive impairment, neurodegenerative and cerebrovascular disease has stimulated interest in the role of homocysteine in neurological and neuropsychiatric disorders. Homocysteine is an intermediate in the folate, vitamin B12 and B6 dependent pathways of one-carbon and sulfur amino acid metabolism. Impairments of these pathways may cause CNS dysfunction by promoting the intracellular generation of homocysteine, which is postulated to have vasotoxic and neurotoxic properties. It might also inhibit the methylation of myelin basic protein and membrane phospholipids, or disrupt biogenic amine metabolism and many other vital CNS reactions. However, it is unclear which, if any, of these putative mechanisms underlies the epidemiological associations. Genetic mouse models of hyperhomocysteinemia suggest that the primary metabolic disturbances rather than homocysteine per se may be important in determining neurological outcomes. However, severe and early developmental abnormalities in these mice limit their usefulness for understanding the relation of hyperhomocysteinemia to adult CNS disorders. Pharmacologic and dietary studies on homocysteine in rodents have reported heightened neuronal sensitivity to neurotoxic insults, neurochemical abnormalities and cerebrovascular dysfunction. Such studies are consistent with a causal relationship, but they fail to distinguish between effects that might result from a dietary imbalance and those that might be caused by homocysteine per se. Future work should be directed towards refining these models in order to distinguish between the effects of homocysteine and its determinants on neurological and behavioral outcomes that represent different CNS disorders.

Topics: Animals; Central Nervous System; Disease Models, Animal; Folic Acid; Folic Acid Deficiency; Homocystine; Humans; Hyperhomocysteinemia; Methylenetetrahydrofolate Reductase (NADPH2); Vitamin B 12

Various nutritional disorders can occur in patients with advanced or recurrent carcinoma of the gastrointestinal tract due to the disease itself or the absence of the organs after surgery. Routine parenteral nutrition for cancer patients who undergo chemotherapy results in no benefit and troublesome complications such as catheter sepsis. Consequently, it is important to provide sufficient and proper specialized nutritional support to patients who need it, taking into account the pathologic status resulting from malignant disease. Patients with advanced or recurrent carcinoma of the gastrointestinal tract are likely to be deficient in folate and/or vitamin B12 for various reasons. Neurological disorders in vitamin B12 deficiency should worsen when folate is administered without supplementation of vitamin B12. This phenomenon should be avoided when 5-fluorouracil is used with reduced folate in cancer chemotherapy. The indications for specialized nutritional support for patients with advanced or recurrent carcinoma of the gastrointestinal tract are the same as for malnourished patients without cancer. The initial dose and formula of nutrition for cancer patients with malnutrition and various metabolic disorders should be calculated to avoid overloading. The oral intake of normal food is desirable for such patients. The placement of a central venous catheter to prevent the toxicity of chemotherapy or for venous access is contraindicated. Jejunal feeding or percutaneous endoscopic gastrostomy is performed in patients who cannot eat even a liquid diet. Total parenteral nutrition should be introduced when these accesses cannot be used. If any bowel obstruction occurs in the small intestine and/or colon, it is necessary to discuss the efficacy of surgery to resolve the obstruction.

Topics: Enteral Nutrition; Folic Acid; Folic Acid Deficiency; Gastrointestinal Neoplasms; Humans; Neoplasm Recurrence, Local; Nutrition Assessment; Nutrition Disorders; Nutritional Support; Vitamin B 12; Vitamin B 12 Deficiency

The increasing number of older people is characteristic for most industrialised nations and implicates the known psychosocial and economic consequences. Therefore, an optimal nutrient supply that promotes continuing mental and physical well-being is particularly important. In this respect, vitamin B(12) and folic acid play a major role, since deficiency of both vitamins is associated with the pathogenesis of different diseases such as declining neurocognitive function and atherosclerotic lesions. Vitamin B(12) and folic acid act as coenzymes and show a close molecular interaction on the basis of the homocysteine metabolism. In addition to the serum concentrations of the vitamins, the metabolites homocysteine and methylmalonic acid are sensitive markers of cobalamin and folate status. Depending on the used marker, 3-60% of the elderly are classified as vitamin B(12) deficient and about 29% as folate deficient. Predominantly, this high prevalence of poor cobalamin status is caused by the increasing prevalence of atrophic gastritis type B, which occurs with a frequency of approximately 20-50% in elderly subjects. Atrophic gastritis results in declining gastric acid and pepsinogen secretion, and hence decreasing intestinal digestion and absorption of both B vitamins. This is the reason why an insufficient vitamin B(12) status in the elderly is rarely due to low dietary intake. In contrast, folic acid intake among elderly subjects is generally well below the recommended dietary reference values. Even moderately increased homocysteine levels or poor folate and vitamin B(12) status are associated with vascular disease and neurocognitive disorders. Results of a meta-analysis of prospective studies revealed that a 25% lower homocysteine level (about 3 micromol/L) was associated with an 11% lower ischemic heart disease risk and 19% lower stroke risk. It is still discussed, whether hyperhomocysteinemia is causally related to vascular disease or whether it is a consequence of atherosclerosis. Estimated risk reduction is based on cohort studies, not on clinical trials. Homocysteine initiates different proatherogenetic mechanisms such as the formation of reactive oxygen species and an enhanced fibrin synthesis. Supplementation of folic acid (0.5-5 mg/d) reduces the homocysteine concentration by 25%. Additional vitamin B(12) (0.5 mg/d) induces further reduction by 7%. In secondary prevention, supplementation already led to clinical improvements (reduction of restenosis

Topics: Aged; Aged, 80 and over; Aging; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Nutritional Status; Prevalence; Vitamin B 12; Vitamin B 12 Deficiency

In cross-sectional studies, low levels of folate and B12 have been shown to be associated with cognitive decline and dementia Evidence for the putative role of folate, vitamin B12 in neurocognitive and other neurological functions comes from reported cases of severe vitamin deficiencies, particularly pernicious anemia, and homozygous defects in genes that encode for enzymes of one-carbon metabolism. The neurological alterations seen in these cases allow for a biological role of vitamins in neurophysiology. Results are quite controversial and there is an open debate in literature, considering that the potential and differential role of folate and B12 vitamin in memory acquisition and cognitive development is not completely understood or accepted. What is not clear is the fact that vitamin B12 and folate deficiency deteriorate a pre-existing not overt pathological situation or can be dangerous even in normal subjects. Even more intriguing is the interaction between B12 and folate, and their role in developing hyperhomocysteinemia. The approach to the rehabilitation of the deficiency with adequate vitamin supplementation is very confusing. Some authors suggest it, even in chronic situations, others deny any possible role. Starting from these quite confusing perspectives, the aim of this review is to report and categorize the data obtained from the literature. Despite the plausible biochemical mechanism, further studies, based on clinical, neuropsychological, laboratory and (lastly) pathological features will be necessary to better understand this fascinating biochemical riddle.

Topics: Cognition; Cognition Disorders; Dementia; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Methylmalonic Acid; Vitamin B 12; Vitamin B 12 Deficiency

Lower levels of dietary folate are associated with the development of epithelial cell tumours in man, particularly colo-rectal cancer. In the majority of epidemiological studies blood folate or reported folate intake have been shown to be inversely related to colo-rectal cancer risk. Folate, via its pivotal role in C1 metabolism, is crucial both for DNA synthesis and repair, and for DNA methylation. This function is compromised when vitamin B12 is low. Vitamin B12 deficiency has been shown to increase biomarkers of DNA damage in man but there is no evidence directly linking low vitamin B12 with cancer. Disturbingly, folate and vitamin B12 deficiencies are common in the general population, particularly in the underprivileged and the elderly. How folate and/or vitamin B12 deficiency influence carcinogenesis remains to be established, but it is currently believed that they may act to decrease DNA methylation, resulting in proto-oncogene activation, and/or to induce instability in the DNA molecule via a futile cycle of uracil misincorporation and removal. The relative importance of these two pathways may become clear by determining both DNA stability and cytosine methylation in individuals with different polymorphic variants of key folate-metabolising enzymes. 5,10-Methylenetetrahydrofolate reductase converts 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate and thereby controls whether folate is employed for DNA synthesis or DNA methylation. Colo-rectal cancer risk is decreased in subjects homozygous for a common variant (C677T) of the gene coding for this enzyme, suggesting that DNA synthesis and repair may be 'enhanced' in these individuals. Evidence from animal and human studies is presented here in support of folate acting to maintain genomic stability through both these mechanisms.

Topics: Carbon-Nitrogen Ligases; Colorectal Neoplasms; DNA Damage; DNA Methylation; DNA Repair; Folic Acid; Folic Acid Deficiency; Gene Expression Regulation, Neoplastic; Humans; Polymorphism, Genetic; Proto-Oncogene Mas; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Inadequate folate status is associated with an increased risk for chronic diseases that may have a negative impact on the health of the aging population. Folate, a water-soluble vitamin, includes naturally occurring food folate and synthetic folic acid in supplements and fortified foods. Inadequate folate status may result in hyperhomocysteinemia, a significant risk factor for atherosclerotic vascular disease, changes in DNA that may result in pro-carcinogenic effects and increased risk for cognitive dysfunction. Folate status may be negatively influenced by inadequate intake, genetic polymorphisms and interactions with various drugs. In the US, folic acid is now added to enriched grain products and continues to be included in the majority of ready-to-eat breakfast cereals. Recent data indicate that the folate status in the US population has improved significantly, presumably due to the effects of fortification. Folic acid (not food folate) intake in excess of the Tolerable Upper Intake Level may mask the diagnosis of a vitamin B(12) deficiency, which is more prevalent in the elderly than younger individuals. When folic acid supplements are recommended, a multivitamin that includes vitamin B(12) should also be advised. To safely and effectively increase folate intake in the elderly, naturally occurring folate-rich food sources should be promoted. Folate-rich foods include orange juice, dark green leafy vegetables, asparagus, strawberries and legumes. These foods are also excellent sources of other health-promoting nutrients associated with chronic disease risk reduction.

Topics: Aged; Biological Availability; Cardiovascular Diseases; Cognition Disorders; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Male; Neoplasms; Nutrition Policy; Risk Factors; United States; Vegetables; Vitamin B 12; Vitamin B 12 Deficiency

Nitrous oxide interacts with vitamin B12 resulting in selective inhibition of methionine synthase, a key enzyme in methionine and folate metabolism. Thus, nitrous oxide may alter one-carbon and methyl-group transfer most important for DNA, purine and thymidylate synthesis. Long-term exposure to high concentrations of nitrous oxide may cause megaloblastic bone-marrow depression and neurological symptoms. Exposure to higher doses for less than 6 hours, as in clinical anaesthesia, are considered harmless. Recent studies seem to suggest a correlation between nitrous oxide anaesthesia and hyperhomocysteinaemia which is accepted to be an independent risk factor for coronary artery disease. As for today, available data do not support the notion that exposure to trace amounts of nitrous oxide is associated with impaired fertility or an increased risk of developing cancer. Emission of nitrous oxide from medical use is estimated to contribute less than 0.05% to total annual greenhouse gas emission.

Topics: Animals; Bone Marrow; Folic Acid Deficiency; Humans; Methionine; Nervous System Diseases; Nitrous Oxide; Occupational Exposure; Vitamin B 12; Vitamin B 12 Deficiency

Cobalamin/folate deficiency may lead to neuropsychiatric symptoms. This review summarizes present findings concerning the different markers for cobalamin/folate deficiency in psychogeriatric patients. These findings suggest the use of plasma homocysteine, serum cobalamin and serum folate to evaluate cobalamin/folate status in psychogeriatric patients, whereas the use of serum methylmalonic acid and whole blood folate could be omitted.

Topics: Aged; Biomarkers; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Mental Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Folates are vitamins essential to the development of the central nervous system. Insufficient folate activity at the time of conception and early pregnancy can result in congenital neural tube defects. In adult life folate deficiency has been known for decades to produce a characteristic form of anaemia ("megaloblastic"). More recently degrees of folate inadequacy, not severe enough to produce anaemia, have been found to be associated with high blood levels of the amino acid homocysteine. Such degrees of folate inadequacy can arise because of insufficient folates in the diet or because of inefficient absorption or metabolic utilisation of folates due to genetic variations. Conventional criteria for diagnosing folate deficiency may be inadequate for identifying people capable of benefiting from dietary supplementation. High blood levels of homocysteine have been linked with the risk of arterial disease, dementia and Alzheimer's disease. There is therefore interest in whether dietary supplements of folic acid (an artificial chemical analogue of naturally occurring folates) can improve cognitive function of people at risk of cognitive decline associated with ageing or dementia, whether by affecting homocysteine metabolism or through other mechanisms. There is a risk that if folic acid is given to people who have undiagnosed deficiency of vitamin B12 it may lead to neurological damage. Vitamin B12 deficiency produces both an anaemia identical to that of folate deficiency but also causes irreversible damage to the central and peripheral nervous systems. Folic acid will correct the anaemia of vitamin B12 deficiency and so delay diagnosis but will not prevent progression to neurological damage. For this reason trials of folic acid supplements may involve simultaneous administration of vitamin B12. Apparent benefit from folic acid given in the combination would therefore need to be "corrected" for any effect of vitamin B12 alone. A separate Cochrane review of vitamin B12 and cognitive function is being prepared.. To examine the effects of folic acid supplementation, with or without vitamin B12, on elderly healthy and demented people, in preventing cognitive impairment or retarding its progress.. Trials were identified from a search of the Cochrane Dementia and Cognitive Improvement Specialized Register Group on 9 April 2003 using the terms: folic acid, folate, vitamin B9, leucovorin, methyltetrahydrofolate, vitamin B12, cobalamin, cyanocobalamin, dementia, cognitive function, cognitive impairment, Alzheimer's disease, vascular dementia, mixed dementia and controlled trials. MEDLINE and EMBASE (both all years) were searched for additional trials on healthy people.. All double-blind placebo-controlled randomized trials, in which supplements of folic acid with or without vitamin B12 were compared with placebo for elderly healthy people or people with any type of dementia or cognitive impairment.. The reviewers independently applied the selection criteria and assessed study quality. One reviewer extracted and analysed the data. In comparing intervention with placebo, weighted mean differences, and standardized mean difference or odds ratios were estimated.. Four randomized controlled trials fulfilled the inclusion criteria for this review. One trial (Bryan 2002) enrolled healthy women, and three (Fioravanti 1997; Sommer 1998; VITAL 2003) recruited people with mild to moderate cognitive impairment or dementia with or without diagnosed folate deficiency. Fioravanti 1997 enrolled people with mild to moderate cognitive impairment or dementia as judged by scores on the Mini-Mental State Examination (MMSE) and Global Deterioration Scale and with serum folate level<3ng/l. One trial (VITAL 2003) studied the effects of a combination of vitamin B12 and folic acid on patients with mild to moderate cognitive impairment due to Alzheimer's disease or mixed dementia. The analysis from the included trials found no benefit from folic acid with or without vitamin B12 in comparison with placebo on any measures of cognition and mood for healthy or cognitively impaired or demented people: Folic acid effect and healthy participants: there was no benefit from of oral 750 mcg folic acid per day for five weeks compared with placebo on measures of cognition and mood of 19 healthy women aged 65 to 92. Folic acid effect and people with mild to moderate cognitive decline or dementia: there were no statistically significant results in favour of folic acid with or without vitamin B12 on any measures of cognitive function. Scores on the Mini-Mental State Examination (MMSE) revealed no statistically significant benefit from 2 mg per day folic acid plus 1mg vitamin B12 for 12 weeks when compared with placebo (WMD 0.39, 95% CI -0.43 to 1.21, P=0.35). Cognitive scores on the Alzheimer's Disease Scale (ADAS-Cog) showed no statistically significant benefit from 2 mg /day folic acid plus 1 mg /day vitamin B12 for 12 weeks compared with placebo (WMD 0.41, 95% -1.25 to 2.07, P=4.63). The Bristol Activities of Daily Living Scale (BADL) revealed no benefit from 2mg per day of folic acid plus 1 mg vitamin B12 for 12 weeks in comparison with placebo (WMD -0.57, 95%CI -1.95 to 0.81, P=0.42). None of the sub tests of the Randt Memory Test (RMT) showed statistically significant benefit from 15 mg of folic acid orally per day for 9 weeks when compared with placebo. One trial (Sommer 1998) reported a significant decline compared with placebo in two cognitive function tasks in demented patients who had received high doses of folic acid (10 mg /day) for unspecified periods. One trial (VITAL 2003) showed that 2 mg folic acid plus 1 mg vitamin B12 daily for 12. There was no beneficial effect of 750 mcg of folic acid per day on measures of cognition or mood in older healthy women. In patients with mild to moderate cognitive decline and different forms of dementia there was no benefit from folic acid on measures of cognition or mood. Folic acid plus vitamin B12 was effective in reducing the serum homocysteine concentrations. Folic acid was well tolerated and no adverse effects were reported. More studies are needed.

Topics: Cognition; Cognition Disorders; Dementia; Dietary Supplements; Drug Therapy, Combination; Folic Acid; Folic Acid Deficiency; Humans; Randomized Controlled Trials as Topic; Vitamin B 12

Angiogenic brain damage and Alzheimer's disease caused by a progressing degenerative process are listed among the most frequent causes of dementia. These two processes are often concurrent and interrelated. Risk factors for vascular diseases including hypercholesteremia, arterial hypertension, and diabetes are also recognized risk factors for Alzheimer's disease. Results of many studies conducted in recent years suggest that the atheromatous process may be induced by elevated levels of homocysteine. Hyperhomocysteinemia first and foremost accelerates the onset of microangiopathic changes in small vessels. The mechanism underlying atherogenic action of homocysteine is still unclear. Hyperhomocysteinemia, generally assumed to have cytotoxic properties, damages endothelium in blood vessels, enhances thrombotic changes, and directly acts upon nitrogen oxide (NO), a vessel-dilating factor. Homocysteine is a metabolite of methionine. Homocysteine metabolism depends on current needs of the organism and involves either methionine reproduction (the reaction of remethylation, with such cofactors as B12 vitamin and folic acid), or cysteine synthesis (the transsulphuration reaction, with B6 vitamin as a cofactor). The normal range of plasma homocysteine concentration is assumed to be 5-14 mumol/L. The prevalence rates of hyperhomocysteinemia are 3-7% in the general population and 25% among those with vascular diseases. Elevated plasma homocysteine concentrations are due both to genetic and to environmental factors. In 2/3 of cases hyperhomocysteinemia is caused by decreased levels of folic acid, pyridoxine, and cobalamin. Deficiency of these vitamins is often seen in healthy elderly people.

Topics: Aged; Alzheimer Disease; Folic Acid Deficiency; Humans; Hyperhomocysteinemia; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6 Deficiency

Increased folate intake reduces the risk of neural tube defects, other malformations and also possibly, pregnancy complications. Increasing evidence suggests that the beneficial effect of folate may be related to improved function of methionine synthase, a vitamin B12-dependent enzyme that converts homocysteine to methionine. In India, the majority of the population adheres to a vegetarian diet known to be deficient in vitamin B12. In such a population, increased folate intake may offer minimal protection against birth defects, whereas vitamin B12 administration should be considered. In this review, is described the metabolism of and interrelations between folate, vitamin B12 and homocysteine. This is followed by a brief discussion of some of the proposed mechanisms for their biological effects in relation to birth defects and pregnancy outcome.

Topics: Congenital Abnormalities; Deficiency Diseases; Developing Countries; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Infant, Newborn; Neural Tube Defects; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Vitamin B 12; Vitamin B 12 Deficiency

The purpose of this review is to outline the principal mechanisms involved in folate metabolism and how they may relate to the pathogenesis of colorectal cancer (CRC). In recent years, mild folate depletion (low normal level) has been associated with an increased risk of developing certain cancers, in particular colorectal neoplasia. The epidemiologic and mechanistic evidence linking folate deficiency with carcinogenesis is reviewed, with a particular emphasis on colorectal neoplasia. Methylenetetrahydrofolate reductase (MTHFR) is a critical folate metabolizing enzyme, and a functional polymorphic variant of this enzyme, the so-called thermolabile variant, caused by a C677T transition in the MTHFR gene, is common in the general population. This review critically examines the evidence that suggests that carriers of this C677T variant may be at increased risk of developing colorectal neoplasia. Although folate depletion may predispose to the initiation of the neoplastic process, folate supplementation, on the other hand, might potentiate the progression of an already established early neoplastic clone (eg, a colorectal adenoma). This could have potential public health implications, given an increasingly widespread policy of folate supplementation of food staples.

Topics: Adenoma; Animals; Colorectal Neoplasms; Dietary Supplements; DNA Methylation; DNA, Neoplasm; Folic Acid; Folic Acid Deficiency; Humans; Methylenetetrahydrofolate Reductase (NADPH2); Oxidoreductases Acting on CH-NH Group Donors; Vitamin B 12

Vitamin B(12) and folate are two vitamins that have interdependent roles in nucleic acid synthesis. Deficiencies of either vitamin can cause megaloblastic anemia; however, inappropriate treatment of B(12) deficiency with folate can cause irreversible nerve degeneration. Inadequate folate nutrition during early pregnancy can cause neural tube defects in the developing fetus. In addition, folate and vitamin B(12) deficiency and the compensatory increase in homocysteine are a significant risk factor for cardiovascular disease. Laboratory support for the diagnosis and management of these multiple clinical entities is controversial and somewhat problematic. Automated ligand binding measurements of vitamin B(12) and folate are easiest to perform and widely used. Unfortunately, these tests are not the most sensitive indicators of disease. Measurement of red cell folate is less dependent on dietary fluctuations, but these measurements may not be reliable. Homocysteine and methylmalonic acid are better metabolic indicators of deficiencies at the tissue level. There are no "gold standards" for the diagnosis of these disorders, and controversy exists regarding the best diagnostic approach. Healthcare strategies that consider the impact of laboratory tests on the overall costs and quality of care should consider the advantages of including methylmalonic acid and homocysteine in the early evaluation of patients with suspected deficiencies of vitamin B(12) and folate.

Topics: Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Methylmalonic Acid; Vitamin B 12; Vitamin B 12 Deficiency

Classically, deficiency of folic acid (folate) or vitamin B12 (cobalamin) was recognized by the presence of a macrocytic anemia resulting from megaloblastic changes in the bone marrow. A markedly changing paradigm has identified both new mechanisms for altered folate and cobalamin status and new sequelae and clinical interrelationships that include altered mechanisms of absorption, a changing pattern of neurologic deficits, an increased risk of vascular occlusive lesions, and an important relationship with the mechanisms of neoplastic transformation. Several of these newer characterizations relate to issues of neoplasia in the nonpregnant woman and to issues in pregnancy, such as the potential for developmental abnormalities of the fetal nervous system.

Topics: Anemia, Megaloblastic; Anemia, Pernicious; Female; Folic Acid; Folic Acid Deficiency; Humans; Hyperhomocysteinemia; Neoplasms; Neural Tube Defects; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Vascular Diseases; Vitamin B 12; Vitamin B 12 Deficiency

Hyperhomocysteinemia refers to an elevated circulating level of the sulfur-containing amino acid homocysteine and has been shown to be a risk factor for vascular disease in the general population. In patients with renal failure, hyperhomocysteinemia is a common feature. The underlying pathophysiological mechanism for this phenomenon is unknown. Proposed mechanisms include reduced renal elimination of homocysteine and impaired nonrenal disposal, possibly because of inhibition of crucial enzymes in the methionine-homocysteine metabolism by the uremic milieu. Absolute or relative deficiencies of folate, vitamin B6, or vitamin B12 may also play a role. Several case-control and prospective studies have now indicated that hyperhomocystenemia is an independent risk factor for atherothrombotic disease in patients with predialysis and end-stage renal disease. In renal patients, plasma homocysteine concentration can be reduced by administration of folic acid in doses ranging from 1 to 15 mg per day. In more than 50% of the cases, however, the homocysteine concentration remains above 15 micromol/L. The effects of vitamin B12 or vitamin B6 are unclear. Large intervention trials are now needed to establish whether homocysteine-lowering therapy will reduce atherothrombotic events in patients with renal failure. These studies are now planned or are ongoing.

Topics: Adult; Arteriosclerosis; Cardiovascular Diseases; Case-Control Studies; Child; Endothelium, Vascular; Female; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Homocysteine; Humans; Hyperhomocysteinemia; Kidney Diseases; Kidney Failure, Chronic; Kidney Transplantation; Life Tables; Male; Methionine; Peritoneal Dialysis; Prospective Studies; Pyridoxine; Renal Dialysis; Survival Analysis; Thrombophilia; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6 Deficiency

Folate or cobalamin deficiencies are usually detected by hematologic abnormalities, such as a macrocytic megaloblastic anemia, or often milder signs, such as hypersegmented neutrophils. In fact, these vitamin deficiencies may be associated with clinical conditions in which anemia and/or macrocytosis are absent, such as neuropsychiatric disorders and inborn errors of folate or cobalamin metabolism. A battery of sensitive tests, including blood vitamin levels, serum methylmaIonic acid and homocysteine assays, and the deoxyuridine suppression test in the bone marrow, allows for early detection of vitamin deficiency. Additional tests may be included to identify the causes of deficiency, such as the Schilling test using crystalline cyanocobalamin, or a modified Schilling test for showing food cobalamin malabsorption. Strategies for diagnosing a vitamin deficiency differ according to the hematologic and clinical presentations. The deleterious effects (aside from anemia) that arise from cobalamin or folate deficiency and include neurological complications, increased risk of vascular disease due to hyperhomocysteinemia, and increased risk of some types of cancer related to folate deficiency, underscore the importance of making an early diagnosis and instituting treatment with the appropriate vitamin in preventing permanent damage.

Topics: Deoxyuridine; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

At one time, the diagnosis of a deficiency of vitamin B12 or folate was considered to be relatively straightforward. As knowledge has accumulated, the limitations of such tests as serum vitamin level measurements and the Schilling test have become apparent. With the development of newer tests, atypical and subclinical deficiency states have been recognized. In this review, available tests used in the diagnosis of vitamin B12 and folate deficiency are discussed, and a rational approach to the diagnosis of these deficiency states is presented.

Topics: Antibodies; Clinical Laboratory Techniques; Clinical Trials as Topic; Decision Trees; Diagnosis, Differential; Erythrocytes; Folic Acid Deficiency; Hematologic Diseases; Homocysteine; Humans; Intrinsic Factor; Methylmalonic Acid; Nervous System Diseases; Parietal Cells, Gastric; Primary Health Care; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

We performed a systematic literature search for diagnostic criteria in establishing cobalamin deficiency. The diagnostic procedure is particularly uncertain in elderly patients with neurological symptoms and in cases with borderline cobalamin values. In any patient with suspected cobalamin deficiency we recommend analysing a full blood count and determining cobalamin concentration in a serum sample. Particularly in elderly patients and cases with neurological symptoms presenting borderline cobalamin values and no abnormalities in the blood count, we recommend further investigation with methylmalonic acid, homocystein and Schilling test. These additional tests should make it possible to decide whether to recommend lifelong substitution with cobalamin. Various cobalamin assays, Schilling test, food cobalamin test, gastroscopic evaluation and the problems surrounding these assays in the elderly are discussed. Our own experience with methylmalonic acid, homocystein determination and food cobalamin test did not reveal a simple diagnostic procedure in such cases. We conclude that there is still no "gold standard" for diagnostic procedure in the special cases mentioned.

Topics: Aging; Anemia, Pernicious; Blood Cell Count; Diagnosis, Differential; Folic Acid Deficiency; Gastritis, Atrophic; Gastroscopy; Homocysteine; Humans; Methylmalonic Acid; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Megaloblastic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

The folates are made up of a pterdine ring attached to a p-aminobenzoate and a polyglutamyl chain. The active form is tetrahydrofolate which can have C1 units enzymically attached. These C1 units (as a formly group) are passed on to enzymes in the purine pathway that insert the C-2 and C-8 into the purine ring. A methylene group (-CH2-) attached to tetrahydrofolate is used to convert the uracil-type pyrimidine base found in RNA into the thymine base found in DNA. A further folate cofactor, i.e. 5-methyltetrahydrofolate, is involved in the remethylation of the homocysteine produced in the methylation cycle back to methionine. After activation to S-adenosylmethionine this acts as a methyl donor for the dozens of different methyltransferases present in all cells. Folate deficiency results in reduction of purine and pyrimidine biosynthesis and consequently DNA biosynthesis and cell division. This process is most easily seen in a reduction of erythrocytes causing anaemia. Reduction in the methylation cycle has multiple effects less easy to identify. One such effect is certainly on the nerve cells, because interruption of the methylation cycle causing neuropathy can also happen in vitamin B12 deficiency due to reduced activity of the vitamin B12-dependent enzyme methionine synthase (EC 2.1.1.13). In vitamin B12 deficiency, blocking of the methylation cycle causes the folate cofactors in the cell to become trapped as 5-methyltetrahydrofolate. This process in turn produces a pseudo folate deficiency in such cells, preventing cell division and giving rise to an anaemia identical to that seen in folate deficiency.

Topics: Diet; Folic Acid; Folic Acid Deficiency; Humans; Nutritional Requirements; Vitamin B 12; Vitamin B 12 Deficiency

Vitamin B12 (cobalamin) deficiency associated neuropathy, originally called subacute combined degeneration, is particularly common in the elderly. The potential danger today is that with supplementation with folic acid of dietary staples such as flour, that the incidence of this disease could rise as folic acid, as opposed to natural folate (N5CH3HFGlu1), enters the cell and the metabolic cycle by a cobalamin independent pathway. This chapter briefly describes the clinical presentation of the disease, which unless treated will induce permanent CNS damage. The biochemical basis of the interrelationship between folate and cobalamin is the maintenance of two functions, nucleic acid synthesis and the methylation reactions. The latter is particularly important in the brain and relies especially on maintaining the concentration of S-adenosylmethionine (SAM) which, in turn, maintains the methylation reactions whose inhibition is considered to cause cobalamin deficiency associated neuropathy. SAM mediated methylation reactions are inhibited by its product S-adenosylhomocysteine (SAH). This occurs when cobalamin is deficient and, as a result, methionine synthase is inhibited causing a rise of both homocysteine and SAH. Other potential pathogenic processes related to the toxic effects of homocysteine are direct damage to the vascular endothelium and inhibition of N-methyl-D-aspartate receptors.

Topics: Aged; DNA; Folic Acid; Folic Acid Deficiency; Humans; Methylation; Nervous System Diseases; S-Adenosylmethionine; Vitamin B 12; Vitamin B 12 Deficiency

An elevated level of total homocysteine (tHcy) in blood, denoted hyperhomocysteinemia, is emerging as a prevalent and strong risk factor for atherosclerotic vascular disease in the coronary, cerebral, and peripheral vessels, and for arterial and venous thromboembolism. The basis for these conclusions is data from about 80 clinical and epidemiological studies including more than 10,000 patients. Elevated tHcy confers a graded risk with no threshold, is independent of but may enhance the effect of the conventional risk factors, and seems to be a particularly strong predictor of cardiovascular mortality. Hyperhomocysteinemia is attributed to commonly occurring genetic and acquired factors including deficiencies of folate and vitamin B12. Supplementation with B-vitamins, in particular with folic acid, is an efficient, safe, and inexpensive means to reduce an elevated tHcy level. Studies are now in progress to establish whether such therapy will reduce cardiovascular risk.

Topics: Arteriosclerosis; Cardiovascular Diseases; Coronary Artery Disease; Female; Folic Acid; Folic Acid Deficiency; Forecasting; Homocysteine; Humans; Intracranial Arteriosclerosis; Male; Peripheral Vascular Diseases; Prevalence; Risk Factors; Safety; Thromboembolism; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Cardiovascular Diseases; Dietary Supplements; Folic Acid; Folic Acid Deficiency; Hematinics; Homocysteine; Humans; Kidney Failure, Chronic; Kidney Transplantation; Pyridoxine; Renal Dialysis; Vitamin B 12

The fortification of all grain products with folate is mandatory in the USA from 1st January 1999. The decision has been prompted by research indicating that the risk of heart disease, cancer, stroke, nervous system disorders, including Alzheimer's disease, and neural tube defects may be reduced by daily intake of folate higher than is currently normal in the American population. There is a debate on the adequacy of the level of folate mandated and on the limiting of fortification to grain products. Furthermore, there have been representations to the US Food and Drug Administration to include B12 in the fortification requirement. Would British health also benefit from such fortification?

Topics: Adolescent; Adult; Diet Surveys; Edible Grain; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Male; Middle Aged; Nutrition Policy; Nutritive Value; United Kingdom; United States; United States Food and Drug Administration; Vitamin B 12

The sulfur-containing amino acid, homocysteine, is formed from the essential amino acid methionine, and a number of B vitamins are involved in methionine metabolism. Pyridoxine, vitamin B6, is a cofactor for cystathionine beta synthase, which mediates the transformation of homocysteine to cystathionine, the initial step in the transsulfuration pathway and the urinary excretion of sulfur. In a normal diet there is conservation of the carbon skeleton, and about 50% of the homocysteine formed is remethylated to methionine via steps that require folic acid and vitamin B12. A deficiency of any of these three vitamins leads to modest homocyst(e)ine elevation, as does diminished renal function, both of which are common in the elderly. It is also established that homocyst(e)ine elevation of this order is associated with increased cardiovascular risk but is also associated with most established risk factors, although it is thought to be an independent contributor. In the inborn error of metabolism homocystinuria due to cystathionine beta synthase deficiency there is greatly increased circulating homocyst(e)ine and a clear association with precocious vascular disease. In about 50% of these patients there is a vascular event before the age of 30 years. The homocysteine-induced adverse vascular changes appear to result from endothelial and smooth muscle cell effects and increased thrombogenesis. We have documented a highly significant reduction in the occurrence of vascular events during 539 patient years of treatment in 32 patients with cystathionine beta synthase deficiency (mean age 30 years, range 9-66 years) by aggressive homocyst(e)ine lowering with pyridoxine, folic acid, and B12 (p = 0.0001). The 15 pyridoxine nonresponsive patients also received oral betaine. Although a cause and effect relationship is postulated for the increased cardiovascular risk associated with mild homocysteine elevation, a common cause of this elevation is the methylenetetrahydrofolate reductase C677T mutation. Homozygotes occur in about 11% of Caucasian populations. However, the mutation is not associated with increased coronary risk. Since mild homocysteine elevation is easily normalized by B vitamin supplementation, usually with folic acid, it remains for controlled clinical trials of this inexpensive therapy to determine whether normalizing mild homocyst(e)ine elevation reduces cardiovascular risk.

Topics: Aging; Cardiovascular Diseases; Diet; Folic Acid; Folic Acid Deficiency; Homocysteine; Homocystinuria; Humans; Pyridoxine; Risk Factors; Vitamin B 12; Vitamin B Deficiency

Topics: Adult; Aged; Alcoholism; Anemia, Macrocytic; Female; Folic Acid; Folic Acid Deficiency; Humans; Hydroxocobalamin; Hypothyroidism; Infant, Newborn; Liver Failure; Male; Pregnancy; Risk Factors; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Studies with low-income pregnant and lactating women from the city of Rio de Janeiro, concerned mainly with the changes in micronutrient homeostasis during pregnancy and lactation in the absence of overt clinical deficiencies, are reported. These studies focused on folate, cobalamin, iron, zinc and vitamin A. Factors that may affect the maternal micronutrient state, such as dietary intakes, use of supplements and interrelationships of micronutrients have been considered, as well as the implications of these changes for maternal-fetal transfer and milk composition. Although these studies were not designed to evaluate the prevalence of sub-clinical micronutrient deficiencies in pregnant and lactating women, they indicate that high frequencies of sub-clinical deficiencies of folate, iron, zinc and vitamin A, especially in pregnant women, are expected to be found in Rio de Janeiro.

Topics: Appetite Regulation; Brazil; Female; Folic Acid; Folic Acid Deficiency; Homeostasis; Humans; Iron; Iron Deficiencies; Lactation; Micronutrients; Pregnancy; Vitamin A; Vitamin A Deficiency; Vitamin B 12; Vitamin B 12 Deficiency; Zinc

Research during the last 5 years has made it clear that people who do not take folic acid supplements are at increased risk for functional folate deficiency, which has been proven to cause spina bifida and anencephaly and also has been associated with an increased risk for occlusive cardiovascular disease. The overriding folate policy issue is how to increase dramatically the folate consumption of 75% of the population who are now consuming 0.4 mg of folic acid in a supplement. The most expeditious way to increase consumption is through fortification of a food staple. Public health programs are also needed to educate people about the vital importance of increased consumption of folic acid vitamin supplements and of food rich in natural folates. It is urgent that fortification of cereal-grain products be implemented now. The level proposes by FDA would accomplish some prevention, but much more prevention would occur if the fortification were 2.5 times that level. Fortification at the higher level would prevent about 1000 spina bifida and anencephaly birth defects each year and perhaps as many as 50,000 premature deaths each year from coronary disease. Available data have not demonstrated that increasing consumption of folic acid by 0.1 to 0.25 mg of folic acid a day is harmful. If a policy needs to be established on the assumption that people who take vitamin supplements could be harmed, a good policy option ia available; require that all folic acid vitamin supplements also contain 0.4 mg of vitamin B-12.

Topics: Adult; Aged; Anencephaly; Cardiovascular Diseases; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Homocysteine; Humans; Infant, Newborn; Male; Pregnancy; Risk Factors; Spinal Dysraphism; United States; Vitamin B 12; Vitamin B 12 Deficiency

Folate and vitamin B12 are required both in the methylation of homocysteine to methionine and in the synthesis of S-adenosylmethionine. S-adenosylmethionine is involved in numerous methylation reactions involving proteins, phospholipids, DNA, and neurotransmitter metabolism. Both folate and vitamin B12 deficiency may cause similar neurologic and psychiatric disturbances including depression, dementia, and a demyelinating myelopathy. A current theory proposes that a defect in methylation processes is central to the biochemical basis of the neuropsychiatry of these vitamin deficiencies. Folate deficiency may specifically affect central monoamine metabolism and aggravate depressive disorders. In addition, the neurotoxic effects of homocysteine may also play a role in the neurologic and psychiatric disturbances that are associated with folate and vitamin B12 deficiency.

Topics: Depressive Disorder; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Methylation; Multiple Sclerosis; Vitamin B 12; Vitamin B 12 Deficiency

Malnutrition of folate and cobalamin occurs on a world-wide scale. Millions of individuals, for a variety of cultural, religious and socio-economic reasons, ingest less than the daily amounts required to maintain body stores. Assessment of intake depends on the population under study, method of food preparation and assay technique. Up to 90% of folate may be destroyed by cooking and, although less, significant amounts of cobalamin can also be lost in this way. Estimates of the proportion of both vitamins absorbed from a mixed diet vary, but may be as little as 50%. The need for supplementation is more common with folate than cobalamin. However, recent advances have highlighted subtle sub-clinical metabolic changes in some groups, particularly the elderly. Further investigation into their requirements is indicated. New assays for metabolites of cobalamin and folate are highly sensitive but lack specificity and are not readily available.

Topics: Adult; Aged; Folic Acid; Folic Acid Deficiency; Humans; Infant; Nutritional Requirements; Vitamin B 12; Vitamin B 12 Deficiency

Folate deficiency causes anaemia owing to impaired purine and pyrimidine biosynthesis. Vitamin B12 deficiency causes an identical anaemia owing to metabolic trapping of intracellular folate. Vitamin B12 also causes nerve damage. Unlike the anaemia, the nerve damage is probably owing to inhibition of methyltransferase involved in nerve cell biosynthesis. This decreased activity is owing to a reduction in the availability of SAM, the methyl donor, together with product inhibition by its demethylated form, SAH.

Topics: Animals; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Mammalian cells contain two Cbl-dependent enzymes, L-methylmalonyl-CoA mutase and methionine synthase. The former requires adenosyl-Cbl and catalyzes the conversion of L-methylmalonyl-CoA to succinyl-CoA. The latter requires CH3-Cbl and catalyzes the conversion of 5-CH3-tetrahydrofolate and homocysteine to tetrahydrofolate and methionine, respectively. Biochemical abnormalities related to a decrease in the activity of methionine synthase are thought to be responsible for the indistinguishable hematologic abnormalities seen in both Cbl and folate deficiency. The biochemical basis for the neuropsychiatric abnormalities seen in Cbl deficiency, but not in folate deficiency, is not known although hypotheses have been proposed that implicate one or the other of the two Cbl-dependent enzymes. Recent studies have shown that levels of serum methylmalonic acid, 2-methylcitric acids I and II, total homocysteine, and cystathionine are elevated in most patients with Cbl deficiency and that total homocysteine, cystathionine, N,N-dimethylglycine, and N-methylglycine are elevated in most patients with folate deficiency. Analysis of these metabolic abnormalities in various patient groups fails to support hypotheses that either L-methylmalonyl-CoA mutase or methionine synthase alone are responsible for the neuropsychiatric abnormalities. We suggest that they may result from a third, unknown mammalian Cbl-dependent enzyme or from a combined deficiency of both Cbl-dependent enzymes together with an unknown genetic or environmental factor.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Adolescent; Adult; Aged; Animals; Betaine; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Methylmalonyl-CoA Mutase; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Amino Acid Metabolism, Inborn Errors; Blood Coagulation Factors; Blood Platelets; Child; Cystathionine beta-Synthase; Endothelium, Vascular; Fibrinolytic Agents; Folic Acid Deficiency; Homocysteine; Humans; Incidence; Male; Methionine; Methylation; Methylenetetrahydrofolate Reductase (NADPH2); Oxidoreductases Acting on CH-NH Group Donors; Penicillamine; Risk Factors; Thrombosis; Vascular Diseases; Vitamin B 12; Vitamin B 6 Deficiency; Vitamins

Folic acid (FA) and vitamin B12 have been measured prospectively in 110 children that were under treatment with anticonvulsants. The control group consisted of 59 healthy children. A statistically significant difference in levels of serum FA and mean corpuscular volume (MCV) was observed between groups. Children under anticonvulsant treatment had lower serum FA levels and higher MCV. No significant difference was observed between the two groups in levels of serum vitamin B12. All children with serum FA levels lower than 3 ng/ml were given folate and no adverse side effects were observed due to treatment. Anticonvulsant drugs decrease serum FA levels; therefore, FA should be determined periodically in children under long-term anticonvulsant treatment.

Topics: Adolescent; Anticonvulsants; Child; Child, Preschool; Dose-Response Relationship, Drug; Epilepsy; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Long-Term Care; Male; Vitamin B 12

Topics: Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Neural Tube Defects; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

The interaction between plasma homocysteine levels and vitamins B6, B12, and folate is an exciting field and one that has gathered great momentum over the past few years, with the recognition that homocysteine probably plays an important role in occlusive vascular disease. Our understanding in this field is greatly advanced compared to just a few years ago. There are a number of important issues, however, that will need to be addressed in the future if we are to develop a sufficient knowledge base to effectively minimize the risk of occlusive vascular disease ascribable to hyperhomocysteinemia. These include (1) definitive evidence that homocysteine is the actual agent that mediates accelerated occlusive vascular disease and the mechanism by which this occurs; (2) an understanding of what constitutes a pathologic elevation in homocysteine (is there a threshold concentration in the plasma below which no vascular injury occurs? is the peak concentration achieved the critical determinant of injury, or is the area under the curve, or some other feature, more important?); (3) understanding what synergies might exist by adding B6 or B12 to a regimen of folate supplementation (what doses are most appropriate? will toxologic issues limit the utility of supplementation?); and (4) determining the circumstances where reduction of plasma homocysteine will retard or reverse the process of occlusive vascular disease.

Topics: Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Pyridoxine; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6 Deficiency

Macrocytic and/or megaloblastic anaemias of infants and children are more often due to a defective bone marrow production than to haemolysis. They are mostly related to folate and/or cobalamin deficiency or to a disturbance in the metabolism of one of these vitamins (enzyme deficiencies or defect of synthesis of their active forms). More rarely, these anaemias are associated with congenital deficiency of the enzymes involved in pyrimidine or purine biosynthesis. A few cases of thiamine-responsive megaloblastic anaemia have been reported. Some blood diseases may also associated with macrocytic anaemia. Finally, many drugs (antifolic agents, antipurine or antipyrimidine compounds) may induce macrocytic anaemia.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Folic Acid; Folic Acid Deficiency; Humans; Infant; Vitamin B 12; Vitamin B 12 Deficiency

Reduction of circulating homocysteine levels by folic acid suggests an additional approach to the prophylaxis of certain forms of vascular disease related to atherogenic amino acids.

Topics: Arterial Occlusive Diseases; Arteriosclerosis; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Metabolism, Inborn Errors; Vascular Diseases; Vitamin B 12; Vitamin B 12 Deficiency

Cobalamin deficiency leads to impaired folate function as demonstrated by markedly impaired single-carbon unit transfer into purine, thymidine and methionine. This occurs in the total absence of 'methylH4folate trapping'. In cobalamin deficiency there is impaired synthesis of formylH4folate and raised levels of endogenous formate in blood and liver. FormylH4folate and methionine reverse the effects of cobalamin deficiency. Methionine provides formate via its metabolism to methylthioribose. Recently it has been suggested that the neuropathy of cobalamin deficiency is due to impaired methylation but this was not confirmed. It is likely that defects demonstrated in marrow and liver are also the explanation for the effects of cobalamin deficiency in the CNS.

Topics: Anemia, Megaloblastic; Animals; Central Nervous System Diseases; Coenzymes; Folic Acid; Folic Acid Deficiency; Formates; Humans; Methionine; Models, Biological; Tetrahydrofolates; Thymidine; Vitamin B 12; Vitamin B 12 Deficiency

Vitamin B12 deficiency in the elderly is a common disorder associated with an increased morbidity if it goes undetected, as often happens. Its diagnosis can be enhanced if the clinician recognizes the associated clinical features of nonspecific symptoms, glossitis, and dermatologic and neuropsychiatric abnormalities, and realizes the limitations of various tests (serum B12 assay, parietal cell and intrinsic factor antibody, mean corpuscular volume, and Schilling tests). Available data indicate it is sufficient to prescribe replacement B12 injections three or four times a year.

Topics: Aged; Aging; Diagnosis, Differential; False Negative Reactions; False Positive Reactions; Folic Acid Deficiency; Humans; Middle Aged; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Animals; Antibody Formation; Carcinogens; Choline; Choline Deficiency; Diet; DNA; Folic Acid; Folic Acid Deficiency; Humans; Immunity, Cellular; Lipotropic Agents; Liver; Liver Neoplasms; Methionine; Methylation; Neoplasms; Neoplasms, Experimental; Pharmaceutical Preparations; Risk; Tetrahydrofolates; Vitamin B 12; Vitamin B 12 Deficiency

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Anemia, Megaloblastic; Animals; Central Nervous System; Deoxyuridine; Disease Models, Animal; Drug Interactions; Enzyme Activation; Folic Acid; Folic Acid Deficiency; Histidine; Humans; Liver; Methionine; Methylmalonyl-CoA Mutase; Nitrous Oxide; Oxidation-Reduction; Pteroylpolyglutamic Acids; Purines; Serine; Tetrahydrofolates; Thymidylate Synthase; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Child; Child, Preschool; Demyelinating Diseases; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Middle Aged; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Alcoholism; Biological Transport; Central Nervous System; Dementia; Depressive Disorder; Drug Interactions; Ethnicity; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Mental Disorders; Neurocognitive Disorders; Neuropsychology; Nutrition Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Megaloblastic; Animals; Female; Folic Acid; Folic Acid Deficiency; Formiminoglutamic Acid; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Male; Nutritional Requirements; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12; Vitamin B 12 Deficiency

The studies discussed in this review support the view that biochemical and clinical symptoms common to both folate and vitamin B12 deficiency are due to the induction of a functional folate deficiency, which in turn is induced by cobalamin deprivation. The interrelationship between these two vitamins is best explained by the methyl trap hypothesis stating that vitamin B12 deficiency can lead to lowered levels of methionine synthetase, which results in a functional folate deficiency by trapping an increased proportion of folate as the 5-methyl derivative. In addition, as 5-methyl-H4PteGlu is a poor substrate for folylpolyglutamate synthetase, there is a decreased synthesis of folylpolyglutamates and consequently a decreased retention of folates by tissues. The real folate deficiency that ensues because of decreased tissue folate levels is probably as important physiologically as the functional deficiency caused by the methyl trap. The sparing effect of methionine can be explained by adenosylmethionine inhibition of methylenetetrahydrofolate reductase, which would prevent the buildup of 5-methyl-H4PteGlun. A deficiency in vitamin B12 would not, in itself, be sufficient to cause a disturbance in folate metabolism. The deficiency would have to result in lowered methyltransferase levels before any such disturbance would be manifest.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Amino Acids; Animals; Bone Marrow; Folic Acid; Folic Acid Deficiency; Formates; Formiminoglutamic Acid; Histidine; Homeostasis; Humans; Liver; Megaloblasts; Methionine; Methylation; Nitrous Oxide; Peptide Synthases; Pteroylpolyglutamic Acids; Purines; Serine; Thymidine Monophosphate; Thymidylate Synthase; Thyroid Gland; Vitamin B 12; Vitamin B 12 Deficiency

The fetus, the neonate, and the pregnant woman have a greater requirement for folic acid and vitamin B12 and are more likely to suffer from a deficiency of these vitamins. This article reviews the source, requirement, absorption, and metabolism of these vitamins and discusses the problems attributed to their deficiency in pregnancy and in the neonatal period.

Topics: Abortion, Spontaneous; Anemia; Congenital Abnormalities; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant, Newborn; Infant, Premature; Intellectual Disability; Neural Tube Defects; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Vitamin B 12; Vitamin B 12 Deficiency

Deficiency of either folic acid or vitamin B12 may interfere with DNA synthesis and result in megaloblastic anemia or other conditions. These 2 vitamins have dissimilar molecular structures and are present in different foods; they are also absorbed and metabolized differently. In 201 consecutive cases of megaloblastic anemia, for 90% the cause was alcoholism and poor diet; 0.5% (1 case) was related to oral contraceptives (OCs). Megaloblastic anemia due to folate deficiency has occasionally been reported in patients with inflammatory bowel disease and has been attributed to poor diet, impaired absorption, and increased tissue utilization of folate. Sulfasalazine, a compound containing a sulfa drug and a salicylate that is broken down to its active components by the gut flora, is widely used in the treatment of inflammatory bowel disease and has been shown to impair the absorption of folic acid, polyglutamyl folate, and methyl-tetrahydrofolic acid in patients with these disorders. There is also evidence suggesting an interaction between anticonvulsant drugs and folate balance. A number of cases of megaloblastic anemia due to folate deficiency have been reported in women taking OCs. While in some cases no apparent cause for the megaloblastic anemia other than contraceptive therapy was demonstrated, in many patients other underlying disorders that were likely to disturb folate balance such as celiac disease, decreased dietary vitamin intake, and the administration of other drugs known to affect folate status have also been present. There is no convincing evidence that sex steroids affect folate absorption; about 20% of women taking OCs were found to have mild megaloblastic changes on Papanicolaou smears. These changes disappered after folic acid therapy, suggesting that OCs may cause an increased demand for folate limited to the reproductive system. Another finding is of low serum cobalamin levels in women using OCs; this appears however to be a laboratory abnormality of uncertain cause and of no clinical significance.

Topics: Alcoholism; Animals; Anticonvulsants; Ascorbic Acid; Contraceptives, Oral; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Intestinal Absorption; Nervous System; Nitrous Oxide; Sulfasalazine; Vitamin B 12

The risk of developing folate deficiency is greatest in patients who have a poor diet and malabsorption secondary to disease of the jejunal mucosa or drugs which interfere with its metabolism. In contrast to cobalamin deficiency, in which body stores delay the onset of major metabolic complications, folate deficiency may develop in a matter of months. It is frequently possible to predict these deficiencies and always possible to reverse them by supplementation.

Topics: Diet; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Intestinal Mucosa; Malabsorption Syndromes; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Amblyopia; Erythrocytes; Folic Acid; Folic Acid Deficiency; Humans; Niacin; Nutrition Disorders; Pyridoxine; Vitamin B 12; Vitamins

Women who use oral contraceptives have impaired folate metabolism as shown by slightly but significantly lower levels of folate in the serum and the erythrocytes and an increased urinary excretion of formiminoglutamic acid. The vitamin B12 level in their serum is also significantly lower than that of control groups. However, there is no evidence of tissue depletion of vitamin B12 associated with the use of oral contraceptives. The causes and clinical significance of the impairment of folate and vitamin B12 metabolism in these women is discussed in this review of the literature. Clinicians are advised to ensure that women who shop taking "the pill" because they wish to conceive have adequate folate stores before becoming pregnant.. The effects of oral contraception (OC) on folate and vitamin B12 metabolism are a subject of much controversy. Many studies indicate that OCs impair folate metabolsim and produce some degree of folate depletion, as demonstrated by slight but significant lower levels of folate in the serum and the erythrocytes, and by an increased urinary excretion of formiminoglutamic acid. These effects are unlikely to cause anemia or megalobastic changes in women who have a good dietary intake of folate. Since pregnant women are predisposed to the development of folate deficiency, it would be necessary when stopping the pill for desire of pregnancy to take folate supplements before becoming pregnant. OCs may also produce a low serum level of vitamin B12; this effect, however, is not associated with evidence of tissue depletion of vitamin B12, and does not have any great clinical significance; the effect may also be caused by vitamin B12 malabsorption rather than by OC treatment.

Topics: Anemia, Megaloblastic; Contraceptives, Oral; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Formiminoglutamic Acid; Hematocrit; Hemoglobins; Humans; Pregnancy; Vitamin B 12

Topics: Child, Preschool; Diagnosis, Differential; Female; Folic Acid Deficiency; Homocystinuria; Humans; Infant; Intestinal Absorption; Metabolism, Inborn Errors; Methylmalonic Acid; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Animals; Antibody Formation; Choline Deficiency; Deoxyuridine; Drug Interactions; Folic Acid; Folic Acid Deficiency; Humans; Hypersensitivity, Delayed; Immunity; Lymphocyte Activation; Lymphocytes; Lymphoid Tissue; Methionine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Alcoholism; Anemia, Hemolytic; Anticonvulsants; Bone Marrow Cells; Bone Marrow Diseases; Cells; Deoxyuridine; Erythrocytes, Abnormal; Female; Fluorouracil; Folic Acid; Folic Acid Deficiency; Formyltetrahydrofolates; Homocysteine; Humans; Hypothyroidism; Lymphocyte Activation; Methionine; Pregnancy; Pregnancy Complications; Statistics as Topic; Tetrahydrofolates; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Amino Acids; Animals; Enterobacteriaceae; Enterotoxins; Folic Acid Deficiency; gamma-Glutamyl Hydrolase; Humans; Intestinal Absorption; Nutrition Disorders; Potassium; Rabbits; Rats; Sodium; Sprue, Tropical; Vitamin B 12; Water

A review of nutritional anaemia in Africa is presented above. It has been noted that nutritional anaemia, including iron-deficiency anaemia, megaloblastic anaemia due to folate deficiency or vitamin B12 deficiency, or both, and protein deficiency-anaemia, is widespread throughout Africa. It is particularly common in growing children, women of child-bearing age, pregnant women and lactating mothers. The anaemia is also especially common during the second half of the dry season and the first half of the wet season, when food supplies are limited. In all cases the anaemia is caused either by limited dietary intake, excessive loss of nutrients or excessive utilization. The anaemia is associated with a number of sequelae including both structural changes, like mitochondrial swelling and mucosal atrophy, and functional abnormalities, such as cardiac failure, decreased work output, increased pregnancy risks and increased susceptibility to infections. The evidence in favour of increased susceptibility to infections in megaloblastic anaemia and protein-deficiency anaemia is overwhelming, but in iron-deficiency anaemia the available information argues in favour of reduced susceptibility to infections, except after initiation of iron therapy. The treatment of nutritional anaemia includes replacement of the deficient nutrients (and blood transfusion in severe cases), prevention of further nutrient losses and treatment of associated complications.

Topics: Adult; Africa; Anemia; Anemia, Hypochromic; Anemia, Megaloblastic; Child; Deficiency Diseases; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Male; Pregnancy; Protein Deficiency; Tropical Climate; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Alcoholism; Animals; Beer; Bone Marrow Cells; Erythropoiesis; Folic Acid; Folic Acid Deficiency; Formiminoglutamic Acid; Humans; Intestinal Absorption; Liver Diseases, Alcoholic; Nutrition Disorders; Peripheral Nervous System Diseases; Psychoses, Alcoholic; Tetrahydrofolates; Thrombocytopenia; Vitamin B 12; Vitamin B 12 Deficiency; Wine

The diagnosis of megaloblastic anemia and the differentiation of folate and vitamin B12 deficiency require, in addition to careful attention to the history and physical findings, the use of laboratory tests. In this paper the commonly ordered tests for such a diagnosis are discussed, with emphasis on the conditions that may cause false-positive or false-negative results in the complete blood count, examination of a peripheral blood smear and a bone marrow specimen, serum and erythrocyte folate assays, serum vitamin B12 assays, tests of vitamin B12 absorption and gastric analysis.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Anemia, Sideroblastic; Biological Assay; Blood Cell Count; Bone Marrow Examination; Diagnostic Errors; Erythrocytes; Folic Acid; Folic Acid Deficiency; Humans; Lacticaseibacillus casei; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Anticonvulsants; Blood Cell Count; Child, Preschool; Contraceptives, Oral; Diagnosis, Differential; Diet; Erythropoiesis; Ethanol; Female; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Male; Medical History Taking; Methionine Adenosyltransferase; Vitamin B 12; Vitamin B 12 Deficiency

The authors, after having reviewed folic acid and folates chemical and biochemical characteristics and their absorption and excretion modalities, determine serum folate levels by radioassay method on 30 patients with renal failure in chronic dialysis and on 24 normal controls. Low serum folate levels concerned 14 uremic patients (46.6% of th cases): 10 in hemodialysis and 4 in peritoneal dialysis. The mean serum folate values was 3.31 ng/ml (+/- 1.93) for the uremic patients' group and 4.29 ng/ml (+/- 1.21) for the control group. The difference between the mean level of these groups was statistically significant (p less than 0.05). No significant difference was observed among the mean serum folate levels of the uremic patients in peritoneal dialysis and of those in hemodialysis. Significantly low serum folate levels were finally found for the uremic HBsAg-positive patients, but in the same subjects the dialytic treatment period had been very prolonged. The authors conclude emphasizing the usefulness of folic acid treatment in uremic patients on dialysis, also without having an evident hematologic picture of megaloblastic anemia.

Topics: Adolescent; Adult; Aged; Bone Marrow Diseases; Female; Folic Acid; Folic Acid Deficiency; Hemolysis; Hepatitis B Antigens; Humans; Iron Deficiencies; Male; Middle Aged; Peritoneal Dialysis; Renal Dialysis; Uremia; Vitamin B 12

Since 1949, the World Health Organization, recognizing the public health importance of nutritional anemia, has sponsored efforts directed towards its understanding and control. During this period, often as a result of the work of the Organization, advances have been made in many areas. Basic understanding of iron, folate and vitamin B12 nutrition, and the various factors which may influence the availability and requirements of these factors, has greatly increased. Surveys in a number of countries have highlighted the widespread prevalence of nutritional anemia, particularly in developing countries. The major factor responsible is a deficiency of iron, whith folate deficiency also playing a role in some population groups, especially in preganant women. There is increasing evidence that anemia adversely affects the health of individuals and may have profound socioeconomic consequences. Control of nutritional anemia is possible by providing the deficient nutrient(s) either as therapeutic supplements or by fortification of commonly used foodstuffs. Some control programs are reviewed and suggestions for further action outlined. The Organization still has an important role to play in this field, encouraging the development of control programs and providing advice and technical assistance ot member countries.

Topics: Adolescent; Adult; Anemia, Hypochromic; Child; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Health Planning; Humans; Infant; Iron; Male; Nutritional Requirements; Parasitic Diseases; Pregnancy; Pregnancy Complications; Vitamin B 12; Vitamin B 12 Deficiency; World Health Organization

Topics: Anemia, Pernicious; Diagnosis, Differential; Folic Acid; Folic Acid Deficiency; Humans; Hydrolysis; Intestinal Absorption; Intestinal Mucosa; Intrinsic Factor; Malabsorption Syndromes; Pancreas; Pteroylpolyglutamic Acids; Sprue, Tropical; Vitamin B 12; Vitamin B 12 Deficiency

The role of the metals, iron and copper, and the vitamins E, folic acid, and B12 in the genesis of nutritional anemias in infancy have been reviewed. All are preventable. The precise requirements for each of these trace elements and vitamins in the small premature infant remain to be defined. The nonhematologic consequences of these nutritional deficiencies require further study. Anemia may prove to be the least important manifestation of the deficiency states.

Topics: Adolescent; Anemia; Anemia, Hemolytic; Anemia, Hypochromic; Child; Child, Preschool; Copper; Female; Folic Acid; Folic Acid Deficiency; Growth; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Iron; Nutritional Requirements; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Deficiency; Vitamin E; Vitamin E Deficiency

Topics: Adult; Anemia; Anemia, Hypochromic; Contraceptives, Oral; Deficiency Diseases; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iron; Iron Deficiencies; Lactation; Male; Menstruation; Middle Aged; Nutritional Requirements; Pregnancy; Pregnancy Complications; Sex Factors; United States; Vitamin B 12; Vitamin B 12 Deficiency

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Amino Acids; Animals; Bacteria; Coenzymes; DNA; Folic Acid; Folic Acid Deficiency; Formiminoglutamic Acid; Glutamates; Hematopoiesis; Humans; Megaloblasts; Methionine; Methylmalonyl-CoA Mutase; Neurologic Manifestations; Purines; Pyrimidines; Ribonucleotide Reductases; Tetrahydrofolates; Vitamin B 12; Vitamin B 12 Deficiency

Subnormal red-cell folate values were encountered in 20 of 63 thalassaemic subjects in a population with a low incidence of megaloblastosis. The abnormality was not associated with haematological changes of megaloblastosis and could not be explained on the basis of incomplete liberation of intra-erythrocytic folates, serum conjugase deficiency of vitamin B12 deficiency. Evidence is presented to indicate that it is unlikely to represent a state of subclinical folate deficiency. The exact cause of the abnormality is unknown.

Topics: Anemia, Megaloblastic; Bone Marrow; Bone Marrow Cells; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; gamma-Glutamyl Hydrolase; Hong Kong; Humans; Male; Thalassemia; Vitamin B 12

Topics: Adolescent; Adult; Anemia, Hemolytic; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Biological Transport; Bone Marrow; Bone Marrow Cells; Child; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Homocystinuria; Humans; Infant; Intrinsic Factor; Malabsorption Syndromes; Male; Metabolism, Inborn Errors; Methionine; Methionine Adenosyltransferase; Orotic Acid; Phenylketonurias; Tetrahydrofolate Dehydrogenase; Transcobalamins; Vitamin B 12

Topics: Adult; Aged; Anemia, Megaloblastic; Anticonvulsants; Blood-Brain Barrier; Brain; Brain Diseases; Child; Epilepsy; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Formiminoglutamic Acid; Humans; Intellectual Disability; Male; Mental Disorders; Metabolism, Inborn Errors; Methotrexate; Middle Aged; Nervous System Diseases; Vitamin B 12; Vitamin B 12 Deficiency

1. Low serum B12 levels can be measured with considerable precision by microbiological assay with the Euglena gracilis assay and B12 deficiency can be recognised with a high level of consistency by either the Euglena or L. leichmannii assays. Either method is ideally suited for the assay of large numbers of specimens. The Lactobacillus leichmanii technique requires preliminary extraction of protein and it has been suggested that this may be a source of inaccuracy. 2. The radioisotope dilution assay should be the ideal method of measuring B12 levels in small or moderate numbers of specimens for it is a simple method that can be carried out in any laboratory with suitable counting equipment. After many false starts the conditions required for accurate assay are now understood. Each of 40 to 50 radioisotopic dilution techniques that have been introduced claims to be capable of differentiating B12 deficiency from control subjects but the reported correlations between the actual levels found in the two different assays are variable and the levels may be much higher with some radioisotopic methods. 3. The subnormal serum levels which are found in pernicious anaemia with all these techniques indicate severe reduction of the liver B12 level. A low serum B12 level in other conditions has, in the absence of associated folate or iron deficiency, the same significance. If the fall in the serum B12 level is associated with folate or iron deficiency, the tissue B12 levels are usually reduced but not to the low levels found in B12 deficiency states. 4. In practice, a subnormal B12 level is a valuable pointer not only to unsuspected pernicious anaemia but also to other gastrointestinal or nutritional disorders. The significance of a fall in the B12 level can only be understood if its cause is defined by a full clinical and gastroenterological investigation. 5. Falsely low serum B12 levels are found under certain iatrogenic conditions and B12 levels may be normal in spite of cellular deficiency of B12 under the rare circumstances of pernicious anaemia being associated with chronic myeloid leukaemia or when there is deficiency of TC 2.

Topics: Anemia, Megaloblastic; Anemia, Pernicious; Ascorbic Acid; Biological Assay; Bone Marrow; Bone Marrow Cells; Carrier Proteins; Deoxyuridine; Euglena gracilis; Female; Folic Acid Deficiency; Humans; Intrinsic Factor; Lactobacillus; Leukemia, Myeloid; Male; Pregnancy; Pregnancy Complications; Radioisotope Dilution Technique; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Aged; Animals; Biotin; Chemical Phenomena; Chemistry; Child; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infant, Newborn; Male; Mouth Diseases; Nicotinic Acids; Nutritional Requirements; Pellagra; Pregnancy; Riboflavin; Riboflavin Deficiency; Thiamine; Thiamine Deficiency; Tryptophan; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Vitamin B Deficiency

Topics: Adult; Anemia; Anemia, Hypochromic; Deficiency Diseases; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Hemoglobins; Humans; International Cooperation; Iron; Male; Pregnancy; Pregnancy Complications; Vitamin B 12

The literature concerning the influence of estrogen-containing oral contraceptives on vitamins is reviewed. The appearance of an elevated plasma concentration of vitamin A is probably without clinical importance, while there seems to be a clear connection between disturbances of vitamin B6 metabolism and mental symptoms. Low levels of folic acid and vitamin B12 have also been noted. Despite this, it is very rare that hematologic abnormalities develop during hormonal contraception. A reduced concentration of vitamin C in plasma and blood corpuscles has been reported. The clinical significance of these alterations is unknown.

Topics: Ascorbic Acid; Contraceptives, Oral; Depression; Estradiol Congeners; Female; Folic Acid; Folic Acid Deficiency; Humans; Lipids; Menstruation; Nicotinic Acids; Pyridoxine; Tryptophan; Vitamin A; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6 Deficiency; Vitamins

Topics: Adult; Animals; Bone Marrow; Bone Marrow Cells; DNA; Fibroblasts; Folic Acid; Folic Acid Deficiency; Humans; Liver; Metabolism, Inborn Errors; Methionine; Methyltransferases; Rats; Skin; Tetrahydrofolate Dehydrogenase; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Animals; Cell Division; Euglena gracilis; Folic Acid; Folic Acid Deficiency; Humans; Leukemia; Methylation; Nucleic Acids; Nucleotides; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anticonvulsants; Blood-Brain Barrier; Clinical Trials as Topic; Epilepsy; Folic Acid; Folic Acid Deficiency; Humans; Phenobarbital; Phenytoin; Primidone; Seizures; Tetrahydrofolates; Vitamin B 12

Topics: Adolescent; Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Female; Folic Acid Deficiency; Humans; India; Infant; Infant, Newborn; Infant, Premature; Lactation; Nutritional Physiological Phenomena; Nutritional Requirements; Pregnancy; Pregnancy Complications, Hematologic; United Kingdom; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Ascorbic Acid; Chemical Phenomena; Chemistry; Child, Preschool; Digestive System; Erythropoiesis; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Intestinal Absorption; Iron; Male; Pregnancy; Riboflavin; Vitamin B 12

Topics: Alcoholism; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Diagnosis, Differential; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Intestinal Absorption; Intrinsic Factor; Malabsorption Syndromes; Pyrimidine Nucleotides; Thymine Nucleotides; Uracil Nucleotides; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Age Factors; Diet; Female; Folic Acid; Folic Acid Deficiency; Gastrointestinal Diseases; Humans; Infant; Intrinsic Factor; Malabsorption Syndromes; Metabolic Diseases; Metabolism, Inborn Errors; Nutrition Disorders; Nutritional Physiological Phenomena; Nutritional Requirements; Pregnancy; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anticonvulsants; Contraceptives, Oral; DNA; Drug-Related Side Effects and Adverse Reactions; Erythrocytes; Ethanol; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Nucleotidyltransferases; Purines; Pyrimidines; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Achlorhydria; Anemia, Pernicious; Animals; Binding Sites; Biological Transport; Blind Loop Syndrome; Cestode Infections; Folic Acid Deficiency; Humans; Intestinal Absorption; Intestine, Small; Intrinsic Factor; Liver; Malabsorption Syndromes; Pancreas; Postgastrectomy Syndromes; Protein Binding; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Abnormalities, Drug-Induced; Anticonvulsants; Blood Coagulation; Epilepsy; Female; Fetal Death; Fetus; Folic Acid Deficiency; Humans; Infant, Newborn; Maternal-Fetal Exchange; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Vitamin B 12; Vitamin D; Vitamin D Deficiency; Vitamin K

Topics: Alcoholism; Anticonvulsants; Cyanides; Deficiency Diseases; Electroencephalography; Erythrocytes; Folic Acid Deficiency; Humans; Isoniazid; Nervous System Diseases; Neurocognitive Disorders; Pellagra; Polyneuropathies; Schilling Test; Spinal Cord Diseases; Thiamine Deficiency; Transketolase; Tryptophan; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6 Deficiency; Vitamin B Deficiency; Wernicke Encephalopathy

Topics: Anemia, Macrocytic; Bile; Binding Sites; Feces; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Intrinsic Factor; Protein Binding; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Ascorbic Acid Deficiency; Avitaminosis; Calcium; Contraceptives, Oral; Copper; Female; Folic Acid Deficiency; Humans; Iron; Metals; Middle Aged; Nicotinic Acids; Nutritional Requirements; Pregnancy; Riboflavin Deficiency; Vitamin A; Vitamin B 12; Vitamin B 6 Deficiency; Vitamin K; Vitamins; Zinc

Topics: Bile; Biological Transport, Active; Enzymes; Folic Acid; Folic Acid Deficiency; Food Deprivation; Gastric Juice; Humans; Intestinal Absorption; Intestinal Diseases, Parasitic; Nutrition Disorders; Nutritional Requirements; Phenytoin; Polycythemia; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Deoxyuridine; DNA; Erythrocytes, Abnormal; FIGLU Test; Folic Acid Deficiency; Homocysteine; Humans; Methionine; Nervous System Diseases; Tetrahydrofolate Dehydrogenase; Tetrahydrofolates; Thymine Nucleotides; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Animals; Biological Assay; Blood Proteins; Cobalt Isotopes; Euglena gracilis; Evaluation Studies as Topic; Folic Acid Deficiency; Gastrectomy; Humans; Lactobacillus; Methods; Protein Binding; Radioisotope Dilution Technique; Vitamin B 12

Topics: Anemia, Pernicious; Animals; Bacteroides; Blind Loop Syndrome; Celiac Disease; Dietary Proteins; Electrolytes; Escherichia coli; Folic Acid Deficiency; Humans; Hypoproteinemia; Intestinal Absorption; Intestinal Diseases; Intestinal Mucosa; Intestine, Small; Iron; Klebsiella; Lipid Metabolism; Malabsorption Syndromes; Microscopy, Electron; Vitamin B 12; Water; Xylose

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Biological Transport; Diet; Female; Folic Acid; Folic Acid Deficiency; Food; Hematopoiesis; Humans; Intestinal Absorption; Iron; Male; Pregnancy; Protein Binding; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Animals; Folic Acid; Folic Acid Deficiency; Humans; Liver; Methionine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Amino Acids; Anemia, Macrocytic; Contraceptives, Oral; Diet; DNA; Ethanol; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Glycine; Homocysteine; Humans; Malabsorption Syndromes; Methionine; Pharmacology; Serine; Toxins, Biological; Vitamin B 12

Topics: Anemia, Macrocytic; Clinical Laboratory Techniques; Diagnosis, Differential; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Amino Acids; Anemia, Pernicious; Cell Nucleus; Diet; DNA; Erythrocytes; Folic Acid; Folic Acid Deficiency; Glycine; Hematologic Diseases; Homocystine; Humans; Methionine; Polycythemia; Pyridoxine; Serine; Tetrahydrofolate Dehydrogenase; Thymine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Animals; Blood Cell Count; Feces; FIGLU Test; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Milk; Milk, Human; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Sideroblastic; Arthritis, Rheumatoid; Bone Marrow; Cobalt; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Gastric Acidity Determination; Hemoglobinometry; Humans; Intestinal Absorption; Iron; Liver Extracts; Male; Mononuclear Phagocyte System; Plasma Volume; Potassium; Salicylates; Sex Factors; Steroids; Vitamin B 12

Topics: Anemia, Macrocytic; Anticonvulsants; Electroconvulsive Therapy; Electroencephalography; Epilepsy; Folic Acid; Folic Acid Deficiency; Humans; Mental Disorders; Methionine; Phenethylamines; Phenothiazines; Schizophrenia; Vitamin B 12

Topics: Adult; Anemia, Hemolytic; Anemia, Macrocytic; Ascorbic Acid; Ascorbic Acid Deficiency; Blood Cell Count; Bone Marrow Cells; Erythrocytes; Erythropoiesis; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hemolysis; Hemorrhagic Disorders; Humans; Iron; Leukocytes; Liver; Reticulocytes; Scurvy; Tissue Extracts; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Aplastic; Anemia, Hemolytic; Anemia, Hemolytic, Congenital; Anemia, Hypochromic; Anemia, Pernicious; Anticoagulants; Chelating Agents; Erythroblastosis, Fetal; Exchange Transfusion, Whole Blood; Female; Fibrinolysis; Folic Acid Deficiency; Hematologic Diseases; Hemoglobinopathies; Hemophilia A; Hemophilia B; Humans; Infant, Newborn; Iron; Leukemia; Pregnancy; Splenectomy; Vitamin B 12; Vitamin B 12 Deficiency; Waldenstrom Macroglobulinemia

Topics: Absorption; Anemia; Anemia, Macrocytic; Biological Assay; Carbon Isotopes; Chromatography; Clinical Enzyme Tests; Clinical Laboratory Techniques; Coenzymes; Corrinoids; Deficiency Diseases; Electrophoresis; FIGLU Test; Folic Acid; Folic Acid Deficiency; Formates; Histidine; Humans; Male; Metabolism; Tritium; Urine; Vitamin B 12

For women of reproductive age, a population-level red blood cell (RBC) folate concentration below the threshold 906 nmol/L or 400 ng/mL indicates folate insufficiency and suboptimal neural tube defect (NTD) prevention. A corresponding population plasma/serum folate concentration threshold for optimal NTD prevention has not been established.. The aim of this study was to examine the association between plasma and RBC folate concentrations and estimated a population plasma folate insufficiency threshold (pf-IT) corresponding to the RBC folate insufficiency threshold (RBCf-IT) of 906 nmol/L.. We analyzed data on women of reproductive age (n = 1673) who participated in a population-based, randomized folic acid supplementation trial in northern China. Of these women, 565 women with anemia and/or vitamin B-12 deficiency were ineligible for folic acid intervention (nonintervention group); the other 1108 received folic acid supplementation for 6 mo (intervention group). We developed a Bayesian linear model to estimate the pf-IT corresponding to RBCf-IT by time from supplementation initiation, folic acid dosage, methyltetrahydrofolate reductase (MTHFR) genotype, body mass index (BMI), vitamin B-12 status, or anemia status.. Using plasma and RBC folate concentrations of the intervention group, the estimated median pf-IT was 25.5 nmol/L (95% credible interval: 24.6, 26.4). The median pf-ITs were similar between the baseline and postsupplementation samples (25.7 compared with 25.2 nmol/L) but differed moderately (±3-4 nmol/L) by MTHFR genotype and BMI. Using the full population-based baseline sample (intervention and nonintervention), the median pf-IT was higher for women with vitamin B-12 deficiency (34.6 nmol/L) and marginal deficiency (29.8 nmol/L) compared with the sufficient group (25.6 nmol/L).. The relation between RBC and plasma folate concentrations was modified by BMI and genotype and substantially by low plasma vitamin B-12. This suggests that the threshold of 25.5 nmol/L for optimal NTD prevention may be appropriate in populations with similar characteristics, but it should not be used in vitamin B-12 insufficient populations. This trial was registered at clinicaltrials.gov as NCT00207558.

Topics: Adult; Bayes Theorem; Body Mass Index; China; Dietary Supplements; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Genotype; Humans; Methylenetetrahydrofolate Reductase (NADPH2); Neural Tube Defects; Nutrition Therapy; Population Health; Preconception Care; Pregnancy; Reference Values; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Topics: Biomarkers; Breast Feeding; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Infant; Infant Nutritional Physiological Phenomena; Male; Methylmalonic Acid; Nepal; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency

We investigated whether daily supplementation with low-dose B vitamins in the healthy elderly population improves the Framingham risk score (FRS), a predictor of cardiovascular disease risk.. Between 2007 and 2012, a double-blind randomized controlled trial was conducted in a rural area of North China. In all, 390 healthy participants aged 60-74 were randomly allocated to receive daily vitamin C (50 mg; control group) or vitamin C plus B vitamins (400 µg folic acid, 2 mg B6, and 10 µg B12; treatment group) for 12 months. FRSs were calculated for all 390 subjects.. Folate and vitamin B12 plasma concentrations in the treatment group increased by 253 and 80%, respectively, after 6 months, stopped increasing with continued supplementation after 12 months and returned to baseline levels 6 months after supplementation cessation. Compared with the control group, there was no significant effect of B vitamin supplementation on FRSs after 6 months (mean difference -0.38; 95% CI -1.06, 0.31; p = 0.279), whereas a significant effect of supplementation was evident after 12 months (reduced magnitude 7.6%; -0.77; 95% CI -1.47, -0.06; p = 0.033). However, this reduction disappeared 6 months after supplementation stopped (-0.07; 95% CI -0.80, 0.66; p = 0.855). The reduction in FRS 12 months after supplementation was more pronounced in individuals with a folate deficiency (10.4%; -1.30; 95% CI -2.54, -0.07; p = 0.039) than in those without (4.1%; -0.38; 95% CI -1.12, 0.36; p = 0.313). B vitamins increased high-density lipoprotein cholesterol by 3.4% after 6 months (0.04; 95% CI -0.02, 0.10; p = 0.155) and by 9.2% after 12 months (0.11; 95 % CI 0.04, 0.18; p = 0.003). Compared with the control group, this change in magnitude decreased to 3.3% (0.04; 95 % CI -0.02, 0.10; p = 0.194) 6 months after supplementation cessation.. Daily supplementation with a low-dose of B vitamins for 12 months reduced FRS, particularly in healthy elderly subjects with a folate deficiency. These reduced effects declined after supplementation cessation, indicating a need for persistent supplementation to maintain the associated benefits.

Topics: Aged; Asian People; Blood Pressure; Body Mass Index; Cardiovascular Diseases; China; Cholesterol, HDL; Cholesterol, LDL; Dietary Supplements; Dose-Response Relationship, Drug; Double-Blind Method; Female; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Homocysteine; Humans; Male; Middle Aged; Risk Factors; Triglycerides; Vitamin B 12; Vitamin B 6; Vitamin B Complex

Deficiencies of vitamin B12 and folate are associated with delayed development and neurological manifestations. The objective of this study was to measure the effect of daily supplementation of vitamin B12 and/or folic acid on development in young North Indian children.. In a randomized, double blind trial, children aged six to 30 months, received supplement with placebo or vitamin B12 and/or folic acid for six months. Children were allocated in a 1:1:1:1 ratio in a factorial design and in blocks of 16. We measured development in 422 children by the Ages and Stages Questionnaire 3rd ed. at the end of the intervention.. Compared to placebo, children who received both vitamin B12 and folic acid had 0.45 (95% CI 0.19, 0.73) and 0.28 (95% CI 0.02, 0.54) higher SD-units in the domains of gross motor and problem solving functioning, respectively. The effect was highest in susceptible subgroups consisting of stunted children, those with high plasma homocysteine (> 10 μmol/L) or in those who were younger than 24 at end study. With the exception of a significant improvement on gross motor scores by vitamin B12 alone, supplementation of either vitamin alone had no effect on any of the outcomes.. Our findings suggest that supplementation of vitamin B12 and folic acid benefit development in North Indian Children.. ClinicalTrials.gov NCT00717730.

Topics: Child, Preschool; Developmental Disabilities; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Humans; India; Infant; Male; Motor Skills; Placebos; Problem Solving; Social Skills; Vitamin B 12; Vitamin B 12 Deficiency

Iron, vitamin B12, and folic acid deficiencies are among the most common deficiencies occurring after laparoscopic Roux-en-Y gastric bypass (LRYGB). The present study evaluates the effectiveness of a specially designed multivitamin supplement (WLS Forte, FitForMe, Rotterdam, the Netherlands) specifically developed for LRYGB patients.A triple-blind, randomized, 12-month study was conducted comparing WLS forte with a standard multivitamin supplement (sMVS) containing approximately 100% of the recommended daily allowance (RDA) for iron, vitamin B12, and folic acid. WLS Forte contains vitamin B12 14000% RDA, iron 500% RDA, and folic acid 300% RDA.In total, 148 patients (74 in each group) underwent a LRYGB procedure. Baseline characteristics were similar for both groups. Per protocol analysis demonstrated that sMVS treatment was associated with a decline in ferritin (-24.4 ± 70.1 μg/L) and vitamin B12 (-45.9 ± 150.3 pmol/L) over 12 months, whereas in WLS Forte patients, ferritin remained stable (+3.2 ± 93.2 μg/L) and vitamin B12 increased significantly (+55.1 ± 144.2 pmol/L). The number of patients developing ferritin or vitamin B12 deficiency was significantly lower with WLS Forte compared with sMVS (P < 0.05). Iron deficiency (ID) was reduced by 88% after WLS Forte compared with sMVS. Adverse events related to supplement use did not occur.An optimized multivitamin supplement is safe and reduces the development of iron and vitamin B12 deficiencies after LRYGB.

Topics: Avitaminosis; Dietary Supplements; Folic Acid; Folic Acid Deficiency; Gastric Bypass; Hematologic Tests; Humans; Iron; Netherlands; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin D Deficiency

Young children in low- and middle-income countries frequently have inadequate vitamin B-12 (cobalamin) status. Poor folate status is also common and is associated with increased diarrheal and respiratory morbidity.. The objective was to measure the effect of folic acid and/or vitamin B-12 administration on the incidence of diarrhea and acute lower respiratory tract infections.. One thousand North Indian children (6-30 mo of age) were enrolled in a randomized, double-blind, placebo-controlled trial to receive 2 times the Recommended Dietary Allowance of folic acid and/or vitamin B-12 or placebo daily for 6 mo. Children were individually randomly assigned in a 1:1:1:1 ratio in blocks of 16. Primary outcomes were the number of episodes of acute lower respiratory infections, diarrhea, and prolonged diarrhea.. Folic acid and vitamin B-12 supplementation significantly improved vitamin B-12 and folate status, respectively. Neither folic acid nor vitamin B-12 administration reduced the incidence of diarrhea or lower respiratory infections. In comparison with placebo, children treated with folic acid alone or in combination with vitamin B-12 had a significantly higher risk of persistent diarrhea (OR: 2.1; 95% CI: 1.1, 3.8).. Folic acid or vitamin B-12 supplementation did not reduce the burden of common childhood infections. In view of the increased risk of diarrhea, the safety of folic acid supplements in young children should be further assessed. This trial was registered at www.clinicaltrials.gov as NCT00717730 and at www.ctri.nic.in as CTRI/2010/091/001090.

Topics: Child, Preschool; Diarrhea; Dietary Supplements; Double-Blind Method; Female; Folic Acid; Folic Acid Deficiency; Humans; India; Infant; Male; Nutrition Policy; Odds Ratio; Respiratory Tract Infections; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Vitamin B Deficiency

Folic acid supplementation in those with a low vitamin B-12 intake or status may have adverse effects. These effects are unknown with regard to birth outcome in pregnant Indian women who are routinely supplemented with high doses of folic acid.. The objective was to examine the association of unbalanced vitamin B-12 and total folate (folic acid supplement + dietary folate) intakes during pregnancy with outcomes in small-for-gestational-age (SGA) infants.. This was a prospective observational cohort study of 1838 pregnant women in South India. Low intake of dietary vitamin B-12 in the presence of high total folate intake was examined as the ratio of vitamin B-12 intake to total folate intake.. The inadequacy of vitamin B-12 intake (<1.2 μg/d) assessed by a food-frequency questionnaire in the first, second, and third trimesters of pregnancy was 25%, 11%, and 10%, respectively. Multivariate log binomial regression showed that low vitamin B-12 and folate intakes in the first trimester were independently associated with a higher risk of SGA. In a subgroup of women with high supplemental folic acid intakes in the second trimester, those with the lowest tertile of vitamin B-12:folate ratio had a higher risk of SGA outcome than did those in the highest tertile (adjusted RR: 2.73; 95% CI: 1.17, 6.37). A similar trend was observed in the analysis of blood micronutrient status in a random subset (n = 316) of the sample.. These findings suggest that, in addition to vitamin B-12 and folate deficiencies alone, there may be adverse birth outcomes associated with unbalanced vitamin B-12 and folate intakes or status during pregnancy. These findings have important implications for the antenatal B vitamin supplementation policy in India. This trial was registered at the Clinical Trial Registry of India as 2013/07/005342.

Topics: Adult; Cohort Studies; Diet; Dietary Supplements; Female; Fetal Growth Retardation; Folic Acid; Folic Acid Deficiency; Humans; Incidence; India; Infant, Small for Gestational Age; Male; Maternal Nutritional Physiological Phenomena; Pregnancy; Pregnancy Complications; Premature Birth; Risk; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

To assess the prevalence and determinants of haematinic deficiency (lack of B12 folate or iron) and macrocytosis in blood from a national population-based study of middle-aged and older adults.. A cross-sectional study involving 1,207 adults aged ≥45 years, recruited from a sub-study of the Irish National Survey of Lifestyle Attitudes and Nutrition (SLÁN 2007). Participants completed a health and lifestyle questionnaire and a standard food frequency questionnaire. Non-fasting blood samples were obtained for measurement of full blood count and expert morphological assessment, serum ferritin, soluble transferrin receptor assay (sTfR), B12, folate and coeliac antibodies. Blood samples were also assayed for thyroid function (T4, TSH), liver function, aminotransferase (AST) and gamma-glutamyl transferase (GGT).. The overall prevalence (95% C.I.) of anaemia (Hb <13.5 g/dl men and 11.3 g/dl women) was 4.6% (2.9%-6.4%) in men and 1.0% (0.2%-1.9%) in women. Iron deficiency (ferritin <17 ng/ml men and <11 ng/ml in women) was detected in 6.3% of participants (3.7% in males and 8.7% in females, p<0.001). Based on both low ferritin and raised sTfR (>21 nmol/ml) only 2.3% were iron-deficient. 3.0% and 2.7% were found to have low levels of serum folate (<2.3 ng/ml) and serum B12 (<120 ng/l) respectively. Clinically significant macrocytosis (MCV>99fl) was detected in 8.4% of subjects. Strong, significant and independent associations with macrocytosis were observed for lower social status, current smoking status, moderate to heavy alcohol intake, elevated GGT levels, deficiency of folate and vitamin B12, hypothyroidism and coeliac disease. The population attributable fraction (PAF) for macrocytosis associated with elevated GGT (25.0%) and smoking (24.6%) was higher than for excess alcohol intake (6.3%), folate deficiency (10.5%) or vitamin B12 (3.4%).. Haematinic deficiency and macrocytosis are common in middle-aged/older adults in Ireland. Macrocytosis is more likely to be attributable to an elevated GGT and smoking than vitamin B12 or folate deficiency.

Topics: Adult; Aged; Celiac Disease; Female; Folic Acid; Folic Acid Deficiency; gamma-Glutamyltransferase; Hematologic Diseases; Humans; Hypothyroidism; Ireland; Iron; Iron Deficiencies; Male; Middle Aged; Receptors, Transferrin; Smoking; Thyrotropin; Transaminases; Vitamin B 12; Vitamin B 12 Deficiency

Micronutrient deficiencies can affect cognitive function. Many young children in low- and middle-income countries have inadequate cobalamin (vitamin B-12) status.. The objective was to measure the association of plasma concentrations of folate, cobalamin, total homocysteine, and methylmalonic acid with cognitive performance at 2 occasions, 4 mo apart, in North Indian children aged 12-18 mo.. Bayley Scales of Infant Development II were used to assess cognition. In multiple regression models adjusted for several potential confounders, we measured the association between biomarkers for folate and cobalamin status and psychomotor or mental development scores on the day of blood sampling and 4 mo thereafter.. Each 2-fold increment in plasma cobalamin concentration was associated with a significant increment in the mental development index score of 1.3 (95% CI: 0.2, 2.4; P = 0.021). Furthermore, each 2-fold increment in homocysteine or methylmalonic acid concentration was associated with a decrement in mental development index score of 2.0 (95% CI: 0.5, 3.4; P = 0.007) or 1.1 (95% CI: 0.3, 1.8; P = 0.004) points, respectively. Plasma folate concentration was significantly and independently associated with mental development index scores only when children with poor cobalamin status were excluded, ie, in those who had cobalamin concentrations below the 25th percentile. None of these markers was associated with psychomotor scores in the multiple regression models.. Cobalamin and folate status showed a statistically significant association with cognitive performance. Given the high prevalence of deficiencies in these nutrients, folate and cobalamin supplementation trials are required to measure any beneficial effect on cognition.

Topics: Biomarkers; Child Development; Cognition Disorders; Cohort Studies; Developmental Disabilities; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; India; Infant; Male; Methylmalonic Acid; Neurogenesis; Nutritional Status; Prevalence; Psychomotor Performance; Vitamin B 12; Vitamin B 12 Deficiency

Poor micronutrient status is associated with diarrheal illness, but it is not known whether low folate and/or cobalamin status are independent risk factors for diarrhea. We measured the association between plasma folate and cobalamin and subsequent diarrheal morbidity in a prospective cohort study of 2296 children aged 6-30 mo in New Delhi, India. Plasma concentrations of folate, cobalamin, total homocysteine (tHcy), and methylmalonic acid were determined at baseline. Whether a child had diarrhea was recorded during weekly visits in a 4-mo zinc supplementation trial. Diarrhea episodes lasting <7, ≥7, and ≥14 d were classified as acute, prolonged, and persistent, respectively. There was a total of 4596 child periods with acute, 633 with prolonged, and 117 with persistent diarrhea during follow-up. Children with plasma folate concentrations in the lowest quartile had higher odds of persistent diarrhea than children in the other quartiles [adjusted OR = 1.77 (95% CI = 1.14, 2.75); P = 0.01]. This effect differed between boys [adjusted OR = 2.51 (95% CI = 1.47, 4.28)] and girls [adjusted OR = 1.03 (95% CI = 0.53, 2.01); P-interaction = 0.030]. We found a small but significant association between high plasma tHcy concentration and acute diarrhea [adjusted OR = 1.14 (95% CI = 1.04, 1.24); P = 0.006]. Plasma cobalamin concentration was not a predictor of diarrheal morbidity. In conclusion, poor folate status was an independent predictor of persistent diarrhea in this population.

Topics: Biomarkers; Child, Preschool; Diarrhea; Female; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Homocysteine; Humans; India; Infant; Interviews as Topic; Male; Prospective Studies; Risk Factors; Treatment Outcome; Vitamin B 12

The objective of this study was to assess the prevalence of anemia and the therapeutic and prophylactic response to ferrous sulfate and folic acid. A double-blind, randomized, controlled clinical trial was conducted with 196 children 6 to 24 months of age enrolled in municipal daycare centers in Goiânia, Goiás State, Brazil. The children were assigned to two treatment groups that received a daily dose (5 times a week) of either 4.2mg/kg/day of ferrous sulfate + folic acid (50microg) or 4.2mg/kg/day of ferrous sulfate + folic acid placebo. One of the prevention groups received 1.4mg/kg/day of ferrous sulfate + folic acid (50microg/day) and the other 1.4mg/kg/day of ferrous sulfate + folic acid placebo. Supplementation lasted approximately three months. Baseline anemia prevalence was 56.1% (95%CI: 48.9-63.1). After treatment, anemia prevalence in the folic acid group (14%) was lower than in the placebo group (34.9%) (p = 0.02). After prophylaxis in the non-anemic children, the incidence of anemia did not differ between the groups, but there was an increase in hemoglobin level in the folic acid group (p = 0.003). Iron plus folic acid was effective for the treatment of anemia and improvement of hemoglobin level in non-anemic children.

Topics: Anemia, Iron-Deficiency; Brazil; Child Day Care Centers; Child, Preschool; Dietary Supplements; Drug Administration Schedule; Epidemiologic Methods; Female; Ferrous Compounds; Folic Acid; Folic Acid Deficiency; Hematinics; Hemoglobins; Humans; Infant; Male; Placebos; Treatment Outcome; Vitamin B 12

Population-based data on the prevalence of cobalamin and folate deficiency in India are lacking.. The objective was to measure the prevalence of cobalamin and folate deficiency among children aged 6-30 mo residing in a low-to-middle income community in North India.. Children aged 6-30 mo (n = 2482) were identified through a community survey in a low-to-middle socioeconomic area in New Delhi, India. Non-fasting venous blood samples were collected before enrollment in another trial.. The median (interquartile range; IQR) cobalamin concentration in 6-11-mo-old children was substantially lower in breastfed (183; 120-263 pmol/L) than in nonbreastfed (334; 235-463 pmol/L) children. Cobalamin concentrations decreased progressively with increasing age in the nonbreastfed children. Median (IQR) plasma folate concentrations in the 6-11-mo-old group were higher in breastfed (20.3; 11.7-34.4 nmol/L) than in nonbreastfed (5.3; 3.4-7.7 nmol/L) children (P < 0.001). Folate concentrations decreased with increasing age in the breastfed children. In the nonbreastfed children, folate concentrations increased with increasing age. Low concentrations of plasma cobalamin (<150 pmol/L) were detected in 36% of breastfed and 9% of nonbreastfed children (P < 0.001). The proportions of children with plasma folate concentrations <5 nmol/L in these 2 subgroups were 6% and 33%, respectively (P < 0.001).. In north Indian preschool children, cobalamin and folate concentrations were commonly low and were associated with elevated total homocysteine and methylmalonic acid concentrations. Because low cobalamin and folate concentrations have functional consequences, population-based measures for improving cobalamin and folate concentrations need to be seriously considered.

Topics: Child, Preschool; Double-Blind Method; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; India; Infant; Male; Methylmalonic Acid; Nutritional Status; Socioeconomic Factors; Vitamin B 12; Vitamin B 12 Deficiency

To assess the prevalence of hyperhomocysteinemia in pediatric patients treated with antiepileptic drugs (AEDs) and to evaluate the effect of folic acid supplementation on plasma total homocysteine (tHcy) concentrations in hyperhomocysteinemic patients.. 123 patients from three regional hospitals participated in the study. Patients with hyperhomocysteinemia were included in a 3-month double-blind randomized trial testing oral folic acid supplementation (1 mg/day) versus placebo.. Hyperhomocysteinemia (tHcy >10.4 micromol/L) was present in 19 of 123 patients. Patients with hyperhomocysteinemia were older (13.7 +/- 4 vs. 11.0 +/- 3.9 years) and had significantly lower folate and cobalamin concentrations. Multidrug (two or more) AED treatment and duration of therapy correlated significantly with elevated total homocysteine (tHcy) and low folate. In contrast, polymorphisms in the methylene tetrahydrofolate reductase gene (MTHFR 677 C-->T, 1298 A-->C, 1793 G-->A) had no significant impact on tHcy. Nine of 19 patients with hyperhomocysteinemia were randomized to placebo, whereas the remaining 10 patients received folic acid supplementation. Folic acid supplementation resulted in a significant increase of folate and decrease of tHcy, whereas both parameters remained unchanged in the placebo group.. Hyperhomocysteinemia is present in 15.5% of children receiving long-term AED treatment. Multidrug treatment and long duration of therapy enhance the risk for hyperhomocysteinemia. Folic acid supplementation significantly reduces tHcy. We recommend assessment of serum folate and plasma tHcy in children receiving AEDs.

Topics: Anticonvulsants; Child; Dietary Supplements; Double-Blind Method; Drug Therapy, Combination; Epilepsy; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Treatment Outcome; Vitamin B 12

To investigate, in an elderly population: (1) the effects of oral B-vitamin therapy on P-tHcys, S-MMA and Hb/MCV, (2) the appropriate decision limit for 'high' metabolite concentrations and (3) the estimated prevalence of vitamin B(12)/folate deficiency on the basis of different decision limits.. Double-blind placebo-controlled intervention study.. Outpatient clinic.. A total of 209 community-dwelling subjects, median age 76 y (range 70-93) y.. Four months of oral daily supplementation with 0.5 mg cyanocobalamin, 0.8 mg folic acid and 3 mg vitamin B(6).. High P- tHcys was found in 64% of men and 45% of women, high S-MMA in 11% of both. Vitamin B(12) deficiency was observed in 7.2% and folate deficiency in 11% of all subjects. Health-related upper reference limits for the metabolites at the start were higher than the laboratory's upper reference limits. The latter were, however, similar to those of the vitamin replete group. There was a significant decrease in P-tHcys (P<0.001) and S-MMA (P=0.009) after 4 months of vitamin treatment. In a multivariate analysis, the P-Hcys change correlated positively with baseline P-tHcys and inversely with baseline P-folate and transferrin saturation (Fe/TIBC ratio). The S-MMA change correlated with baseline S-MMA and inversely with baseline vitamin B(12) and age.. Suboptimal vitamin status is an important cause of elevated P-tHcys and S-MMA in apparently healthy elderly subjects. Oral B-vitamin therapy is an effective and convenient way to normalise P-tHcys and S-MMA.

Topics: Aged; Aged, 80 and over; Double-Blind Method; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Methylmalonic Acid; Reference Values; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6

Hyperhomocysteinemia, a risk factor for vascular disease, is commonly found in adult patients with end-stage renal disease. Major determinants of elevated plasma homocysteine levels in these patients include deficiencies in folate and vitamin B12, methylenetetrahydrofolate reductase (MTHFR) genotype and renal function. Little information is available for children with chronic renal failure (CRF). The prevalence and the factors that affect plasma homocysteine concentration were determined in children. Twenty-nine children with various degrees of CRF (15 were dialyzed, 14 were not dialyzed) were compared with 57 age- and sex-matched healthy children. Homocysteine concentrations were higher in patients than controls (17.3 micromol/l vs 6.8 micromol/l, P<0.0001) and hyperhomocysteinemia (>95th percentile for controls: 14.0 micromol/l) was seen in 62.0% of patients and 5.2% of controls. Folate concentrations were lower in patients (9.9 nmol/l) than controls (13.5 nmol/l), P<0.01. Vitamin B12 was similar in patients (322 pmol/l) and controls (284 pmol/l). Dialyzed patients have a higher prevalence of hyperhomocysteinemia than nondialyzed patients (87% vs 35%). Dialyzed patients with MTHFR mutation have higher plasma homocysteine (28.5 micromol/l) than nondialyzed patients with the mutation (10.7 micromol/l), P<0.002. In our study, differences between controls and patients in plasma homocysteine concentrations are observed when age is greater then 92 months, folate less than 21.6 nmol/l and vitamin B12 less than 522 pmol/l. Our study shows that hyperhomocysteinemia is common in children with CRF and is associated with low folate and normal vitamin B12 status, compared to normal children. Among the patients, the dialyzed patients with the MTHFR mutation are particularly at risk for hyperhomocysteinemia. Further studies are needed to investigate therapeutic interventions and the potential link with vascular complications in these patients.

Topics: Adolescent; Aging; Child; Child, Preschool; Diet; Female; Folic Acid Deficiency; Genotype; Homocysteine; Humans; Infant; Kidney Failure, Chronic; Kidney Function Tests; Male; Methylenetetrahydrofolate Reductase (NADPH2); Oxidoreductases Acting on CH-NH Group Donors; Reference Values; Renal Dialysis; Vitamin B 12

Cobalamin/folate deficiency in elderly subjects may lead to psychiatric symptoms, but more often it increases the severity of various organic and nonorganic mental diseases. A major clinical problem, however, is the uncertainty and controversy concerning biochemical markers of cobalamin/folate deficiency to be used in the diagnostic evaluation of suspected cobalamin/folate deficiency.. We measured plasma homocysteine (tHcy), blood folate, serum methylmalonic acid, and serum cobalamin in 80 psychogeriatric patients (age, 77.3 +/- 8.6 years) and 50 controls (age, 76.1 +/- 8. 0 years). We assessed associations of these tests with measures of cognitive and behavior performance by use of regression analyses.. Plasma tHcy was increased in 45% of the psychogeriatric population (mean, 20.5 +/- 9.2 micromol/L vs 15.3 +/- 4.7 micromol/L for controls; P <0.01). Plasma tHcy correlated with severity of dementia (r = 0.36; P <0.01), the Katz ADL index (r = 0.29; P <0.05), the Berger scale (r = 0.29; P <0.05), and the score of symptoms (r = 0.39; P <0.001) in the psychogeriatric population. Similarly, blood folate was significantly correlated with these measures, but the concentrations of serum cobalamin and methylmalonic acid were not. In a stepwise multiple regression analysis including the biochemical markers, tHcy was the only significant predictor of the severity of dementia (r(2) = 0.11; P <0.01) and the score of symptoms (r(2) = 0.16; P <0.001).. Plasma tHcy is the best marker of those measured to investigate suspected tissue deficiency of cobalamin/folate.

Topics: Aged; Aged, 80 and over; Dementia; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Methylmalonic Acid; Psychiatric Status Rating Scales; Regression Analysis; Vitamin B 12; Vitamin B 12 Deficiency

Previous studies suggest that folate deficiency may occur in up to one third of patients with severe depression, and that treatment with the vitamin may enhance recovery of the mental state. There are, however, difficulties in interpreting serum and red cell folate assays in some patients, and it has been suggested that total plasma homocysteine is a more sensitive measure of functional folate (and vitamin B12) deficiency. Other studies suggest a link between folate deficiency and impaired metabolism of serotonin, dopamine, and noradrenaline (norepinephrine), which have been implicated in mood disorders. A study of homocysteine, folate, and monoamine metabolism has, therefore, been undertaken in patients with severe depression.. In 46 inpatients with severe DSM III depression, blood counts, serum and red cell folate, serum vitamin B12, total plasma homocysteine, and, in 28 patients, CSF folate, S-adenosylmethionine, and the monoamine neurotransmitter metabolites 5HIAA, HVA, and MHPG were examined. Two control groups comprised 18 healthy volunteers and 20 patients with neurological disorders, the second group undergoing CSF examination for diagnostic purposes.. Twenty four depressed patients (52%) had raised total plasma homocysteine. Depressed patients with raised total plasma homocysteine had significant lowering of serum, red cell, and CSF folate, CSF S-adenosylmethionine and all three CSF monoamine metabolites. Total plasma homocysteine was significantly negatively correlated with red cell folate in depressed patients, but not controls.. Utilising total plasma homocysteine as a sensitive measure of functional folate deficiency, a biological subgroup of depression with folate deficiency, impaired methylation, and monoamine neurotransmitter metabolism has been identified. Detection of this subgroup, which will not be achieved by routine blood counts, is important in view of the potential benefit of vitamin replacement.

Topics: Adult; Biogenic Monoamines; Blood Cell Count; Body Weight; Depression; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Homovanillic Acid; Humans; Hydroxyindoleacetic Acid; Male; Methoxyhydroxyphenylglycol; Methylation; Middle Aged; S-Adenosylmethionine; Vitamin B 12

Hearing impairment is 1 of the 4 most prevalent chronic conditions in the elderly. However, the biological basis of age-related hearing loss is unknown.. The objective was to test the hypothesis that age-related hearing loss may be associated with poor vitamin B-12 and folate status.. A thorough audiometric assessment was conducted in 55 healthy women aged 60-71 y. Hearing function was determined by the average of pure-tone air conduction thresholds at 0.5, 1, 2, and 4 kHz and was categorized into 2 groups for logistic regression analyses: normal hearing (<20 dB hearing level; n = 44) and impaired hearing (> or = 20 dB hearing level; n = 11).. Mean age was the same (65 y) for the normal hearing and impaired hearing groups. Pure-tone averages were inversely correlated with serum vitamin B-12 (r = -0.58, P = 0.0001) and red cell folate (r = -0.37, P = 0.01). Women with impaired hearing had 38% lower serum vitamin B-12 (236 compared with 380 pmol/L, respectively, P = 0.008) and 31% lower red cell folate (425 compared with 619 nmol/L, respectively, P = 0.02) than women with normal hearing. Among participants who did not take supplements containing vitamin B-12 or folate, women with impaired hearing had 48% lower serum vitamin B-12 (156 compared with 302 pmol/L, respectively, P = 0.0007) and 43% lower red cell folate (288 compared with 502 nmol/L, respectively, P = 0.001) than women with normal hearing.. Poor vitamin B-12 and folate status may be associated with age-related auditory dysfunction.

Topics: Aged; Aging; Audiometry, Pure-Tone; Diet; Female; Folic Acid; Folic Acid Deficiency; Health Status; Hearing Loss, Functional; Humans; Logistic Models; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

In a series of studies, we have been able to confirm that the micronucleus index in cytokinesis-blocked lymphocytes is significantly negatively correlated with plasma vitamin B12 (B12) concentration and significantly positively correlated with plasma homocysteine (HC). Furthermore we have shown in a randomised double-blind placebo-controlled dietary intervention study that intake of 3.5 times the RDI of folic acid and B12 significantly reduces the micronucleus index only in those with above average levels of micronucleus frequency. Micronucleus frequency is minimised when plasma HC is below 7.5 micromol/l and plasma B12 is above 300 pmol/l. Therefore, it is important to take account of the effect of B12 and HC when using the micronucleus assay for human biomonitoring studies.

Topics: Adolescent; Adult; Aged; Cell Division; Cross-Sectional Studies; Double-Blind Method; Environmental Monitoring; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Lymphocytes; Male; Micronuclei, Chromosome-Defective; Micronucleus Tests; Vitamin B 12; Vitamin B 12 Deficiency

The authors examined the relationships between levels of three metabolites (folate, vitamin B12, and homocysteine) and both depressive subtype and response to fluoxetine treatment in depressed patients.. Fluoxetine, 20 mg/day for 8 weeks, was given to 213 outpatients with major depressive disorder. At baseline, depressive subtypes were assessed, and a blood sample was collected from each patient. Serum metabolite levels were assayed. Response to treatment was determined by percentage change in score on the 17-item Hamilton Depression Rating Scale.. Subjects with low folate levels were more likely to have melancholic depression and were significantly less likely to respond to fluoxetine. Homocysteine and B12 levels were not associated with depressive subtype or treatment response.. Overall, the results are consistent with findings linking low folate levels to poorer response to antidepressant treatment. Folate levels might be considered in the evaluation of depressed patients who do not respond to antidepressant treatment.

Topics: Adolescent; Adult; Ambulatory Care; Depressive Disorder; Female; Fluoxetine; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Middle Aged; Psychiatric Status Rating Scales; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

To determine if changes in serum homocysteine values during folic acid supplementation can identify objectively healthy subjects with subclinical folate deficiency.. Blood drawn and processed in a regimented fashion from fasting subjects. Serum homocysteine values determined by gas chromatography-mass spectrometry twice before and on days 5 and 8 of daily folic acid supplementation.. Outpatient University Hospital Clinical Research Center, Denver, Colorado.. Subjectively healthy adults with normal hematologic and biochemical screening tests.. Folic acid 1 mg daily for eight consecutive days.. Homocysteine values of the group fell significantly during folic acid supplementation. Values pre supplementation were 7.8 +/- 1.8 and 7.4 +/- 2.4 mumol/L while values on days 5 and 8 of supplementation were 6.5 +/- 2.2 and 6.3 +/- 2.2 mumol/L. However, the homocysteine values of any given individual varied up to 60% (rises up to 7 mumol/L and falls of 5 mumol/L) during folic acid supplementation despite the controlled circumstances of blood handling, and an assay coefficient of variation of 8%.. Although group values of serum homocysteine fall during folic acid supplementation, intraindividual variation is so great that subjects with subclinical folate deficiency can not be identified using this study design. Furthermore, these data suggest than an individuals homocysteine values vary enough that single values must be interpreted with caution.

Topics: Adolescent; Adult; Aged; Female; Folic Acid; Folic Acid Deficiency; Gas Chromatography-Mass Spectrometry; Homocysteine; Humans; Male; Middle Aged; Vitamin B 12

We measured the vitamin B-6, vitamin B-12, and folic acid nutritional status in a group of apparently healthy men (n = 44) with moderate hyperhomocysteinemia (plasma homocysteine concentration > 16.3 mumol/L). Compared with control subjects (n = 274) with normal plasma homocysteine (< or = 16.3 mumol/L) concentrations, significantly lower plasma concentrations of pyridoxal-5'-phosphate (P < 0.001), cobalamin (P < 0.001), and folic acid (P = 0.004) were demonstrated in hyperhomocysteinemic men. The prevalence of suboptimal vitamin B-6, B-12, and folate status in men with hyperhomocysteinemia was 25.0%, 56.8%, and 59.1%, respectively. In a placebo-controlled follow-up study, a daily vitamin supplement (10 mg pyridoxal, 1.0 mg folic acid, 0.4 mg cyanocobalamin) normalized elevated plasma homocysteine concentrations within 6 wk. Because hyperhomocysteinemia is implicated as a risk factor for premature occlusive vascular disease, appropriate vitamin therapy may be both efficient and cost-effective to control elevated plasma homocysteine concentrations.

Topics: Adult; Aged; Cardiovascular Diseases; Cystathionine beta-Synthase; Dose-Response Relationship, Drug; Double-Blind Method; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Homocysteine; Humans; Male; Middle Aged; Pyridoxine; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6 Deficiency

Folic acid (FA) and vitamin B12 have been measured prospectively in 110 children that were under treatment with anticonvulsants. The control group consisted of 59 healthy children. A statistically significant difference in levels of serum FA and mean corpuscular volume (MCV) was observed between groups. Children under anticonvulsant treatment had lower serum FA levels and higher MCV. No significant difference was observed between the two groups in levels of serum vitamin B12. All children with serum FA levels lower than 3 ng/ml were given folate and no adverse side effects were observed due to treatment. Anticonvulsant drugs decrease serum FA levels; therefore, FA should be determined periodically in children under long-term anticonvulsant treatment.

Topics: Adolescent; Anticonvulsants; Child; Child, Preschool; Dose-Response Relationship, Drug; Epilepsy; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Long-Term Care; Male; Vitamin B 12

41 (33%) of 123 patients with acute psychiatric disorders (DSM III diagnosis of major depression or schizophrenia) had borderline or definite folate deficiency (red-cell folate below 200 micrograms/l) and took part in a double-blind, placebo-controlled trial of methylfolate, 15 mg daily, for 6 months in addition to standard psychotropic treatment. Among both depressed and schizophrenic patients methylfolate significantly improved clinical and social recovery. The differences in outcome scores between methylfolate and placebo groups became greater with time. These findings add to the evidence implicating disturbances of methylation in the nervous system in the biology of some forms of mental illness.

Topics: Adult; Aged; Depressive Disorder; Double-Blind Method; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Methotrexate; Middle Aged; Randomized Controlled Trials as Topic; Schizophrenia; Vitamin B 12

To help understand the haematological significance of the low concentrations of serum vitamin B12 and erythrocyte folate occurring in elderly patients, 17 acute admissions to a geriatric unit with a low concentration of serum vitamin B12 or erythrocyte folate but a normal blood count were treated with vitamin B12 and folic acid for 3 months. Bone marrow deoxyuridine suppression was abnormal in 3 of these 17 patients, 2 of whom also had megaloblastic change in the marrow. With treatment, the MCV fell in 13 of the 17, and the average MCV fell from 90.5 to 87.9 fl (p = 0.007), but the mean Hb did not change. Ten untreated similar patients showed no change in their MCV over the same period, but the mean Hb fell from 14.0 to 13.1 g/dl (p = 0.04). Thus the low concentrations of serum vitamin B12 or erythrocyte folate found in approximately a quarter of acutely admitted elderly patients may indicate true tissue deficiency of these vitamins, even when the blood count is normal.

Topics: Blood Cell Count; Folic Acid; Folic Acid Deficiency; Humans; Reference Values; Vitamin B 12; Vitamin B 12 Deficiency

Fifty-three patients with megaloblastic anaemia treated with cyanocobalamin and folic acid have been studied. Repeat marrow examination was found to be of value in assessing response to treatment. The early improvement in marrow morphology in patients with pernicious anaemia was greater with 1000 mug than with 5 mug doses of cyanocobalamin. The effect of folate deficiency in delaying marrow response to cyanocobalamin in patients with pernicious anaemia is described and combined cyanocobalamin and folic acid treatment was found to be more effective than either alone. The response to large doses of cyanocobalamin in folate deficient patients was unrelated to the initial serum vitamin B12 level.

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow Examination; Clinical Trials as Topic; Erythroblasts; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Male; Middle Aged; Time Factors; Vitamin B 12

Topics: Anticonvulsants; Blood-Brain Barrier; Clinical Trials as Topic; Epilepsy; Folic Acid; Folic Acid Deficiency; Humans; Phenobarbital; Phenytoin; Primidone; Seizures; Tetrahydrofolates; Vitamin B 12

Topics: Administration, Oral; Adolescent; Adult; Aged; Anticonvulsants; Clinical Trials as Topic; Epilepsy; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Placebos; Vitamin B 12

Topics: Adolescent; Adult; Blood Cell Count; Blood Volume; Diet; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iodine Isotopes; Iron; Nutritional Requirements; Pregnancy; Pregnancy Complications, Hematologic; Socioeconomic Factors; Vitamin B 12

Folic acid administered to pregnant Bantu, whose diet is low in folate, was associated with a significant reduction in the incidence of prematurity. No such effect could be demonstrated in White patients subsisting on an average Western diet. This suggests that folate deficiency may contribute to the "pregnancy wastage" in populations whose dietary folate intake is low, and is a further indication for folic acid supplementation during pregnancy in these groups.

Topics: Anemia, Macrocytic; Birth Weight; Black People; Diet; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant, Newborn; Infant, Premature; Iron; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12; White People

Topics: Anemia, Macrocytic; Anemia, Pernicious; Clinical Trials as Topic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Pernicious; Clinical Trials as Topic; Diet, Vegetarian; Electroencephalography; England; Female; Folic Acid Deficiency; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Premature atherosclerosis and ischemic heart disease represent a major cause of comorbidities among children with Turner syndrome. The identification of non-traditional risk aspects is crucial for the early identification and management of such comorbidities through establishing effective preventive measures. The aim of the study is to explore the role of the deficiency of vitamin B12, folic acid and homocysteine in children with Turner syndrome.. The study included 78 children with Turner syndrome and 67 healthy age and sex matched children. Karyotype was implemented for all patients. The serum levels of vitamin B12, folic acid and serum homocysteine were assessed. The prevalence of the deficiency of vitamin B12 and folic acid was estimated to study its correlation to hyperhomocysteinemia in Turner syndrome children.. The karyotype analysis showed 45,X (monosomy X) in the 78 patients. Vitamin B12 and folic acid were significantly decreased in children with Turner syndrome in 65-73% of the patients, respectively, while the serum level of homocysteine significantly increased to 48.7% compared to healthy controls. Homocysteine level negatively correlated with vitamin B12 and folic acid. The deficiency of vitamin B12 and folic acid increased the risk of hyperhomocysteinemia in children with Turner syndrome (OR 2.49 and 2.36, respectively).. This report highlights that hyperhomocyste-inemia in children with Turner syndrome may be related to the deficiency vitamin B12 and folic acid.

Topics: Child; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Turner Syndrome; Vitamin B 12; Vitamin B 12 Deficiency

Classically, deficiencies of vitamin B

Topics: Anemia, Hemolytic; Female; Folic Acid; Folic Acid Deficiency; Humans; Middle Aged; Purpura, Thrombotic Thrombocytopenic; Thrombotic Microangiopathies; Vitamin B 12; Vitamins

Vitamin B12 and folate are key nutrients that help children reach their full potential in growth and development; however, little is known about the status of these vitamins in Brazilian children.. To describe the serum concentrations of vitamin B12 and folate, to investigate the association between high folate concentration (HFC) and vitamin B12 deficiency, and to evaluate the association between vitamin B12 and stunting/underweight in Brazilian children aged 6-59 mo.. Data from 7417 children aged 6-59 mo collected during the Brazilian National Survey on Child Nutrition were used. Serum concentrations of vitamin B12 of <150 pmol/L and folate of <10 nmol/L were classified as deficient, and folate concentrations of >45.3 nmol/L were classified as HFC. Children with length/height-for-age z-score of less than -2 were considered stunted, and those with weight-for-age z-score of less than -2 were underweight. Logistic regression models were performed.. In Brazil, 14.2% (95% CI: 12.2, 16.1) of children aged 6-59 mo had vitamin B12 deficiency, 1.1% (95% CI: 0.5, 1.6) had folate deficiency, and 36.9% (95% CI: 33.4, 40.3) had HFC. Vitamin B12 deficiency was higher in children from the northern region of Brazil (28.5%), between 6 and 24 mo (25.3%), whose mothers had lower formal education (0-7 y; 18.7%). Children with HFC had 62% lower odds (OR: 0.38; 95% CI: 0.27, 0.54) of vitamin B12 deficiency than those with normal/deficient folate. Children with vitamin B12 deficiency and normal/deficient folate had higher odds of stunting (OR: 1.58; 95% CI: 1.02, 2.43) than children without vitamin B12 deficiency and normal/deficient folate.. Vitamin B12 deficiency is a public health problem among Brazilian children aged <2 y with vulnerable socioeconomic status. HFC was inversely associated with vitamin B12 deficiency, and lower odds of stunting were observed in children with HFC and vitamin B12 deficiency than in those with vitamin B12 deficiency and normal/deficient folate.

Topics: Brazil; Child; Female; Folic Acid; Folic Acid Deficiency; Growth Disorders; Humans; Nutritional Status; Thinness; Vitamin B 12; Vitamin B 12 Deficiency

Anemia-causing fever has been described in patients with megaloblastic anemia. Although the exact mechanism of this is unknown, high-grade fever is relatively less reported.. This prospective observational study included all new cases of megaloblastic anemia presenting with febrile illness (>101°F) during a 3-year period. Patients with existing anemia, comorbidities, and other causes of macrocytosis were excluded. A detailed evaluation for megaloblastic anemia and workup for excluding tropical infections was done. The patients were treated with parenteral vitamin B12, folic acid, and other hematinics.. Around 24 cases of megaloblastic anemia presenting with high-grade fever were included, with 14 (58.3%) males, mean duration of fever 7.7 days (4-18 days), and 09 (37.5%) having temperature >103°F. The mean hemoglobin (Hb) was 8.15 g/dL (3.7-11.1 g/dL), the mean corpuscular volume (MCV) was 111 ± 7.8 fL, 18 (75%) had unconjugated hyperbilirubinemia, the mean lactate dehydrogenase (LDH) was 814 ± 24 IU/L, and 21 (87.5%) had low B12 or folate levels. Most showed good therapeutic response to B12 or folic acid with defervescence in 1-5 days (mean 2.6 days) and improvement in lab parameters in 1 week. The study population was divided into those with temperature ≥103°F, and temperature <103°F it was seen that there was a significant association (p < 0.05) with leucocyte count of ≤3000/cumm, and MCV ≥110 fL, in patients with temperature ≥103°F Conclusion: Megaloblastic anemia should be considered in the differentials of a patient presenting with a febrile illness with no clinical localization and a negative initial fever workup. Early identification and prompt therapy of this easily treatable disorder are very essential.

Topics: Anemia; Anemia, Megaloblastic; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

Dietary intake and biomarkers of micronutrient status of 100 non-pregnant women of reproductive age (NPWRA) were assessed to determine optimal levels of iron, zinc, vitamin B12, and folic acid to include in multiply-fortified salt (MFS) that will be evaluated in an upcoming trial. Weighed food records were obtained from participants to measure intake of micronutrients and discretionary salt, and to assess adequacy using Indian Nutrient Reference Values (NRVs). Statistical modeling was used to determine optimal fortification levels to reduce inadequate micronutrient intake while limiting intake above the upper limit. Fasting blood samples were obtained to assess iron, zinc, vitamin B12, and folate status. In usual diets, inadequate intake of iron (46%), zinc (95%), vitamin B12 (83%), and folate (36%) was high. Mean intake of discretionary salt was 4.7 g/day. Prevalence estimates of anemia (37%), iron deficiency (67%), zinc deficiency (34%), vitamin B12 insufficiency (37%), and folate insufficiency (70%) were also high. Simulating the addition of optimized MFS to usual diets resulted in percentage point (pp) reductions in inadequate intake by 29 pp for iron, 76 pp for zinc, 81 pp for vitamin B12, and 36 pp for folate. MFS holds potential to reduce the burden of micronutrient deficiencies in this setting.

Topics: Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Iron; Malnutrition; Micronutrients; Prevalence; Sodium Chloride; Sodium Chloride, Dietary; Vitamin B 12; Zinc

Hyperhomocysteinemia─a condition characterized by elevated levels of homocysteine in the blood─is associated with multiple health conditions including folate deficiency and birth defects, but there are no convenient, low-cost methods to measure homocysteine in plasma. A cell-free biosensor that harnesses the native homocysteine sensing machinery of

Topics: Cross-Sectional Studies; Folic Acid; Folic Acid Deficiency; Humans; Hyperhomocysteinemia; Multimorbidity; Vitamin B 12

Anemia is the most common dose-limiting toxicity of olaparib. However, few studies have analyzed the clinical features of olaparib-induced anemia. This study investigated the clinical features of olaparib-induced anemia. Additionally, the role of folate or vitamin B12 in olaparib-induced anemia was examined. This retrospective case-control study included patients who received olaparib at Mie University Hospital between January 2018 and December 2020. Data were collected between initiation of olaparib and discontinuation of olaparib or till December 2021. We investigated the development of grade ≥ 3 anemia during olaparib administration for at least 1 year. We examined patients with grade ≥ 3 anemia considering the mean corpuscular volume (MCV), its association with gastrointestinal events and cumulative dose of carboplatin. For the sub-study analysis, data on patients treated with olaparib for ovarian or endometrial cancer were collected to evaluate the Common Terminology Criteria for Adverse Events (CTCAE) or monthly changes in folate or vitamin B12 levels from baseline to 3 months after olaparib initiation. These data were collected between initiation of olaparib and discontinuation of olaparib or till November 2022. Patients with no data on folic acid or vitamin B12 levels were excluded from the sub-study. In the main study, 40 patients were included. Eighteen patients (45%) developed grade ≥ 3 anemia, and all patients discontinued treatment (94%) or reduced olaparib dose (67%) after developing anemia. Among the patients with grade ≥ 3 anemia, 9 (50%) exhibited macrocytic anemia and 15 (83%) had previously received carboplatin. The incidence of grade ≥ 2 dysgeusia was significantly higher in patients with grade ≥ 3 anemia (P = .034). Moreover, the cumulative dose of previously administered carboplatin was higher in patients who had 3 episodes of anemia (P = .102). In sub-study, 12 had data on folic acid and vitamin B12 levels. Sub-study analysis showed that none fulfilled the criteria for deficiency of folate or vitamin B12, while 3 developed grade 3 anemia. This study revealed that olaparib-induced anemia frequently occurs as macrocytic and normocytic erythroblastic anemia without folate or vitamin B12 deficiencies. A high cumulative dose of previously administered carboplatin and dysgeusia may be associated with olaparib-induced anemia.

Topics: Anemia; Carboplatin; Case-Control Studies; Dysgeusia; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

We investigated the prevalence of folate deficiency and associated factors in a large population of Korean women of reproductive age during the COVID-19 pandemic. We utilized different cut-offs and evaluated age, year of testing, geographical region, and the utilization of serum homocysteine levels. Out of the 27,758 women evaluated, the overall prevalence of folate deficiency was 12.5% (<4 ng/mL, metabolic indicator) and 5.4% (<3 ng/mL, hematologic indicator). Homocysteine testing was observed in 8.4% of women, with 2.7% having elevated homocysteine levels (>15.4 µmol/L). According to our multiple logistic regression analysis, younger women, particularly those aged 20 to 24 years, tested in 2020, and from Jeolla province, Gyeongsang province, and Jeju Island, were identified as being more prone to folate deficiency. Receiver operating characteristic curve analysis demonstrated that a cut-off of >8.4 µmol/L provided the most accurate definition of folate deficiency with serum folate levels <4 ng/mL, while a cut-off of >8.8 µmol/L best defined folate deficiency with serum folate levels <3 ng/mL, with both cut-offs being lower than 15.4 µmol/L. Our study emphasizes the prevalence of folate deficiency, associated factors, and the role of homocysteine in planning nutritional support programs in Korea.

Topics: COVID-19; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Pandemics; Prevalence; Republic of Korea; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Diagnosis, Differential; Folic Acid Deficiency; Humans; Thrombotic Microangiopathies; Vitamin B 12; Vitamin B 12 Deficiency

Folate and vitamin B12 deficiencies can impair proper growth and brain development in children. Data on the folate and vitamin B12 status of children aged 6-59 months in Guatemala are scarce. Identification of factors associated with higher prevalence of these micronutrient deficiencies within the population is needed for national and regional policymakers.. To describe national and regional post-fortification folate and vitamin B12 status of children aged 6-59 months in Guatemala.. A multistage, cluster probability study was carried out with national and regional representation of children aged 6-59 months. Demographic and health information was collected for 1246 preschool children, but blood samples for red blood cell (RBC) folate and vitamin B12 were collected and analyzed for 1,245 and 1143 preschool children, respectively. We used the following deficiency criteria as cutoff points for the analyses: < 305 nmol/L for RBC folate, < 148 pmol/L for vitamin B12 deficiency, and 148-221 pmol/L for marginal vitamin B12 deficiency. Prevalence of RBC folate deficiency and vitamin B12 deficiency and marginal deficiency were estimated. Prevalence risk ratios of RBC folate and vitamin B12 deficiency were estimated comparing subpopulations of interest.. The national prevalence estimates of RBC folate deficiency among children was 33.5% [95% CI 29.1, 38.3]. The prevalence of RBC folate deficiency showed wide variation by age (20.3-46.6%) and was significantly higher among children 6-11 months and 12-23 months (46.6 and 37.0%, respectively), compared to older children aged 48-59 months (20.3%). RBC folate deficiency also varied widely by household wealth index (22.6-42.0%) and geographic region (27.2-46.7%) though the differences were not statistically significant. The national geometric mean for RBC folate concentrations was 354.2 nmol/L. The national prevalences of vitamin B12 deficiency and marginal deficiency among children were 22.5% [95% CI 18.2, 27.5] and 27.5% [95% CI 23.7, 31.7], respectively. The prevalence of vitamin B12 deficiency was significantly higher among indigenous children than among non-indigenous children (34.5% vs. 13.1%, aPRR 2.1 95% CI 1.4, 3.0). The prevalence of vitamin B12 deficiency also significantly varied between the highest and lowest household wealth index (34.3 and 6.0%, respectively). The national geometric mean for vitamin B12 concentrations was 235.1 pmol/L. The geometric means of folate and B12 concentrations were significantly lower among children who were younger, had a lower household wealth index, and were indigenous (for vitamin B12 only). Folate and vitamin B12 concentrations showed wide variation by region (not statistically significant), and the Petén and Norte regions showed the lowest RBC folate and vitamin B12 concentrations, respectively.. In this study, a third of all children had RBC folate deficiency and half were vitamin B12 deficient. Folate deficiency was more common in younger children and vitamin B12 deficiency was more common in indigenous children and those from the poorest families. These findings suggest gaps in the coverage of fortification and the need for additional implementation strategies to address these gaps in coverage to help safeguard the health of Guatemalan children.

Topics: Adolescent; Child; Child, Preschool; Folic Acid; Folic Acid Deficiency; Guatemala; Humans; Infant; Prevalence; Vitamin B 12; Vitamin B 12 Deficiency

Congenital heart defects continue to remain a major cause of serious morbidity and mortality, especially in the developing world. This study was planned to get some insight into the role of modifiable nutritional elements in structural CHD etiology. This cross-sectional, observational study was conducted at a hospital in Northern India from January 2017 to December 2017. Infants < 6 mo with structural CHD as cases and those without structural heart disease were enrolled as controls. Blood samples were collected from mother-child pairs and tested for serum folate, vitamin B12, and homocysteine. It was found that 46.7% infant-mother pairs, out of 45 in the cases group had folate deficiency, whereas in the control group, only 20% had folate deficiency, which was statistically significant (p = 0.013). Baby (0-6 mo) with congenital heart defects (CHD) and their mothers are more likely to have low folate levels compared to those not having CHD.

Topics: Cross-Sectional Studies; Folic Acid; Folic Acid Deficiency; Heart Defects, Congenital; Homocysteine; Humans; Infant; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

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.. 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.. 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.. 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.

Topics: Aged; China; Cognitive Dysfunction; Cohort Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Vitamin B 12

Anemia in children is a significant public health problem in our country. Comprehensive National Nutrition Survey 2016-18 provides evidence that more than 50% of childhood anemia is due to an underlying nutritional deficiency. The National Family Health Survey-5 has reported an increase in the prevalence of anemia in the under-five age group from 59% to 67.1% over the last 5 years. Clearly, the existing public health programs to decrease the prevalence of anemia have not shown the desired results. Hence, there is a need to develop nationally acceptable guidelines for the diagnosis, treatment and prevention of nutritional anemia.. To review the available literature and collate evidence-based observations to formulate guidelines for diagnosis, treatment and prevention of nutritional anemia in children.. These guidelines have been developed by the experts from the Pediatric Hematology-Oncology Chapter and the Pediatric and Adolescent Nutrition (PAN) Society of the Indian Academy of Pediatrics (IAP). Key areas were identified as: epidemiology, nomenclature and definitions, etiology and diagnosis of iron deficiency anemia (IDA), treatment of IDA, etiology and diagnosis of vitamin B12 and/or folic acid deficiency, treatment of vitamin B12 and/or folic acid deficiency anemia and prevention of nutritional anemia. Each of these key areas were reviewed by at least 2 to 3 experts. Four virtual meetings were held in November, 2021 and all the key issues were deliberated upon. Based on review and inputs received during meetings, draft recommendations were prepared. After this, a writing group was constituted which prepared the draft guidelines. The draft was circulated and approved by all the expert group members.. We recommend use of World Health Organization (WHO) cut-off hemoglobin levels to define anemia in children and adolescents. Most cases suspected to have IDA can be started on treatment based on a compatible history, physical examination and hemogram report. Serum ferritin assay is recommended for the confirmation of the diagnosis of IDA. Most cases of IDA can be managed with oral iron therapy using 2-3 mg/kg elemental iron daily. The presence of macro-ovalocytes and hypersegmented neutrophils, along with an elevated mean corpuscular volume (MCV), should raise the suspicion of underlying vitamin B12 (cobalamin) or folic acid deficiency. Estimation of serum vitamin B12 and folate level are advisable in children with macrocytic anemia prior to starting treatment. When serum vitamin B12 and folate levels are unavailable, patients should be treated using both drugs. Vitamin B12 should preferably be started 10-14 days ahead of oral folic acid to avoid precipitating neurological symptoms. Children with macrocytic anemia in whom a quick response to treatment is required, such as those with pancytopenia, severe anemia, developmental delay and infantile tremor syndrome, should be managed using parenteral vitamin B12. Children with vitamin B12 deficiency having mild or moderate anemia may be managed using oral vitamin B12 preparations. After completing therapy for nutritional anemia, all infants and children should be advised to continue prophylactic iron-folic acid (IFA) supplementation as prescribed under Anemia Mukt Bharat guidelines. For prevention of anemia, in addition to age-appropriate IFA prophylaxis, routine screening of infants for anemia at 9 months during immunization visit is recommended.

Topics: Adolescent; Anemia; Anemia, Iron-Deficiency; Anemia, Macrocytic; Child; Child, Preschool; Ferritins; Folic Acid; Folic Acid Deficiency; Hematology; Hemoglobins; Humans; Infant; Iron; Vitamin B 12; Vitamin B 12 Deficiency

Crohn's disease is a chronic inflammatory condition that can involve any area in the gastrointestinal tract often involving the distal ileum where vitamin B12 is specifically absorbed. The aim of this study was to ascertain serum vitamin B12 and folate levels in order to investigate the correlation among these vitamin levels and disease activation, localization, duration and age at the onset of the disease. Study population included 103 patients with Crohn's disease and a healthy control group of 114 individuals. C-reactive protein, vitamin B12, folate levels were studied along with hemogram analyses. The results were evaluated in statistical comparisons. While serum vitamin B12 levels and serum folate levels were 161.9 ± 63.2(73-496) pg/mL and 4.9 ± 1.4(1.2-9.4) ng/mL in the Crohn's patient group respectively, they were 321.7 ± 126.3(85-680) pg/mL and 7.6 ± 3.8(3-25.1) ng/mL in the control group respectively. Vitamin B12 and folate levels were distinctly lower in patients with Chron's disease than those of the control group (P < .001). The intragroup analysis of the patient group revealed that low vitamin B12 levels were significantly lower in the moderate group classified according to the Crohn's Disease Activity Index (P < .001), along with those in the L1 group with terminal/distal ileal involvement (P < .001). Vitamin B12 and folate deficiencies are quite prevalent in patients with Crohn's disease while this condition can lead to various complications and they prove to be important risk factors associated especially with thrombosis and its complications. Patients must be regularly followed-up for vitamin B12 and folate levels to supplement them where needed.

Topics: Crohn Disease; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Cognitive Dysfunction; Folic Acid Deficiency; Humans; Peru; Retrospective Studies; Thyroid Gland; Vitamin B 12

'Locked-in syndrome (LIS)' is a neurological disorder, often missed initially and can have grave consequences. A rare case of LIS caused due to folic acid deficiency-induced hyperhomocysteinemia is being described here. A 16-year-old boy presented with complaints of sudden onset weakness of all the four limbs with loss of voice for one day. All the tendon reflexes were increased, bilateral planters were extensor and sensory system was intact. Patient was conscious and responded to verbal commands by ocular movements in vertical direction. Hence, a diagnosis of LIS was made. Magnetic resonance imaging of the head revealed an acute infarct in ventral pons. Serum homocysteine level was elevated (20.65 μmol/l) and folic acid level was severely low (1.7 nmol/ml). Cause of LIS was found to be hyperhomocysteinemia induced stroke in the pons, related to folic acid deficiency. The patient was managed with antiplatelet agents and folic acid supplementation and was discharged subsequently. Recognition of LIS is important as casual remarks at bedside can severely traumatize an already paralyzed but conscious and awake patient. Folic acid deficiency can lead to hyperhomocysteinemia, which can cause strokes and even LIS. Prevention of hyperhomocysteinemia may possibly prevent such neurological disasters.

Topics: Adolescent; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Locked-In Syndrome; Male; Vitamin B 12; Young Adult

Topics: Biomarkers; Case-Control Studies; Folic Acid; Folic Acid Deficiency; Glossitis; Hemoglobins; Homocysteine; Humans; Hyperhomocysteinemia; Parietal Cells, Gastric; Vitamin B 12; Vitamin B 12 Deficiency

Our previous study found the serum gastric parietal cell antibody (GPCA) positivity in 12.3% of burning mouth syndrome (BMS) patients. This study assessed whether GPCA-positive BMS (GPCA. The mean corpuscular volume, blood hemoglobin (Hb), and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels were measured and compared between any two of three groups of 109 GPCA. We found that 109 GPCA. GPCA

Topics: Anemia; Burning Mouth Syndrome; Folic Acid; Folic Acid Deficiency; Glossitis; Hematinics; Hemoglobins; Humans; Hyperhomocysteinemia; Iron; Parietal Cells, Gastric; Vitamin B 12; Vitamin B 12 Deficiency

The association of moderate hyperhomocysteinemia (HHcy) (15-30 μmol/L) with cardiovascular diseases (CVD) has been challenged by the lack of benefit of vitamin supplementation to lowering homocysteine. Consequently, the results of interventional studies have confused the debate regarding the management of patients with intermediate/severe HHcy.. We sought to evaluate the association of intermediate (30-100 μmol/L) and severe (>100 μmol/L) HHcy related to vitamin deficiencies and/or inherited disorders with CVD outcomes.. We performed a retrospective cross-sectional study on consecutive patients who underwent a homocysteine assay in a French University Regional Hospital Center. Patients with CVD outcomes were assessed for vitamin B12, folate, Hcy, methylmalonic acid, and next-generation clinical exome sequencing.. We evaluated 165 patients hospitalized for thromboembolic and other cardiovascular (CV) manifestations among 1006 patients consecutively recruited. Among them, 84% (138/165) had Hcy >30 μmol/L, 27% Hcy >50 μmol/L (44/165) and 3% Hcy >100 μmol/L (5/165). HHcy was related to vitamin B12 and/or folate deficiency in 55% (87/165), mutations in one or more genes of one-carbon and/or vitamin B12 metabolisms in 11% (19/165), and severe renal failure in 15% (21/141) of the studied patients. HHcy was the single vascular risk retrieved in almost 9% (15/165) of patients. Sixty % (101/165) of patients received a supplementation to treat HHcy, with a significant decrease in median Hcy from 41 to 17 µmol/L (IQR: 33.6-60.4 compared with 12.1-28). No recurrence of thromboembolic manifestations was observed after supplementation and antithrombotic treatment of patients who had HHcy as a single risk, after ∼4 y of follow-up.. The high frequency of intermediate/severe HHcy differs from the frequent moderate HHcy reported in previous observational studies of patients with pre-existing CVD. Our study points out the importance of diagnosing and treating nutritional deficiencies and inherited disorders to reverse intermediate/severe HHcy associated with CVD outcomes.

Topics: Adult; Cardiovascular Diseases; Child, Preschool; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Male; Metabolism, Inborn Errors; Methylmalonic Acid; Middle Aged; Retrospective Studies; Vitamin B 12

Topics: Adolescent; Aged; Cognition; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; Nutrition Surveys; Pregnancy; Pregnant Women; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

Little is known about the reference interval of serum folate concentration if using recently re-standardized assays traceable to the World Health Organization (WHO) international standard reference 03/178 in a Korean population. This study aimed to investigate serum folate levels in Korean subjects without macrocytic anemia or increased homocysteine, for the assessment of folate deficiency.. We retrospectively reviewed data from Korean adults whose hemoglobin, mean corpuscular volume, and serum total homocysteine values were within reference limits.. The median (interquartile range) serum folate level was 7.8 (5.4 - 12.6) ng/mL in men and 10.2 (6.9 - 15.6) ng/mL in women. The reference interval for serum folate (2.5th and 97.5th percentiles) ranged from 2.9 to 38.0 ng/ mL. From among 723 Korean adults, the lower limit of reference intervals of serum folate for folate deficiency, defined as the 2.5th percentile, was 2.9 ng/mL. The prevalence of folate deficiency was higher in men (6.5%) than in women (1.2%, p < 0.05) when a cutoff value of 3.0 ng/mL was applied. Using the cutoff value of 4 ng/mL for folate deficiency, which is in accordance with the instructions from the manufacturer of the new assay and the WHO 2012 guideline for homocysteine as a metabolic indicator before assay standardization, about 5% of subjects were reclassified as folate deficient.. Our study suggests that any change of reference limits using a re-standardized assay needs to be verified in clinical laboratories.

Topics: Adult; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Reference Values; Republic of Korea; Retrospective Studies; Vitamin B 12; World Health Organization

Hyperhomocysteinemia (HHCys) is an independent risk factor for various diseases such as cardiovascular diseases, Alzheimer's, and cancers. Folate deficiency is one of the significant reasons for HHCys. However, it is not known whether folate deficiency with HHCys is associated with any serum metabolites.. Our objective was to identify the metabolic alterations in people having folate deficiency with HHCys and check whether a short-term folic acid therapy could reverse those metabolic changes.. The study enrolled 34 participants aged between 18 and 40 years having folate deficiency (< 4.6 ng/mL) with HHCys (> 15 μmol/L) and 21 normal healthy individuals. A short-term intervention of oral folic acid (5 mg/day) was done in the HHCys group for 30 days. Untargeted metabolomics analysis of serum was performed in all study subjects before and after the folic acid treatment. Different univariate methods and the multivariable-adjusted linear regression models were employed to determine an association between homocysteine level and metabolite profile.. Metabolomics analysis data showed that many metabolites involved in the biochemical pathways of lipid metabolisms such as polyunsaturated fatty acids, glycerolipids, and phospholipids were downregulated in the HHCys group. Short-term oral folic acid therapy significantly reduced their serum homocysteine level. However, the metabolic pathway alterations observed in folate-deficient HHCys-condition were unaltered even after the folic acid treatment.. Our study revealed that people who have a folic acid deficiency with HHCys have an altered metabolite profile related to lipid metabolism, which cannot be reversed by short-term folic acid therapy.

Topics: Adolescent; Adult; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Metabolome; Vitamin B 12; Young Adult

Vitamin B12 and folate (methyl donors) deficiency is frequent during pregnancy. Experimental rat models with methyl donor deficit during pregnancy and lactation (Initial methyl donor deficit (iMDD)) produce impaired myocardium fatty acid oxidation and mitochondrial energy metabolism at weaning.. The consequences of iMDD on heart of rat pups under normal diet after weaning and high fat diet (HF) between day (D) 50 and D185 are investigated. iMDD/HF induces increased histological fibrosis and increased B-type natriuretic peptide blood level. Inflammation is evidenced by increased protein expression of NFkB, Caspase1, and IL1β and fibrosis by increased expression of αSMA, col1a1, and col1a2 in females, but not in males. Fibrosis is related to increased angiotensin at D50 and D185 and increased protein expression of TGFB1 and AT1 angiotensin receptors at D185. The limited fibrosis in males is consistent with increased expression of AT2, the antagonist receptor of AT1. The increased expression of GLUT4 and decreased expression of PGC1α and PPARα reflect a shift from fatty acid oxidation to glycolysis.. Developmental programming by iMDD produces cardiomyopathy in female offspring exposed to HF. The cardiomyopathy is linked to inflammation and fibrosis through angiotensin-AT2 and TGFB1 pathways and alteration of energy metabolism.

Topics: Animals; Cardiomyopathies; Diet, High-Fat; Energy Metabolism; Female; Fetal Development; Folic Acid; Folic Acid Deficiency; Lactation; Lipid Metabolism; Male; Maternal Nutritional Physiological Phenomena; Myocardium; Pregnancy; Rats; Rats, Wistar; Receptor, Angiotensin, Type 2; Transforming Growth Factor beta1; Ventricular Function, Left; Vitamin B 12; Vitamin B 12 Deficiency

Genomic imprinting is important for mammalian development and its dysregulation can cause various developmental defects and diseases. The study evaluated the effects of different dietary combinations of folic acid and B12 on epigenetic regulation of IGF2R and KCNQ1OT1 ncRNA in C57BL/6 mice model. Female mice were fed diets with nine combinations of folic acid and B12 for 4 weeks. They were mated and off-springs born (F1) were continued on the same diet for 6 weeks postweaning and were allowed to mate. The placenta and fetal (F2) tissues were collected at day 20 of gestation. Dietary deficiency of folate (BNFD and BOFD) and B12 (BDFN) with either state of other vitamin or combined deficiency of both vitamins (BDFD) in comparison to BNFN, were overall responsible for reduced expression of IGF2R in the placenta (F1) and the fetal liver (F2) whereas a combination of folate deficiency with different levels of B12 revealed sex-specific differences in kidney and brain. The alterations in the expression of IGF2R caused by folate-deficient conditions (BNFD and BOFD) and both deficient condition (BDFD) was found to be associated with an increase in suppressive histone modifications. Over-supplementation of either folate or B12 or both vitamins in comparison to BNFN, led to increase in expression of IGF2R and KCNQ1OT1 in the placenta and fetal tissues. The increase in the expression of IGF2R caused by folate over-supplementation (BNFO) was associated with decreased DNA methylation in fetal tissues. KCNQ1OT1 noncoding RNA (ncRNA), however, showed upregulation under deficient conditions of folate and B12 only in female fetal tissues which correlated well with hypomethylation observed under these conditions. An epigenetic reprograming of IGF2R and KCNQ1OT1 ncRNA in the offspring was evident upon different dietary combinations of folic acid and B12 in the mice.

Topics: Animals; Body Weight; Brain; Diet; Dose-Response Relationship, Drug; Drug Interactions; Epigenesis, Genetic; Female; Fetus; Folic Acid; Folic Acid Deficiency; Gene Expression Regulation, Developmental; Genomic Imprinting; Homocysteine; Kidney; Liver; Male; Mice; Placenta; Pregnancy; Pregnancy Complications; Receptor, IGF Type 2; RNA, Long Noncoding; RNA, Messenger; Vitamin B 12; Vitamin B 12 Deficiency

Deficiency of vitamin B6 and vitamin B12, mostly in vegetarians, is found to be associated with depression and adverse neurological function. We investigated whether vitamin B6, B12, and folate have an effect on brain structure, especially among depressed people who follow a specific diet. The study sample comprised 9426 participants from the UK Biobank cohort with a mean age of 62.4 years. A generalized linear model controlling for age, sex, body mass index, ethnicity, town send deprivation index, educational qualification, smoking, and alcohol intake was used to test the association between study groups and structural brain volumes. Depression was more prevalent, and intake of vitamin B6 and B12 was lower among vegetarians, while non-vegetarians had a lower intake of folate. Overall, no significant association was observed between vitamin B6, B12, and folate intakes and both global and subcortical brain volumes among participants with depression. However, vitamin B12 intake was positively associated with right pallidum among non-depressed participants, and a significant interaction between vitamin B12 intake and depression status on the right pallidum was observed. Also, a significant interaction between folate intake and depression status on grey matter (GM) volume and left thalamus was observed. Upon diet stratification, folate intake is associated with total brain volume and GM volume among vegetarians with depression. Furthermore, no significant associations were observed for subcortical regions. Our findings suggest that dietary intake of vitamin B6 and B12 might have an effect on brain structure. Vegetarians, particularly those who suffer from depression may benefit from supplementing their diets with vitamins B6, B12, and folate to ensure brain health. Further studies, especially with a larger sample size and longitudinal design, are needed to confirm these findings.

Topics: Aged; Brain; Depression; Diet; Eating; Female; Folic Acid; Folic Acid Deficiency; Gray Matter; Humans; Linear Models; Magnetic Resonance Imaging; Male; Middle Aged; Nutritional Status; United Kingdom; Vegetarians; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6; Vitamin B 6 Deficiency

Our previous study found that 180 of 1064 atrophic glossitis (AG) patients have iron deficiency. This study assessed whether all AG patients with iron deficiency (so-called ID/AG patients) had iron deficiency anemia (IDA) and evaluated whether the ID/AG patients had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than healthy control subjects.. The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 180 ID/AG patients and 532 healthy control subjects were measured and compared.. We found that 180 ID/AG patients had significantly lower mean corpuscular volume (MCV) and lower mean blood Hb and serum iron levels as well as significantly higher mean serum homocysteine level than healthy control subjects (all P-values < 0.001). Moreover, 180 ID/AG patients had significantly higher frequencies of blood Hb (46.1%), serum iron (100.0%), vitamin B12 (8.3%), and folic acid (4.4%) deficiencies, hyperhomocysteinemia (16.1%), and serum GPCA positivity (31.1%) than 532 healthy control subjects (all P-values < 0.001). In addition, of 83 anemic ID/AG patients, 9 (10.8%) had pernicious anemia, 40 (48.2%) had normocytic anemia, 30 (36.2%) had IDA, and 4 (4.8%) had thalassemia trait-induced anemia.. We conclude that ID/AG patients had significantly higher frequencies of blood Hb, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 532 healthy control subjects. Normocytic anemia is the most common type of anemia in ID/AG patients, followed by IDA, pernicious anemia, and thalassemia trait-induced anemia.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Anemia, Pernicious; Autoantibodies; Case-Control Studies; Comorbidity; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Glossitis; Hematinics; Hemoglobins; Humans; Hyperhomocysteinemia; Iron; Male; Middle Aged; Parietal Cells, Gastric; Taiwan; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Our previous study found that 56 of 1064 atrophic glossitis (AG) patients have vitamin B12 deficiency. This study assessed whether the AG patients with vitamin B12 deficiency (B12D/AG patients) had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than healthy control subjects.. The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 56 B12D/AG patients and 532 healthy control subjects were measured and compared.. We found that 56 B12D/AG patients had significantly lower mean blood Hb and serum iron levels as well as significantly higher mean corpuscular volume (MCV) and mean serum homocysteine level than healthy control subjects (all P-values < 0.05). Moreover, 56 B12D/AG patients had significantly higher frequencies of macrocytosis (53.6%), blood Hb (64.3%), iron (26.8%), and folic acid (3.6%) deficiencies, hyperhomocysteinemia (89.3%), and serum GPCA positivity (55.4%) than 532 healthy control subjects (all P-values < 0.005). In addition, of 36 anemic B12D/AG patients, 22 (61.1%) had pernicious anemia (PA), 6 (16.7%) had macrocytic anemia other than PA, 4 (11.1%) had normocytic anemia, 3 (8.3%) had iron deficiency anemia (IDA), and one (2.8%) had microcytic anemia other than IDA and thalassemia trait-induced anemia.. We conclude that B12D/AG patients have significantly higher frequencies of macrocytosis, blood Hb, iron, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than healthy control subjects. PA is the most common type of anemia in our B12D/AG patients.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Autoantibodies; Case-Control Studies; Comorbidity; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Glossitis; Hematinics; Hemoglobins; Humans; Hyperhomocysteinemia; Iron; Male; Middle Aged; Parietal Cells, Gastric; Vitamin B 12; Vitamin B 12 Deficiency

Burning mouth syndrome (BMS) is characterized by burning sensation of the oral mucosa in the absence of clinically apparent oral mucosal alterations. This study evaluated the anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity in 884 BMS patients.. The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, GPCA levels in 884 BMS patients were measured and compared with the corresponding levels in 442 age- and sex-matched healthy control subjects.. We found that 175 (19.8%), 143 (16.2%), 42 (4.8%), 20 (2.3%), 170 (19.2%), and 109 (12.3%) BMS patients had blood Hb, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Moreover, 884 BMS patients had significantly higher frequencies of blood Hb and serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 442 healthy control subjects (all P-values < 0.005). Of 175 anemic BMS patients, 95 had normocytic anemia, 27 had thalassemia trait-induced anemia, 21 had iron deficiency anemia, 15 had pernicious anemia, 15 had macrocytic anemia other than pernicious anemia, and 2 had microcytic anemia other than iron deficiency anemia and thalassemia trait-induced anemia. Burning sensation of oral mucosa (100.0%), dry mouth (48.1%), numbness of oral mucosa (30.7%), and dysfunction of taste (16.7%) were the four common symptoms in 884 BMS patients.. BMS patients have significantly higher frequencies of blood Hb and serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than healthy control subjects.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Autoantibodies; Burning Mouth Syndrome; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Hyperhomocysteinemia; Iron; Male; Middle Aged; Parietal Cells, Gastric; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

The value of testing for folate deficiency has been scrutinized recently given low prevalence of deficiency with widespread dietary fortification. Numerous studies have shown folate testing to be low yield overall. However, the value of such testing in the inpatient cancer population has not been defined.. We queried all folate tests performed during 2017 at our center on admitted cancer patients. We used diagnosis codes and manual chart review to assess risk factors for folate deficiency. Descriptive statistics were used to summarize characteristics of patients undergoing folate testing, the frequency of vitamin B12 co-testing, and repeat folate testing. Fisher's exact test was used to compare the proportion of deficient vs. not deficient tests based on the presence of risk factors. A Cox proportional hazards model was fit to examine the association between folate deficiency and survival.. In total, 937 patients had 1065 tests performed during 2017. Among all tests, 7.0% indicated folate deficiency. In patients who underwent two folate tests in a single hospitalization, 89% were deficient neither instance. Risk factors for folate deficiency were equally common in instances with deficient compared with replete testing (25.3 vs. 20.4%, P = 0.334). Folate deficiency was associated with higher risk for death (HR 1.49, 95% CI 1.10-2.03, P = 0.01).. Folate deficiency was present in 7% of hospitalized cancer patients and associated with shorter overall survival. Repeat testing in the same patient over time was low yield. Traditional risk factors for folate deficiency do not appear to apply in this patient population.

Topics: Academic Medical Centers; Aged; Diet; Female; Folic Acid; Folic Acid Deficiency; Humans; Inpatients; Male; Middle Aged; Prevalence; Proportional Hazards Models; Risk Factors; Vitamin B 12

Topics: Anemia, Pernicious; Female; Folic Acid Deficiency; Gastritis, Atrophic; Homocysteine; Humans; Hydroxocobalamin; Methylmalonic Acid; Middle Aged; Tetrahydrofolates; Vitamin B 12; Vitamin B Complex

To determine the prevalence of anemia, and to evaluate the etiology and risk factors of anemia in patients with newly diagnosed cancer.. In this cross-sectional study, 310 patients with newly diagnosed cancer who were referred to a university hospital in Turkey over a 6-month period and 218 age-matched healthy individuals as controls were evaluated in terms of anemia: complete blood count (CBC), ferritin, transferrin saturation (TS%), serum iron (SI), cobalamin (B12), and folate levels. Carcinoma of the breast (21.3%), lung (12.9%), and gastrointestinal tract (GIT) (35.8%) accounted for the majority of the patients, and 44.7% of the patients had metastatic disease.. Anemia was observed in 49.7% of patients with cancer and in 11.9% of healthy controls (p < 0.001). SI and TS% were lower in patients with cancer than in the controls (p < 0.001); however, the median serum ferritin level, which is also an acute-phase reactant, was higher in the patient group than the healthy matched controls (42.2 ng/mL and 41 ng/mL, respectively, p < 0.001). Folate and B12 deficiencies were seen more frequently in the cancer group than in the controls [6.5% and 0.9% (p < 0.001); 39.3% and 18.9% (p < 0.05), respectively]. In the cancer group, anemia was seen more frequently in the metastatic subgroup than in the non-metastatic subgroup (59.7% and 55.3%, respectively, p < 0.05). The prevalence of anemia was similar in both groups of patients with and without primary GIT cancers, as well as in patients who did and did not undergo tumor surgery (p > 0.05).. This study showed that, at the time a patient is diagnosed as having cancer, the patient already has a significant risk for anemia, nearly five times that of healthy people. Having metastatic disease, and having nutritional deficiencies as iron, B12, and folate were evaluated as possible risk factors for anemia in patients with newly diagnosed cancer, whereas cancer with GIT localization and previous history of tumor surgery were not.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Case-Control Studies; Cross-Sectional Studies; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Humans; Iron; Male; Middle Aged; Neoplasms; Prevalence; Risk Factors; Turkey; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Vitamin B12 and folate deficiency are not only linked to hematological, neurological, and cardiovascular diseases, but are also associated with insulin resistance. Metformin can decrease vitamin B12 and folate concentrations.. To examine (1) effects of short-term metformin treatment on serum holotranscobalamin (holoTC) and folate and (2) their association with insulin sensitivity in recent-onset type 2 diabetes.. This cross-sectional analysis comprised patients (known disease duration <12 months) on metformin monotherapy (MET, n = 123, 81 males, 53 ± 12 years) or nonpharmacological treatment (NPT, n = 126, 77 males, 54 ± 11 years) of the German Diabetes Study.. HoloTC (enzyme-linked immunosorbent assay), cobalamin, and folate (electrochemiluminescence); beta-cell function and whole-body insulin sensitivity, measured during fasting (HOMA-B, HOMA-IR) and intravenous glucose tolerance tests combined with hyperinsulinemic-euglycemic clamp tests.. HoloTC (105.4 [82.4, 128.3] vs 97 [79.7, 121.9] pmol/L) and folate concentrations (13.4 [9.3, 19.3] vs 12.7 [9.3, 22.0] nmol/L) were similar in both groups. Overall, holoTC was not associated with fasting or glucose-stimulated beta-cell function and insulin-stimulated glucose disposal. Cobalamin measurements yielded similar results in representative subgroups. In NPT but not MET, folate levels were inversely correlated with HOMA-IR (r = -0.239, P = .007). Folate levels did not relate to insulin sensitivity or insulin secretion in the whole cohort and in each group separately after adjustment for age, body mass index, and sex.. Metformin does not affect circulating holoTC and folate concentrations in recent-onset type 2 diabetes, rendering monitoring of vitamin B12 and folate dispensable, at least during the first 6 months after diagnosis or initiation of metformin.

Topics: Adolescent; Adult; Aged; Biomarkers; Blood Glucose; Cross-Sectional Studies; Diabetes Mellitus, Type 1; Female; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Humans; Hypoglycemic Agents; Insulin Resistance; Male; Metformin; Middle Aged; Prognosis; Prospective Studies; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Depression is a heterogeneous disorder and is thought to develop as a result of complex interactions between genetic and environmental factors. One-carbon metabolism that includes vitamin B12, folic acid, and homocysteine has been investigated in psychiatric disorders like depression. In recent years, vitamin D has also been considered to contribute to psychiatric disorders. In this study, serum levels of folate, vitamin B12, and homocysteine related to one-carbon metabolism and vitamin D were investigated in children and adolescents with depression and to assess possible roles in depression pathogenesis.. The study included 89 children and adolescents with depression (69 female, 20 male; mean age ± SD = 15.08 ± 1.46) and 43 control subjects (31 female, 12 male; mean age ± SD = 14.41 ± 2.32) without any DSM-5 diagnosis. Each subject completed a sociodemographic form, Childhood Depression Inventory, State-Trait Anxiety Inventory 1-2 and measured serum folate, vitamin B12, homocysteine, and 25-OH vitamin D levels.. There was no significant difference between the groups in terms of folate levels (p = .052). In the patient group, the vitamin B12 and vitamin D levels were clearly low (p values for both levels were <.001), while homocysteine levels were found to be remarkably high (p < .001). In addition, there was a negative correlation between depression severity and vitamin B12 and vitamin D, while a positive correlation was found with homocysteine.. The results of the study show that vitamin B12 deficiency or insufficiency and elevated homocysteine may contribute to the etiopathogenesis of depression. Additionally, it was shown that lower vitamin D levels may be associated with depression.. Depression of children and adolescents is associated with the interaction of environmental and genetic factors. Homocysteine, vitamin B12, and folate related to one-carbon metabolism are associated with psychiatric disorders such as depression in adulthood. Vitamin D also contributes to psychiatric disorders pathogenesis. There are not enough studies in the literature about these parameters in children with depression. Low vitamin B12 and vitamin D levels and increased homocysteine levels may play a role in the pathogenesis of depression in children and adolescents. Investigation of vitamin B12, folate, homocysteine, and vitamin D levels are recommended in children and adolescents with depression.

Topics: Adolescent; Child; Depressive Disorder; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Severity of Illness Index; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin D

Megaloblastic anaemia due to vitamin B12 and folic acid deficiency is uncommon in infancy and rarely reported in infants below 3 months of age. We hereby report a case of megaloblastic anaemia in a 9-weeks old infant having fever from 7th week of life. Blood picture showed pancytopenia and diagnosis was confirmed on bone marrow biopsy and serum level of vitamins. Patient positively responded to vitamin B12 and folic acid supplementation. Infants with pancytopenia even younger than 2 months, should also be investigated for vitamin B12 and folate deficiency. Mother of the baby was not antenatally investigated for anaemia. Prompt antenatal diagnosis and treatment of mothers can reduce the incidence in the infants.

Topics: Anemia, Megaloblastic; Bone Marrow; Diagnosis, Differential; Early Diagnosis; Early Medical Intervention; Failure to Thrive; Folic Acid; Folic Acid Deficiency; Humans; Infant; Male; Pancytopenia; Prenatal Care; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

Osteoporosis is an age-related bone disease, affecting mainly postmenopausal women, characterized by decreased bone mineral density (BMD) and consequent risk of fractures. Homocysteine (Hcy), a sulfur-aminoacid whose serum level is regulated by methylenetrahydrofolate reductase (MTHFR) activity and vitamin B12 and folate as cofactors, is a risk factor for inflammatory diseases. Literature data concerning the link between Hcy and osteoporosis are still debated. The aim of our study was to assess the relationship among Hcy and BMD, inflammation, vitamin status and bone turnover in postmenopausal osteoporosis. In 252 postmenopausal women, BMD was measured by dual-energy X-ray absorptiometry (DXA). In addition to serum Hcy, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and bone turnover markers (bone alkaline phosphatase-BAP, osteocalcin-OC, C-terminal telopeptide of type I collagen (CTX), vitamin deficiencies and MTHFR-C677T polymorphism were evaluated. Hcy, inflammation, bone resorption markers and prevalence of C677T polymorphism were higher, whereas vitamin D, B12, folate, and bone formation markers were lower in women with decreased BMD compared to those with normal BMD. Our results suggest a significant association between Hcy, BMD and inflammation in postmenopausal osteoporosis. The regulation of Hcy overproduction and the modulation of the inflammatory substrate could represent additional therapeutic approaches for osteoporosis prevention.

Topics: Bone Density; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Inflammation; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Osteitis; Osteoporosis, Postmenopausal; Oxidoreductases; Polymorphism, Genetic; Postmenopause; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Alcohol Drinking; Folic Acid; Folic Acid Deficiency; Humans; Male; Nicotiana; Nutrition Disorders; Optic Nerve Diseases; Smoking; Tomography, Optical Coherence; Vision Disorders; Visual Field Tests; Visual Fields; Vitamin B 12; Vitamin B Complex

Despite broad appreciation of their clinical utility, it has been unclear how vitamin B12 and folic acid (FA) function at the molecular level to directly prevent their hallmark symptoms of deficiency like anemia or birth defects. To this point, B12 and FA have largely been studied as cofactors for enzymes in the one-carbon (1C) cycle in facilitating the de novo generation of nucleotides and methylation of DNA and protein. Here, we report that B12 and FA function as natural antagonists of aryl hydrocarbon receptor (AhR). Our studies indicate that B12 and FA bind AhR directly as competitive antagonists, blocking AhR nuclear localization, XRE binding, and target gene induction mediated by AhR agonists like 2,3,7,8-tetrachlorodibenzodioxin (TCDD) and 6-formylindolo[3,2-b]carbazole (FICZ). In mice, TCDD treatment replicated many of the hallmark symptoms of B12/FA deficiency and cotreatment with aryl hydrocarbon portions of B12/FA rescued mice from these toxic effects. Moreover, we found that B12/FA deficiency in mice induces AhR transcriptional activity and accumulation of erythroid progenitors and that it may do so in an AhR-dependent fashion. Consistent with these results, we observed that human cancer samples with deficient B12/FA uptake demonstrated higher transcription of AhR target genes and lower transcription of pathways implicated in birth defects. In contrast, there was no significant difference observed between samples with mutated and intact 1C cycle proteins. Thus, we propose a model in which B12 and FA blunt the effect of natural AhR agonists at baseline to prevent the symptoms that arise with AhR overactivation.

Topics: Animals; Basic Helix-Loop-Helix Transcription Factors; Carbazoles; Congenital Abnormalities; Female; Folic Acid; Folic Acid Deficiency; Gene Expression; Humans; Male; Malnutrition; Mice; Mice, Inbred C57BL; Neoplasms; Polychlorinated Dibenzodioxins; Receptors, Aryl Hydrocarbon; Vitamin B 12; Vitamin B 12 Deficiency

There is a high prevalence of hyperhomocysteinemia that has been linked to high cardiovascular risk in obese individuals and could be attributed to poor nutritional status of folate and vitamin B12. We sought to examine the association between blood homocysteine (Hcy) folate, and vitamin B12 levels and vascular dysfunction in morbidly obese adults using novel ex vivo flow-induced dilation (FID) measurements of isolated adipose tissue arterioles. Brachial artery flow-mediated dilation (FMD) was also measured. Subcutaneous and visceral adipose tissue biopsies were obtained from morbidly obese individuals and non-obese controls. Resistance arterioles were isolated in which FID, acetylcholine-induced dilation (AChID), and nitric oxide (NO) production were measured in the absence or presence of the NO synthase inhibitor, L-NAME, Hcy, or the superoxide dismutase mimetic, TEMPOL. Our results demonstrated that plasma Hcy concentrations were significantly higher, while folate, vitamin B12, and NO were significantly lower in obese subjects compared to controls. Hcy concentrations correlated positively with BMI, fat %, and insulin levels but not with folate or vitamin B12. Brachial and arteriolar vasodilation were lower in obese subjects, positively correlated with folate and vitamin B12, and inversely correlated with Hcy. Arteriolar NO measurements and sensitivity to L-NAME were lower in obese subjects compared to controls. Finally, Hcy incubation reduced arteriolar FID and NO sensitivity, an effect that was abolished by TEMPOL. In conclusion, these data suggest that high concentrations of plasma Hcy and low concentrations of folate and vitamin B12 could be independent predictors of vascular dysfunction in morbidly obese individuals.

Topics: Adult; Alcohol Drinking; Arterioles; Bariatric Surgery; Brachial Artery; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Male; Nitric Oxide; Nutritional Status; Obesity, Morbid; Vascular Diseases; Vitamin B 12; Vitamin B 12 Deficiency

Ideally, the upper reference limit of plasma or serum homocysteine (Hcy) is to be defined from the studies done on individuals with normal cobalamin and folate status. It is difficult to separate the truly healthy (Cobalamin/Folate Replete) individuals from the randomly selected, apparently healthy individuals who are sub-clinically deficient of cobalamin/folate. The present study was aimed at defining the reference values for the serum homocysteine from individuals with normalized cobalamin and folate status.. In our study, 215 patients with cobalamin, folic acid deficiency were treated accordingly till complete restoration of clinical and laboratory abnormalities. The post-therapy serum Hcy values were used as reference values.. Post-therapy serum Hcy values 12.56 μmol/L (95th percentile), 11.4 μmol/L (85th percentile), 9.8 μmol/L (67th percentile) were seen. The hyperhomocysteinemia was more visible (17.3% gain in prevalence) in the same patient group if interpreted using the post-therapy Hcy value (11.4 μmol/L) as the cut-off. There was no difference between the genders and age groups in the pre or post-therapy Hcy values.. The benefit of the gain in prevalence of disease or the increase in the sensitivity of the test, though small, gets magnified in common diseases and in populous countries. Selection of the individuals is as important as the method or the reagent used in the method when a particular parameter is studied. Repleting the vitamin stores in the confirmed vitamin-deficient patients is more appropriate and easily feasible, since anyway they require treatment, than doing the same on the apparently healthy people. The data thus obtained can be better used as the reference value, for a more meaningful interpretation. The reference range can in turn be used to identify the sub-clinically deficient but asymptomatic people and managed accordingly.

Topics: Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Reference Values; Vitamin B 12; Vitamin B 12 Deficiency

Oral manifestations of deficiency of iron, vitamin B12 and folic acid are thought to be common. Prevalence of these deficiencies among patients with compatible symptoms is not well known. The goal of this study was to summarize evidence from a dental practice of iron, vitamin B12 and folic acid deficiency in patients presenting with compatible oral manifestations.. 250 patients who presented with burning mouth syndrome, angular cheilitis, recurrent aphthous stomatitis, papillar atrophy of the tongue dorsum or mucosal erythema were identified. Patients underwent clinical examination, and the blood samples were taken.. 250 patients (208 females; 42 males, mean age 44.1 years) with at least one corresponding symptom or sign were identified. The nutritional deficiency of one or more nutrients was found in 119 patients (47.6%). Seven times more females than males were noted to have one type of deficiency (104 females, 15 males). Iron deficiency as defined was diagnosed in 62 patients (24.8%), vitamin B12 or folic acid deficiency in 44 patients (17.6%) and both deficiencies (iron + vitamin B12/folic acid) in 13 patients (5.2%). The only predictive factor was gender and only for iron deficiency. The presence of more than one deficiency was noted in 10 patients (4.9%).. The most commonly observed deficiency in dental practice over the course of 11 years was an iron deficiency in the female population. Age, diet and reported co-morbidities did not show statistically significant predictable value in recognizing these deficiencies.

Topics: Adult; Czech Republic; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Iron Deficiencies; Male; Malnutrition; Mouth Diseases; Practice Patterns, Dentists'; Sex Factors; Vitamin B 12; Vitamin B 12 Deficiency

To study the relationship between atrophic glossitis and anemia, anemia types and other related factors(oral candida infection, xerostomia) in 124 consecutive cases.. One hundred and twenty-four cases with atrophic glossitis and 53 healthy controls were collected from Qingdao local population. The main indexes including general status, oral examination findings, hemoglobin (Hb), mean red blood cell volume (MCV), vitamin B12, ferritin, folic acid, anemia and anemia type, xerostomia and candida infection were statistically analyzed using SPSS 20.0 software package for Student's t test.. Among 124 cases of glossitis group, 48.39% were found with anemia, 41.94% with xerostomia, 79.03% with Candida infection, 29.03% with Vitamin B12 deficiency, 22.58% with ferritin deficiency, 11.29% with folic acid deficiency. The contents of hemoglobin, ferritin and vitamin B12 in glossitis group were significantly lower than those in the control group(P<0.05), and the number of glossitis patients with anemia, xerostomia and candida infection were significantly higher than those in the control group (P<0.05). There was no significant difference in folic acid content between the two groups(P<0.05).. Occurrence of atrophic glossitis is closely related to anemia, vitamin B12 deficiency, ferritin deficiency, xerostomia, oral candida infection. There is no correlation with folic acid deficiency. Patients with atrophic glossitis accompanied by anemia have a higher proportion of macrocytic anemia.

Topics: Anemia; Folic Acid Deficiency; Glossitis; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Current guidelines pertaining to diagnosing macrocytic anemia in association with vitamin B12 and folate deficiency recommend that vitamin B12, folate, homocysteine, and methylmalonic acid assays should be assessed concurrently due to their close relationship in metabolism. We aimed to investigate the completion of these assays in local clinics and hospitals without in-house clinical laboratories in Korea.. We retrospectively reviewed data from the laboratory information system between September 25, 2017, and June 30, 2019, to investigate usage rates of vitamin B12, folate, homocysteine, and methylmalonic acid assays in patients with macrocytic anemia.. During the study period, 14 894 Korean adults among 109 524 (13.6%) total hemoglobin-tested subjects underwent concurrent erythrocyte mean corpuscular volume (MCV) tests. Among these 14,894 adults, 265 (1.2%) from 94 local clinics or hospitals without in-house clinical laboratories in Korea had macrocytic anemia. Furthermore, among these 265 adults, only one woman underwent serum vitamin B12 and folate assay and one man underwent serum homocysteine testing during the study period. No patients among the 265 individuals with macrocytic anemia received erythrocyte folate or methylmalonic acid testing (with either serum, plasma, random urine, or 24-hour collected urine).. The results of this study provide basic information regarding utilization rates of assays in association with vitamin B12 and folate deficiency. Making more data available is expected to improve rates of testing in patients with macrocytic anemia in local clinics and hospitals without in-house clinical laboratories in Korea.

Topics: Adult; Anemia, Macrocytic; Blood Chemical Analysis; Erythrocyte Indices; Folic Acid; Folic Acid Deficiency; Hematologic Tests; Homocysteine; Humans; Methylmalonic Acid; Republic of Korea; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

In order to propose a course of action to be taken in the face of any hyperhomocysteinemia, we have reported for the first time in a French journal the recommendations made within the framework of the European E-HOD project for the diagnosis and treatment of remethylation disorders. The remethylation route ensures homocysteine-methionine conversion. It is linked to the folate cycle and the intracellular metabolism of cobalamins. Remethylation disorders can be classified into three groups: 1) isolated disorders (cblD-HC, cblE, cblG) corresponding to an isolated deficit in the production of methylcobalamin, cofactor of methionine synthase; 2) combined disorders (cblC, cblD-MMA/HC, cblF, cblJ) corresponding to an alteration of the transport and intracellular metabolism of cobalamins, which causes a defect in the synthesis of the two functional forms of cobalamin: methylcobalamin and adenosylcobalamin, a cofactor for methyl malonylCoA mutase; 3) MTHFR deficit, an abnormality of the folate cycle. The biological anomalies observed are hyperhomocysteinemia and hypomethioninaemia associated in the case of disorders combined with increased urinary excretion of methylmalonic acid. The clinical presentation is however heterogeneous according to the remethylation disorder but also for the same pathology according to the age. Given the large number of pathologies grouped together in remethylation disorders, this point is illustrated by only two clinical cases concerning the same deficit (deficit in MTHFR) but with different discovery circumstances: a neonatal form and a late form.

Topics: Alcoholism; Amino Acid Metabolism, Inborn Errors; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Homocystinuria; Humans; Infant, Newborn; Metabolic Networks and Pathways; Methionine; Methylation; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Muscle Spasticity; Psychotic Disorders; Vitamin B 12

Deficiencies in vitamin D, folate and cobalamin are common in Inflammatory Bowel Disease (IBD). The aim of the present study was to assess serum levels of these vitamins in IBD adults based on the respective serum cut off values for vitamin deficiencies, and to explore possible associations with IBD-related biomarkers and nutritional intake. A cross-sectional study was carried out and patients with Crohn's disease (CD) or ulcerative colitis (UC) from Attica-Greece were enrolled. Medical and dietary history, clinical examination and blood/stool biomarkers were evaluated. In total, 87 patients participated in the study. Serum levels of 25(OH)D, folate and cobalamin were deficient in 36.8%, 18.4% and 5.7% of patients, respectively. Linear regression analysis in the overall patients showed positive associations between (a) serum 25(OH)D with serum iron (beta = 0.083,

Topics: Adult; Bilirubin; Biomarkers; Colitis, Ulcerative; Crohn Disease; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Greece; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Nutritional Status; Oxidative Stress; Seasons; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin D; Vitamin D Deficiency

Vegetarianism may result in low vitamin B12 and acquired hyperhomocysteinemia leading to thrombotic conditions such as cerebral venous sinus thrombosis (CVST). The clinico-radiological presentation and outcome of patients with hyperhomocysteinemia may be different from those without, but there is a paucity of information. This study was undertaken to find out the relationship of homocysteine (Hcy) with vitamin B12, folic acid and methyltetrahydrofolate reductase (MTHFR) mutation in the patients with CVST, and compare clinico-radiological severity and outcome of patients with and without hyperhomocysteinemia.. Ninety-six CVST patients in whom Hcy level was measured, were included, and their risk factors and neurological, magnetic resonance (MR) imaging and MR venography findings were noted. They were evaluated for prothrombotic conditions including Hcy, vitamin B12, folic acid and MTHFR 677C→T mutation. Three month outcome was categorized as death, poor and good.. Seventy three per cent patients had risk factors; hyperhomocysteinemia in 52.1 per cent, protein S deficiency in 47.8 per cent, protein C deficiency in 19.4 per cent, MTHFR 677C→T mutation in 30.7 per cent, antinuclear antibody 11 per cent, and Factor V Leiden mutation in two per cent each. Thirty two per cent patients with hyperhomocysteinemia had no other thrombotic cause, and 22 per cent of them had either vitamin B12 and or folic acid deficiency only. The patients with hyperhomocysteinemia more frequently had vitamin B12 deficiency (70 vs. 13%), MTHFR 677C→T mutation (47.5 vs. 9.1%) and superior sagittal sinus thrombosis (78 vs. 56.5%) than normal Hcy group. The clinico-radiological severity and outcome were similar.. Hyperhomocysteinemia was an important correctable risk factor of CVST in patients from northern India, and majority of them had either low vitamin B12 level or MTHFR mutation.

Topics: Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; India; Methylenetetrahydrofolate Reductase (NADPH2); Risk Factors; Sinus Thrombosis, Intracranial; Vitamin B 12; Vitamin B 12 Deficiency

Normocytosis is defined as having the mean corpuscular volume (MCV) between 80 fL and 99.9 fL. This study evaluated whether 944 atrophic glossitis (AG) patients with normocytosis had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than 532 healthy control subjects or 1064 AG patients.. Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 944 AG patients with normocytosis, 1064 AG patients, and 532 healthy control subjects were measured and compared.. We found that 12.4%, 14.5%, 2.3%, 2.0%, 9.0%, and 25.7% of 944 AG patients with normocytosis had blood hemoglobin (Hb), iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Furthermore, 944 AG patients with normocytosis had significantly higher frequencies of blood Hb, iron, vitamin B12, folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 532 healthy control subjects (all P-values < 0.01). On the contrary, 944 AG patients with normocytosis had significantly lower frequencies of blood Hb and vitamin B12 deficiencies and hyperhomocysteinemia than overall 1064 AG patients (all P-values < 0.05).. We conclude that there are significantly higher frequencies of anemia and serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity in AG patients with normocytosis than in healthy control subjects. On the contrary, AG patients with normocytosis have significantly lower frequencies of blood Hb and vitamin B12 deficiencies and hyperhomocysteinemia than overall AG patients.

Topics: Case-Control Studies; Erythrocyte Indices; Folic Acid; Folic Acid Deficiency; Glossitis; Hematinics; Hemoglobins; Humans; Hyperhomocysteinemia; Parietal Cells, Gastric; Vitamin B 12; Vitamin B 12 Deficiency

Previous studies have suggested that prenatal maternal folate deficiency is associated with reduced prenatal brain growth and psychological problems in offspring. However, little is known about the longer-term impact. The aims of this study were to investigate whether prenatal maternal folate insufficiency, high total homocysteine levels and low vitamin B12 levels are associated with altered brain morphology, cognitive and/or psychological problems in school-aged children. This study was embedded in Generation R, a prospective population-based cohort study. The study sample consisted of 256 Dutch children aged between 6 and 8 years from whom structural brain scans were collected using MRI. The mothers of sixty-two children had insufficient (<8 nmol/l) plasma folate concentrations in early pregnancy. Cognitive development was assessed by the Snijders-Oomen Niet-verbale intelligentietest - Revisie and the NEPSY-II-NL. Psychological problems were assessed at age 6 years using the parent report of the Child Behavior Checklist. Low prenatal folate levels were associated with a smaller total brain volume (B -33·34; 95 % CI -66·7, 0·02; P=050) and predicted poorer performance on the language (B -0·28; 95 % CI -0·52, -0·04; P=0·020) and visuo-spatial domains (B -0·27; 95 % CI -0·50, -0·04; P=0·021). High homocysteine levels (>9·1 µmol/l) predicted poorer performance on the language (B -0·31; 95 % CI -0·56, -0·06; P=0·014) and visuo-spatial domains (B -0·36; 95 % CI -0·60, -0·11; P=0·004). No associations with psychological problems were found. Our findings suggest that folate insufficiency in early pregnancy has a long-lasting, global effect on brain development and is, together with homocysteine levels, associated with poorer cognitive performance.

Topics: Brain; Child; Child Behavior Disorders; Cognition Disorders; Cohort Studies; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Language Development Disorders; Magnetic Resonance Imaging; Male; Netherlands; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Prospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Alzheimer disease (AD) is the most common neurodegenerative disease in the world. The relationship between AD and homocysteine (Hcy) is contradictory.A community-based investigation was conducted to find patients with AD in a vitamin B deficient population (≥55 years old) in Lüliang area in China. Venous blood samples were collected. Serum Hcy, folate, and vitamin B12 were measured. For each case, 4 controls were selected matched with age to evaluate the relationship between Hcy and AD.The crude prevalence of AD among people ages 55 years or older in this area was 8.60%. There were significant differences in serum Hcy and B12 between the case and control groups. We found that the higher level of serum Hcy was associated with a high risk of AD, and higher education level, higher folate and B12 concentration were protective factors to AD.Adjustment of diet structure and supplementation of folate and B12 may offer potential therapeutic measures in this area.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; China; Cognitive Dysfunction; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

DNA methylation, a central component of the epigenetic network is altered in response to nutritional influences. In one-carbon cycle, folate acts as a one-carbon carrier and vitamin B12 acts as co-factor for the enzyme methionine synthase. Both folate and vitamin B12 are the important regulators of DNA methylation which play an important role in development in early life. Previous studies carried out in this regard have shown the individual effects of these vitamins but recently the focus has been to study the combined effects of both the vitamins during pregnancy. Therefore, this study was planned to elucidate the effect of the altered dietary ratio of folate and B12 on the expression of transporters, related miRNAs and DNA methylation in C57BL/6 mice. Female mice were fed diets with 9 combinations of folate and B12 for 4 weeks. They were mated and off-springs born (F1) were continued on the same diet for 6 weeks post-weaning. Maternal and fetal (F2) tissues were collected at day 20 of gestation. Deficient state of folate led to an increase in the expression of folate transporters in both F1 and F2 generations, however, B12 deficiency (BDFN) also led to an increase in the expression in both the generations. B12 transporters/proteins were found to be increased with B12 deficiency in F1 and F2 generations except for TC-II in the kidney which was found to be decreased in the F1 generation. miR-483 was found to be increased with all conditions of folate and B12 in both F1 and F2 generations, however, deficient conditions of B12 led to an increase in the expression of miR-221 in both F1 and F2 generations. The level of miR-133 was found to be increased in BDFN group in F1 generation however; in F2 generation the change in expression was tissue and sex-specific. Global DNA methylation was decreased with deficiency of both folate and B12 in maternal tissues (F1) but increased with folate deficiency in placenta (F1) and under all conditions in fetal tissues (F2). DNA methyltransferases were overall found to be increased with deficiency of folate and B12 in both F1 and F2 generations. Results suggest that the dietary ratio of folate and B12 resulted in altered expression of transporters, miRNAs, and genomic DNA methylation in association with DNMTs.

Topics: Animals; Brain; Carrier Proteins; Diet; DNA (Cytosine-5-)-Methyltransferases; DNA Methylation; Female; Fetal Growth Retardation; Fetus; Folic Acid; Folic Acid Deficiency; Gene Expression Regulation, Developmental; Homocysteine; Kidney; Liver; Male; Maternal Exposure; Mice; Mice, Inbred C57BL; MicroRNAs; Paternal Exposure; Placenta; Pregnancy; Pregnancy Complications; Reverse Transcriptase Polymerase Chain Reaction; Vitamin B 12; Vitamin B 12 Deficiency

The aim of this study was to examine the associations between the risk of cognitive impairment and the serum levels of folate, vitamin B. Subjects were persons aged 60-79 years who participated in the Yangpyeong Cohort study between 2011 and 2012. Cognitive impairment and normal subjects consisted of 100 pairs of old adults matched by age, sex, and education levels. Cognitive function was evaluated with the Korean version of the Mini-Mental State Examination for Dementia Screening (MMSE-DS). Pearson's partial correlation coefficients and conditional multiple logistic regression analysis were applied to determine the associations between cognitive function and the serum levels of folate, vitamin B. Compared with the matched normal group, the cognitive impairment group had higher proportions of folate deficiency (< 3 ng/mL) and hyperhomocysteinemia (≥ 15 µmol/L). Serum Hcy concentrations were inversely associated with serum folate (r = - 0.234, p = 0.001) and MMSE-DS score (r = - 0.150, p = 0.037) after adjusting for age, sex, and education. The high Hcy group showed a higher prevalence of cognitive impairment (4th vs. 1st quartile, OR 3.30, 95% CI 1.12-9.72, p for trend = 0.014) after adjusting for exercise.. The present findings suggest a putative protective role of high serum folate and normal Hcy against cognitive impairment among older adults.

Topics: Aged; Causality; Cognitive Dysfunction; Cohort Studies; Comorbidity; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Middle Aged; Neuropsychological Tests; Prevalence; Republic of Korea; Vitamin B 12

Megaloblastic, nonregenerative anemia is a well-known consequence of cobalamin or folate deficiencies in humans but is not recognized in hypocobalaminemic or hypofolatemic dogs. Establishment of relationships between hypocobalaminemia or hypofolatemia and hematologic disease would encourage vitamin B testing, and potentially supplementation, in anemic dogs.. To determine the prevalence of anemia in hypocobalaminemic or hypofolatemic dogs and to report the prevalence of hypocobalaminemia and hypofolatemia and nonregenerative anemia, macrocytosis, and anisocytosis in anemic dogs.. One hundred and fourteen client-owned dogs with known serum cobalamin and folate concentrations and CBCs and 42 client-owned anemic dogs.. Retrospective comparison of anemia prevalence in hypocobalaminemic or hypofolatemic and normocobalaminemic or normofolatemic dogs was performed. Prospective measurement of erythrocyte variables and cobalamin and folate concentrations in anemic dogs was carried out; relationships among hypocobalaminemia and regenerative status, mean corpuscular volume, and red cell distribution width were evaluated.. Significant differences in prevalence of anemia between hypocobalaminemic (36%) and normocobalaminemic dogs (26%; P = .23) or between hypofolatemic (31%) and normofolatemic dogs (30%; P = .99) were not detected. Between hypocobalaminemic and normocobalaminemic dogs, no significant differences in prevalence of nonregenerative anemia (69% vs 63%; P = .65), macrocytosis (17% vs 0%; P = .53), or anisocytosis (28% vs 0%; P = .14) were detected. Anemic dogs had high prevalence of vitamin B deficiencies (nonregenerative: 64% hypocobalaminemic, 18% hypofolatemic; regenerative: 57% hypocobalaminemic, 21% hypofolatemic).. The association between cobalamin and folate deficiencies and macrocytic, nonregenerative anemia established in humans is not routinely present in dogs.

Topics: Anemia; Animals; Case-Control Studies; Dog Diseases; Dogs; Female; Folic Acid; Folic Acid Deficiency; Male; Prevalence; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Folate and vitamin B. The aims of this study were to assess the folate and vitamin B. This study was a part of the Azar cohort study, which is designed as a noncommunicable disease survey in the population of Shabestar, East Azerbaijan, Iran. A total of 95 healthy adults (35 men, 60 women) were chosen according to exclusion criteria and assessed using demographic characteristics and blood sampling.. Low concentrations of serum folate, vitamin B. There was a high prevalence of low folate and vitamin B

Topics: Adult; Age Factors; Cohort Studies; Erythrocyte Indices; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hematology; Hemoglobins; Humans; Iran; Male; Middle Aged; Nutritional Status; Prevalence; Sex Factors; Surveys and Questionnaires; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

This study examined whether folate and vitamin B. A cross-sectional study was performed in 406 Chinese pregnant women. Serum folate, vitamin B. Higher folate levels were associated with higher glucose concentrations and a higher risk of GDM (OR 1.98; 95% confidence interval [CI] 1.00-3.90), whereas higher vitamin B. An imbalance between folate and vitamin B. 摘要: 背景 本研究探讨了叶酸和维生素B

Topics: Adult; Biomarkers; Blood Glucose; Case-Control Studies; Cross-Sectional Studies; Diabetes, Gestational; Female; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Humans; Pregnancy; Prognosis; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

To assess the nutritional status of folate and vitamin B12 with anaemia in young children.. A cross-sectional study was conducted at the primary health-care centres of four Brazilian cities. Folate and vitamin B12 were assessed by fluoroimmunoassay. Multilevel Poisson regression models were used to explore the association of folate and vitamin B12 status in relation to anaemia in young children.. Brazil.ParticipantsChildren (n 460) aged 11 to 15 months.. The median (interquartile range) of serum folate was 39·7 (28·8-55·3) nmol/l and only four children presented with folate deficiency (<10 nmol/l). Surprisingly, 30·9 % of children presented with serum folate concentrations above the upper limit of detectable values by the commercial kit used for analysis. The frequency of vitamin B12 deficiency (<148 pmol/l) was 15 % and it was inversely associated with the highest tertile of serum folate concentrations (P<0·001). Having high serum folate concentration (≥50·1 nmol/l) and vitamin B12≥148 pmol/l was associated with lower frequency of anaemia in these children (prevalence ratio=0·53; 95% CI 0·30, 0·92).. High frequency of elevated serum concentration of folate was found among young Brazilian children and 15 % of them had vitamin B12 deficiency. The combination of high serum folate and normal vitamin B12 status was associated with a lower frequency of anaemia in these children. Improvements in the current strategies to promote healthy food-based complementary feeding along with prevention and control of micronutrient deficiencies are recommended to improve children's health.

Topics: Brazil; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Male; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency

Atherosclerosis, a common cause of atherosclerotic vascular diseases, is associated with several risk factors including hyperhomocysteinemia, and vitamin B

Topics: Adult; Aged; Atherosclerosis; Cohort Studies; Female; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Homocysteine; Humans; Incidence; Male; Middle Aged; Republic of Korea; Risk Factors; Surveys and Questionnaires; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Megaloblastic; Breast Neoplasms; Folic Acid; Folic Acid Deficiency; Humans; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Aged, 80 and over; Diagnostic Tests, Routine; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Methylmalonic Acid; Middle Aged; Procedures and Techniques Utilization; Purpura, Thrombocytopenic, Idiopathic; Sarcoidosis; Thrombocytopenia; Unnecessary Procedures; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Schizophrenia (SCH) and drug addiction are chronic disorders that are frequently accompanied by physical diseases, poor nutrition and reduced self-care, all of which are likely to result in vitamin deficiencies. The objective of this study was to compare vitamin levels in SCH patients, substance use disorder (SUD) patients and healthy controls (HCs). The study included 189 SCH patients, 119 SUD patients and 109 HCs. Information on vitamin B12, folic acid and vitamin D levels were retrieved from the hospital's database, and mean values and deficiency/insufficiency were evaluated. Vitamin D deficiency (<30 ng/ml) was more common in the SCH group than in the SUD and HC groups (88.4%, 74.8% and 86.4%, respectively). Although there were no significant differences in folic acid deficiency (<3.0 ng/ml) in the SUD and SCH groups (15.1% and 8.5%, respectively), the incidence of folic acid deficiency was significantly higher in both groups as compared with that in the HC group (5.8%). Significantly higher numbers of patients in the SCH group than in the SUD group had vitamin B12 deficiency (45.5% vs. 28.3%). The prevalence of vitamin B12 deficiency in the SUD group was significantly higher than that the HC group (28.3% vs.11.5%). As compared with the HC group, vitamin D and B12 levels were significantly lower in SCH group, and folic acid and B12 levels were significantly lower in the SUD group. Several vitamin deficiencies appear to be common in both SCH and SUD. Possible reasons should be investigated.

Topics: Adult; Female; Folic Acid; Folic Acid Deficiency; Humans; Incidence; Male; Middle Aged; Prevalence; Schizophrenia; Substance-Related Disorders; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin D; Vitamin D Deficiency

Cognitive disorders in old age have a serious impact on the health and social aspects of patients and their families.. The scope of this paper is to explore the role of cobalamin and folate that has been linked to cognitive decline, not only as a deficiency state depending on malnutrition, but also a determinant in cognitive impairment.. A 6-year observational, retrospective study was conducted by collecting the routine blood analyses and cognitive screening scores of patients aged 60 years or older, followed at our Centre for the Diagnosis and Treatment of Cognitive Disorders.. In a linear regression with a multi-vitamin model, higher folate concentrations were correlated with better cognitive performances through MMSE score, even after correction for sex, age, and years of education (beta = 0.144, p = 0.001). Estimated MMSE marginal means for folate versus homocysteine showed that folate deficiency was associated with worse cognitive performances, with a more severe cognitive impairment when hyperhomocysteinemia was present.. The assessment of B-vitamin status among elderly adults can contribute to an economic and practical approach to the prevention and management of cognitive decline. Future studies focused to define optimal vitamin status are warranted.

Topics: Aged; Aged, 80 and over; Biomarkers; Cognitive Dysfunction; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Male; Middle Aged; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Our previous studies found relatively higher frequencies of anemia, hematinic deficiencies, and hyperhomocysteinemia in patients with different types of oral mucosal diseases. This study evaluated whether patients with oral precancerous lesions (oral precancer patients) had significantly higher frequencies of anemia, hematinic deficiencies, and hyperhomocysteinemia than healthy control subjects.. The complete blood count, serum iron, vitamin B12, folic acid, and homocysteine levels in 131 oral precancer patients including 96 oral leukoplakia, 26 oral erythroleukoplakia, and 9 oral verrucous hyperplasia patients and in 131 age- and sex-matched healthy control subjects were measured and compared.. We found significantly lower mean serum iron (for women only), vitamin B12, and folic acid levels and a significantly higher mean serum homocysteine level in oral precancer patients than in healthy control subjects (all P-values < 0.05). Moreover, 131 oral precancer patients had significantly higher frequencies of blood hemoglobin (3.1%), vitamin B12 (43.5%), and folic acid (46.6%) deficiencies and hyperhomocysteinemia (22.1%) than 131 healthy control subjects (all P-values < 0.05). Of 131 oral precancer patients, lower mean serum folic acid levels were found in 87 cigarette smokers than in 44 non-smokers (P = 0.002), in 26 smokers consuming > 20 cigarettes per day than in 61 smokers consuming ≤ 20 cigarettes per day (P = 0.024), and in 52 betel quid chewers than in 79 non-chewers (P = 0.051).. There are significantly higher frequencies of anemia, serum vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia in oral precancer patients than in healthy control subjects.

Topics: Adult; Aged; Anemia; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Hematinics; Hemoglobins; Humans; Hyperhomocysteinemia; Iron; Leukoplakia, Oral; Male; Middle Aged; Mouth Diseases; Parietal Cells, Gastric; Sex Factors; Taiwan; Vitamin B 12; Vitamin B 12 Deficiency

Microcytosis is defined as having mean corpuscular volume (MCV) < 80 fL. This study evaluated whether 79 atrophic glossitis (AG) patients with microcytosis and 985 AG patient without microcytosis had higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than 532 healthy control subjects.. Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and serum GPCA levels in 79 AG patients with microcytosis, 985 AG patient without microcytosis, and 532 healthy control subjects were measured and compared.. We found that 69.6%, 43.0%, 5.1%, 3.8%, 11.4%, and 22.8% of 79 AG patients with microcytosis and 14.9%, 14.8%, 5.3%, 2.1%, 12.0%, and 27.0% of 985 AG patients without microcytosis were diagnosed as having blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Both 79 AG patients with microcytosis and 985 AG patients without microcytosis had significantly higher frequencies of blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 532 healthy control subjects (all P-values < 0.01). Moreover, 79 AG patients with microcytosis had significantly higher frequencies of blood hemoglobin and iron deficiencies than 985 AG patients without microcytosis.. There are significantly higher frequencies of anemia, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity in AG patients with or without microcytosis than in healthy control subjects. AG patients with microcytosis have significantly higher frequencies of blood hemoglobin and iron deficiencies than AG patients without microcytosis.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Atrophy; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Erythropoiesis; Female; Folic Acid; Folic Acid Deficiency; Glossitis; Hemoglobins; Homocysteine; Humans; Hyperhomocysteinemia; Iron; Iron Deficiencies; Male; Middle Aged; Parietal Cells, Gastric; Tongue; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Vitamin B. Absztrakt: A B

Topics: Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant, Newborn; Neural Tube Defects; Pregnancy; Vitamin B 12; Vitamin B Complex; Vitamin B Deficiency

The aim of this study was to evaluate the prevalence of anemia and other vitamin deficiencies among elderly home care patients and to evaluate the causes of anemia and effect of malnutrition as a contributing factor.. Anemia was defined according to the World Health Organization. Hemogram, serum iron, iron binding capacity, ferritin and transferrin saturation values, serum vitamin B12, folic acid and vitamin D levels were evaluated. It was tried to differentiate as absolute iron deficiency anemia, anemia of chronic disease, anemia of unknown cause and vitamin B12 deficiency anemia. Malnutrition was evaluated by Mini Nutritional Assessment test.. Total of 472 patients (mean age 81,4±7,4 years) were included in the study. Anemia was detected in 179 (%37,9) patients, 22,7% of males and 45,5 % of female. Prevalence of iron deficiency anemia, vitamin B12, folic acid and vitamin D deficiencies were found 43%, 46%, 19% and 91% respectively. 22,8% of all patients were malnourished, 17,5% were under malnutrition risk. In patients with anemia 16,2% chronic disease anemia and 37,4% unknown anemia were detected.. With or without malnutrition, iron deficiency anemia, vitamin B12 deficiency and vitamin D deficiency were common in the home care elderly patients.

Topics: Aged; Anemia; Anemia, Iron-Deficiency; Chronic Disease; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Home Care Services; Homes for the Aged; Humans; Male; Malnutrition; Nutrition Assessment; Nutritional Status; Prevalence; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin D Deficiency

A growing body of evidence suggests a role for homocysteine (Hcys) and folate (FA) in erectile function (EF): Hcys appears to impair EF affecting endothelium via several mechanism whereas the role of FA remains to be elucidated, besides decreasing Hcys. To assess correlation between erectile dysfunction (ED) and serum levels of FA, Hcys, and B12, we enrolled 31 patients affected by ED (Group A; age 52.83 ± 11.89 years) and 31 healthy adults (Group B; age 49.14 ± 13.63 years). Fasting blood samples were taken for each subject. ED was assessed by the International Index of Erectile Function-5 (IIEF-5). IIEF-5 mean score was significantly lower in Group A than in Group B (10.71 ± 4.24 versus 23.32 ± 1.33, p < .001). Compared to Group B, Group A also showed significantly lower serum FA levels (5.11 ± 1.79 versus 7.9 ± 3.55 ng/ml, p < .001) and significantly higher serum Hcys levels (13.61 ± 3.55 versus 9.17 ± 2.32 µmol/L, p < .001). No significant correlation was observed between Hcys and FA both groups. Our results showed a significant association among ED, FA deficiency and hyperomocisteinemia. Lack of correlation between FA and Hcys suggests that FA deficit may directly impair EF.

Topics: Adult; Case-Control Studies; Erectile Dysfunction; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Male; Middle Aged; Risk Factors; Severity of Illness Index; Surveys and Questionnaires; Ultrasonography; Vitamin B 12

Exclusively breast-fed infants born to vitamin B12 (cobalamin, cbl)-deficient mothers can develop symptoms within a few months following delivery. The authors aimed to assess the relationship between maternal and infantile markers of cbl status.. In 240 full-term infants (age, 2-30 d) admitted to Samsun Maternity and Child Health Hospital and their mothers, complete blood count testing and serum cbl, folate and plasma total homocysteine (tHcy) measurements were performed. In the mothers, serum ferritin and holotranscobalamin (holoTC) levels were measured additionally.. Among the infants, 146 (60.8%) had cbl deficiency (serum cbl <259 pg/mL), whereas 184 (76.7%) mothers had a low cbl level (serum cbl <300 pg/mL). When cbl deficiency was defined as a serum holoTC level < 40 pmol/L, 152 (63.3%) mothers were found as deficient. In addition, 147 (61.3%) infants had an elevated tHcy level (>10 μmol/L), in 35 (23.8%) of these 147 infants tHcy level being markedly elevated (>20 μmol/L). None of the infants had folate deficiency. In the correlational analysis between maternal and infantile markers associated with cbl status, the strongest correlation was observed between maternal holoTC and infantile tHcy (r = -0.49, p < 0.001), followed by the correlation between maternal tHcy and infantile tHcy (r = 0.47, p < 0.001). The weakest correlations were found between maternal cbl and infantile cbl (r = 0.28, p < 0.001), and between maternal cbl and infantile tHcy (r = -0.25, p < 0.001).. Maternal cbl status is an important determinant of infantile cbl status. Both maternal holoTC and tHcy may assist in predicting infantile cbl status. The finding of high prevalence of maternal and infantile cbl deficiency in this study points towards the need for effective strategies to prevent cbl deficiency in women prior to getting pregnant.

Topics: Breast Feeding; Diet; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Infant; Infant, Newborn; Male; Pregnancy; Prenatal Exposure Delayed Effects; Turkey; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Dietary Supplements; Folic Acid; Folic Acid Deficiency; Humans; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Inadequate maternal micronutrient status during pregnancy can lead to short- and long-term health risks for mother and offspring. The present study investigated the association between pre-pregnancy weight status and micronutrient status during pregnancy.. Maternal blood samples were collected during early pregnancy (median 13, interquartile range 12-15 weeks) and were assayed for serum folate, ferritin, Fe and vitamin B12. Regression modelling was used to assess the association between pre-pregnancy underweight, normal weight, overweight and obesity, and micronutrient levels, as well as the odds for deficiencies.. The Amsterdam Born Children and their Development (ABCD) study, the Netherlands.. Women with singleton pregnancies without diabetes (n 4243).. After adjustment for covariates, overweight women and obese women had lower (β; 95 % CI) folate (-1·2; -2·2, -0·2 and -2·3; -4·0, -0·7 nmol/l, respectively) and Fe (-1·7; -2·3, -1·1 and -3·6; -4·7, -2·6 μmol/l, respectively) levels than women with normal weight. Furthermore, overweight women had 6 % (95 % CI -9, -3 %) and obese women had 15 % (-19, -10 %), lower vitamin B12 levels, and obese women had 19 % (6, 32 %) higher ferritin levels, than normal-weight women. Obese women had higher odds (OR; 95 % CI) for folate deficiency (2·03; 1·35, 3·06), Fe deficiency (3·26; 2·09, 5·08) and vitamin B12 deficiency (2·05; 1·41, 2·99) than women with normal weight. Underweight was not associated with micronutrient status.. During early pregnancy, women with pre-pregnancy overweight and obesity had lower serum folate, Fe and vitamin B12 status. This resulted in increased risk of serum folate, Fe and vitamin B12 deficiencies in women with obesity.

Topics: Adult; Body Mass Index; Body Weight; Deficiency Diseases; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Humans; Ideal Body Weight; Iron; Iron Deficiencies; Maternal Nutritional Physiological Phenomena; Micronutrients; Nutritional Status; Odds Ratio; Overweight; Pregnancy; Pregnancy Complications; Regression Analysis; Thinness; Vitamin B 12; Vitamin B 12 Deficiency

The correlation between abnormal vitamin serum levels and chronic liver disease has been previously described in literature. However, the association between the severity of folate serum levels (B9), vitamin B12 and nonalcoholic steatohepatitis (NASH) has not been widely evaluated. Therefore, the aim of this study was to investigate the existence of such a correlation in a cohort of NASH patients.. All patients aged 18 years and older who were diagnosed with biopsy-proven NASH at the EMMS hospital in Nazareth during the years 2015-2017 were enrolled in this study. Data regarding demographic, clinical and laboratory parameters was collected. Patients with other liver diseases were excluded.. Eighty-three NASH patients were enrolled during the study period. The mean age was 41 ± 11 years and the majority of patients were male. Mean values of folate and B12 were 9.85 ± 10.90 ng/mL and 387.53 ± 205.50 pg/mL, respectively. Half of the patients were presented with a grade 1 steatosis (43.4%), a grade 2 fibrosis (50.6%) and a grade 3 activity score (55.4%). The fibrosis grade was significantly correlated with low folate levels on multivariate analysis (. Our study demonstrated a statistically significant correlation between low levels of folate and vitamin B12 with the histological severity of NASH. These findings could have diagnostic and therapeutic implications for patient management and follow-up.

Topics: Adolescent; Adult; Aged; Biopsy; Cohort Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; Liver; Liver Cirrhosis; Male; Middle Aged; Non-alcoholic Fatty Liver Disease; Severity of Illness Index; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Behcet's disease (BD) patients may have one or more hematinic deficiencies. This study evaluated whether there were significantly higher frequencies of hemoglobin, iron, vitamin B12, and folic acid deficiencies and of hyperhomocysteinemia in BD patients.. The blood hemoglobin, iron, vitamin B12, folic acid, and homocysteine concentrations in 63 BD patients were measured and compared with the corresponding levels in 126 age- and sex-matched healthy control subjects.. We found that 30.2%, 34.9%, 6.3%, 6.3%, and 14.3% of 63 BD patients had hemoglobin, iron, vitamin B12, and folic acid deficiencies and hyperhomocysteinemia, respectively. Both 63 BD and 19 major-typed RAS/BD patients had significantly higher frequencies of hemoglobin, iron, vitamin B12, and folic acid deficiencies and of hyperhomocysteinemia than 126 healthy control subjects (all P-values < 0.05). Moreover, 44 minor-typed RAS/BD patients had significantly higher frequencies of hemoglobin and iron deficiencies than 126 healthy control subjects (both P-values < 0.001). Of the 19 anemic BD patients, one had pernicious anemia, one had macrocytic anemia, 12 had normocytic anemia, four had iron deficiency anemia, and one had thalassemia trait-induced anemia.. There are significantly higher frequencies of hemoglobin, iron, vitamin B12, and folic acid deficiencies and of hyperhomocysteinemia in BD patients. The normocytic anemia is the most common type of anemia in our 63 BD patients. We suggest that supplementations of vitamin BC capsules plus deficient vitamin B12 and/or folic acid may reduce the abnormally high serum homocysteine level to a relatively lower level in BD patients with hyperhomocysteinemia.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Behcet Syndrome; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Hematinics; Hemoglobins; Homocysteine; Humans; Hyperhomocysteinemia; Iron; Male; Middle Aged; Taiwan; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

The red blood cell (RBC) folate test is a laboratory test with limited clinical utility. Previous attempts to reduce physician ordering of unnecessary laboratory tests, including folate levels, have resulted in only modest success. The objective of this study was to assess the effectiveness and impacts of restricting RBC folate ordering in the electronic health record (EHR).. This was a retrospective observational study that took place from January 2010 to December 2016 at a large academic healthcare network in Toronto, Canada. All inpatients and outpatients who underwent at least 1 RBC folate or vitamin B12 test during the study period were included. Ordering an RBC folate test was restricted to clinicians in gastroenterology and hematology. The option to order the test was removed from other physicians' computerized order entry screens in the EHR in June 2013.. RBC folate testing decreased by 94.4% during the study, from a mean of 493.0 ± 48.0 tests per month prior to intervention to 27.6 ± 10.3 tests per month after intervention (P < .001).. Restricting RBC folate ordering in the EHR resulted in a large and sustained reduction in RBC folate testing. Significant cost savings, estimated at more than a quarter of a million Canadian dollars over 3 years, were achieved. There was no significant clinical impact of the intervention on the diagnosis of folate deficiency.

Topics: Cost Savings; Electronic Health Records; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hospital Costs; Humans; Male; Medical Order Entry Systems; Retrospective Studies; Unnecessary Procedures; Vitamin B 12

Mandatory fortification of staple grains with folic acid and/or vitamin B12 (B12) is under debate in many countries including Ireland, which has a liberal, but voluntary, fortification policy. Older adults can be at risk of both deficiency and high folate status, although little is known on the actual prevalence and the major predictors. Population prevalence estimates from older adults (n 5290 ≥50 years) from the Irish Longitudinal Study on Ageing (TILDA) (Wave 1) are presented here. Measures included plasma total vitamin B12 and folate, whereas predictors included detailed demographic, socio-economic, geographic, seasonal and health/lifestyle data. The prevalence of deficient or low B12 status (45 nmol/l) was observed in 8·9 %, whereas high B12 status was observed in 3·1 % (>601 pmol/l). The largest positive predictor of B12 concentration was self-reported B12 injection and/or supplement use (coefficient 51·5 pmol/; 95 % CI 9·4, 93·6; P=0·016) followed by sex and geographic location. The largest negative predictor was metformin use (-33·6; 95 % CI -51·9, -15·4; P<0·0001). The largest positive predictor of folate concentration was folic acid supplement use (6·0; 95 % CI 3·0, 9·0 nmol/l; P<0·001) followed by being female and statin medications. The largest negative predictor was geographic location (-5·7; 95 % CI -6·7, -4·6; P<0·0001) followed by seasonality and smoking. B-vitamin status in older adults is affected by health and lifestyle, medication, sampling period and geographic location. We observed a high prevalence of low B12 and folate status, indicating that the current policy of voluntary fortification is ineffective for older adults.

Topics: Aged; Aged, 80 and over; Aging; Biomarkers; Cluster Analysis; Cohort Studies; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Geography; Humans; Ireland; Life Style; Longitudinal Studies; Male; Middle Aged; Nutritional Status; Prevalence; Regression Analysis; Risk; Seasons; Smoking; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

Patients are at risk of anemia post Roux-en-Y gastric bypass (RYGB). We sought to determine the prevalence of anemia and related nutritional deficiencies 5 years after RYGB and to evaluate adherence to nutritional supplements with iron, vitamin B12, and folate.. Patients operated with RYGB 2004-2006 were eligible for evaluation. Blood samples were collected and use of nutritional supplements was recorded preoperatively, and at outpatients' consultations 1, 2, and 5 years postoperatively. Of 203 patients operated, 184 (91%) completed the 5 year follow-up and were included in the study. Of these, 97% had valid measurements of hemoglobin both at baseline and after 5 years.. During the 5 years after RYGB, the prevalence of anemia increased from 4% preoperatively to 24% in females, and from 0% to 7% in males. Ferritin levels decreased gradually in both genders. Iron deficiency increased from 6% preoperatively to 42% at 5 years in females, and from 0% to 9% in males. Vitamin B12 deficiency was not altered while folate deficiency decreased from 10% preoperatively to 1% at 5 years. Five years after surgery 25% reported the use of supplements with iron, while 83% used vitamin B12 and 65% used multivitamins with folate.. We observed a long-term increase in anemia and iron deficiency after RYGB in both genders, but most pronounced in women. Our postoperative protocol for prevention of vitamin B12 and folate deficiencies appear acceptable. Iron status and iron supplementation seems to need stronger emphasis during follow-up after RYGB.

Topics: Adult; Anemia, Iron-Deficiency; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Gastric Bypass; Humans; Iron; Linear Models; Male; Medication Adherence; Middle Aged; Norway; Obesity, Morbid; Postoperative Period; Sex Distribution; Vitamin B 12; Vitamin B 12 Deficiency

Retinal vascular occlusions are uncommon in young people and require more in-depth investigation into the cause. Studies have revealed that a high level of circulating homocysteine poses a risk for retinal vaso-occlusive events across a wide age range. This case report reflects on how the interplay of genetic mutation and vitamin deficiency can cause a pathological level of homocysteine with resultant branch retinal artery occlusion in a young patient.. A 16-year-old boy presented to eye casualty with acute inferior visual field loss in the left eye. Visual acuity remained normal at 6/6 each eye and the event was painless. Initial assessment, and retinal photography revealed a left superior hemi-field branch retinal artery occlusion with macular sparing. Given the patient's age, extensive investigation into the cause was carried out. Positive findings were of an elevated level of homocysteine as a result of vitamin B12 and folic acid deficiency as well as a genetic mutation in the MTHFR gene (encoding MTHFR enzyme which is vital in normal homocysteine metabolism). Vitamin B12 and folic acid were replaced which in turn normalized the patient's homocysteine levels. At two months, the patient's visual fields had also improved, and no further vascular event had occurred.. This case report has highlighted the link between hyperhomocysteinaemia and retinal artery occlusion. However, despite vitamin replacement being shown to normalize homocysteine levels, no evidence exists to date as to whether this will reduce the risk of further retinal vascular occlusion.

Topics: Adolescent; Folic Acid; Folic Acid Deficiency; Genetic Predisposition to Disease; Genotype; Homocysteine; Humans; Hyperhomocysteinemia; Male; Malnutrition; Methylenetetrahydrofolate Reductase (NADPH2); Retinal Artery Occlusion; Vision Disorders; Visual Acuity; Visual Field Tests; Visual Fields; Vitamin B 12; Vitamin B 12 Deficiency

In our study, we aimed to evaluate the serum homocysteine levels, pyridoxine, folate and vitamin B12 levels in children with attention deficit hyperactivity disorders (ADHD).. This study included 30 newly diagnosed drug-naive children with ADHD (23 males and 7 female, mean age 9.3±1.8 years) and 30 sex-and age matched healthy controls. The diagnosis of ADHD was made according to DSM-V criteria. Children and adolescents were administered the Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Lifetime Version, the Conners' Parent Rating Scale-Revised, Long Form, the Conners' Teacher Rating Scale and the Wechsler Intelligence Scale for Children Revised (WISC-R) for all participants. Homocysteine, pyridoxine, folate and vitamin B12 levels were measured with enzyme-linked immunosorbent assay.. Homocysteine, pyridoxine, folate and vitamin B12 levels were significantly lower in children with ADHD compared with their controls (p<0.05). A positive significant correlation was observed between the all WISC-R scores and vitamin B12 level in patients (r=0.408, p=0.025).. The results obtained in this study showed that reduced homocysteine, pyridoxine, folate and vitamin B12 levels could be a risk factor in the etiology of ADHD.

Topics: Attention Deficit Disorder with Hyperactivity; Behavior Rating Scale; Child; Enzyme-Linked Immunosorbent Assay; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Pyridoxine; Reference Values; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6 Deficiency; Wechsler Scales

Impaired B vitamin status has been identified as a risk factor for major chronic diseases. This study aims at examining the determinants of plasma folate and vitamin B12 concentrations, considering lifestyle factors and MTHFR polymorphisms.. A total of 988 women aged 40-65 years from the French E3N cohort were investigated. Intakes of folate and vitamin B12 were assessed using food frequency questionnaires, and plasma concentrations were measured by microbiological assay. Dietary scores were computed to summarize folate and vitamin B12 dietary sources. MTHFR-C677T and MTHFR-A1298C were determined by Kaspar assay. Pearson's partial correlation coefficients and multivariable linear regression models were used to assess correlations between main determinants and plasma folate and vitamin B12 levels.. The partial correlation coefficient between dietary intakes and plasma folate was 0.19 (p value <0.001) and 0.08 (p value = 0.008) for vitamin B12. Dietary scores were the main determinant of B vitamin plasma concentrations with a percent change per unit increase of 12.64% (p value <0.001) for folate and 7.6% (p value <0.001) for vitamin B12. Homozygous (T/T) or heterozygous (C/T) women for MTHFR-C677T had lower plasma folate concentrations [C/T: -6.48% (p value = 0.038) and T/T: -15.89% (p value <0.001)] compared to women carrying the C/C genotype. Other determinants of B vitamin plasma concentration include: smoking status for folate, and age and hormone replacement therapy for vitamin B12.. We confirmed previous findings on the role of diet as main determinant of folate and vitamin B12 plasma concentrations. However, the impact of genetic polymorphisms and lifestyle factors on plasma B vitamin concentrations should not be neglected.

Topics: Amino Acid Substitution; Biomarkers; Case-Control Studies; Cohort Studies; Diet; Diet, Healthy; Female; Folic Acid; Folic Acid Deficiency; France; Genetic Association Studies; Genetic Predisposition to Disease; Humans; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Nutritional Status; Patient Compliance; Polymorphism, Single Nucleotide; Prospective Studies; Self Report; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Anemia; Belize; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Middle Aged; Nutrition Surveys; Nutritional Status; Prevalence; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Young Adult

Obsessive compulsive disorder (OCD) is a complex disorder with a poorly understood aetiopathogenesis. One carbon metabolism that includes vitamin B12, folic acid and homocysteine has been investigated in many psychiatric disorders like OCD. In recent years, vitamin D has also been considered to contribute to many of these psychiatric disorders. In this study we investigated whether vitamin B12, homocysteine and vitamin D play a role in the aetiology of paediatric OCD. With this aim we compared 52 children and adolescent OCD patients with 30 healthy controls. The participants were tested for vitamin B12, folic acid, homocysteine and vitamin D levels and were evaluated with a sociodemographic form, state-trait anxiety inventory 1 and 2, Kovacs Depression Inventory and Yale-Brown Obsessive Compulsive Scale (Y-BOCS). As a result we found significantly lower levels of vitamin B12 and vitamin D and higher levels of homocysteine in the patient group compared to control group (p values for all three scores were <0.001), whereas there was no significant difference between groups in terms of folate levels (p=0.083). This demonstrates that one carbon metabolism and vitamin D deficiency can play a role in the aetiology of OCD.

Topics: Adolescent; Biomarkers; Child; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Vitamin B 12; Vitamin D; Vitamin D Deficiency

Serum anti-gastric parietal cell (GPCA), anti-thyroglobulin (TGA), and anti-thyroid microsomal antibodies (TMA) can be found in some recurrent aphthous stomatitis (RAS) patients. This study mainly assessed whether serum GPCA, TGA, TMA and RAS itself played significant roles in causing anemia and hematinic deficiencies in TGA/TMA-positive RAS patients with GPCA positivity (GPCA+/TGA/TMA/RAS patients) or negativity (GPCA-/TGA/TMA/RAS patients).. The mean corpuscular volume (MCV) and mean blood hemoglobin (Hb), iron, vitamin B12, and folic acid levels were measured and compared between any two of the four groups of 15 GPCA+/TGA/TMA/RAS patients, 69 GPCA-/TGA/TMA/RAS patients, 240 all autoantibodies-negative RAS patients (Abs-/RAS patients), and 342 healthy control subjects.. GPCA+/TGA/TMA/RAS patients had significantly lower mean Hb (for men only) and vitamin B12 levels as well as significantly greater frequencies of Hb, iron, and vitamin B12 deficiencies than healthy control subjects. GPCA+/TGA/TMA/RAS patients had lower serum vitamin B12 level and higher MCV as well as a significantly greater frequency of vitamin B12 deficiency than GPCA-/TGA/TMA/RAS patients. Furthermore, both GPCA-/TGA/TMA/RAS and Abs-/RAS patients did have significantly lower mean Hb, MCV, and iron levels as well as significantly greater frequencies of Hb, iron and vitamin B12 deficiencies than healthy control subjects. There were no significant differences in blood data between GPCA-/TGA/TMA/RAS and Abs-/RAS patients CONCLUSION: Both serum GPCA positivity and RAS itself are the contributing factors causing anemia and hematinic deficiencies in GPCA+/TGA/TMA/RAS patients. RAS itself but not TGA/TMA positivity plays a significant role in causing anemia and hematinic deficiencies in GPCA-/TGA/TMA/RAS patients.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Anemia, Pernicious; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iron; Male; Middle Aged; Parietal Cells, Gastric; Stomatitis, Aphthous; Taiwan; Vitamin B 12

Approximately 13% of recurrent aphthous stomatitis (RAS) patients have serum anti-gastric parietal cell antibody (GPCA) positivity. This study assessed whether serum GPCA or RAS itself was a significant factor causing hematinic deficiencies and anemia statuses in GPCA-positive RAS (GPCA+/RAS) and all autoantibodies-negative RAS (Abs-/RAS) patients.. The mean corpuscular volume (MCV) and mean blood hemoglobin (Hb), iron, vitamin B12, and folic acid levels were measured and compared between any two of three groups of 31 GPCA+/RAS patients, 240 Abs-/RAS patients, and 342 healthy control subjects.. GPCA+/RAS patients had significantly lower mean Hb and serum iron level (for women only) as well as significantly greater frequencies of Hb, iron, and vitamin B12 deficiencies than healthy control subjects. Moreover, GPCA+/RAS patients had a significantly higher MCV and a significantly greater frequency of vitamin B12 deficiency than Abs-/RAS patients. Furthermore, Abs-/RAS patients did have significantly lower mean Hb, MCV, iron, and folic acid levels and significantly greater frequencies of Hb, iron, vitamin B12, and folic acid deficiencies than healthy control subjects. Of 31 GPCA+/RAS patients, 3 (9.7%) had PA, 6 (19.4%) had vitamin B12 deficiency, and 3 (9.7%) had macrocytosis. Moreover, normocytic anemia (54.0%) and iron deficiency anemia (26.4%) are the two more common types of anemia in our RAS patients.. We conclude that serum GPCA plays a significant role in causing vitamin B12 deficiency and high MCV in GPCA+/RAS patients. RAS itself does play a significant role in causing anemia and hematinic deficiencies in both GPCA+/RAS and Abs-/RAS patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Anemia, Iron-Deficiency; Anemia, Macrocytic; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iron; Male; Middle Aged; Parietal Cells, Gastric; Stomatitis, Aphthous; Taiwan; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Folate and cobalamin are essential cofactors for homocysteine (HCY) metabolism. Hyperhomocysteinemia, a multifactorial condition, may reflect B vitamin deficiency and is associated with increased risk of cardiovascular disease, thrombosis, and neurodegenerative and chronic gastrointestinal diseases in humans. Hyperhomocysteinemia has been reported in Greyhounds with suspected chronic enteropathy.. To evaluate the frequencies of and the association between hypofolatemia and hyperhomocysteinemia in Greyhounds.. Data and serum samples from 559 Greyhounds.. Nested case-control study. The frequency of hypofolatemia in Greyhounds was determined by a laboratory database search. The relationship between hyperhomocysteinemia (measured by gas chromatography-mass spectrometry) and hypocobalaminemia and hypofolatemia was evaluated, and its frequency compared between healthy Greyhounds and Greyhounds with thrombosis or chronic diarrhea.. Hypofolatemia was identified in 172 of 423 (41%) Greyhounds and was more common in hypo- than in normocobalaminemic dogs (49% vs. 35%; P = .0064). Hyperhomocysteinemia was detected in 53 of 78 (68%) of Greyhounds, being more common in hypo- than in normofolatemic dogs (88% vs. 59%; P = .0175). All healthy Greyhounds, 21 of 30 (70%) of dogs with chronic diarrhea and 6 of 8 (75%) of those with thrombosis, were hyperhomocysteinemic. Serum HCY concentrations were inversely correlated with serum folate concentration (ρ = -0.28; P = .0386) and were positively associated with serum albumin concentration (ρ = 0.66; P = .0022).. Hyperhomocysteinemia occurs frequently in the Greyhound population. Its association with hypofolatemia suggests decreased intracellular availability of B vitamins, but the functional implications warrant further investigation. Hyperhomocysteinemia in Greyhounds potentially may serve as a spontaneous canine model to further investigate hyperhomocysteinemia in humans.

Topics: Animals; Case-Control Studies; Dog Diseases; Dogs; Female; Folic Acid; Folic Acid Deficiency; Hyperhomocysteinemia; Male; Ohio; Pedigree; Surveys and Questionnaires; Texas; Vitamin B 12

Epidemiological studies have reported inconsistent findings for the association between B vitamins and breast cancer (BC) risk. We investigated the relationship between biomarkers of folate and vitamin B12 and the risk of BC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Plasma concentrations of folate and vitamin B12 were determined in 2,491 BC cases individually matched to 2,521 controls among women who provided baseline blood samples. Multivariable logistic regression models were used to estimate odds ratios by quartiles of either plasma B vitamin. Subgroup analyses by menopausal status, hormone receptor status of breast tumors (estrogen receptor [ER], progesterone receptor [PR] and human epidermal growth factor receptor 2 [HER2]), alcohol intake and MTHFR polymorphisms (677C > T and 1298A > C) were also performed. Plasma levels of folate and vitamin B12 were not significantly associated with the overall risk of BC or by hormone receptor status. A marginally positive association was found between vitamin B12 status and BC risk in women consuming above the median level of alcohol (OR

Topics: Adult; Aged; Alcohol Drinking; Biomarkers; Breast Neoplasms; Case-Control Studies; Diet; Estrogens; Europe; Female; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Genes, erbB-2; Humans; Life Style; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Neoplasms, Hormone-Dependent; Polymorphism, Single Nucleotide; Progesterone; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Many children in low- and middle-income countries may have inadequate intake of vitamin B12 and folate; data confirming these inadequacies are limited. We used biochemical, demographic, behavioral and anthropometric data to describe the folate and vitamin B12 concentrations among six- to 23-month-old Nepalese children. Vitamin B12 (serum B12 < 150 pmol/L) and folate deficiencies (red blood cell (RBC) folate < 226.5 nmol/L) were assessed. We used logistic regression to identify predictors of vitamin B12 deficiency. The vitamin B12 geometric mean was 186 pmol/L; 30.2% of children were deficient. The mean RBC folate concentration was 13,612 nmol/L; there was no deficiency. Factors associated with vitamin B12 deficiency included: (a) age six to 11 months (adjusted odds ratio (aOR) 1.51; 95% confidence interval (CI): 1.18, 1.92) or 12-17 months (aOR 1.38; 95% CI: 1.10, 1.72) compared to 18-23 months; (b) being stunted (aOR 1.24; 95% CI: 1.03, 1.50) compared to not being stunted; (c) and not eating animal-source foods (aOR 1.85; 95% CI: 1.42, 2.41) compared to eating animal-source foods the previous day. There was a high prevalence of vitamin B12 deficiency, but no folate deficiency. Improving early feeding practices, including the consumption of rich sources of vitamin B12, such as animal-source foods and fortified foods, may help decrease deficiency.

Topics: Cluster Analysis; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Logistic Models; Male; Nepal; Prevalence; Vitamin B 12; Vitamin B 12 Deficiency

Anemia is a major public health issue despite preventive interventions. Data on non-iron nutritional deficiency anemia in hospitalized patients are limited.. This study explored the incidence, clinical features, and outcomes of hospitalized patients diagnosed with non-iron nutritional deficiency anemia at a major teaching hospital in Thailand.. Medical records of in-patient departments dated between January 2001 and June 2011 were retrospectively reviewed.. One hundred and two cases were identified, including 40 patients with vitamin B12 deficiency, 46 with folate deficiency, and 16 with other nutritional deficiency anemias; corresponding incidence rates were 0.4, 0.6, and 0.2 cases per 100,000 per year, respectively. Patients with vitamin B12 deficiency were mostly female, while patients with folate deficiency were preponderantly male. Glossitis and pancytopenia were common characteristics of vitamin B12 deficiency cases, whereas alcohol abuse and cirrhosis were more frequent in folate deficiency cases, as expected. Serum ferritin levels were relatively high across all categories. A significant proportion of anemia cases across all subgroups presented concomitantly with anorexia or poor food intake, which indicates underlying nutritional problems in these patients. Survival of patients with folate and other types of nutritional deficiency anemia was lower than for patients with vitamin B12 deficiency anemia (hazard ratio [HR] and p-values were 2.65, 0.001 and 2.35, 0.023, respectively). Hemoglobin normalization in patients with vitamin B12 deficiency anemia could be achieved by intramuscular injection and oral vitamin B12 treatment in 55.56% and 33.33% (p = 0.248), with a median response time of 9 and 86 weeks (p = 0.151), respectively.. Non-iron nutritional deficiency anemia was not common in hospitalized patients in this study. Vitamin B12 injections resulted in faster responses, but with similar efficacy compared with oral treatments. Survival of patients with vitamin B12 deficiency anemia was significantly better than that of those with folate or other types of nutritional anemia.

Topics: Anemia; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Incidence; Male; Retrospective Studies; Thailand; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Folic Acid; Folic Acid Deficiency; Hematinics; Humans; Prospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Carcinogenesis; Case-Control Studies; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Greece; Homocysteine; Humans; Male; Neoplasms; Vitamin B 12; Vitamin B 12 Deficiency

The aim of the present study was to assess the prevalence of deficiency of folate and vitamin B12 and, simultaneously, the nutrient intake adequacy of folate, vitamin B12, iron, vitamin A, vitamin C, vitamin B6 and calcium in 391 adolescent anaemic (Hb<120 g/l) schoolgirls living in the delta region of Myanmar (Burma). Dietary intakes were assessed using a 3 d estimated food record. The distribution of observed intakes calculated from the food records were adjusted for usual intakes, and the prevalence of inadequacy was estimated using the estimated average requirement cut-point method. Median (first, third quartile) serum folate and vitamin B12 concentrations were 6·5 (4·6, 8·5) nmol/l and 612·8 (443·2, 795·2) pmol/l, respectively. The prevalence of folate deficiency defined as <6·8 nmol/l was 54 %; however, vitamin B12 deficiency defined as <148 pmol/l was negligible (<1 %). The prevalence of inadequate intake of folate was high (100 %) as was the prevalence of inadequate intakes of vitamin A, vitamin C, vitamin B6 and calcium, ranging from 60 to 100 %. Red meat or poultry was rarely consumed, but fish was consumed on a daily basis. Green leafy vegetables were also consumed frequently but consumption of dairy products was uncommon. Folate deficiency was high, and the prevalence of inadequate intake of folate among other key micronutrients was relatively common in this sample of anaemic adolescent schoolgirls. Appropriate strategies such as food fortification and dietary diversification are needed to improve the micronutrient status of these young women to ensure optimal health and future reproductive success.

Topics: Adolescent; Anemia; Diet; Diet Records; Diet Surveys; Feeding Behavior; Female; Folic Acid; Folic Acid Deficiency; Humans; Myanmar; Vitamin B 12; Vitamin B 12 Deficiency

Deficiency of vitamin B12 (B12) and folate (FA) leads to a wide spectrum of disorders that affect all age groups. However, reports on B12 and FA status in healthy adults in India are limited. Hence, we determined the plasma levels and dietary intake of B12 and FA in the adult population.. We conducted a community-based cross-sectional study in an urban setup among 630 apparently healthy adults distributed into 3 age groups: 21-40, 41-60 and >60 years. Plasma concentrations of B12 and FA were analyzed by radio immunoassay and dietary intake by 24-hour recall method.. The overall prevalence of FA deficiency was 12%, but there was no significant difference in plasma FA concentrations among the groups. While the overall prevalence of B12 deficiency was 35%, it was significantly higher in the 21-40 (44%) and 41-60 age groups (40%) when compared with the >60 group (30%). B12 deficiency was higher in vegetarians (54%) compared to those consuming mixed diet (31%), and the reverse was the case with FA. However, the dietary intakes of FA and B12 were not significantly different among the groups.. These results indicate a higher prevalence of B12 deficiency in apparently healthy adults in an urban setup.

Topics: Adult; Age Factors; Aged; Anthropometry; Cross-Sectional Studies; Diet; Diet, Vegetarian; Female; Folic Acid; Folic Acid Deficiency; Humans; India; Male; Middle Aged; Nutrition Assessment; Nutritional Status; Prevalence; Urban Population; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins; Young Adult

A 63-year-old man was admitted to our hospital because of convulsive seizures. Radiological examinations revealed cerebral venous sinus thrombosis in the anterior part of the superior sagittal sinus. He had marked hyperhomocysteinemia (93.5 nmol/ml) due to combined deficiencies of folate and vitamin B12. He was T/T homozygous for methylene tetrahydrofolate reductase C677T polymorphism. He received a supplement therapy of vitamins. First, he was administered folate orally. After 3 months, the serum level of homocysteine decreased to 22.6 nmol/ml (an 86% reduction), but was still above the normal level. Next, an additional supplement therapy of vitamin B12 lowered the homocysteine level to normal (12.3 nmol/ml) after 4 months. These results showed that the increase of homocysteine levels in this patient was mainly caused by the deficiency of folate. Additionally, acquired risk factors like vitamin deficiencies increased the level of serum homocysteine to almost 100 nmol/ml.

Topics: Folic Acid; Folic Acid Deficiency; Humans; Hyperhomocysteinemia; Male; Methylenetetrahydrofolate Dehydrogenase (NADP); Middle Aged; Mutation; Risk Factors; Sinus Thrombosis, Intracranial; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

To explore whether maternal vitamin B12 and folate status during early pregnancy are associated with cardiometabolic risk factors in the offspring at age 5-6.. Prospective multi-ethnic birth cohort, the Amsterdam Born Children and their Development study (ABCD).. 12,373 pregnant women living in Amsterdam were approached between 2003 and 2004 for participation in the study.. Mother-child pairs for whom information on maternal vitamin B12 or folate status in early gestation and health at age 5-6 years was available (n = 1950).. Vitamin B12 and folate concentrations were determined in maternal serum at intake in early pregnancy (median 13 weeks' gestation). Anthropometric measurements, blood pressure and fasting blood samples were collected during a health check of children aged 5-6 years. Multiple linear regression was performed to investigate the association between maternal serum concentrations and children's outcomes, corrected for confounders.. Gestational age at birth, birthweight, body mass index (BMI), glucose levels, triglyceride levels, blood pressure and heart rate of the offspring at age 5-6.. Low maternal folate levels during early pregnancy were associated with slightly higher BMI in the offspring [decrease per 10 units: β 0.07 kg/m(2), 95% confidence interval (CI) 0.01, 0.13]. Low maternal vitamin B12 concentrations were associated with higher heart rates (decrease per 100 units: β 0.49 beats/min, 95% CI 0.11, 0.87).. This study provides further evidence that maternal nutrition in early pregnancy may possibly program cardiometabolic health of the offspring.. Low folate and vitamin B12 levels during pregnancy are associated with higher BMI and heart rate in offspring.

Topics: Adult; Child; Child, Preschool; Ethnicity; Female; Folic Acid; Folic Acid Deficiency; Heart Diseases; Humans; Male; Metabolic Diseases; Pregnancy; Pregnancy Complications; Prospective Studies; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Both deficiency and, according to recent reports, excess of vitamin B12 (B12) are associated with increased mortality. Thus, it is difficult to estimate the effect of B12 on overall survival, which also depends on folate (FA) in homocysteine lowering. This study aimed to assess FA and B12 serum concentrations associated with long-term survival of vascular surgery patients by means of a prognostic index (PI).. This single-center, prospective cohort study comprised 485 consecutive carotid surgery patients. B-vitamin baseline concentrations of B12 and FA were used to compute a PI for postoperative overall survival from January 2003 to January 2012 (mean observation period 102.3 months).. Increasing B12 serum concentrations showed a nonlinear association with overall survival (P = .033). A B vitamin-based PI significantly predicted overall (hazard ratio [HR] per standard deviation = 1.97, confidence interval [CI] 1.37-2.82; P < .001), cardiovascular (HR = 3.03, CI 1.78-5.14; P < .001), and stroke-free survival (HR = 2.20, CI 1.22-3.98; P = .009), and revealed that the highest adverse event-free survival was predicted by high FA (16.3 ± 12.9 ng/mL) but only moderate B12 (360.3 ± 156.0 pmol/L) baseline concentrations.. Prediction of increased long-term overall, cardiovascular, and stroke-free survival is based on high FA but only moderate B12 serum concentrations. Excessive B12 concentrations might harbor a potential harm and are no requisite for low homocysteine concentrations. The association between B vitamins and survival might serve either as a tool for risk stratification or, if causative, as effective therapy, if optimal dosing of B vitamins is provided and on-treatment concentrations, including homocysteine and renal functions, are closely monitored.

Topics: Aged; Austria; Biomarkers; Carotid Stenosis; Disease-Free Survival; Endarterectomy, Carotid; Female; Folic Acid; Folic Acid Deficiency; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Nonlinear Dynamics; Proportional Hazards Models; Prospective Studies; Risk Factors; Stroke; Time Factors; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

Undernutrition as well as low levels of vitamin B12 and folic acid are common problems among older adults. However, recommended routine nutritional status assessment tools may result in inadequate vitamin serum levels to go unnoticed. Therefore, the aim of this study is to evaluate the inadequacy of serum levels of vitamin B12 and folic acid within Mini Nutritional Assessment (MNA) classification categories among older adults. A cross-sectional study was conducted with 97 older adults residing in care homes in Portugal. Undernutrition was identified through the MNA, and serum levels of vitamin B12 and folic acid were measured using chemiluminescence. Cognitive function, depressive symptoms and functional characteristics were also assessed using the Abbreviated Mental Test Score, the Epidemiologic Studies Depression Scale and the Barthel Index, respectively. The mean age of older adults was 82.2 (6.3) years; 3.1% were undernourished and 26.8% were at undernutrition risk. In the MNA normal nutritional status group, 11.8% presented vitamin B12 deficiency (<200 pg/ml), 32.4% had low serum levels (200-400 pg/ml) and 4.4% had folic acid deficiency (<3 ng/ml). A high proportion of older adults with low serum levels of vitamin B12 presenting normal nutritional status by MNA was identified. This finding emphasizes the need to evaluate serum vitamin B12 levels, independently of the MNA results.

Topics: Aged; Aged, 80 and over; Cognition; Cognition Disorders; Cross-Sectional Studies; Depression; Female; Folic Acid; Folic Acid Deficiency; Geriatric Assessment; Hematinics; Humans; Luminescence; Male; Malnutrition; Nutrition Assessment; Nutritional Status; Portugal; Reference Values; Vitamin B 12; Vitamin B 12 Deficiency

Epigenetics (particularly DNA methylation) together with environmental and genetic factors, are key to understanding the pathogenesis of many diseases including dementia. Disturbances in DNA methylation have already been implicated in dementia. Homocysteine metabolism, with folate and vitamin B12 as essential cofactors, is integral to methylation processes. We evaluated in a case-control study the association of global DNA methylation, homocysteine, folate and vitamin B12 status with dementia. Selected polymorphisms of genes previously associated with dementia development and the influence of various factors on DNA methylation were also investigated. 102 patients with dementia (53 with Alzheimer's disease, 17 with vascular dementia and 32 with mixed dementia) were recruited. The non-demented controls consisted of 45 age-matched subjects without dementia and 47 individuals with mild cognitive impairment. Global DNA methylation was determined by Imprint Methylated DNA Quantification Kit MDQ1 (Sigma-Aldrich, Gillingham, Dorset, UK). Plasma homocysteine, serum folate and vitamin B12 were determined by chemiluminescence. Plasma and erythrocyte 5-methyltetrahydrofolate and plasma methylmalonic acid (markers of folate and vitamin B12 status) were measured by HPLC. APOE, PON1 p.Q192R, MTHFR 677C>T (c.665C>T) and IL1B-511C>T polymorphisms were identified using PCR-RFLP methods. Patients with dementia had significantly higher concentrations of homocysteine (p=0.012) and methylmalonic acid (p=0.016) and lower folate (p=0.002) and plasma 5-methyltetrahydrofolate (p=0.005) than non-demented subjects. There was no difference in DNA methylation between patients and controls. A non-significant tendency to higher DNA methylation in patients with vascular dementia (p=0.061) was observed. Multivariate regression analysis of all recruited individuals demonstrated a significant positive association between DNA methylation and folate (p=0.013), creatinine (p=0.003) concentrations and IL1B-511T (p=0.002) and PON1 192R (p=0.049) alleles and negative association with fasting glucose (p=0.004). The biochemical results showed significantly lower folate and vitamin B12 status in demented patients than controls. Global DNA methylation was associated with markers of folate status, creatinine, glucose and PON1 and IL1B polymorphisms.

Topics: Aged; Aryldialkylphosphatase; Case-Control Studies; Dementia; DNA Methylation; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Interleukin-1beta; Male; Middle Aged; Poland; Polymorphism, Restriction Fragment Length; Tetrahydrofolates; Vitamin B 12

Cobalamin and folate are especially important for women of childbearing age due to their ubiquitous role in fetal growth and development. Population-based data on cobalamin and folate status are lacking from Nepal, where diets are mostly vegetarian. The objectives of the study were to investigate cobalamin and folate intake and status, and to explore associations with socio-demographics, anthropometrics, anemia, and dietary habits. Following a random selection of geographical clusters, we collected blood samples from 500 non-pregnant women and 24-h dietary recalls and food frequency questionnaires from a subsample of 379 women. Twenty percent of the women did not consume any food containing cobalamin during the days recalled, and in 72% nutritional cobalamin intake was <1 μg/day. Eighty-four percent of the women had cobalamin intake lower than the estimated average requirement (EAR) (<2 μg/day). In contrast, only 12% of the women had a folate intake less than 100 μg per day, whereas 62% had intake between 100 and 320 μg. Low plasma cobalamin (<150 pmol/L) was found in 42% of the women, most of whom (88%) also had elevated levels of methylmalonic acid. Our results indicated a high prevalence of nutritional cobalamin deficiency, while folate deficiency was uncommon.

Topics: Adolescent; Adult; Body Mass Index; Body Weight; Cross-Sectional Studies; Energy Intake; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Linear Models; Methylmalonic Acid; Nepal; Nutritional Status; Prevalence; Socioeconomic Factors; Surveys and Questionnaires; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

To investigate the association of Crohn's disease (CD) with transcobalamin Ⅱ (TCN2) gene polymorphisms and serum homocysteine (Hcy), folate, and vitamin B12 levels in Chinese patients.. In a total of 307 CD patients (CD group) and 574 healthy controls (control group) of Han ethnicity selected at 4 hospitals in Wenzhou between January 2007 and August 2015, TCN2 gene polymorphisms (rs1801198, C/G; rs9606756, A/G) in peripheral blood were determined using improved multiple ligase detection reaction (iMLDR). The Simplified Crohn's Disease Activity Index (CDAI) was applied to evaluate activity of CD. Eighty-eight CD patients and 138 age- and sex-matched controls were randomly selected from all the study subjects using computer-generated random numbers, in whom serum Hcy level was tested by enzymatic cycling assay, folate and vitamin B12 levels were examined by chemiluminescence immunoassay.. (1) The mutant allele (G) and genotype (CG+ GG) of rs1801198 were not significantly different between the CD group and the control group (both P>0.05), but more prevalent in patients with stricturing CD than in controls (65.75% vs 56.10%, 93.15% vs 82.40%, both P<0.05). The frequencies of mutant allele (G) and heterozygous genotype (AG) of rs9606756 were higher in CD patients than in controls (2.44% vs 1.05%, 4.89% vs 2.09%, both P<0.05), also higher in patients with stricturing CD or ileocolonic CD compared with controls (stricturing CD: 4.79% vs 1.05%, 9.59% vs 2.09%; ileocolonic CD: 3.18% vs 1.05%, 6.36% vs 2.09%; all P<0.05). The two polymorphic loci (rs1801198 and rs9606756) were shown to be in a weak linkage disequilibrium. The frequency of haplotype (GG) was higher in the CD patients than in the controls (2.23% vs 0.81%, P<0.05). (2) When compared with the controls, the serum Hcy level was higher in the CD patients (P=0.023), whereas the folate and vitamin B12 levels were decreased in the CD patients (both P<0.001). The prevalence of hyperhomocysteinemia (Hcy >15 μmol/L), folate deficiency (folate <4 μg/L) and vitamin B12 deficiency (<203 ng/L) were higher in the CD patients than in the controls (18.18% vs 4.35%, 27.27% vs 5.07%, 31.82% vs 5.07%, all P<0.01). Compared to the patients at remission stage (CDAI<5), the serum Hcy level was increased in those at active stage (CDAI≥5) (P=0.005), while the folate and vitamin B12 levels were decreased in the patients ate active stage (both P<0.05). (3) According to the results of multivariate linear regression analysis, average Hcy level in the CD patients was negatively associated with folate level (β=-0.494, P<0.001), while positively correlated with percentage of neutrophils (β=0.294, P=0.004). Unconditional Logistic regression showed that both folate deficiency and vitamin B12 deficiency were independent risk factors for CD (OR=5.415, OR=7.112, both P<0.001).. TCN2 rs1801198 mutation might be associated with increased risk of stricturing CD. TCN2 rs9606756 mutation might be a potential functional locus to affect CD susceptibility. Individuals carrying the haplotype (GG) formed by TCN2 (rs1801198 and rs9606756) seem to be at higher risk of developing CD. Hyperhomocysteinemia, folate deficiency, and vitamin B12 deficiency are prevalent in this cohort of CD patients of Han ethnicity from Zhejiang province. Both folate deficiency and vitamin B12 deficiency are independent risk factors for CD.

Topics: Alleles; Crohn Disease; Folic Acid; Folic Acid Deficiency; Genotype; Haplotypes; Heterozygote; Homocysteine; Humans; Hyperhomocysteinemia; Mutation; Polymorphism, Genetic; Prevalence; Risk Factors; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Folate, vitamin B12 and vitamin B6 are required for homocysteine metabolism and their deficiency can result in increased homocysteine concentration. Homocysteine concentrations have been found to be increased in late pregnancy toward nonpregnant values.. To study folate, vitamin B12 and homocysteine levels in cord blood and maternal blood in preeclampsia.. One hundred fifty pregnant women attending Out Patient Department of Department of Obstetrics and Gynaecology were recruited for the study. Grouped as: GROUP I (control): Fifty normotensive women with singleton pregnancy immediately after delivery; GROUP II (study): Fifty (age and gestation matched women with singleton pregnancy) women with preeclampsia immediately after delivery; GROUP III (study): Fifty normotensive pregnant women were recruited in first trimester (8-12 weeks) that were followed in second (24-28 weeks) and third trimester (32-36 weeks). Homocysteine, vitamin B12 and folic acid levels were investigated by competitive immunoassay using direct chemiluminiscence technology.. Homocysteine and folic acid levels were higher in maternal blood of hypertensive pregnant women as compared to normotensive pregnant women (p<0.001, p>0.05 respectively). Vitamin B12 levels were lower in maternal blood of hypertensive pregnant women as compared to normotensive pregnant women. Levels of homocysteine were higher in cord blood of hypertensive pregnant women as compared to normotensive pregnant women (p<0.01). Levels of vitamin B12 and folic acid was lower in cord blood of preeclamptic women as compared to normotensive pregnant women (p<0.001, p<0.01 respectively). A negative correlation was found between homocysteine and folic acid levels of mothers in group II that was statistically significant.. Elevated homocysteine and folate and vitamin B12 deficiency during pregnancy may be a risk factor for preeclampsia and future risk of cardiovascular risk.

Topics: Case-Control Studies; Female; Fetal Blood; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Pre-Eclampsia; Pregnancy; Pregnancy Trimesters; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Old age and diabetes mellitus are risk factors for vitamin deficiencies, weakness and falls. Deficiencies of vitamin D, and possibly vitamin B12 and folate (which are associated with hyperhomocysteinaemia), contribute to sarcopenia. Determination of the physical effects of vitamin deficiencies in specific groups of people can help to guide public health policy with regard to vitamin supplementation.. A pilot cross-sectional study was conducted to determine the association of levels of vitamin D, vitamin B12, folate and homocysteine with muscle strength, gait and fall history in 56 patients >65 years old with diabetes mellitus in primary care in Singapore. Hand-grip and leg-quadriceps strength measures were obtained and divided by body mass index (BMI). The timed up-and-go and Tinetti tests were used to measure gait. A history of "at least one fall in the preceding year" was obtained.. Vitamin B12 deficiency (<150 pmol/l) was present in 43 % of patients, folate deficiency (<13.5 mmol/l) in 20 %, hyperhomocysteinaemia (≥15.0 μmol/l) in 52 % and vitamin D deficiency (<49.9 nmol/l) in 25 %. Levels of vitamin D, vitamin B12 and homocysteine did not significantly predict muscle strength in regression analyses. Folate (B = 0.010, P < 0.01) and gender (B = 0.356, P < 0.001) predicted average grip strength corrected for BMI (F(2,53) = 17.74, P < 0.001, R. The prevalence of vitamin deficiency was very high in our sample of patients >65 years old with diabetes mellitus. Folate levels were significantly correlated with grip and leg strength (with correction for BMI). Leg strength was positively correlated with gait measures and negatively correlated with a history of falls. The role of folate in muscle weakness and falls warrants further study.

Topics: Accidental Falls; Aged; Cross-Sectional Studies; Diabetes Mellitus; Female; Folic Acid; Folic Acid Deficiency; Gait; Hand Strength; Homocysteine; Humans; Hyperhomocysteinemia; Male; Muscle Strength; Pilot Projects; Primary Health Care; Risk Factors; Singapore; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin D; Vitamin D Deficiency

Megaloblastic anemia (MBA), also known as macrocytic anemia, is a type of anemia characterized by decreased number of RBCs as well as the presence of unusually large, abnormal and poorly developed erythrocytes (megaloblasts), which fail to enter blood circulation due to their larger size. Lack of vitamin-B12 (VB12) and / or folate (Vitamin-B9, VB9) with elevated homocysteine is the key factor responsible for megaloblastic anemia. Prior studies have demonstrated the induction of apoptosis in these abnormal under-developed erythrocytes. However, it is not clear whether this apoptosis induction is due to elevated p53 level or due to any other mechanism. Furthermore, it is also not fully known whether decreased vitamin-B12 and / or folate are responsible for apoptosis induction mediated by p53 in pre-erythroblasts.. Levels of serum VB9, VB12 and homocysteine in 50 patients suffering from MBA were compared with 50 non-megaloblastic anemia control subjects, who were referred by the clinicians for bone marrow examination for medical conditions other than MBA. Next, we have measured the p53 expression in the paraffin embedded blocks prepared from bone marrow biopsy, using immunohistochemistry, and the expression levels correlated with VB9 and VB12 levels.. Out of 50 MBA patients 40 (80%) and 44 (88%) subjects had very low VB12 and VB9 levels respectively. In contrast, only 2 (4%) and 12 (24%) non-megaloblastic anemia controls, out of 50 subjects, had low VB12 and VB9 respectively. Correlating with low vitamin B9 and B12, the homocysteine levels were high in 80% cases. But, only 20% non-megaloblastic controls exhibited high homocysteine in plasma. Immunohistochemical analysis for p53 expression showed a significantly high level of expression in MBA cases and no-or very low-expression in control subjects. Our correlation studies comparing the VB12 and VB9 levels with p53 expression concludes unusually high p53 levels in patients suffering from VB12 and VB9 deficiency induced MBA compared to control subjects not suffering from MBA.. Tumor protein p53 is the key protein expressed heavily in the bone marrow biopsies of patients suffering from VB12 and VB9 deficiency induced MBA but not in control subjects. Hence, p53 expression could be used as a surrogate marker for confirming the VB9 and VB12 induced MBA.

Topics: Aged; Aged, 80 and over; Anemia, Megaloblastic; Bone Marrow Examination; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Middle Aged; Tumor Suppressor Protein p53; Up-Regulation; Vitamin B 12; Vitamin B 12 Deficiency

Some of recurrent aphthous stomatitis (RAS) patients had concomitant atrophic glossitis (AG). This study assessed whether RAS patients with AG (AG+/RAS patients) or without AG (AG-/RAS patients) had anemia and hematinic deficiencies and to evaluate whether RAS combined with AG or RAS itself was a significant factor causing anemia and hematinic deficiencies in AG+/RAS or AG-/RAS patients, respectively.. The mean corpuscular volume (MCV) and mean blood hemoglobin (Hb), iron, vitamin B12, and folic acid levels were measured and compared between any two of three groups of 160 AG+/RAS patients, 195 AG-/RAS patients, and 355 healthy control subjects.. Both AG+/RAS and AG-/RAS patients had significantly lower mean Hb, iron, and vitamin B12 levels as well as significantly greater frequencies of Hb, iron, vitamin B12, and folic acid deficiencies than healthy control subjects. Moreover, AG+/RAS patients had significantly lower mean Hb and serum iron level (for women only) and significantly greater frequencies of Hb and iron deficiencies than AG-/RAS patients. Of 69 anemia AG+/RAS patients, 30 (43.5%) had normocytic anemia and 23 (33.3%) had iron deficiency anemia. Of 38 anemia AG-/RAS patients, 26 (68.4%) had normocytic anemia and 5 (13.2%) had iron deficiency anemia.. We conclude that some of AG+/RAS or AG-/RAS patients do have anemia and hematinic deficiencies and AG+/RAS patients do have severer anemia statuses and iron deficiency than AG-/RAS patients. RAS combined with AG or RAS itself does play a significant role in causing anemia and hematinic deficiencies in AG+/RAS or AG-/RAS patients, respectively.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Anemia, Iron-Deficiency; Atrophy; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Glossitis; Hematinics; Hemoglobins; Humans; Iron; Male; Middle Aged; Recurrence; Risk Factors; Stomatitis, Aphthous; Tongue; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Deficiencies in nutrients such as folic acid and vitamin B12 may play a role in fetal growth restriction (FGR). However, whether folic acid, vitamin B12, or homocysteine is associated with FGR in Chinese populations remains unclear. This study investigated the relationship between these nutrient deficiencies and FGR in pregnant Chinese women. We selected 116 mother and infant pairs, and categorized the neonates into the FGR, appropriate for gestational age, and large for gestational age groups. Birth weight, body length, head circumference, body mass index (BMI), and Rohrer's body index of the newborns were measured. Serum folic acid, vitamin B12, and homocysteine levels were measured in mothers during the first three days of their hospital stay. Results showed that the FGR group exhibited reduced folic acid and vitamin B12 levels and elevated homocysteine levels than those in the other two groups. Folic acid and vitamin B12 levels were positively correlated with birth weight, head circumference, and BMI, whereas homocysteine level was negatively correlated with these variables. The FGR ratio in the folic acid and vitamin B12 deficiency group was higher than that in the sufficiency group (χ

Topics: Adult; China; Female; Fetal Growth Retardation; Folic Acid; Folic Acid Deficiency; Gestational Age; Homocysteine; Humans; Infant, Newborn; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Hepatitis B virus (HBV) typically causes chronic hepatitis, cirrhosis, and hepatocellular carcinoma. It is associated with a variety of extrahepatic complications. We herein, present a rare extrahepatic complication of HBV infection. A 32-year man presented with melena, bleeding from gums and fever. Peripheral blood examination revealed anemia, macrocytosis and severe thrombocytopenia. His hepatitis B surface antigen (HBsAg) was positive but deoxyribonucleic acid (HBV DNA) by polymerase chain reaction (PCR) was negative. Other hepatitis, human immune deficiency virus (HIV), dengue, and autoimmune serology were negative. Bone marrow examination revealed megaloblastic erythropoiesis. There was mild to moderate reduction of megakaryocytes in bone marrow, which was not compatible with severe peripheral thrombocytopenia. His response to cyanocobalamin and folic acid was remarkable for myeloid cell lines and moderate for erythroid cell lines, but poor to platelet counts. Platelet counts gradually improved to safe limits with eltrombopag, likely reflecting autoimmune pathogenesis for thrombocytopenia. This case report highlights multiple targets of HBV infection with associated multiple pathogenetic mechanisms.

Topics: Adult; Anemia, Megaloblastic; Benzoates; Folic Acid; Folic Acid Deficiency; Hepatitis B; Hepatitis B Surface Antigens; Hepatitis B virus; Humans; Hydrazines; Male; Platelet Count; Polymerase Chain Reaction; Pyrazoles; Tenofovir; Thrombocytopenia; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Various micronutrients are essential for optimal functioning of the peripheral nervous system. Serum vitamin E, vitamin B12, and folic acid were estimated in childhood acute lymphoblastic leukemia survivors aged between 5 and 18 years in first continuous remission within 3 years of completion of vincristine-based chemotherapy with and without electrophysiologically defined neuropathy. A total of 80 children were studied. Neuropathy was seen in 27 (33.75%) children electrophysiologically. None of the children had vitamin E deficiency. However, the alpha tocopherol/(cholesterol + triglyceride) ratio was significantly lower in children with neuropathy (P = .05). The prevalence of folate (P = .48) and vitamin B12 (P = .21) deficiency in children with and without neuropathy was not significantly different. Thus, the prevalence of deficiencies of these micronutrients was not significantly different in childhood acute lymphoblastic leukemia survivors with or without electrophysiologically defined neuropathy.

Topics: Adolescent; alpha-Tocopherol; Child; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Micronutrients; Peripheral Nervous System Diseases; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prevalence; Survivors; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin E; Vitamin E Deficiency

To determine the prevalence, clinical correlates and the effects on outcome of vitamin B12 and folic acid levels in patients with chronic heart failure (HF).. We studied an international pooled cohort comprising 610 patients with chronic HF. The main outcome measure was all-cause mortality.. Mean age of the patients was 68±12 years and median serum N-terminal prohormone brain natriuretic peptide level was 1801 pg/mL (IQR 705-4335). Thirteen per cent of the patients had an LVEF >45%. Vitamin B12 deficiency (serum level <200 pg/mL), folate deficiency (serum level <4.0 ng/mL) and iron deficiency (serum ferritin level <100 µg/L, or 100-299 µg/L with a transferrin saturation <20%) were present in 5%, 4% and 58% of the patients, respectively. No significant correlation between mean corpuscular volume and vitamin B12, folic acid or ferritin levels was observed. Lower folate levels were associated with an impaired health-related quality of life (p=0.029). During a median follow-up of 2.10 years (1.31-3.60 years), 254 subjects died. In multivariable proportional hazard models, vitamin B12 and folic acid levels were not associated with prognosis.. Vitamin B12 and folate deficiency are relatively rare in patients with chronic HF. Since no significant association was observed between mean corpuscular volume and neither vitamin B12 nor folic acid levels, this cellular index should be used with caution in the differential diagnosis of anaemia in patients with chronic HF. In contrast to iron deficiency, vitamin B12 and folic acid levels were not related to prognosis.

Topics: Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Biomarkers; Chronic Disease; Erythrocyte Indices; Europe; Female; Ferritins; Folic Acid Deficiency; Heart Failure; Humans; Iron; Kaplan-Meier Estimate; Linear Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prevalence; Proportional Hazards Models; Quality of Life; Risk Factors; Stroke Volume; Time Factors; Transferrin; Treatment Outcome; Ventricular Function, Left; Vitamin B 12; Vitamin B 12 Deficiency

To assess iron, folate and vitamin B12 status in hospitalized children aged between 6 mo to 5 y with severe acute malnutrition and its correlation with their clinico-epidemiological profile.. The study was conducted on 50 children with severe acute malnutrition. Anthropometric measurements were taken to determine their nutritional status. The demographic profile and relevant information of individual patient were collected by using structured proforma and an informed consent was taken for enrolling the children into the study. Serum ferritin, folate and vitamin B12 was estimated using electrochemiluminiscence (ECL) method.. Seventy eight percent patients had weight/height (WT/HT) Z score < -3 standard deviation (3SD), 72 % with mid upper arm circumference (MUAC) <11.5 cm and 22 % of them had edematous malnutrition. Anemia was prevalent in 47(94 %) and there was significant correlation between WT/HT < -3SD and vitamin B 12 deficiency (p = 0.015). Significantly higher number of these patients had vitamin B12 deficiency as compared to folate and iron deficiency (p = 0.0006 each).. Vitamin B12 deficiency was more common than iron and folate deficiencies in these patients with severe acute malnutrition.

Topics: Anemia; Anthropometry; Child, Preschool; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; India; Infant; Iron; Iron Deficiencies; Male; Nutritional Status; Prevalence; Severe Acute Malnutrition; Statistics as Topic; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Iron-Deficiency; Dose-Response Relationship, Drug; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Iron, Dietary; Vitamin B 12; Vitamin B 12 Deficiency

Many studies have reported that serum total homocysteine (tHcy) levels in cystathionine-beta-synthase (CBS) carriers are usually normal and only elevated after a methionine load. However, the amount of methionine required for a loading test is non-physiological and is never reached with regular feeding. Therefore, CBS carriers do not seem to be at an increased risk of cardiovascular diseases. However, the risk of cardiovascular diseases of CBS carriers with folate deficiency has not been studied. We recently found an extraordinarily high carrier rate (1/7.78) of a novel CBS mutation (p.D47E, c.T141A) in an Austronesian Taiwanese Tao tribe who live in a geographic area with folate deficiency. We evaluated if the CBS carriers tend to have higher fasting serum tHcy concentrations than non-carriers in presence of folate deficiency.. The serum tHcy and folate levels before and after folate replacement were measured in 48 adult Tao carriers, 40 age-matched Tao non-carriers and 40 age-matched Han Taiwanese controls.. The serum tHcy level of the Tao CBS carriers (17.9 ± 3.8 μmol/l) was significantly higher than in Tao non-carriers (15.7 ± 3.5 μmol/l; p < 0.008) and Taiwanese controls (11.8 ± 2.9 μmol/l; p < 0.001). Furthermore, a high prevalence of folate deficiency in the Tao compared with the Taiwanese controls (4.9 ± 1.8 ng/ml vs. 10.6 ± 5.5 ng/ml; p < 0.001) was also noted. Of note, the difference in tHcy levels between the carriers and non-carriers was eliminated by folate supplementation. (carriers:13.65 ± 2.13 μmol/l; non-carriers:12.39 ± 3.25 μmol/l, p = 0.321).. CBS carriers tend to have a higher tHcy level in the presence of folate deficiency than non-carriers. Although many reports have indicated that CBS carriers are not associated with cardiovascular disease, the risk for CBS carriers with folate deficiency has not been well studied. Owing to a significantly elevated level of fasting tHcy without methionine loading, it is important to evaluate the risk of cardiovascular disease in CBS carriers with folate deficiency.

Topics: Aged; Cardiovascular Diseases; Case-Control Studies; Cystathionine beta-Synthase; Dietary Supplements; Fasting; Female; Folic Acid; Folic Acid Deficiency; Genotyping Techniques; Heterozygote; Homocysteine; Homocystinuria; Humans; Male; Methionine; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Prevalence; Risk Factors; Taiwan; Vitamin B 12

A portion of patients with oral lichen planus (OLP) may have nutritional deficiency. This study evaluated whether there was an intimate association of the deficiencies of hemoglobin (Hb), iron, vitamin B12, and folic acid and high blood homocysteine level with OLP.. The blood Hb, iron, vitamin B12, folic acid, and homocysteine concentrations in 352 OLP patients were measured and compared with the corresponding levels in 352 age- and sex-matched healthy control participants.. We found that 77 (21.9%) OLP patients, 48 (13.6%) OLP patients, 25 (7.1%) OLP patients, and one (0.3%) OLP patient had deficiencies of Hb (men < 13 g/dL, women < 12 g/dL), iron (< 60 μg/dL), vitamin B12 (< 200 pg/mL), and folic acid (< 4 ng/mL), respectively. Moreover, 52 (14.8%) OLP patients had abnormally high blood homocysteine level. OLP patients had a significantly higher frequency of Hb, iron, or vitamin B12 deficiency and of abnormally elevated blood homocysteine level than healthy control participants (all p < 0.001). Upon further dividing OLP patients into those with major erosive OLP (MjEOLP; n = 67), minor erosive OLP (n = 202), and nonerosive OLP (NEOLP; n = 83), we found that MjEOLP patients had a significantly higher mean homocysteine level than NEOLP patients (p = 0.035).. We conclude that there is a significant association of deficiencies of Hb, iron, folic acid, and vitamin B12 and abnormally high blood homocysteine level with OLP. There may be a close relation of high blood homocysteine level to severity of OLP.

Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Homocysteine; Humans; Iron; Iron Deficiencies; Lichen Planus, Oral; Male; Middle Aged; Severity of Illness Index; Taiwan; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

To analyse the relationship between serum folate (SF), vitamin B12 and impaired cognitive function in the Chilean elderly.. We analysed the relationships between impaired cognitive function and age, SF (µg/l) and vitamin B12 (pg/ml) with Student's t test, as well as between impaired cognitive function and gender, educational level, residence area, diabetes and hypertension with the χ 2 test. Multiple logistic regressions with interactions were estimated to assess the impact of SF on impaired cognitive function according to these methods.. Chile.. Older adults (>65 years, n 1051), drawn from representative households of a national prevalence study, assessed using the Modified Mini Mental Status Examination (MMMSE). Individuals with altered MMMSE scores (≤13 points) were sequentially assessed using the Pfeffer Functional Activities Questionnaire (PFAQ).. Multivariate models using the MMMSE demonstrated an increased risk of impaired cognitive function for seniors who had hypertension, diabetes and higher vitamin B12 levels. SF and its square (SF2) were statistically significant, indicating that this predictor of impaired cognitive function displays a U-shaped distribution. The interaction between SF and vitamin B12 was not statistically significant. Models using the MMMSE plus PFAQ suggested that urban residence decreased the risk of impaired cognitive function, whereas male gender, older age, vitamin B12 levels and hypertension increased this risk. The variables SF and SF2 and the SF × vitamin B12 interaction were statistically significant (P<0.05). The risk of impaired cognitive function depended on different combinations of SF and vitamin B12 levels. When SF was low, a one-unit increase in SF (1 µg/l) diminished the risk. When SF was elevated, a further increase in SF raised the risk, especially at low vitamin B12 levels.. The relationship between folate, vitamin B12 and impaired cognitive function warrants further study.

Topics: Activities of Daily Living; Age Factors; Aged; Chile; Cognition; Cognition Disorders; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Geriatric Assessment; Humans; Hypertension; Male; Nutrition Assessment; Nutritional Status; Sex Factors; Surveys and Questionnaires; Urban Population; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Folate and vitamin B12 are essential nutrients, whose deficiencies are considerable public health problems worldwide, affecting all age groups. Low levels of these vitamins have been associated with high concentrations of homocysteine (Hcy) and can lead to health complications. Several genetic polymorphisms affect the metabolism of these vitamins. The aims of this study were to assess folate, vitamin B12 and homocysteine status in distinct Brazilian individuals after the initiation of folic acid fortification by Brazilian authorities and to investigate the effects of RFC1 A80G, GCPII C1561T and MTHFR C677T polymorphisms on folate, vitamin B12 and Hcy levels in these populations.. A total of 719 individuals including the elderly, children, as well as pregnant and lactating women were recruited from our health care center. Folate, vitamin B12 and Hcy levels were measured by conventional methods. Genotype analyses of RFC1 A80G, GCPII C1561T and MTHFR C677T polymorphisms were performed by PCR-RFLP.. The overall prevalence of folate and vitamin B12 deficiencies were 0.3% and 4.9%, respectively. Folate deficiency was observed only in the elderly (0.4%) and pregnant women (0.3%), whereas vitamin B12 deficiency was observed mainly in pregnant women (7.9%) and the elderly (4.2%). Plasma Hcy concentrations were significantly higher in the elderly (33.6%). Pregnant women carrying the MTHFR 677TT genotype showed lower serum folate levels (p = 0.042) and higher Hcy levels (p = 0.003). RFC1 A80G and GCPII C1561T polymorphisms did not affect folate and Hcy levels in the study group. After a multivariate analysis, Hcy levels were predicted by variables such as folate, vitamin B12, gender, age and RFC1 A80G polymorphism, according to the groups studied.. Our results suggest that folate deficiency is practically nonexistent in the post-folic acid fortification era in the subgroups evaluated. However, screening for vitamin B12 deficiency may be particularly relevant in our population, especially in the elderly.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Brazil; Carboxypeptidases; Child; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Infant; Lactation; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Pregnancy; Prevalence; Reduced Folate Carrier Protein; Risk Factors; Sex Factors; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Vitamin B12 and iron deficiencies lead to macrocytosis [mean corpuscular volume (MCV) ≥ 100 fL] and microcytosis (MCV < 80 fL), respectively. This study evaluated anemic status, MCV, serum homocysteine level, and serum gastric parietal cell antibody (GPCA) level in oral mucosal disease patients with both vitamin B12 and iron deficiencies.. The blood hemoglobin (Hb), iron, vitamin B12, folic acid and homocysteine concentrations, MCV, and serum GPCA in 149 patients with both vitamin B12 and iron deficiencies were measured and compared with the corresponding data in 149 age- and sex-matched healthy control subjects.. We found that 54 (36.2%), 16 (10.7%), 44 (29.5%), and 36 (24.2%) patients with both vitamin B12 and iron deficiencies had Hb deficiency (men <13 g/dL, women <12 g/dL), folic acid deficiency (≤ 6 mg/mL), abnormally high blood homocysteine level (>12.6 μM), and serum GPCA positivity, respectively. Patients with both vitamin B12 and iron deficiencies had a significantly higher frequency of Hb deficiency, abnormally elevated blood homocysteine level, and serum GPCA positivity than healthy control subjects (all p values < 0.001). Of 149 patients with both vitamin B12 and iron deficiencies, 10 (6.7%) had high MCV (≥ 100 fL), 108 (72.5%) had normal MCV (between 80 fL and 99 fL), and 31 (20.8%) had low MCV (<80 fL).. Approximately 73%, 30%, and 24% of patients with both vitamin B12 and iron deficiencies are found to have normal MCV, abnormally high blood homocysteine level, and serum GPCA positivity, respectively.

Topics: Adult; Aged; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Homocysteine; Humans; Iron; Iron Deficiencies; Male; Middle Aged; Mouth Diseases; Parietal Cells, Gastric; Taiwan; Vitamin B 12; Vitamin B 12 Deficiency

Macrocytosis is defined as having the mean corpuscular volume (MCV) ≥ 100 fL. This study assessed hematinic deficiencies and pernicious anemia (PA) in oral mucosal disease patients with macrocytosis.. The blood hemoglobin (Hb), iron, vitamin B12, folic acid, and homocysteine concentrations and MCV in 60 oral mucosal disease patients with macrocytosis were measured and compared with the corresponding data in 120 age- and sex-matched healthy control participants. PA was defined by the World Health Organization (WHO) as having an Hb concentration < 13 g/dL for men and < 12 g/dL for women, an MCV ≥ 100 fL, a serum vitamin B12 level < 200 pg/mL, and serum gastric parietal cell antibody (GPCA) positivity.. We found that 30 (50.0%), 7 (11.7%), 24 (40.0%), and three (5.0%) oral mucosal disease patients with macrocytosis had deficiencies of Hb (men < 13 g/dL, women < 12 g/dL), iron (< 60 μg/dL), vitamin B12 (< 200 pg/mL), and folic acid (< 4 mg/mL), respectively. Moreover, 38 (63.3%) and 16 (26.7%) macrocytosis patients had abnormally high blood homocysteine level (> 12.3 μM) and serum GPCA positivity, respectively. Macrocytosis patients had a significantly higher frequency of Hb, iron, or vitamin B12 deficiency, of abnormally elevated blood homocysteine level, and of GPCA positivity than healthy control participants (p < 0.001). However, only 16.7% of 60 macrocytosis patients were diagnosed as having PA by the WHO definition.. Only 16.7% of oral mucosal disease patients with macrocytosis are discovered to have PA by the WHO definition.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Anemia, Pernicious; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Erythrocytes, Abnormal; Female; Folic Acid; Folic Acid Deficiency; Hematologic Diseases; Hemoglobins; Humans; Iron; Male; Middle Aged; Mouth Diseases; Parietal Cells, Gastric; Taiwan; Vitamin B 12; Young Adult

Genetic variation can cause variable responses to environmental stimuli. A number of single-nucleotide polymorphisms (SNPs) have been associated with B vitamin status or chronic diseases related to vitamin B-12 and folate metabolism.. Our objective was to identify associations between common SNPs in genes related to folate and vitamin B-12 metabolism or associated with B vitamin-related chronic diseases and biomarkers of nutrient status in a population exposed to folic acid fortification.. A panel of 116 SNPs was sequenced by using the Sequenom iPLEX Gold platform in a sample of 3114 adults aged 20-79 y from the Canadian Health Measures Survey, cycle 1. Associations between these SNPs and red blood cell (RBC) folate, serum vitamin B-12, and plasma total homocysteine were determined.. Twenty-one SNPs and 6 haplotype blocks were associated with RBC folate, serum vitamin B-12, and/or plasma homocysteine concentrations. Vitamin status was associated mainly with SNPs in genes directly involved in vitamin absorption/uptake (CUBN, CD320), transport (TCN1, TCN2), or metabolism (BHMT2, CBS, MTHFR, MUT, SHMT1). Other SNPs included those in the DNMT2, DPEP1, FUT2, NOX4, and PON1 genes.. We identified novel associations between SNPs in CD320 and DNMT2, which had been previously associated with neural tube defects, and vitamin B-12 status, as well as between SNPs in SHMT1, which had been previously associated with colorectal cancer and cardiovascular disease risk, and RBC folate status. These novel associations provide a plausible metabolic rationale for the association of these SNPs with B vitamin-related diseases. We also observed a novel association between an SNP in CUBN with RBC folate and confirmed the association of a number of SNPs with B vitamin status in this large cross-sectional study.

Topics: Adult; Biomarkers; Canada; Case-Control Studies; Cross-Sectional Studies; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Genotype; Genotyping Techniques; Health Surveys; Homocysteine; Humans; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Neural Tube Defects; Nutritional Status; Polymorphism, Single Nucleotide; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Information on folate and vitamin B12 deficiency rates in Guatemala is essential to evaluate the current fortification program. The objectives of this study were to describe the prevalence of folate and vitamin B12 deficiencies among women of childbearing age (WCBA) in Guatemala and to identify vulnerable populations at greater risk for nutrient deficiency.. A multistage cluster probability study was designed with national and regional representation of nonpregnant WCBA (15-49 years of age). Primary data collection was carried out in 2009-2010. Demographic and health information was collected through face-to-face interviews. Blood samples were collected from 1473 WCBA for serum and red blood cell (RBC) folate and serum vitamin B12. Biochemical concentrations were normalized using geometric means. Prevalence rate ratios were estimated to assess relative differences among different socioeconomic and cultural groups including ethnicity, age, education level, wealth index and rural versus urban locality.. National prevalence estimates for deficient serum [<10 nmol per liter (nmol/L)] and RBC folate (<340 nmol/L) concentrations were 5.1 % (95 % CI 3.8, 6.4) and 8.9 % (95 % CI 6.7, 11.7), respectively; for vitamin B12 deficiency (<148 pmol/L) 18.5 % (95 % CI 15.6, 21.3). Serum and RBC folate deficiency prevalences were higher for rural areas than for urban areas (8.0 vs. 2.0 % and 13.5 vs. 3.9 %, respectively). The prevalence of RBC folate deficiency showed wide variation by geographic region (3.2-24.9 %) and by wealth index (4.1-15.1 %). The prevalence of vitamin B12 deficiency also varied among regions (12.3-26.1 %).. In Guatemala, folate deficiency was more prevalent among indigenous rural and urban poor populations. Vitamin B12 deficiency was widespread among WCBA. Our results suggest the ongoing need to monitor existing fortification programs, in particular regarding its reach to vulnerable populations.

Topics: Adolescent; Adult; Cross-Sectional Studies; Female; Folic Acid Deficiency; Guatemala; Humans; Middle Aged; Rural Population; Surveys and Questionnaires; Urban Population; Vitamin B 12; Vitamin B 12 Deficiency; Vulnerable Populations

To determine the association between hyperhomocysteinemia and cognitive function, taking into account the effect of B group vitamin (BGV) deficiency.. Cross-sectional.. Memory Clinic, S. Anna University Hospital, Ferrara, Italy.. Elderly individuals (≥65) (N = 318; 44 normal cognition, 127 with cognitive impairment, 147 with dementia) divided into four groups according to plasma homocysteine (high vs normal) and BGV (normal vs deficit) levels.. Cognitive, clinical, biochemical, functional, and neuroimaging parameters were evaluated.. Hyperhomocysteinemia (>15 μmol/L) was associated with a higher prevalence of cognitive and functional impairment and dementia (odds ratio (OR) = 1.98, 95% confidence interval (CI) = 1.13-3.48), independent of BGV status and other confounders. Participants with hyperhomocysteinemia with normal BGV status had the worst functional status and the highest prevalence of dementia (high homocysteine/normal BGV vs normal homocysteine/normal BGV: OR = 3.20, 95% CI = 1.65-6.21). Homocysteine levels were correlated negatively with folate and vitamin B12 levels and glomerular filtration rate and positively with free thyroxine and uric acid levels (model coefficient of determination = 0.43).. Hyperhomocysteinemia was associated with worse cognitive and functional status and dementia independently of BGV levels. Approximately half of participants with hyperhomocysteinemia had normal BGV levels, suggesting that other unmeasured factors might be associated with high homocysteine levels.

Topics: Aged; Aged, 80 and over; Cognition; Cognition Disorders; Comorbidity; Confidence Intervals; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Italy; Male; Odds Ratio; Prevalence; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6; Vitamin B 6 Deficiency

Iron, folate, and vitamin B12 serum levels are closely related with dietary habits and have an essential role in the healthy development of a fetus. We aimed to investigate hemoglobin, ferritin, folate, and vitamin B12 levels in preconceptional women in an area where a plant-based diet referred to as Mediterranean cuisine is commonly used.. The study population included 466 women between the ages of 18 and 45 years admitted for thalassemia screening. Sociodemographic variables and history of menometrorrhagia, pica, and dietary habits were collected. Serum vitamin B12, folate, ferritin, and hemoglobin levels were measured. Ferritin of <12µg/L, vitamin B12 of <200 pg/mL, and folate of <4 ng/mL were accepted as deficiencies. Hemoglobin level of <12 g/dL was classified as anemia.. Polymenorrhea was present in 11.7% and hypermenorrhea in 24.8% of women. Anemia was detected in 24.9% and thalassemia trait in 3.0% of women. Low ferritin levels were observed in 46.1%, vitamin B12 in 21.6%, and folate in 3.4% of women. In the group with low vitamin B12, decreased meat consumption was more prevalent (27.5% vs. 16.9%; P = 0.019).. Vitamin B12 and iron are the main micronutrients depleted in our community. This necessitates implementing a public health program for women consuming a Mediterranean diet.

Topics: Adult; Anemia; Demography; Diet, Mediterranean; Feeding Behavior; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Humans; Mass Screening; Menorrhagia; Needs Assessment; Preconception Care; Prospective Studies; Socioeconomic Factors; Turkey; Vitamin B 12; Vitamin B 12 Deficiency

Oral submucous fibrosis (OSF) is a chronic progressive scaring oral disease associated with areca quid chewing. This study evaluated whether OSF patients had anemia, hematinic deficiencies, and serum gastric parietal cell antibody (GPCA) positivity.. The blood hemoglobin (Hb), iron, vitamin B12, and folic acid concentrations, mean corpuscular volume, and serum GPCA in 68 male OSF patients were measured and compared with the corresponding data in 136 age-matched male healthy control individuals.. We found that five (7.4%), 14 (20.6%), 34 (50.0%), 28 (41.2%), and nine (13.2%) of the 68 male OSF patients had Hb (< 13 g/dL), iron (≤ 70 μg/dL), vitamin B12 (≤ 450 pg/mL), and folic acid (≤ 6 ng/mL) deficiencies, and serum GPCA positivity, respectively. Furthermore, OSF patients had a significantly higher frequency of Hb (p = 0.006), vitamin B12 (p < 0.001), or folic acid (p < 0.001) deficiency and of serum GPCA positivity (p = 0.011) than healthy control participants. Of the five OSF patients with anemia, two had thalassemia trait, one had iron deficiency anemia, and two had macrocytic anemia (mean corpuscular volume ≥ 100 fL). In addition, of the nine OSF patients with serum GPCA positivity, six had vitamin B12 deficiency, five had folic acid deficiency, and two had iron deficiency. However, none of the nine GPCA-positive OSF patients had pernicious anemia based on the strict World Health Organization definition.. We conclude that there are high frequencies of vitamin B12 and folic acid deficiencies and of serum GPCA positivity in our male OSF patients.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iron; Male; Middle Aged; Oral Submucous Fibrosis; Parietal Cells, Gastric; Taiwan; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

The prevalence of vitamin B12 deficiency increases with age and is suggested to be even higher in the elderly living in institutions. This retrospective study evaluated the vitamin B12 and folate status of 1996 institutionalized elderly residents aged over 65years. Among them, 34.9% had vitamin B12 deficiency (serum vitamin B12 <150pmol/L), 11.8% had folate deficiency (serum folate <6.8nmol/L), and 4.9% had both. The majority of vitamin B12 deficient residents (68%) had serum vitamin B12 between 100pmol/L and 149pmol/L. Macrocytosis was found in 24.2% of vitamin B12 deficient residents. A significant increase in macrocytosis was associated with a decrease in serum vitamin B12 below 100pmol/L. Macrocytosis was most common in those with vitamin B12 ≦69pmol/L (50.9%). Overall, vitamin B12 deficiency is common in the institutionalized elderly, however macrocytosis cannot predict deficiency. More liberal testing for vitamin B12 status in the institutionalized elderly may be warranted.

Topics: Aged; Aged, 80 and over; China; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Humans; Institutionalization; Male; Prevalence; Residential Facilities; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Folic acid deficiency (FAD) may result in macrocytic anemia. This study assessed the hematinic deficiencies and anemia statuses in oral mucosal disease patients with FAD (defined as folic acid ≤ 6 ng/mL).. The blood hemoglobin (Hb), iron, vitamin B12, and folic acid concentrations, serum gastric parietal cell antibody level, and mean corpuscular volume (MCV) in 198 oral mucosal disease patients with FAD were measured. Based on World Health Organization (WHO) criteria, anemia or Hb deficiency was defined as having an Hb concentration of <13 g/dL for men and <12 g/dL for women. In this study, macrocytic anemia due to FAD was defined as having an MCV ≥100 fL and folic acid ≤6 ng/mL; pernicious anemia as having MCV ≥100 fL, vitamin B12 < 200 pg/mL, and serum gastric parietal cell antibody positivity; iron deficiency anemia as having MCV <80 fL and iron <60 μg/dL; and thalassemia trait as having MCV <74 fL, red blood cell (RBC) count > 5.0 × 10(12)/L, and Mentzer index (MCV/RBC) < 13.. We found that by WHO definitions, 73 (36.9%), 41 (20.7%), and 10 (5.1%) of our 198 FAD patients had concomitant Hb, iron, and vitamin B12 deficiencies, respectively. Of 73 anemic FAD patients, three had macrocytic anemia due to FAD, one had pernicious anemia, 14 had iron deficiency anemia, eight had thalassemia trait, and the resting 47 had normocytic anemia.. In addition to macrocytic anemia (2.0%), FAD patients may have concomitant normocytic (23.7%) or microcytic (11.1%) anemia.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Anemia, Macrocytic; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iron; Male; Middle Aged; Mouth Diseases; Parietal Cells, Gastric; Taiwan; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Dihydrofolate reductase (DHFR) is essential for the conversion of folic acid to active folate needed for one-carbon metabolism. Common genetic variation within DHFR is restricted to the noncoding regions, and previous studies have focused on a 19 bp deletion/insertion polymorphism (rs70991108) within intron 1. Reports of an association between this polymorphism and blood folate biomarker concentrations are conflicting.. In this study, we evaluated whether the DHFR 19 bp deletion/insertion polymorphism affects circulating folate biomarkers in, to our knowledge, the largest cohort to address this question to date.. Healthy young Irish individuals (n = 2507) between 19 and 36 y of age were recruited between February 2003 and February 2004. Folic acid intake from supplements and fortified foods was assessed with the use of a customized food intake questionnaire. Concentrations of serum folate and vitamin B-12, red blood cell (RBC) folate, and plasma total homocysteine (tHcy) were measured. Data were analyzed with the use of linear regression models.. Folic acid intake was positively associated with serum (P < 0.0001) and RBC (P = 0.0005) folate concentration and was inversely associated with plasma tHcy (P = 0.001) as expected. The DHFR 19 bp polymorphism was not significantly associated with either serum (P = 0.82) or RBC (P = 0.21) folate, or plasma tHcy (P = 0.20), even in those within the highest quintile of folic acid intake (>326 μg folic acid/d; P = 0.96). A nonsignificant trend toward lower RBC folate by genotype (P = 0.09) was observed in the lowest folic acid intake quintile (0-51 μg/d).. In this cohort of healthy young individuals, the DHFR 19 bp deletion allele did not significantly affect circulating folate status, irrespective of folic acid intake. Our data rule out a strong functional effect from this polymorphism on blood folate concentrations.

Topics: Adult; Biomarkers; Cohort Studies; Diet; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Genetic Association Studies; Homocysteine; Humans; Introns; Ireland; Male; Nutritional Status; Polymorphism, Genetic; Tetrahydrofolate Dehydrogenase; Vitamin B 12; Young Adult

Representative data on folate and vitamin B-12 dietary intake and status in low-income countries are rare, despite the widespread adoption of folic acid fortification.. The purpose of this study was to evaluate folate and vitamin B-12 intake, status, and risk factors for deficiency before implementation of a national fortification program in Cameroon.. A nationally representative cross-sectional cluster survey was conducted in 3 ecologic zones of Cameroon (South, North, and the 2 largest cities, Yaoundé/Douala), and information on dietary intake was collected from 10 households in each of 30 randomly selected clusters per zone. In a subset of women and their 12- to 59-mo-old children (n = 396 pairs), plasma folate and vitamin B-12, as well as breast milk vitamin B-12, were analyzed.. Vitamin B-12 and folate dietary intake patterns and plasma concentrations were similar for women and children. In the subsample, 18% and 29% of women and 8% and 30% of children were vitamin B-12 (≤ 221 pmol/L) and folate (< 10 nmol/L) deficient, respectively. Mean dietary folate ranged from 351 μg dietary folate equivalents/d in the North to 246 μg dietary folate equivalents/d in Yaoundé/Douala; plasma folate was negatively associated with socioeconomic status (P = 0.001). Plasma vitamin B-12 deficiency was similar in the South and North, 29% and 40%, respectively, but was only 11% in Yaoundé/Douala, and was positively associated with socioeconomic status. Mean breast milk vitamin B-12 was statistically significantly lower in the North (101 pmol/L) than in the South (296 pmol/L) or Yaoundé/Douala (349 pmol/L).. Folate intake and status are inadequate among women and young children in Yaoundé/Douala, whereas low vitamin B-12 intake and status are more common in poor and rural areas, especially in the North. Different strategies may be needed to control deficiency of these nutrients in different regions of Cameroon.

Topics: Adolescent; Adult; Cameroon; Child, Preschool; Cluster Analysis; Cross-Sectional Studies; Diet; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Male; Middle Aged; Milk, Human; Nutritional Status; Risk Factors; Rural Population; Socioeconomic Factors; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

To associate the severity of nutritional anaemia with serum levels of ferritin, vitamin B12 and folate; and to determine demographic, socio-economic and nutritional correlates for nutritional anemia in adolescents.. Cross-sectional hospital-based study among 200 adolescents (10-18 y) with anemia. Dietary intake (24-h recall), and serum levels of folate, vitamin B12 and ferritin were estimated.. Iron, folate and vitamin B12 deficiency was present in 30.5% 79.5% and 50% of adolescents, respectively. Statistically significant association was observed between severity of anemia and serum vitamin B12 levels, iron intake, folate intake, Vitamin B12 intake, vegetarian diet, attainment of menarche and history of worm infestation.. Folate and vitamin B12 deficiencies are more common than iron deficiency in anemic adolescents. Low dietary intake of these nutrients seems to be a significant determinant of their deficiencies.

Topics: Adolescent; Age Factors; Anemia, Iron-Deficiency; Child; Cross-Sectional Studies; Feeding Behavior; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Humans; India; Male; Reference Values; Vitamin B 12; Vitamin B 12 Deficiency

A study was made of the association between recurrent aphthosis (RAS) and iron, ferritin, vitamin B12, and folic acid deficiency.. A total of 186 adults were consecutively recruited: 92 subjects with RAS (28 males and 64 females, with a mean age of 41 years) and 94 controls (20 men and 74 women, with a mean age of 44 years), and subjected to clinical and hematological evaluation.. The overall frequency of hematinic deficiencies was 14.14% in the RAS group versus 6.39% in the control group (P = 0.086). Patient age and a family history of aphthosis were associated to the presence of RAS.. There is still no conclusive evidence relevant to the etiopathogenesis of RAS. Routine hematological screening and tests for serum iron, folic acid, and vitamin B12 deficiencies should be assessed in all patients with RAS.

Topics: Adult; Case-Control Studies; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Humans; Iron; Iron Deficiencies; Male; Middle Aged; Recurrence; Stomatitis, Aphthous; Vitamin B 12; Vitamin B 12 Deficiency

Low vitamin B12 and folate levels in expectant mothers may lead to low stores in babies. The aim of this study was to determine the frequencies of vitamin B12 and folate deficiencies in pregnant women and neonates, and to assess the effect of maternal vitamin status on babies' vitamin levels in the Aegean region of Turkey, where the Mediterranean diet (mainly fresh fruits and vegetables) is adopted. We studied 72 pregnant women and their singleton-term babies. Venous blood samples of expectant mothers were collected 1 h before delivery and cord blood of babies were obtained at birth. The mean vitamin B12 in maternal and cord blood serum was 163.1 ± 72.0 pg/mL and 146.2 ± 102.5 pg/mL, and the mean folate, 9.8 ± 4.8 ng/mL and 15.8 ± 3.8 ng/mL, respectively. There were statistically significant correlation between maternal and cord blood serum vitamin B12 (r = 0.61, P = .04) and folate levels (r = 0.65, P < .001). 70.8% of the mothers and 83.9% of the babies were vitamin B12 deficient (<200 pg/mL). Neither group showed folate deficiency. The mean level of vitamin B12 in mothers significantly varied by the type of diet (241.6 (72.1) pg/mL versus 155.9 (68.2) pg/mL; P = .012). Vitamin B12 deficiency in pregnant women and neonates may be a public health problem in our community. The Mediterranean diet in these vulnerable groups may be an aggravating factor for vitamin B12 deficiency. Prenatal screening of all expectant mothers, prenatal supplementation of vitamin B12, and an increase in animal-source food intake may improve expectant mother's vitamin B12 level.

Topics: Adult; Diet, Mediterranean; Female; Fetal Blood; Folic Acid; Folic Acid Deficiency; Fruit; Humans; Infant, Newborn; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications; Turkey; Vegetables; Vitamin B 12; Vitamin B 12 Deficiency; Vulnerable Populations; Young Adult

Anemia and macrocytosis are well-defined expected hematologic findings of vitamin B12 and folate deficiency; however, some previous studies did not show a significant association of subnormal B12 with anemia and macrocytosis.. We retrospectively analyzed 17 713 laboratory patient records to evaluate vitamin B12 and folate levels in relation to anemia and macrocytosis.. In an age- and sex-adjusted logistic regression model, low B12 status but not marginal B12 status was significantly associated with anemia [ORs respectively, 1.291 (95% CI, 1.182-1.410), 1.022 (95% CI, 0.943-1.108)] and macrocytosis [ORs, respectively, 3.853 (95% CI, 3.121-4.756), 1.031 (95% CI, 0.770-1.381)]. Also low folate status but not marginal folate status was significantly associated with anemia [adjusted ORs, respectively, 1.819 (95% CI, 1.372-2.411), 1.101 (95% CI, 0.931-1.301)] and macrocytosis [adjusted ORs, respectively, 2.945 (95% CI, 1.747-4.965), 1.228 (95% CI, 0.795-1.898)].. Our results show that increased anemia and macrocytosis are observed at values below commonly used B12 lower-reference thresholds. Determining a hematologic cutoff value may help physicians in clinical practice.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia, Macrocytic; Female; Folic Acid; Folic Acid Deficiency; Humans; Logistic Models; Male; Middle Aged; Reference Values; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

There are several causes for folate deficiency in Crohn's disease: malnutrition, malabsorption, excess folate utilization and medications. A combination of these factors may be responsible for the deficiency of this vitamin in some cases.

Topics: Crohn Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

Folate deficiency in patients with Crohn's disease may be due to a combination of factors: poor diet, malabsorption, increased requirements due to inflammation of the mucosa, and the taking of certain drugs as sulfasalazine and methotrexate. A significant proportion of patients with Crohn's disease suffer from folate deficiency, suggesting that regular screening should be performed.

Topics: Crohn Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

Folate deficiency is assessed by serum and red blood cell folate measurements. Nevertheless, no consensus for the lower limit of serum folate reference values exists. We investigated the appropriate use of RBC folate to detect folate deficiency and the relationship between serum and RBC folate and with other parameters such as vitamin B12 and homocysteine in order to propose serum folate cut-off values.. Retrospectively, 63,113 and 20,459 results of serum and RBC folate were collected. If present, the results of red cell indices, vitamin B12 and homocysteine were also collected.. A significantly positive correlation between serum and RBC folate was demonstrated. A significant effect of serum folate levels under 6 μg/L (or 14 nm) was observed on RBC indices. A relation was found between vitamin B12 and folate, for serum and RBC. A significant rise in homocysteine concentrations was observed for serum folate levels under 8 μg/L (or 18 nm).. To observe haematological abnormalities, folate deficiency should be profound. Serum folate levels under 8 μg/L (or 18 nm) should be considered as a decision limit for folate depletion because a positive effect on homocysteine was observed. Fasting serum folate concentration should be preferred for assessing folate status. Our results suggest that the need for RBC folate testing is less meaningful.

Topics: Erythrocyte Indices; Erythrocytes; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Retrospective Studies; Vitamin B 12

Premacular retrohyaloid hemorrhage is a rare complication of acute severe anemia. The authors report two cases of premacular hemorrhage in which no treatment other than clinical and spectral-domain optical coherence tomography observation was performed. The natural history of this condition reveals that complete clinical resolution is not accompanied by full anatomical restoration. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:E5-E7.].

Topics: Acute Disease; Adult; Anemia, Hemolytic, Autoimmune; Anemia, Megaloblastic; Blood Transfusion; Fluorescein Angiography; Folic Acid; Folic Acid Deficiency; Glucocorticoids; Humans; Male; Retinal Hemorrhage; Thrombocytopenia; Tomography, Optical Coherence; Vision Disorders; Visual Acuity; Vitamin B 12; Vitamin B 12 Deficiency

Autoimmune thyroiditis can be diagnosed by measuring patients' serum levels of thyroid stimulating hormone (TSH), anti-thyroglobulin antibody (TGA), and anti-thyroid microsomal antibody (TMA). This study evaluated whether there were hematinic deficiencies, high blood homocysteine levels, and serum gastric parietal cell antibody (GPCA) positivity in patients with TGA or TMA.. The blood hemoglobin (Hb), iron, vitamin B12, folic acid, homocysteine and TSH concentrations and the serum GPCA level in 190 TGA- or TMA-positive patients were measured and compared with the corresponding levels in 190 age- and sex-matched healthy control subjects.. We found that 31 (16.3%), 27 (14.2%), 12 (6.3%), and 2 (1.1%) TGA- or TMA-positive patients had deficiencies of Hb (Men<13g/dL, Women<12g/dL), iron (< 60μg/dL), vitamin B12 (< 200pg/mL), and folic acid (< 4ng/mL), respectively. Moreover, 25 (13.2%) and 48 (25.3%) TGA- or TMA-positive patients had abnormally high blood homocysteine level and serum GPCA positivity, respectively. TGA- or TMA-positive patients had a significantly higher frequency of Hb (p<0.001), iron (p<0.001), or vitamin B12 deficiency (p=0.001), of abnormally elevated blood homocysteine level (p=0.001), or of serum GPCA positivity (p<0.001) than healthy control subjects. Of 190 TGA- or TMA-positive patients, 8 (4.2%) had lower serum TSH level (< 0.1μIU/mL, suggestive of hyperthyroidism), 163 (85.8%) had serum TSH level within normal range (0.1-4.5μIU/mL), and 19 (10%) had higher serum TSH level (>4.5μIU/mL, suggestive of hypothyroidis).. There are significant deficiencies of hemoglobin, iron, and vitamin B12, abnormally high blood homocysteine levels, and serum GPCA positivity in TGA- or TMA-positive patients. In addition, the majority (85.8%) of TGA- or TMA-positive patients had euthyroid and only a small portion (14.2%) of TGA- or TMA-positive patients had either hypothyroidism or hyperthyroidism.

Topics: Adult; Aged; Aged, 80 and over; Autoantibodies; Biomarkers; Case-Control Studies; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Homocysteine; Humans; Hyperthyroidism; Hypothyroidism; Iron; Iron Deficiencies; Male; Middle Aged; Parietal Cells, Gastric; Thyroiditis, Autoimmune; Vitamin B 12; Vitamin B 12 Deficiency

Descriptive study on maternal serum vitamin B12 and folic acid in term pregnancy and in umbilical cord blood that was performed in an inner city hospital with a mixed ethnic population in the region of Flanders in Belgium.. A prospective cohort study that took place from April 1 until May 31, 2011. Plasma folic acid and vitamin B12 were measured in maternal and umbilical cord blood from all term uncomplicated deliveries in a single regional hospital. Data on age, previous obstetric history, ethnicity, nutritional intake, and use of vitamin supplements were registered.. Data were collected from 110 patients, mean maternal serum vitamin B12 was 243.9 pmol/l and mean folic acid level was 43.0 nmol/l. Using a cutoff of respectively 150 pmol/l for vitamin B12 and 7.1 nmol/l for folic acid, 13% of the women were classified as vitamin B12-deficient and 23% were deficient for folic acid. Vitamin B12 deficiency was only seen in autochthonous Belgian women. A correlation between the maternal and umbilical cord levels was noted (R = 0.7 for vitamin B12, R = 0.85 for folic acid), but none of the umbilical cord levels demonstrated deficiency. Number of previous pregnancies and intake of supplements had no influence.. Pregnant women in Antwerp, Belgium, frequently show vitamin B12 and folic acid deficiency, although a correlation exists with lower umbilical cord levels, the present limited data did not demonstrate any case of deficiency in umbilical cord blood. The frequency is highest in the autochthonous population and is not influenced by intake of vitamin supplements.

Topics: Alcohol Drinking; Belgium; Diet; Female; Fetal Blood; Folic Acid; Folic Acid Deficiency; Humans; Infant, Newborn; Linear Models; Pregnancy; Prospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Blood Chemical Analysis; Folic Acid; Folic Acid Deficiency; Humans; Laboratories; Light; Photolysis; Vitamin B 12; Vitamin B 12 Deficiency

Homocysteine (Hcy) has been implicated in abdominal aortic aneurysm (AAA). However, the association of Hcy, vitamin B12, and folate in patients with AAA has not been studied in China. This study was conducted with the aim to evaluate the relationship of vitamin B12, folic acid, and Hcy levels in AAA.. 463 patients who had AAA were included in this study. 463 control subjects were age- and sex-matched with the patients. In all of the subjects, we evaluated total plasma levels Hcy, vitamin B12, folic acid and the distribution of the C677T methylenetetrahydrofolate reductase (MTHFR) gene mutation.. The mean plasma Hcy levels were significantly higher in patients with AAA compared with controls (18.37 ± 6.97 vs. 12.89 ± 4.08 μmol/L, P < 0.001). The frequency of homozygous (TT) genotype in MTHFR C677T mutation was significantly higher in patients with AAA than that in control subjects (19.4 % vs. 11.9 %, P = 0.002). The fasting Hcy correlated negatively with folate (AAA: r = - 0.311, P < 0.01;. r = - 0.348, P < 0.01). The aneurysm size was significantly greater (P < 0.001) in patients with hyperhomocysteinemia than that in patients with normal Hcy plasma levels. The size of the AAA had a linear correlation with the plasma Hcy level (r = 0.286; P< 0.001).. Serum folate deficiency and hyperhomocysteinemia were associated with an increased risk of AAA in Northeast China. The homozygous (TT) genotype of MTHFR gene mutation may be a crucial hereditary risk factor in AAA.. Hintergrund: Homocystein (Hcy) wurde mit dem Bauchaortenaneurysma (AAA) in Verbindung gebracht. Allerdings wurde der Zusammenhang von Hcy, Vitamin B12 und Folsäure bei Patienten mit AAA bislang nicht in unserer Population untersucht. Patienten und Methoden: 463 Patienten mit einem AAA wurden in die Studie eingeschlossen. 463 Probanden waren nach Alter und Geschlecht mit den Patienten abgestimmt. Wir untersuchten bei allen den Plasmaspiegel von Hcy, Vitamin B12, Folsäure und die Verteilung der C677T Methylentetrahydrofolat Reduktase (MTHFR) Gen-Mutation. Ergebnisse: Die mittlere Plasma- Hcy Konzentrationen waren bei Patienten mit AAA im Vergleich zur Kontrollgruppe signifikant höher (18,37 ± 6,97 vs 12,89 ± 4,08 umol/l, P < 0,001). Die Häufigkeit des homozygoten (TT) Genotyps der MTHFR C677T Mutation war bei Patienten mit AAA signifikant höher als in der Kontrollgruppe (19,4 % vs 11,9 %, P = 0,002). Nüchtern Hcy korrelierte negativ mit Folsäure (AAA: r = - 0,311, P < 0,01; Kontrolle: r = - 0,348, P < 0,01). Die Aneurysmen waren signifikant größer (p < 0,001) bei Patienten mit Hyperhomocysteinämie als bei Patienten mit normalen Hcy Plasmaspiegel. Die Größe des AAA korrelierte linear mit dem Plasma- Hcy Spiegel (r = 0,286, p < 0,001). Schlussfolgerungen: Serum Folsäuremangel und Hyperhomocysteinämie waren mit einem erhöhten Risiko von AAA assoziiert. Der homozygote (TT) Genotyp des MTHFR Genmutation kann ein entscheidender erblicher Risikofaktor für AAA sein.

Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortography; Biomarkers; Case-Control Studies; China; Female; Folic Acid; Folic Acid Deficiency; Gene Frequency; Genetic Predisposition to Disease; Heterozygote; Homozygote; Humans; Hyperhomocysteinemia; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Mutation; Phenotype; Risk Factors; Tomography, X-Ray Computed; Vitamin B 12

Vitamin B12 deficiency is highly prevalent worldwide and has been linked to hematologic, neurologic and psychiatric diseases. There are a few studies regarding vitamin B12 deficiency in developing countries in general and in Jordan in particular.. The aims of the present study were to assess the vitamin B12 status of Jordanians at national level and to identify population groups at high risk for vitamin B12 deficiency.. Vitamin B12 status was assessed in a national sample of 5,640 subjects aged >8 years. The study involved interviews, laboratory measurements of vitamin B12 and other parameters, and physical measurements. The present report deals exclusively with subjects aged >18 years (n = 2,847).. The percentages of subjects with low (<200 pg/ml, n = 857), borderline (201-350 pg/ml, n = 382) and normal vitamin B12 level (>350 pg/ml, n = 1,608) were 30.1, 13.4 and 56.5%, respectively. Of the 382 subjects who had borderline vitamin B12 level, 61 subjects had both increased total homocysteine (tHcy; >13 µmol/l) and low holocobalamin (<35 pmol/l). Since elevated tHcy also indicates folate deficiency, the overall prevalence of vitamin B12 deficiency reached 32.2% (31.9% among males and 32.4% among females) after adding those 61 subjects to the 857 subjects with low vitamin B12 level.. In conclusion, our study showed that almost one third of Jordanian adults have vitamin B12 deficiency with no gender differences. Intake of vitamin B complex and multivitamins seems to protect from vitamin B12 deficiency. An in-depth study of the dietary and eating habits of Jordanians may be needed to explain the observed age and regional differences in vitamin B12 deficiency in the study population.

Topics: Adult; Aged; Aged, 80 and over; Female; Folic Acid Deficiency; Homocysteine; Humans; Jordan; Logistic Models; Male; Middle Aged; Multivariate Analysis; Nutritional Status; Pilot Projects; Prevalence; Socioeconomic Factors; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Young Adult

Vitamin B12 and folic acid deficiency are common in the older and are associated with several conditions including anaemia, cardiovascular disease, cognitive impairment and cancer. Evidence from in vitro studies suggests that solar radiation can degrade both vitamins in the skin. Chile is the longest country in the world running perfectly North-South making it an ideal place to study potential associations of latitude and solar radiation on vitamin B12 and folic acid deficiency.. The objective was to examine the association between vitamin B12 and folic acid deficiencies and latitude.. Plasma samples were collected from Chileans aged 65+ years (n=1013) living across the whole country and assayed for vitamin B12 and folic acid concentrations as part of the Chilean Health Survey 2009-2010, which is a national representative sample study.. Overall, the prevalence of vitamin B12 deficiency was 11.3%, with the prevalence in the North of the country being significantly greater than in the Central and South zones (19.1%,10.5%, and 5.7%, respectively; P<0.001). The prevalence of folic acid deficiency in the whole cohort was 0.7% with no difference between the 3 geographical zones. Using logistic regression analyses, vitamin B12 deficiency was significantly associated with geographical latitude (OR 0.910 [95% confidence intervals 0.890-0.940], P<0.001) and solar radiation (OR 1.203 [95% confidence intervals 1.119-1.294], P<<0.001). These associations persisted after adjustments for confounders (OR 0.930, P<0.001 and 1.198, P=0.002, respectively).. In the Chilean population of 65+, the prevalence of vitamin B12 deficiency is associated with living closer to the Equator and solar radiation. Although degradation by solar radiation might explain this observation, further work is required to establish the potential mechanisms. In countries that routinely fortify food with folic acid, efforts to identify vitamin B12 deficiency might be more cost-efficiently targeted in areas closest to the Equator.

Topics: Aged; Aged, 80 and over; Chile; Cohort Studies; Demography; Enzyme-Linked Immunosorbent Assay; Female; Folic Acid; Folic Acid Deficiency; Humans; Light; Logistic Models; Male; Prevalence; Skin; Vitamin B 12; Vitamin B 12 Deficiency

This study aimed to describe the nutritional status of elderly people living in a rural area of North China.. Community-based, cross-sectional prevalence survey.. 3 rural towns of Lvliang City, Shanxi Province, China.. A sample of 1845 community residents (29.1% of those eligible) 55 years or older (birth before 1958-01-01).. The participants were assessed regarding demographic characteristics, height, weight, as well as having a physical examination and blood sampling for serum cholesterol, total homocysteine (tHcy), folate, and vitamin B12 levels.. 991 (53.7%) were female and 139 (7.5%) did not complete the anthropometric measurement. Prevalence of underweight and obesity was 3.5% and 24.9% in men and 6.7% and 31.0% in women (P = 0.003, P = 0.005, respectively). Prevalence of hypercholesterolemia and hypocholesterolemia was 13.5% and 52.6% in men and 25.0% and 34.3% in women (P < 0.001, P < 0.001, respectively). Prevalence of high LDL-c concentrations was 8.8% in men and 16.8% in women (P < 0.001). The mean serum tHcy in men (28.8 ± 20.1 μmmol/l) was significantly higher than in women (21.0 ± 15.1 μmmol/L, P < 0.001). Prevalence of hyperhomocysteinemia (defined as > 15μmmol/L) was 79.7% in men and 65.5% in women (P < 0.001). Prevalence of low folate (defined as < 11 nmol/L) and vitamin B12 levels (defiend as < 185 pmol/L) was 70.8 % and 76.8% in men and 56.5% and 72.6% in women (P < 0.001, P = 0.036, respectively). Correlation coefficients between tHcy, folate, and vitamin B12 indicated an inverse linear correlation (r = -0.21, P < 0.001, r = -0.35, P < 0.001, respectively).. As China's economic climate has developed, the nutritional status of elderly people in the rural parts of the country has improved in some aspects. However, the trend toward obesity will lead to a shift in the burden of obesity-related chronic diseases. In addition, rurally-located elderly people are at high risk of death that may be associated with abnormal serum cholesterol. The data also suggest that severe deficiencies in folate and vitamin B12 levels exist, as well as there being a high prevalence of hyperhomocysteinemia. Folate and vitamin B12 supplementation are necessary to prevent related diseases.

Topics: Aged; Aged, 80 and over; Body Mass Index; China; Cholesterol; Cross-Sectional Studies; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Male; Middle Aged; Nutrition Surveys; Nutritional Status; Obesity; Prevalence; Rural Health; Rural Population; Thinness; Vitamin B 12; Vitamin B 12 Deficiency

To assess the status of the vitamin B12 and folate of Chinese women living in northwest China.. A population-based cross-sectional study was conducted in 2008 among Chinese women aged 10-49 years living in Shaanxi province of northwest China. A stratified multistage random sampling method was adopted to obtain a sample of 1170 women. The women were interviewed for collection of their background information and their plasma vitamin B12 and folate were measured with the immunoassay method. The status of both vitamins was evaluated and the prevalence of deficiency was estimated.. The median value of the women was 214.5 pg/mL for vitamin B12 and 4.6 ng/mL for folate. The urban women had a significantly higher vitamin B12 (254.1 vs. 195.9 pg/mL) but lower folate (4.4 vs. 4.7 ng/mL) than rural women. Total prevalence of deficiency was 45.5% (95% CI: 42.6% ∼ 48.4%) for vitamin B12 and 14.7% (95% CI: 12.6% ∼ 16.8%) for folate. About 36% of women presented vitamin B12 deficiency alone, 5.2% belonged to folate deficiency alone and 9.5% was combined deficiency in both vitamins. More than 25% of the women were in marginal vitamin B12 status (200-299 pg/mL) and 60% in marginal status of folate (3-6 ng/mL). About 75.2% of rural women with folate deficiency were deficient in vitamin B12 and 46% for urban women. Quantile regression model found decreasing coefficient of folate status across 73 different quantiles of vitamin B12, which indicated that the women with folate deficiency had lower vitamin B12 significantly compared with those with no deficiency.. The deficiency of vitamin B12 and folate is still prevalent among the Chinese women in northwest China. Vitamin B12 deficiency could be more serious and the improvement of poor vitamin B12 status should be invoked when practicing the supplementation of folate against the neural tube defects in northwest China.

Topics: Adolescent; Adult; Child; China; Cross-Sectional Studies; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Humans; Middle Aged; Neural Tube Defects; Nutritional Status; Rural Population; Urban Population; Vitamin B 12; Vitamin B 12 Deficiency

Micronutrient status may be a contributing factor to the development of childhood obesity in many industrializing countries passing the nutritional transition. The few studies investigating associations between serum concentrations of vitamin B and intake of B vitamins with adiposity, however, have reported inconsistent findings.. The aim of the study was to examine associations between serum vitamin B-12 and folate concentrations and intakes of B vitamins with body fat by using data on 1131 Mexican American children 8-15 y of age included in NHANES 2001-2004.. Children's body mass index (BMI), trunk fat mass (TrFM), and total body fat mass (TBFM) were used as body adiposity (BA) measures. Serum concentrations of folate and vitamin B-12 were measured in blood samples collected from children. Intake of B vitamins was collected according to 24-h dietary recall. Associations of BA with serum concentrations of vitamin B-12 and folate and intake of B vitamins were determined by using linear and multinomial regression models.. Serum concentrations of vitamin B-12 and folate were inversely associated with BMI (β: -2.68, P < 0.01; β = -1.33, P < 0.01), TrFM (β:-3.32, P < 0.01; β: -0.14, P < 0.05), and TBFM (β:-1.93, P < 0.01; β: -3.19; P < 0.01). Higher serum concentrations of vitamin B-12 were associated with a reduced risk of obesity (OR: 0.48; 95% CI: 0.31, 0.77; P < 0.001). Thiamin and riboflavin intakes were inversely associated with BMI (β:-1.35, P < 0.05; β: -1.11, P < 0.05) and TrFM (β:-1.26, P < 0.05; β: -1.37, P < 0.05).. Similar inverse associations between BA and status of both vitamin B-12 and folate and intake of thiamin and riboflavin suggest that these micronutrients may play a role in adipogenesis and risk of childhood obesity.

Topics: Adiposity; Adolescent; Body Mass Index; Child; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; Linear Models; Male; Mental Recall; Mexican Americans; Micronutrients; Multivariate Analysis; Nutrition Surveys; Pediatric Obesity; Riboflavin; Riboflavin Deficiency; Thiamine; Thiamine Deficiency; Vitamin B 12; Vitamin B 12 Deficiency

The aim of this study was to determine canine breed predispositions for decreased serum folate or markedly decreased cobalamin concentrations.. Retrospective analysis of samples from dogs that had serum folate and cobalamin concentrations measured, from 1990 to 2002 at the Comparative Gastroenterology Laboratory of Liverpool, were enrolled. A total of 13,069 samples were analysed. Those with trypsin-like immunoreactivity < 5·0 lg/L were excluded, and only breeds with at least 30 individuals tested were further analyzed. Breed predisposition was determined by calculating odds ratios and 95% confidence intervals for hypocobalaminaemia or decreased folate concentration. Significance was tested with a two-sided Fisher's exact test, and the level of statistical significance was set at P<0·05.. A total of 9960 dogs fulfilled the inclusion criteria. Forty breeds contained at least 30 individuals. Predispositions for hypocobalaminaemia were identified in shar peis, Staffordshire bull terriers, German shepherd dogs and mixed breeds. Predispositions for decreased folate concentration were found in golden retrievers and boxers.. Predisposition for marked hypocobalaminaemia and decreased folate concentration differed between breeds. The shar peis had a markedly increased odds ratio for hypocobalaminaemia, as previously reported in North America, but other at-risk breeds were also identified.

Topics: Animals; Breeding; Confidence Intervals; Dog Diseases; Dogs; Female; Folic Acid; Folic Acid Deficiency; Genetic Predisposition to Disease; Male; Odds Ratio; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Folate and vitamin B12 are essential components in the metabolism of homocysteine (Hcy). Hyperhomocysteinemia has been implicated in endothelial dysfunction and cardiovascular disease. However, the association of Hcy, vitamin B12, and folic acid with cardiovascular risk factors in patients with coronary artery disease (CAD) has not been studied in Indian patients. This study was conducted with the aim to evaluate the relationship of vitamin B12, folic acid, and Hcy levels with cardiovascular risk factors in subjects with known CAD.. Three hundred patients (216 men; 84 women; aged 25-92 years) who had CAD on angiography were included in this study consecutively. All patients were evaluated for anthropometry and cardiovascular risk factors, and blood samples were collected for biochemical, nutritional, and inflammatory markers.. Percentage of vitamin B12 and folate deficiency was 86.7% and 2.7%, respectively. Hyperhomocysteinemia was present in 95.3% patients. Vitamin B12 levels were significantly lower and Hcy levels were significantly higher in subjects with dyslipidemia, DM, and/or hypertension. Serum vitamin B12 was inversely associated with triglyceride and very low-density lipoprotein (VLDL) and positively with high-density lipoprotein (HDL). Hcy was positively associated with triglyceride and VLDL and negatively with HDL. Vitamin B12 was inversely correlated with inflammatory markers (high-sensitivity C-reactive protein and interleukin-6) directly related to insulin resistance whereas Hcy showed the opposite pattern.. Serum vitamin B12 deficiency and hyperhomocysteinemia are related with cardiovascular risk factors in Indian patients with CAD.

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Diseases; Coronary Artery Disease; Dyslipidemias; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; India; Male; Middle Aged; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Fortification of cereal products with folic acid is not mandatory in Israel, yet folate deficiency remains rare and is usually associated with poor diet, malabsorption, alcoholism, or use of certain drugs. A retrospective review of all folate level determinations performed between January 2004 and January 2007 in the central district of Clalit Health Services in Israel revealed that only 4.3% of the 43,176 tests ordered were below the norm (5.6 nmol/L).. To determine parameters that identify folate-deficient patients without known risk factors and to establish principles that aid the physician in deciding when to order folate determinations.. Study population included 152 patients from 13 large primary care clinics with folate deficiency but without known risk factors for folate deficiency (37 with anemia). They were matched with 556 controls (141 with anemia).The medical records were reviewed for the indication of the test and treatment that followed the results.. Hematologic indices, vitamin B12, ferritin, and transferrin saturation levels were similar in the study and control groups. Subgroup comparisons based on anemia status showed similar results. The clinical indications for folate determinations were similar in the folate-deficient patients and the control group. Only 68 of 152 patients (44.7%) were prescribed a folate supplement.. Neither laboratory parameters nor clinical findings in patients' charts were capable of distinguishing folate-deficient patients from controls. It seems that folate determinations in patients without known risk factors for folate deficiency are of little clinical significance.

Topics: Case-Control Studies; Ferritins; Folic Acid; Folic Acid Deficiency; Humans; Primary Health Care; Retrospective Studies; Risk Factors; Transferrins; Vitamin B 12

Chronic alcohol consumption leads to malnutrition and to the deficiency of many vitamins. One of the most important is folate deficiency. Folate deficiency disrupts the process of hematopoiesis, which can be evaluated by the changes of red cell indices. The aim of this study was to determine the hematological disturbances by the measurement of red blood cell indices in a Polish population of chronic alcoholics according to folate status. We studied 80 consecutive chronic alcoholic men and 30 healthy controls. Patients were divided into 2 groups according to the folate concentration. The serum folate and vitamin B12 concentration and the blood count were determined. We have shown that the serum folate concentration was decreased in 40% of alcoholics, but there was no folate deficiency and the level of vitamin B12 was normal. There was no correlation between folate, vitamin B12 and hematological indices. We have observed that most hematological parameters (Hb, RBCs, and Hct) in alcoholics were decreased and only two of them (MCV and MCHC) were increased in comparison with the controls. We observed no significant correlation between the RBCs indices and the weekly alcohol intake, but the correlation between RBCs, Hb, Hct and the duration of dependence have been shown. We concluded that, there is no folate deficiency in the Polish alcoholic population but the abusers with low folate levels may already have some RBCs indices affected. It means that the Polish alcoholic population consumes a sufficient amount of vitamins, which prevents the occurrence of hematological disturbances.

Topics: Adult; Aged; Alcohol Drinking; Alcoholics; Alcoholism; Case-Control Studies; Erythrocytes; Ethanol; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Homocysteine; Humans; Male; Middle Aged; Poland; Vitamin B 12; Young Adult

Epidemiologic evidence of a relation between serum total homocysteine (tHcy), vitamin B-12, and folate and age-related macular degeneration (AMD) is inconsistent and unresolved.. In this cohort study, we aimed to investigate associations between intakes and serum concentrations of folate and vitamin B-12 or serum tHcy and 10-y AMD incidence.. Serum folate, vitamin B-12, and tHcy were determined from blood samples drawn in 1997-1999 from cohort members aged ≥55 y. AMD was assessed in 1760 survivors from retinal photographs taken in 2002-2004 and 2007-2009. Total intakes of folate and vitamin B-12 were assessed by using a food-frequency questionnaire.. After adjustment for age, sex, current smoking, white blood cell count, and fish consumption, each 1-SD increase in serum tHcy was associated with increased risk of incident early and any AMD [ORs (95% CIs): 1.33 (1.09, 1.63) and 1.33 (1.11, 1.60), respectively]. Participants with a serum vitamin B-12 deficiency (<185 pmol/L) had higher risk of incident early and late AMD [ORs (95% CIs): 1.58 (1.06, 2.36) and 2.56 (1.38, 4.73), respectively]. Folate deficiency (<11 nmol/L) was associated with 75% and 89% increased risk of incident early and any AMD, respectively, 10 y later. Participants who reported supplementary vitamin B-12 intake had 47% reduced risk of incident any AMD (OR: 0.53; 95% CI: 0.33, 0.85).. Elevated serum tHcy and folate and vitamin B-12 deficiencies predicted increased risk of incident AMD, which suggests a potential role for vitamin B-12 and folate in reducing AMD risk.

Topics: Aged; Animals; Female; Fishes; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Incidence; Leukocyte Count; Macular Degeneration; Male; Middle Aged; Prospective Studies; Risk Factors; Surveys and Questionnaires; Vitamin B 12; Vitamin B 12 Deficiency

Our earlier studies show that maternal diets imbalanced in micronutrients like folic acid and vitamin B12 reduced brain docosahexaenoic acid (DHA) and brain derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in the offspring at birth and postnatal d21. This study followed the offspring till 3 months to examine the hypothesis that impaired brain neurotrophins at birth and d21 due to altered maternal micronutrients can be reversed by prenatal omega 3 fatty acid but not a postnatal control diet leading to altered cognition in adult life.. Pregnant rats were divided into control and five treatment groups at two levels of folic acid (normal and excess folate) in the presence and absence of vitamin B12 (NFBD, EFB and EFBD). Omega 3 fatty acid supplementation was given to the vitamin B12 deficient groups (NFBDO and EFBDO). Following delivery, 8 dams from each group were shifted to control and remaining continued on same diet.. Imbalance in maternal micronutrients up to 3months decreased DHA, BDNF and NGF in cortex and only BDNF in the hippocampus and impaired cognitive performance. Postnatal control diet normalized BDNF in the cortex but not the hippocampus and also altered cognitive performance. Prenatal omega 3 fatty acid supplementation normalized DHA, BDNF and NGF while long term supplementation was not beneficial only when micronutrients were imbalanced.. Patterns established at birth are not totally reversible by postnatal diets and give clues for planning intervention studies for improving brain functioning and cognitive abilities.

Topics: Animal Nutritional Physiological Phenomena; Animals; Brain; Brain-Derived Neurotrophic Factor; Cerebral Cortex; Cognition; Diet; Dietary Supplements; Fatty Acids, Omega-3; Female; Folic Acid; Folic Acid Deficiency; Hippocampus; Homocysteine; Maze Learning; Micronutrients; Nerve Growth Factor; Organ Size; Pregnancy; Prenatal Exposure Delayed Effects; Random Allocation; Rats; Vitamin B 12; Vitamin B 12 Deficiency

The burden of chronic noncommunicable diseases (NCDs) such as diabetes, obesity and cardiovascular disease is shifting rapidly to low- and middle-income countries. It calls for a review of the classic 'dogma' of genetic predisposition, precipitated by adult lifestyle. The paradigm of early life origins of chronic disease has focused attention on maternal health and nutrition as major determinants of the health of the offspring. India has high burden of maternal ill health and also of diabetes and cardiovascular disease, offering unique opportunities to study the links between the two. Pune studies showed that the Indian babies were thin but fat (more adipose) compared to European babies, and that maternal micronutrient status during pregnancy was a determinant of offspring size and body composition. Two thirds of the mothers had low vitamin B12 concentrations, while folate deficiency was rare. Higher circulating concentrations of homocysteine predicted smaller baby size. Follow-up studies revealed that higher maternal folate in pregnancy predicted higher adiposity and insulin resistance in the child at 6 years of age, and that low maternal vitamin B12 exaggerated the risk of insulin resistance. Low maternal vitamin B12 status is also associated with increased risk of neural tube defects and poor offspring cognitive functions. Our results suggest an important role for maternal one-carbon metabolism in offspring growth and programming of NCD risk. These ideas are supported by animal studies. Improvement of adolescent nutrition could effect intergenerational prevention of chronic diseases.

Topics: Adiposity; Adolescent; Adult; Animals; Body Weight; Carbon; Cardiovascular Diseases; Child; Chronic Disease; Diabetes Mellitus; Female; Folic Acid; Folic Acid Deficiency; Growth; Homocysteine; Humans; India; Infant; Infant, Newborn; Insulin Resistance; Maternal Nutritional Physiological Phenomena; Neural Tube Defects; Nutritional Status; Pregnancy; Pregnancy Complications; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Topics: Folic Acid; Folic Acid Deficiency; Humans; Reproducibility of Results; Sensitivity and Specificity; Vitamin B 12; Vitamin B 12 Deficiency

Crohn's disease commonly involves the small intestine, which is the site of vitamin B12 and folate absorption. Our aim was to define the prevalence of vitamin B12 and folate deficiency in patients with Crohn's disease and to identify predictive factors associated with such abnormalities.. Two years prospective study of 180 consecutive Crohn's disease patients. Vitamin B12 and folate deficiency was defined as serum levels below 200 pg/ml and 3 ng/ml, respectively. We analysed prevalence of these deficiencies and possible predictive factors including small intestine resection, disease location, activity and duration of disease. Controls were ulcerative colitis patients (n = 70).. The prevalence of B12 deficiency in Crohn's disease was 15.6% (95%CI 9.7-20%) compared with 2.8% (95%CI 0.8-9.8%) in ulcerative colitis (p = 0.007). With regard to folate deficiency, the prevalence in patients with Crohn's disease was 22.2% (95%CI 16-28%) compared with 4.3% (95%CI 1.4-12%) in ulcerative colitis (p = 0.001); 7.8% of Crohn's disease patients had macrocytic anemia. Ileal resection was found to be a risk factor for B12 deficiency (OR 2.7; 1.2-6.7; p = 0.02), and disease activity a risk factor for folate deficiency (OR 2.4; 1.2-5.1; p = 0.01).. A significant proportion of patients with Crohn's disease suffer from vitamin B12 and/or folate deficiency, suggesting that regular screening should be performed, with closer monitoring in patients with ileal resection or active disease.

Topics: Adult; Case-Control Studies; Colitis, Ulcerative; Crohn Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestine, Small; Male; Middle Aged; Prevalence; Prospective Studies; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Increased blood cell regeneration in exsanguinated experimental animals treated either with liver or with aqueous liver extracts was reported by Whipple and by Jeney and Jobling, respectively. These findings stimulated Minot and Murphy to provide evidence for the efficacy of liver against anaemia in clinical studies. After oral administration of liver (45-50 g per day) for 45 patients with anaemia perniciosa improvement of the hematological status was demonstrated. Consequently, for proving the therapeutic value of liver therapy Whipple, Minot and Murphy received Nobel price in 1934. The isolation of the antianemic factor from the liver has been succeeded in 1948 and designated as vitamin B12. At the same time Lucy Wills applied yeast for the treatment of pregnant women with anemia related to undernourishment. The conclusions of this study inspired the discovery of folate. The detailed investigation of the mode of action of vitamin B12 and folate enriched our knowledge in the area of pathophysiology and extended the clinical application of these two drugs.. A kivéreztetett kísérleti állatok vérregenerációját Whipple a nyers máj, Jeney és Jobling pedig a máj vizes kivonatának adagolásával tudta fokozni. A májetetés terápiás hatékonyságát Minot és Murphy 45, anaemia perniciosás betegen 1926-ban igazolták. Whipple, Minot és Murphy a májterápia sikeres alkalmazásáért 1934-ben Nobel-díjban részesült. A B12-vitaminnak elnevezett hatóanyagot 1948-ban sikerült májból kivonni. Lucy Wills ugyanezen években alultáplált, terhes asszonyok anaemiáját kedvezően tudta befolyásolni élesztőkivonattal, ami a folsav felfedezéséhez vezetett. Mindkét gyógyszer hatásmódjának tanulmányozása jelentősen gazdagította patofiziológiai ismereteinket, továbbá újabb terápiás alkalmazásokat tárt fel. Orv. Hetil., 2013, 154, 1754–1758.

Topics: Anemia, Pernicious; Antineoplastic Agents; Autoimmunity; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; History, 19th Century; History, 20th Century; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Reports from some Western countries indicate that mandatory folate food fortification (FFF) has substantially reduced the prevalence of folate deficiency, leading to calls for folate testing following FFF to be limited to specific indications such as macrocytic anaemia. This is premature for low-income countries, where folate deficiency is predominantly the result of poor intake coupled with the increasing demand in pregnancy. There is also evidence that HIV infection is prejudicial to folate nutrition, and low-income HIV-infected women and their offspring could be among the most susceptible to folate deficiency. In assessing folate nutrition, the value of serum folate has been compromised by FFF, and both serum and red cell folate are necessary for optimal assessment of folate status. Although the limited data available suggest that large-scale masking of vitamin B12 deficiency by FFF has not occurred, it has been suggested that B12 be incorporated into folate-fortified foods. However, significant B12 deficiency is usually due to malabsorption, and physiological doses added to food would be of questionable value because they would not be absorbed. Extensive work, especially randomised clinical trials, must be done before dietary intervention with B12 on a national scale can be justified. 

Topics: Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Nutritional Status; South Africa; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Dietary methyl donors and their genetic determinants are associated with Crohn's disease risk. We investigated whether a methyl-deficient diet (MDD) may affect development and functions of the small intestine in rat pups from dams subjected to the MDD during gestation and lactation. At 1 month before pregnancy, adult females were fed with either a standard food or a diet without vitamin B12, folate and choline. A global wall hypotrophy was observed in the distal small bowel (MDD animals 0·30 mm v. controls 0·58 mm; P< 0·001) with increased crypt apoptosis (3·37 v. 0·4%; P< 0·001), loss of enterocyte differentiation in the villus and a reduction in intestinal alkaline phosphatase production. Cleaved caspase-3 immunostaining (MDD animals 3·37% v. controls 0·4%, P< 0·001) and the Apostain labelling index showed increased crypt apoptosis (3·5 v. 1·4%; P= 0·018). Decreased proliferation was observed in crypts of the proximal small bowel with a reduced number of minichromosome maintenance 6 (MDD animals 52·83% v. controls 83·17%; P= 0·048) and proliferating cell nuclear antigen-positive cells (46·25 v. 59 %; P= 0·05). This lack of enterocyte differentiation in the distal small bowel was associated with an impaired expression of β-catenin and a decreased β-catenin-E-cadherin interaction. The MDD affected the intestinal barrier in the proximal small bowel by decreasing Paneth cell number after immunostaining for lysosyme (MDD animals 8·66% v. controls 21·66%) and by reducing goblet cell number and mucus production after immunostaining for mucin-2 (crypts 8·66 v. 15·33%; villus 7 v. 17%). The MDD has dual effects on the small intestine by producing dramatic effects on enterocyte differentiation and barrier function in rats.

Topics: Alkaline Phosphatase; Animal Feed; Animals; Apoptosis; beta Catenin; Cadherins; Caspase 3; Cell Differentiation; Choline; Choline Deficiency; Enterocytes; Female; Folic Acid; Folic Acid Deficiency; Gene Expression Regulation; Intestine, Small; Muramidase; Paneth Cells; Rats; Rats, Wistar; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

In September 2009, Australia implemented mandatory folic acid fortification of wheat flour for bread-making to reduce the incidence of neural tube defects. Our study aimed to establish baseline folate status data in Aboriginal and non-Aboriginal Western Australians.. Patients who presented at a health service or collection centre for blood tests were invited to participate. One hundred and ninety-one Aboriginals and 159 non-Aboriginals were recruited between April 2008 and September 2009. Participants completed a five-minute questionnaire and had blood taken for red blood cell (RBC) folate and serum vitamin B12. Data were analysed using SPSS (version 17.0.2, SPSS Inc., Chicago, IL, USA).. Ten per cent (95% confidence intervals (CI): 5, 19) of the Aboriginal women participants and 26% (95% CI: 16, 40) of men had RBC folate concentrations below 250 ng/mL, the cut-off associated with folate deficiency. None of the non-Aboriginal women (95% CI: 0, 4) and 4% of the non-Aboriginal men (95% CI: 2, 12) had RBC folate concentrations below 250 ng/mL. All participants were vitamin B12 replete. None of the 96 Aboriginal and 8% of non-Aboriginal women aged 16-44 reported consumption of supplements with a daily intake of >400 μg folic acid during the previous week.. This study established a baseline of RBC folate, folate consumption and supplement use in Aboriginal and non-Aboriginal groups. We identified 10% of Aboriginal women and none of non-Aboriginal women participants with low folate concentrations. The higher prevalence of folate deficiency in Aboriginal participants suggests they are more likely to benefit from a universal program of folate fortification.

Topics: Adolescent; Adult; Biomarkers; Cohort Studies; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Health Surveys; Humans; Male; Native Hawaiian or Other Pacific Islander; Neural Tube Defects; Nutrition Policy; Surveys and Questionnaires; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Western Australia; Young Adult

Folic acid and vitamin B12 deficiencies are associated with high reproductive risks ranging from infertility to fetal structural defects. The aim of the present study was to examine the effects of preconceptional omega-3 fatty acid supplementation (eicosapentaenoic acid and docosahexaenoic acid) to a micronutrient-deficient diet on the reproductive cycle in Wistar rats. Female rats were divided into five groups from birth and throughout pregnancy: a control group, a folic acid-deficient (FD) group, a vitamin B12-deficient (BD) group, a folic acid-deficient + omega-3 fatty acid-supplemented (FDO) group and a vitamin B12 deficient + omega-3 fatty acid-supplemented (BDO) group. Dams were killed on gestation Day 20 and their ovaries and mammary glands were dissected out and subjected to histological examination. Maternal micronutrient deficiency (FD and BD groups) resulted in an abnormal oestrous cycle (P<0.001), whereas omega-3 fatty acid supplementation (FDO and BDO groups) restored the oestrous cycle to normal. There were fewer corpora lutea in the ovaries of FD rats compared with controls. In addition, rats in both the FD and BD groups exhibited an absence of lactating ducts in their mammary glands compared with controls. The findings of the present study indicate, for the first time, that maternal micronutrient deficiency affects the oestrous cycle and morphology of the ovary and mammary glands. Omega-3 fatty acid supplementation ameliorated these effects. This may have implications for infertility and pregnancy outcomes.

Topics: Animals; Corpus Luteum; Diet; Dietary Supplements; Docosahexaenoic Acids; Eicosapentaenoic Acid; Estrous Cycle; Fatty Acids, Omega-3; Female; Folic Acid; Folic Acid Deficiency; Lactation; Mammary Glands, Animal; Micronutrients; Organ Size; Preconception Care; Pregnancy; Pregnancy Outcome; Rats; Rats, Wistar; Reproduction; Vitamin B 12; Vitamin B 12 Deficiency

Arab populations lack data related to nutritional assessment in children with autism spectrum disorders (ASDs), especially micronutrient deficiencies such as folate and vitamin B12.. To assess the dietary and serum folate and vitamin B12 statuses, a hospital-based case-control study was conducted in 80 Omani children (40 children with ASDs versus 40 controls).. The ASD cases showed significantly lower levels of folate, vitamin B12, and related parameters in dietary intake and serum levels.. These data showed that Omani children with ASDs exhibit significant deficiencies in folate and vitamin B12 and call for increasing efforts to ensure sufficient intakes of essential nutrients by children with ASDs to minimize or reverse any ongoing impact of nutrient deficiencies.

Topics: Autistic Disorder; Case-Control Studies; Child, Preschool; Diet; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Nutrition Assessment; Nutritional Status; Odds Ratio; Oman; Vitamin B 12; Vitamin B 12 Deficiency

Serum homocysteine level is a biomarker of cardiovascular disease.. In this study, 399 primary and secondary burning mouth syndrome (BMS) patients without or with hematinic deficiencies were treated with vitamin BC capsules plus none, one, or two deficient hematinics depending on the corresponding deficiency statuses of the patients. One hundred and seventy-seven patients showed complete remission of all oral symptoms after treatment. The blood homocysteine, vitamin B12, folic acid, iron, and hemoglobin concentrations at baseline and after treatment till all oral symptoms had disappeared in these 177 complete-response BMS patients were measured and compared by paired t-test.. For BMS patients with concomitant deficiencies of vitamin B12 only (n = 48), folic acid only (n = 12), vitamin B12 plus folic acid (n = 9), or vitamin B12 plus iron (n = 15), supplementations with vitamin BC capsules plus corresponding deficient hematinics could significantly reduce the abnormally high serum homocysteine levels to normal levels after a mean treatment period of 5.4-8.2 months (all P-values < 0.01). For BMS patients without definite hematinic deficiencies (n = 62), supplementation with vitamin BC capsules only could also significantly decrease the relatively higher homocysteine levels to significantly lower levels after a mean treatment period of 10.2 months (P < 0.001).. Specific supplementations with vitamin BC capsules plus none or corresponding deficient vitamin B12 and/or folic acid can reduce the abnormally high serum homocysteine levels to normal levels in BMS patients without or with deficiencies of corresponding hematinics.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Burning Mouth Syndrome; Calcium; Female; Ferric Compounds; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Hematinics; Hemoglobins; Homocysteine; Humans; Iron; Male; Middle Aged; Niacinamide; Pantothenic Acid; Remission Induction; Riboflavin; Thiamine; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6; Vitamin B Complex

To estimate the prevalence of optic neuropathy (ON) among prisoners in a provincial prison in Papua New Guinea, and to explore risk factors for this condition among this population.. Cross-sectional observation study of 148 male prisoners aged ≥18 years using an interview-based questionnaire, assessment of visual and nervous system function, ocular examination, and blood analysis (α-tocopherol, β-carotene, lutein, folate, homocysteine, holotranscobalamin II, riboflavin, selenium, thiamin, and vitamins A, B(12) and C). Likelihood of the presence of ON was based on ordered groups determined by weighted combination of optic nerve head appearance and visual dysfunction (acuity, field, color perception). Main outcome measures were prevalence and associations of ON.. Sample prevalence of clinical ON was 10.4% (95% confidence interval [CI], 6.2-16.8). No cases were found of unexplained non-visual nervous system dysfunction, including peripheral neuropathy. Increasing age (p = 0.001), length of current (p = 0.002) and lifetime (p = 0.03) incarceration, and duration of smoking by current smokers (p = 0.001) were associated with increased ON likelihood. However, when age-controlled, the smoking duration association was not maintained (p = 0.6). Prisoners were folate deficient. Adjusting for age and duration of current incarceration, whole blood (p = 0.02) and red blood cell (p = 0.04) folate concentrations were inversely associated with ON likelihood. No association was found for any other assessed demographic, lifestyle or biochemical measure.. A cluster of ON associated with folate deficiency has been identified. Recommendations for dietary change and micronutrient supplementation have been made.

Topics: Adult; alpha-Tocopherol; beta Carotene; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; Lutein; Male; Optic Nerve Diseases; Papua New Guinea; Prevalence; Prisoners; Risk Factors; Selenium; Surveys and Questionnaires; Vision Disorders; Vitamin A; Vitamin B 12

To find out the relationship between recurrent aphthous stomatitis (RAS) with deficiencies of haemoglobin, haematocrit, serum vitamin B12, serum Ferritin and red blood cells (RBC) Folate level.. An analytical cross-sectional study.. Department of Oral Health Sciences, Shaikh Zayed Federal Postgraduate Medical Complex, Lahore, from February to July 2008.. Sixty consecutive subjects with active RAS were taken as the aphthous group; 60 age and gender matched subjects without RAS were as the Non-Aphthous group. Five milliliter blood was taken from both groups to evaluate the levels of serum B12, and RBC Folate through radio immuno assay and serum ferritin with enzyme linked immuno-sorbent assay tests. Complete blood count was carried out to determine the level of haemoglobin and haematocrit in both groups. Proportion of subjects with lower values was compared using 2 text of proportions with significance at p < 0.05.. Serum Ferritin (p = 0.001), haematocrit (p < 0.001), RBC Folate (p < 0.001) and serum B12 (p < 0.001) were significantly lower in the RAS group. Combined deficiency state (haemoglobin, serum Ferritin, haematocrit, RBC Folate and serum B12) was identified in 13% (n = 8) RAS patients.. Frequency of haematinic deficiencies was high in RAS patients. Serum B12 and RBC Folate were significantly low in aphthous group.

Topics: Adolescent; Adult; Case-Control Studies; Child; Cross-Sectional Studies; Enzyme-Linked Immunosorbent Assay; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Humans; Male; Middle Aged; Radioimmunoassay; Recurrence; Stomatitis, Aphthous; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

The importance of the B vitamins folate and vitamin B12 for healthy neurological development and function is unquestioned. Folate and vitamin B12 are required for biological methylation and DNA synthesis. Vitamin B12 also participates in the mitochondrial catabolism of odd-chain fatty acids and some amino acids. Inborn errors of their metabolism and severe nutritional deficiencies cause serious neurological and hematological pathology. Poor folate and vitamin B12 status short of clinical deficiency is associated with increased risk of cognitive impairment, depression, Alzheimer's disease and stroke among older adults and increased risk of neural tube defects among children born to mothers with low folate status. Folate supplementation and food fortification are known to reduce incident neural tube defects, and B vitamin supplementation may have cognitive benefit in older adults. Less is known about folate and vitamin B12 requirements for optimal brain development and long-term cognitive health in newborns, children and adolescents. While increasing suboptimal nutritional status has observed benefits, the long-term effects of high folate intake are uncertain. Several observations of unfavorable health indicators in children and adults exposed to high folic acid intake make it imperative to achieve a more precise definition of folate and B12 requirements for brain development and function.

Topics: Aging; Central Nervous System; Cognition; Cognition Disorders; Dietary Supplements; Epigenesis, Genetic; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Neural Tube Defects; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency

There is no doubt that folic acid fortification can be effective for reducing the incidence of neural tube defects. The degree of efficacy depends on both the level of folate depletion and other, yet to be fully characterized, genetic and/or environmental factors. This article summarizes briefly data on neural tube defect reduction and other benefits of folic acid fortification as these have been reviewed in more detail elsewhere. More attention is drawn to questions that have been raised about the possible adverse effects of folic acid fortification including the incidence of colorectal cancer and immune function. The main question addressed here is whether folic acid fortification can exacerbate the adverse effects of vitamin B12 deficiency. Most analyses of this question have been conducted in wealthier countries based on data from elderly populations - which have the highest prevalence of vitamin B12 deficiency. However, of potentially greater concern is the increasingly common practice of folic acid fortification in developing countries, where folate status is probably often adequate even prior to fortification, and vitamin B12 depletion or deficiency is common. To add to this information, data from a group of Chilean elderly with a range of vitamin B12 status and exposed to high levels of folic acid fortification will be presented.

Topics: Aged; Chile; Flour; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Neural Tube Defects; Nutritional Status; Prevalence; Randomized Controlled Trials as Topic; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Cognition; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Iodine; Male; Nutritional Requirements; Sodium Chloride, Dietary; Vitamin B 12; Vitamin B 12 Deficiency; Weaning

Unlike most Western populations, MTHFR 677T is a rare allele and a risk factor for a variety of disorders in India. What kind of nutritional (environmental) and/or genetic factors could contribute to the genetic risk is not known. To assess the incidence of hyperhomocysteinemia and its correlation with the polymorphism in homocysteine (Hcy)-pathway genes and associated cofactors in the native populations of eastern India.. Healthy population from four eastern states of India. Genotyping of SNPs, HPLC and chemiluminescence-based assay for homocysteine, vitamin B12 and folic acid.. Approximately 30% of the population has hyperhomocysteinemia (>15 μmol/lit; hypHcy) with varying frequencies in the four states from where samples were collected (n=1426). Polymorphisms of MTR and CBS do not affect hypHcy. 677T and 1298C alleles of MTHFR and G80 RFC-1 show association with hypHcy. In contrast, RFC-1 80AA is protective even in presence of 677T MTHFR. Addition of each mutant allele has an additive effect on Hcy level. Vitamin B12 (cofactor in methionine synthesis) clearly modulates the genotypic effect on Hcy level. Although frequency of individuals with low folic acid is ≈11, 49% of the population is vitamin B12 deficient (<220 pg/lit) and has a significant negative correlation with Hcy. Individuals with optimum vitamin B12 and folic acid generally have low Hcy, even in risk genotypes.. One of the plausible reasons for susceptibility of individuals with MTHFR C677T in the studied population to various disorders is the high frequency of hyperhomocysteinemia and vitamin B12 deficiency in the 'healthy population'. Apparently, supplementation of vitamin B(12) to this health-impoverished community may help lessen the risk of several multifactorial disorders.

Topics: Adult; Alleles; Female; Folic Acid; Folic Acid Deficiency; Genotype; Homocysteine; Humans; Hyperhomocysteinemia; India; Male; Methylenetetrahydrofolate Reductase (NADPH2); Nutritional Status; Polymorphism, Single Nucleotide; Prevalence; Replication Protein C; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Vitamin B Deficiency

The associations of serum levels of homocysteine (tHcy), vitamin B(12), and folate with risk of all-cause and coronary heat disease (CHD) mortality is controversial, and the evidence in older adults is limited. The aim of this study was to examine whether serum folate, vitamin B(12), and tHcy independently predict risk of CHD-related and all-cause mortality in older adults.. Serum concentrations of folate, vitamin B(12), and tHcy were determined from blood samples obtained from 3010 Blue Mountains Eye Study participants (1997-99), aged ≥55 years. CHD and all-cause mortality was confirmed using the Australian National Death Index.. Persons in the highest quartile of serum tHcy had increased risk of CHD mortality compared to those in the lowest quartile (multivariable-adjusted hazard ratio, HR, 2.45, 95% CI 1.30-4.62). A significant continuous association was observed between serum tHcy and CHD mortality (HR per SD ( = 4.8 µmol/l) increase in serum tHcy 1.25, 95% CI 1.08-1.45), after multivariable-adjustment. A significant association between folate deficiency and CHD-mortality was found (multivariable-adjusted HR 1.53, 95% CI 1.01-2.29). Hyperhomocysteinaemia (>15 µmol/l) was a significant predictor of all-cause mortality (multivariable-adjusted HR 1.47, 95% CI 1.18-1.83). A significant interaction was observed between hyperhomocysteinaemia and folate deficiency for all-cause and CHD mortality (p for interaction = 0.03 and p for interaction = 0.05, respectively).. Serum tHcy and folate were independent predictors of CHD and all-cause mortality, while vitamin B(12) was not associated. As raised tHcy levels and folate deficiency are associated with poorer lifestyle, changes to a more healthful lifestyle among older adults may minimize the adverse vascular effects of elevated tHcy.

Topics: Age Factors; Aged; Aged, 80 and over; Biomarkers; Coronary Disease; Down-Regulation; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; New South Wales; Prognosis; Proportional Hazards Models; Risk Assessment; Risk Factors; Up-Regulation; Vitamin B 12

To investigate the frequencies of vitamin B12 and folate deficiencies in pregnant women in low socioeconomic group, the relation between the animal-source foods consumption and maternal vitamin B12-folate statuses, and their impacts on anthropometric measurements of the infants.. A total of 208 pregnant women in the last trimester were included in the study. A questionnaire about socio-demographic status, consumption of meat, egg, milk-dairy products, multivitamin supplementation was used. Vitamin B(12) and folate concentrations were studied by chemiluminescence method. The babies of Vitamin B(12) deficient mothers were evaluated after birth.. The rate of vitamin B(12) deficiency was 47.6% and folate deficiency was 17.3% of pregnant women. Animal food consumption was inadequate about half of pregnant women and vitamin B(12) levels in these women were significantly low. There were no statistically significant relationships between the birth weight, birth length and head circumference measurements, and maternal vitamin B(12) and folate concentrations.. The rate of vitamin B12 deficiency in pregnant women in low socioeconomic population is high. Although there were no significant effects of the vitamin B12 and folate deficiencies on birth size, additional studies are required to elucidate the subsequent effects.

Topics: Adult; Anthropometry; Birth Weight; Body Weights and Measures; Cross-Sectional Studies; Diet; Diet Surveys; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant, Newborn; Maternal Nutritional Physiological Phenomena; Nutritional Status; Pregnancy; Pregnancy Complications; Pregnant Women; Term Birth; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Topics: Anemia; Anemia, Iron-Deficiency; Colitis, Ulcerative; Crohn Disease; Folic Acid; Folic Acid Deficiency; Inflammatory Bowel Diseases; Iron; Iron Deficiencies; Micronutrients; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Deficiency

Homocysteine (Hcy) is a sulfur-containing amino acid involved in methionine metabolism. An elevated total plasma Hcy concentration (tHcy) is a risk factor for vascular disease. The present study aimed to assess the role of antiepileptic drugs (AEDs) and C677T methylenetetrahydrofolate (MTHFR) polymorphisms on tHcy in pediatric patients with epilepsy treated for at least 6 months with various treatment regimens protocols including the newer AEDs. The study group was recruited from children and adolescents with epilepsy followed up in the Child Neuropsychiatry Clinic of the Second University of Naples, between January 2007 and March 2008. Inclusion criteria were: (1) patients with epilepsy, treated with one or more anticonvulsant drugs for at least 6 months; (2) age between 2 and 16 years. Plasma tHcy concentrations were considered elevated when they exceeded 10.4 μmol/L, and folate concentrations <3 ng/mL were considered deficient. Serum vitamin B12 levels were considered normal between 230 and 1,200 pg/mL. The study group was composed of 78 patients (35 males, 43 females), aged between 3 and 15 years (mean 8.9 years). Thirty-five patients were taking AED monotherapy, 43 polytherapy. Sixty-three healthy sex- and age-matched children and adolescents served as controls. The mean tHcy value in the patient group was higher than the mean value in the control group (12.11 ± 7.68 μmol/L vs 7.4±4.01 μmol/L; p<0.01). DNA analysis for the MTHFR C677T polymorphism showed the CT genotype in 46%, CC in 35% and TT in 17.8% of cases. Decreased folic acid serum levels significantly correlated with increased tHcy levels (p<0.003). Female sex was a less significant risk factor for increased tHcy levels (p=0.039). Our study confirms the association between hyperhomocysteinemia and epilepsy. The elevation of tHcy is essentially related to low folate levels. Correction of poor folate status, through supplementation, remains the most effective approach to normalize tHcy levels in patients on AED mono- or polytherapy.

Topics: Adolescent; Anticonvulsants; Child; Child, Preschool; Epilepsy; Female; Folic Acid; Folic Acid Deficiency; Genotype; Homocysteine; Humans; Hyperhomocysteinemia; Male; Methylenetetrahydrofolate Reductase (NADPH2); Polymorphism, Genetic; Vitamin B 12

The purpose of this study was to examine the status of folate and vitamin B12 (B12) in relation to serum homocysteine (HCY) and oxidative stress indices in patients with type 2 diabetes (T2DM).. This case-control study involved 100 Omani adults (50 patients newly diagnosed with T2DM and 50 age- and gender-matched healthy controls). Several parameters were investigated, including dietary intake and biochemical assessments of folate, B12, HCY, oxidative stress markers (glutathione and total antioxidant status), and antioxidant enzymes (superoxide dismutase, glutathione peroxidase, and catalase).. Low serum levels of folate, B12, and hyperhomocysteinemia were prevalent in patients with T2DM compared with controls. Oxidative stress was evident in patients with T2DM as indicated by low serum levels of glutathione, total antioxidant status, and impaired antioxidant enzymatic activities (superoxide dismutase, glutathione peroxidase, and catalase).. The low intake of folate and B12 is associated with low serum levels of these two nutrients and hyperhomocysteinemia in Omani adults with T2DM.

Topics: Adult; Antioxidants; Case-Control Studies; Diabetes Mellitus, Type 2; Diet; Female; Folic Acid; Folic Acid Deficiency; Glutathione; Hospitals, University; Humans; Hyperhomocysteinemia; Male; Middle Aged; Oman; Outpatient Clinics, Hospital; Oxidative Stress; Oxidoreductases; Prevalence; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Despite the key role in neuronal development of a deficit in the methyl donor folate, little is known on the underlying mechanisms. We therefore studied the consequences of folate deficiency on proliferation, differentiation, and plasticity of the rat H19-7 hippocampal cell line. Folate deficit reduced proliferation (17%) and sensitized cells to differentiation-associated apoptosis (+16%). Decreased production (-58%) of S-adenosylmethionine (the universal substrate for transmethylation reactions) and increased expression of histone deacetylases (HDAC4,6,7) would lead to epigenomic changes that may impair the differentiation process. Cell polarity, vesicular transport, and synaptic plasticity were dramatically affected, with poor neurite outgrowth (-57%). Cell treatment by an HDAC inhibitor (SAHA) led to a noticeable improvement of cell polarity and morphology, with longer processes. Increased homocysteine levels (+55%) consecutive to folate shortage produced homocysteinylation, evidenced by coimmunoprecipitations and mass spectrometry, and aggregation of motor proteins dynein and kinesin, along with functional alterations, as reflected by reduced interactions with partner proteins. Prominent homocysteinylation of key neuronal proteins and subsequent aggregation certainly constitute major adverse effects of folate deficiency, affecting normal development with possible long-lasting consequences.

Topics: Animals; Blotting, Western; Cell Differentiation; Cell Line; Cell Movement; Cell Survival; Cells, Cultured; Folic Acid; Folic Acid Deficiency; Hep G2 Cells; Hippocampus; Homocysteine; Humans; Immunohistochemistry; Neurons; Protein Binding; Rats; Rats, Wistar; Real-Time Polymerase Chain Reaction; Vitamin B 12

A moderate elevation of plasma total homocysteine (tHcy) is considered a potential risk factor for Alzheimer's disease (AD).. We have investigated the main determinants (age, renal impairment, cobalamin/folate status and the presence of vascular disease) of plasma tHcy in 326 patients with AD, and also in 281 patients with mild cognitive impairment (MCI), since about half of these patients develop AD during the first 5 years.. Elevated plasma tHcy in patients with AD could mainly be attributed to cobalamin/folate deficiency or renal impairment. Younger patients (below 75 years) with AD and patients with MCI without cobalamin/folate deficiency or renal impairment showed normal levels of plasma tHcy.. Our findings suggest that plasma tHcy is not primarily involved in the pathogenesis of AD but rather a reflection of changes of the main determinants of plasma tHcy in AD patients.

Topics: Age Factors; Aged; Aged, 80 and over; Aging; Alzheimer Disease; Case-Control Studies; Cognitive Dysfunction; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Male; Middle Aged; Renal Insufficiency; Risk Factors; Vascular Diseases; Vitamin B 12; Vitamin B 12 Deficiency

There is a paucity of studies, as well as inconsistent findings, on the associations of homocysteine, folate, and vitamin B-12 with physical function and decline in older persons.. We investigated the independent associations of homocysteine, folate, and vitamin B-12 with gait and balance performance and Instrumental Activities of Daily Living (IADL) in community-living older persons.. We performed cross-sectional analyses on baseline data of 796 respondents in the Singapore Longitudinal Ageing Study who had laboratory measurements of fasting homocysteine folate and vitamin B-12 and completed Performance Oriented Mobility Assessment (POMA) of gait and balance and self-reports of IADLs.. In multivariate analyses in which sex, age, education, housing type, comorbidities, hospitalization, depression and global cognitive scores, BMI, creatinine, arthritis and hip fracture, serum albumin and hemoglobin, and physical activities were controlled for, we showed that homocysteine, independently of folate and vitamin B-12, showed significant negative associations with POMA balance (P = 0.02), POMA gait scores (P < 0.01), and IADL (P < 0.01). Serum folate showed a significant positive association only with POMA balance scores (P < 0.045). No significant independent associations for vitamin B-12 were observed.. The independent association of elevated homocysteine and low folate, but not vitamin B-12, on physical and functional decline was supported in this study. Interventional studies of the physical functional effects of folate and vitamin B-12 status in different populations are needed.

Topics: Activities of Daily Living; Aged; Aged, 80 and over; Aging; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Gait; Geriatric Assessment; Homocysteine; Humans; Hyperhomocysteinemia; Longitudinal Studies; Male; Middle Aged; Mobility Limitation; Postural Balance; Prospective Studies; Singapore; Vitamin B 12; Vitamin B 12 Deficiency

Abnormal methionine challenge test results cannot be explained by a deficiency in pyridoxal phosphate, folic acid, or cobalamin. The methionine challenge test is reliable for demonstrating hyperhomocysteinemia.. To research the status of pyridoxal phosphate, folic acid, and cobalamin as part of an examination for hyperhomocysteinemia and to establish their relationship to the results of methionine challenge tests in women, who were tested at least 3 months after they had ended a pregnancy which was complicated by preeclampsia or other vascular-related pregnancy complications.. In the Isala clinics in Zwolle, women with vascular-related complications of pregnancy were tested at least 3 months postpartum for hyperhomocysteinemia, by performing a methionine challenge test, as well as tests to measure their vitamin status. The diagnosis of hyperhomocysteinemia was made after two abnormal test results. The χ(2) test was used to compare the vitamin status of the group with normal results to those with an abnormal result of methionine challenge tests.. No statistically significant differences in the vitamin status were found between the group of women with an abnormal and the group with normal results of the methionine challenge tests.. Abnormal methionine challenge test results cannot be explained by a deficiency in pyridoxal phosphate, folic acid, or cobalamin. We demonstrate that, when women are tested 3 months postpartum, the methionine challenge test is reliable for demonstrating hyperhomocysteinemia as a risk factor for vascular-related complications of pregnancy.

Topics: Adult; Female; Folic Acid; Folic Acid Deficiency; Humans; Hyperhomocysteinemia; Methionine; Pregnancy; Pyridoxal Phosphate; Reproducibility of Results; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6 Deficiency

Inflammatory bowel diseases (IBD) result from complex interactions between environmental and genetic factors. Low blood levels of vitamin B12 and folate and genetic variants of related target enzymes are associated with IBD risk, in population studies. To investigate the underlying mechanisms, we evaluated the effects of a methyl-deficient diet (MDD, folate, vitamin B12 and choline) in an experimental model of colitis induced by dextran sodium sulphate (DSS), in rat pups from dams subjected to the MDD during gestation and lactation. Four groups were considered (n = 12-16 per group): C DSS(-) (control/DSS(-)), D DSS(-) (deficient/DSS(-)), C DSS(+) (control/DSS(+)) and D DSS(+) (deficient/DSS(+)). Changes in apoptosis, oxidant stress and pro-inflammatory pathways were studied within colonic mucosa. In rat pups, the MDD produced a decreased plasma concentration of vitamin B12 and folate and an increased homocysteine (7.8 ± 0.9 versus 22.6 ± 1.2 μmol/l, P < 0.001). The DSS-induced colitis was dramatically more severe in the D DSS(+) group compared with each other group, with no change in superoxide dismutase and glutathione peroxidase activity, but decreased expression of caspase-3 and Bax, and increased Bcl-2 levels. The mRNA levels of tumour necrosis factor (TNF)-α and protein levels of p38, cytosolic phospolipase A2 and cyclooxygenase 2 were significantly increased in the D DSS(+) pups and were accompanied by a decrease in the protein level of tissue inhibitor of metalloproteinases (TIMP)3, a negative regulator of TNF-α. MDD may cause an overexpression of pro-inflammatory pathways, indicating an aggravating effect of folate and/or vitamin B12 deficiency in experimental IBD. These findings suggest paying attention to vitamin B12 and folate deficits, frequently reported in IBD patients.

Topics: Animals; Apoptosis; bcl-2-Associated X Protein; Caspase 3; Choline Deficiency; Colitis, Ulcerative; Colon; Cyclooxygenase 2; Dextran Sulfate; Diet; Folic Acid; Folic Acid Deficiency; Glutathione Peroxidase; Homocysteine; Oxidative Stress; p38 Mitogen-Activated Protein Kinases; Phospholipases A2; Proto-Oncogene Proteins c-bcl-2; Rats; Rats, Wistar; RNA, Messenger; Superoxide Dismutase; Tissue Inhibitor of Metalloproteinase-3; Tumor Necrosis Factor-alpha; Vitamin B 12; Vitamin B 12 Deficiency

Limited data exist on sources of folate and cobalamin in the toddler diet.. We examined the influence of diet on folate and cobalamin status in healthy toddlers in an unfortified population.. Dietary intake was assessed in 178 children, aged 24 mo, by using 7-d food records and related to serum folate and cobalamin status in 155 children.. Median (25th-75th percentile) daily intakes of folate and cobalamin were 87 μg (74-104 μg) and 3.1 μg (2.4-3.8 μg), respectively. Thirty-five percent of subjects had a folate intake below the Norwegian recommendations (80 μg folate/d), but only 5.8% of subjects had low serum folate concentrations (<10 nmol/L). All children reached the recommended cobalamin intake (0.8 μg cobalamin/d). Median (25th-75th percentile) serum concentrations were as follows: folate, 19 nmol/L (14-24 nmol/L); cobalamin, 410 pmol/L (334-521 pmol/L); holotranscobalamin, 94 pmol/L (67-121 pmol/L); holohaptocorrin, 315 pmol/L (241-409 pmol/L); methylmalonic acid, 0.16 μmol/L (0.13-0.20 μmol/L); and total homocysteine, 5.0 μmol/L (4.2-5.7 μmol/L). Folate intake correlated with serum folate concentrations (ρ = 0.25, P < 0.01), and cobalamin intake correlated with serum holotranscobalamin concentrations (ρ = 0.21, P < 0.05). In multivariate models, serum folate concentrations were significantly positively associated with the consumption of fruit and berries and grain products; however, this was not the case with dairy products, which was the food group that contributed most to folate intake. Cobalamin status was associated with dairy products (cobalamin and holotranscobalamin), cobalamin supplements (cobalamin and holohaptocorrin), and liver pâté (holotranscobalamin).. In this unfortified toddler population, folate status was associated with intakes of fruit and berries and grain products. Cobalamin status was associated with intakes of dairy, liver pâté, and supplements. In the assessment of vitamin sources, vitamin availability must be considered.

Topics: Child, Preschool; Dairy Products; Diet; Diet Records; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Methylmalonic Acid; Multivariate Analysis; Norway; Nutrition Policy; Nutritional Status; Transcobalamins; Vitamin B 12; Vitamin B Complex

Chronic occupational exposure to chromium can result in a broad range of adverse effects including multiple organ damage, genotoxicity and carcinogenesis. However, the metabolic consequences of chromium exposure have not been fully investigated. This study was designed to examine vitamin B12, folate and homocysteine metabolic changes in workers chronically exposed to chromate. The potential association between metabolic alteration and renal impairment induced by chromate exposure was also assessed.. The level of chromium exposure was evaluated by measuring chromium concentrations in red blood cells (RBC-Cr) and urine (U-Cr). Renal impairment was assessed with serum cystatin C (Cys-C) and urinary β2-microglobulin (β2M). Serum vitamin B(12), folate and plasma total homocysteine (tHcy) were measured and correlations analysed.. Significant increases in RBC-Cr, U-Cr, serum Cys-C, plasma tHcy and urinary β2M concentrations were observed in workers chronically exposed to chromate compared to controls. In the exposed workers, serum vitamin B12 and folate levels were decreased and significantly inversely correlated with RBC-Cr concentrations, and increased plasma tHcy concentrations were mirrored by decreased serum vitamin B12 and folate levels. Elevated plasma tHcy concentrations were positively related to serum Cys-C concentrations.. Hyperhomocysteinemia in chronically exposed workers was primarily induced by vitamin B12 and folate deficiency. This metabolic change might be associated with renal dysfunction in chromate processing workers after long term exposure.

Topics: Adult; China; Chromates; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Male; Middle Aged; Occupational Diseases; Occupational Exposure; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

To examine the associations between variants of genes involved in the uptake, retention, and metabolism of folate and depressive symptoms and to analyze whether such associations are direct or through mediation by folate or homocysteine.. We performed a cross-sectional analysis of data from 976 Puerto Rican adults, aged 45 to 75 years, residing in the greater Boston area, Massachusetts. Twelve single nucleotide polymorphisms (SNPs) in genes involved in folate uptake, retention, and metabolism were investigated. These include FOLH1 (folate hydrolase), FPGS (folate polyglutamate synthase), GGH (γ-glutamyl hydrolase), MTHFR (methylenetetrahydrofolate reductase), MTR (methionine synthase), PCFT (proton-coupled folate transporter), and RFC1 (reduced folate carrier 1). The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depressive symptoms.. The FOLH1 rs61886492 C>T (or 1561C>T) polymorphism was significantly associated with lower CES-D score (p = .0025) after adjusting for age, sex, population admixture, smoking, and educational attainment. Individuals with the TT and TC genotypes were 49% less likely (odds ratio = 0.51, 95% confidence interval = 0.29-0.89) to report mild depressive symptoms (CES-D score ≥16 and ≤26) and 64% less likely (odds ratio = 0.36, 95% confidence interval = 0.18-0.69) to report moderate to severe depressive symptoms (CES-D score >26), compared with those with the CC genotype. No significant mediation effects by plasma folate or homocysteine on the associations between this single nucleotide polymorphism and CES-D score were observed.. The FOLH1 1561C>T polymorphism may be associated with the risk of depressive symptoms.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Adult; Aged; Boston; Cross-Sectional Studies; Depression; Female; Folate Receptor 1; Folic Acid; Folic Acid Deficiency; gamma-Glutamyl Hydrolase; Gene Frequency; Genotype; Glutamate Carboxypeptidase II; Homocysteine; Humans; Linear Models; Logistic Models; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Polymorphism, Single Nucleotide; Proton-Coupled Folate Transporter; Psychiatric Status Rating Scales; Pteroylpolyglutamic Acids; Puerto Rico; Pyridoxal Phosphate; Reduced Folate Carrier Protein; Vitamin B 12

There are no data regarding basal folate levels in patients without colorectal adenoma. This study aimed to determine the minimum serum folate concentration that associates with reduced risk of colorectal adenoma.. 1510 consecutive patients underwent total colonoscopy for suspected colorectal lesions after barium enema examination. Prior to colonoscopy, history of alcohol consumption was noted and blood serum analyzed for folate and vitamin B12 levels. Polypoid lesions were evaluated histologically. We excluded patients with anemia, history of colonoscopy, overconsumption of alcohol, or malignancies. In all, 458/1510 patients (male/female; 258/200, 40-75 years) were determined eligible. Variables were compared between patients with adenoma and those without adenoma.. Serum folate concentration was the variable with the most significant statistical variation between males with adenoma (8.0 ng/ml) and males without adenoma (9.2) (p = 0.001). Serum folate concentrations in females with adenoma did not differ significantly from those in females without adenoma (10.7 versus 10.9). When subjects were stratified into groups according to serum folate, we found no significant difference in the prevalence of adenoma in patients with folate levels greater than 8.0 ng/ml.. Patients with serum folate concentrations above 8.0 ng/ml had the lowest risk of developing colorectal adenoma.

Topics: Adenoma; Adult; Aged; Colorectal Neoplasms; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Hospitals, Teaching; Humans; Japan; Male; Mass Screening; Middle Aged; Prevalence; Prospective Studies; Risk; Sex Factors; Vitamin B 12; Vitamin B 12 Deficiency

Bilateral optic neuropathy in Dar-es-Salaam, Tanzania was first reported as an epidemic in 1988. Now argued to be endemic in 2010, the aetiology remains unclear. The authors investigated the hypothesis that low folate and vitamin B₁₂ status are associated with optic neuropathy, and also sought to investigate whether mercury, commonly used drugs, dietary factors and indoor pollution may also be risk factors.. 57 cases and 102 controls were recruited from two tertiary referral centres in Dar-es-Salaam. Data were collected on demographic characteristics, diet, medication history and HIV status. Folate and vitamin B₁₂ (holo-transcobalamin) were measured in stored serum samples. Exposure to mercury was assessed from concentrations in random urine samples.. Cooking indoors more than twice per week (OR 54.48 (95% CI 9.30 to 319.10)) and indoor use of charcoal or firewood (OR 21.20 (95% CI 2.51 to 179.36)) increased the risk of optic neuropathy. Risk was reduced in those with a higher folate status (highest versus lowest quartile OR=0.11 (95% CI 0.02 to 0.51)) and higher protein intakes (OR=0.84 (95% CI 0.72 to 0.96). No association was found with mercury exposure or any common drug or food commodity.. This study presents the first direct evidence of low folate status and indoor pollution in the aetiology of endemic bilateral optic neuropathy in Tanzania.

Topics: Adolescent; Adult; Air Pollution, Indoor; Child; Cooking; Environmental Exposure; Folic Acid; Folic Acid Deficiency; Humans; Nutrition Assessment; Optic Nerve Diseases; Risk Factors; Tanzania; Visual Acuity; Vitamin B 12; Young Adult

Topics: Anemia, Megaloblastic; Anemia, Pernicious; Autoantibodies; Autoimmune Diseases; Folic Acid Deficiency; Gastritis, Atrophic; Humans; Intrinsic Factor; Parietal Cells, Gastric; Vitamin B 12; Vitamin B 12 Deficiency

Flour fortification with folic acid is one of the main strategies for improving folate status in women of childbearing age. No interventional trial on the efficacy of folic acid fortification has been conducted so far in Iran.. To study the effects of flour fortification with folic acid on any reduction in neural tube defects (NTDs) and folate status of women of childbearing age.. In a longitudinal hospital-based study, 13,361 postpartum women were studied after admission for childbirth before and after fortification. In addition, two cross-sectional surveys were conducted before (2006) and after flour fortification (2008). The cluster sampling method was used and 580 women, 15-49 years old, were studied as a representative sample of Golestan province in the north of Iran. Fasting blood samples were collected to measure serum vitamin B(12), folate and plasma homocysteine. Sociodemographic data, health characteristics and dietary intake were determined.. The mean daily intakes of folate from natural food before and after flour fortification were 198.3 and 200.8 μg/day, respectively. The total folate intake increased significantly from 198.3 to 413.7 μg/day after fortification (p < 0.001). Folate intake increased by an average of 226 μg/day from fortified bread. The mean serum folate level increased from 13.6 to 18.1 nmol/l; folate deficiency decreased from 14.3 to 2.3% (p < 0.001). The incidence rate of NTDs declined by 31% (p < 0.01) in the post-fortification period (2.19 per 1,000 births; December 2007 to December 2008) compared to the pre-fortification period (3.16 per 1,000 births; September 2006 to July 2007).. Implementation of mandatory flour fortification with folic acid can lead to a significant increase in serum folate and a significant decrease in NTDs.

Topics: Adolescent; Adult; Bread; Cross-Sectional Studies; Female; Flour; Folic Acid; Folic Acid Deficiency; Food, Fortified; Homocysteine; Humans; Iran; Longitudinal Studies; Middle Aged; Neural Tube Defects; Nutritional Status; Socioeconomic Factors; Vitamin B 12; Young Adult

Vitamin B-12 is an important cofactor required for nucleotide and amino acid metabolism. Vitamin B-12 deficiency causes anemia and neurologic abnormalities-a cause for concern for the elderly, who are at increased risk of vitamin B-12 malabsorption. Vitamin B-12 deficiency is also associated with an increased risk of neural tube defects and hyperhomocysteinemia. The metabolism of vitamin B-12 and folate is interdependent, which makes it of public health interest to monitor biomarkers of vitamin B-12, folate, and homocysteine in a folic acid-fortified population.. The objective was to determine the vitamin B-12, folate, and homocysteine status of the Canadian population in the period after folic acid fortification was initiated.. Blood was collected from a nationally representative sample of ∼5600 participants aged 6-79 y in the Canadian Health Measures Survey during 2007-2009 and was analyzed for serum vitamin B-12, red blood cell folate, and plasma total homocysteine (tHcy).. A total of 4.6% of Canadians were vitamin B-12 deficient (<148 pmol/L). Folate deficiency (<320 nmol/L) was essentially nonexistent. Obese individuals were less likely to be vitamin B-12 adequate than were individuals with a normal BMI. A total of 94.9% of Canadians had a normal tHcy status (≤13 μmol/L), and individuals with normal tHcy were more likely to be vitamin B-12 adequate and to have high folate status (>1090 nmol/L).. Approximately 5% of Canadians are vitamin B-12 deficient. One percent of adult Canadians have metabolic vitamin B-12 deficiency, as evidenced by combined vitamin B-12 deficiency and high tHcy status. In a folate-replete population, vitamin B-12 is a major determinant of tHcy.

Topics: Adolescent; Adult; Aged; Biomarkers; Canada; Child; Cross-Sectional Studies; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Health Surveys; Homocysteine; Humans; Legislation, Food; Male; Middle Aged; Nutritional Status; Obesity; Prevalence; Severity of Illness Index; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

To determine the overall folate status of a population-based multi-ethnic sample of octogenarians and centenarians and the specific dietary, demographic and physiological factors associated with observed abnormalities.. Population-based multiethnic sample of adults aged 80 to 89 and 98 and above.. Northern Georgia, USA.. Men and women aged 80 to 89 (octogenarians, n = 77) and 98 and older (centenarians, n = 199).. Wilcoxon rank sum tests, and Chi square and logistic regression analyses were used to examine associations of low and high folate status with hematological indicators and other variables of interest.. The prevalence of low red blood cell (RBC) folate was low overall, but tended to be higher in centenarians than in octogenarians (6.5% vs. 1.3%, p = 0.058; defined as RBC folate < 317 nmol/L). The risk of having lower RBC folate (< 25th vs. > 25th percentile for RBC folate for 60yr+ in NHANES 1999-2000) was greater in association with vitamin B12 deficiency (OR = 5.36; 95%CI: 2.87-10.01), African American race (OR = 4.29; 95%CI: 2.08-8.83), and residence in a skilled nursing facility (OR = 3.25; 95%CI: 1.56-6.78) but was not influenced by age, gender, B-vitamin supplement use, high/low food score or presence of atrophic gastritis. Combined high plasma folate and low vitamin B12 status was present in some individuals (n=11), but was not associated with increased prevalence of anemia or cognitive impairment in this study.. Low RBC folate status (< 317 nmol/L) was rare in this post folic acid fortification sample of octogenarians and centenarians. RBC folate status (< 25th percentile) was strongly associated with 1) vitamin B12 deficiency, which has strong implications for vitamin treatment, and 2) with being African American, suggesting racial disparities exist even in the oldest old.

Topics: Aged, 80 and over; Anemia; Black or African American; Cohort Studies; Dietary Supplements; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Georgia; Health Status Disparities; Humans; Male; Nutrition Surveys; Nutritional Status; Prevalence; Surveys and Questionnaires; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; White People

Topics: Anemia; Animals; Bird Diseases; Bone Marrow; Diagnosis, Differential; Disease Progression; Folic Acid; Folic Acid Deficiency; Macadamia; Male; Parrots; Vitamin B 12; Vitamin B 12 Deficiency

Leukocytosis, splenomegaly, and an increased vitamin B(12) level are characteristic findings of chronic myelogenous leukemia in the chronic phase (CML-CP). Here, we report a patient with CML-CP accompanied by megaloblastic anemia. A 61-year-old man consulted our hospital because of anemia and thrombocytopenia. On physical examination, there were no remarkable findings; there was no hepatosplenomegaly. Laboratory findings were: hemoglobin 6.0 g/dl; MCV 113.6 fl; platelet count 100×10(9)/l; white cell count 8.66×10(9)/l; and LDH 1,236 IU/l. Peripheral blood smear demonstrated hypersegmented neutrophils and megalocytes with emergence of myeloblasts, giant metamyelocytes, and nucleated red cells. Vitamin B(12) and folic acid levels were low. Bone marrow examination showed megaloblastic change in the erythroblasts and myeloid hyperplasia. Following vitamin B(12) and folic acid administration, anemia and thrombocytopenia rapidly improved; thereafter, marked leukocytosis became evident. Based on the presence of t(9;22)(q34;q11) on cytogenetic study and a positive result for Major bcr/abl fusion gene, a diagnosis of CML-CP was established. This case illustrates that ineffective erythropoiesis results in anemia and thrombocytopenia in CML with vitamin B12 and/or folic acid deficiency.

Topics: Anemia, Megaloblastic; Diagnosis, Differential; Erythropoiesis; Folic Acid; Folic Acid Deficiency; Fusion Proteins, bcr-abl; Humans; Karyotyping; Leukemia, Myeloid, Chronic-Phase; Male; Middle Aged; Thrombocytopenia; Translocation, Genetic; Vitamin B 12; Vitamin B 12 Deficiency

Recurrent aphthosis is a common oral ulcerative condition consisting also of a subset of similar ulcers, properly named 'aphthous-like' ulcers (ALU), linked to systemic diseases and among these, to iron, folic acid and vitamin B(12) deficiencies.. The main objectives of this study were: (i) to evaluate the association between recurrent aphthosis and the most common predisposing factors; (ii) to assess the frequency of ALU in recurrent aphthosis; (iii) to verify the efficacy of a replacement therapy in all ALU patients.. Thirty-two adults with recurrent aphthosis and 29 otherwise healthy controls were consecutively recruited, interviewed and subjected to haematological investigations.. Family history of recurrent aphthosis was significantly associated (P < 0.01). The overall frequency of haematinic deficiencies was 56.2% in recurrent aphthosis patients vs. 7% in controls (P < 0.0001). All ALU patients with a negative family history showed a complete remission of the ulcerative episodes after replacement therapy, while those with a positive family history only had a reduction in frequency and severity. In the logistic regression model, only family history was associated with recurrent aphthosis (P = 0.0137).. The strong association with familiarity, the unexpected higher frequency of ALU (compared with the idiopathic variant) and the good response to replacement therapy means that familiarity should always be investigated. Furthermore, routine haematological screening and tests for serum iron, folic acid and vitamin B(12) deficiencies should be assessed in all patients with recurrent aphthosis to treat any nutritional deficiency and to prevent more important related systemic manifestations.

Topics: Adult; Aged; Anemia, Iron-Deficiency; Case-Control Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Logistic Models; Male; Middle Aged; Prevalence; Recurrence; Sicily; Stomatitis, Aphthous; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

Danish legislation regarding food fortification has been very restrictive resulting in few fortified food items on the Danish market. Folate and vitamin B12 deficiency is thought to be common due to inadequate intakes but little is known about the actual prevalence of low serum folate and vitamin B12 in the general population. The aim of the present study was to evaluate the folate and vitamin B12 status of Danish adults and to investigate associations between vitamin status and distinct lifestyle and genetic factors. The study included a random sample of 6784 individuals aged 30-60 years. Information on lifestyle factors was obtained by questionnaires and blood samples were analysed for serum folate and vitamin B12 concentrations and several genetic polymorphisms. The overall prevalence of low serum folate ( < 6.8 nmol/l) was 31.4 %. Low serum folate was more common among men than women and the prevalence was lower with increasing age. Low serum folate was associated with smoking, low alcohol intake, high coffee intake, unhealthy diet, and the TT genotype of the methylenetetrahydrofolate reductase (MTHFR)-C677T polymorphism. The overall prevalence of low serum vitamin B12 ( < 148 pmol/l) was 4.7 %. Low serum vitamin B12 was significantly associated with female sex, high coffee intake, low folate status, and the TT genotype of the MTHFR-C677T polymorphism. In conclusion, low serum folate was present in almost a third of the adult population in the present study and was associated with several lifestyle factors whereas low serum concentrations of vitamin B12 were less common and only found to be associated with a few lifestyle factors.

Topics: Adult; Aged; Body Mass Index; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Genotype; Humans; Life Style; Male; Middle Aged; Neural Tube Defects; Prevalence; Vitamin B 12

Patients with liver disease frequently experience changes in their nutritional status.. To determine changes in vitamin B12 and folic acid plasma levels in patients with chronic cirrhosis and to assess whether these parameters may be useful in the etiologic diagnosis of this disease.. Thirty-nine patients admitted for decompensated cirrhosis (29 with alcoholic etiology and 10 with non-alcoholic etiology) and 35 controls were prospectively studied. Plasma levels of vitamin B(12), folate acid, mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT), AST/ALT ratio, and gamma-glutamyltransferase (GGT), among other parameters, were measured.. Vitamin B(12) levels were 1151+/-568pg/ml in patients with decompensated cirrhosis and 440+/-133pg/ml in controls (p<0.05). Plasma folate levels were 8.57+/-3.8ng/ml in controls and 6.68+/-2.74ng/ml in patients with cirrhosis (p<0.05). Folate levels were lower in patients with alcoholic cirrhosis (mean value, 5.7+/-2.1) than in those with non-alcoholic cirrhosis (9.3+/-2.6; p<0.0005). The vitamin B(12)/folate ratio discriminated alcoholic etiology better than other parameters such as AST, ALT, MCV, AST/ALT ratio and GGT.. Plasma levels of vitamin B12 in patients with decompensated chronic liver disease are high, whereas plasma folate levels are low. The ratio between vitamin B12 and folic acid may be useful in the differential diagnosis of the etiology of chronic liver disease.

Topics: Adolescent; Adult; Aged; Alanine Transaminase; Aspartate Aminotransferases; Diagnosis, Differential; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; gamma-Glutamyltransferase; Homocysteine; Humans; Liver Cirrhosis; Liver Cirrhosis, Alcoholic; Liver Diseases, Alcoholic; Liver Failure; Liver Function Tests; Male; Middle Aged; Prognosis; Prospective Studies; Vitamin B 12; Young Adult

Folate and vitamin B-12 are essential for normal brain development. Few studies have examined the relationship of maternal folate and vitamin B-12 status during pregnancy and offspring cognitive function. To test the hypothesis that lower maternal plasma folate and vitamin B-12 concentrations and higher plasma homocysteine concentrations during pregnancy are associated with poorer neurodevelopment, 536 children (aged 9-10 y) from the Mysore Parthenon birth cohort underwent cognitive function assessment during 2007-2008 using 3 core tests from the Kaufman Assessment Battery, and additional tests measuring learning, long-term storage/retrieval, attention and concentration, and visuo-spatial and verbal abilities. Maternal folate, vitamin B-12, and homocysteine concentrations were measured at 30 +/- 2 wk gestation. During pregnancy, 4% of mothers had low folate concentrations (<7 nmol/L), 42.5% had low vitamin B-12 concentrations (<150 pmol/L), and 3% had hyperhomocysteinemia (>10 micromol/L). The children's cognitive test scores increased by 0.1-0.2 SD per SD increase across the entire range of maternal folate concentrations (P < 0.001 for all), with no apparent associations at the deficiency level. The associations with learning, long-term storage/retrieval, visuo-spatial ability, attention, and concentration were independent of the parents' education, socioeconomic status, religion, and the child's sex, age, current size, and folate and vitamin B-12 concentrations. There were no consistent associations of maternal vitamin B-12 and homocysteine concentrations with childhood cognitive performance. In this Indian population, higher maternal folate, but not vitamin B-12, concentrations during pregnancy predicted better childhood cognitive ability. It also suggests that, in terms of neurodevelopment, the concentration used to define folate deficiency may be set too low.

Topics: Adult; Brain; Child; Cognition; Cohort Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; Hyperhomocysteinemia; India; Male; Neurogenesis; Nutritional Status; Pregnancy; Prenatal Nutritional Physiological Phenomena; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Topics: Administration, Oral; Female; Folic Acid Deficiency; Humans; Hydroxocobalamin; Injections, Intramuscular; Pregnancy; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

Recently, hyperhomocysteinemia has been shown to be associated with impaired fracture healing in mice. The main causes for hyperhomocysteinemia are deficiencies of folate and vitamin B12. However, there is no information on whether deficiencies of these B vitamins are affecting bone repair, too.. We used two groups of mice to investigate the impact of folate and vitamin B12 deficiency on fracture healing: mice of the first group were fed a folate- and vitamin B12-deficient diet (n=14), while mice of the second group received an equicaloric control diet (n=13). Four weeks after stabilizing a closed femur fracture, bone repair was analyzed by histomorphometry and biomechanical testing. In addition, serum concentrations of homocysteine, folate, vitamin B12, the bone formation marker osteocalcin (OC), and the bone resorption marker collagen I C-terminal crosslaps (CTX) were measured.. Serum analyses revealed significantly decreased concentrations of folate and vitamin B12 in animals fed the folate- and vitamin B12-deficient diet when compared to controls. This was associated with a moderate hyperhomocysteinemia in folate- and vitamin B12-deficient mice, while no hyperhomocysteinemia was found in controls. Three-point bending tests showed no significant differences in callus stiffness between bones of folate- and vitamin B12-deficient animals and those of control animals. In accordance, the histomorphometric analysis demonstrated a comparable size and tissue composition of the callus, and also serum markers of bone turnover did not differ significantly between the two groups.. We conclude that folate and vitamin B12 deficiency does not affect bone repair in mice.

Topics: Animals; Biomechanical Phenomena; Body Weight; Bony Callus; Femoral Fractures; Folic Acid; Folic Acid Deficiency; Fracture Healing; Homocysteine; Mice; Radiography; Vitamin B 12; Vitamin B 12 Deficiency

To investigate serum levels of homocysteine (Hcys) and the risk that altered levels carry for thrombosis development in ulcerative colitis (UC) patients.. 55 UC patients and 45 healthy adults were included. Hcys, vitamin B12 and folic acid levels were measured in both groups. Clinical history and thromboembolic events were investigated.. The average Hcys level in the UC patients was 13.3 +/- 1.93 micromol/L (range 4.60-87) and was higher than the average Hcys level of the control group which was 11.2 +/- 3.58 micromol/L (range 4.00-20.8) (P < 0.001). Vitamin B12 and folic acid average values were also lower in the UC group (P < 0.001). When multivariate regression analysis was performed, it was seen that folic acid deficiency was the only risk factor for hyperhomocysteinemia. Frequencies of thromboembolic complications were not statistically significantly different in UC and control groups. When those with and without a thrombosis history in the UC group were compared according to Hcys levels, it was seen that there were no statistically significant differences. A negative linear relationship was found between folic acid levels and Hcys.. We could not find any correlations between Hcys levels and history of prior thromboembolic events.

Topics: Adult; Aged; Biomarkers; Case-Control Studies; Chi-Square Distribution; Colitis, Ulcerative; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Linear Models; Male; Middle Aged; Risk Assessment; Risk Factors; Thromboembolism; Up-Regulation; Vitamin B 12; Young Adult

Prematurity and small-for-gestational age (SGA) neonates are at risk for postnatal complications. Concentrations of total homocysteine (tHcy) might be related to neonatal outcome. We hypothesized that concentrations of tHcy are not related to growth restriction in neonates from mothers receiving 5 mg/day folic acid. We studied a total of 133 preterm neonates from normotensive mothers; SGA (n=96) and appropriate-for-gestational age (AGA, n=37).. Concentrations of tHcy, folate and vitamin B12 were measured in venous umbilical cord plasma.. AGA preterm neonates had higher mean birth weight (BW) compared to SGA preterms (2472 g vs. 2007 g; p<0.001) of comparable mean gestational age (GA) (35.1 vs. 35.7 weeks; p=0.059). Concentrations of tHcy (4.86 vs. 4.95 micromol/L), folate (63.3 vs. 55.7 nmol/L), and vitamin B12 (409 vs. 394 pmol/L) were not significantly different between the groups. GA was a strong positive predictor, BW was a significant negative predictor of cord plasma folate. Vitamin B12 concentration was a significant negative predictor of cord tHcy.. Concentrations of tHcy did not differ between SGA and AGA preterm neonates born to mothers supplemented with folic acid. This finding argues against a causal role for folate deficiency or increased tHcy in growth restriction.

Topics: Adult; Birth Weight; Female; Fetal Blood; Fetal Growth Retardation; Folic Acid; Folic Acid Deficiency; Gestational Age; Homocysteine; Humans; Infant, Newborn; Infant, Small for Gestational Age; Mothers; Predictive Value of Tests; Pregnancy; Premature Birth; Vitamin B 12

Methylenetetrahydrofolate reductase (MTHFR) encoding genes were associated with ulcerative colitis in Chinese in our previous study. We further studied association of a new polymorphism of MTHFR G1793A with ulcerative colitis and assessed relationship of this polymorphism with hyperhomocysteinemia (HHcy, > or = 15 mmol/L) and deficiency of folate (< or = 7 nmol/L) and vitamin B(12) (< or = 150 pmol/L) in a cohort of patients with ulcerative colitis in central China.. A total of 252 patients and 654 healthy controls were recruited. Polymorphism of MTHFR G1793A was examined using a polymerase chain reaction-restriction fragment length polymorphism method. Plasma levels of homocysteine (Hcy), folate and vitamin B(12) were determined by enzymatic cycling assay and corpuscle immune chemiluminescence assay, respectively.. Frequencies of alleles and genotypes in MTHFR G1793A gene differed significantly between ulcerative colitis patients and the healthy controls (20.83% vs 10.47%, 95% confidence interval [CI]: 1.703-2.972, P = 0.0006; 40.48% vs 19.88%, 95% CI: 1.997-3.761, P = 0.0002, respectively). Plasma Hcy levels were higher and folate and vitamin B(12) concentrations were lower in the patients than in the healthy controls (21.72 +/- 6.59 vs 12.47 +/- 5.02, 95% CI: -10.93--7.58, P < 0.0001; 11.25 +/- 6.19 vs 15.28 +/- 7.72, 95% CI: 2.03-6.04; P < 0.001; 322.81 +/- 128.47 vs 442.59 +/- 129.36, 95% CI: 62.61-136.95, P < 0.0001, respectively). HHcy and folate deficiency were more prevalent in patients with ulcerative colitis (45.32% vs 26.17%, 95% CI: 1.285-4.378, P = 0.005; 30.68% vs 13.0%, 95% CI: 1.416-6.197, P = 0.003, respectively).. MTHFR G1793A gene polymorphism, HHcy, folate deficiency and low vitamin B(12) concentration were associated with ulcerative colitis in central China. Our findings demonstrate that the Hcy-related gene and metabolites are involved in pathogenesis of ulcerative colitis.

Topics: Adult; Alleles; China; Colitis, Ulcerative; DNA; Female; Folic Acid; Folic Acid Deficiency; Gene Frequency; Genetic Predisposition to Disease; Genotype; Homocysteine; Humans; Hyperhomocysteinemia; Immunoenzyme Techniques; Male; Methylenetetrahydrofolate Dehydrogenase (NADP); Middle Aged; Polymorphism, Genetic; Prevalence; Vitamin B 12

The aims of this study were to investigate the prevalence of serum vitamin B(12) and folate abnormalities in patients with inflammatory bowel diseases (IBD) and to identify risk factors associated with B12 and folate abnormalities in this entity.. 138 patients with IBD (45 Crohn's disease and 93 ulcerative colitis) and 53 healthy subjects were enrolled into the study. Fasting serum B12 and folic acid levels were measured and clinical data regarding inflammatory bowel diseases were gathered.. While the mean serum B(12) concentration in CD patients was 281+/-166pg/ml, the mean serum vitamin B12 concentration in UC patients was 348+/-218pg/ml (p=0.224). The number of patients with vitamin B12 deficiency in the CD group was greater than the number of patients with UC [n=10 (22%) vs. n=4 (7.5%), p=0.014]. The number of patients (n=10, 22%) with B12 deficiency in the CD group was also greater than controls (n=4, 7.5%) (p=0.039). With regard to folate levels, the median serum folate level was 7.7+/-5.3ng/ml in CD patients, 8.6+/-8.3ng/ml in UC patients and 9.9+/-3.3ng/ml in the control group (p=n.s.). Patients with a prior ileocolonic resection had an abnormal B12 concentration compared to patients without surgery (p=0.008). In CD patients, ileal involvement was the only independent risk factor for having a low folate level.. Serum vitamin B12 and folate deficiencies are common in patients with CD compared to UC patients and controls. In CD patients, prior small intestinal surgery is an independent risk factor for having a low serum vitamin B12 level.

Topics: Adolescent; Adult; Age Factors; Case-Control Studies; Chi-Square Distribution; Child; Child, Preschool; Colitis, Ulcerative; Crohn Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Inflammatory Bowel Diseases; Logistic Models; Male; Middle Aged; Odds Ratio; Prevalence; Retrospective Studies; Risk Factors; Sex Factors; Statistics, Nonparametric; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Vegans, and to a lesser extent vegetarians, have low average circulating concentrations of vitamin B12; however, the relation between factors such as age or time on these diets and vitamin B12 concentrations is not clear. The objectives of this study were to investigate differences in serum vitamin B12 and folate concentrations between omnivores, vegetarians and vegans and to ascertain whether vitamin B12 concentrations differed by age and time on the diet.. A cross-sectional analysis involving 689 men (226 omnivores, 231 vegetarians and 232 vegans) from the European Prospective Investigation into Cancer and Nutrition Oxford cohort.. Mean serum vitamin B12 was highest among omnivores (281, 95% CI: 270-292 pmol/l), intermediate among vegetarians (182, 95% CI: 175-189 pmol/l) and lowest among vegans (122, 95% CI: 117-127 pmol/l). In all, 52% of vegans, 7% of vegetarians and one omnivore were classified as vitamin B12 deficient (defined as serum vitamin B12 <118 pmol/l). There was no significant association between age or duration of adherence to a vegetarian or a vegan diet and serum vitamin B12. In contrast, folate concentrations were highest among vegans, intermediate among vegetarians and lowest among omnivores, but only two men (both omnivores) were categorized as folate deficient (defined as serum folate <6.3 nmol/l).. Vegans have lower vitamin B12 concentrations, but higher folate concentrations, than vegetarians and omnivores. Half of the vegans were categorized as vitamin B12 deficient and would be expected to have a higher risk of developing clinical symptoms related to vitamin B12 deficiency.

Topics: Adult; Age Factors; Aged; Cohort Studies; Cross-Sectional Studies; Diet; Diet, Vegetarian; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Nutrition Surveys; Nutritional Requirements; Nutritional Status; Prospective Studies; Time Factors; United Kingdom; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Young Adult

To assess the prevalence of folate, vitamin B(12), and iron deficiencies and their associations with anemia among women of childbearing age in northern China, an area with a reported high incidence of neural tube defects.. Plasma folate, vitamin B(12), ferritin, and hemoglobin levels were measured among 1,671 non-pregnant women of childbearing age from Xianghe County, Hebei Province, China in June 2004.. Geometric means [95 % confidence interval (CI)] of plasma concentrations were 9.3 (4.0, 21.6) nmol/L for folate, 213.1 (82.4, 550.9) pmol/L for vitamin B(12), 17.4 (1.1, 278.6) microg/L for ferritin, and 129.9 (104.6, 161.4) g/L for hemoglobin (Hb). Approximately 24 % of women had biochemical evidence of folate deficiency (<6.8 nmol/L), 21.4 % were deficient (<148 pmol/L) in vitamin B(12), 30.2 % had iron depletion (<15 microg/L), and anemia (Hb < 120 g/L) was detected among 15.4 % of women. Of the three nutrients, only iron depletion (ferritin < 15 microg/L) was independently associated with anemia (adjusted odds ratio = 6.4, 95 % CI 4.8, 8.6).. Although there were substantial proportions of folate and vitamin B(12) deficiencies among women of childbearing age in northern China, iron deficiency was the most important contributor to anemia.

Topics: Adult; Anemia; Anemia, Iron-Deficiency; China; Cross-Sectional Studies; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iron; Iron Deficiencies; Odds Ratio; Prevalence; Rural Population; Vitamin B 12; Vitamin B 12 Deficiency

The present study aimed to investigate the associations between genetic polymorphism of methylenetetrahydrofolate reductase (MTHFR) G1793A, plasma homocysteine (Hcy) levels, vitamin status and ulcerative colitis (UC) in a cohort of patients in Hubei Han nationality.. Two hundred and ninety-nine UC patients and 764 age- and sex-matched healthy controls were recruited in this study. Polymorphism of MTHFR G1793A was examined using a PCR-RELP method. Plasma levels of Hcy, folate and vitamin B12 were determined by enzymatic cycling assay and corpuscle immune chemiluminescence assay, respectively.. Both variant allele and genotype frequencies in MTHFR G1793A gene were significantly higher in the UC patients compared to the controls (22.24% vs 14.20%, P < 0.001; 42.81% vs 26.97%, P<0.001, respectively). Plasma Hcy levels were increased in UC patients compared to the controls [(20.67 ± 6.42) mmol/L vs (13.21±5.11) mmol/L, P<0.001] while folate and vitamin B12 concentrations were significantly decreased [(11.37±6.34) nmol/L vs (14.89±7.21) nmol/L, P<0.001; (324.15±127.53) pmol/L vs (421.54±128.45) pmol/L, P<0.001, respectively]. Furthermore, hyperhomocysteinaemia (HHcy) and folate deficiency were also more prevalent in the UC patients (32.44% vs 25.78%, P=0.029; 23.41% vs 17.01%, P=0.016, respectively).. Genetic polymorphism of MTHFR G1793A was strongly associated with UC. HHcy, folate deficiency and low vitamin B12 concentration were common phenomena in the UC patients of Hubei Han nationality. Our findings demonstrate that the genes related to Hcy metabolism may play an important role in the pathogenesis of UC.

Topics: Adult; Case-Control Studies; Colitis, Ulcerative; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Polymorphism, Single Nucleotide; Vitamin B 12

Myofascial pain syndrome (MPS) is characterized by myofascial trigger points in a palpable taut band of skeletal muscle.. We aimed to investigate serum trace elements, vitamin B12, folic acid levels and their correlations with clinical findings and functional status in patients with MPS.. Thirty eight patients with at least one trigger point located on shoulder muscles, and at least 6 months duration, were included in this study. The demographic data, disease duration of patients were noted. Serum copper, zinc, magnesium and iron levels, vitamin B12 and folic acid levels were measured. Visual analogue scale (VAS) was implemented to estimate daily severity of pain. Pain pressure threshold of subjects and control groups were assessed by using Fischer's tissue compliancemeter. The Turkish version of the Beck Depression Inventory (BDI) was administered for the presence of any depressive disorder.. The mean age of patients in MPS group and control group were 33.1 and 37.8 years respectively. Serum levels of zinc (p< 0.006) were significantly decreased in patients with MPS. VAS, total myalgic and BDI scores of patients were significantly higher than the control group (Respectively p< 0.000, p< 0.012, p< 0.000). Association between TMS and magnesium, vitamin B12 levels was found statistically significant. BDI score correlated significantly with the serum zinc level (r:-0.548, p< 0.001) and VAS in patients with MPS (r:0.641, p< 0.000).. According to the results of this study, it was asserted that trace elements, vitamins may play an important role in the pathophysiology of MPS and psychological factors may also have additional effect.

Topics: Adult; Case-Control Studies; Depression; Facial Neuralgia; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Trace Elements; Vitamin B 12; Vitamin B 12 Deficiency; Zinc

Determine the correlation between the hearing threshold and the serum levels of vitamin B12 (cobalamin) and folic acid among elderly subjects (> 60 years) with age-related hearing loss (ARHL).. Cross-sectional.. Community.. Subjects included elderly who were found apparently healthy following repeated examination by physicians. The pure tone average (PTA) for the speech and high frequencies, and the serum folate and cobalamin were determined and the correlation found.. The mean ± SD values of serum folate among the subjects with normal PTA in the speech frequencies (0-30 dB) was 412.3 nmol/L ± 17.6 nmol/L, while among those with hearing loss (HL), it was 279.1 nmol/L ± 17.2 nmol/L (P = 0.01). In the high frequencies, the mean ± SD values among the subjects with normal PTA was 426.3 nmol/L ± 17.6 nmol/L, while among those with HL, it was 279.14 nmol/L ± 171.2 nmol/L. The serum cobalamin among the subjects with normal PTA within the speech frequencies was 49.7 pmol/L ± 9.4 pmol/L, while among those with speech-frequency HL, it was 42.6 pmol/L ± 10.2 pmol/L. However, for high frequencies, the mean ± SD values among the subjects with normal PTA was 47.4 pmol/L ± 7.3 pmol/L, while among those with HL, it was 41.3 pmol/L ± 9.2 pmol/L. Spearman's correlation revealed that low folate (correlation coefficient = -0.27, P = 0.01) and cyanocobalamin (correlation coefficient = -0.35, P = 0.02) were significantly associated with increasing hearing threshold in the high frequencies. After adjusting for age, serum folate (correlation coefficient = -0.01, P = 0.01) was significant, while vitamin B12 (correlation coefficient = -0.01, P = 0.74) was not.. Serum folate was significantly lower among elderly with ARHL. Trials on nutritional supplementation may substantiate the role of serum folate in ARHL.

Topics: Age Factors; Aged; Aged, 80 and over; Audiometry, Pure-Tone; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Hearing Loss; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Folate-deficiency anaemia occurs in about 4 per 100 000 people, although severe cases causing moderate pancytopenia are rarer. We present the case of a significant folate deficiency in a 50-year-old alcoholic with a background of mild liver impairment and recurrent nasal and rectal bleeding. Her blood tests showed profound macrocytic anaemia with haemoglobin 2.6 g/dl, leucopoenia with white cell count 3.2 × 10(9)/litre and thrombocytopenia with platelets 17 × 10(9)/litre. Serum folate was 0.8 ng/ml (normal 2.5-13.5 ng/ml) confirming severe deficiency. Despite these life-threatening results, the patient was stable, alert and was keen to avoid admission. Medical management of the anaemia included slow transfusion of red cells and one unit of platelets in view of haemorrhagic symptoms, two injections of vitamin B12 while awaiting assays and oral folic acid. A rapid improvement in the leucopoenia and thrombocytopenia resulted and no additional complications were encountered.

Topics: Anemia, Macrocytic; Combined Modality Therapy; Epistaxis; Erythrocyte Transfusion; Female; Folic Acid; Folic Acid Deficiency; Gastrointestinal Hemorrhage; Humans; Leukopenia; Liver Diseases, Alcoholic; Middle Aged; Pancytopenia; Platelet Transfusion; Thrombocytopenia; Vitamin B 12

To assess the folate and vitamin B12 status of a group of Vietnamese women of reproductive age and to estimate the rate of neural tube defects (NTD) based on red blood cell (RBC) folate concentrations.. A representative sample of non-pregnant women (15-49 years) living in Hanoi City (n 244) and Hai Duong Province (n 245).. RBC folate, plasma vitamin B12 and plasma holo-transcobalamin (holoTC), a sensitive indicator of vitamin B12 status.. Mean (95% CI) concentrations of RBC folate, plasma B12 and plasma holoTC were 856 (837, 876) nmol/l, 494 (475, 513) pmol/l and 78 (74, 82) pmol/l, respectively. Only 3% and 4% of women had plasma B12 and holoTC concentrations indicative of deficiency. No woman had an RBC folate concentration indicative of deficiency (<317 nmol/l). Only 47% of women had an RBC folate concentration > or = 905 nmol/l. Accordingly, we predict the NTD rate in these regions of Vietnam to be 14.7 (14.2, 15.1) per 10,000 pregnancies.. There was no evidence of folate and vitamin B12 deficiency among this population of Vietnamese women. However, suboptimal folate status may be placing three out of five women at increased risk of NTD. Reductions in NTD rates are still possible and women would benefit from additional folic acid during the periconceptional period from either supplements or fortified foods.

Topics: Adolescent; Adult; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Middle Aged; Neural Tube Defects; Nutrition Assessment; Nutritional Status; Risk Factors; Transcobalamins; Vietnam; Vitamin B 12; Vitamin B 12 Deficiency; Women's Health; Young Adult

Vitamin B12 and folate deficiency causing neuropsychiatric and thrombotic manifestations, such as peripheral neuropathy, subacute combined degeneration of cord, dementia, ataxia, optic atrophy, catatonia, psychosis, mood disturbances, myocardial infarction and portal vein thrombosis are well known. This present report highlights an unusual presentation of vitamin B12 deficiency-psychotic disorder, extrapyramidal symptoms in a 12-year-old boy. His symptoms responded to parenteral vitamin B12 therapy. So with this report we emphasized that serum vitamin B12 and folate levels should be measured, especially in those patients who present with other known neuropsychiatric features of vitamin B12 and folate deficiency.

Topics: Basal Ganglia Diseases; Child; Folic Acid; Folic Acid Deficiency; Humans; Male; Psychotic Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Neurologic and hematologic abnormalities are common in HIV-infected children and may be related to concomitant deficiencies in serum B12 and folate, which are highly prevalent in HIV-infected adults. We sought to determine the prevalence of B12 and folate deficiencies in HIV-infected children in the United States.. Cross-sectional information on demographics, folate and B12 levels, hematological parameters, concurrent CD4%, HIV-viral load and antiretroviral regimens were abstracted from the medical records of 103 vertically infected children followed in an outpatient pediatric HIV clinic in the Bronx, during 2001-2002.. Mean age was 10 years (+/-4.4 years), 46% were male, 53% African-American and 46% Hispanic. Nineteen percent had significant immunologic suppression and 18 children had AIDS. All were receiving combination antiretroviral therapy and 66% were on a protease inhibitor-based regimen. Sixteen were taking cotrimoxazole prophylaxis. None were taking multivitamins or manifested clinical evidence of gastrointestinal malabsorption. All patients had serum folate or B12 levels within or above the normal range. Children with elevated B12 were significantly more likely to be younger (P = 0.0002) and have higher mean folate levels (P = 0.0004) compared with children with normal serum B12. In a multivariate logistic regression analysis, factors independently associated with elevated levels of vitamin B12 included: elevated serum folate [odds ratio (OR): 3.2; P = 0.01], nonnucleoside reverse transcriptase inhibitor use (OR: 0.38; P = 0.05) and female sex (OR: 0.67; P = 0.42). Folate and B12 deficiencies are uncommon in HIV-infected children in the United States, suggesting that routine supplementation with B12 and folate is not indicated without confirmation of micronutrient deficiency.

Topics: Adolescent; Anti-HIV Agents; CD4 Lymphocyte Count; Child; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; HIV Infections; HIV-1; Humans; Infectious Disease Transmission, Vertical; Male; Retrospective Studies; Viral Load; Vitamin B 12; Vitamin B 12 Deficiency

In some prospective studies, associations of serum vitamin B(12) and homocysteine concentrations with cognitive decline have been reported but few have examined the role of methylmalonic acid, a more specific marker of vitamin B(12) deficiency than homocysteine.. The aim of the study was to determine whether serum concentrations of vitamin B(12) or selected metabolites are related to cognitive decline.. A total of 516 subjects were selected in a stratified random sampling design from among Chicago Health and Aging Project participants for clinical evaluation. We used linear mixed models to examine the association of blood markers of vitamin B(12) status to change in cognitive scores over 6 years. Cognitive function was assessed every 3 years and measured as the sum of standardized scores on four tests.. Probable vitamin B(12) deficiency was observed in 14.2% of the sample. Elevated serum concentrations of homocysteine were present in 19.2% of subjects, and of methylmalonic acid, in 36.4%. Higher serum methylmalonic acid concentrations were predictive of faster rates of cognitive decline (beta = -0.00016, SE = 0.0001, p = 0.004) and higher serum vitamin B(12) concentrations were associated with slower rates of cognitive decline (beta = +0.00013, SE < 0.0001, p = 0.005) in multivariable adjusted mixed models. Serum concentrations of homocysteine had no relationship to cognitive decline.. Serum methylmalonic acid and vitamin B(12) concentrations may be the more important risk factors for cognitive decline when compared to serum homocysteine concentrations, particularly in older populations exposed to food fortification and possible supplements containing folic acid.

Topics: Aged; Aged, 80 and over; Biomarkers; Cognition Disorders; Cohort Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; Indicators and Reagents; Male; Methylmalonic Acid; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Using the Bayley test, the mental and psychomotor development in a cohort of 253 children were evaluated. Maternal dietary intake of vitamin B(12) and folate was assessed from a semiquantitative questionnaire administered during the first trimester of pregnancy. Maternal genotypes of MTHFR (677C>T and 1298A>C), were ascertained by PCR-RFLP. The 677T and 1298C variant alleles were present in 59% and 10% of participants, respectively. A dietary deficiency of vitamin B(12) was negatively associated with mental development (beta = -1.6; 95% CI = -2.8 to -0.3). In contrast, dietary intake of folate (< 400 mg/day) reduced the mental development index only among children of mothers who were carriers of the TT genotype (beta = -1.8; 95% CI = -3.6 to -0.04; P for interaction = 0.07). Vitamin B(12) and folate supplementation during pregnancy could have a favorable impact on the mental development of children during their first year of life, mainly in populations that are genetically susceptible.

Topics: Adolescent; Adult; Brain; Child Development; Cohort Studies; Diet; Environment; Female; Folic Acid; Folic Acid Deficiency; Genotype; Humans; Infant; Methylenetetrahydrofolate Reductase (NADPH2); Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Psychomotor Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Increased homocysteine has in some cases been linked with an increased incidence of Alzheimer's disease and motor neuron disease. Folate or B12 deficiency increases homocysteine, but controversy exists as to whether their levels also correlate with either disorder. Since their presence within various dietary constituents may confound interpretation, we tested the impact of deprivation of either or both in the closed environment of neuronal cell cultures. Deprivation of either increased cytosolic calcium, reactive oxygen species, intracellular homocysteine, and apoptosis, but deprivation of both fostered substantially larger increases, supporting the notion that both are required for optimal neuroprotection.

Topics: Calcium; Cell Line, Tumor; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Nerve Degeneration; Neuroblastoma; Neurons; Reactive Oxygen Species; Vitamin B 12; Vitamin B 12 Deficiency

In the present work we measured blood levels of total homocysteine ((t)Hcy), vitamin B(12) and folic acid in patients with Parkinson s disease (PD) and in age-matched controls and searched for possible associations between these levels with smoking, alcohol consumption, L-DOPA treatment and disease duration in PD patients. We initially observed that plasma (t)Hcy levels were increased by around 30 % in patients affected by PD compared to controls. Linear correlation, multiple regression and comparative analyses revealed that the major determinant of the increased plasma concentrations of (t)Hcy in PD patients was folic acid deficiency, whereas in controls (t)Hcy levels were mainly determined by plasma vitamin B(12) concentrations. We also observed that alcohol consumption, gender and L-DOPA treatment did not significantly alter plasma (t)Hcy, folic acid and vitamin B(12) levels in parkinsonians. Furthermore, disease duration was positively associated with (t)Hcy levels and smoking was linked with a deficit of folic acid in PD patients. Considering the potential synergistic deleterious effects of Hcy increase and folate deficiency on the central nervous system, we postulate that folic acid should be supplemented to patients affected by PD in order to normalize blood Hcy and folate levels, therefore potentially avoiding these risk factors for neurologic deterioration in this disorder.

Topics: Analysis of Variance; Case-Control Studies; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Levodopa; Male; Matched-Pair Analysis; Middle Aged; Nerve Degeneration; Parkinson Disease; Reference Values; Statistics, Nonparametric; Vitamin B 12

Several clinical trials have reported B vitamins to be associated with osteoporosis.. Our objective was to investigate whether low serum B vitamins are associated with altered structural and biomechanical properties of human bone.. Femoral heads of 94 men and women who underwent hip arthroplasty were analyzed by using dual-energy X-ray absorptiometry (DXA), biomechanical testing (indentation method), and histomorphometry. In addition, blood was collected to measure serum concentrations of homocysteine, folate, vitamin B-6, vitamin B-12, the bone formation marker osteocalcin, and the bone resorption marker tartrate-resistant acid phosphatase (TRAP). Measurement outcomes were grouped according to subjects with high and low serum concentrations, respectively, of folate, vitamin B-6, and vitamin B-12 (n = 47 for each group).. Histomorphometric analysis showed a significantly lower trabecular thickness and trabecular area in subjects with low serum folate concentrations than in those with high serum folate concentrations and a significantly lower trabecular number in subjects with low serum vitamin B-6 concentrations than in those with high serum vitamin B-6 concentrations. In contrast, we found a comparable trabecular structure in subjects with high and low serum vitamin B-12 concentrations. DXA and biomechanical testing did not show significant differences between subjects with high and low serum B vitamin concentrations. Osteocalcin was significantly lowered in subjects with a low serum B vitamin concentration, whereas there was no association between serum B vitamins and TRAP.. The results of the present study indicate that low serum folate and vitamin B-6 concentrations, but not low serum vitamin B-12 concentrations, are associated with an altered morphology of human bone.

Topics: Absorptiometry, Photon; Aged; Arthroplasty, Replacement, Hip; Body Height; Body Weight; Bone and Bones; Bone Density; Female; Femur Head; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Osteoporosis; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6 Deficiency

A 52-year-old woman was admitted to the hospital because of appetite loss, unsteadiness, psychogenic symptoms, ataxia, and consciousness disturbance as a result of the ingestion of a diet restricted to only carbohydrates for a long term. Laboratory examination indicated the presence of pancytopenia with macrocytic anemia; further, decreased vitamin B1 and B12 levels were detected in her serum. Magnetic resonance imaging fluid attenuated inversion recovery (FLAIR), revealed high-signal intensity in the bilateral corpus striatum, third ventricle circumference, and cerebellar cortex. Thereafter, she received drip infusion that did not include vitamin B1 or B12 and subsequently suffered a cardiac arrest due to the aggravation of cardiac insufficiency; consequently, she was transferred to our hospital. Upon admission the patient was diagnosed to have obvious cardiomegaly with pleural effusion; further, a negative T-wave was obtained on the electrocardiogram. A diagnosis of beriberi heart disease was made because of thiamine deficiency. She was treated by thiamine administration, following which the cardiac symptoms improved immediately. Various neurological symptoms caused by encephalopathy, peripheral neuropathy and subacute combined spinal cord degeneration improved by treatment with thiamine and cyanocobalamine administration; however, some of these symptoms still remained. General awareness of the fact that neurological symptoms can be caused by vitamin deficiency is essential.

Topics: Beriberi; Cardiomegaly; Corpus Striatum; Female; Folic Acid; Folic Acid Deficiency; Heart Arrest; Humans; Middle Aged; Subacute Combined Degeneration; Thiamine; Thiamine Deficiency; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Wernicke Encephalopathy

Vitamin B-12 is related to neurocognitive function in school-age children, yet sociodemographic and dietary correlates of vitamin B-12 status in this age group are not well characterized. The prevalences of vitamin B-12 or folate deficiencies in Colombia are unknown. We conducted a cross-sectional study in a representative sample of 2800 low- and middle-income children aged 5-12 y from Bogotá's public schools. Plasma vitamin B-12 and erythrocyte folate concentrations (mean +/- SD) were 327 +/- 106 pmol/L and 858 +/- 256 nmol/L, respectively. The prevalence of vitamin B-12 deficiency (<148 pmol/L) was 1.6% and the prevalence of marginal status (148-221 pmol/L) was 15.0%. Only 2 children had folate deficiency (<305 nmol/L). In multivariate analysis, mean vitamin B-12 concentrations significantly decreased with age and were 15 pmol/L higher in girls than boys (95%CI = 8, 23). Vitamin B-12 was inversely related to the mother's parity and positively associated with the amount of money spent on food per person per day at home and the household's neighborhood socioeconomic status (SES) classification. Folate concentrations were lower in girls than in boys and significantly increased with the household's SES. We identified 4 dietary patterns with principal components analysis of a FFQ in a random subsample (n = 972). Plasma vitamin B-12 was strongly, positively associated with a pattern that included frequent intake of beef, chicken, and dairy products in a dose-response manner (P-trend, adjusted, = 0.008). Low vitamin B-12 status is not negligible in Colombian school children and is associated with poverty and marginal intake of animal food sources.

Topics: Animals; Child; Child, Preschool; Colombia; Diet; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Nutritional Status; Socioeconomic Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Cardiovascular Diseases; Female; Folic Acid; Folic Acid Deficiency; Humans; Hyperhomocysteinemia; Nutritional Status; Pregnancy; Pregnancy Outcome; Public Health; Vitamin B 12; Vitamin B 12 Deficiency; World Health Organization

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aging; Child; Child, Preschool; Diet; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Infant; Infant, Newborn; Male; Middle Aged; Nutrition Assessment; Nutritional Requirements; Outcome and Process Assessment, Health Care; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency; World Health Organization

Folate and cobalamin are responsible for healthy growth. However, the B-vitamin and homocysteine status of adolescents is not well known. The aim was to assess the status of folate, cobalamin, and homocysteine in healthy Spanish adolescents.. Serum cobalamin, serum folate, homocysteine, methylenetetrahydrofolate reductase 677C>T variant, BMI, smoking habits, and Tanner stage were determined according to gender in 165 adolescents (84 females, 81 males; 13-18.5 years) using the Student's t test, Mann-Whitney U test and chi(2) test, respectively. Interactions between socioeconomic status, age group, methylenetetrahydrofolate reductase polymorphism, BMI, smoking habits, Tanner stage, and vitamin status, respectively, were examined by ANOVA or Kruskal-Wallis H test (p < 0.05).. Boys had markedly higher homocysteine (males 8.92 (5.51-22.94) micromol/l; females 7.91 (5.09-13.86) micromol/l), whereas girls showed higher serum cobalamin concentrations (males 540.00 (268.00-946.47) pmol/l; females 594.82 (280.63-1,559.64) pmol/l). Data are shown as medians and the 2.5th to 97.5th percentiles in parentheses. Adolescents with the homozygous variant of methylenetetrahydrofolate reductase displayed significantly higher homocysteine and lower serum folate: normal 5.73 (3.09-10.73) ng/ml serum folate, 7.57 (4.94-12.94) micromol/l homocysteine; homozygous 4.10 (2.75-7.88) ng/ml serum folate, 10.83 (7.00-22.82) micromol/l homocysteine.. The present study provides data on the folate, cobalamin, and homocysteine status of Spanish adolescents. To assure a better assessment, revision of references for adolescents is still needed.

Topics: Adolescent; Adolescent Nutritional Physiological Phenomena; Analysis of Variance; Body Mass Index; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Methylenetetrahydrofolate Reductase (NADPH2); Nutrition Assessment; Nutritional Status; Polymorphism, Genetic; Sex Factors; Smoking; Spain; Vitamin B 12; Vitamin B Complex

Endothelial dysfunction is a key process in atherosclerosis. Hypomethylation is one of the postulated mechanisms involved in atherogenesis and is mainly secondary to a decrease in essential factors such as, folate and vitamin B12 for the biosynthesis of S-adenosylmethionine (SAM), the main methyl-group donor for methylation reactions.. To investigate in an animal model, whether hypomethylation, secondary to folate or vitamin B12 deficiency, affects endothelium-dependent relaxation (EDR) induced by acetylcholine (ACh).. Adult male Wistar rats were divided into 4 groups of 12 rats each: folate and B12 deficiency (FB12D 0mg folate/kg, 0 microg/kg B12), folate deficiency (FD 0mg folate/kg and 50 microg/kg B12), B12 deficiency (B12D: 8 mg/kg folate and 0 microg/kg B12 and control diet (CD)). After eight weeks the animals were killed and thoracic aorta and liver removed. Serum concentration of homocysteine, folate and vitamin B12 were determined. Hepatic levels of SAM and S-adenosylhomocysteine (SAH) were measured, as indicator of hypomethylation. ACh-induced EDR and sodium nitroprusside (SNP)-induced endothelium-independent relaxation (EIR), in isolated aorta rings were evaluated.. Hcy concentrations were significantly increased in the folate and B12 deficient groups. SAM and the SAM/SAH ratio were lower in the FD and FB12D than in the control and B12D group. Folate, B12 deficiency, serum Hcy levels and hepatic SAM/SAH ratio did not affect EDR neither EIR.. In adult Wistar rats, chronic folate or folate plus vitamin B12 deficiency generates hypomethylation which is not related to an alteration of endothelial function.

Topics: Acetylcholine; Animals; Aorta, Thoracic; Atherosclerosis; Endothelium, Vascular; Folic Acid Deficiency; Homocysteine; In Vitro Techniques; Liver; Male; Methylation; Nitric Oxide Donors; Nitroprusside; Rats; Rats, Wistar; S-Adenosylmethionine; Vasodilation; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Folic Acid; Folic Acid Deficiency; Humans; Nutritional Sciences; Public Health; Vitamin B 12; Vitamin B 12 Deficiency

Folic acid fortification implemented mandatorily in many countries has been associated with significant increase in blood folate concentrations and reduction in the prevalence of neural tube defects. However, there are controversial findings on the probability of vitamin B(12) deficiency being masked in the population after folic acid fortification. Baseline data on folate and vitamin B(12) status are necessary before mandatory flour fortification is implemented.. To assess dietary intake of folate and vitamin B(12) and to determine blood concentrations of folate, vitamin B(12) and homocysteine in women of childbearing age as baseline data regarding folic acid fortification in Iran.. A descriptive cross-sectional survey was performed with 579 healthy women as a representative sample of the Golestan province. Fasting blood samples were taken and dietary (24-hour recall), health and sociodemographic data were collected with an interview. Serum concentrations of folate and vitamin B(12) were measured with radioimmunoassay, and plasma homocysteine concentrations were assessed by high-performance liquid chromatography with fluorescence detection.. Mean serum concentrations of folate and vitamin B(12) were 13.6 nmol/l (95% CI 12.8-14.4) and 194.4 pmol/l (95% CI 183.8-205.0), respectively. Inadequate serum folate levels were present in 14.3% of the women and 22.7% had serum vitamin B(12) levels below normal. Mean plasma homocysteine concentration was 12.6 micromol/l (95% CI 12.1-13.2) and hyperhomocysteinemia was observed in 38.3% of the women. Mean daily intake of folate and vitamin B(12) was 198.3 microg (95% CI 185.4-211.3) and 2.6 microg (95% CI 1.9-3.2), respectively. Folate intake from food was positively correlated with serum folate concentrations (r = 0.084, p < 0.05) and inversely correlated with plasma homocysteine concentrations (r = -0.115, p < 0.01).. An insufficient vitamin B(12) as well as folate status is present in Iranian women of childbearing age. The final evaluation will be carried out 18 months after flour fortification and the results will be compared with baseline data obtained from the present study in order to show the efficacy and safety of folic acid fortification in Iran.

Topics: Adolescent; Adult; Chromatography, High Pressure Liquid; Cross-Sectional Studies; Female; Flour; Folic Acid; Folic Acid Deficiency; Food, Fortified; Homocysteine; Humans; Iran; Middle Aged; Neural Tube Defects; Nutritional Status; Outcome and Process Assessment, Health Care; Triticum; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Screening for deficiencies in vitamin B(12) and folate is advocated to prevent anemia in very elderly individuals. However, the effects of vitamin B(12) and folate deficiency on the development of anemia in old age have not yet been established.. The current study is embedded in the Leiden 85-Plus Study, a population-based prospective study of subjects aged 85 years. Levels of vitamin B(12), folate, and homocysteine were determined at baseline. Hemoglobin levels and mean corpuscular volume (MCV) were determined annually during 5 years of follow-up.. We analyzed data from 423 subjects who did not use any form of cyanocobalamin, hydroxocobalamin, or folic acid supplementation, neither at baseline nor during follow-up. Folate deficiency (<7 nmol/L; n = 34) and elevated homocysteine levels (>13.5 mumol/L; n = 194) were associated with anemia at baseline (adjusted odds ratio [OR], 2.44; 95% confidence interval [CI], 1.06-5.61; and adjusted OR, 1.82; 95% CI, 1.08-3.06, respectively), but vitamin B(12) deficiency (<150 pmol/L; n = 68) was not (adjusted OR, 1.51; 95% CI, 0.79-2.87). Furthermore, vitamin B(12) deficiency was not associated with the development of anemia during follow-up (adjusted HR, 0.92; 95% CI, 0.46-1.82) or with changes in MCV (adjusted linear mixed model; P = .77). Both folate deficiency and elevated homocysteine levels were associated with the development of anemia from age 85 years onward (adjusted HR, 3.33; 95% CI, 1.55-7.14; and adjusted HR, 1.70; 95% CI, 1.01-2.88, respectively), but not with an increase in MCV over time (P > .30).. In the general population of very elderly individuals, anemia in 85-year-old subjects is associated with folate deficiency and elevated homocysteine levels but not with vitamin B(12) deficiency.

Topics: Aged, 80 and over; Anemia; Cross-Sectional Studies; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Hemoglobins; Homocysteine; Humans; Male; Prospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Iron-Deficiency; Child, Preschool; Ethnicity; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Iron; Male; Middle Aged; Nutrition Surveys; Prevalence; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Retinal vein occlusion (RVO) is one of the most common retinal vascular disorders. During the last years, high levels of homocysteine (Hcy) have been demonstrated to be an independent risk factor for RVO. Aim of this study was to investigate the association among circulating B-group vitamins, Hcy and RVO. Thus, we studied 262 RVO patients and 262 age- and sex-comparable healthy subjects. Serum vitamin B6 was measured by HPLC, serum folic acid and vitamin B12 by radioimmunoassay and plasma Hcy by FPIA. Blood levels of vitamin B6, folate and Hcy, but not of vitamin B12, were found to be significantly different in patients as compared to healthy subjects. At the univariate analysis, the lowest tertile of vitamin B6 [odds ratio (OR) 4.03; 95% confidence interval (CI) 2.58-6.31; P<0.0001)] and folate (OR 6.13; 95% CI 3.85-9.76, P<0.0001), and the highest tertile of Hcy (OR 8.08; 95% CI 5.05-12.92, P<0.0001) were found to be significantly associated with RVO. Moreover, at multivariate analysis, after adjustment for traditional cardiovascular risk factors, Hcy, and circulating levels of vitamins, respectively, the lowest tertile of vitamin B6 (OR 3.29; 95% CI 1.89-5.70, P<0.0001) and folate (OR 5.41; 95% CI 3.08-9.51, P<0.0001) and the highest tertile of Hcy (OR 2.58; 95% CI 1.12-5.94, P<0.0001) maintained their significant association with RVO. In conclusion, the present study documents, on a large sample of patients, that low vitamin B6 levels, low folic acid levels and elevated Hcy levels are each independently associated with RVO.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Case-Control Studies; Chromatography, High Pressure Liquid; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Logistic Models; Male; Middle Aged; Radioimmunoassay; Retinal Vein Occlusion; Risk Factors; Vitamin B 12; Vitamin B 6; Vitamin B 6 Deficiency

Topics: Folic Acid Deficiency; Humans; Intestinal Absorption; Malabsorption Syndromes; Proctocolectomy, Restorative; Schilling Test; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Elevated plasma homocysteine (Hcy) concentrations have been implicated with risk of cognitive impairment and dementia, but it is unclear whether low vitamin B12 or folate status is responsible for cognitive decline. Most studies reporting associations between cognitive function and Hcy or B-vitamins have used a cross-sectional or case-control design and have been unable to exclude the possibility that such associations are a result of the disease rather than being causal. The Hcy hypothesis of dementia has attracted considerable interest, as Hcy can be easily lowered by folic acid and vitamin B12, raising the prospect that B-vitamin supplementation could lower the risk of dementia. While some trials assessing effects on cognitive function have used folic acid alone, vitamin B12 alone or a combination, few trials have included a sufficient number of participants to provide reliable evidence. An individual-patient-data meta-analysis of all randomised trials of the effects on cognitive function and vascular risk of lowering Hcy with B-vitamins will maximise the power to assess the epidemiologically-predicted differences in risk. Among the twelve large randomised Hcy-lowering trials for prevention of vascular disease, data should be available on about 30 000 participants with cognitive function. The principal investigators of such trials have agreed to combine individual-participant data from their trials after their separate publication.

Topics: Aged; Aged, 80 and over; Cognition; Dementia; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Hyperhomocysteinemia is frequently observed in alcohol-dependent subjects, in particularly in those with marked withdrawal symptoms. The common C677T transition on the methylenetetrahydrofolate reductase (MTHFR) gene influences homocysteinemia. Our objective was to study the prevalence of the MTHFR C677T polymorphism in alcohol-dependent subjects and the influence of this polymorphism on symptoms associated with alcoholism.. MTHFR C677T polymorphism was determined in 93 control subjects and 242 alcohol-dependent subjects. Serum homocysteine, folate and vitamin B12 levels together with hepatic biological parameters were determined in the control and alcohol-dependent subjects.. Hyperhomocysteinemia is frequently observed in alcohol-dependent subjects, particularly in those with marked withdrawal symptoms. Alcohol-dependent subjects showed a significant decrease in MTHFR 677TT prevalence (9%, 21/242) compared to controls (18%, 17/93) (p<0.02). The relative risk estimated as an odds ratio for alcoholism in subjects with the TT genotype is 0.42 (odd ratio 95% confidence interval, 0.21-0.83). Moreover, drinkers with TT genotype presented lower values for markers of alcohol misuse (p<0.05), better liver function tests, a lower frequency of relapses and no marked withdrawal symptoms as assessed by the Lesch typology.. MTHFR 677TT genotype could play a protective role against alcohol dependence. Moreover, when subjects with MTHFR 677TT genotype become dependent to alcohol, they seem to constitute a subgroup of alcoholic patients with a decreased risk for developing neurotoxic withdrawal symptoms and hepatic toxicity.

Topics: Alcohol Drinking; Alcoholic Neuropathy; Alcoholism; Control Groups; Female; Folic Acid; Folic Acid Deficiency; Gene Frequency; Genetic Predisposition to Disease; Genotype; Homocysteine; Humans; Hyperhomocysteinemia; Liver Diseases, Alcoholic; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Polymorphism, Genetic; Risk; Vitamin B 12

In the present non-interventional postmarketing surveillance study, patients with symptoms of an inadequate supply of vitamins were tested for how a treatment with a combination vitamin injection consisting of vitamins B6, B12 and folic acid affects mood and fitness. The evaluation of the efficacy and tolerability as well as the documentation of adverse drug reactions were carried out by the physician.. The patient collective included 1430 patients (70.8% women, average age 67.1 years, average BMI 25.5 kg/m2). The average duration of treatment was 4.5 weeks with an average of 8.3 intramuscular injections. The principal method for determining the efficacy was the self-assessment scale of well-being (Bf-S) according to Zerssen (sum score with a value range between 0 and 56 points).. The sum score of the Bf-S decreased from 37.5 (+/-10.1) points at admission to 15.6 (+/- 9.4) points after four weeks of treatment. The subjective impression improved correspondingly in 96.3% of the patients. The improvement of the Bf-S was equally good in women and men. The number of injections correlated with the improvement in the sum score. The tolerability was mainly rated as very good or good.. Eight vitamin infections over four weeks led to a clear improvement in the mood and vitality of patients with symptoms of intracellular vitamin B deficiency.

Topics: Aged; Drug Administration Schedule; Drug Combinations; Fatigue; Female; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intramuscular; Male; Middle Aged; Quality of Life; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6; Vitamin B 6 Deficiency

Total homocysteine (tHcy) has been linked to the severity of chronic heart failure (CHF). Elevated tHcy concentrations are mainly caused by folate and vitamin B-12 deficiencies.. We hypothesized that folate and vitamin B-12 deficiencies can explain the relation between tHcy and the severity of CHF.. We investigated 987 CHF patients. All subjects underwent a physical examination and blood sampling. Cardiac catheterization was performed in 929 patients and echocardiography in 460 patients. Serum tHcy, folate, vitamin B-12, and N-terminal pro-B-type natriuretic-peptide (NT-proBNP) were measured and renal and hepatic function were studied.. tHcy increased with increasing New York Heart Association (NYHA) classes of heart failure (P < 0.001) and correlated with the left ventricular ejection fraction (EF; r = -0.150, P < 0.001). Contrary to the hypothesis, vitamin B-12 (P < 0.001) increased with NYHA class (P < 0.001) and was negatively correlated with EF (r = -0.080, P = 0.015). Folate showed no relation with NYHA class or EF. Comparable results were obtained for NT-proBNP (tHcy: r = 0.27, P < 0.001; vitamin B-12: r = 0.091, P = 0.004; folate: r = -0.045, P = 0.169). The correlations between tHcy, EF, and NT-proBNP were significantly stronger in patients without coronary artery disease (CAD) than in those with CAD. Regression analysis showed that tHcy, but not B vitamins, is a strong predictor of EF and NT-proBNP.. This study showed that tHcy, but not folate and vitamin B-12, is related to clinical, echocardiographic, and laboratory variables of CHF, which indicates a relation between tHcy and the severity of CHF. This relation is stronger in patients without CAD. The lack of association of folate and the paradoxical relation of vitamin B-12 with CHF can possibly be explained by a disturbance in hepatic homeostasis.

Topics: Aged; Cardiac Catheterization; Echocardiography; Female; Folic Acid; Folic Acid Deficiency; Heart Failure; Homocysteine; Humans; Liver; Male; Middle Aged; Multivariate Analysis; Severity of Illness Index; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

To explore the dependence of glomerular filtration rate (GFR) on plasma total homocysteine (tHcy) and serum methylmalonic acid (MMA), as well as the consequences for the diagnosis of cobalamin and/or folic acid deficiency in an elderly community-dwelling population.. Population-based study of 209 community-dwelling subjects, mean age 76 years.. Four months' treatment study with oral vitamin B(12), folic acid and B(6) or placebo.. Determinants of tHcy and MMA: cystatin C as a marker of GFR and serum/plasma concentrations of vitamin B(12) and folate, age and sex.. Elevated cystatin C (>1.55 mg L(-1)) was found in 31.3% (men) and 13.0% (women). Elevated tHcy (> or = 16 micromol L(-1)) occurred in 53% and elevated MMA (> or = 0.34 micromol L(-1)) in 11% of all subjects. When GFR was taken into consideration, the proportion of elevated tHcy was reduced to 10% (20/209), whilst the proportion of elevated MMA was unchanged. Cystatin C was correlated with tHcy (r = 0.45, P < 0.001) and with MMA (r =0.28, P < 0.001), independently of vitamin B(12)- and folate status. According to multiple regression, independent predictors for tHcy were plasma folate (15%), cystatin C (11%) and vitamin B(12) (4%), and for MMA, cystatin C (8%) and vitamin B(12) (2%).. The prevalence of elevated tHcy may be overestimated in elderly populations unless GFR is taken into account. Nomograms for evaluation of tHcy and MMA in relation to both cystatin C and serum creatinine are presented.

Topics: Aged; Avitaminosis; Biomarkers; Creatinine; Cystatin C; Cystatins; Female; Folic Acid; Folic Acid Deficiency; Glomerular Filtration Rate; Homocysteine; Humans; Kidney; Male; Methylmalonic Acid; Nutritional Status; Regression Analysis; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6

Topics: Aged; Anemia; Australia; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Humans; Middle Aged; Prevalence; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Hypocobalaminaemia in cats has previously been identified, but the incidence reported has varied, and the frequency of folate deficiency is unknown. The aims of this study were to evaluate the incidence of low cobalamin and folate levels in a population of cats that were suffering predominantly from diseases of the alimentary tract (including the liver and pancreas) and to ascertain whether severity of disease (as assessed by bodyweight and body condition score (BCS)) related to degree of deficiency. The study population comprised 103 cats, of which 16.5% had low cobalamin levels and 38.8% had low folate levels. A serendipitous finding was inorganic phosphate levels below the reference range in 48% of the cases. Significant associations were found between subnormal cobalamin levels and median BCS (P=0.049); combined low folate and low cobalamin and bodyweight (P=0.002), BCS (P=0.024) and inorganic phosphate levels (P=0.003). The finding of low levels of folate and cobalamin in clinical cases suggests that supplementation may be indicated more frequently than is currently recognised.

Topics: Animals; Blood Chemical Analysis; Cat Diseases; Cats; Deficiency Diseases; Female; Folic Acid; Folic Acid Deficiency; Gastrointestinal Diseases; Incidence; Male; Phosphates; Scotland; Severity of Illness Index; Vitamin B 12; Vitamin B 12 Deficiency

To investigate serum levels of folate, B12, and total homocysteine (tHcy) in elderly post-stroke patients, and the possible correlations with radiological markers of neuropathology.. Cross-sectional study.. Department of Neurology, Cardinal Tien Hospital.. Eighty-nine elderly post-stroke patients were enrolled for dietary assessment and blood tests. Neuroradiological assessment was done in 62 of these patients.. Dietary folate and vitamin B12 intakes were evaluated by a 24-h recall system using a semi-quantitative questionnaire. Circulating levels of folate, B12, and tHcy were measured. Magnetic resonance imaging (MRI) or computed tomography (CT) was used for evaluation of brain lesions including infarction and atrophy.. Mean folate and B12 intakes of these post-stroke patients were 69% and 261% of the recommended dietary allowances (RDA), respectively. Inadequate folate levels, defined as serum folate < 6 ng/mL, was noted in 68% of these patients. Hyperhomocysteinemia levels (tHcy >or=15 micromol/L) were observed in 48%. According to tertiles of serum tHcy and folate levels, the rate of brain atrophy, but not brain infarctions, are significantly associated with elevated tHcy (P = 0.0126) and decreased folate levels (P = 0.0273). After adjustments for age, sex, disease status, brain infarctions and carotid stenosis, the odds ratio of brain atrophy was 9.8 (95% CI: 1.7-56.4, P = 0.0101) in the hyperhomocysteinemia group and 9.6 (95% CI: 1.1-81.3, P = 0.0377) in the low folate group (serum folate < 3.0 ng/mL) compared with the group with normal tHcy and folate levels. No significant association was noted between vitamin B12 levels and brain lesions.. Our data shows that folate deficiency and hyperhomocysteinemia are prevalent in elderly post-stroke patients. These two conditions are strongly and independently associated with the development of brain atrophy.

Topics: Aged; Biomarkers; Brain; Brain Infarction; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Magnetic Resonance Imaging; Male; Mental Recall; Nutrition Assessment; Nutrition Policy; Stroke; Surveys and Questionnaires; Vitamin B 12; Vitamin B Complex

Plasma total homocysteine (tHcy) is often elevated in patients with mental illness. Since patients with mental illness and vascular disease exhibit a higher plasma tHcy concentration than patients without vascular disease, it is possible that elevated plasma tHcy in mental illness is mainly due to concomitant vascular disease.. We have investigated plasma tHcy, cobalamin/folate status, renal function and the presence of vascular disease in patients with vascular dementia (VaD, n = 501), Alzheimer's disease (AD, n = 300), depression (n = 259) and in healthy subjects (n = 144) stratified according to age (below and above 75 years).. Plasma tHcy concentration showed the highest increase in patients with VaD compared to patients with AD or depression. After the exclusion of patients with cobalamin/folate deficiencies and increased serum creatinine, patients with AD or depression above 75 years with vascular disease showed a similar elevation of plasma tHcy concentration as patients with VaD. Furthermore, patients with AD and depression without vascular disease showed a similar plasma tHcy concentration to healthy subjects.. The findings imply that elevated plasma tHcy concentration in elderly patients with mental illness is mainly associated with the presence of vascular disease and is not related to the specific psychogeriatric diagnosis.

Topics: Aged; Aged, 80 and over; Aging; Creatinine; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Kidney Function Tests; Male; Mental Disorders; Psychiatric Status Rating Scales; Vascular Diseases; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Dietary Supplements; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Hyperhomocysteinemia is an accepted risk factor for cardiovascular disease, and possibly also for cognitive impairment and dementia. It has also been proposed as a marker for the status of the B vitamins, which participate in the metabolism of homocysteine. Therefore, especially in the elderly, it is important to know the prevalence of high homocysteine (tHcy) levels and the influence that B vitamins have on them.. 218 elderly of both sexes, aged 60-105, living in an elderly home in Granada (Spain), were screened for serum folate, red blood cell (RBC) folate, serum cobalamin (B12) (Abbott, IMx), holotranscobalamin II (Holo-TC II) (HoloTC RIA, Axis-Shield), methylmalonic acid (MMA) (MS-GC), total pyridoxine (B6) (HPLC), and total homocysteine (tHcy) (Abbott, IMx).. Hyperhomocysteinemia (tHcy >12 pmol/L) was detected in 80.7%. Serum folate deficiency was severe (< or =4 ng/mL) in 19.3% and moderate (4-7 ng/mL) in 43.1%. In 14.2% of the elderly RBC folate was < or =175 ng/mL, and in 61.0% it was between 175-400 ng/mL. Vitamin B12, measured in serum (< or =200 pg/mL), was deficient in 15.8%, but if measured as Holo-TC II (< or =45 pmol/L), deficiency ranged up to 39.1%. MMA was high (> or =300 nmol/L) in 45.6%. Vitamin B6 (< 20 nmol/L) was low only in one person. In order to identify the factors that could predict tHcy levels, a multiple regression analysis was performed. Best results corresponded to the combination of log serum folate and log Holo-TC II, which gave values of R > 0.5. If analyzed independently, the highest correlation was with log serum folate (r = -0.290), followed by RBC folate (r = -0.263), Holo-TC II (r = -0.228), log B12 (r = -0.175), and log B6 (r = -0.078).. There is a high prevalence of vitamin B deficiency and hyperhomocysteinemia in the studied population. Our data confirm the influence of these vitamins, especially folate, on tHcy levels, but hyperhomocysteinemia cannot be used as the only diagnostic criterion to detect subclinical vitamin deficiency in elderly people, especially to detect vitamin B12 deficiency.

Topics: Aged; Aged, 80 and over; Aging; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Institutionalization; Male; Middle Aged; Regression Analysis; Sex Characteristics; Spain; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Vitamin B Deficiency

The aim of the project was the assessment of clinical usefulness of the determination of blood serum homocysteine concentration, folic acid and vitamin B12 in recurrent miscarriages.. 30 non-pregnant women with recurrent miscarriages (examined group-I) and for 20 non-pregnant women without obstetric failures in medical history (control group-II) were examined.. In the examined group (group I), the average concentration of homocysteine (9,45 micromol/l) was not statistically higher in comparison to the control group (group II) (8,47 micromol/l) (p>0,05). In group I the average vitamin B12 concentration in blood serum was 178,3 pg/ml and it was statistically lower (p<0,001) in comparison with the control group (II) (268,6 pg/ml). Such a relation was not observed for the vitamin B12, where the average concentration of this parameter was not dependent on the miscarriage number. A high negative correlation (R= -0,5397, p<0,01) was observed between the level of folic acid and homocysteine concentration in the group of women with recurrent miscarriages and a very high negative correlation (r = -0,9586 p<0,001) in the control group. No relation (R=0,0992 p>0,05) between the average concentration of vitamin B12 in blood serum and the average homocysteine in the nullipara group with recurrent miscarriages. Together with the increasing number of abortions, the average homocysteine concentrations grew and the average folic acid concentrations lowered.

Topics: Abortion, Habitual; Adult; Case-Control Studies; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Vitamin B 12

Deficiency in nutritional determinants of homocysteine (HCY) metabolism, such as vitamin B(12) and folate, during pregnancy is known to influence HCY levels in the progeny, which in turn may exert adverse effects during development, including liver defects. Since short hypoxia has been shown to induce tolerance to subsequent stress in various cells including hepatocytes, and as vitamins B deficiency and hypoxic episodes may simultaneously occur in neonates, we aimed to investigate the influence of brief postnatal hypoxia (100% N(2) for 5 min) on the liver of rat pups born from dams fed a deficient regimen, i.e., depleted in vitamins B(12), B(2), folate, and choline. Four experimental groups were studied: control, hypoxia, deficiency, and hypoxia + deficiency. Although hypoxia transiently stimulated HCY catabolic pathways, it was associated with a progressive increase of hyperhomocysteinemia in deficient pups, with a fall of cystathionine beta-synthase activity at 21 days. At this stage, inducible NO synthase activity was dramatically increased and glutathione reductase decreased, specifically in the group combining hypoxia and deficiency. Also, hypoxia enhanced the deficiency-induced drop of the S-adenosylmethionine/S-adenosylhomocysteine ratio. In parallel, early exposure to the methyl-deficient regimen induced oxidative stress and led to hepatic steatosis, which was found to be more severe in pups additionally exposed to hypoxia. In conclusion, brief neonatal hypoxia may accentuate the long-term adverse effects of impaired HCY metabolism in the liver resulting from an inadequate nutritional regimen during pregnancy, and our data emphasize the importance of early factors on adult disease.

Topics: Animals; Animals, Newborn; Apoptosis; Cell Proliferation; Choline Deficiency; Cystathionine beta-Synthase; Female; Folic Acid; Folic Acid Deficiency; Food, Formulated; Glutathione; Homocysteine; Hypoxia; Liver; Nitric Oxide Synthase Type II; Pregnancy; Rats; Rats, Wistar; Riboflavin; Riboflavin Deficiency; S-Adenosylhomocysteine; S-Adenosylmethionine; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Deficiency

Monitoring the folate status of US population groups over time has been a public health priority for the past 2 decades, and the focus has been enhanced since the implementation of a folic acid fortification program in the mid-1990s.. We aimed to determine how population concentrations of serum and red blood cell (RBC) folate and serum vitamin B-12 have changed over the past 2 decades.. Measurement of blood indicators of folate and vitamin B-12 status was conducted in approximately 23,000 participants in the prefortification third National Health and Nutrition Examination Survey (NHANES III; 1988-1994) and in approximately 8000 participants in 3 postfortification NHANES periods (together covering 1999-2004).. Serum and RBC folate concentrations increased substantially (by 119-161% and 44-64%, respectively) in each age group in the first postfortification survey period and then declined slightly (by 5-13% and 6-9%, respectively) in most age groups between the first and third postfortification survey periods. Serum vitamin B-12 concentrations did not change appreciably. Prevalence estimates of low serum and RBC folate concentrations declined in women of childbearing age from before to after fortification (from 21% to <1% and from 38% to 5%, respectively) but remained unchanged thereafter. Prevalence estimates of high serum folate concentrations increased in children and older persons from before to after fortification (from 5% to 42% and from 7% to 38%, respectively) but decreased later after fortification.. The decrease in folate concentrations observed longer after fortification is small compared with the increase soon after the introduction of fortification. The decrease is not at the low end of concentrations and therefore does not raise concerns about inadequate status.

Topics: Adolescent; Adult; Child; Child, Preschool; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Male; Middle Aged; Nutrition Surveys; Nutritional Requirements; Prevalence; Reference Values; Time Factors; United States; Vitamin B 12; Vitamin B Complex

Topics: Aged; Aged, 80 and over; Aging; Cognition Disorders; Dementia; Folic Acid Deficiency; Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Homocysteine; Humans; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

The anatomical and physiological changes of aging make elderly people a vulnerable group to malnutrition and specific deficiencies of nutrients such as vitamin B12 and folate. This study was aimed to establish relationships among serum vitamin B12, folate, homocysteine concentrations and dietary intake and adequacy. Fifty five male and female elderly (60 and more years), free-living, were assessed. Measurements were: serum vitamin B12 and folate by radioimmunoanalysis (RIA), homocysteine by polarized fluorescence immunoassay, nutrient intake by three 24 hours recalls and food frequency questionnaire. Nutritional status was determined by Body Mass Index (BMI). Serum vitamin B12 and folate were at normal range (423,3+/-227,6 pmol/l and 6,4 +/- 4,5 mg/ml), but 17,5% of elderly had B12 deficiency and 12% had folate deficiency. Serum homocysteine was higher than reference values (15,8+/-4,4 mmol/l), but 47,5% showed concentrations above 15 mmol/L, male population showed higher mean value (p: 0,01). Nutrient intake was inadequate by deficiency. BMI indicated 11,8% of undernutrition, 29,4% of overweight and 20,6% of obesity A negative and inverse correlation between homocysteine and serum folate was found. Results suggest a biochemical deficiency of B12 and folate that is expressed as elevated homocysteine levels. These finding represent a high cardiovascular risk factor for this elderly group.

Topics: Aged; Aged, 80 and over; Body Mass Index; Energy Intake; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Homocysteine; Humans; Male; Middle Aged; Reference Values; Venezuela; Vitamin B 12; Vitamin B 12 Deficiency

To understand the correlation of lower serum folate, and red blood cell (RBC) folate level with birth defects including unexplained recurrent pregnancy loss, and to evaluate the role of RBC folate level as a suitable marker for folate supplement.. Two hundred and ninety-nine non-pregnant women at child-bearing age with a birth defect history were selected as birth defect group. The levels of serum and RBC folate, and serum vitamin B(12) were determined. By comparing with the group of non-pregnant women at child-bearing age without any birth defect history (control group), we evaluated the correlation between lower serum folate, RBC folate level and main kinds of birth defects including unexplained recurrent pregnancy loss. And the levels of serum and RBC folate of birth defect group were also determined and compared before and after oral folate intake (5 mg/d) for one month.. The serum folate level of birth defect group was not different from the control group (17 - 26 vs 14 nmol/L, P > 0.05). The RBC folate level of birth defect group except the urinary defect was significantly lower compared with the control group (233 - 547 vs 689 nmol/L, P < 0.05). After the oral folate intake (5 mg/d), the serum folate level of unexplained recurrent pregnancy loss group and neural tube defects group were significantly increased than before [(22 +/- 9) vs (27 +/- 12) nmol/L, (19 +/- 10) vs (25 +/- 18) nmol/L; P < 0.05]. The RBC folate level of unexplained recurrent pregnancy loss group and congenital heart defect group were significantly increased than before [(374 +/- 275) vs (567 +/- 397) nmol/L, (322 +/- 205) vs (527 +/- 351) nmol/L, P < 0.05].. RBC folate level is more closely correlated than serum folate level with the incidence of main birth defect.

Topics: Abortion, Spontaneous; Adult; Congenital Abnormalities; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Heart Defects, Congenital; Humans; Infant, Newborn; Nutritional Requirements; Pregnancy; Pregnancy Outcome; Vitamin B 12

Iron, folate, and vitamin B12 deficiencies have adverse effects on pregnancy outcome. In India, data on the concomitant prevalence of these deficiencies among pregnant women are meager.. We conducted a community-based study to assess the prevalence of deficiencies of iron, folate, and vitamin B12 among pregnant women in a rural block of Haryana State.. The study was approved by the ethics committee of the All India Institute of Medical Sciences, New Delhi. A total of 283 pregnant women were enrolled in the study. After oral informed consent had been obtained from the women, blood was drawn from the antecubital vein for estimation of the levels of serum ferritin by enzyme-linked immunosorbent assay (levels < 12 ng/ mL were considered as indicative of poor iron stores); serum folate was determined by radioimmunoassay (levels <3 ng/mL were considered as indicative of poor folate stores); and serum vitamin B12 was estimated by the microbiologic method (levels < 200 pg/mL were considered as indicative of poor vitamin B12 stores).. The results indicated that 67.7%, 26.3%, and 74.1% of the women had poor iron, folate, and vitamin B12 stores, respectively. Concomitant deficiencies of iron, folate, and vitamin B12 occurred in 16.2% of the women. We found that 59.9% of the women were consuming less than 75% of the recommended daily caloric allowance (2175 kcal), indicating an overall poor food intake. This could be one of the predominant reasons for poor iron, folate, and vitamin B12 stores among the women.. Our findings suggest that apart from iron and folate, vitamin B12 deficiencies may play an important role in causing anemia.

Topics: Adolescent; Adult; Comorbidity; Female; Folic Acid; Folic Acid Deficiency; Humans; India; Iron; Iron Deficiencies; Malnutrition; Micronutrients; Nutritional Requirements; Nutritional Status; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prevalence; Rural Population; Vitamin B 12; Vitamin B 12 Deficiency

To investigate the relation between lactation and markers of folate and vitamin B12 (B12) deficiency in women with and without vitamin supplementation.. A 9-month follow-up study.. Blood samples from 91 women, who gave birth to a single healthy child, were collected 3 weeks, 4 and 9 months postpartum and analysed for circulating level of homocysteine (tHcy), methylmalonic acid (MMA), folate and B12. The participants were categorized as exclusively, partly or not breast-feeding dependent on the degree of lactation 4 months postpartum. During follow-up, lifestyle factors were recorded by structured interviews.. Among 72 exclusively breast-feeding women, the median (10-90% percentile) tHcy was 5.8 (3.1-8.3) micromol/l 3 weeks postpartum, 6.1 (4.1-10.3) micromol/l 4 months postpartum and 5.3 (3.6-8.7) micromol/I 9 months postpartum. At 9 months postpartum, none of the women breast-fed exclusively. No significant change occurred in the concentration of B12 and folate. Exclusively breast-feeding women without vitamin supplementation had higher median tHcy than supplemented exclusively breast-feeding women 4 and 9 months postpartum (7.0 vs 5.4 micromol/l (P < 0.001) and 5.8 vs 4.5 micromol/l (P = 0.003), respectively). Six women had increased (>15 micromol/l) tHcy; four of these were unsupplemented and exclusively breast-feeding.. We found no overall indication of depletion of the folate and B12 stores during the lactation period in this population. However, folate-supplemented women had lower tHcy and higher folate levels, suggesting a beneficial effect of supplementation with folate throughout lactation.

Topics: Adult; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Lactation; Life Style; Methylmalonic Acid; Nutritional Requirements; Nutritional Status; Postpartum Period; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Deficiencies of cobalamin and folate may play a causal role in the development or exacerbation of psychiatric illnesses. We compared cobalamin and folate levels in newly admitted psychiatric patients to mentally healthy controls and assessed their correlation with various psychiatric conditions.. All patients consecutively admitted to a psychiatric hospital were examined for serum cobalamin and folate levels. Controls were obtained from a population with no known mental illness. Values were considered to be below normal if cobalamin was <223 pg/ml and folate <3.1 ng/ml.. The 224 newly admitted patients did not differ significantly from controls, both with regard to the mean cobalamin level and to the prevalence of lower than normal levels. About 30% of patients had low folate values compared to 2.5% in the control group (P<0.0001). Mean folate level in controls was significantly higher than in patients (P<0.0001), where a positive correlation was found between low folate levels and depression.. The results of our study suggest that folate levels be assessed in patients admitted to psychiatric wards, especially in those with depression. Further study is needed to evaluate the role of folate and cobalamin in psychiatric illness.

Topics: Adolescent; Adult; Aged; Case-Control Studies; Depression; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Mental Disorders; Mental Health; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Elevated plasma total homocysteine is an independent risk factor for cardiovascular disease and a sensitive marker of the inadequate vitamin B12 and folate insufficiency. Folate and vitamin B12 have a protective effect on cardiovascular disease. This population based study was conducted to evaluate the plasma total homocysteine, folate, and vitamin B12 in healthy Iranian individuals.. This study was a part of the Cardiovascular Risk Factors Survey in the Population Lab Region of Tehran University has been designed and conducted based on the methodology of MONICA/WHO Project. A total of 1214 people aged 25-64 years, were recruited and assessed regarding demographic characteristics, homocysteine, folate, and vitamin B12 levels with interview, questionnaires, examination and blood sampling. Blood samples were gathered and analyzed according to standard methods.. The variables were assessed in 1214 participants including 428 men (35.3%) and 786 women (64.7%). Age-adjusted prevalence of hyperhomocysteinemia (Hcy > or = 15 micromol/L) was 73.1% in men and 41.07% in women (P < 0.0001). Geometric mean of plasma homocysteine was 19.02 +/- 1.46 micromol/l in men and 14.05 +/- 1.45 micromol/l in women (P < 0.004) which increased by ageing. Age-adjusted prevalence of low serum folate level was 98.67% in men and 97.92% in women. Age-adjusted prevalence of low serum vitamin B12 level was 26.32% in men and 27.2% in women. Correlation coefficients (Pearson's r) between log tHcy and serum folate, and vitamin B12 indicated an inverse correlation (r = -0.27, r = -0.19, P < 0.0001, respectively).. These results revealed that the prevalence of hyperhomocysteinemia, low folate and vitamin B12 levels are considerably higher than other communities. Implementation of preventive interventions such as food fortification with folic acid is necessary.

Topics: Adult; Age Factors; Cardiovascular Diseases; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Incidence; Iran; Male; Middle Aged; Nutrition Surveys; Prevalence; Sex Factors; Vitamin B 12; Vitamin B 12 Deficiency

Folic acid and vitamin B12 are of particular interest for their diverse biological functions and preventive roles in many prevalent chronic diseases. However, ethnic differences on the status of these vitamins have not been investigated among multiethnic adult college students.. A cross-sectional study (n = 177) was conducted to determine the dietary intakes and levels of serum concentrations of folate and vitamin B12 among triethnic college students-non-Hispanic white, Hispanic and non-Hispanic black. Dietary intake was assessed using a validated food frequency questionnaire, and serum was analyzed for folate and vitamin B12 using standardized methods.. Mean intakes of both vitamins without supplementation was higher (P < 0.05) among non-Hispanic white males than females, and non-Hispanic white and non-Hispanic black males and females. Non-Hispanic white females had a significantly lower mean dietary intake of vitamin B12 than the females of other ethnic groups (P < 0.01). There was a positive correlation between B12 intake and serum concentrations. More than 52% of the females did not meet the required folate intake of 400 microg/day.. The data suggest that there was no difference in overall mean intake of folate and vitamin B12 or serum concentrations in regard to gender or ethnicity. One-fourth of the female subjects failed to meet the recommended folate intake when supplement was excluded.

Topics: Adolescent; Adult; Analysis of Variance; Cross-Sectional Studies; Ethnicity; Female; Florida; Folic Acid; Folic Acid Deficiency; Humans; Male; Nutrition Surveys; Surveys and Questionnaires; Vitamin B 12; Vitamin B 12 Deficiency

Vitamin B12 deficiency in infancy may cause failure to thrive, severe neurological disorders and megaloblastic pancytopenia. It is well known that infants born with deficient vitamin B12 storage have increased the risk of vitamin B12 deficiency. Vitamin B12 deficiency is more prevalent in infancy in Sanliurfa province (at the southeast region of Turkey).. The aim of this study was to determine the frequencies of vitamin B12, folic acid and iron deficiencies in pregnants and their babies at birth and to what extend the mothers' deficiency becomes effective on babies' deficiencies.. The study groups were constituted by 180 pregnant women and their single and term babies. Venous blood samples of pregnants were obtained 1-3 h before delivery and babies' cord bloods were collected at birth. Vitamin B12 and folic acid levels were measured with electro chemiluminiscence method; serum iron and iron binding capacities were measured by colorimetric method and complete blood counts were performed by automatic blood counter.. Mean vitamin B12 levels in maternal and cord blood serum were 130 +/- 61.7 pg/ml and 207 +/- 141 pg/ml; mean folic acid levels were 8.91 +/- 6.46 ng/ml and 17.8 +/- 11.8 ng/ml; mean serum iron levels were 56.9 +/- 37.5 microg/dl and 147 +/- 43.2 microg/dl; and mean transferrin saturations were 11.8 +/- 8% and 65.6 +/- 24%, respectively. There were vitamin B12 deficiency (<160 pg/ml) in 72% of the mothers and 41% of the babies, and severe deficiency (<120 pg/ml) in 48% of the mothers and 23% of the babies. Folic acid deficiency was found in 12% of the mothers, but was not found in the babies. There were iron deficiency in 62% of the mothers and 1% of the babies. There were statistically significant correlation between maternal and cord blood serum vitamin B12 levels (r = 0.395, P < 0.001) and folic acid levels (r = 0.227, P = 0.017), while there were no correlation between maternal and cord blood iron levels and transferrin saturations.. The study results showed that vitamin B12 deficiency is prevalent in pregnants in this region and that 41% of infants have born with deficient vitamin B12 storages. Therefore, prophylactic use of vitamin B12 by pregnant women in Sanliurfa and other poor communities could have considerable benefits to prevent vitamin B12 deficiency and its complications in infants.

Topics: Adult; Cross-Sectional Studies; Female; Fetal Blood; Folic Acid; Folic Acid Deficiency; Health Status; Humans; Infant, Newborn; Iron; Iron Deficiencies; Nutritional Status; Pregnancy; Pregnancy Complications; Turkey; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

In developing countries, a deficiency of cobalamine and folate contributes significantly to megaloblastic anaemia. Neurological observations in infants and young children with megaloblastic anaemia have included hypotonia, developmental regression, tremors and other abnormal movements. Following therapy with vitamin B12, coarse tremors occurred in six of 51 patients (12%) with megaloblastic anaemia. The tremors, which were noticed initially in the hands and feet, gradually became generalised and disappeared during sleep. They subsided within 5-11 days. Thirteen of 25 (52%) patients developed thrombocytosis between day 3 and week 5 of follow-up. In one child, the platelet count increased to >1300 x 10(9)/L. The importance of recognising these clinical findings during treatment of megaloblastic anaemia is emphasised.

Topics: Anemia, Megaloblastic; Child; Child, Preschool; Developing Countries; Folic Acid; Folic Acid Deficiency; Humans; India; Infant; Platelet Count; Thrombocytosis; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

Hyperhomocysteinemia is known as an independent risk factor of atherosclerosis, but the probable role of hyperhomocysteinemia in premature Coronary Artery Disease (CAD) is not well studied. The aim of this study was to assess the role of hyperhomocysteinemia, folate and Vitamin B12 deficiency in the development of premature CAD.. We performed an analytical case-control study on 294 individuals under 45 years (225 males and 69 females) who were admitted for selective coronary angiography to two centers in Tehran.. After considering the exclusion criteria, a total number of 225 individuals were enrolled of which 43.1% had CAD. The mean age of participants was 39.9 +/- 4.3 years (40.1 +/- 4.2 years in males and 39.4 +/- 4.8 years in females). Compared to the control group, the level of homocysteine measured in the plasma of the male participants was significantly high (14.9 +/- 1.2 versus 20.3 +/- 1.9 micromol/lit, P = 0.01). However there was no significant difference in homocysteine level of females with and without CAD (11.8 +/- 1.3 versus 11.5 +/- 1.1 micromol/lit, P = 0.87). Mean plasma level of folic acid and vitamin B12 in the study group were 6.3 +/- 0.2 and 282.5 +/- 9.1 respectively. Based on these findings, 10.7% of the study group had folate deficiency while 26.6% had Vitamin B12 deficiency. Logistic regression analysis for evaluating independent CAD risk factors showed hyperhomocysteinemia as an independent risk factor for premature CAD in males (OR = 2.54 0.95% CI 1.23 to 5.22, P = 0.01). Study for the underlying causes of hyperhomocysteinemia showed that male gender and Vitamin B12 deficiency had significant influence on incidence of hyperhomocysteinemia.. We may conclude that hyperhomocysteinemia is an independent risk factor for CAD in young patients (below 45 years old)--especially in men--and vitamin B12 deficiency is a preventable cause of hyperhomocysteinemia.

Topics: Adult; Case-Control Studies; Coronary Angiography; Coronary Artery Disease; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Male; Prevalence; Risk Factors; Sex Characteristics; Vitamin B 12; Vitamin B 12 Deficiency

We aimed to investigate the presence of psychomotor retardation, physical and laboratory examination in infants with megaloblastic anemia. Inclusion criteria for the study were; age 9 to 36 months, refusal of food except for breast and cow milk, loss of appetite, developmental delay, significant pallor, and hypersegmentation neutrophils in the peripheral blood smear. A total of 33 children fulfilling the inclusion criteria were enrolled among 3368 patients attending Pediatric Outpatient Clinics of şirnak-Cizre State Hospital between January 25, 2004 and May 5, 2004. Mean age was 16.4 months. Thirty-two patients had Vitamin B12 deficiency, 1 patient had folate deficiency, and 10 patients had combined vitamin B12 and folate deficiency. Statistically, a positive significant relationship was detected between serum vitamin B12 levels and mean corpuscular volume (P = 0.001, r = 0.56), and between vitamin B12 levels and hemoglobin (P = 0.004, r = 0.49). We believe that preventative measures such as fortification of flour with vitamin B12, nutritional support with vitamin B12 for the mother during pregnancy and nursing, provision of adequate primary preventive health services, and starting complementary food after 6 months of age are important determinants for preventing megaloblastic anemia.

Topics: Anemia, Megaloblastic; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Intellectual Disability; Male; Motor Skills Disorders; Neutrophils; Turkey; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Administration, Oral; Anemia, Megaloblastic; Anemia, Pernicious; Antibodies; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intramuscular; Intrinsic Factor; Leucovorin; Schilling Test; Vitamin B 12; Vitamin B Complex

To cross sectionally investigate the association of serum vitamin B(12) and folate concentrations with cognitive and functional ability in the very old in the general population.. Serum vitamin B(12) and folate concentrations were assessed in 471 consenting subjects participating in the Monzino 80-plus study (mean age: 87.4 years), a door-to-door population-based survey among very old subjects living in Northern Italy. Cognitive and functional evaluations included Mini-Mental State Examination (MMSE), Instrumental Activities of Daily Living (IADL) and Spontaneous Behavior Interview-basic Activities of Daily Living (SBI-bADL).. MMSE, IADL and SBI-bADL scores were all significantly correlated with folate concentrations (respectively: r = 0.36, r = -0.39, r = -0.35; p < 0.0001), while no significant associations were found with vitamin B(12) concentrations. When entered into multiple linear regression analyses with several covariates, folate showed a highly significant, curvilinear association with both cognitive and functional scores (p < 0.0001). Subjects in low and middle folate tertiles had significantly higher odds ratios for dementia (p < 0.0001; adjusted ORs = 5.40 and 6.56, lower 95% CIs 2.53 and 3.11, higher 95% CIs 12.73 and 15.29).. Findings of this population-based study suggest that subclinical folate deficiency may represent a risk factor for the cognitive decline associated with aging that could contribute to AD as well as other dementia development.

Topics: Activities of Daily Living; Aged, 80 and over; Aging; Alzheimer Disease; Cognition Disorders; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Geriatric Assessment; Humans; Linear Models; Male; Nutritional Requirements; Vitamin B 12; Vitamin B Complex

The adherence to a Mediterranean Dietary Pattern ensures an adequate intake of B vitamins and w-3 fatty acids. A protective role on depression has been suggested for both nutrients.. Cross-sectional analysis from the SUN (Seguimiento Universidad de Navarra) prospective cohort study. Data from 9670 participants (4211 men and 5459 women) were analised. Logistic regression analyses were fitted to assess the association between B-vitamins and w-3 fatty acids intake (quintiles) and the prevalence of depression.. Folate intake was inversely associated with depression prevalence among men, especially smokers. Among women, B12 vitamin intake was inversely associated with depression, especially among smokers and physically active women. No significant associations were observed for w-3 fatty acids intake.. The adherence to a Mediterranean Dietary Pattern ensures an adequate intake of fruits, nuts, vegetables, cereals, legumes or fish, important sources of nutrients linked to depression prevention.

Topics: Cross-Sectional Studies; Depression; Diet, Mediterranean; Fatty Acids, Omega-3; Feeding Behavior; Female; Folic Acid; Folic Acid Deficiency; Humans; Life Style; Male; Middle Aged; Prevalence; Risk Factors; Sex Factors; Spain; Vitamin B 12; Vitamin B 6; Vitamin B Deficiency

Folate and vitamin B12 are essential cofactors for the methionine/homocysteine cycle in the brain. These vitamins mediate the remethylation of homocysteine (HCY), which affects the production of the universal methyl donor, S-adenosylmethionine (SAM), in the brain among other organs. Acquired or inherited disorders in these metabolic pathways are associated with brain abnormalities and severe neurological symptoms that are mostly irreversible, even after providing the missing cofactors. This review discusses the relationship between brain and blood levels of key vitamins and metabolites related to one carbon metabolism.

Topics: Aquaporins; Brain; Epilepsy; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Muscular Dystrophy, Duchenne; S-Adenosylmethionine; Vitamin B 12; Vitamin B 12 Deficiency

To describe nutritional status, B6, B12, and antioxidant vitamins, as well as homocysteine concentrations in postmenopausal women.. A cross-sectional study was conducted in Mexico City. One hundred twenty-five women were selected if they were healthy and were in their first five years after menopause onset. Women were spontaneously divided in two groups: women who did not receive any hormonal treatment for at least six months before the study (n = 66), and those who received hormonal treatment at the moment of the study (n = 59). Anthropometry was measured and a fasting blood sample from a peripheral vein was obtained to determine homocysteine, vitamins A, C, E, B6, B12, and folic acid. Results were compared with Student t-test, and a logistic regression model was used to calculate the risk of hyperhomocystinemia after adjusting by some potential confounders.. Women who did not receive hormone replacement therapy presented higher body mass index and waist-hip ratio than those who received such treatment. In contrast, this group presented higher prevalence of folic acid deficiency and hyperhomocystinemia, despite they consumed higher amounts of folic acid in the diet. This high risk of hyperhomocystinemia was independent of vitamin serum concentrations and the level of physical activity (OR = 15.1, IC95 = 1.60,141.9).. These results suggest that hormone replacement therapy may protect against overweight and central fat distribution that occur after menopause, but increases the risk of hyperhomocystinemia.

Topics: Abdominal Fat; Antioxidants; Body Mass Index; Cross-Sectional Studies; Estrogens; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Hormone Replacement Therapy; Humans; Hyperhomocysteinemia; Middle Aged; Motor Activity; Overweight; Postmenopause; Progesterone; Risk; Urban Population; Vitamin B 12; Vitamin B 6; Waist-Hip Ratio

Elevated plasma total homocysteine concentration may be a risk factor for cognitive decline and Alzheimer disease, but data from prospective studies are limited. Further, high homocysteine levels are associated with low vitamin status, and it is unknown whether it is homocysteine toxicity or vitamin insufficiency that is responsible for the observed cognitive dysfunction.. We performed cross-sectional and longitudinal analyses of a cohort of 499 high-functioning community-dwelling persons aged 70 to 79 years to determine the effect of homocysteine and related vitamin plasma concentrations on cognitive function and cognitive decline. Nonfasting plasma concentrations of homocysteine, folate, vitamin B(6), and vitamin B(12) were measured at baseline. Summary measures of cognitive function were created from tests of multiple cognitive domains administered at baseline and again after 7 years.. In cross-sectional analyses investigating each variable separately, subjects with elevated homocysteine levels, or low levels of folate or vitamin B(6), demonstrated worse baseline cognitive function. In longitudinal analyses, after adjusting for multiple covariates, including homocysteine, those in the bottom quartile of folate had a 1.6-fold increased risk (95% confidence interval: 1.01 to 2.31; P =0.04) of being in the worst quartile of 7-year cognitive decline. Low folate levels largely accounted for a trend towards greater cognitive decline with elevated homocysteine level.. In high-functioning older adults, low folate levels appear to be a risk factor for cognitive decline. The risk of developing cognitive decline might be reduced through dietary folate intake.

Topics: Aged; Aging; Alzheimer Disease; Cognition Disorders; Cohort Studies; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Longitudinal Studies; Male; Risk Factors; Vitamin B 12; Vitamin B 6

Elderly people is a vulnerable population group to specific nutrient deficiencies as vitamin B12 and folic acid, which are closely related to mental functions deterioration, especially of cognitive functions. This study was aimed to measure B12 vitamin and folic acid indicators and to establish relationships to mental function. 53 elderly, older than 60 years, living in a geriatric home were assessed. The dietary intake was evaluated by the direct weighed method, serum B12 vitamin and folic acid by radioimmunoanalysis and mental function by Foltein's mini-mental test. Dietary intake for Vit B12 was adequate and deficient for folic acid while serum levels were within normal range. Vitamin B12 levels were at marginal or deficiency values in 26,4% of the elderly and folic acid deficiency was present in 43.4%. 49% of the elderly had mental function alterations and B12 vitamin levels were significantly lower in this group. A positive association between age and mental function (elderly below 80 years had lower risk of mental impairment) and between serum B12 and mental function were found. Elderly were at risk of deficiency for both vitamins and age and mental function were associated to this risk. Further evaluation including other nutrients should be performed.

Topics: Age Factors; Aged; Aged, 80 and over; Cognition Disorders; Diet; Female; Folic Acid; Folic Acid Deficiency; Homes for the Aged; Humans; Male; Mental Health; Middle Aged; Radioimmunoassay; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Case control studies have supported a relationship between low folic acid and vitamin B112 and high homocysteine levels as possible predictors of depression. The results from epidemiological studies are mixed and largely from elderly populations.. A random subsample of 412 persons aged 60-64 years from a larger community sample underwent psychiatric and physical assessments, and brain MRI scans. Subjects were assessed using the PRIME-MD Patient Health Questionnaire for syndromal depression and severity of depressive symptoms. Blood measures included serum folic acid, vitamin B12, homocysteine and creatinine levels, and total antioxidant capacity. MRI scans were quantified for brain atrophy, subcortical atrophy, and periventricular and deep white-matter hyperintensity on T2-weighted imaging.. Being in the lowest quartile of homocysteine was associated with fewer depressive symptoms, after adjusting for sex, physical health, smoking, creatinine, folic acid and B12 levels. Being in the lowest quartile of folic acid was associated with increased depressive symptoms, after adjusting for confounding factors, but adjustment for homocysteine reduced the incidence rate ratio for folic acid to a marginal level. Vitamin B12 levels did not have a significant association with depressive symptoms. While white-matter hyperintensities had significant correlations with both homocysteine and depressive symptoms, the brain measures and total antioxidant capacity did not emerge as significant mediating variables.. Low folic acid and high homocysteine, but not low vitamin B12 levels, are correlates of depressive symptoms in community-dwelling middle-aged individuals. The effects of folic acid and homocysteine are overlapping but distinct.

Topics: Aged; Antioxidants; Australia; Brain; Case-Control Studies; Causality; Creatinine; Cross-Sectional Studies; Depressive Disorder; Depressive Disorder, Major; Female; Folic Acid; Folic Acid Deficiency; Health Status Indicators; Health Surveys; Homocysteine; Humans; Hyperhomocysteinemia; Magnetic Resonance Imaging; Male; Middle Aged; Neuropsychological Tests; Personality Assessment; Predictive Value of Tests; Psychometrics; Reference Values; Statistics as Topic; Vitamin B 12; Vitamin B 12 Deficiency

Pakistani people belong to an ethnic group which has the highest rate of coronary artery disease (CAD). We investigated the possible correlation between deficiency of vitamins B6, B12 or folic acid and hyperhomocysteinemia in Pakistani patients with acute myocardial infarction (AMI). A case-control study was carried out involving 224 AMI patients (age 30-70 years; 55 females and 169 males) and 126 normal healthy subjects (age 31-70 years; 35 females and 91 males).. Fasting venous blood was obtained from cases and controls. Serum was analyzed for folic acid and B12 using radioassays. Plasma was analyzed for pyridoxal phosphate (PLP; coenzymic form of B6) using a radioenzymatic assay and for total homocysteine using a fluorescence polarization immunoassay. Mean serum B12 concentration in AMI patients was found to be significantly lower than the mean for controls (241+/-185 pg/ml vs 608+/-341 pg/ml; p < 0.001). Mean serum folate level in patients was also found to be lower than controls (3.35+/-3.78 ng/ml vs 4.93+/-2.93 ng/ml), however, the differences were not statistically significant. Similarly, mean PLP concentration in plasma of cases (19.4+/-24.4 nmol/l) was lower than the concentration in controls (23.2+/-17.6 nmol/l), but the difference was not statistically significant. Mean plasma homocysteine level in AMI cases (18+/-8.36 micromol/l) was higher than the mean level in controls (16.4+/-4.9 micromol/l), but not to a significant extent. However, this mean homocysteine concentration in normal healthy subjects was among the highest reported in the literature and was significantly more than mean values reported in most Eastern and Western studies. Compared to controls, there was significantly greater deficiency of folate (32.5% vs 67.1%), B12 (3.2% vs 63.4%) and PLP (49.2% vs 74.1%) in AMI patients. Deficiencies of folate, B12 and PLP were defined as serum folate levels less than 3.5 ng/ml, serum levels of B12 less than 200 pg/ml and plasma PLP levels less than 20 nmol/l. Mean plasma homocysteine levels in smokers were found to be significantly higher in both cases and controls. Similarly, mean serum folate levels in smokers (compared to nonsmokers) were significantly lower in both cases and controls.. Substantial nutritional deficiencies of these three vitamins along with mild hyperhomocysteinemia, perhaps through an interplay with the classical cardiovascular risk factors (highly prevalent in this population), could be further aggravating the risk of CAD in the Pakistani population.

Topics: Adult; Aged; Aging; Body Mass Index; Case-Control Studies; Female; Fluorescence Polarization Immunoassay; Folic Acid; Folic Acid Deficiency; Humans; Hyperhomocysteinemia; Male; Middle Aged; Myocardial Infarction; Obesity; Pakistan; Pyridoxal Phosphate; Smoking; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6; Vitamin B 6 Deficiency

Indian Asian men residing in the United Kingdom have a higher prevalence of hyperhomocysteinemia than do their European counterparts. This has been largely attributed to dietary deficiencies in cobalamin associated with vegetarianism among these Indian Asians.. We aimed to ascertain the prevalence of folate and cobalamin deficiencies and hyperhomocysteinemia in Bangladesh.. Plasma concentrations of homocysteine, folate, and cobalamin and urinary concentrations of creatinine were assessed in 1650 adults in Bangladesh.. The prevalence of hyperhomocysteinemia (men: >11.4 micromol/L; women: >10.4 micromol/L) was markedly (P < 0.0001) greater among men (63%; x +/- SD: 15.3 +/- 9.5 micromol/L) than among women (26%; 9.5 +/- 4.7 micromol/L). Folate was lower (9.8 +/- 6.5 and 12.3 +/- 7.6 nmol/L, respectively), whereas cobalamin was higher (281 +/- 115 and 256 +/- 118 pmol/L, respectively) (P < 0.0001 for both) among men than among women. Folate explained 15% and cobalamin explained 5% of the variation in homocysteine concentrations. For men, folate (P = 0.005) and cobalamin (P = 0.03) were positively correlated with urinary creatinine. Smoking (P < 0.0003) and betelnut use (P < 0.0002) were independent negative predictors of folate.. Bangladeshi men have a high prevalence of hyperhomocysteinemia, which is more closely associated with folate than with cobalamin, although other factors, eg, smoking and betelnut use, may also contribute to its cause. The positive correlations between urinary creatinine and plasma folate and cobalamin were unanticipated and could suggest that, in marginal nutrition, these vitamins may be limiting for creatine biosynthesis.

Topics: Adult; Aged; Areca; Bangladesh; Cohort Studies; Creatinine; Diagnosis, Differential; Diet, Vegetarian; Female; Folic Acid; Folic Acid Deficiency; Hematinics; Homocysteine; Humans; Hyperhomocysteinemia; Male; Middle Aged; Prevalence; Prospective Studies; Sex Factors; Smoking; Vitamin B 12; Vitamin B 12 Deficiency

There is increased worldwide concern about the consequences of folic acid and vitamin B12 deficiencies on health, which include megaloblastic anemia, neural tube defects and cardiovascular disease.. This study intended to determine the prevalence of folic acid and vitamin B12 deficiencies in vulnerable groups in labor and poor socioeconomic strata of the Venezuelan population.. A total of 5658 serum samples were processed to determine folic acid and vitamin B12 concentrations. The study involved three surveys performed during 2001-2002 and included infants, children, adolescents and pregnant women from labor and poor socioeconomic strata of the population. The method used was a radio immunoassay designed for the simultaneous measurement of serum folic acid and vitamin B12.. The prevalence of folic acid deficiency was higher than 30% for all groups studied, reaching 81.79% in adolescents. Vitamin B12 deficiency was 11.4% in samples collected nationwide, but there was also a similar prevalence of high serum levels. The prevalence of folic acid and vitamin B12 deficiencies in pregnant women reached 36.32 and 61.34%, respectively.. This work shows that there is a high prevalence of folic acid deficiency, especially in women of reproductive age, pregnant adolescents and in the whole population studied in Vargas state. This situation requires immediate intervention as supplementation or food fortification programs.

Topics: Adolescent; Adult; Anemia, Megaloblastic; Cardiovascular Diseases; Child; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Male; Neural Tube Defects; Nutrition Surveys; Pregnancy; Radioimmunoassay; Seroepidemiologic Studies; Venezuela; Vitamin B 12; Vitamin B 12 Deficiency

Unlike iron therapy, folate use is not a standard of care in hemodialysis (HD) patients. Despite iron repletion, poor response to erythropoietin (EPO) treatment is common. Theoretical evidence for folate deficiency (FD) includes chronic blood loss, inflammation, malnutrition, and nutrient loss during dialysis. Due to poor diagnostic standards, early studies failed to establish a role for FD in EPO resistance. Given that hematological response to therapeutic intervention is the gold standard for FD, its diagnosis was therefore based on composite scoring of RBC and/or folate indices. Fifteen subjects (8-20 years) on chronic HD were enrolled in this study. No folate supplement was given in the first six months. Thereafter, 5-mg folic acid was administered orally after HD sessions over a six-month period. Folate indices before and after treatment were compared using percentage differences and paired t-tests. After folate use, the mean Hb increased by 11.4%, while MCV and RDW were reduced. Similarly, 4 of the 15 subjects each had a > or = 20% rise in Hb and a > or = 5% reduction in MCV, while 46.7% had a > or = 2.5% reduction in RDW. Mean RBC folate increased by 24%, while FD scores reduced from 3.8+/-1.2 to 0.4+/-0.7, and the EPO requirement by 90%. In contrast to previous studies, 26.7% of study subjects met the criteria for FD. Furthermore, the substantial (post-folate) reduction in the EPO requirement validates the need for therapeutic intervention, and therefore the presence of functional FD in the population.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Child; Drug Resistance; Erythropoietin; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Kidney Failure, Chronic; Male; Recombinant Proteins; Renal Dialysis; Vitamin B 12

Elevated homocysteine concentrations may contribute to cognitive impairment. Most elevations in homocysteine result from inadequate folate, vitamin B-12, or vitamin B-6 intake. It is not clear whether the observed associations between homocysteine and cognitive measures are causal or whether they are due to homocysteine, to independent actions of the B vitamins, or to both.. We aimed to assess the individual and independent effects of baseline plasma homocysteine, folate, vitamin B-12, and vitamin B-6 and of dietary B vitamin intakes on 3-y changes in cognitive measures in 321 aging men.. Participants were from the Veterans Affairs Normative Aging Study. Cognitive function was assessed with the Mini-Mental State Examination and on the basis of measures of memory, verbal fluency, and constructional praxis, which were adapted from the revised Wechsler Adult Intelligence Scale and the Consortium to Establish a Registry for Alzheimer's Disease batteries at 2 time points. At baseline, dietary intakes were assessed with a food-frequency questionnaire, and blood was drawn for the measurement of B vitamins and homocysteine.. Over a mean 3-y follow-up, declines in constructional praxis, measured by spatial copying, were significantly associated with plasma homocysteine, folate, and vitamins B-6 and B-12 and with the dietary intake of each vitamin. Folate (plasma and dietary) remained independently protective against a decline in spatial copying score after adjustment for other vitamins and for plasma homocysteine. Dietary folate was also protective against a decline in verbal fluency. A high homocysteine concentration was associated with a decline in recall memory.. Low B vitamin and high homocysteine concentrations predict cognitive decline. Spatial copying measures appear to be most sensitive to these effects in a general population of aging men.

Topics: Aged; Aged, 80 and over; Aging; Cognition; Cognition Disorders; Cohort Studies; Cross-Sectional Studies; Diet; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Homocysteine; Humans; Male; Middle Aged; Predictive Value of Tests; Vitamin B 12; Vitamin B 6; Vitamin B Complex

To investigate the relationship between homocysteine (Hcy) and B vitamins status in the Taiwanese elderly population, an analysis was made of the plasma Hcy levels in elderly persons. The study sample was taken from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) (Elderly NAHSIT) and included 1094 males and 1135 females aged 65-90 years. The results showed that average plasma Hcy was 13.3+/-0.6 micromol/ L for males and 10.6+/-0.7 micromol/L for females. The average plasma Hcy levels of males from all age groups were significantly higher than those of females, and significantly increased with age (P<0.0001). The overall prevalence of hyperhomocysteinemia (Hcy>15 micromol/L) was 23.4% for elderly males and 11.2% for elderly females, and this also increased with age (P<0.0001). In subjects with normal renal function, folate, vitamin B2, B6, and B12 status were significantly lower in males with hyperhomocysteinemia, while only folate and vitamin B12 were significantly lower in females with hyperhomocysteinemia. Further analysis suggested that folate, vitamin B6 or B12 insufficiency were associated with hyperhomocysteinemia in both sexes, while vitamin B2 insufficiency was significantly associated only in males. In elderly persons with adequate folate, vitamin B6, and B12 status, there was no significant association between vitamin B2 and hyperhomocysteinemia. This association occurred only in those who had concurrent poor folate, vitamin B6, or B12 status. The strength of the association between vitamin B12 insufficiency and hyperhomocysteinemia was not affected by simultaneous vitamin B2 or B6 insufficiency, but increased about 3-fold when combined with folate. This suggests that poor folate and vitamin B12 status has a synergistic effect on the risk of hyperhomocysteinema in the elderly, as did a poor folate and vitamin B6 status. Therefore, maintaining adequate vitamin B12 status and avoiding multiple B vitamin insufficiency, especially that of folate and vitamin B12 or B6, should be emphasized as an important measure for reducing plasma Hcy levels among elderly Taiwanese.

Topics: Age Factors; Aged; Aged, 80 and over; Cardiovascular Diseases; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Health Surveys; Homocysteine; Humans; Hyperhomocysteinemia; Male; Nutrition Surveys; Nutritional Status; Sex Factors; Taiwan; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6; Vitamin B 6 Deficiency; Vitamin B Complex

Analyses of total homocysteine (tHcy) and to some extent methyl malonic acid (MMA) have become increasingly used in Sweden, primarily for investigating folate and cobalamin deficiency. This has led to increasing costs for diagnosis and laboratory testing, since clinicians still order the established tests, cobalamin and folate. The purpose of this study was to compare the profile of test parameters in six Swedish counties, using laboratory statistics from 2003, and to relate these to medical prescriptions for folate and cobalamin in the same counties. We also wanted to evaluate whether or not a laboratory algorithm with tHcy as the primary test-parameter, followed by vitamin analyses only when tHcy is above a certain decision limit, could reduce the expanding cost of diagnosing folate and cobalamin deficiency. For this analysis we used patient results from two counties in Sweden collected during 2003. There is a slight positive correlation between resources spent upon tests and resources spent upon treating these deficiencies, and a laboratory algorithm based upon initial analysis of tHcy, instead of conventional clinical requests for all parameters, could save approximately 30% of laboratory costs. A typical annual saving in one of these counties (ca. 260,000 inhabitants) by implementing this algorithm would be ca 100,000.

Topics: Algorithms; Folic Acid Deficiency; Homocysteine; Humans; Research; Research Design; Sweden; Vitamin B 12

Although anemia is frequent in inflammatory rheumatic diseases, data regarding vitamin B12 status is scarce. The purpose of this study was to analyze the incidence and nature of B12 and folic acid (FA) deficiencies in a cohort of rheumatic patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and systemic lupus erythematosus (SLE).. Levels of B12, FA, and parameters of anemia were recovered or examined in 276 outpatients. In those with recent findings of low serum B12 levels, further studies of serum homocysteine (Hcy) and urine methylmalonic acid (MMA) levels were performed.. The incidence of anemia was high: 49%, 46%, and 35%, in RA, SLE, and PsA, respectively. Low levels of serum B12 were also frequent (24%), with almost similar occurrence in the three disease groups. Deficiency in FA was rare (<5%). Mean levels of both vitamins did not differ significantly among the three groups. No correlation between serum B12 levels and anemia was found. In the 15 patients with recently detected low B12 levels, Hcy and MMA were evaluated before and following B12 therapy. In ten of them, baseline Hcy levels were high, while MMA was increased in one patient only. Response to B12 administration, i.e., a decrease in Hcy and/or MMA levels, was noticed in four patients only, suggesting that only 26% of the low-serum-B12 patients had true B12 deficiency.. The incidences of anemia and decreased serum B12 levels were high in these three groups of rheumatic patients. However, true tissue deficiency seems to be much rarer.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Arthritis, Psoriatic; Arthritis, Rheumatoid; Cohort Studies; Female; Folic Acid Deficiency; Homocysteine; Humans; Incidence; Israel; Lupus Erythematosus, Systemic; Male; Methylmalonic Acid; Middle Aged; Retrospective Studies; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

to examine the prevalence of vitamin B12 deficiency and folate deficiency in later life in representative samples of the elderly population in the United Kingdom.. a population-based cross-sectional analysis of 3,511 people aged 65 years or older from three studies was used to estimate the age-specific prevalence of vitamin B12 deficiency and of folate deficiency. Vitamin B12 deficiency is conventionally diagnosed if serum vitamin B12 < 150 pmol/l ('low vitamin B12'). We defined 'metabolically significant vitamin B12 deficiency' as vitamin B12 < 200 pmol/l and blood total homocysteine >20 micro mol/l. Folate deficiency, which usually refers to serum folate <5 nmol/l, was defined as 'metabolically significant' if serum folate was <7 nmol/l and homocysteine >20 micro mol/l.. the prevalence of vitamin B12 deficiency, whether defined as low vitamin B12 or metabolically significant vitamin B12 deficiency increased with age in all three studies, from about 1 in 20 among people aged 65-74 years to 1 in 10 or even greater among people aged 75 years or greater. The prevalence of folate deficiency also increased with age, and was similar to that for vitamin B12 deficiencies, but only about 10% of people with low vitamin B12 levels also had low folate levels.. the high prevalence of vitamin B12 and folate deficiency observed in older people indicates a particular need for vigilance for deficiency of these vitamins. Reliable detection and treatment of vitamin deficiency could reduce the risk of deficiency-related disability in old age.

Topics: Age Factors; Aged; Aged, 80 and over; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Institutionalization; Prevalence; United Kingdom; Vitamin B 12; Vitamin B 12 Deficiency

A large body of evidence links plasma concentrations of homocysteine and cardiovascular disease. Several genetic and environmental variables may modulate such relationship. We investigated the influence of methylenetetrahydrofolate reductase (MTHFR) gene variants C677T, A1298C, and T1317C on homocysteine, folate, and cobalamin concentrations in a sample of individuals from a mild folate deficiency population to better clarify the complex interactions existing among these variables.. In the present study, 209 individuals belonging to an admixed urban population characterized by mild folate deficiency were investigated. MTHFR gene variants C677T, A1298C, and T1317C were genotyped and homocysteine-, folate-, and cobalamin-determined for each individual.. Univariate analyses showed a significant association between the C677T variant with homocysteine (P<0.001) and cobalamin (P=0.005) as well as a significant relationship between the T allele and serum folate concentrations (P<0.05). The TT genotype of the C677T polymorphism remained significantly associated with log-transformed homocysteine even after adjustment for age, sex, smoking status, ethnicity, folate, and cobalamin concentrations (P<0.01). Both univariate and multivariate analysis have failed to show any effect of the A1298C and T1317C genetic variants in homocysteine concentrations in this population. Finally, a significant interaction between folate and C677T polymorphism in the determination of homocysteine was also disclosed (P<0.005).. Taken together, these results demonstrate a significant interaction between serum folate and MTHFR genotype in predicting homocysteine concentrations. One may consider that a differential response of homocysteine to folic acid supplementation may depend on MTHFR genotype which may have important implications when attempting to lower homocysteine concentrations in populations with mild folate deficiency.

Topics: Adult; Female; Folic Acid; Folic Acid Deficiency; Genotype; Homocysteine; Humans; Male; Methylenetetrahydrofolate Reductase (NADPH2); Polymorphism, Genetic; Vitamin B 12

Hyperhomocysteinemia is a risk factor for cardiovascular disease. C677T mutation at the MTHFR gene and deficiencies of folic acid and vitamin B-12 may account for elevation of total homocysteine (tHcy). Ninety Brazilian Parkatêjê Indians (90.0% of the population without admixture, aged > or = 20 years) were studied. Hyperhomocysteinemia was observed in 26.7% of the Indians. No case of vitamin B-12 deficiency was detected. Folic acid deficiency was found in 43.3% of the subjects. Rates of mutated allele 677T and TT genotype were 40.7% and 14.0%, respectively. Prevalence of hypertension, dyslipidemia, smoking, WHR > or = 0.9, BMI > or = 25 kg/m2 and chronic alcohol use were 4.4%, 44.4%, 25.6%, 72.2%, 67.8%, and 0.0%, respectively. All creatinine values were normal. Natural logarithmic (ln) tHcy showed no correlation with age, but was positively correlated with systolic (r = 0.22) and diastolic (r = 0.21) blood pressure and triglycerides (r = 0.39) and inversely correlated with folic acid (r = -0.40) adjusted for age and sex. Total homocysteine (tHcy) was higher among TT genotype (P < .001). The multiple linear regression model, containing variables for sex, folic acid, TT genotype, and triglycerides, explained 50.0% of the variation of the ln tHcy. In summary, high rates of cardiovascular risk factors were discovered. C667T mutation and folic acid deficiency can explain, at least in part, the observed hyperhomocysteinemia.

Topics: Adult; Brazil; Cardiovascular Diseases; Female; Folic Acid Deficiency; Health Status Indicators; Homocysteine; Humans; Hyperhomocysteinemia; Indians, South American; Linear Models; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Risk Factors; Sex Factors; Smoking; Vitamin B 12

Topics: Brazil; Cardiovascular Diseases; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Indians, South American; Risk Factors; Vitamin B 12

Moderate hyperhomocysteinemia is a risk for neural tube defect and neurodegenerative and vascular diseases and has nutritional, metabolic, and genetic determinants. Its prevalence in sub-Saharan Africa remains unknown.. Our goal was to evaluate the prevalence of hyperhomocysteinemia and the influence of nutritional, metabolic, and genetic determinants in savanna and coastal regions of Togo and Benin.. Volunteers were recruited from coastal (C groups; n = 208) and savanna (S group; n = 68) regions. Vitamin B-12, folate, total homocysteine (tHcy), cystatin C (a marker of glomerular filtration), and inflammatory and nutritional protein markers were measured in plasma, and the methylenetetrahydrofolate reductase (MTHFR) 677C-->T and 1298A--> C polymorphisms and the methionine synthase 2756A-->G polymorphism were examined in genomic DNA.. Moderate hyperhomocysteinemia (tHcy > 15 micromol/L) was recorded in 62.3% and 29.4% of the subjects from the coast and savanna, respectively (P < 0.0001). A histogram distribution of tHcy in the coastal groups showed a distinct group, C2 (15% of the total group), with tHcy > 28 micro mol/L. Folate < 6.75 nmol/L (lower quartile) and MTHFRCT/TT genotype were the 2 main risk factors for moderate hyperhomocysteinemia in the whole population [odds ratios: 5.3 (95% CI: 2.5, 11.2; P < 0.0001) and 4.9 (1.6, 14.8; P = 0.0048), respectively] and in the C2 group [odds ratios: 15.9 (4.5, 56.8; P < 0.0001) and 9.0 (2.3, -35.2; P = 0.0017), respectively]. Cystatin C was another potent risk factor in the C2 group.. A high prevalence of hyperhomocysteinemia in coastal West Africa, related to folate concentrations and the MTHFR 677 T allele, suggests the need to evaluate the influence of hyperhomocysteinemia on disease in this area.

Topics: Adult; Benin; Cystatin C; Cystatins; Female; Folic Acid Deficiency; Genotype; Humans; Hyperhomocysteinemia; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Population Surveillance; Prevalence; Risk Factors; Togo; Vitamin B 12

Anemia in chronic heart failure (CHF) is common, varying in prevalence between 14.4% and 55%, and is more frequent in patients with more severe heart failure. Patients with CHF who have anemia have a poorer quality of life, higher hospital admission rates, and reduced exercise tolerance. We explored the relation between hematinic levels and hemoglobin (Hb) levels and exercise tolerance in a group of patients with CHF.. We analyzed data from 173 patients with left ventricular systolic dysfunction (LVSD), 123 patients with symptoms of heart failure, but preserved left ventricular (LV) systolic function ("diastolic dysfunction"), and 58 control subjects of similar age. Each underwent echocardiography, a 6-minute walk test, and blood tests for renal function and Hb and hematinic levels (vitamin B12, iron, and folate). We classified patients as having no anemia (Hb level >12.5 g/dL), mild anemia (Hb level from 11.5-12.5 g/dL), or moderate anemia (Hb level <11.5 g/dL).. Of patients with LVSD, 16% had moderate anemia and 19% had mild anemia. Of patients with preserved LV function, 16% had moderate anemia and 17% had mild anemia. Four control subjects had a Hb level <12.5 g/dL. Of all patients, 6% were vitamin B12 deficient, 13% were iron deficient, and 8% were folate deficient. There was no difference between patients with LVSD and the diastolic dysfunction group. In patients with LVSDS, the average Hb level was lower in New York Heart Association class III than classes II and I. The distance walked in 6 minutes correlated with Hb level in both groups of patients with CHF (r = 0.29; P <.0001). Patients with anemia achieved a lower pVO2 (15.0 [2.3] vs 19.5 [4.4], P <.05). Peak oxygen consumption correlated with Hb level (r = 0.21, P <.05) in the patients, but not in the control subjects. In patients with anemia, the mean creatinine level was higher than in patients with a Hb level >12.5 g/dL, but there was no clear relationship with simple regression. Hematocrit level and mean corpuscular volume were not different in the patients with diastolic dysfunction, patients with LV dysfunction, or the control subjects. Hematocrit levels were not influenced by diuretic dose. Patients with anemia were not more likely to be hematinic deficient than patients without anemia.. Patients with symptoms and signs of CHF have a high prevalence of anemia (34%) whether they have LV dysfunction or diastolic dysfunction, but few patients have hematinic deficiency. Hemoglobin levels correlate with subjective and objective measures of severity and renal function.

Topics: Aged; Anemia; Anemia, Iron-Deficiency; Case-Control Studies; Chronic Disease; Creatinine; Exercise Test; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Heart Failure; Humans; Iron; Male; Oxygen Consumption; Ventricular Dysfunction, Left; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Bone Density; Female; Folic Acid Deficiency; Humans; Osteoporosis, Postmenopausal; Vitamin B 12

A relation between low folate status and depression has been recognized since the 1960s. Since 1998, flour in the United States has been fortified with folic acid, and the prevalence of folate deficiency has decreased dramatically.. We investigated whether, in this era of folic acid fortification, low folate status is a determinant of depressive symptoms in a cohort of elderly Latinos (aged >/=60 y) participating in the Sacramento Area Latino Study on Aging (SALSA).. In a cross-sectional logistic regression analysis of data from SALSA (n = 627 M, 883 F), odds ratios (ORs) were ascertained for elevated depressive symptoms [Center for Epidemiologic Studies Depression Scale (CES-D) score >/=16] among tertiles of plasma folate. Depressive symptoms were assessed by using the CES-D. Plasma folate concentrations were determined by radioassay.. The prevalence of folate deficiency (plasma folate

Topics: Acculturation; Aged; Aging; California; Cross-Sectional Studies; Depression; Diet; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Hispanic or Latino; Homocysteine; Humans; Logistic Models; Male; Middle Aged; Sex Factors; Vitamin B 12

The purpose of this study was to compare the folate and vitamin B (12) levels in pregnant and nonpregnant women to evaluate the risk for hyperhomocysteinemia and for folate and vitamin B (12) deficiencies during pregnancy. Healthy pregnant women (n = 92; 24 to 28 gestational weeks; 18 to 39 years old) and nonpregnant women (n = 176; 18 to 39 years old) were sampled for serum levels of folate, vitamin B (12), and homocysteine. Pregnant women were less likely to have folate deficiency (8.0% versus 12.0%) but much more likely to have vitamin B (12) deficiency (46.1% versus 0.6%) than nonpregnant women. Those with lower dietary vitamin intakes were more likely to have vitamin B (12) deficiency. Serum folate and vitamin B (12) were negatively correlated with homocysteine among pregnant women. Pregnant women with folate deficiency were more likely to have hyperhomocysteinemia than those without folate deficiency. The vitamin B (12) level associated with hyperhomocysteinemia was lower in pregnant subjects than in nonpregnant subjects in this study, indicating that pregnant women require vitamin B (12) supplementation.

Topics: Adolescent; Adult; Case-Control Studies; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Korea; Pregnancy; Pregnancy Complications; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Before the advent of highly active antiretroviral therapy (HAART), 20% and 10% of HIV-infected patients had low vitamin B-12 and red blood cell folate (RBCF) concentrations, respectively. However, few patients had real vitamin B-12 deficiency.. We evaluated the prevalence of low vitamin B-12 and RBCF concentrations in HIV-infected patients receiving HAART and the usefulness of serum homocysteine (sHcy) for differentiating patients with deficiency from those with harmlessly low vitamin B-12.. The prevalence of low vitamin B-12 and RBCF was evaluated in 126 HIV-infected patients receiving HAART. Moreover, sHcy concentrations were evaluated in 40 HIV-infected patients with low vitamin B-12 and in 37 HIV-infected patients with low RBCF and were compared with those in 128 HIV-infected patients with normal vitamin B-12 and RBCF. sHcy was used to monitor treatment with vitamin B-12 and folic acid in 28 patients (24 with low vitamin B-12 and RBCF and 4 with hyperhomocysteinemia but normal vitamin B-12 and RBCF).. The prevalence of low vitamin B-12 was significantly lower in patients receiving HAART than in previously studied patients who did not receive HAART (8.7% compared with 27%). Nine of the 40 patients (22.5%) with low vitamin B-12 (< or = 200 pmol/L) had hyperhomocysteinemia (> 17.5 micromol homocysteine/L). Nineteen (51.4%) of the 37 patients with low RBCF (< or = 580 nmol/L, percentile 10) had hyperhomocysteinemia. Among the 9 patients with an RBCF concentration < or = 450 nmol/L (percentile 2.5), all had hyperhomocysteinemia. The treatment with vitamin B-12 and folic acid normalized sHcy concentrations.. The prevalence of low vitamin B-12 decreased after the introduction of HAART. The study of sHcy is useful for detecting HIV-infected patients with low vitamin B-12 and real deficiency.

Topics: Adult; Antiretroviral Therapy, Highly Active; Diagnosis, Differential; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; HIV Infections; Homocysteine; Humans; Hyperhomocysteinemia; Male; Nutrition Assessment; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Anemia, Megaloblastic; Anemia, Pernicious; Animals; Bone Marrow Cells; Deoxyuracil Nucleotides; DNA; Folic Acid; Folic Acid Deficiency; Humans; Rats; Vitamin B 12; Vitamin B 12 Deficiency

Plasma homocysteine concentrations increase with age and remain an independent risk factor for vascular disease in the elderly. There are negative correlations between plasma homocysteine and serum folate and vitamin B12 concentrations. Two mechanisms, poor nutritional status, and chronic atrophic gastritis, could explain hyperhomocysteinemia.. The purpose of the study was to determine prevalence and mechanisms of hyperhomocysteinemia in older hospitalized patients.. During a 12-month period, all the consecutive hospitalized patients who underwent gastric endoscopy were recruited in this observational prospective study. Clinical, histological, and biological data concerning nutritional status, gastric analysis, homocysteine, vitamin B12, and folate concentrations were collected during the study for each included patient.. One hundred and ninety six patients (132 women and 64 men, mean age: 85.3 5.7 years) were included. Hyperhomocysteinemia (>or= 18 mmol/l) was diagnosed in 45.4 %, cobalamin deficiency in 13.3 %, and folate deficiency in 11.7 % patients. Hyperhomocysteinemia was significantly correlated to cobalamin deficiency (r = - 0.21; p = 0.005). In a sub group of patients without hypothyroidism, or chronic renal impairment, univariate and multivariate analysis showed a significant association between hyper homocysteinemia and low MNA (OR: 0.92; 95% CI 0.85-0.99), and low albumin (OR: 0.92; 95% IC: 0.83-0.99; p = 0.04). No correlation was found between homocysteine concentrations and chronic atrophic gastritis or Helicobacter pylori infection.. Hyperhomocysteinemia seems to be frequent in the elderly and is associated with poor nutritional status rather than chronic atrophic gastritis.

Topics: Aged; Aged, 80 and over; Aging; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Male; Nutritional Status; Prevalence; Vitamin B 12; Vitamin B 12 Deficiency

This study investigated levels of serum homocysteine, vitamin B12, folic acid, vitamin B6 and vitamin C, in 37 male and 112 female overweight and obese Thai volunteers (body mass index; BMI > or = 25.00), and 23 male and 90 female normal-weight Thai volunteers, who came for a physical check-up at the Out-patient Department, General Practice Section, Rajvithi Hospital, Bangkok from March to October of 2000. Data included anthropometric measurements and waist/hip ratios. All anthropometric variables, except height, were significantly higher for the overweight subjects than for the normal subjects. Statistically significantly higher levels of serum homocysteine were found in the overweight subjects. Serum homocysteine concentrations in overweight and obese males were significantly higher than in overweight and obese females. Serum folic acid and vitamin C in the overweight and obese were found to be statistically significantly lower than in the control subjects. No statistically significant difference in vitamin B12 was found in the overweight and obese subjects compared with the normal control subjects. The medians of serum folic acid and vitamin C concentrations for the overweight and obese males were significantly lower than those of the overweight and obese females. A negative correlation was found between serum folic acid and homocysteine concentrations in all overweight and obese subjects. A significant negative correlation between serum folic acid and vitamin B6 was observed in both male and female overweight and obese subjects. The results of the investigation suggest that homocysteine levels in overweight and obese subjects seem to be caused by insufficient dietary folic acid intake and probably not by B12 deficiency.

Topics: Adolescent; Adult; Antioxidants; Ascorbic Acid; Body Constitution; Case-Control Studies; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Middle Aged; Obesity; Thailand; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6

Plasma total homocysteine (tHcy) level is an independent risk factor for cardiovascular disease (CVD) even among children. The purpose of this study is to evaluate the determinants and distributions of plasma tHcy levels and the relationship between plasma tHcy, folate and vitamin B12 levels among school children in Taipei.. After multi-stage sampling, we randomly selected 1234 school children (609 boys and 625 girls) with the mean age of 13 years (from 12 to 15 years) in this study. Fasting plasma tHcy levels were measured using an ABBOTT IMx analyzer (Axis Biochemicals ASA, Oslo, Norway). Plasma folate and vitamin B12 levels were measured by ACS:180 automated chemiluminescence analyzer (Bayer, Tarrytown, NY, USA).. The distribution of plasma tHcy levels were skewed to the right with the mean values of 10.50 and 8.95 micromol/l and medians of 9.67 and 8.474 micromol/l for boys and girls, respectively. Plasma tHcy concentrations were lower in younger children and progressively increased with increasing age. Boys had significantly higher plasma tHcy levels than girls (10.50 +/- 4.134 vs. 8.95 +/- 2.61 micromol/l, p < 0.01) and lower plasma folate levels (6.05 +/- 2.85 vs. 6.39 +/- 2.58 nmol/l, p < 0.01), and vitamin B12 levels (444.8 +/- 158.4 vs. 495.0 +/- 181.5 pmol/l, p < 0.001). Plasma tHcy levels were significantly positively associated with anthropometric measures in boys; but these characteristics attenuated and became insignificant after adjusting for other potential confounders in girls. Plasma tHcy levels were negatively associated with plasma folate and vitamin B12 levels even after adjusting for BMI and other potential confounders in both genders.. From this study, the distributions of tHcy levels were skewed to the right and the boys had higher plasma tHcy levels than girls. Plasma tHcy levels were significantly positively associated with BMI among boys. Further studies are needed to evaluate the relationship between tHcy and CVD risk factors among children for the better prevention of heart disease in early life.

Topics: Adolescent; Age Factors; Anthropometry; Cardiovascular Diseases; Child; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Health Surveys; Homocysteine; Humans; Hyperhomocysteinemia; Male; Risk Factors; Schools; Sex Factors; Taiwan; Vitamin B 12; Vitamin B 12 Deficiency

Vitamin B-12 deficiency is usually accompanied by elevated concentrations of serum total homocysteine (tHcy) and methylmalonic acid (MMA). Folate deficiency also results in elevated tHcy. Measurement of these metabolites can be used to screen for functional vitamin B-12 or folate deficiency.. We assessed the prevalence of vitamin B-12 and folate deficiency in a population-based study (n = 1562) of older persons living in Oxford City, United Kingdom.. We postulated that, as vitamin B-12 or folate concentrations declined from adequate to impaired levels, tHcy (or MMA) concentrations would increase. Individuals were classified as being at high risk of vitamin B-12 deficiency if they had low vitamin B-12 (< 150 pmol/L) or borderline vitamin B-12 (150-200 pmol/L) accompanied by elevated MMA (> 0.35 micromol/L) or tHcy (> 15.0 micromol/L). Individuals were classified as being at high risk of folate deficiency if they had low folate (< 5 nmol/L) or borderline folate (5-7 nmol/L) accompanied by elevated tHcy (> 15 micromol/L).. Cutoffs of 15.0 micro mol/L for tHcy and 0.35 micro mol/L for MMA identified persons with normal or elevated concentrations. Among persons aged 65-74 and >or= 75 y, respectively, approximately 10% and 20% were at high risk of vitamin B-12 deficiency. About 10% and 20%, respectively, were also at high risk of folate deficiency. About 10% of persons with vitamin B-12 deficiency also had folate deficiency.. Use of tHcy or MMA among older persons with borderline vitamin concentrations may identify those at high risk of vitamin B-12 deficiency who should be considered for treatment.

Topics: Age Factors; Aged; Aged, 80 and over; Creatinine; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Homocysteine; Humans; Male; Mass Screening; Methylmalonic Acid; Prevalence; Reference Values; Risk Factors; Sex Factors; United Kingdom; Vitamin B 12; Vitamin B 12 Deficiency

Severe folate deficiency in pregnancy may mimick HELLP syndrome as there are similar features in both. Proper diagnosis is important as far as the prognosis and management are concerned. Two cases of severe folate deficiency occuring in multigravid women mimicking HELLP syndrome are reported below with review of literature.

Topics: Adult; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; HELLP Syndrome; Humans; Pregnancy; Pregnancy Complications; Vitamin B 12

We have assessed the relationship between homocysteine, its thiol metabolites, specific folate coenzymes, and vitamin B12 according to the two main functionally relevant genotype-genotype categories that maintain the balance between homocysteine transsulphuration to cysteine, and homocysteine remethylation via folate dependent methionine biosynthesis, namely 2756A-->G-MS/66A-->G-MSR and 677C-->T-MTHFR/1298A-->C-MTHFR. We examined 152 individuals who were being treated for either thromboembolic (TE) or non-thromboembolic (non-TE) events. Chi2 test for linear trend in odds ratio provides reasonable evidence for an altered risk of thromboembolism within the range of compound MS/MSR genotypes encountered (wt/wt-->recessive/recessive) (p< or =0.05), but not within the same range of MTHFR/MTHFR genotypes. Logistic regression analysis of the risk for a TE event gave OR=0.49 (95% CI, 0.26-0.92; p=0.026) for 2756A-->G-MS, OR=1.08 (95% CI, 0.65-1.78) for 66A-->G-MSR, OR=1.19 (95% CI, 0.69-2.06) for 677C-->T-MTHFR and OR=0.98 (95% CI, 0.52-1.85) for 1298A-->C-MTHFR. When genotypes were examined individually, one-way ANOVA showed only 677C-->T-MTHFR (p=0.005 [TE]) and 2756A-->G-MS (p=0.005 [non-TE] and p=0.0006 [all subjects]) influence homocysteine. One-way ANOVA also showed that MTHFR/MTHFR compound genotype significantly influences TE homocysteine distribution (p=0.044), but no other variable. In MS/MSR, homocysteine distribution is not significantly affected in TE subjects, but approaches significance in non-TE individuals (p=0.062). However, the increased power obtained when all subjects are analysed demonstrates a significant influence of MS/MSR upon homocysteine distribution (p=0.008). Other significant influences of MS/MSR were on total cellular 5-methyl-H4folate in non-TE subjects (p=0.042) and vitamin B12 in TE subjects (p=0.018). Given the central role of vitamin B12 in MS/MSR activity, 5-methyl-H4folate and homocysteine were also looked at by vitamin B12 quartile, independent of genotype: Vitamin B12 quartile significantly affected homocysteine distribution in TE (p=0.013) but not non-TE individuals, with no effect on 5-methyl-H4folate distributions. Similarly, the prevalence of clinical phenotypes (p=0.013) and of 'high risk' 2756A-->G-MS wildtypes (p=0.039) was associated with the disposition of homocysteine/B12 in TE but not non-TE subjects. Overall, results indicate compound MS/MSR genotype is associated with risk for a TE event. This may be related t

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Aged; Alleles; Data Interpretation, Statistical; Ferredoxin-NADP Reductase; Folic Acid; Folic Acid Deficiency; Genetic Predisposition to Disease; Genotype; Homocysteine; Humans; Nutritional Status; Point Mutation; Polymorphism, Single Nucleotide; Prevalence; Reverse Transcriptase Polymerase Chain Reaction; Thromboembolism; Vitamin B 12; Vitamin B 12 Deficiency

To investigate the effects of tobacco smoking on serum vitamin B12, folic acid and haematological parameters in healthy Thai smokers and non-smokers.. Cross-sectional study of smokers and non-smokers in a military unit in Bangkok, Thailand.. A military unit in Thailand.. One hundred and twenty-three male smokers from a military unit in Bangkok, who participated voluntarily in the study, were investigated. Sixty-six male non-smokers from the same unit were selected as controls. Fasting blood samples were collected for investigation of vitamin B12, folic acid and haematological variables.. The serum folic acid concentration of smokers was lower than that of non-smokers, but was not statistically significantly different. Haemoglobin was lower in smokers than in non-smokers; 16.3% of smokers were anaemic compared with only 3.0% of non-smokers. Anaemia was not related to folate deficiency. The white blood cell count was found to be higher in smokers than in non-smokers.. The results of this study suggest that there were low serum folic acid concentrations in smokers compared with non-smokers, which might contribute to the development of vascular and cardiovascular diseases. The higher white blood cell count might be indicative alterations in the immune functions of smokers.

Topics: Adult; Anemia; Cardiovascular Diseases; Case-Control Studies; Cross-Sectional Studies; Erythrocyte Indices; Folic Acid; Folic Acid Deficiency; Hematologic Tests; Humans; Leukocyte Count; Male; Middle Aged; Risk Factors; Smoking; Thailand; Vitamin B 12; Vitamin B 12 Deficiency

The prevalences of vitamin B12 and folic acid deficiency in the general Israeli population of elders has not been assessed. We measured plasma cobalamin and folic acid concentrations in 418 subjects from four institutions for the aged, 749 subjects attending 19 geriatric day centres and 104 healthy controls. Methylmalonic acid (MMA) and/or homocysteine concentrations were determined in subjects who had a cobalamin concentration <221 pmol/l or folic acid concentration <11 nmol/l respectively. The prevalences of vitamin B12 deficiency (cobalamin <147 pmol/l and MMA > or =0.24 micromol/l), and folic acid deficiency (folic acid <11 nmol/l and homocysteine of >15 micromol/l) in subjects from day centres were 12.6% and 16.4% respectively, and in subjects from institutions 1.2% and 2.2% respectively (P < 0.001). Multiple logistic regression analysis indicated that the relative risk of living at home versus institutions for the aged was highly significant, with odds ratios (OR) of 6.8 [95% confidence interval (CI) 2.6-18.0] for vitamin B12 deficiency and 6.6 (95% CI 2.9-13.1) for folic acid deficiency. Analysis of data for day centre patients showed that folic acid deficiency was a significant risk factor of vitamin B12 deficiency (adjusted OR 3.68, 95% CI 2.27-5.98), and vitamin B12 deficiency was a significant risk of folic acid deficiency (adjusted OR 3.69, 95% CI 2.27-6.01). These data suggest that malnutrition is a major cause of the highly prevalent deficiencies of vitamin B12 and/or folic acid in elderly Israeli subjects dwelling at home.

Topics: Aged; Aged, 80 and over; Black People; Case-Control Studies; Day Care, Medical; Female; Folic Acid; Folic Acid Deficiency; Homes for the Aged; Humans; Israel; Logistic Models; Male; Prevalence; Vitamin B 12; Vitamin B 12 Deficiency; White People

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Animals; Biomarkers; Dietary Supplements; Disease Models, Animal; Folic Acid; Folic Acid Deficiency; Vitamin B 12; Vitamin B 12 Deficiency

A nine-year-old girl without aggravating family history or adverse pregnancy and neonatal outcome, who underwent a resection of the end section of the small bowel as a result of atresia in the first twenty four hours of her life, was admitted to the Department on account of spastic paresis of the lower extremities. Apathy and tiredness appeared the most striking features on the physical examination of the child; likewise the pale colour of skin and a scar on the abdomen integuments--a result of the resection. Neurological examination revealed pyramidal syndrome from the lower extremities, disturbed sense of balance with intensified with closed eyes, and deep sensibility disorders. Megaloblastic anaemia was revealed on further examination, while bone marrow image showed normoblastic erythropoiesis with the presence of megaloid cells. The extremely low level of vitamin B12 in the blood serum and a regular level of folic acid were found. The vitamin B12 absorption test (Schilling test) showed considerable impairment in the process. The inflammation of the esophagus and duodenum mucosa was confirmed in a histopathological examination. Furthermore, irregular result of somatosensory induced potentials (SEP) and conductivity test revealed some characteristics of axonal--demyelinating neuropathy in the lower extremities. MRI of the head and spinal cord was correct. The diagnostics excluded methylomalonic acidosis, multiple sclerosis and other causes of ataxia in children. The overall clinical picture, that is megaloblastic anaemia, the characteristics of the myelosis funicularis and interview data--resection of the bowel as well as other examinations confirmed that the observed disorders resulted from the impairment of vitamin B12 absorption. An appropriate treatment consisted of supplementation of vitamin B12 (intramuscular) and folic acid (orally) improved the neurological condition and hematologic parameters.. It is necessary to monitor hematologic parameters and the neurologic condition in the group of children who underwent the resection of the ileum in infancy. If vitamin B12 deficiency symptoms occur, appropriate treatment should be duly applied.

Topics: Anemia, Megaloblastic; Child; Female; Folic Acid Deficiency; Humans; Ileal Diseases; Infant; Intussusception; Malabsorption Syndromes; Primary Myelofibrosis; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; beta-Thalassemia; Erythrocyte Indices; Female; Folic Acid Deficiency; Gastritis; Hemoglobins; Humans; Middle Aged; Vitamin B 12

Elevated plasma total homocysteine (tHcy) levels have been established as a risk factor for occlusive cardiovascular disease. Also known is that plasma folate and vitamin B12 influence homocysteine metabolism as cosubstrate and cofactor, respectively. However, not much information is available describing plasma tHcy levels and their relationship to plasma folate and vitamin B12 status in Koreans. We measured the plasma levels of tHcy, folate, and vitamin B12 in 195 adults (99 males, 96 females; 23-72 y old in the lower middle class). The mean plasma tHcy levels of males, 11.18 +/- 3.88 micromol/L, was significantly higher (p < 0.001) than that of females, 9.20 +/- 2.65 micromol/L. The distribution of tHcy levels of males showed a wide range, 3-50 micromol/L, with a long tail toward higher values. Thus the incidence of hyperhomocysteinemia (> or = 5 micromol/L) in males, 10.1%, was significantly higher (< 0.02) than the 2.1% in females. As age increased, plasma tHcy levels tended to be higher in females. Therefore, sex differences in plasma tHcy levels disappeared in subjects over fifty. On the other hand, both plasma folate (6.47 +/- 3.06 vs 7.96 +/- 3.55 ng/mL, p < 0.01) and vitamin B12 levels (537.0 +/- 222.0 vs. 664.1 +/- 309.8 ng/mL, p < 0.01) were significantly lower in males than in females. A plasma folate deficiency (< 3.0 ng/mL) was found in 6.1% of males and 2.1% of females. And a vitamin B12 deficiency (< 150 pg/mL) was detected in 2.0% and 1.0%, respectively. Plasma tHcy levels were related with inversely plasma concentrations of folate (r = -0.37249, p < 0.001) as well as vitamin B12 (r = -0.22560, p < 0.01) in both sexes. Plasma levels of tHcy and the prevalence of hyperhomocysteinemia in Korean adults are similar to findings in the West. Our results indicate that male adults may be in worse condition for cardiovascular disease (CVD) than females. And improving folate and vitamin B12 status may reduce plasma tHcy level, which may be more important in males.

Topics: Adult; Age Factors; Aged; Area Under Curve; Cardiovascular Diseases; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Incidence; Korea; Male; Middle Aged; Nutritional Status; Prevalence; Sex Factors; Vitamin B 12; Vitamin B 12 Deficiency

In previous studies we observed a high frequency of elevated total plasma homocysteine (tHcy) concentrations in psychogeriatric patients. The objective of the present study was to obtain detailed information on folate status in psychogeriatric patients and its association with elevated tHcy concentration.. We measured serum and blood folate, tHcy, serum cobalamin, and serum methylmalonic acid in a study population consisting of 141 psychogeriatric patients, 49 of whom had elevated tHcy concentration.. The concentrations of serum and blood folate showed a high correlation and were significantly lower, and age significantly higher, in patients with elevated tHcy compared to patients with normal concentrations of tHcy. A stepwise multiple regression analysis including age, serum and blood folate, serum cobalamin, serum methylmalonic acid and serum creatinine showed that only serum creatinine (p<0.001), age (p<0.01), serum folate (p<0.05) and blood folate (p<0.05) independently predicted tHcy concentration. Only one patient of those with serum folate above 12 nmo/L had an elevated tHcy concentration. No such clear limit was observed for the relation between tHcy and blood folate. Thirty-two of the patients with elevated tHcy had decreased serum folate concentrations (<7.0 nmol/L), and seven of these patients also had signs of cobalamin deficiency. Ten patients had only signs of cobalamin deficiency.. Folate deficiency appears to be common in psychogeriatric patients, and serum folate seems to reflect folate deficiency better than blood folate. Our findings suggest the use of tHcy, serum cobalamin and serum folate to evaluate cobalamin-folate status in psychogeriatric patients.

Topics: Aged; Aged, 80 and over; Aging; Cognition Disorders; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Male; Methylmalonic Acid; Regression Analysis; Vitamin B 12

The aim of this study was to analyse the hematologic status in patients with recurrent oral ulceration (ROU). Twenty-three patients with ROU and 19 control subjects were examined consecutively for hematological abnormalities including serum folate, red cell folate and vitamin B12 levels. Their complete blood counts, hemoglobin typing, serum and red cell folate and serum vitamin B12 levels were studied. Low red cell folate levels were found in 11 out of 23 patients (47.83%) with ROU. They were defined as having folate deficiency (n=5), folate deficient erythropoiesis (n=1), and folate depletion (n=5). The serum and red cell folate levels in the control group were within normal range. There was a statistically significant low red cell folate in the ROU compared to the control group (p=0.000). The serum vitamin B12 levels were within normal range in both ROU and control groups. Hemoglobin, hematocrit and mean corpuscular hemoglobin concentrations were in the normal range in both groups and none had anemia or macrocytosis.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Case-Control Studies; Erythrocyte Indices; Erythrocytes; Erythropoiesis; Female; Fluocinolone Acetonide; Folic Acid; Folic Acid Deficiency; Glucocorticoids; Hematocrit; Hemoglobins; Humans; Male; Middle Aged; Oral Ulcer; Recurrence; Reference Values; Risk Factors; Stomatitis, Aphthous; Time Factors; Vitamin B 12

We present a case of extreme pancytopenia in a 27-year-old pregnant woman. The initial picture was compatible with a severe hematological problem in the category of aplastic anemia, paroxysmal nocturnal hemoglobinuria or even acute leukemia. The further biochemical investigations revealed, however, a folate deficiency. Nowadays this is a very rare cause of pancytopenia. Next to this she also had a Vitamin B(12) deficiency due to intrinsic factor failure. The recent literature is discussed.

Topics: Adult; Anemia, Megaloblastic; Blood Transfusion; Bone Marrow; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant, Newborn; Intrinsic Factor; Male; Pancytopenia; Platelet Transfusion; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Vitamin B 12; Vitamin B 12 Deficiency

Mild hyperhomocysteinemia is an independent risk factor for cardiovascular disease and may result from a deficiency of folate, vitamin B-6 or vitamin B-12. Because vitamin B-12 deficiency is often associated with vegetarianism, this study was designed to examine the effect of Taiwanese vegetarian diets on B-vitamin status and plasma homocysteine levels. Female Buddhist lacto-vegetarians (n = 45; 31-45 y) and matched omnivores (n = 45) recruited in Hualien, Taiwan, were investigated. Taiwanese vegetarians consumed normal amount of folate, but only 21% of Taiwan Recommended Daily Nutrient Allowances (RDNA) values of vitamin B-12. Compared with the omnivores, the vegetarians had significantly higher levels of plasma folate (14.79 +/- 7.70 vs. 11.98 +/- 8.29 nmol/L), but lower levels of vitamin B-12 (207.7 +/- 127.1 vs. 403.5 +/- 138.9 pmol/L). Fasting plasma homocysteine levels were significantly higher in vegetarians than in omnivores (mean: 11.20 +/- 4.27 vs. 8.64 +/- 2.06 micromol/L; median: 10.5 vs. 8.5 micromol/L). Fasting plasma homocysteine was inversely correlated with plasma folate and vitamin B-12 in the vegetarian group. Multiple regression analysis revealed that plasma folate, vitamin B-12 and creatinine were independent determinants of homocysteine variation and contributed to 38.6% of homocysteine variation in the vegetarians. Compared with the omnivores, vegetarians also had significantly lower serum levels of valine, isoleucine, leucine, lysine, alanine and arginine, but higher levels of glycine. In the vegetarian group, fasting plasma homocysteine correlated negatively with serum threonine, lysine, histidine, arginine and cystine, and these amino acids contributed to 38.7% of homocysteine variation. In conclusion, the Buddhist nuns who consumed a lacto-vegetarian diet had mildly elevated fasting plasma homocysteine levels presumably due to lower levels of plasma vitamin B-12.

Topics: Adult; Amino Acids; Cardiovascular Diseases; Diet, Vegetarian; Fasting; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Middle Aged; Nutritional Status; Regression Analysis; Risk Factors; Taiwan; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6; Vitamin B 6 Deficiency

Hyperhomocysteinaemia, a risk factor for atherosclerosis, is common in dialysis patients and particularly in those homozygous for a common polymorphism in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene (C677T transition). B-complex vitamin supplements have been shown to lower plasma total homocysteine (tHcy) concentrations, but the respective effectiveness of folate and oral vitamin B12 is not yet known. Our objectives were: (i) to determine the status of folate and vitamin B12 in a cohort of unsupplemented dialysis patients (ii) to assess the homocysteine-lowering effect of a folate supplement and then of a folate supplement with added vitamin B12. The responses were analysed for the C677T genotypes of MTHFR.. Plasma tHcy, folate and vitamin B12 were measured in 51 haemodialysis patients genotyped for the C677T MTHFR mutation (homozygotes, TT; heterozygotes, CT; without mutation, CC). All patients were then given daily supplements of 15 mg of folic acid for 2 months. They were given daily supplements of 1 mg of vitamin B12 in addition to the folate supplements for a further 2 months. Plasma tHcy, folate and vitamin B12 were monitored after each intervention.. At baseline folate and vitamin B12 deficiencies were found in 10% and 6% of the patients. Initial plasma tHcy concentrations were high in all patients (mean 38.1+/-15 micromol/l). CC patients tended to have a lower tHcy concentration than pooled CT and TT patients. After 2 months of folate therapy, tHcy concentration decreased significantly to 20.2+/-7 micromol/l (P<0.001) and no significant differences were observed between the different genotype subgroups (19.4+/-6 for CC, 21.3+/-8 for CT, 18.5+/-4 for TT). A significant positive relationship was found between the reduction of tHcy and its initial value (rho=0.615, P<0.0001). The impact of the added vitamin B12 was negligible since tHcy concentrations did not change for the patients as a whole (19.8+/-7 micromol/l, NS) or in any subgroup (19.1+/-5 for CC, 20.3+/-9 for CT and 20+/-7 micromol/l for TT).. (i) Folate and vitamin B12 deficiencies were observed in 10% and 6% respectively of our unsupplemented dialysis patients. (ii) After folate therapy, tHcy levels decreased significantly in all patients and were identical between the three C677T MTHFR genotype subgroups. (iii) Vitamin B12 supplements are useful in folate treated patients to prevent cobalamin deficiency and its neurological consequences but they did not lower tHcy plasma levels for the patients as a group or for any of the MTHFR subgroups.

Topics: Administration, Oral; Aged; Cohort Studies; Female; Folic Acid; Folic Acid Deficiency; Genotype; Humans; Hyperhomocysteinemia; Kidney Failure, Chronic; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Oxidoreductases Acting on CH-NH Group Donors; Polymorphism, Genetic; Prospective Studies; Renal Dialysis; Vitamin B 12; Vitamin B 12 Deficiency

Hyperhomocysteinemia, a well-recognized cardiovascular risk factor, is frequent in hemodialysis (HD) patients. A common polymorphism in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene, C-->T substitution at nucleotide 677, is associated with homocysteine (Hcy) level elevation. We examined whether three factors involved in the methionine cycle could influence plasma Hcy concentrations in HD patients: MTHFR polymorphism; vitamin B12, an essential cofactor; and folate, the substrate. In a cross-sectional study, serum vitamin B12, folate, and plasma Hcy were measured and MTHFR genotyping was performed in 534 HD patients. Effects of MTHFR genotypes, vitamin B12, and folate on plasma Hcy levels were examined in 450 HD patients not administered vitamin B12 or folate. To examine the effect of vitamin B12 on plasma Hcy concentrations, we compared plasma Hcy concentrations in HD patients with and without vitamin B12 supplementation. To examine whether functional vitamin B12 deficiency exists even in HD patients with normal vitamin B12 concentrations, 15 HD patients (serum vitamin B12 concentrations, 250 to 2,100 pg/mL) were treated with vitamin B12 (mecobalamin, 1.5 mg/d) for 8 weeks. Serum concentrations of methylmalonic acid (MMA) and vitamin B12 were measured. Hcy levels were higher and folate levels were lower in patients with the TT and CT genotypes compared with patients with the CC genotype. Analysis of covariance to determine independent predictors of high Hcy levels identified low serum vitamin B12 and folate levels and high albumin (Alb) levels in CC-genotype patients, low folate levels and high Alb levels in CT-genotype patients, and low folate levels in TT-genotype patients. Plasma Hcy levels were lower in CC- and CT-genotype patients with vitamin B12 supplementation than in those without supplementation. Vitamin B12 supplementation for 8 weeks significantly reduced MMA concentrations in HD patients with normal serum vitamin B12 concentrations. These results indicate that MTHFR genotype influences the correlation of Hcy level with vitamin B12 and folate levels in HD patients. Functional vitamin B12 deficiency may exist, even in HD patients with normal vitamin B12 concentrations. The efficacy of vitamin B12 and folate supplementation on plasma Hcy levels may depend on MTHFR genotype.

Topics: Cross-Sectional Studies; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Genotype; Homocysteine; Humans; Hyperhomocysteinemia; Kidney Failure, Chronic; Male; Methylenetetrahydrofolate Reductase (NADPH2); Methylmalonic Acid; Middle Aged; Oxidoreductases Acting on CH-NH Group Donors; Polymorphism, Genetic; Renal Dialysis; Vitamin B 12; Vitamin B 12 Deficiency

To assess B12 and folate deficiency after continent urinary diversion via a Kock continent urinary reservoir in children and adolescents.. Ten boys and 10 girls (10.8-18 years old at surgery) were operated with a Kock reservoir and followed for 5-12 years (mean 8.5). The follow-up period was divided into early (3 months-5 years, EFU) and late (5-12 years, LFU) follow-up. Patients were investigated for haemoglobin, serum iron, total iron binding capacity (TIBC), serum Vitamin B12, serum and blood folate, methylmalonic acid (MMA), homocystine and glomerular filtration rate.. Two patients developed subnormal B12 values (median 107.5 pmol/l), one at the EFU, and the other at LFW. The B12 value decreased during the LFU compared to the EFU in nine patients, but it was still within the normal range. Two patients with renal impairment had elevated MMA with normal B12 values. Five patients had high values of homocystine with folate deficiency and/or B12 deficiency and renal impairment. Plasma folate mean value was normal during the whole follow-up. Blood folate was below normal in five patients at the EFU. Two of these five patients, in addition to three patients, had low values at the LFU. Three of four patients with remaining short terminal ileum (20-45 cm) had normal B12 values at both the EFU & LFU and one had low values at the LFU. Six patients had subnormal GFR at the LFU.. To a similar degree as in adults, Vitamin B12, folate and iron deficiency can occur in children and adolescents after continent urinary diversion using an ileal segment. Therefore, Vitamin B12 and folate should be monitored regularly in these patients. Serum MMA and homocystine may offer increased detection of Vitamin B12 deficiency, especially in the patients with normal renal function. Vitamin B12 deficiency is neither correlated with the time elapsed since surgery, nor with the ileum length. Patients are usually asymptomatic, so patients with true B12 deficiency should be identified and placed on life-long Vitamin B12 therapy. An adequate synthetic folic acid as supplements or fortified food is recommended for patients with folate deficiency.

Topics: Adolescent; Child; Child Welfare; Colonic Pouches; Female; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Glomerular Filtration Rate; Hemoglobins; Homocysteine; Humans; Ileum; Iron; Kidney; Male; Methylmalonic Acid; Postoperative Complications; Prospective Studies; Time Factors; Ureterostomy; Urinary Reservoirs, Continent; Vitamin B 12; Vitamin B 12 Deficiency

This article presents the case of a 46-year-old vegetarian who had a painful dry socket in the left third molar areas. Since the patient's general appraisal was anaemic, investigations for haematological status, folic acid and vitamin B12 were performed. The results revealed that the patient was severely iron deficient and slightly vitamin B12 deficient.

Topics: Anemia, Iron-Deficiency; Anemia, Megaloblastic; Diet, Vegetarian; Dry Socket; Enzyme-Linked Immunosorbent Assay; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Humans; Middle Aged; Radioimmunoassay; Thailand; Vitamin B 12; Vitamin B 12 Deficiency

The effect of increasing dietary folate on folate status during pregnancy is controversial. The aim of this study was to compare folate intake and folate status during pregnancy of women with high long-term vegetable intake and those eating an average Western diet. In a prospective study that included 109 participants, pregnant women adhering to a predominant vegetarian diet with high vegetable intake for 8 +/- 0.5 y with subgroups of ovo-lacto vegetarians (n = 27) and low meat eaters (n = 43) and women eating an average Western diet (control group, n = 39) were compared with regard to dietary intake and plasma and red blood cell (RBC) folate concentrations during wk 9-12, 20-22 and 36-38 of gestation. Plasma and RBC folate concentrations were highest in ovo-lacto vegetarians, followed by low meat eaters and lowest in the controls. Ovo-lacto vegetarians and low meat eaters showed a lower risk for folate deficiency, with RBC folate concentrations of <320 nmol/L resulting in odds ratios of 0.10 (95% confidence interval, 0.01-0.56) and 0.52 (95% confidence interval, 0.20-1.34), respectively. In ovo-lacto vegetarians, the RBC folate concentration was positively related to the intake of vitamin B-12 (r = 0.51, P: < 0.0001). The results of the study suggest that long-term high vegetable intake favorably affects plasma folate as well as RBC folate concentrations throughout pregnancy and reduces the risk of folate deficiency if an adequate vitamin B-12 supply is ensured.

Topics: Adult; Animals; Diet; Diet, Vegetarian; Erythrocytes; Feeding Behavior; Female; Folic Acid; Folic Acid Deficiency; Humans; Meat; Nutritional Status; Odds Ratio; Pregnancy; Prospective Studies; Risk Factors; Surveys and Questionnaires; Time Factors; Vegetables; Vitamin B 12

This study examined the relationship between low levels of serum vitamin B12 and folic acid (FA) and cognitive functioning in very old age. The four subsamples of non-demented persons aged 75-96 years - normal B12/normal FA; low B12/normal FA; normal B12/low FA; and low B12/low FA, were matched for age and education. A battery of cognitive tests was administered including Clock Tests, Block Design, Trail Making Tests (TMT), Digit Span, and tests of verbal fluency. Subjects with low levels of vitamins showed deficits in Block Design, TMT-B, Digit Span Backward, and letter fluency, but not in the remaining tests. In general, the effects of FA exceeded those of B12. This pattern of results was interpreted to mean that elderly persons with low vitamin levels have difficulty when fast and accurate processing of novel information is required, but are quite efficient in utilizing pre-existing knowledge structures.

Topics: Aged; Aged, 80 and over; Aging; Cognition; Cognition Disorders; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

The aim of the study was to investigate folate and other selected vitamin status (ascorbic acid, tocopherol, retinol, vitamin B12), haematological indices and total homocysteine concentration of serum in women of childbearing age.. A cross-sectional study.. Warsaw.. Healthy women aged 18-30 y (n=78) not pregnant presently or previously, and not taking drugs.. Haemoglobin and haematocrit values according to WHO criteria for 18 to 30-y-old women were normal. The optimal levels of serum tocopherol, >1.29 mg/dl (>29.9 micromol/l) to preventing civilization diseases, were found in 5.5% and serum retinol >71.6 mcg/dl (>2.5 micromol/l) in 6.4% of all studied persons. The analysis of serum folate concentration showed high-risk deficiency,<3 ng/ml (<6.8 nmol/l), in 6.4%, moderate and low risk together (7.0-14.9 nmol/l) in 61.6% and optimal folate levels (>14.9 nmol/l) in 32.0% of the studied group. Folate body stores were insufficient in almost all women. There was no high or moderate deficiency risk of vitamin B12 or ascorbic acid. None of the women under study had serum total homocysteine (tHcy) concentration >15 micromol/l, indicating hyperhomocysteinaemia. Serum total homocysteine concentrations in the range of 5-15 micromol/l were found in 71.8%, and serum tHcy >10 micromol/l in 7.7% of the studied group of women.. The study was sponsored by the Polish Committee for Scientific Research.

Topics: Adolescent; Adult; Ascorbic Acid; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Nutrition Assessment; Nutrition Disorders; Nutritional Status; Poland; Seroepidemiologic Studies; Vitamin A; Vitamin B 12; Vitamin E; Vitamins

The aim of our investigation was to evaluate possible connection between burning mouth syndrome and hematinic deficiencies, a hypothesis previously reported in the literature with contradictory results. Serum levels of iron, vitamin B12, folic acid, calcium and magnesium were determined in 41 (aged 31-87 years, mean 68,7 yrs) patients with burning mouth syndrome and 35 matched controls (35-83, mean 63 yrs). Serum iron levels were determined according to Fairbanks and Klee. Levels of vitamin B12 and folic acid were determined on commercially available kits (Imx12 and Imx folate assay, Abbot Park lab, IL, USA) on Imx analyser. Calcium and magnesium levels were determined using atomic absorption spectrophotometry. No statistically significant differences in serum levels of iron, folic acid, calcium and magnesium were found between patients with burning mouth syndrome and controls. Statistically significant lowered vitamin B12 levels were found in patients with burning mouth syndrome. Our results suggest that serum deficiencies of iron, folic acid, calcium and magnesium are not etiological factor in patients with burning mouth syndrome.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Burning Mouth Syndrome; Calcium; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Magnesium; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

The aim of this study was to investigate homocysteine and methylmalonic acid levels as markers of functional cobalamin and folate status in pregnant Nepali women.. Cross-sectional study.. Patan Hospital, Kathmandu, Nepal.. A sub-sample (n=382) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. The selection of the sub-sample was based on maternal haematocrit values, categorised into three groups: severely, moderately and non-anaemic women. As serum levels of total homocysteine (s-tHcy) and methylmalonic acid (s-MMA) were similar in the three groups, pooled data are presented. Women who had already received micronutrient supplementation (n=54) were excluded. The remaining women (n=328) were included in the statistical analysis.. Overall mean values (+/-s.d.) of s-tHcy and s-MMA were 9.5 (+/-4.2) micromol/l and 0.39 (+/-0.32) micromol/l, respectively. Elevated s-tHcy (>7.5 micromol/l) was found in 68% of the women, while 61% had elevated s-MMA (>0.26 micromol/l). Low s-cobalamin values (<150 pmol/l) were observed in 49% of the women, while only 7% had low s-folate values (< or =4.5 nmol/l). s-tHcy was significantly correlated with s-MMA (r=0.28, P<0.001), s-cobalamin (r=-0.30, P<0.001) and s-folate (r=-0.24, P<0.001). s-MMA was significantly associated with s-cobalamin (r=-0.40, P<0.001), but not with s-folate.. Functional cobalamin deficiency was very common in the study population, while functional folate deficiency was rather uncommon. We suggest considering cobalamin supplementation to pregnant Nepali women.. The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education.

Topics: Adolescent; Adult; Biomarkers; Cross-Sectional Studies; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Methylmalonic Acid; Nepal; Nutritional Status; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Avitaminosis; Child; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; HIV Infections; Homocysteine; Humans; Hyperhomocysteinemia; Infant; Infant, Newborn; Male; Methylmalonic Acid; Pediatrics; Pregnancy; Vitamin B 12

Our aim was the detection of possible deficiencies of folate and cobalamin by the measurement of plasma total homocysteine (tHcy) in 69 human immunodeficiency virus (HIV) -infected children on antiretroviral treatment. We studied the relationship of these vitamins and methionine with tHcy values.. Plasma tHcy was determined by high-performance liquid chromatography with fluorescence detection, folate and cobalamin by competitive protein-binding chemiluminescence, and methionine by ion exchange chromatography.. Significant differences were observed between tHcy concentrations in the HIV-infected patients and the reference values for children of similar ages (P < 0.0001). Folate values were significantly lower in HIV-infected children compared with our reference paediatric population (P < 0.0001), but cobalamin concentrations were similar between patients and reference values. A significantly negative correlation was found between tHcy and folate (r = - 0.596; P < 0.0001), and a significantly positive correlation between folate and the methionine : tHcy ratio (r = 0.501; P < 0.0001). Plasma tHcy was significantly higher (P = 0.008), while folate values and methionine : tHcy ratios were significantly lower (P = 0.007 and P = 0.042), in patients on protease inhibitor treatment than in patients on other antiretroviral therapies.. The hyperhomocysteinaemia and low methionine : tHcy ratios observed in our group of HIV-infected children are probably a consequence of the low folate values, which interfere in the remethylation of homocysteine to methionine. Patients on protease inhibitor treatment showed significantly higher plasma tHcy concentrations, and lower folate values and methionine : tHcy ratios, compared with patients on other antiretroviral therapies. Hyperhomocysteinaemia is associated with the risk of premature stroke, which may have adverse consequences in the evolution of disease.

Topics: Adolescent; Anti-HIV Agents; Child; Child, Preschool; Female; Folic Acid Deficiency; HIV Infections; HIV-1; Homocysteine; Humans; Hyperhomocysteinemia; Infant; Male; Methionine; Statistics as Topic; Vitamin B 12

The presence of psychiatric illness in general hospital medical inpatients can complicate a patient's clinical course. Currently, there is no standard laboratory work-up recommended for this patient population. To begin to assess the utility of a routine panel of tests, the results of serum vitamin B12 (cobalamin) levels, folate levels, thyroid stimulating hormone levels, and syphilis serology of 349 patients were reviewed. These patients had been admitted to the hospital for nonpsychiatric conditions but either had preexisting psychiatric disturbances or developed a mood spectrum disorder or cognitive spectrum disorder during their hospitalization. The incidence of vitamin B12 and folate deficiencies in these patients was found to be higher than has been reported for the general population. Thus, routine screening for these vitamin deficiencies may be indicated because of their prevalence in this patient population.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Folic Acid; Folic Acid Deficiency; Humans; Inpatients; Mental Disorders; Middle Aged; Retrospective Studies; Syphilis Serodiagnosis; Thyrotropin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Megaloblastic; Folic Acid; Folic Acid Deficiency; Homocystinuria; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

Although the occurrence of iron deficiency anemia and hemoglobinopathies in Vietnamese immigrants has been reported, folate and vitamin B12 deficiencies have not. Proper diagnosis and effective treatment is necessary to achieve a complete correction of anemia.. We retrospectively analyzed the records of Vietnamese immigrants seen in our medical clinic from 1991 to 1993. Fifty-nine anemic patients (48 females and 11 males) had low levels of red blood cell (RBC) folate and/or serum vitamin B12.. The patients' mean age was 37.7+/-17 years. Mean hemoglobin and hematocrit values were 11.4+/-0.7 g/dL and 34.4%+/-2.2%, respectively. Mean corpuscular volume (MCV) was normal in 40 patients (68%) (mean, 89.1+/-5 fL) and low in 19 patients (32%) (mean, 69.7+/-6 fL). Forty-four patients had low RBC folate levels (mean, 157.7+/-41.7 ng/mL). Twenty patients had low serum vitamin B12 levels (mean, 165.6+/-47 pg/mL). Fourteen patients had ferritin levels of <20%.. Concomitant folate, vitamin B12, and iron deficiencies or hemoglobinopathies might have been responsible for either normal or low MCV in some of our anemic patients. In this ethnic group, RBC folate and serum vitamin B12 levels should be determined in all anemic patients.

Topics: Adolescent; Adult; Aged; Anemia; California; Child, Preschool; Erythrocyte Indices; Erythrocytes; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Humans; Male; Middle Aged; Retrospective Studies; Vietnam; Vitamin B 12; Vitamin B 12 Deficiency

Mild hyperhomocysteinemia has been considered a cardiovascular risk factor. However, recent prospective studies have not demonstrated that hyperhomocysteinemia or the underlying genetic defect on methylentetrahydrofolate reductase is associated with a higher risk of coronary or peripheral artery disease. We compared serum homocysteine, folate, and vitamin B(12) levels of patients with coronary and peripheral vascular disease with those of age- and sex-matched healthy individuals. Subjects taking multivitamins, with diabetes mellitus, or serum creatinine levels over 1.5 mg/dL were excluded from the study. Homocysteine was measured by fluorimetric high-performance liquid chromatography. Serum folate and vitamin B(12) levels were measured by an ion-capture method. We studied 32 patients with peripheral vascular disease (10 female), aged 69.6 +/- 11 y, 24 age- and sex-matched control subjects, 52 patients with coronary artery disease (7 female), aged 59.5 +/- 10.4 y, and 42 age- and sex-matched control subjects. Serum homocysteine levels were 11.7 +/- 7.4 and 9.3 +/- 4.5 micromol/L in vascular patients and in the control counterparts, respectively (not significant). The levels for coronary patients and the control counterparts were 9.0 +/- 3.9 and 8.6 +/- 3.6 micromol/L, respectively (not significant). Folate levels were 4.48 +/- 2.42 and 7.14 +/- 4.04 ng/mL in vascular patients and control subjects, respectively (P < 0.02); the levels in coronary patients and control counterparts were 5.15 +/- 1.9 and 6.59 +/- 2.49 ng/mL, respectively (P < 0.01). No differences in vitamin B(12) or tocopherol levels were observed between patients and control subjects. There were no differences in homocysteine levels, but lower serum folate levels were observed when comparing patients with atherosclerotic vascular disease and healthy control subjects.

Topics: Aged; Arteriosclerosis; Cholesterol; Chromatography, High Pressure Liquid; Coronary Disease; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Lipoproteins, HDL; Male; Middle Aged; Risk Factors; Triglycerides; Vitamin B 12; Vitamin E

Elevation of mean cell volume (MCV) is a common clinical problem, but the etiologic spectrum and optimal diagnostic evaluation of macrocytosis are not well defined.. We studied 300 consecutive hospitalized adult patients with MCV values > or = 100 fL. Assessment included complete blood counts, morphologic review, liver function tests, and levels of serum cobalamin (Cbl), methylmalonic acid, and total homocysteine.. The most common cause of macrocytosis was drug therapy, followed by alcohol, liver disease, and reticulocytosis. Megaloblastic hematopoiesis accounted for less than 10% of cases. MCV values > 120 fL were usually caused by Cbl deficiency. Anisocytosis, macro-ovalocytosis, and teardrop erythrocytes were most prominent in megaloblastic hematopoiesis. Elevated levels of serum methylmalonic acid and total homocysteine were useful in the diagnosis of Cbl deficiency.. Drugs and alcohol are the most common causes of macrocytosis in hospitalized patients in a New York City teaching hospital. We have formulated tentative guidelines for the evaluation of high MCV values in this setting.

Topics: Adult; Aged; Alcohol Drinking; Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow Diseases; Diagnosis, Differential; Drug-Related Side Effects and Adverse Reactions; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; L-Lactate Dehydrogenase; Leukocyte Count; Liver Diseases; Liver Diseases, Alcoholic; Male; Methylmalonic Acid; Middle Aged; Platelet Count; Predictive Value of Tests; Prospective Studies; Reticulocyte Count; Sensitivity and Specificity; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Coronary Disease; Folic Acid; Folic Acid Deficiency; Fructose; Homocysteine; Humans; Hyperhomocysteinemia; India; Malabsorption Syndromes; United Kingdom; Vitamin B 12

Epidemiological studies report an inverse relationship between intake of the B vitamin folic acid and colon cancer. Folate is important for DNA synthesis and repair. Moreover, the production of S-adenosylmethionine (SAM), essential for normal DNA methylation and gene expression, is dependent on folic acid. Folate deficiency may increase the risk of malignant transformation by perturbing these pathways.. The principal aim of this study was to determine the effects of folate deficiency on DNA stability and DNA methylation in rat colonocytes in vivo. As the metabolic pathways of folate and other dietary methyl donors are closely linked, the effects of methionine and choline deficiency were also evaluated.. Male Hooded-Lister rats were fed a diet deficient in folic acid, or in methionine and choline, or in folate, methionine and choline for 10 weeks. DNA strand breakage and misincorporated uracil were determined in isolated colonocytes using alkaline single cell gel electrophoresis. Global DNA methylation was measured in colonic scrapings. Folate was measured in plasma, erythrocyte and liver samples.. Methyl donor deficiency induced DNA strand breakage in colonocytes isolated from all experimental groups. Uracil levels in colonocyte DNA remained unchanged compared with controls. DNA methylation was unaffected either by folate and/or methionine and choline depletion. Rats fed a folate-deficient diet had less folate in plasma, red blood cells and liver than controls.. Folate and methyl deficiency in vivo primarily affects DNA stability in isolated colonocytes of rats, without affecting overall DNA methylation.

Topics: Animals; Choline Deficiency; Colon; Colonic Neoplasms; Comet Assay; DNA; DNA Damage; DNA Methylation; Folic Acid; Folic Acid Deficiency; Liver; Male; Methionine; Rats; S-Adenosylmethionine; Vitamin B 12

The diets of populations in many developing countries are low in folate and vitamin B12 and a deficiency of either of these vitamins results in increased risk for cardiovascular disease and neural tube defects. The rates of neural tube defects in Nigeria are among the highest reported worldwide. Since many girls marry at an early age in northern Nigeria, we therefore determined the folate and vitamin B12 status of adolescent girls between 12 and 16 years of age in Maiduguri, Nigeria. The mean serum folate concentration for subjects was 15.3 +/- 5.2 nmol/L. Whereas only four subjects (2.4%) had serum folate concentrations lower than 6.8 nmol/L, a level indicative of negative folate balance, 9% of the subjects had serum vitamin B12 concentrations at or below 134 pmol/L, the lower limit of the reference range for their age group. Serum homocysteine was measured in 56 of the 162 subjects and the mean level was 15.9 +/- 5.0 mumol/L. The majority of subjects had serum homocysteine concentrations above the upper limit of the reference range for their age group. We conclude that the adolescent girls we studied were at greater risk for vitamin B12 deficiency than folate deficiency. This conclusion is consistent with the fact that their diet included few foods that contained vitamin B12.

Topics: Adolescent; Biomarkers; Child; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Incidence; Nigeria; Vitamin B 12; Vitamin B 12 Deficiency

We measured the concentrations of folate and vitamin B-12 in paired tissue samples of squamous cell cancer (SCC) and adjacent grossly normal-appearing uninvolved bronchial mucosa (from which SCC developed and also "at risk" of developing SCC) of the lung in 12 subjects to determine the involvement of these vitamins in 1) lung carcinogenesis and 2) global DNA methylation. The folate concentrations were significantly lower in SCCs than in uninvolved tissues (p = 0.03). The vitamin B-12 concentrations were also significantly lower in SCCs than in uninvolved tissues (p = 0.02). The radiolabeled methyl incorporation (inversely related to the degree of in vivo DNA methylation) was significantly higher in SCCs than in uninvolved tissues (p < 0.0001). The correlation between folate and radiolabeled methyl incorporation was inverse and statistically significant in SCCs (p = 0.03). The correlation between vitamin B-12 and radiolabeled methyl incorporation also was inverse and statistically significant in SCCs (p = 0.009). The relationship between tissue vitamin B-12 and DNA methylation was minimal in uninvolved tissues. The relationship between folate and DNA methylation, however, was inverse in uninvolved tissues. In the multiple regression models that included both vitamins, only folate was inversely associated with radiolabeled methyl incorporation in uninvolved and cancerous tissues. These results suggested that folate might be the limiting vitamin for proper DNA methylation in SCC as well as in tissues at risk of developing SCC. Several possible mechanisms of folate deficiency, including inactivation of the vitamin by exposure to carcinogens of cigarette smoke and underexpression or absence of folate receptor in SCCs and associated premalignant lesions, are discussed in light of these findings.

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; DNA Methylation; Folic Acid; Folic Acid Deficiency; Humans; Lung Neoplasms; Middle Aged; Smoking; Statistics as Topic; Vitamin B 12; Vitamin B 12 Deficiency

Plasma homocysteine has been reported to be useful in the evaluation of patients with suspected vitamin B12 or folate deficiency. In November 1998, Canada began its mandatory fortification of all flour, and some corn and rice products, with folic acid. We evaluated the status of folate and vitamin B12 in Ontario since this fortification program began, and also studied the role of plasma homocysteine in the assessment of vitamin B12 deficiency since that time.. A retrospective cross-sectional study design was performed using a community database of all Ontario samples analyzed by MDS Laboratories, a major provider of diagnostic laboratory services in Canada. All consecutive single-patient fasting samples for plasma homocysteine collected between January 1 and September 30, 1999 were included, as well as corresponding red cell folate and serum B12 concentrations. Data for serum folate were included when available. Descriptive statistics included the arithmetic and geometric means for each measure, as well as the lower and upper centile values. After excluding cases with a concomitant serum creatinine > 120 micromol/L or red cell folate < 215 nmol/L, we established the test properties of a plasma homocyteine level of 15 micromol/L or greater for the diagnosis of "low" (< 120 pmol/L) or "indeterminate" (i.e., between 120 and 150 pmol/L) serum vitamin B12 concentrations.. The mean age of all subjects was 58.4 years (95% CI 57.4 to 59.4). Plasma homocysteine samples were obtained from 403 males (56.7%) and 308 females. The geometric mean homocysteine concentration for the entire population was 8.3 micromol/L, and was significantly higher among males (9.3 micromol/L) than females (8.3 micromol/L) (unpaired t-test: 2-p < 0.0001). The geometric mean serum folate concentration was significantly higher in females (35.8 nmol/L) than males (33.6 nmol/L) (2-p < 0.0001), as were the mean red cell folate levels (females 966.8 nmol/L, males 949.3 nmol/L; 2-p < 0.0001). Serum vitamin B12 concentrations were available for 692 subjects, with a geometric mean of 322.0 pmol/L. Again, mean vitamin B12 was higher in females (332.5 pmol/L) than males (314.3 pmol/L) (2-p < 0.0001). The fifth centile for vitamin B12 was 134.6 pmol/L. A plasma homocysteine concentration > 15 micromol/L did not discriminate between cobalamin concentrations below versus above 120 pmol/L (positive and negative predictive values 7.4% and 97.2%, respectively), nor did it discriminate "indeterminate" B12 levels between 120 and 150 pmol/L (positive and negative predictive values 6.3% and 94.0%, respectively).. In a large select group of Ontarians, serum and red cell folate concentrations appear to be higher than expected, possibly due to a recent national folate fortification programme; cobalamin levels are no higher than expected. Given our inability to detect mild B12 deficiency using such indicators as plasma homocysteine, and considering the substantial growth in the elderly segment of the Canadian population, occult cobalamin deficiency could become a common disorder. Accordingly, we recommend either consideration of the addition of vitamin B12 to the current folate fortification programme, and/or the development of better methods for the detection of cobalamin deficiency.

Topics: Age Factors; Biomarkers; Creatinine; Cross-Sectional Studies; Dietary Supplements; Erythrocyte Indices; Erythrocytes; Female; Folic Acid Deficiency; Hemoglobins; Homocysteine; Humans; Male; Middle Aged; Ontario; Population Surveillance; Retrospective Studies; Sex Factors; Vitamin B 12; Vitamin B 12 Deficiency

The development of certain human cancers has been linked with inadequate intake of folates. The effects of folate deficiency in vivo on DNA stability (strand breakage, misincorporated uracil and oxidative base damage) in lymphocytes isolated from rats fed a diet deficient in folic acid was determined. Because the metabolic pathways of folate and other methyl donors are closely coupled, the effects of methionine and choline deficiency alone or in combination with folate deficiency were determined. Feeding male Hooded Lister rats a folate-free diet for 10 weeks created a moderate folate deficiency (25-50% (approx.) decrease in plasma, red blood cell and hepatic folate concentrations (P < 0.05) and a 20% rise in plasma homocysteine (P < 0.05)). Lymphocyte DNA strand breakage was increased successively in all groups after 4 weeks and 8 weeks on the diet (50-100% (approx.) after 8 weeks). Only low folate specifically and progressively induced uracil misincorporation throughout the study (100% (approx.) after 8 weeks). Neither folate deficiency nor choline/methionine deficiency altered oxidative DNA base damage. In summary, moderate folate deficiency in vivo is associated with a decrease in DNA stability, measured as increased DNA strand breakage and misincorporated uracil.

Topics: Animals; Choline Deficiency; Comet Assay; DNA; DNA Damage; Erythrocytes; Folic Acid; Folic Acid Deficiency; Liver; Lymphocytes; Male; Methionine; Rats; Uracil; Vitamin B 12

Intracellular B-vitamin and folate deficiency indicated by hyperhomocysteinemia is very frequent in the elderly population. Hyperhomocysteinemia increases the risk of atherothrombotic diseases and neuropsychiatric complications. Our aim was to evaluate the prevalence of increased serum metabolite concentrations in subjects of a higher age, and whether the measurement of metabolite concentrations is more effective in diagnosing B-vitamin deficiency than mere homocysteine.. Homocysteine (HCY), cystathionine (CYS) and methylmalonic acid (MMA) were investigated in serum together with vitamin B-12, B-6 and folate in 90 high-aged subjects (85-102 years), 92 seniors (65-75 years), and in 50 younger subjects (19-50 years).. Elderly subjects (high-aged and senior) had elevated serum concentrations of metabolites. High-aged subjects had a higher frequency of pathological increases than seniors: HCY 62% vs. 24%; MMA 62% vs. 23%; CYS 81% vs. 36%. Folate and vitamin B-6 concentrations were significantly decreased in both elderly groups; vitamin B-12 was only decreased in high-aged subjects. Utilising vitamin B-6, B-12 and folate for diagnosis of intracellular vitamin deficiency, the rate was 30% in seniors and 55% in high aged subjects. However, utilising the metabolites (HCY, MMA and CYS) for the diagnosis of intracellular vitamin deficiency, there was a distinctly increased rate of 55% in seniors respective to 90% in high-aged subjects. Backward multiple regression analysis revealed that only folate, MMA, creatinine and age were independent variables influencing the HCY concentration. Furthermore, the MMA concentration was significantly and independently influenced by folate, vitamin B-12, HCY and creatinine, and the serum concentration of CYS by vitamin B-12, creatinine and age.. The metabolites HCY, MMA and CYS are sensitive indicators diagnosing impaired remethylation of homocysteine to methionine with parallel activation of catabolic pathway. Compared to mere HCY or B-vitamins in serum, the efficiency of diagnosing a disturbed HCY metabolism increases very much in utilising the metabolites HCY, MMA and CYS. For differential diagnosis, parallel measurement of folate and creatinine is recommended. The early and correct diagnosis of B-vitamin deficiency in elderly subjects is of high clinical relevance.

Topics: Adult; Aged; Cystathionine; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Kidney; Male; Methylmalonic Acid; Middle Aged; Models, Chemical; Pyridoxine; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6 Deficiency

The risk for thrombotic events is increased in inflammatory bowel disease. The factors responsible for such a risk are poorly defined. Recently, an elevated homocysteine level is emerging as a risk factor for thrombosis. The aim of this study was to determine the levels of homocysteine in a well-characterized population of patients with Crohn's disease and to compare it to controls.. The levels of homocysteine were determined in 105 well-characterized patients with Crohn's disease and 106 controls. The levels of folate and B12, which are involved in the metabolism of homocysteine were determined as well. Patients were treated with steroid preparations only.. Homocysteine levels were significantly elevated in the patient population. Elevated levels were correlated with both low B12 and folate levels, but folate deficiency turned out to be a more important factor. Low B12 levels were in correlation with the involvement of the terminal ileum. No correlation was found between homocysteine levels and either disease activity or involvement of the terminal ileum.. Homocysteine levels are increased in patients with Crohn's disease and this finding is inversely correlated with folate levels. Supplementation of folate to patients with Crohn's disease may be warranted.

Topics: Adult; Aged; Anti-Inflammatory Agents; Budesonide; Case-Control Studies; Crohn Disease; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Middle Aged; Prednisone; Risk Factors; Thromboembolism; Time Factors; Vitamin B 12

A twenty-one-year-old female known to suffer from bipolar type I disorder developed features of a pseudodementia. Following prompt initial response to treatment with antidepressants, there was an early recurrence of cognitive impairment. Blood investigations confirmed a macrocytic anaemia and vitamin B12 and folate deficiencies. There was dramatic resolution of cognitive impairment after vitamin replacement. This suggested the occurrence of a reversible nutritional dementia and reinforced the need to rule out secondary organic causes of psychiatric symptoms even in patients previously diagnosed with a primary psychiatric disorder.

Topics: Adult; Bipolar Disorder; Dementia; Female; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Biological Availability; Biomarkers; Cardiovascular Diseases; Choline; Congenital Abnormalities; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Homocysteine; Humans; Male; Neoplasms; Neural Tube Defects; Nutrition Policy; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency

Homocysteine is an experimental convulsant and an established risk factor in atherosclerosis. A nutritional deficiency of vitamin B6, vitamin B12, or folate leads to increased homocysteine plasma concentrations. During treatment with carbamazepine (CBZ), phenytoin, or phenobarbital, a deficiency in these vitamins is common. The objective of the study was to test the hypothesis that antiepileptic drug (AED) treatment is associated with increased homocysteine plasma concentrations.. A total of 51 consecutive outpatients of our epilepsy clinic receiving stable, individually adjusted AED treatment and 51 sex- and age-matched controls were enrolled in the study. Concentrations of total homocysteine and vitamin B6 were measured in plasma; vitamin B12 and folate were measured in the serum of fasted subjects.. Patients and controls differed significantly in concentrations of folate ( 13.5+/-1.0 vs. 17.4+/-0.8 nM and vitamin B6 (39.7+/-3.4 vs. 66.2+/-7.5 nM), whereas serum concentrations of vitamin B12 were similar. The homocysteine plasma concentration was significantly increased to 14.7+/-3.0 microM in patients compared with controls (9.5+/-0.5 microM; p < 0.05, Wilcoxon rank-sum test). The number of patients with concentrations of >15 microM was significantly higher in the patient group than among controls. The same result was obtained if only patients with CBZ monotherapy were included. Patients with increased homocysteine plasma concentrations had lower folate concentrations.. These data support the hypothesis that prolonged AED treatment may increase plasma concentrations of homocysteine, although the alternative explanation that increased homocysteine plasma concentrations are associated with the disease and not the treatment cannot be completely excluded at the moment.

Topics: Age Factors; Ambulatory Care; Anticonvulsants; Carbamazepine; Convulsants; Depression, Chemical; Epilepsy; Fasting; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Middle Aged; Phenobarbital; Phenytoin; Pyridoxine; Risk Factors; Sex Factors; Valproic Acid; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6 Deficiency

The relationship between vitamin status and cognitive functioning has been addressed in several recent studies with inconclusive results. The purpose of this study was to examine separate and combined effects of serum vitamin B12 and folic acid on episodic memory functioning in very old age.. Four study groups were selected from a population-based sample of healthy very old adults (90-101 years of age): normal B12/normal folic acid, low B12/normal folic acid, normal B12/low folic acid, and low B12/low folic acid. Cutoff levels were set at 180 pmol/L for vitamin B12 and at 13 nmol/L for folic acid. Subjects completed two episodic recall tasks (objects and words) and two episodic recognition tasks (faces and words).. Neither vitamin affected recognition or primary memory. Most interesting, although B12 was unrelated to recall performance, subjects with low folic acid levels showed impairment in both word recall and object recall.. These results replicate and extend previous findings that folic acid may be more critical than B12 to memory functioning in late life. The selective effects of folic acid on episodic recall were discussed in terms of encoding and retrieval mechanisms, as well as in relation to brain protein synthesis.

Topics: Aged; Aged, 80 and over; Analysis of Variance; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Memory; Memory Disorders; Mental Recall; Reference Values; Sampling Studies; Vitamin B 12; Vitamin B 12 Deficiency

To determine whether folate metabolism in pregnant diabetic women is significantly different from that in pregnant nondiabetic women, thus predisposing them to having offspring with major congenital anomalies.. A total of 31 pregnant diabetic women and 54 pregnant nondiabetic control subjects were studied at their first prenatal visits. Dietary folate intake, serum folate, red blood cell folate, urinary folate, and homocysteine were measured and compared after controlling for folate supplementation. Among diabetic women the relationships among parameters of folate metabolism and glycemic control were also assessed.. There were no significant differences between the pregnant diabetic and non-diabetic women for any measures of folate metabolism after accounting for folate supplementation. In addition, among diabetic women, there were no associations among parameters of folate metabolism and glycemic control.. Abnormal folate metabolism does not appear to occur in pregnant diabetic women. It is unlikely that deranged folate metabolism explains the higher incidence of major anomalies in infants of diabetic mothers. These results do not diminish the importance of periconception folate supplementation or preclude other possible scenarios that could restrict folate use by the embryo, leading to congenital anomalies.

Topics: Adult; Creatinine; Diet; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Glycated Hemoglobin; Homocysteine; Humans; Pregnancy; Pregnancy in Diabetics; Reference Values; Vitamin B 12

Three problems in identifying genes causing schizophrenia and other developmental disorders may be locus heterogeneity, high disease allele frequency, and unknown mode of inheritance. The DNA polymorphism-diet-cofactor-development (DDCD) hypothesis addresses the first two. The gene-teratogen model addresses the third. The DDCD hypothesis is that schizophrenia results in part from brain abnormality in utero from the aggregate effect of multiple mutations of small effect of genes related to important cofactors (e.g., folate, cobalamin, or pyridoxine) potentiated by maternal dietary deficiency of these cofactors and by pregnancy. The effect results from insufficiency of the cofactors and from resulting effects such as impaired DNA synthesis, immune deficiency, effects on niacin and serotonin metabolism, and teratogens, e.g., hyperhomocysteinemia. The hypothesis addresses all of the unusual features of schizophrenia: e.g., decreased brain gray matter, birth-month effect, geographical differences, socioeconomic predilection, association with obstetrical abnormalities, decreased incidence of rheumatoid arthritis, and association with famine and viral epidemics. In the gene-teratogen model, a teratogenic effect in utero produces a developmental disorder through a teratogenic locus and a modifying or specificity locus, as well as through environmental factors. An example is the major intrauterine effect seen in offspring of phenylketonuric mothers. Thus, the mode of inheritance of genes acting prenatally may in some cases be fundamentally different from that of genes acting postnatally. The model is interesting because it is simple and because teratogenic loci will be difficult to locate by conventional linkage mapping techniques due to misspecification of the affection status of both mother and affected children. A new study design is suggested for identifying teratogenic loci.

Topics: Alleles; Brain; Diet; Female; Folic Acid; Folic Acid Deficiency; Genetic Linkage; Genotype; Humans; Male; Models, Genetic; Pedigree; Phenotype; Phenylketonuria, Maternal; Polymorphism, Genetic; Pregnancy; Pregnancy Complications; Pyridoxine; Schizophrenia; Teratogens; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6 Deficiency

To assess folate status and to evaluate the need for conventional folate supplementation in patients on dialysis, we measured serum folate, vitamin B12, and red cell folate concentrations by radioimmunoassay. Thirty-four continuous ambulatory peritoneal dialysis (CAPD) patients and 60 hemodialysis (HD) patients who had not been supplemented with folate were enrolled. Serum folate levels (5.8 +/- 3.6 ng/mL vs 2.0 +/- 1.1 ng/mL, p < 0.001) and vitamin B12 levels (831.4 +/- 416.9 pg/mL vs 513.9 +/- 213.3 pg/mL, p < 0.001) were significantly higher in CAPD patients than HD patients. The red cell folate levels (849.7 +/- 489.4 ng/mL vs 491.0 +/- 253.2 ng/mL, p < 0.001) were also significantly higher in CAPD patients. The incidences of folate deficiency in CAPD and HD patients were overestimated using the cut-off value for serum folate concentration (3.0% vs 71.7%, respectively), but the incidence of true folate deficiency was lower using the cut-off value for red cell folate level (0.0% vs 10.0%, respectively). In conclusion, the true incidence of folate deficiency in stable CAPD and HD patients is surprisingly low, even in patients who may not be taking folate supplements. The need for conventional folate supplementation in patients with end-stage renal disease on dialysis must therefore be re-evaluated. Before the decision is made to use folate supplementation, measurement of red cell folate is essential to assess of folate reserves of the patients on dialysis.

Topics: Adult; Aged; Dietary Supplements; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Radioimmunoassay; Renal Dialysis; Vitamin B 12

To determine the diagnostic value of megaloblastic marrow in patients with possible vitamin B12 and/or folate deficiency and to look for criteria that could be used in diagnosis of vitamin B12 deficiency.. Prospective study.. Kenyatta National Hospital and M P Shah Hospital, Nairobi.. Patients of all age groups and both sexes presenting with clinical and blood picture of macrocytic anaemia.. Response to vitamin B12 injections. Vitamin B12 deficiency diagnosed by the following methods: Vitamin B12 serum level assays alone, bone marrow examination alone and both vitamin B12 assays and bone marrow examination. Response was measured clinically and by increase in haemoglobin level after three weeks of treatment.. Three hundred and forty-three patients were evaluated; 156 (45.5%) were males, and 187 (54.5%) females. Age range was 13-80 years and a mean of 37.7 years. Initial investigations were as follows: 21.9% had vitamin B12 assays only, 59.2% bone marrow examination only and 19.9% both vitamin B12 assayed and bone marrow evaluated. Haemoglobin increase after a total of 6,000 mcg of vitamin B12 was between 2.6-4.6 g/dl in three weeks. Reticulocytes measured on day ten ranged between 12% and 17%. Uniform improvement in all patients was observed for white blood cells (WBC) and platelet counts. Other significant results and observations included clinical improvement in the signs and symptoms of anaemia after the 6,000 mcg injection of vitamin B12 given over three weeks. Serum folic acid level was determined in 21% of cases and in all these it was normal.. The important practical points were response to vitamin B12 in all cases and the importance of re-assessing patients after a total of 6,000 mcg of vitamin B12. Folic acid deficiency was not detected. Patients in these two institutions with megaloblastic anaemia had vitamin B12 deficiency. It is proposed that a model consisting of oval macrocytosis on blood film and megablastic bone marrow be treated with vitamin B12 injections in settings where vitamin B12 serum level assays are not easily available.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow Examination; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; Hospitals, Urban; Humans; Kenya; Male; Middle Aged; Prospective Studies; Reproducibility of Results; Vitamin B 12; Vitamin B 12 Deficiency

Controlled clinical trials in the UK have shown folate deficiency in psychiatric patients, and it has been suggested that such deficiency is most likely to occur among patients with affective disorders. Studies have led to the use of folate as an adjunct to therapy in such patients. The present paper describes a preliminary investigation into the red cell folate status of psychiatric patients in a general hospital unit compared with age- and sex-matched healthy controls, using up-to-date assays and strict entry criteria and overall improved methods on previous studies. The study showed that, although there is a trend for psychiatric patients to have lower serum folate levels than controls, there is no statistically significant difference in folate levels as measured by red cell folate, a more reliable measure of folate status, between healthy controls and psychiatric patients, and all but one of the patients had normal haematological indices.

Topics: Adult; Analysis of Variance; Case-Control Studies; Chi-Square Distribution; Erythrocytes; Female; Folic Acid Deficiency; Hospitals, Psychiatric; Humans; Inpatients; Ireland; Male; Mental Disorders; Prevalence; Vitamin B 12

Periconceptional folate prevents neural tube defects (NTD) by a mechanism which is unclear. The present study found significant changes in the equilibrium of the homocysteine remethylation cycle in NTD affected mothers, possibly involving B12-dependent methionine synthase or 5,10-methylenetetrahydrofolate reductase. Data were consistent with impaired Hcy remethylation leading to poor regeneration of H4PteGlu1, the main intracellular precursor of all folates. This lesion leads to cellular folate deficiency indicated by a significantly lower radioassay RBC folate and 5CH3H4PteGlu4 in affected mothers. The drop in this tetraglutamate is associated with an increase in the abundance of longer chain oligo-gamma-glutamyl folate, again reflecting the underlying folate deficiency. This effect may compromise purine, DNA-thymine, and methionine production, particularly during embryogenesis when folate demand is high. At this time serine hydroxymethyltransferase may play a critical role in conserving H4PteGlu1 for purine synthesis. Many of these depletion effects were corrected with folate supplementation for 1 month.

Topics: Female; Folic Acid; Folic Acid Deficiency; Humans; Pregnancy; Pregnancy Complications; Spinal Dysraphism; Tetrahydrofolates; Vitamin B 12

The results of this series of experiments with chicks trained on a single trial, passive avoidance task, demonstrate that methotrexate-induced folate deficiency, and excess levels of folate and B12 lead to amnesia in these subjects. The amnesia appears only after 50 min following learning, leaving the earlier processing stages of memory formation unaffected. The application of methotrexate resulted in disruption of righting reflex in a dose dependent manner, however the ataxia did not appear to be the cause of the memory deficit. The deficit in memory induced by methotrexate-induced folate deficiency could be ameliorated with methionine. These studies suggest that cellular processes involving folate metabolism may play an important role in the memory formation of the young chick and that the observed disruption of memory may well occur due to its affect on protein synthesis mediated by alterations in methionine metabolism.

Topics: Animals; Avoidance Learning; Chickens; Dose-Response Relationship, Drug; Drug Synergism; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Memory; Methionine; Methotrexate; Reflex; Time Factors; Vitamin B 12

Relationships of nutritional status with ethanol consumption and diet were studied in 33 chronic alcoholics with no clinical or laboratory evidence of liver disease.. Nutritional assessment included subjective global assessment, weight-height index, body mass index, and serum albumin measurements. Dietary intake included estimates of daily intake of substrates, folic acid, vitamins B1, B5, B6, and B12. Circulating concentrations of folate, pyridoxal-phosphate and vitamin B12 were evaluated as well.. Only 18.1% of patients were considered malnourished, with body mass indices lower than those with an average or good nutritional status (p < 0.0001). Body weight was under 90% of the ideal in 8/33 (24%) patients. Serum albumin values were within normal range in all patients. In terms of calories provided by nonalcoholic substrates, protein, or vitamin intake, we observed no differences between well and poorly nourished individuals. However, malnourished alcoholics consumed significantly more ethanol (p = 0.01) and an inverse correlation was found between ethanol intake and weight-height index (r = -0.35; p = 0.03). Low circulating concentrations of pyridoxal-phosphate and red blood cell folate were found in 51.5% and 60.6% of alcoholics, respectively. These were not correlated with vitamin dietary intake or ethanol consumption, but there was a trend toward malnourished patients to present lower concentrations of red blood cell folate (p = 0.13).. Although over malnutrition is infrequent in this group of chronic alcoholics, specific vitamin deficiencies are present in a substantial proportion of patients and are more likely related to alcohol consumption.

Topics: Adult; Alcohol Drinking; Alcoholism; Avitaminosis; Body Height; Body Mass Index; Body Weight; Diet; Dietary Proteins; Energy Intake; Erythrocytes; Ethanol; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Nutrition Assessment; Nutrition Disorders; Nutritional Status; Prospective Studies; Pyridoxal Phosphate; Pyridoxine; Serum Albumin; Thiamine; Vitamin B 12

It has been reported that patients with vascular disease seem to increase their concentration of plasma homocysteine after the acute episode, whereas reexamined control subjects do not change their concentration of plasma homocysteine over time. Since the main determinants of plasma homocysteine are serum cobalamin, blood folate and serum creatinine we measured these quantities in 20 control subjects and 49 stroke patients in the acute phase and at reexamination 1.5-2 years after acute stroke onset. There were no significant differences between the levels of blood folate, serum cobalamin and serum creatinine in the acute and convalescent phase of all 49 stroke patients. However, we noted a significant decrease of blood folate concentrations in a subgroup of patients (n = 25) who had increased plasma homocysteine concentrations. Thus the increase in plasma homocysteine concentrations in this group of patients may partly be caused by a marginal folate deficiency.

Topics: Aged; Case-Control Studies; Cerebrovascular Disorders; Creatinine; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Middle Aged; Time Factors; Vitamin B 12

An adequate intake of folates and vitamin B12 is essential for the rapid growth rates characteristic of infancy. However, little information exists on the prevalence of deficiencies of these nutrients in preschool children. The status of these vitamins was therefore evaluated in a group of 79 children between 2 and 6 years of age. A 5 day dietary record (including a Sunday) was kept for all subjects. All food taken at day care centres was monitored using "Precise individual weighing" and recorded by trained personnel. Measurements were made of serum and erythrocyte folate levels, vitamin B12 levels, number of red blood cells, haemoglobin and haematocrit levels, and mean corpuscular volume. Though the mean intake of folic acid surpassed recommended levels for this age group 31.4% of the subjects showed intakes below those recommended. 7.7% of the subjects showed serum folate levels between 3 and 6 ng/mL, values which indicate a moderate deficiency of this vitamin. A correlation was found between folate intake and serum folate levels r = 0.3654 (P < 0.01). Vitamin B12 intake was 438% that recommended. Only 2.9% of the subjects showed vitamin B12 intake below recommended and none showed serum values below 150 pg/ml, the lower normal limit below which deficiency is considered to exist.. Amongst preschool children, folate deficiency is probably much more common than vitamin B12 deficiency. However, its incidence is low, and much lower than that observed in other age groups.

Topics: Anthropometry; Child; Child, Preschool; Diet Records; Female; Folic Acid; Folic Acid Deficiency; Growth; Humans; Male; Nutritional Status; Prevalence; Spain; Vitamin B 12; Vitamin E Deficiency

Topics: Aged; Female; Folic Acid; Folic Acid Deficiency; Geriatric Psychiatry; Humans; Male; Memory Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Over a period of about 6 weeks a 49-year-old woman developed increasing exercise-dependent dyspnoea. Her general practitioner had diagnosed marked megaloblastic anaemia and she was hospitalised for its further elucidation. She reported to have eaten or drunk nothing but sweets, potato chips, salty pretzels, lemonade, coffee and tea over the last 2 years. Alcohol intake had been reliably denied by her and outsiders. On admission she weighed 106 kg, her height was 167 cm, and she looked anaemic, had dyspnoea and a sinus tachycardia. There was no evidence of external or internal bleeding and the physical examination was otherwise unremarkable.. Laboratory tests showed a haemoglobin concentration of 4.7 g/dl, as well as marked folic and vitamin B12 deficiency. The food items taken by her contain practically no cobalamine and no folic acid. Gastroscopy revealed grade 1 reflux oesophagitis. Malabsorption being excluded (normal Schilling test, no demonstrable autoantibodies against parietal cells, no evidence of exocrine pancreatic insufficiency), the lack of both vitamins and the megaloblastic anaemia caused by it could be explained only by a deficient food intake over several years.. After administration of cobalamine (1 mg intramuscularly twice weekly for 6 weeks, then 300 micrograms daily by mouth for 4 weeks) and folic acid (5 mg twice daily for 10 weeks), as well as a well-balanced diet as prescribed by a dietician, reticulocyte and erythrocyte concentrations had quickly risen to normal at a follow-up examination 2 months later.. The case of an anaemia entirely caused by a deficient diet dearly illustrates the need of a well-balanced food intake even in adults.

Topics: Anemia, Megaloblastic; Diet; Energy Intake; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Middle Aged; Nutritional Requirements; Vitamin B 12; Vitamin B 12 Deficiency

Plasma total homocysteine (tHcy) and serum folate (FA) concentrations were measured in 130 epileptic patients taking anticonvulsant drugs. A significant inverse correlation was found between FA and tHcy. This was greater in the older group (> or = 15 years) than in the younger group (1 to 14 years). There were four FA-deficient patients (FA concentration < 3 ng/mL regardless of symptoms), including three patients in the older group and one in the younger group. All FA-deficient patients had received long-term treatment (> 7 years) with multiple anticonvulsants. Their tHcy levels were higher than the 90th percentile of those in control subjects. Two patients showed extremely high levels of tHcy (57.9 and 29.1 mumol/L) and subnormal plasma methionine levels. After FA therapy, their tHcy decreased to levels the same as or less than those of control subjects and FA increased to above the normal range. Based on these findings, we conclude that measuring FA and tHcy concentrations may be useful for preventing thrombosis due to hyperhomocysteinemia in epileptic patients taking anticonvulsants, particularly those who receive long-term treatment with multiple agents.

Topics: Adolescent; Adult; Anticonvulsants; Child; Child, Preschool; Epilepsy; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Infant; Male; Vitamin B 12

The prevalence of iron, folic acid and vitamin B12 deficiencies and their role in the development of recurrent oral ulcerations is not well known. The aim of this study was to determine the prevalence of these deficiencies in our patients.. Iron, folic acid and vitamin B12 levels were studied in 80 patients with recurrent oral ulcerations (ROU) and the results were compared with a control group of 29 patients with different oral diseases.. In the recurrent oral ulcers patients, deficiencies were detected in 21/80 patients (26.2%). In 18 cases they were pure: iron (4), folic acid (10) and vitamin B12 (4). In 3 patients, combined deficiencies were detected, being secondary to pernicious anaemia in two patients. In the control group, deficiencies were observed in 4/29 cases (13.7%). In three cases they were isolated (one case suffered from ferropenic anaemia and two patients of pernicious anaemia).. Patients with recurrent oral ulcerations have more frequently iron, folic acid and vitamin B12 deficiencies than those with other diseases of oral mucosa. However, there were not significant differences when the frequency of deficiency of each one of such elements were taken into account separately.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Anemia, Pernicious; Child; Data Interpretation, Statistical; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Iron Deficiencies; Male; Middle Aged; Prospective Studies; Recurrence; Stomatitis, Aphthous; Vitamin B 12; Vitamin B 12 Deficiency

The diagnosis of megaloblastic anaemias caused by cobalamine or folate deficiency are still difficult. The dosage of these two substances help to differenciate between both carencies, but it is not determinant of any of them and is an expensive method. Homocisteinuria (HC), methylmalonuria (MMA) and formiminoglutamic acid (FIGLU) are cheap tests which could help in the differential diagnosis, if they are used properly. We report 62 patients to whom we made these test simultaneously. All of the patients received 10 micrograms of vit B12 and after 72 hours, 1 mg/day of folic acid (for 3 days). In both cases waiting for the increase of reticulocytyes up to 150 x 10(9)/L as a form of therapeutic test of diagnosis. By this simple way we have detected 97.9% of specificity for cobalamin deficiency of the MMA test, and only 4.2% for HC. This last test had increased its specificity up to 91.6% in association with the negative FIGLU test. We have also found a high specificity (92.3%) for FIGLU due to the detection of folate deficiency, in opposition with other authors who had described it as low as 50%. We have also compared the costs of the 3 tests with the dosage of cobalamine and folate, and we have found that the formers are 11 times less expensive than the last ones.

Topics: Adolescent; Adult; Algorithms; Anemia, Megaloblastic; Cost Control; Diagnosis, Differential; Diagnostic Tests, Routine; Female; Folic Acid; Folic Acid Deficiency; Formiminoglutamic Acid; Histidine; Homocysteine; Humans; Male; Methylmalonic Acid; Middle Aged; Predictive Value of Tests; Pregnancy; Pregnancy Complications, Hematologic; Reticulocyte Count; Retrospective Studies; Sensitivity and Specificity; Time Factors; Urinalysis; Vitamin B 12; Vitamin B 12 Deficiency

In a previous study, we showed that diabetic patients exhibited significantly increased concentrations of total plasma homocysteine (tHcy), but not until the onset of nephropathy. It was suggested that the hyperhomocysteinaemia might contribute to the accelerated atherosclerotic process in diabetic patients. In the present study, we have analysed the main determinants of plasma homocysteine (i.e. serum cobalamin, blood folate and serum creatinine), and also some other parameters related to diabetes mellitus, such as medical history, metabolic and renal quantities, on two occasions with a 5-year interval in 50 patients with insulin-dependent diabetes mellitus, in order to further elucidate the relation between plasma tHcy and diabetes mellitus. The result of the present study shows that diabetic patients with the lowest age at onset and with the poorest metabolic control are those most prone to a rapid increase in plasma tHcy concentration. The increment in plasma tHcy concentration in this group of patients may at least partly be explained by a marginal deficiency of blood folate concentrations.

Topics: Adult; Age of Onset; Diabetes Mellitus, Type 1; Diabetic Retinopathy; Female; Folic Acid Deficiency; Follow-Up Studies; Homocysteine; Humans; Male; Middle Aged; Vitamin B 12

Hyperhomocysteinemia in cobalamin and folate deficiency reflects an imbalance between influx and elimination of homocysteine (Hcy) in plasma. We investigated the kinetics of total Hcy (tHcy) in plasma after peroral Hcy administration in 19 volunteers with hyperhomocysteinemia (mean +/- SD: 67.1 +/- 39.5 mumol/L; range: 23.5-142.8 mumol/L) before and after supplementation with cobalamin and/or folate. Vitamin therapy decreased plasma tHcy to 21.8 +/- 14.1 mumol/L (range: 9.6-57.9 mumol/L) but caused only a marginal decline in the area under the curve (AUC) by 8% and plasma half-life by 21%. Using the equations for steady-state kinetics, these data indicate that mean plasma tHcy clearance is normal and that massive export of Hcy from tissues into plasma is the major cause of hyperhomocysteinemia in cobalamin or folate deficiency. However, the spread in AUC and plasma half-life values was large in hyperhomocysteinemia subjects, suggesting marked individual variability in tHcy clearance. Plasma methionine after Hcy loading did not increase before (0.9 +/- 6.8 mumol/L) but increased normally (12.8 +/- 4.6 mumol/L) after vitamin therapy, and the methionine response discriminated between vitamin-deficient and vitamin-replete subjects. In cobalamin- or folate-deficient subjects, only 6.5 +/- 3.0% of the Hcy dose was excreted unchanged in the urine, demonstrating that urinary Hcy excretion does not explain normal tHcy plasma clearance in subjects with impaired Hcy remethylation. Our data suggest that hyperhomocysteinemia in folate and cobalamin deficiency is related to increased influx of Hcy to plasma, and that the methionine synthase function is not an important determinant of elimination of Hcy from plasma. The large interindividual difference in Hcy clearance may be explained by variable adaptation to impaired methionine synthase function through increased Hcy flux through alternate metabolic pathways.

Topics: Adolescent; Adult; Aged; Female; Folic Acid; Folic Acid Deficiency; Half-Life; Hematinics; Homocysteine; Humans; Kinetics; Male; Methionine; Methylmalonic Acid; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

The deterioration of functional and mental capacity is one of the major problems of the elderly. This deterioration may be caused or worsened by folate deficiency. The aim of this investigation was to analyze the relationship between mental and functional capacities and folate status in a group of 177 elderly Spanish people. Folate deficiency is common in the Spanish population. In this study, 48.6% of the elderly subjects had folate intakes below recommended values (200 microg/day), 34.9% had serum concentrations < 14 nmol/L and 6.6% had <360 nmol/L erythrocyte folate. Subjects took part in a series of tests: Katz' scale of activities of daily living, Lawton's scale of instrumental activities of daily living, Pfeiffer's mental status questionnaire, Folstein's Mini-Mental State Test and the Geriatric Depression scale of Yesavage. The results for Lawton's scale of instrumental activities of daily living were significantly better (indicating greater independence and capacity) when folate intake and serum or erythrocyte folate concentrations were adequate (i.e., folate intake no less than recommended, > or = 14 nmol/L serum folate or > or = 360 nmol/L erythrocyte folate). Subjects with adequate Mini-Mental State Exam results (> or = 28 points) had serum and erythrocyte folate concentrations significantly higher than those with less adequate results (<28 points). Thus, there is evidence to suggest that the folate status of the elderly should be monitored and, if possible, improved.

Topics: Activities of Daily Living; Aged; Aged, 80 and over; Aging; Anthropometry; Body Height; Body Weight; Eating; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Intelligence Tests; Iron; Male; Prospective Studies; Social Class; Spain; Surveys and Questionnaires; Vitamin B 12

Topics: Biomarkers; Chemistry, Clinical; Folic Acid; Folic Acid Deficiency; Hematology; Homocysteine; Humans; Methylmalonic Acid; Practice Guidelines as Topic; Predictive Value of Tests; Sensitivity and Specificity; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Female; Folic Acid; Folic Acid Deficiency; Humans; Neural Tube Defects; Pregnancy; Pregnancy Complications; Vitamin B 12; Vitamin B 12 Deficiency

On the present study the authors evaluate the utility of electrophysiologic examination in uraemic polyneuropathy. A group of 19 uraemic patients in chronic dialysis underwent the Blink reflex and BAEPSs study to evaluate the alterations of nervous pathways. The results obtained were compared with those of a group of 10 healthy patients comparable for age and sex. The electrophysiologic parameters have been statistically compared with the plasma levels of vit. B12. folic acid, PTH and beta-2-microglobulin. The results show a significant difference of uremic patients compared with the healthy ones for the Blink reflex (ipsilateral and contralateral R2 responses). Also BAEPSs show significant alterations in the uraemic group (latencies of the III, V components). A statistically significantly inverse correlation is present between folic acid values and blink reflex R1 and R2 responses. Therefore our study shows the existence of a combined degeneration of central and peripheral nervous pathways in chronic uraemic patients. We believe that the decrease in folic acid concentration found in our study may be one of the causes of the beginning and then of the worsening of neurologic damage.

Topics: Adult; Aged; beta 2-Microglobulin; Blinking; Disease Progression; Evoked Potentials, Auditory, Brain Stem; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Parathyroid Hormone; Peripheral Nervous System Diseases; Reflex, Abnormal; Renal Dialysis; Uremia; Vitamin B 12

Topics: Anemia, Macrocytic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

This study was designed to estimate the prevalence of biochemical iron, folate, and vitamin B12 depletion among a group of Canadian pregnant adolescents accessed through the Public Health system. Further, the impact of prenatal supplement use, chronologic age, gynecologic age, living arrangement, main source of income, postpartum custody plan, time of entry into prenatal care, and cigarette smoking on laboratory indices of the three nutrients were determined.. Fifty-eight adolescents (14.5-19.0 years) were interviewed and blood samples were collected at 36 +/- 2 wk gestation.. Thirteen (22%) of the pregnant adolescents had anemia (hemoglobin < 110 g/L) and forty-five (78%) had depleted iron stores (plasma ferritin < 26.6 pmol/L or 12.0 micrograms/L). Twenty-five subjects had plasma B12 values in the sub-optimal range (< 148 pmol/L). Five of the 16 adolescents who infrequently or never consumed a folate-containing supplement had suboptimal erythrocyte folate values. Twenty-four percent of the subjects had hypersegmented neutrophils and of these, all and 71% of subjects had plasma ferritin and B12 concentrations in the suboptimal range, respectively. Self-reported folic acid and B12 supplement intakes were correlated with the corresponding blood values for these nutrients. In contrast, supplement iron use was only weakly, or not at all associated with biochemical indices of iron status.. Data from the present study indicate that plasma B12 and ferritin levels are low in a group of pregnant adolescents. These low values appear to be associated with a high prevalence of hypersegmented neutrophils. Prenatal supplement use appears to reduce the risk of low folate and B12 blood values but not biochemical iron status.

Topics: Adolescent; Anemia, Iron-Deficiency; Anthropometry; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Iron; Life Style; Pregnancy; Pregnancy in Adolescence; Prenatal Care; Smoking; Socioeconomic Factors; Vitamin B 12; Vitamin B 12 Deficiency

To examine the graded risks for coronary artery disease (CAD) associated with plasma homocyst(e)ine [H(e)] and to evaluate the extent to which this risk is mediated by altered vitamin status, we measured plasma concentrations of H(e), vitamins B6 and B12, and folate as well as other coronary risk factors in subjects with early familial CAD and in control subjects. We studied 120 male and 42 female patients with early CAD who were unrelated to each other but were from families in which at least one other sibling had early CAD. Control subjects were 85 men and 70 women with the same age range (38 to 68) as the subjects with CAD at screening. Increasing H(e) was associated with graded increased risks of CAD that appeared consistent with a multiplicative model. Relative odds for CAD were approximately 12.8 in women when those with H(e) levels of 9 mumol/L and above were compared with those with H(e) levels of 9 mumol/L or less (P = .007). For men, the same comparison yielded relative odds of 13.8 (P = .0002). Plasma H(e) remained a strong, independent risk factor after adjustment for standard risk factors and plasma vitamin levels in multiple logistic regression (relative odds, 8.1 for a 10-mumol/L increase in H(e); 95% confidence interval, 3.2 to 20.4; P < .0001). In multivariate ANCOVA the slope of H(e) versus folate was much steeper in subjects with CAD than in control subjects (P = .0035). These data suggest that high plasma H(e) is an important, independent contributor to risk for early familial CAD.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Coronary Disease; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Middle Aged; Pyridoxine; Regression Analysis; Risk Factors; Vitamin B 12

Plasma homocysteine, serum cobalamin and blood folate were analysed in 296 consecutive patients referred to a psychogeriatric department for diagnosis of mental disease. Plasma homocysteine correlated with positive significance with age and serum creatinine, and with negative significance with serum cobalamin and blood folate. Approximately 35-40% of the patients with low serum cobalamin (< 150 pmol l-1) or low blood folates (< 150 nmol l-1) exhibited normal values of plasma homocysteine (< 19.9 mumol l-1). Possibly, these patients do not have a deficiency of the vitamins in the tissue. At least 7.5% of the patients with serum cobalamin levels (> 150 pmol l-1) showed an inexplicably increased level of plasma homocysteine. These patients might have a deficiency of tissue cobalamin despite the normal serum cobalamin levels. The effect of cobalamin supplementation for 7-10 days on plasma homocysteine was tested in 62 patients with different levels of serum cobalamins. We found the most pronounced decrease of plasma homocysteine in the patients with lowest serum cobalamin levels and in the patients with highest plasma homocysteine, indicating that the percentage decrease of the initial concentration of plasma homocysteine could reflect the degree of cobalamin deficiency. Folate supplementation for 7-10 days reduced plasma homocysteine not only in patients with folate deficiency but also in those with a normal folate status, and even in patients with cobalamin deficiency. The latter patients further reduced their plasma homocysteine after additional cobalamin treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Aged, 80 and over; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Mental Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Ten healthy adult men were fed a diet low in folate and exogenous methyl groups to study the effects on folate requirement and status. The men were housed in a metabolic unit for the entire 108-d study. After a 9-d base-line period (P1), the men were fed an amino acid-defined soybean product diet for 45 d, which provided 25 micrograms/d of folate for 30 d (P2) and (with a folate supplement) 99 micrograms/d for 15 d (P3). During P2 and P3, the low methionine and choline diet was supplemented with methionine for half the subjects to vary the dietary methyl group intake. The periods were then repeated over the next 54 d (P4-P6), with a cross-over of methionine intakes in P5 and P6. Restricting dietary methyl group intake did not increase the dietary folate requirement. Plasma total homocysteine rose during folate depletion and correlated inversely with plasma folate; however, the response of homocysteine to changes in folate intake varied among individuals from very strong to absent. The results support previous suggestions that increased plasma homocysteine concentrations provide a marker of functional folate deficiency, and further indicate that individuals may differ greatly in their susceptibility to hyperhomocysteinemia due to low folate intakes. Judged by the lack of normalization of high homocysteine concentrations during folate repletion, the current folate RDA for adult men may not provide the expected margin of protection.

Topics: Adult; Choline; Diet; Folic Acid; Folic Acid Deficiency; Glycine max; Homocysteine; Humans; Male; Methionine; Middle Aged; Nutritional Requirements; Nutritional Status; Vitamin B 12

To determine the prevalence and causes of anemia in rural Mexico, blood samples and longitudinal dietary data were collected from 187 women, some pregnant and then lactating, and from 72 men. Blood was used to measure anemia, mean cell volume, and plasma ferritin, folate and vitamin B-12. Anemia was found in 33% of the men, 54% of nonpregnant, nonlactating women, 35% of pregnant women and 41% of lactating women, and varied by season. Low iron stores (ferritin) accompanied anemia in only 8% of men compared with 38-67% of women. Low meat intake and poor dietary iron bioavailability were associated with anemia in women. There were no cases of low plasma folate. Low plasma vitamin B-12 was common in all groups, and the incidence increased from 15% at 7 mo of pregnancy to 30% at 7 mo of lactation. Vitamin B-12 was lower in the plasma and milk of anemic lactating women than in plasma and milk of non-anemic lactating women and was classified as deficient in 62% of breast milk samples.

Topics: Adult; Anemia; Diet; Female; Folic Acid Deficiency; Humans; Iron Deficiencies; Lactation; Longitudinal Studies; Male; Mexico; Middle Aged; Milk, Human; Pregnancy; Pregnancy Complications; Rural Population; Vitamin B 12; Vitamin B 12 Deficiency

Eight patients with vitamin deficiency pancytopenia were admitted, within a year, in a department of internal medicine. Folic acid and vitamin B12 metabolism and the clinical and haematological symptoms are discussed. These vitamin deficiencies are frequent in underdeveloped countries and are responsible of megaloblastic anaemia. Such deficiencies may also influence the granulocyte and platelet lines and may be mistaken for leukaemia. A therapeutic test may be undertaken, giving rapid diagnosis and avoiding high mortality.

Topics: Adult; Blood Cell Count; Bone Marrow Examination; Developing Countries; Female; Folic Acid Deficiency; Humans; Male; Middle Aged; Pancytopenia; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Five cases of Biermer's disease presenting as pancytopenia were observed over a 17-year period. In all cases, haemorrhagic and/or infectious complications occurred. The myelogram revealed qualitative medullary deficiency and laboratory data led to diagnosis. The importance of prompt substitutive therapy is underlined.

Topics: Aged; Aged, 80 and over; Anemia, Pernicious; Bone Marrow Examination; Female; Folic Acid Deficiency; Humans; Male; Pancytopenia; Vitamin B 12; Vitamin B 12 Deficiency

An adult male patient of Dutch ancestry has a slowly progressive neurological disease characterised by a cerebellar syndrome, distal spinal muscular atrophy, pyramidal tract dysfunction, and perceptive hearing loss. A severe folate deficiency state was found in CSF in combination with a normal serum and red cell folate state. Two unknown abnormal metabolites were present in CSF. The concentration of immunoreactive folate binding protein in CSF was unusually low, whereas the concentration of the protein measured with radioligand (3H-folate) binding was unusually high. The transfer of folate over the choroid plexus seems to be disturbed, potentially reflecting a defect in the choroid plexus folate binder.

Topics: Adolescent; Carrier Proteins; Central Nervous System; Folate Receptors, GPI-Anchored; Folic Acid; Folic Acid Deficiency; Humans; Male; Nervous System Diseases; Receptors, Cell Surface; Vitamin B 12

Homocysteine and 5-CH3-tetrahydrofolate (5-CH3-THF) are converted to methionine and THF by the CH3-cobalamin (CH3-Cbl)-dependent enzyme methionine synthase. Serum homocysteine levels are elevated in more than 95% of patients with Cbl or folate deficiency and in patients with inborn errors involving the synthesis of 5-CH3-THF or CH3-Cbl. Homocysteine and betaine are converted to methionine and N,N-dimethylglycine by betaine-homocysteine methyltransferase. It requires neither Cbl nor folate, although N,N-dimethylglycine is converted to N-methylglycine and then to glycine in reactions that both involve the formation of 5,10-CH2-THF from THF. Large amounts of betaine are often given orally to patients with inborn errors, even though little is known about its metabolism in normal subjects or these patients. Thus we developed new gas chromatographic-mass spectrometric assays for serum betaine, N,N-dimethylglycine, and N-methylglycine. In 60 blood donors, we found ranges for normal serum of 17.6 to 73.3, 1.42 to 5.27, and 0.60 to 2.67 mumol/L for the three metabolites, respectively, which were normal in the majority of 50 patients with Cbl deficiency, none of whom had increased levels of N-methylglycine. In 25 patients with folate deficiency, serum betaine level was normal in most, but 76% and 60% had elevations of N,N-dimethylglycine and N-methylglycine levels that ranged as high as 343 and 43.2 mumol/L, respectively. All of seven patients on betaine therapy for inborn errors had high values for betaine (167 to 3,900 mumol/L), N,N-dimethylglycine (15.1 to 250 mumol/L), and N-methylglycine (2.93 to 49.3 mumol/L). Serum total homocysteine levels remained very high at 47.2 to 156 mumol/L (normal, 5.4 to 16.2). In patients with cbl C and cbl D mutations, methionine levels remained low or low-normal at 8.3 to 15.6 mumol/L (normal, 13.3 to 42.7) despite betaine treatment. We conclude that (1) betaine levels are maintained in most patients with Cbl and folate deficiency; (2) levels of N,N-dimethylglycine and N-methylglycine are increased in most patients with folate deficiency; and (3) betaine therapy is relatively ineffective in patients with defective synthesis of CH3-Cbl.

Topics: Adolescent; Adult; Aged; Animals; Betaine; Betaine-Homocysteine S-Methyltransferase; Chromatography; Creatinine; Cystathionine beta-Synthase; Female; Folic Acid Deficiency; Gas Chromatography-Mass Spectrometry; Homocysteine; Humans; Male; Metabolism, Inborn Errors; Methionine; Methyltransferases; Middle Aged; Rats; Rats, Sprague-Dawley; Reference Values; Renal Insufficiency; Sarcosine; Vitamin B 12; Vitamin B 12 Deficiency

Serum vitamin B12, folic acid and haematological data from 147 elderly people (55 males and 92 females) who visited the special clinic for the elderly at Rajvithi Hospital, Bangkok between July and November 1989 were investigated. The individuals studied came from a health-conscious group of the middle socio-economic class in Bangkok. All of them were fairly well except for minor ailments and typical diseases of elderly people such as hypertension, mild to moderate degree coronary heart diseases and non-insulin dependent diabetes mellitus. There was a statistically significant difference in haemoglobin concentrations between males and females. According to the standard haemoglobin cut-off point values of 13 g/dl for males and 12 g/dl for females, anaemia was detected in 22 (15%) of the 147 subjects. The percentage of folic acid deficiency was found to be 20.6 per cent (30 of the 147 cases). Vitamin B12 insufficiency was found in only 6.9 per cent (10 of the 147 cases). No statistically significant correlation between haemoglobin, folic acid and vitamin B12 was found. However, when the data were grouped according to different intervals of increasing haemoglobin concentrations, for females there was a tendency for serum vitamin B12 to decrease, and serum folic acid to increase in both males and females. The results of this study suggest that folate deficiency may play a role in the occurrence of anaemia in elderly people, and therefore, dietary counselling and supplementation of folic acid are recommended.

Topics: Aged; Blood Cell Count; Cardiovascular Diseases; Developing Countries; Diabetes Mellitus, Type 2; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobinometry; Humans; Hypertension; Male; Middle Aged; Thailand; Vitamin B 12; Vitamin B 12 Deficiency

The purpose of this study was to examine whether women with first trimester uterine bleeding and low serum folate have a higher incidence of spontaneous abortions and adverse perinatal outcome compared with women whose folate levels are normal. Serum folate and vitamin B12 levels were obtained on 225 women who presented with first trimester vaginal bleeding; pregnancy outcomes of those whose folate or vitamin B12 levels were low were compared with those with normal levels using the chi-square test. Of the 151 women included, 52 had low folate levels (less than 4.0 ng/ml). Their spontaneous abortion rate and perinatal outcomes were similar to those whose folate levels were normal. We concluded that in pregnancies complicated by first trimester vaginal bleeding, low folate levels do not appear to be associated with an increased risk of pregnancy loss and adverse outcome.

Topics: Abortion, Spontaneous; Adult; Case-Control Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Pregnancy Trimester, First; Uterine Hemorrhage; Vitamin B 12

Twenty-one patients (15 women, 6 men) with definite multiple sclerosis (MS) were treated with 1000 mg intravenous methylprednisolone-succinate (MP) daily for 10 days. Before MP treatment there was a negative correlation (r = 0.59, P = 0.0084) between serum vitamin B12 and progression rate, defined as the ratio of the score on Kurtzke's Expanded Disability Status Scale and disease duration. A significant decrease was demonstrated in the cerebrospinal fluid (CSF) and serum levels of folate and in the CSF level of vitamin B12 after MP treatment. The decrease in serum B12 was not statistically significant. After MP treatment all median levels of vitamin B12 and folate were below the reference medians. We hypothesize that low or reduced vitamin B12/folate levels found in MS patients may be related to previous corticosteroid treatments. Otherwise a more causal relationship between low vitamin B12/folate and MS cannot be excluded. Further studies may be required to clarify the vitamin B12 and folate metabolism in patients with MS.

Topics: Adult; Female; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intravenous; Male; Methylation; Methylprednisolone Hemisuccinate; Middle Aged; Multiple Sclerosis; Myelin Sheath; Vitamin B 12; Vitamin B 12 Deficiency

Iron deficiency involvement in the results of long-term replacement therapy of renal anemia with recormon, a preparation of recombinant human erythropoietin, has been studied in chronic renal failure patients on programmed hemodialysis. The effect of recormon subcutaneous administration to 51 patients was found reduced in 9 patients; in 5 of them the decreased sensitivity to recormon was attributed to iron deficiency. During a year of treatment the percentage of iron-deficient patients rose from 9.1% to 45% as a result of intensive uptake of iron in the course of erythropoiesis. Iron preparation as a corrective treatment contributed to hematocrit increment reducing effective doses of erythropoietin. In addition to routine control of ferritin and iron it is recommended to trace the degree of transferrin saturation in the course of recombinant erythropoietin therapy.

Topics: Anemia, Hypochromic; Drug Evaluation; Erythropoietin; Ferritins; Folic Acid; Folic Acid Deficiency; Humans; Iron; Kidney Failure, Chronic; Recombinant Proteins; Renal Dialysis; Transferrin; Vitamin B 12; Vitamin B 12 Deficiency

Low levels of cerebrospinal S-adenosylmethionine in association with abnormal myelination in inherited disorders affecting cobalamin and folate metabolism provide new data on a possible mechanism of cobalamin neuropathy.

Topics: Child, Preschool; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infant, Newborn; Metabolism, Inborn Errors; Nervous System Diseases; S-Adenosylmethionine; Vitamin B 12; Vitamin B 12 Deficiency

Homocysteine can be methylated to form methionine by the cobalamin- (Cbl) and folate-dependent enzyme, methionine synthase; serum levels of total homocysteine are elevated in greater than 95% of patients with either Cbl or folate deficiency. Homocysteine can also condense with serine to form cystathionine in a pyridoxal phosphate-dependent reaction catalyzed by cystathionine beta-synthase. Cystathionine is subsequently cleaved to cysteine and alpha-ketobutyrate by the pyridoxal phosphate-dependent enzyme gamma-cystathionase. To assess levels of cystathionine in Cbl and folate deficiency, we developed a new capillary gas chromatographic-mass spectrometric assay and measured cystathionine in the serum of normal subjects and patients with clinically confirmed deficiencies of these vitamins. The normal range for serum cystathionine was 65 to 301 nmol/L (median = 126 nmol/L) for 50 normal blood donors. In 30 patients with clinically confirmed Cbl deficiency, values for cystathionine ranged from 208 nmol/L to 2,920 nmol/L (median = 816 nmol/L) and 26 (87%) had levels above the normal range. In 20 patients with clinically confirmed folate deficiency, cystathionine concentrations ranged from 138 nmol/L to 4,150 nmol/L (median = 1,560 nmol/L) and 19 (95%) had values above the normal range. Five homozygotes for cystathionine beta-synthase deficiency had high values for serum-total homocysteine and low or low-normal values for serum cystathionine that ranged from 30 nmol/L to 114 nmol/L even though they were on treatment with pyridoxine and had partially responded. One patient with a defect in the synthesis of 5-CH3-tetrahydrofolate and five patients with defects in the synthesis of CH3-Cbl had high values for serum-total homocysteine and high values for cystathionine that ranged from 311 nmol/L to 1,500 nmol/L even though they were on treatment with folic acid and Cbl, respectively, and had partially responded. We conclude that levels of cystathionine are evaluated in the serum of most patients with Cbl and folate deficiency and that they are useful in the differential diagnosis of an elevated serum-total homocysteine level.

Topics: Animals; Cystathionine; Cystathionine beta-Synthase; Folic Acid; Folic Acid Deficiency; Gas Chromatography-Mass Spectrometry; Humans; Reference Values; Renal Insufficiency; Species Specificity; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Abortion, Habitual; Abortion, Spontaneous; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Hematocrit; Hemoglobins; Humans; Longitudinal Studies; Nutritional Status; Pregnancy; Pregnancy Outcome; Reference Values; Vitamin B 12; Zinc

This study examines the relationship between folate, vitamin B12 and severity of cognitive impairment in patients with Alzheimer's disease (AD) as compared with other disorders associated with cognitive impairment. The patients were 97 consecutive referrals to an AD clinic. Forty patients had either possible or probable AD, 31 had other dementias (OD) and 26 had mild cognitive impairment (cognitively impaired, not demented; CIND). Patients had blood drawn for serum, red cell folate and B12, as well as other biochemical indicators of nutrition, within 24 h of the Mini-Mental State Examination (MMSE). In the AD group, only B12 was significantly correlated with MMSE. Using regression analysis, B12 contributed significantly to variance in MMSE. There was no correlation between MMSE and serum, red cell folate or B12 in the OD or CIND group and no significant correlation between MMSE and other nutritional indices in any group. These findings suggest the possibility of a specific relationship between B12 levels and severity of cognitive impairment in patients with AD.

Topics: Aged; Alzheimer Disease; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Mental Status Schedule; Neuropsychological Tests; Prospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

A group of thirty-four patients with recurrent aphthous stomatitis (RAS) and single hematinic deficiencies were given replacement therapy after any reason for the deficiency had been sought and excluded. The response of the RAS was assessed in an open trial. The aphthae in 70% of patients subjectively improved with hematinic replacement therapy, a benefit exceeding the defined placebo response in recurrent aphthous stomatitis.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Humans; Iron; Iron Deficiencies; Male; Middle Aged; Recurrence; Stomatitis, Aphthous; Vitamin B 12; Vitamin B 12 Deficiency

Among 106 pregnant women with anaemia a typical state of iron deficiency could be shown at only 36.8%. 22.5% of the patients had a decreased vitamin B12 level without any characteristic symptoms of a megaloblastic anaemia. Predominantly the grade of the anaemia was small. The mean value of hemoglobin lied at 7.1 +/- 0.59 mmol/l. The severity of the anaemia didn't show any connection to the vitamin B12 level or parameters of the iron metabolism. With a combined therapy of iron, folic acid and vitamin B12 an increase of the Hb-level could be noticed at only 44.3% of the patients. The haematological findings, taken before the therapy, as well as the therapy results show that an important part of anaemias in pregnancy is caused by a complex genesis as a result of immunological reactions in pregnancy.

Topics: Adolescent; Adult; Anemia, Hypochromic; Anemia, Megaloblastic; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Ferrous Compounds; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Infant, Newborn; Iron; Pregnancy; Pregnancy Complications, Hematologic; Quaternary Ammonium Compounds; Vitamin B 12; Vitamin B 12 Deficiency

When compared with the normal population, patients with vitiligo often showed diminished blood levels of folic acid. In a group of fifteen patients with vitiligo, folic acid levels were below normal in the serum of eleven patients, in the whole blood of five patients, and in the erythrocytes of six patients. Vitamin B12 serum levels were below normal in five of the fifteen patients. Ascorbic acid plasma levels were also lowered in four of the patients. In eight patients prolonged oral administration of folic acid with simultaneous parenteral treatment with vitamin B12 and oral ascorbic acid was followed by definite repigmentation without side effects.

Topics: Adolescent; Adult; Aged; Ascorbic Acid; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency; Vitiligo

The case of a young woman from Guadeloupe developing severe megaloblastic anemia is reported. She presented with fever and hemolysis (she had heterozygotic beta-thalassemia) after a six month history of diarrhea. She was shown to have folate deficiency, steatorrhea, vitamin K and B12 malabsorption. She responded well to intravenous folinic acid and tetracyclines. Diagnosis was based on the following criteria: a) no other cause of malabsorption was found despite a comprehensive inquiry, b) the pattern of the illness corresponded to the definition of disease. Three particular aspects are outlined: the acute onset, malabsorption of vitamin B12 requiring prolonged and combined treatment, and the unusual place in which the disease was contracted.

Topics: Adult; Anemia, Megaloblastic; Drug Therapy, Combination; Female; Folic Acid; Folic Acid Deficiency; Humans; Infusions, Parenteral; Sprue, Tropical; Tetracycline; Thalassemia; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin K Deficiency; West Indies

Intermediates in the folate-dependent methylation pathways may play a role in the etiology and treatment of such mental disorders as major depression. These pathways include a step dependent on a riboflavin (B2)-derived coenzyme, flavin adenine dinucleotide (FAD), which is reportedly sensitive to thyroid status and to phenothiazine and tricyclic drug exposure. In a sample of 52 male and female acute psychiatric inpatients, 17% (n = 9) showed B2 deficiency (i.e., insufficient FAD activity) on a functional red blood cell enzyme assay, but only one B2-deficient individual showed deficiency in another B-complex vitamin (folate). All patients with B2 deficiency were women, who were also significantly younger than the rest of the sample. The B2-deficient women had significantly lower thyroxine levels, even when controlling for sex and covarying for age. B2-deficient patients exhibited a nonsignificant trend toward more unipolar depression (44% vs 14%), but not toward bipolar or schizophrenic disorders. As in a previous study, drug exposure did not show a relationship to riboflavin deficiency in this sample. The findings suggest that B2 (FAD) activity may serve as a sensitive marker of thyroxine status in certain female psychiatric inpatients and that B2 deficiency may play an etiological role in defects of the methylation pathways in a subset of mentally ill individuals.

Topics: Adult; Female; Folic Acid; Folic Acid Deficiency; Hospitalization; Humans; Male; Mental Disorders; Middle Aged; Pyridoxine; Riboflavin; Riboflavin Deficiency; S-Adenosylmethionine; Thiamine; Thyroid Function Tests; Thyroxine; Vitamin B 12

Topics: Adult; Age Factors; Anemia, Macrocytic; Anemia, Refractory; Diagnosis, Differential; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Vitamin B12 malabsorption was reported earlier to occur in patients with exocrine pancreatic insufficiency, and pancreatic extracts were shown to improve the absorption of vitamin B12. We investigated serum levels of vitamin B12 and serum folate in patients with chronic pancreatitis and different degrees of pancreatic insufficiency. 137 patients (84 males, 53 females, age 34-72 years) with chronic pancreatitis (C.P.) were included in the study. 123 of 137 (89.8%) patients had a pathologic pancreatic function test result, classified into mild (n = 24), moderate (n = 61) or severe (n = 38) insufficiency. The normal range of serum vitamin B12 and folic acid was established in 58 healthy controls and was found to be 190-1020 pg/ml for serum vitamin B12 and 2.4-16.1 ng/ml for folic acid. 7 patients (5.7%) with C.P. had vitamin B12 serum levels below 190 pg/ml; 4 of these had severe and 3 had mild or moderate exocrine pancreatic insufficiency. However there was no overall correlation between the degree of pancreatic insufficiency and vitamin B12 values. Serum levels of Vitamin B12 were 512 +/- 48 pg/ml in mild, 493 +/- 52 pg/ml in moderate and 428 +/- 45 pg/ml in severe exocrine insufficiency. Serum folic acid below 2.4 ng/ml were present in 5 patients (3.6%). Folic acid serum levels were 8.34 +/- 0.76 ng/ml in mild, 6.34 +/- 0.52 ng/ml in moderate and 7.45 +/- 0.53 ng/ml in severe exocrine insufficiency. We conclude that vitamin B12 deficiency is a rare finding in chronic pancreatitis and does not strictly depend on the degree of exocrine pancreatic insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Chronic Disease; Exocrine Pancreatic Insufficiency; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Aged; Female; Folic Acid; Folic Acid Deficiency; HIV Infections; Humans; Male; Middle Aged; Vitamin B 12

Red cell folate and vitamin B12 estimations were performed on 243 successively admitted in-patients at a District General Hospital Psychiatric Unit and 42 out-patients (29 attending a lithium clinic). Patients were classified into five diagnostic groups. The mean ages of the manic and schizophrenic patients were lower than of the depressed or euthymic patients but age was not correlated with red cell folate or serum B12 levels in any group. There were 89 (31%) patients with red cell folate below 200 ng/ml and 35 (12%) with concentrations below 150 ng/ml. Significantly more of these low-folate patients were in-patients than out-patients. The mean red cell folate in the depressed patients was significantly lower than in the euthymic, manic and schizophrenic groups. Alcoholics had a similar mean red cell folate to depressed patients which was not quite significantly lower than the other groups. The mean serum B12 level in the alcoholics was, however, significantly raised. There were no significant differences in red cell folate or serum B12 between lithium-treated and untreated euthymic patients. The highest proportions of values below 200 ng/ml and 150 ng/ml were found in depressed and alcoholic patients. Endogenous depressives had the highest percentage of values below 150 ng/ml (folate-deficient) of all psychiatric groups and alcoholic patients. The significance of these findings is discussed.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alcoholism; Bipolar Disorder; Depressive Disorder; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Mental Disorders; Middle Aged; Schizophrenia; Vitamin B 12

The metabolism and intracellular recycling of methionine requires vitamin B12 as cofactor and methyltetrahydrofolate as coreactant. To examine the interrelationship between serum levels of methionine, vitamin B12 and folate, serum methionine levels were assayed in patients with reduced levels of these vitamins and in healthy subjects. Approximately half the patients with either vitamin B12 or folate deficiency, and more than half those with combined deficiency, had methionine levels below the reference range (37-136 mumol/l). There was no correlation between vitamin B12 or folate and serum methionine levels within the healthy group. There was also no correlation within the group with low folate levels. Within the vitamin B12 deficient group on the other hand, the correlation was highly significant (r = 0.547, p less than 0.001). The finding that many patients with vitamin B12 or folate deficiency have normal serum levels of methionine suggests a significant role for other factors such as betaine-dependent methionine synthesis in the maintenance of serum methionine concentrations.

Topics: Adult; Folic Acid; Folic Acid Deficiency; Humans; Methionine; Nutritional Requirements; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow Cells; Deoxyuridine; DNA; Folic Acid; Folic Acid Deficiency; Humans; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Between January 15 and April 30, 1988, one thousand assays of serum vitamin B12 and folates were performed, and the reasons why they were requested as well as their clinical usefulness are discussed. In 50 cases these assays were requested for a suspected myeloproliferative syndrome; in some of the patients with polycythaemia vera an excess of B12 was observed without hyperleukocytosis, an argument for keeping the B12 assay as an element of initial evaluation. In numerous cases the assays were performed for aetiological evaluation of a macrocytosis of suspected alcoholic origin in most patients; more than 50 per cent of the patient had folate deficiency and only a few had low B12 values. Folate levels were frequently low and B12 levels generally normal in patients with gastrointestinal disease, but many of them had been supplemented with folate and/or B12 prior to the assay. More than 20 per cent of the 1,000 assays were performed in patients aged 80 years or more, and more than 50 per cent of them had a low folate level; this has no consequences for individual subjects, but it may be of epidemiological or sociological interest. It must be mentioned that too many blood samples (more than 40 per cent) were sent to the laboratory without adequate information and after supplementation in 20 per cent of the cases. Very few patients with very low B12 levels were subjected to Schilling's test, so that the clinical usefulness of this assay, as currently utilized, is questionable in a large number of cases.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anemia, Macrocytic; Child; Child, Preschool; Digestive System Diseases; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infant, Newborn; Middle Aged; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Forty-six male alcoholics hospitalized with polyneuropathy or intellectual impairment were studied after at least 2 wk of alcohol abstention. Neurological evaluation included neurophysiological examination of the sural nerve and tibial nerve, neurophysiological examinations, and CT-scanning of the brain. Alcohol and vitamin intakes were quantified by the interview method. Vitamin B-12 and folate status included examinations of peripheral blood and bone marrow aspirate, plasma vitamin B-12, plasma and erythrocyte folate, formiminoglutamic acid excretion test (FiGlu), methylmalonic acid excretion, and deoxyuridine suppression test (dU) on phytohemagglutinin-stimulated peripheral lymphocytes. The liver function was assessed by galactose elimination capacity and plasma clearance of antipyrine. There was no hematological sign of folate or vitamin B-12 deficiency. About 8% had low plasma folate, while neither erythrocyte folate nor plasma vitamin B-12 were decreased. However, half of the patients had functional folate deficiency as determined by abnormal FiGlu or dU. Compared to the remaining patients, those with abnormal FiGlu or dU had significantly more abnormal neurophysiological tests, and lower folate intake. There was no correlation between FiGlu or dU and the quantitative liver function tests. It is concluded that 1) folate deficiency may contribute to the development of alcoholic polyneuropathy, 2) the classical parameters for folate deficiency (blood concentrations, peripheral blood, and bone marrow examinations) are not reliable in diagnosing folate deficiency and 3) functional tests like FiGlu and dU are necessary to diagnose folate deficiency in alcoholics.

Topics: Adult; Alcoholism; Deoxyuridine; Folic Acid; Folic Acid Deficiency; Formiminoglutamic Acid; Hematologic Tests; Hepatic Encephalopathy; Humans; Liver Function Tests; Male; Middle Aged; Neurologic Examination; Peripheral Nervous System Diseases; Vitamin B 12; Vitamin B 12 Deficiency

Forty-four consecutive, unmedicated outpatients with a major depressive disorder were evaluated to determine the relationships in life course, severity of depressive illness, and serum folate and B12 levels. Duration of current episode was significantly inversely correlated with folate levels. Age at onset of illness was significantly correlated with B12. In a subgroup of recurrent depressives, current age and age at onset of depressive illness were positively correlated with folate. The findings are discussed in light of the current hypotheses regarding the association of folate and mood.

Topics: Adult; Depressive Disorder; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Psychological Tests; Recurrence; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Hypochromic; Child, Preschool; Folic Acid Deficiency; Humans; Infant; Prospective Studies; Protein-Energy Malnutrition; Vitamin B 12

Iron, folate, and vitamin B-12 status was found to be poor in a substantial proportion of outpatients with generally inactive Crohn's disease. Diet counseling was associated with a normalization of TIBC and serum folate over a 6-month period, but no other consistent benefits were noted despite moderate improvements in intake. The outpatients appeared to be at low risk of developing a zinc or copper deficiency.

Topics: Adult; Copper; Counseling; Crohn Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Iron Deficiencies; Male; Random Allocation; Vitamin B 12; Vitamin B 12 Deficiency; Zinc

Serum ferritin, folate, cobalamin and hemoglobin concentrations were determined by radioimmunoassay, radioisotopic assay, radioassay and an automated hematology analyser respectively, and then analysed in 221 normal full-term pregnant women in order to evaluate the incidence and the prevalence of nutritional anemia in pregnancy. None of them had received any hematonic during their pregnancy. Their mean age was 27.68 years and the mean duration of pregnancy was 39.51 weeks. Twenty-three (10.41%) of these previously non-anemic pregnant women had clinical anemia after full-term pregnancy. Of the 23 women, 11 (47.83%) had iron-deficiency anemia, with serum ferritin less than 12 micrograms/l; another 11 women had some degree of iron depletion, with serum ferritin less than 20 micrograms/l. So in 22 of the 23 anemic women (95.65%) the cause of anemia may correlate to iron depletion. The remaining one had folate-deficiency anemia. No pure cobalamin deficiency anemia was found in this study. Among the 198 non-anemic normal full-term pregnant women, 92 (46.46%) had iron depletion (serum ferritin less than 20 micrograms/l), of whom 35 (17.68%) had severe iron deficiency, with serum ferritin less than 12 micrograms/l. Another 3 had folate deficiency and 3 had cobalamin deficiency. By including all the anemic and non-anemic pregnant women, 114 (51.58%) of them had some degree of iron depletion. In other words, pregnancy can produce a considerable degree of iron depletion in more than half of the previously non-anemic women.

Topics: Adult; Anemia; Anemia, Hypochromic; China; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Humans; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12; Vitamin B 12 Deficiency

We performed studies in 25 patients with low serum cobalamin levels who had few if any clinical or hematologic findings of cobalamin deficiency. All but three had morphologically normoblastic hematopoiesis, and 15 were not even anemic. None of those tested excreted methylmalonic acid or homocystine. Nevertheless, the dUST identified metabolic abnormalities in 18 of the 25 cases. In vitro additives were essential in the dUST. Especially noteworthy was MTHF, whose addition unmasked an otherwise undetectable dUST abnormality in four cases. Why MTHF appears to act as a "stress test" in this setting is unknown but deserves further attention. Seven patients had early forms of classical malabsorptive states such as pernicious anemia, defined by abnormal Schilling test results. Among the rest, seven of 13 patients displayed malabsorption of protein-bound cobalamin despite normal absorption of free cobalamin by the Schilling test. In two patients, initially normal Schilling test results became abnormal the following year. These findings demonstrate that seemingly falsely low serum cobalamin levels often indicate subtle biochemical cobalamin deficiency. Early stages of pernicious anemia or other classical malabsorptive states are sometimes responsible for such subtle deficiency. However, malabsorption confined to protein-bound cobalamin is an equally common cause. Current concepts of cobalamin deficiency and the absorptive defects that can cause it should be expanded to include atypical defects requiring newer methods of identification.

Topics: Adult; Aged; Aged, 80 and over; Bone Marrow; Deoxyuridine; Female; Folic Acid Deficiency; Humans; In Vitro Techniques; Intestinal Absorption; Male; Middle Aged; Prospective Studies; Protein Binding; Tetrahydrofolates; Vitamin B 12; Vitamin B 12 Deficiency

The roles of vitamin B12 and folate in carcinogenesis are largely extensions of and linked to their roles in normal metabolism, particularly 1-carbon unit metabolism. A possible key area may be hypomethylation to "switch on" genes and methylation to "switch them off." Some vitamin analogues may act as antivitamins in these reactions, as may some vitamin-binding proteins. Others may act as specific delivery proteins. Using appropriate radioactive substrates and suspensions of vitamin-dependent normal and malignant cells, it may be possible to work out their positive and negative control of DNA synthesis.

Topics: Carcinogens; DNA Replication; Folic Acid; Folic Acid Deficiency; Humans; Neoplasms; Vitamin B 12; Vitamin B 12 Deficiency

The prevalence of anaemia and deficiencies of iron, folate and vitamin B12 were investigated in 140 rural black preschool children aged 3-5 years living in five different villages in the Letaba area, near Tzaneen. Anaemia was highly prevalent, 39.2% of the children having haemoglobin levels below 11.1 g/dl. Approximately 10% were considered to be iron-deficient. On the basis of subnormal red cell folate values, 1 in 4 children was folate-deficient, suggesting the need for intervention at the community level such as enrichment of the staple foodstuff, maize meal, with folic acid.

Topics: Anemia, Hypochromic; Black or African American; Black People; Child, Preschool; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Humans; Iron Deficiencies; Male; Rural Population; South Africa; Vitamin B 12; Vitamin B 12 Deficiency

All patients 65 years and older who had been living in an institution for at least six months had a measurement of red blood cell folate (RBCF), serum folate (SF), vitamin B12, hemoglobin, and mean corpuscular volume. Twenty-two percent of the 97 studied subjects were found deficient in RBCF, although only 6% had anemia. Length of stay at the institution was significantly associated with deficiency in RBCF and this association was uncon-founded by age. The proportion of RBCF deficiency among the studied subjects attributable to length of stay is 80%. The prophylactic administration of folate among long-term nursing home type of patients should be considered.

Topics: Age Factors; Aged; Female; Folic Acid Deficiency; Humans; Institutionalization; Length of Stay; Male; Quebec; Vitamin B 12

1. A high incidence of vitamin B12 or folate deficiency, or both, may be found in the elderly, particularly those in hospital. This report concerns fifty cases detected in an inner-city-area geriatric unit during the course of routine clinical investigation. The majority had none of the classical haematological signs of vitamin B12 or folate deficiency, and all the patients reported had a mean corpuscular volume (MCV) of less than 100 fl. 2. There was a significant negative correlation between the MCV and the erythrocyte folate (P less than 0.01), supporting earlier published work using a low serum folate as an index of folate deficiency. 3. There was no correlation between the MCV and the serum vitamin B12. Published work differs on this point. 4. Serum iron, total Fe-binding capacity and percentage Fe saturation results were available in forty patients in this series. There was a significant positive correlation between the serum Fe and the MCV (P less than 0.01) and 34% of patients had haematological evidence of Fe deficiency. In the majority, however, there was no evidence that associated Fe deficiency had masked the haematological signs of vitamin B12 or folate deficiency. 5. More attention should be paid to the problem of 'masked' vitamin B12 and folate deficiency in the elderly. There is a case for routine screening of the elderly for vitamin B12 and folate deficiency irrespective of the MCV.

Topics: Aged; Aged, 80 and over; Erythrocyte Indices; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Male; Protein Binding; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Avitaminosis; Folic Acid; Folic Acid Deficiency; Humans; Pyridoxine; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Deficiency; Vitamin D; Vitamin D Deficiency; Vitamin E; Vitamin E Deficiency; Vitamin K; Vitamin K Deficiency; Vitamins

Plasma unsaturated R-binder and transcobalamin 2 (TC 2) levels were measured in 62 patients with folate deficiency and compared with 80 control subjects and 52 patients with pernicious anaemia. An increase in unsaturated R-binder concentration was found in the majority of patients with folate deficiency and with PA. In folate deficiency, however, the unsaturated R-binder was often elevated whether the serum cobalamin (Cbl) was low or normal, more frequently when the serum Cbl was normal. Results of a separate in vivo study of plasma retention of injected 57Co cyanocobalamin were consistent with these findings. An elevated TC2 was found in a small number of patients with folate deficiency and with PA. The serum Cbl appears to the maintained at a normal level in some patients with folate deficiency by an increase in R-binder, which is caused by folate deficiency itself.

Topics: Adult; Anemia, Pernicious; Female; Folic Acid Deficiency; Humans; In Vitro Techniques; Kinetics; Male; Transcobalamins; Vitamin B 12

The biochemical data concerning the evaluation of the folacin status in children are insufficient, as there are no biologically based borderlines available. In a study with 165 children between 1 and 15 years we looked for serum and erythrocytic folate concentrations and correlated the results with morphological alterations in the blood picture (lobe average of the neutrophilic granulocytes). As cobalamin and iron status influences different folacin depending parameters we estimated the vitamin B12- and ferritin concentration in serum as well. In our study neither the iron nor the cobalamin status influenced the blood picture and the blood folate concentrations. That's why all samples could be taken for the final evaluation. It could be demonstrated that folacin serum levels below 4.0 ng/ml respectively erythrocytic concentrations below 250 ng/ml correspond with an increasing lobe average above 3.5 compared with normal values ranging between 2.8-3.5. These biologically based borderlines were comparable between the different age groups. On the basis of these data it is possible to assess the duration and severity of folacin deficiency in children.

Topics: Adolescent; Child; Child, Preschool; Erythrocytes; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Humans; Infant; Iron; Male; Neutrophils; Reference Values; Vitamin B 12

In a study with 165 children the folate, cobalamin and iron status was investigated by biochemical and haematological methods. On the basis of biologically based borderlines it could be demonstrated, that 15% of the children showed folate deficiency in a progressive state. This means that low serum resp. low erythrocytic folate concentrations correlated with alterations in the blood picture (lobe average of the neutrophilic granulocytes). Especially children in the age of puberty (11-15 years) are to be regarded as vulnerable; 30% of this group show deficiency symptoms whereas in very young children (1-5 years) only in 10% the supply situation is insufficient. The folate status in pupils (6-10 years) is comparable to adults (15% deficient). As cobalamin and iron status may influence folate depending parameters the status of these nutrients was estimated, too. Cobalamin deficiency was not detectable in any case. Though the iron supply situation was not adequate in all cases, interactions with the folate depending parameters could be excluded.

Topics: Adolescent; Adult; Aging; Child; Child, Preschool; Erythrocytes; Female; Ferritins; Folic Acid Deficiency; Humans; Infant; Iron; Male; Neutrophils; Puberty; Vitamin B 12

To determine the functional importance of the low B12 and red cell folate concentrations repeatedly observed in the elderly 200 consecutive patients admitted to a geriatric unit were studied. Forty six of the patients had low serum concentrations of B12 (15), red cell folate (26), or both (five). Serum B12 and red cell folate concentrations correlated with mean cell volume, and serum B12 correlated with the neutrophil lobe count. Bone marrow deoxyuridine suppression was abnormal in 35% of the patients with low vitamin concentrations, but 55% of those with abnormal deoxyuridine suppression had morphologically normal bone marrow, and 73% had a normal mean cell volume. In patients with low vitamin values the deoxyuridine suppressed value correlated with the haemoglobin concentration and neutrophil lobe count. Thus synthesis of thymidylate was impaired by vitamin B12 or folate deficiency in at least 8% of newly admitted elderly patients, many of whom had normal blood counts despite the biochemical disturbance affecting haemopoiesis. A nutritionally depleted diet may have been responsible for many of the low vitamin values.

Topics: Aged; Bone Marrow; Deoxyuridine; Erythrocytes; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Leukocyte Count; Neutrophils; Serum Albumin; Thyroxine; Vitamin B 12; Vitamin B 12 Deficiency

Anaesthesia with nitrous oxide inactivates vitamin B12 and impairs DNA synthesis in bone marrow cells. The secondary development of folate deficiency may prolong the recovery from these abnormalities in some seriously ill patients. This was investigated, using the deoxyuridine (dU) suppression test, in 48 patients admitted to an Intensive Care Unit (ICU). On admission to the ICU, following nitrous oxide anaesthesia, the pattern of correction of the abnormal dU-suppression tests was typical of that seen in vitamin B12 deficiency; 3 days later the pattern had changed to that usually seen in folate deficiency. During the same period the serum folate levels fell to subnormal values. Further evidence for the development of folate deficiency was provided by treatment with physiological amounts of folic acid which accelerated the recovery of the bone marrow abnormalities present after nitrous oxide anaesthesia. Urinary folate excretion was measured by radioassay, and increased following anaesthesia with nitrous oxide, however, this was insufficient by itself to explain the development of folate deficiency.

Topics: Adolescent; Adult; Aged; Anesthesia; Bone Marrow; Child; Critical Care; Deoxyuridine; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Nitrous Oxide; Vitamin B 12

Topics: Anemia, Hypochromic; Child, Preschool; Drug Therapy, Combination; Folic Acid; Folic Acid Deficiency; Humans; Infant; Iron; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Female; Folic Acid; Folic Acid Deficiency; Humans; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Third; Vitamin B 12; Vitamin B 12 Deficiency

S-adenosylmethionine (SAM) has antidepressant properties. The commonest neuropsychiatric complication of severe folate deficiency is depression. These independent observations suggest that methylation in the nervous system may underlie the expression of mood and related processes and may be implicated in some affective disorders; suggest new biological approaches to the understanding and treatment of some affective disorders; and may explain why methionine sometimes aggravates schizophrenia.

Topics: Anemia, Megaloblastic; Brain; Depressive Disorder; Emotions; Folic Acid Deficiency; Humans; Methylation; S-Adenosylmethionine; Schizophrenia; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Hypochromic; Female; Folic Acid; Folic Acid Deficiency; Humans; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12

A commercial assay kit method for the simultaneous estimation of vitamin B12 and folate concentrations has been evaluated. Values derived for folate by a microbiological assay and vitamin B12 by a verified radioassay showed good correlation with the investigated method. The clinical sensitivity of the assay for detecting deficient concentrations of vitamin B12 and folate was comparable to that of the non-commercial methods and other more definitive clinical procedures. Establishment of reference ranges, based on accepted statistical criteria, are discussed and such ranges are contrasted with those proposed by the manufacturer. The kit method is time and labour saving compared with the non-commercial methods.

Topics: Adult; Anti-Bacterial Agents; Biological Assay; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Methods; Middle Aged; Radioisotope Dilution Technique; Reference Values; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Child; Child, Preschool; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Heterozygote; Humans; Male; Middle Aged; Thalassemia; Vitamin B 12; Vitamin B 12 Deficiency

The potential promoting and/or complete carcinogenic activity of a methyl group-deficient (MD) diet lacking methionine, choline, vitamin B12, and folate on liver tumor induction in weanling male F344/NCr rats was examined. Each of 50 rats per group received one injection 20 mg diethylnitrosamine [(DENA) CAS: 55-18-5; N-nitrosodiethylamine]/kg body weight at 4 weeks of age, and then each was maintained on a methyl group-adequate (MA) diet for 52 weeks (groups 2 and 5) or on an MD diet for 15 weeks followed by the MA diet for 37 weeks (group 4). Controls received injections of saline and were maintained on the same two respective diet regimens (groups 1 and 3, respectively). Histologic results from sacrifices at 6, 10, 15, 22, 39, and 52 weeks revealed early development of foci of eosinophilic gamma-glutamyltransferase (GGT)-positive hepatocytes by week 6 in DENA-MD diet-treated rats, with subsequent development of a diffuse hyperplasia of hepatocytes, oval cell proliferation, cholangiofibrosis, nodular cirrhosis, and neoplastic nodule (NN) formation and, at 52 weeks, hepatocellular carcinomas (HCC) in 13 of 15 rats. Similar but significantly fewer lesions were observed at slightly later sacrifice times in the livers of saline-MD diet-treated rats, with development of NN in 5 of 12 rats and an HCC in 1 of 12 rats at 52 weeks. DENA-treated rats on MA diets developed relatively few GGT-positive foci, and none developed any neoplastic lesions. Except for basophilic foci, areas and foci of cellular alteration containing glycogen-rich hepatocytes frequently exhibited diminished uptake of injected iron and decreased glucose-6-phosphatase and ATPase contents focally or throughout. This study indicates that a relatively brief exposure of both untreated and DENA-treated weanling rats to a severely MD diet produces classical preneoplastic and neoplastic lesions in their livers.

Topics: Animals; Body Weight; Choline; Diet; Diethylnitrosamine; Drug Synergism; Folic Acid Deficiency; Liver; Liver Neoplasms, Experimental; Male; Methionine; Nitrosamines; Rats; Rats, Inbred F344; Time Factors; Vitamin B 12

There is considerable debate on the role of folate in CNS function. Recent work indicates that folate deficiency may affect CNS serotonin metabolism, and clinical studies describe many consequences of such a deficiency. On the other hand some workers maintain that folate deficiency alone causes CNS abnormalities. We maintained rats, through dietary deprivation, at folate levels below 4 ng/ml for more than 6 weeks and showed that at that time both their liver and brain folate levels were significantly reduced. We then studied their local cerebral glucose utilization (LCGU) using the [14C]deoxyglucose technique. This method assesses cerebral function by measuring regional metabolic activity. We also determined LCGU in rats given the same diet but replenished with folate (folate control) and in others given free access to commercially available food (normal controls). Our results show that this degree of folate deficiency has no effect on cerebral function. This contrasts with the focal suppression of LCGU we previously reported in a model of vitamin B12 deficiency.

Topics: Animals; Brain; Folic Acid; Folic Acid Deficiency; Glucose; Male; Organ Specificity; Rats; Rats, Inbred Strains; Time Factors; Vitamin B 12

Serum vitamin B12 levels (as determined by radio-immunoassay) were measured in 20 subjects aged 65 years and over with Alzheimer-type dementia, 20 age-matched subjects with non-Alzheimer type dementia and 20 age-matched subjects with no dementia. Serum vitamin B12 levels were significantly lower and serum vitamin B12 deficiency was significantly more frequent in subjects with Alzheimer-type dementia and were independent of age, sex, haematological abnormality or serum folate.

Topics: Aged; Alzheimer Disease; Dementia; Female; Folic Acid Deficiency; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

The authors have studied Vitamin B 12 and Folic-acid serum levels on 27 women admitted in geriatric psychiatry, aged 60 to 93. They have confirmed the high frequency of Vitamin B 12 deficiency and considered the quasi-constant deficiency of folic-acid. Then follow the implications of this study.

Topics: Age Factors; Aged; Female; Folic Acid; Folic Acid Deficiency; Humans; Mental Disorders; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Anemia, Hypochromic; Anemia, Megaloblastic; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Pernicious; Blood Proteins; Erythrocyte Indices; False Negative Reactions; Female; Folic Acid Deficiency; Humans; Male; Middle Aged; Radioisotope Dilution Technique; Transcobalamins; Vitamin B 12

In a series of 39 subjects previous results for serum folate levels were confirmed while intraglobular folate did not differ from those in a control group. To verify the hypothesis that SASP administration could be responsible for serum folate deficiency three different sub-groups were considered. 11 patients had never taken SASP (sub-group I), 16 patients had taken SASP in the past but the treatment had been withheld at least 2 months before (sub-group II), 12 patients were still taking the drug at the time of the study (sub-group III). Differences in serum folate levels between each one of the three sub-groups and the control group were significant. The same was not true for the differences between each one of the three sub-groups and the other. These findings seem to confirm that SASP treatment is not the major cause of serum folate deficiency, but a multifactorial pathogenesis might account for it.

Topics: Adolescent; Adult; Aged; Crohn Disease; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Ileitis; Ileum; Male; Middle Aged; Reagent Kits, Diagnostic; Sulfasalazine; Vitamin B 12

Biochemical investigations show a decreased bioavailability of 5-methyl-tetrahydrofolic acid in vitamin B12 deficient human cell cultures and bone marrow cells. Tetrahydrofolic acid cannot be liberated from its storage form. This so-called methyl-folate-trap results in a functional folic acid deficiency which is the pathogenetic principle of the defect in the cell proliferation in patients with vitamin B12 deficiency. This knowledge of biochemical mechanisms leads to the identification of rare disorders in the metabolism of vitamin B12 and folic acid. After methotrexate treatment a rescue effect with its antidote Leucovorin can only be achieved, if the ratio antidote: methotrexate is at least 10:1. This ratio is important in cell cultures as well as in bone marrow cells in vivo. The results lead to a formula for the calculation of the optimal dosis to reach a secure rescue for individual patients after high-dose methotrexate treatment. This makes the high-dose methotrexate regimen a treatment modality for malignant tumors without any side effects.

Topics: DNA; Folic Acid; Folic Acid Deficiency; Humans; Leucovorin; Methotrexate; Neoplasms; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Folic Acid Deficiency; Humans; Male; Nervous System Diseases; Vitamin B 12

Topics: Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Vitamin B 12; Vitamin B 12 Deficiency

The incidence and pathogenesis of acute megaloblastic bone-marrow change and of abnormalities in DNA synthesis, as assessed with the deoxyuridine(dU) suppression test, have been investigated in a prospective study of 70 seriously ill patients admitted to an intensive-care unit. On admission megaloblastic bone-marrow change was present in 22 patients, 18 of whom had been anaesthetised with nitrous oxide for 2-6 h during surgical procedures before admission. 16 of these 18 patients died, compared with 7 of 22 patients in whom haemopoiesis remained normoblastic despite receiving equivalent amounts of nitrous oxide. An abnormal dU-suppression test developed only in patients who had received nitrous oxide; on admission an abnormal dU-suppression test was found in 39 of the 42 patients tested who had been exposed to the anaesthetic. The abnormality produced in the dU-suppression test by nitrous oxide in patients admitted to the intensive-care unit was more severe and recovery was slower than the abnormality seen in patients undergoing cardiac-bypass surgery. During the recovery period from the effects of nitrous oxide the pattern of correction of the dU-suppression test changed from that of vitamin-B12 deficiency to folate deficiency.

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Anesthesia; Bone Marrow; Child; Deoxyuridine; DNA; Female; Folic Acid; Folic Acid Deficiency; Hematopoiesis; Humans; Intensive Care Units; Male; Middle Aged; Nitrous Oxide; Vitamin B 12

Six of eight patients with Addisonian pernicious anemia were found to have diminished corticosteroid-binding globulin (CBG) concentrations, which returned within 2 weeks to normal after the im administration of cobalamin. T4-binding globulin was found to be completely normal before and after cobalamin replacement. Other estrogen-responsive proteins, i.e. ceruloplasmin, alpha 1-trypsin inhibitor, haptoglobin, transferrin, and alpha 2-macroglobulin, also did not follow CBG concentration in a parallel fashion. The immunoglobulins similarly did not follow a course parallel to that of CBG. The CBG concentration in two untreated patients had a normal increase in response to estrogen administration, similar to that described in CBG deficiency from other causes. No clue was found regarding the mechanism by which B12 influences the putative hepatic control of CBG concentration. It is speculated that at least two control points may be necessary for a normal CBG concentration. Patients with a genetic deficiency of CBG may also have to have cobalamin deficiency in order for them to reach a concentration approaching zero.

Topics: alpha 1-Antitrypsin; alpha-Macroglobulins; Anemia, Pernicious; Ceruloplasmin; Ethinyl Estradiol; Female; Folic Acid Deficiency; Haptoglobins; Humans; Immunoglobulins; Male; Transcortin; Transferrin; Vitamin B 12

Polymorphonuclear leukocyte functions were studied in 92 patients with protein-calorie malnutrition. Serum folic acid levels were higher than 3 ng/ml in 38 patients and 3 ng/ml or less in 54 patients. Significant differences were found between these two groups of patients with regard to phagocytosis (81.5 +/- 1.9 versus 69.2 +/- 2.0 percent, p less than 0.001) and bactericidal ability (90.6 +/- 1.1 versus 84.5 +/- 2.3 percent, p less than 0.05). Correction of folic acid deficiency in 22 patients was associated with recovery of normal phagocytosis (p less than 0.001) but not bactericidal function. Adding folic acid to the serum of eight patients also restored normal phagocytic function (p less than 0.001). A correlation was found in vivo and in vitro between changes over time in folic acid levels and in phagocytosis.

Topics: Blood Bactericidal Activity; Creatinine; Folic Acid Deficiency; Humans; Neutrophils; Phagocytosis; Protein-Energy Malnutrition; Vitamin B 12

The role of vitamin B12 in the folate dependent biosynthesis of thymidine nucleotides is controversial. In an attempt to clarify this, three methods have been used to assess the relative efficacy of vitamin B12 (hydroxocobalamin) and various folate analogues in titrated concentrations at correcting 'de novo' thymidylate synthesis by megaloblastic human marrow cells: (1) The deoxyuridine (dU) suppression test which analyses the reduction in (3H)-thymidine labeling of DNA by unlabeled dU. Marrow cells were also labeled with (6-3H)-dU with assessment of (2) its incorporation into DNA and (3) the accumulation of (6-3H)-deoxyuridine monophosphate (3H-dUMP). The three methods gave similar results. In both, N6-formyl tetrahydrofolate (formyl-FH4) was the most effective agent at correcting thymidylate synthesis in megaloblastic anemia due to vitamin B12 or folate deficiency. Vitamin B12 corrected the lesion in vitamin B12 deficiency but not in folate deficiency. Tetrahydrofolate (FH4) and folic acid were effective in deficiency of vitamin B12 or folate, although in both deficiencies they were less effective than formyl-FH4. Methyl-FH4 was effective in folate deficiency but not in vitamin B12 deficiency. These results confirm the failure of methyl-FH4 utilisation in vitamin B12 deficiency. They suggest that if vitamin B12 is needed in the formylation of FH4, this is a minor role in provision of the correct coenzyme for thymidylate synthesis compared with its major role of provision of FH4 from methyl-FH4.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow; Deoxyuridine; DNA; Folic Acid; Folic Acid Deficiency; Humans; Leucovorin; Tetrahydrofolates; Thymine Nucleotides; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Aging; Alcoholism; Anemia; Anemia, Aplastic; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Animals; Blood Cell Count; Drug-Related Side Effects and Adverse Reactions; Female; Ferrous Compounds; Folic Acid; Folic Acid Deficiency; Gastrointestinal Hemorrhage; Humans; Male; Mice; Reference Values; Vitamin B 12

Rats were injected with [2-14C]H4PteGlu daily for 3 d and thereafter one group left in air and a second group in an atmosphere of nitrous oxide/oxygen (1/1). Nitrous oxide inactivates cobalamin. The N2O-treated rats excreted large amounts of L. casei-active folate into the urine. The urinary folate co-chromatographed with authentic 3H-labelled 5-methyltetrahydrofolate. Both groups of animals excreted 14C-labelled breakdown products in the urine but there was no evidence of increased folate catabolism in the N2O-treated rats. It was concluded that the folate deficiency that develops in the N2O-treated rat is due to massive urinary loss of folate. This appears to be secondary to impaired cellular uptake of folate which leads to a raised plasma folate level.

Topics: Animals; Chromatography, DEAE-Cellulose; Folic Acid; Folic Acid Deficiency; Liver; Male; Nitrous Oxide; Rats; Rats, Inbred Strains; Tetrahydrofolates; Time Factors; Vitamin B 12

1. Control, folate-deficient and vitamin B12-supplemented chickens were given [3', 5', 9 (n)-3H] pteroylglutamic acid by intraperitoneal injection. After various time intervals (1.5 h-8d) the incorporation of radioactivity into hepatic folate derivatives was measured. 2. The results confirm that avian species have a faster assimilation of folate than most mammalian species. 3. Folate deficiency increased the incorporation and retention of [3H] pteroylglutamic acid. The degree of folate conjugation was unaffected by folate deficiency but the formyl to methyl folate ratio was decreased. 4. Vitamin B12 supplementation had no effect on the uptake or conjugation of [3H] pteroylglutamic acid, but increased the formyl to methyl folate ratio.

Topics: Animals; Body Weight; Chickens; Female; Folic Acid; Folic Acid Deficiency; Injections, Intraperitoneal; Liver; Pteroylpolyglutamic Acids; Vitamin B 12

In three different groups of patients presenting severe folate deficiency (purely nutritional folate deficiency, chronic alcoholism or various intestinal diseases), vitamin B12 absorption has been tested by Schilling test in order to investigate the possible effect of folate deficiency on B12 absorption. Following this study, it appears that folate deficiency in itself, even severe, cannot induce vitamin B12 malabsorption, since in the first group, consisting of malnourished old people, the Schilling test was always normal even in those who presented a lowered B12 serum level; in the group of patients with intestinal disease, the Schilling test was abnormal as expected in some patients; 3 alcoholics out of 12 presented a malabsorption of B12 on the Schilling test; the follow-up of 2 of them exhibited complete correction after normal diet and alcohol suppression. Consequently, folate deficiency does not seem responsible for a secondary B12 malabsorption unless another etiological factor is present, such as alcohol or ileopathy.

Topics: Adult; Aged; Alcoholism; Erythrocyte Indices; Female; Folic Acid Deficiency; Humans; Intestinal Absorption; Intestinal Diseases; Iron; Malabsorption Syndromes; Male; Middle Aged; Schilling Test; Vitamin B 12

Topics: Adolescent; Celiac Disease; Child; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Hematopoiesis; Humans; Infant; Iron; Iron Deficiencies; Male; Vitamin B 12

A young Australian woman developed a severe nutritional megaloblastic anaemia due to poor intake of vitamin B12 and, possibly, of folic acid. Simple dietary advice resulted in an adequate intake of vitamin B12 and folic acid, and in maintenance of normal serum levels of both vitamins.

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Female; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Biological Assay; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Radioisotopes; Vitamin B 12; Vitamin B 12 Deficiency

Experimental deficiencies of cyanocobalamin and folacin separately and in combination were induced in an air-breathing teleost fish Channa punctatus with the help of a complete vitamin test diet. Cyanocobalamin deficiency produced normocytic hypochromic anaemia while the folacin deficiency as well as the combined deficiency of both vitamins produced macrocytic hypochromic anaemia. Leucocytosis was observed in the individual and combined deficiencies of these vitamins with significant increase in thrombocytes and decrease in neutrophil population. The relative population of different developing stages in erythropoiesis showed significant change. Thus small lymphoid haemoblast decreased in number while young and mature reticulocyte populations increased. Recovery to normal condition could be obtained by restoring deficient groups of fishes to complete vitamin test diet fortified with an initial i.m. administration of 0.01 mg/g and 0.02 mg/g body wt. of cyanocobalamin and folacin respectively. A comparison of deficiency effects on C. punctatus with Labeo rohita shows that the former, a carnivorous species with higher Hb content in peripheral blood is more susceptible to deficiency than the latter, a herbivorous species of fish with lower Hb values.

Topics: Anemia, Hypochromic; Animals; Behavior; Diet; Erythropoiesis; Fishes; Folic Acid Deficiency; Hematopoiesis; Hemoglobins; Leukocyte Count; Mortality; Vitamin B 12; Vitamin B 12 Deficiency

An increase in the mean corpuscular volume (MCV), while not diagnostic of vitamin B12 or folate deficiency, is a valuable, readily available screening test. I discuss six instances where an increased MCV was recorded months prior to diagnosis and could, if noted, have led to an earlier diagnosis.

Topics: Aged; Anemia, Pernicious; Diagnosis, Differential; Erythrocyte Indices; Folic Acid Deficiency; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Folic Acid Deficiency; Humans; Malonates; Methylmalonic Acid; Vitamin B 12; Vitamin B 12 Deficiency

A 57-year-old woman developed dementia and peripheral neuropathy 16 years after a partial gastrectomy (Billroth II). Serum cobalamin was 198 pmol/l (reference interval 150-550), and the vitamin B12 absorption test (Schilling) showed decreased absorption (1.7% without and 2.2% with intrinsic factor). In spite of 20 months' therapy with vitamin B12, the neurological symptoms progressed. Folate deficiency was suggested by a very low erythrocyte folate and a slightly abnormal FIGLU test. There were no other signs of general malabsorption. A few months' treatment with folic acid significantly improved the massive neurological manifestations which were verified neurophysiologically as well as histologically. A common role of vitamin B12 and folate in the development of neuropathy is suggested.

Topics: Dementia; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Gastrectomy; Humans; Middle Aged; Peripheral Nervous System Diseases; Schilling Test; Time Factors; Vitamin B 12

The recent introduction of radioassays for 'true' cobalamin, as opposed to cobalamin and its analogues, has resulted in significantly lower levels of cobalamin being found in patients with folate deficiency. In study of 81 patients, cobalamin analogue levels were found to increase and cobalamin to decrease as red cell folates decreased. Cobalamin absorption studies in 15 patients with low cobalamin and folate levels were found to be normal in 10 patients, all of whom demonstrated high levels of analogues relative to true cobalamin. We have found that the mean serum cobalamin increased from 210 ng/l (range 100-380) to 309 (150-470) and analogues fell from 226 ng/l (150-280) to 127 (65-190) in folate deficient patients when treated with folic acid. It appears that cobalamin analogue concentrations are increased in folate deficiency, and that in these patients treatment with folic acid alone may correct both the low cobalamin and the high analogue levels.

Topics: Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12

Previous studies demonstrated that excess deoxyuridine (dU) added to short-term bone marrow and PHA-stimulated lymphocyte cultures, blocks the incorporation of radioactive thymidine into DNA via the salvage pathway. In the current study, we investigated the effects of added thymidine (TdR) in varying concentrations (10(-6) to 1 mumol) on the incorporation of 3H-dU into thymine-DNA, i.e. we executed 'thymidine suppression tests.' Increasing concentrations of exogenous TdR caused progressive inhibition of 3H-dU incorporation into DNA, and decreasing 3H-dU incorporation was parallelled by increasing incorporation of added 14C-TdR. These findings demonstrate reciprocity of the salvage and the de novo pathways of thymine-DNA synthesis, presumably mediated by thymidine-triphosphate (dTTP), the common end product of both pathways, via feedback inhibition. In patients with folate and/or vitamin B12 deficiency, the addition of appropriate vitamins to marrow and lymphocyte cultures enhanced the incorporation of 3H-dU into DNA. As predicted, this was not observed in normal subjects. The enhancing effect of these vitamins on in vitro incorporation of 3H-dU into DNA by deficient cell systems was similar to their correcting effect on abnormal dU suppression. These findings support the theoretical concept that the dU suppression test defines biochemical megaloblastosis due to deficiency of folate and vitamin B12.

Topics: Bone Marrow; Cells, Cultured; Deoxyuridine; DNA; Folic Acid; Folic Acid Deficiency; Humans; Lymphocytes; Phytohemagglutinins; Thymidine; Vitamin B 12; Vitamin B 12 Deficiency

Five commercial kits for the determination of folate and six kits for the determination of vitamin B12 were investigated. Their performance has been compared with microbiological methods for the two vitamins and with a non-commercial radioisotopic method for B12. The results show the importance of the determination of the reference range for an individual laboratory for each method. The precision of the kits varied appreciably, as did their performance using specimens from patients with different haematological disorders. In particular, certain kits failed to detect all patients with pernicious anaemia. The relative accuracy of the kits was assessed. Various factors which should be taken into account in the final selection of a satisfactory kit are discussed.

Topics: Anemia, Pernicious; Biological Assay; Evaluation Studies as Topic; Folic Acid; Folic Acid Deficiency; Humans; Radioimmunoassay; Radioisotopes; Reagent Kits, Diagnostic; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Alcoholism; Celiac Disease; Exocrine Pancreatic Insufficiency; Folic Acid; Folic Acid Deficiency; Gastric Mucosa; Glutamates; Humans; Ileum; Intestinal Absorption; Intrinsic Factor; Malabsorption Syndromes; Protein Binding; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Erythrocyte Count; Erythrocyte Volume; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Reticulocytes; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Child; Democratic Republic of the Congo; Folic Acid; Folic Acid Deficiency; Humans; Iron; Protein-Energy Malnutrition; Vitamin B 12; Vitamin B 12 Deficiency

In 28 patients suffering from subacute combined degeneration of the spinal cord, vitamin B12 metabolism was investigated. Two postulates, proving vitamin B12 deficiency and excluding another cause for the clinical symptoms, have to be fulfilled. Two patients had no disturbance in their vitamin B12 metabolism. Seven patients had a distinct vitamin B12 deficiency. In the remaining 19 patients we found a mild vitamin B12 deficiency. Of these patients, 5 had had a subtotal gastrectomy, one had had a low absorption of vitamin B12, and 13 patients we could not find a distinct cause for the vitamin B12 deficiency. It is not impossible that nutritional habits can be hold responsible for this deficiency. The question whether these 13 patients should be treated with vitamin B12 for the rest of their lives is difficult to answer. It is a conditio sine qua non that in the patients with S.C.D. the vitamin B12 metabolism is examined circumstantially. By so doing, it may be possible to detect, in cases with minor clinical signs and symptoms of S.C.D., the cause of their illness.

Topics: Adult; Aged; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Humans; Hydroxocobalamin; Intestinal Absorption; Male; Middle Aged; Nerve Degeneration; Recurrence; Spinal Cord; Spinal Cord Diseases; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Pernicious; Costs and Cost Analysis; Diagnosis, Differential; Folic Acid Deficiency; Gastroscopy; Humans; Vitamin B 12

Thirteen patients with significant hemorrhage, severe thrombocytopenia, and megaloblastic bone marrows are described. Unusual features of this problem included its acute onset, frequent absence of the typical peripheral blood changes of megaloblastic anemia, normal serum B12 levels, and serum folates which were often not clearly abnormal. Most patients were critically ill and common clinical features included reduced dietary intake, renal failure, renal dialysis, the postoperative state, and sepsis. These clinical features, the laboratory findings, and a platelet increase in most patients after folate therapy lead to the conclusion that this problem is probably due to acute folic acid deficiency. Possible explanations for the atypical laboratory findings include the acuteness of onset, recent blood transfusion therapy, and impaired folate utilization. This problem may be relatively common. Because of its potential clinical importance, rapid onset, and attendent diagnostic difficulties, prophylactic folic acid is recommended in the clinical setting described.

Topics: Acute Disease; Anemia, Megaloblastic; Bone Marrow Examination; Folic Acid; Folic Acid Deficiency; Hemorrhage; Humans; Thrombocytopenia; Vitamin B 12

The net activity of orotidylic pyrophosphorylase and decarboxylase, sequential enzymes which catalyse the formation of uridine monophosphate from orotic acid in de novo pyrimidine biosynthesis, has been evaluated in erythrocytes of patients with folate or cobalamin deficiency. In patients with normoblastic haemopoiesis and normal cobalamin and folate status a direct relationship exists between the maturity of the peripheral blood erythrocyte population, as indicated by G6PD activity, and net orotidylic activity. In contrast in cobalamin or folate deficiency this co-ordinate relationship is not observed and net orotidylic activity is relatively reduced. Fractionation of erythrocytes by centrifugation demonstrates that this inordinately low orotidylic activity consistently occurs in the young erythrocyte population and is reversed by specific replacement therapy. In vitamin B12 or folate deficiency an impressive array of evidence now exists to implicate altered folate metabolism for the observed alterations in purine and pyrimidine metabolism (Das & Herbert, 1976). Of these changes the cornerstone defect resulting in megaloblastic maturation is impaired methylation of deoxyuridine monophosphate to thymidine monophosphate (Hoffbrand et al, 1976). In this context the reduced serum uridine plus uracil levels in patients with vitamin B12 deficiency (Parry & Blackmore, 1976) and the haematological response of these patients to orotic acid therapy (Rundles & Brewer, 1958) are not readily explicable. Since the conversion of orotic acid to uridine monophosphate depends on the integrity of the coupled activities of orotidylic pyrophosphorylase and decarboxylase, this study has quantitated this capacity in peripheral blood erythrocytes in patients with vitamin B12 or folate deficiency.

Topics: Erythrocytes; Female; Folic Acid Deficiency; Glucosephosphate Dehydrogenase; Humans; Male; Orotate Phosphoribosyltransferase; Orotidine-5'-Phosphate Decarboxylase; Pyrimidines; Vitamin B 12; Vitamin B 12 Deficiency

Despite the clinical use of the 'deoxyuridine suppression test' to document vitamin B12 or folate deficiency its biochemical basis is unclear and currently disputed. Because of this the metabolism of deoxyuridine in marrow cells has been examined. In normoblastic marrow cells the ratio of radio-labelled deoxyuridine to thymidine incorporation into DNA approximates one and preincubation of cells with unlabelled deoxyuridine results in progressive reduction of uptake of both radio-labelled deoxynucleosides. In the same cells methotrexate significantly reduces the DNA incorporation of deoxyuridine but not that of thymidine. In megaloblastic marrow the ratio of radio-labelled deoxyuridine to thymidine uptake is less than one and the reduced deoxyuridine uptake is not significantly altered by either cyanocobalamin or folic acid. With megaloblastic samples the reduction by deoxyuridine of radio-labelled deoxyuridine uptake is less marked than that observed with normoblastic cells and to achieve similar results requires folic acid. These findings suggest that reduced deoxyuridylate conversion to deoxythymidylate by thymidylate synthetase is appropriate to explain the 'deoxyuridine suppression test' in megaloblastic marrow cells and that altered substrate requirements for this activity may occur in megaloblastic cells.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow; Deoxyuridine; DNA; Folic Acid; Folic Acid Deficiency; Humans; Methotrexate; Thymidine; Thymidylate Synthase; Vitamin B 12; Vitamin B 12 Deficiency

Charts of 122 patients with megaloblastic anemia due to either B12 or folic acid deficiency were reviewed for the presence of fever. Fever, defined as a temperature of 100 F (37.8 C) or more, was present in approximately 40% of the patients with both. The elevation was usually minimal but was sometimes over 104 F (40 C), usually in those with more severe anemia and thrombocytopenia, and greater elevations of SGOT and bilirubin concentration. In uncomplicated cases, the temperature returned rapidly to normal after adequate vitamin therapy. Failure of the fever to disappear rapidly with treatment should suggest the probability of some cause other than megaloblastic anemia.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Fever; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Administration, Oral; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intramuscular; Injections, Spinal; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Age Factors; Aged; Chronic Disease; Denmark; Folic Acid; Folic Acid Deficiency; Humans; Long-Term Care; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Serum vitamin levels of 40 patients undergoing parenteral nutrition over a 5-to 42-day period were studied while the subjects received daily water-soluble and once weekly fat soluble vitamin formulations intravenously. Initial serum deficiencies of vitamins A, C, and folate were noted in a large portion of the severely malnourished population. At the replacement levels used in this study a small number of patients developed subnormal levels of vitamins A and D. Improvement in levels for vitamin C and folate were noted for most patients. Vitamin B12 deficiencies were not noted in any patient. Currently available commercial vitamin preparations can be used with safety in the parenterally nourished population and recommended guidelines for weekly infusion of both water and fat soluble vitamins are presented.

Topics: Adolescent; Adult; Aged; Ascorbic Acid Deficiency; Child; Female; Folic Acid Deficiency; Humans; Male; Middle Aged; Neoplasms; Nutritional Requirements; Parenteral Nutrition; Parenteral Nutrition, Total; Vitamin A Deficiency; Vitamin B 12; Vitamin D; Vitamins

Topics: Deoxyuridine; Folic Acid; Folic Acid Deficiency; Humans; Methotrexate; Thymidine; Vitamin B 12; Vitamin B 12 Deficiency

Folic acid deficiency is very common in elderly patients who have a mean red cell volume greater than 94 fl. Eighteen out of 40 elderly patients with red cell macrocytosis who initially had normal red cell folate and serum B12 levels subsequently developed folic acid deficiency.

Topics: Aged; Erythrocyte Volume; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Time Factors; Vitamin B 12

Serum folate and B12 estimations were carried out on 272 admissions to a psychiatric unit during 1972 and 1973. 21.3% had serum folate below 2 ng/ml and 26.1% serum B12 below 150 pg/ml. The organic psychosis patients had a significantly lower mean B12 than the others, and were over-represented among the low B12 group. Low B12 status was also associated with low RBC and WBC. Low folate status was linked with depression, malnutrition, physical illness and low Hb, RBC and WBC. There were more chronic alcoholics than others with serum folate greater than 4-9 ng/ml, low RBC and macrocytosis. The presence of one or more haematological abnormalities (macrocytosis, low Hb, low RBC or low WBC) predicted low folate in 76%, and low B12 in 79%, but these were also found in 40% of the normal folate and 41% of the normal B12 patients. Macrocytosis may prove to be a reliable sign of alcoholic abuse.

Topics: Adult; Aged; Alcoholism; Depression; England; Folic Acid; Folic Acid Deficiency; Hospitals, Psychiatric; Humans; Mental Disorders; Middle Aged; Neurocognitive Disorders; Schizophrenia; Vitamin B 12; Vitamin B 12 Deficiency

The utilization of [14C]formate for serine synthesis by lymphocytes was impaired in all the patients with pernicious anaemia and in 70% of other patients with megaloblastic anaemia. In pernicious anaemia this was corrected by vitamin B12 therapy in 48 h but not by folate therapy although patients given folate showed a satisfactory haematological response.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Folic Acid; Folic Acid Deficiency; Formates; Humans; In Vitro Techniques; Lymphocytes; Serine; Vitamin B 12; Vitamin B 12 Deficiency

The concentrations of vitamin B12 in the sera from 77 patients diagnosed as suffering from the toxic optic neuropathy associated with tobacco smoking were compared with control levels and with serum folic acid concentrations from the same patients. Of these, 17 patients had associated pernicious anaemia. Serum vitamin B12 levels were significantly lower, whereas the folic acid concentrations showed great variation. Folic acid levels in the serum tended to be high when the vitamin B12 level was low (r = 0.29). The results suggest that the role of folic acid in the genesis of the optic neuropathy is not marked. However persistently low levels of folic acid occurred in one subject and significant clinical improvement resulted only from specific therapy.

Topics: Adult; Aged; Anemia, Pernicious; Female; Folic Acid; Folic Acid Deficiency; Humans; Hydroxocobalamin; Male; Middle Aged; Optic Nerve Diseases; Smoking; Visual Acuity; Vitamin B 12; Vitamin B 12 Deficiency

Most, but not all, megaloblastic anemia is produced by "ineffective erythropoiesis" in the bone marrow due to either folic acid or vitamin B12 deficiency. In folic acid deficiency the cause frequently is inadequate dietary intake, whereas vitamin B12 deficiency is almost always conditioned by some specific type of malabsorption. Anemia with oval macrocytes, few reticulocytes, moderate leukopenia, and thrombocytopenia is typical of both. Aplastic anemia, refractory anemias with cellular marrow, preleukemia, aleukemia, and erythroleukemia may have somewhat similar blood findings but are usually recognizable from bone marrow biopsy. Decreased levels of folate or vitamin B12 are the most reliable criteria of megaloblastic anemia. With these available in advance, therapy with the appropriate vitamin can be begun at once. If serum levels are unavailable or available only in retrospect, initial treatment, especially of severe anemia, should be with both vitamins. Differentiation between folate and vitamin B12 deficiency is important but impossible by blood and bone marrow morphology alone. Thus, if serum levels are unavailable, the distinction must be made, sometimes retrospectively, on the basis of other laboratory examinations, such as gastric analysis, small-bowel x-ray films, and the Schilling test.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Haemoglobin A2 levels were measured in 50 patients with vitamin B12 deficiency, 50 patients with folate deficiency, and six patients with combined deficiencies of these vitamins. All were normal except for three patients with vitamin B12 deficiency, who had a slightly elevated Hb A2 level; this fell to normal after vitamin B12 therapy. It is concluded that haemoglobin A2 levels are usually normal in vitamin B12 or folate deficiency. However, raised levels of haemoglobin A2 may be found, but these are not as high as is found in beta thalassaemia trait and should not cause difficutly in diagnosis.

Topics: Folic Acid Deficiency; Hemoglobin A; Hemoglobin A2; Humans; Vitamin B 12; Vitamin B 12 Deficiency

In 64 chronic alcoholics folic acid and vitamin B12 in plasma and folic acid in erythrocytes were determined. The mean values of folic acid in plasma and in erythrocytes were significantly below normal. The determination of vitamin B12 showed normal results in a group of 20 cases treated with vitamin B12 containing drugs, whereas in the group of untreated alcoholics significantly reduced values were found. Comparison of folic acid and vitamin B12 concentrations in plasma revealed a more frequent deficiency of folic acid than of vitamin B12, which was combined with anemia in half the alcoholics investigated. The need to treat chronic alcoholics with folic acid and vitamin B12 is pointed out.

Topics: Adult; Aged; Alcoholism; Erythrocytes; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

The probabilities of low transferrin saturation, folic acid, or vitamin B12 levels in association with various erythrocyte indices was determined from the prevalences of these abnormalities and the distributions of the indices among 206 hospitalized and 1,000 ambulatory anemic patients. At mean corpuscular hemoglobin (MCH) greater than 30 pg, the probability of low transferrin saturation was 0.04 for hospitalized patients and 0.14 for ambulatory anemic patients. For MCH less than 27 pg, the corresponding probabilities were 0.52 and 0.67. The probabilities of low vitamin B12 or folic acid levels among hospitalized anemic patients were 0.0011 for mean corpuscular volume (MCV) less than 95 cu micron and 0.18 for MCV greater than or equal to 95 cu micron, indicating that measurements of these vitamins are of very limited value in most cases of anemia. These findings indicate that in some patients, the erythrocyte indices are sufficiently predictive for or against deficiency states to facilitate decisions regarding further diagnostic tests, as opposed to the increasing tendency to order such tests regardless of the indices.

Topics: Anemia, Hypochromic; Erythrocytes; Evaluation Studies as Topic; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Methods; Transferrin; Vitamin B 12; Vitamin B 12 Deficiency

It was found that in patients with decreased serum folate concentration, urinary excretion of vitamin B12 was increased in a statistically highly significant way with both oral administration of 58 Co-labeled vitamin B12 and with a 57Co-labeled vitamin B12 intrinsic factor complex. This increased vitamin B12 excretion may account for some false normal Schilling test results. Furthermore, in folate deficiency, the intrinsic factor no longer seems required for vitamin B12 to pass the intestinal wall. It is also questionable whether vitamin B12 absorbed through the intestine under these circumstances could be properly metabolized. Besides statistical evidence, some clinical support for this theory is presented. These findings offer a possible clue for some literature reports that have lacked a satisfactory explanation.

Topics: Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Vitamin B 12

To investigate the role of folic acid deficiency in the pathogenesis of anemia in the elderly, hematological examinationa and assays of serum iron, vitamin B12 and folate were carried out on the 86 elderly patients admitted to a home for the aged. Means of red blood cell counts, hemoglobin levels and hematocrit were 385.3 x 10(4)/mm3, 12g/dl and 36%, respectively. These levels were lower than any other report in Japan. Anemia was detected in 23 out of 86 patients. Judging from mean corposcular volume and mean corposcular hemoglobin, most of them were normocytic and normochromic. Although low serum levels of iron and folate were rather frequently observed, the results on hematological examinations suggest that deficiency of these factors alone is not the cause of the anemia in the elderly patients. Rapid clearance of 5-methyl-tetrahydrofolic acid and increased excretion of formiminoglutamic acid after histidine loading were revealed in some of those who had subnormal serum folate levels. Therefore, supplementation of folic acid is recommended to those who had poor dietary intake.

Topics: Aged; Anemia; Blood Cell Count; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Humans; Iron; Male; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia, Hypochromic; Binding Sites; Blood Sedimentation; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Iron Deficiencies; Male; Middle Aged; Mouth Diseases; Prospective Studies; Recurrence; Stomatitis, Aphthous; Ulcer; Vitamin B 12; Vitamin B 12 Deficiency

The effect of a vitamin B12 and folic acid deficient diet on juvenile and adolescent baboons (Papio cynocephalus anubis) was studied. The baboons developed clinical and hematological signs characteristics of folacin deficiency, although they were less severe in juvenile baboons. The signs disappeared when folic acid was replaced in the diet. The serum vitamin B12 levels increased in all baboons fed the vitamin B12 and folic acid deficient diet. When folic acid was added to the diet, the levels gradually decreased in adolescent baboons, liver vitamin B12 levels decreased to a lesser extent when fed a vitamin B12 and folic acid deficient diet than when fed a vitamin B12 deficient diet. In juvenile baboons fed a vitamin B12 and folic acid deficient diet, for 7 months and a vitamin B12 deficient diet for a further 11 months, liver vitamin B12 levels did not decrease at any time but were similar to those in baboons fed a vitamin B12 and folic acid supplemented diet.

Topics: Aging; Animals; Blood Cells; Body Weight; Folic Acid; Folic Acid Deficiency; Haplorhini; Liver; Male; Papio; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Aged; Anemia, Pernicious; Female; Folic Acid; Folic Acid Deficiency; Humans; Iodine Radioisotopes; Liver Cirrhosis; Middle Aged; Pregnancy; Pregnancy Complications; Schilling Test; Vitamin B 12

Of 125 pregnant women, of whom 81 were treated and 44 not treated, 14 (12,5%) were found to be suffering from anemia, with a hemoglobin count to be diminished. In 31 cases iron deficiency was established and in 8 women vitamin B12 in serum was reduced. Iron and vitamin deficiencies were found more frequently in the non-treated group than in the treated group.

Topics: Adolescent; Adult; Anemia, Hypochromic; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iron; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12; Vitamin B 12 Deficiency

The metabolism of formate and histidine were compared in rats and in perfused livers of rats on diets deficient in vitamin B-12, methionine, and folic acid. Excretion of formate and formiminoglutamic acid, and the oxidation of [2-14C]histidine and [14C]formate to 14CO2 were measured. Liver folate levels decreased to 40% of normal on the vitamin B-12- and methionine-deficient diets but the rate of oxidation of histidine to CO2 in the whole animal decreased to 15% of normal. This indicated a reduction in the metabolic activity of the liver folates in vitamin B-12deficiency. Comparison of formate and histidine catabolism in folic acid deficiency showed that the oxidation of histine was decreased to 5% of normal but formate oxidation was decreased to only 30% of normal. This indicates that 25% of formate oxidation normally proceeds by a non-folate-dependent pathway.

Topics: Animals; Carbon Dioxide; Catalase; Folic Acid; Folic Acid Deficiency; Formates; Formiminoglutamic Acid; Histidine; Liver; Male; Methionine; Oxidation-Reduction; Rats; Vitamin B 12; Vitamin B 12 Deficiency

The relative amounts of folate compounds having 1--3--, 4--, 5-- and 6--glutamic acid residues in the molecule were measured in red blood cells. The results were expressed in relation to methyltetrahydrofolate pentaglutamate (5-glutamic acid residues) which is the analogue present in highest concentration. When the concentration of pentaglutamate is given a value of 100 the relative concentration of folates with 1--3--, 4--, 5-- and 6--glutamic acid residues in control subjects are 48, 48, 100 and 50 respectively. In folate deficiency there is a fall in the relative amount of the short chain glutamic acid chain compounds in addition to having an overall fall in the amount of folate present, the values for 1--3, 4, 5 and 6 chain folates being 16, 14, 100 and 39. By contrast, in untreated pernicious anaemia there is an accumulation of the short chain folates as well as an overall fall in polyglutamate concentration and the relative concentrations were 72, 44, 100 and 30. Folate polyglutamate appears to be the active coenzyme and the reltive amounts of glutamic acid residues may serve to regulate the rate of enzyme activity. In pernicious anaemia the amount of enzyme is reduced and on this hypothesis the regulatory function impaired.

Topics: Anemia, Pernicious; Erythrocytes; Folic Acid; Folic Acid Deficiency; Glutamates; Humans; Time Factors; Vitamin B 12

Topics: Arginine; Aspartic Acid; Choline; Drug Combinations; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intramuscular; Malates; Phosphorylcholine; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Vitamin B Deficiency

The pathogenesis of anemia in 84 patients with valvular protheses of the heart was investigated. A secondary deficiency of serum iron and folate, caused by chronic hemolysis, was found. There was no indication of vitamin-B12-deficiency.

Topics: Adolescent; Adult; Anemia, Hemolytic; Aortic Valve; Female; Folic Acid Deficiency; Heart Valve Prosthesis; Hemoglobins; Humans; Iron Deficiencies; Male; Middle Aged; Mitral Valve; Transferrin; Tricuspid Valve; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant, Newborn; Infant, Newborn, Diseases; Obstetric Labor Complications; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12

Megaloblastic anaemia is due to a derangement of DNA synthesis caused by insufficient supply of one or other of the four deoxyribonucleoside triphosphate (dNTP) precursors of DNA synthesis or by direct inhibition of one or other DNA polymerase. Reduced supply of the pyrimidine deoxythymidine triphosphate (dTTP) may be caused by folate or vitamin B12 deficiencies or by the action of dihydrofolate reductase inhibitors (e.g. methotrexate, pyrimethamine or trimethoprim), all of which cause reduced supply of the coenzyme 5, 10 methylene tetrahydrofolate (pentaglutamate) needed for thymidylate synthetase. Reduced dTTP supply may also be caused by direct inhibition of thymidylate synthetase by 5-fluorouracil. Reduced supply of both purines, deoxyadenosine triphosphate (dATP) and deoxyguanosine triphosphate (dGTP), may be caused by hydroxyurea, 6-mercaptopurine (and probably by another purine antagonist azaserine), whilst reduced supply of both pyrimidine DNA precursors, dTTP and dCTP (deoxycytidine triphosphate) may be due to inherited orotic aciduria or to treatment with azauridine. Cytosine arabinoside directly inhibits DNA polymerase. DNA replication is a discontinuous process and a number of enzymes are concerned with different aspects of the process. The parental strands partly unwind and a large number of initiation points or origins are activated on both strands. A primer RNA is first synthesised using the parental strand of DNA as template. Fragments of new DNA are then synthesised on the parental DNA template, starting at the RNA primer, under the action of one or other DNA polymerase (probably gamma). The RNA primer is then removed and the gap left is filled by further DNA synthesis under the action of a different DNA polymerase (probably alpha). The fragments of new DNA are joined to give newly synthesised stretches of DNA (replicons) which are then liigated together to form bulk DNA of enormous molecular weight. It is suggested here that reduced supply of one or other of the four deoxyribonucleoside triphosphate (dNTP) during the 'S' phase of the cell cycle (due to vitamin B12 or folate deficiency, drug treatment or other congenital or acquired abnormality in synthesis of the dNTP) impairs the cell's ability to elongate newly initiated DNA fragments by preventing gap-filling, the polymerase needed for gap-filling requiring substantially greater concentrations of the deoxyribonucleoside triphosphates than the polymerase involved in chain initiation. C

Topics: Anemia, Megaloblastic; DNA; Folic Acid; Folic Acid Deficiency; Formiminoglutamic Acid; Glycine; Homocysteine; Humans; Methionine; Methylmalonyl-CoA Mutase; Nervous System Diseases; Vitamin B 12; Vitamin B 12 Deficiency

The nutritional status of 80 patients with non-alcoholic chronic liver disease was assessed by determination of various nutritional parameters in body fluids. With the exception of vitamin C there was a higher incidence (40%) of fat soluble vitamin deficiency (vitamins A, E, and carotene) than of the water soluble vitamins. Less than 10% of patients showed evidence of vitamin B12, nicotinic acid, thiamin, or riboflavin deficiency, and 17% had evidence of folic acid deficiency. The presence of deficiency was not related to age of the patient or fat absorption, and an inadequate dietary intake was not a major cause of deficiency. The incidence of nutritional deficiency is less frequent in non-alcoholic as compared with alcoholic liver disease.

Topics: Adult; Aged; Ascorbic Acid Deficiency; Carotenoids; Eating; Folic Acid Deficiency; Hepatitis; Humans; Iron; Liver Cirrhosis; Male; Middle Aged; Niacinamide; Nutrition Disorders; Riboflavin; Transketolase; Vitamin A Deficiency; Vitamin B 12; Vitamin E Deficiency

The incidence of anemia after total gastrectomy has not received sufficient clinical emphasis. During a follow-up period averaging 32 months, postresectional anemia developed in seven of ten patients without evidence of malignant neoplasm; all but one of these patients had received parenterally administered cyanocobalamin. Despite low levels of circulating erythrocytes and proportionately increased erythropoietin levels, reticulocytosis was not evident. This observation suggests an uncharacterized failure of marrow erythyroid precursors. Multiple deficits in intake of constituents necessary for the production of erythrocytes were demonstrated. With the possible exception of iron, malabsorption of these constituents is not an important factor in the production of anemia. Postresectional anemia is multicausal, but is primarily nutritional. As total gastrectomy becomes more commonly employed in the treatment of nonmalignant conditions, recognition of the frequency and causes of postresectional anemia should assist both diagnostic anticipation and therapy.

Topics: Adult; Aged; Anemia; Female; Folic Acid Deficiency; Gastrectomy; Humans; Intestinal Absorption; Iron; Male; Middle Aged; Vitamin B 12

The anemia observed in patients with partial gastric resection results from a complex interrelationship of deficiencies of these three important hematemics-iron, vitamin B12, and folic acid. Reliance upon morphological evidence of anemia in the peripheral blood smear may be difficult and confusing since deficiency of one hematemic may mask the coexisting deficiency of another. It is common for deficiencies of more than one hematemic to occur in these patients. A number of studies have demonstrated the masking effect of iron deficiency on concurrent vitamin B12 or folic acid deficiency. In addition, the morphologic hallmarks of iron deficiency may be modified by the presence of deficiencies of either vitamin B12 or folate or both. Full hematologic recovery may not occur until more than one hematemic is given to the patient. It is our policy at the University of Florida to rely on serum levels of these three hematemics, especially vitamin B12 and iron, to detect the cause of the anemia in a patient with partial gastric resection. Less reliance is placed upon the appearance of the peripheral smear because of the masking effect described above. If either the serum iron level or vitamin B12 level is decreased, we treat the patient with a preparation such as ferrous sulfate (300 mg. orally three times a day) and vitamin B12 (100 mug. intramuscularly once a month). We are less concerned with folic acid deficiency because of its relatively infrequent occurrence in this setting and because a good diet will usually suffice as adequate therapy for the folic acid deficiency when present. In patients who have had partial gastric resection but who are not anemic, we assess vitamin B12 absorption by the conventional vitamin B12 urinary excretion test (Schilling test) on a yearly basis since deficiency of this hematemic may lead to serious hematologic and neurologic sequelae. If the patient manifests decreased vitamin B12 absorption uncorrected by the administration of pancreatic extract or antibiotics, this patient is also treated with 100 mug. of vitamin B12 intramuscularly on a monthly basis. We have not evaluated the absorption of food B12 as suggested by Doscherholmen. Perhaps more attention should be paid to this aspect of vitamin B12 absorption in these patients. Indeed, because of the serious complications of vitamin B12 deficiency and the observations that deficiencies of this vitamin may occur even when the absorption of crystalline vitamin B12 is normal in the

Topics: Anemia, Hypochromic; Ferrous Compounds; Folic Acid Deficiency; Humans; Postgastrectomy Syndromes; Vitamin B 12; Vitamin B 12 Deficiency

In an attempt to throw light on the question of age-related variations in the normal blood content of cobalamin and on the frequency of deficiencies of antimegaloblastic nutriments in the elderly, 273 geriatric patients have been investigated. Low serum vitamin B12 values were found in one third of these patients, due to latent pernicious anaemia in five and malabsorption in seven cases, and probably caused by nutritional deficiency of folate or cobalamin in 78 cases. In that part of the series with apparently normal vitamin B12 levels, the mean value (379+/-14 pg/ml) was lower than the mean (456+/-20 pg/ml) for a younger control group. However, this cannot be taken as a sign of a physiological lowering of the cobalamin values with age, as nutritional deficiencies could not be ruled out in this part of the series. It is concluded that serum vitamin B12 assays should be performed rather liberally in the aged. Patients with nutritional deficiency of cobalamin or folate should be treated, even if frank megaloblastic anaemia is not present.

Topics: Age Factors; Aged; Anemia, Pernicious; Female; FIGLU Test; Folic Acid Deficiency; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Anemia, Megaloblastic; Animals; Antibody Formation; Child; Disease Models, Animal; DNA Replication; Folic Acid; Folic Acid Deficiency; Humans; Iron; Lectins; Lymphocytes; Middle Aged; Nutrition Disorders; Rats; Spleen; Thymus Gland; Transferrin; Vitamin B 12

Thymidine kinase has been measured in phytohaemagglutinin (PHA)-stimulated lymphocytes from 13 normal subjects and eight patients with megaloblastic anaemia. The levels in normal subjects ranged from 0.20 to 2.10 units/mg protein (mean 0.903 units/mg protein) and in megaloblastic anaemia from 2.99 to 9.97 units/mg protein). All the patients showed raised levels of the enzyme which were partly but not completely reduced to normal by addition of folic acid in vitro. Vitamin B12 in vitro had a lowering effect in the five vitamin-B12-deficient patients and two patients with combined deficiencies but not in one 'pure' folate-deficient patient. Thymidine kinase activity was highest in the cells of the least anaemic patients, suggesting that the degree of anaemia in megaloblastic anaemia may be determined in part by the ability of the cells to utilize thymidine by the 'salvage' pathway when the de novo pathway of thymidylate synthesis is failing. The rise in thymidine kinase activity in megaloblastic anaemia is presumably due to induction of the enzyme. Addition of methotrexate or 5-fluorouracil, drugs known to inhibit de novo thymidylate synthesis, caused an increase in thymidine kinase activity in normal PHA-stimulated lymphocytes after 24 h (but not after 1 h) which could be completely blocked by addition of puromycin. Thymidine mono- and di-phosphate kinases were also measured in normal PHA-stimulated lymphocytes. The activities were substantially higher than that of thymidine kinase and their activities were unaffected by methotrexate addition.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Female; Fluorouracil; Folic Acid; Folic Acid Deficiency; Humans; Lectins; Lymphocyte Activation; Male; Methotrexate; Puromycin; Sonication; Thymidine Kinase; Vitamin B 12; Vitamin B 12 Deficiency

Biochemical disturbances common to vitamin B12 and folate deficiency were investigated in leukocytes from patients with cobalamin deficiency. The investigations focused on the only two human metabolic pathways known to require vitamin B12. In the propionate pathway, deoxyadenosylcobalamin is required for isomerization of methylmalonyl-CoA to succinyl-CoA. Leukocyte oxidation of 14C-propionate to 14CO2 was markedly decreased in 9 patients with Addisonian cobalamin deficiency and 2 patients with low serum cobalamin associated with folate deficiency, whereas 14C-succinate oxidation was normal. Three of the Addisonian patients had only minimal anemia. Within 4 days after one injection of 1,000 mug of cyanocobalamin, in 7 out of 8 patients studied, leukocyte propionate oxidation increased to normal levels. In folate-mediated one-carbon metabolism, as measured by serine biosynthesis from formate, methylcobalamin is required for conversion of methyl-folate to tetrahydrofolate. Leukocyte formation of 14C-serine from 14C-formate was significantly depressed in 5 patients with low serum cobalamin, little or no anemia, and only marginally low total red cell folate, the low serum cobalamin in 2 of these patients was associated with folate deficiency. After 1,000 mug of cyanocobalamin, in 2 of 3 patients, leukocyte serine biosynthesis increased to the normal range. These observations demonstrated that these two metabolic pathways in leukocytes were sensitive to cobalamin deficiency, and responsive to cobalamin therapy. Although there was no correlation between either of these metabolic activities and the serum cobalamin, red cell folate, or hematocrit, there was a striking correlation between impairment of leukocyte propionate oxidation and of leukocyte serine biosynthesis in 5 patients who were minimally anemic. The remarkably close correspondence between effects of low cobalamin on these two metabolic pathways, in nonanemic patients, must be a direct consequence of their common requirements for a cobalamin co-enzyme. These findings emphasize the importance of cobalamin in folate metabolism, and are consistent with the hypothesis that folate is "trapped" as methyl-folate in cobalamin deficiency, but do not exclude the possibility that this "trapping" is caused by a third metabolic function of cobalamin which might mediate transport of folate into cells.

Topics: Adult; Aged; Anemia, Pernicious; Female; Folic Acid; Folic Acid Deficiency; Humans; Leukocyte Count; Leukocytes; Male; Middle Aged; Neutrophils; Propionates; Serine; Succinates; Vitamin B 12; Vitamin B 12 Deficiency

Normal red cells in man were found to contain predominantly folate pentaglutamates with smaller amounts of tetra- and hexapolyglutamates. There was no change in the type of polyglutamate present in red cells from patients with vitamin B12 deficiency and primary folate deficiency. In contrast to the fall in red cell polyglutamate concentration in vitamin B12 deficiency, there was a marked fall in short-chain folates in early folate deficiency (treated non-anaemic epileptics) and a fall in both short chain and long chain polyglutamates in patients with severe folate deficiency and megaloblastic anaemia. These differences in folate distribution within cells exclude a primary failure to transport methylfolate into cells as the lesion in vitamin B12 deficiency. The failure of folate polyglutamate synthesis in ivtamin B12 deficiency arises either from a failure to provide the proper substrate for polyglutamate synthesis or to a direct requirement for vitamin B12 for polyglutamate synthesis.

Topics: Anemia, Pernicious; Epilepsy; Erythrocytes; Folic Acid; Folic Acid Deficiency; Glutamates; Humans; Peptide Biosynthesis; Peptides; Vitamin B 12; Vitamin B 12 Deficiency

The correlations between the deoxyuridine-suppressed value and some conventional haematological parameters (Hb concentration, red cell count, MCV, total white cell count, red cell folate level and serum vitamin B12 level) have been investigated in 40 patients with megaloblastic haemopoiesis due to folate or vitamin B12. deficiency. The only statistically significant correlations found were (a) an inverse correlation between the deoxyuridine-suppressed value and the Hb level or red cell count in both the folate- and vitamin B12-deficient groups and (b) a direct correlation between the deoxyuridine-suppressed value and MCV in the vitamin B12-deficient group. The results indicated that the deoxyuridine-suppressed value was a better index of the magnitude of the disturbance in red cell production induced by folate or vitamin B12 deficiency than either the red cell folate or serum vitamin B12 levels.

Topics: Bone Marrow; Bone Marrow Cells; Deoxyuridine; Erythrocytes; Folic Acid Deficiency; Hematocrit; Hemoglobins; Humans; Leukocytes; Vitamin B 12; Vitamin B 12 Deficiency

Ten patients with severe neurological disease that was clinically indistinguishable from subacute combined degeneration of the spinal cord were found to have normal serum vitamin B12 levels. All were folate deficient. Specific folate treatment led to significant reversal of the neuropathy. These findings indicate the need to review orthodox concepts of the role of folic acid in maintaining the integrity of the nervous system.

Topics: Aged; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Nervous System Diseases; Vitamin B 12

Reports concerning the interaction between steroidal contraceptives (the combined pill) and vitamins indicate that in users the mean serum-vitamin-A level is raised and the mean serum-vitamin-B2 (riboflavine), vitamin-B6 (pyridoxine), vitamine-C, folic-acid, and vitamin-B12 levels are reduced. Other vitamins have been insufficiently studied for comment. Biochemical evidence of co-enzyme deficiency has been reported for vitamin B2, vitamin B6, and folic acid. Clinical effects due to vitamin deficiency have been described for vitamin B6--namely, depression and impaired glucose tolerance. Folic-acid deficiency with megaloblastic anaemia has been reported in only 21 cases.

Topics: Anemia, Megaloblastic; Ascorbic Acid; Avitaminosis; Coenzymes; Contraceptives, Oral; Depression; Female; Folic Acid Deficiency; Glucose Tolerance Test; Humans; Pyridoxine; Riboflavin; Vitamin A; Vitamin B 12; Vitamin B 6 Deficiency

Since trimethoprim-sulfamethoxazole (TMP-SMX) was first marked occasional reviews have surveyed the pattern of adverse reactions. Skin rashes characteristic of sulfonamide sensitivity have predominated, with relatively few of a serious exfoliative nature. Hematologic adverse reactions recorded follow the pattern known to occur with sulfonamides, with a few cases related to the action of trimethoprim on human folate metabolism. Such an effect is more likely to occur when the patient's folate status is already jeopardized; it is rare in relation to the widespread use of the drug combination. Long-term administration does not per se seem to represent an additional hazard provided the dose is the correct one and the hematologic monitoring of the patient is performed regularly. The suggestion that TMP-SMX has a toxic effect on the kidney has not been substantiated. An estimated 250 million "standard treatment courses" have been given in the first 6 years of marketing and, overall, the picture of adverse reactions corresponds with that expected from a sulfonamide of relatively low toxicity.

Topics: Adult; Aged; Bacterial Infections; Blood Cell Count; Blood Cells; Blood Platelets; Child; Drug Combinations; Drug Eruptions; Drug Evaluation; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Gastrointestinal Diseases; Hematologic Diseases; Hemoglobins; Humans; Long-Term Care; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Vitamin B 12

Transcobalamins are proteins which carry vitamin B12 and which are normally partly unsaturated. This study of transcobalamins was carried out in 17 subjects with megaloblastic anemia (12 true cases of pernicious anemia and 5 cases of folate deficiency). Among the latter, the transcobalamins were studied in 4 cases of pernicious anemia, before and after treatment with vitamin B12. The distribution of endogenous B12 was determined in four normal controls and two cases of pernicious anemia. This vitamin is normally distributed roughly equally between the three transcobalamins, whereas in B12 deficiency, T.C.2 is very unsaturated together with T.C.1 to a lesser degree. The latent fixation capacity of the serum is increased together with the latent fixation capacity of T.C. I and, above all, T.C. II but that of T.C. III is reduced in patients with pernicious anemia. In folate deficiency, only the latent fixation capacity of T.C. II is increased. When vitamin B12 is administered in physiological dosage, T.C. I becomes gradually saturated. In pharmacological dosage, total fixation capacity together with that of T.C. I and T.C. II become gradually reduced, but in spite of high levels of circulating B12, these proteins remain partially unsaturated. Various theories are suggested to explain the variations of these three transcobalamins in megaloblastic anemia but the problem is still unclear.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Blood Proteins; Folic Acid; Folic Acid Deficiency; Humans; Kinetics; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

One case each of pernicious anemia and folic acid deficiency with chronic malabsorption with disease of the cord and histologically demonstrated concomitant disease of the peripheral nerve system in the sense of a polyneuropathy are described. The histological findings of nerve obtained by biopsy show, in both cases, the loss of individual nerve fibers as an expression of a chronic axonal degeneration. The pathogenetic basis to be considered in these cases is presented.

Topics: Aged; Anemia, Pernicious; Axons; Female; Folic Acid Deficiency; Humans; Leg; Malabsorption Syndromes; Male; Middle Aged; Nerve Degeneration; Neurologic Manifestations; Peripheral Nerves; Peripheral Nervous System Diseases; Spinal Cord Diseases; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Age Factors; Aged; Anemia; Bone Marrow; Bone Marrow Cells; Bone Marrow Examination; Child; Child, Preschool; Erythrocytes; Erythropoiesis; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Infant; Leukemia; Male; Megaloblasts; Middle Aged; Sex Factors; Transferrin; Vitamin B 12; Vitamin B 12 Deficiency

Because virtually all cases of vitamin B12 deficiency seen in this country are due to malabsorption, the availability of radioactive vitamin B12 for direct measurement of absorption of this essential nutrient has proved to be of great clinical value. These tests are useful not only in demonstrating vitamin B12 malabsorption but also often in defining the pathophysiological mechanism responsible for this abnormality. The urinary excretion test of Schilling remains the most useful test for vitamin B12 absorption. Minor precautions and modifications in technique make the test results more reliable and easier to interpret. The 8-hr plasma test for vitamin B12 absorption can no longer be considered acceptable. Some patients with vitamin B12 malabsorption have results in the normal range when studied by this method. Serum vitamin B12 assays utilizing radioactive vitamin B12 and the isotope dilution principle are not widely used and are useful screening tests. Low normal or borderline results observed in patients with clinical evidence suggestive of vitamin B12 deficiency should be interpreted with caution or confirmed by radioactive vitamin B12 absorption studies. Radioactive vitamin B12 can also be used for rapid, reliable assay of gastric intrinsic factor, antibody to intrinsic factor and unsaturated vitamin B12 serum. Methods using radioactive folate compounds for similar in vivo and in vitro studies are not yet applicable for routine use in nuclear medicine laboratories.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Cobalt Radioisotopes; Erythrocytes; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Intrinsic Factor; Radioimmunoassay; Radioisotope Dilution Technique; Schilling Test; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Alcoholism; Diarrhea; Folic Acid Deficiency; Humans; Intestinal Absorption; Intestinal Diseases; Intestine, Small; Malabsorption Syndromes; Vitamin B 12; Xylose

The occurrence of anemia in a group of aged persons residing in a home for the aged and in a chronic disease hospital was reviewed with regard to etiology, choice of treatment, and therapeutic response. Of the 484 patients, 151 (31 per cent) had anemia or were receiving antianemia therapy. Iron-deficiency anemia was the most common type, and iron was the most common form of treatment. Seventy-eight patients were given antianemia therapy in 97 courses, and a good therapeutic result was achieved in about one-fourth of the courses. The most frequent error in iron therapy was its use in the anemia associated with chronic disorders. Often there was a combination deficiency of iron, vitamin B12 and folic acid. The response to iron in the elderly can be very slow, so therapy should not be discontinued too soon. Anemia may directly contribute to other serious pathologic conditions, especially in aged persons with impaired circulation. In some cases the physiologic concentration of hemoglobin may be higher than the accepted "normal" value. The course of the anemia in relation to the general state of the patient is more significant than any laboratory data in choosing antianemia therapy. Practical laboratory screening procedures for elderly anemic patients are discussed.

Topics: Aged; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Chronic Disease; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iron; Male; Vitamin B 12

Levels of plasma folate, erythrocyte folate and serum vitamin B12 were measured in 106 essentially healthy persons grouped both as to race and economic--educational status. Whereas the mean values of the three assays did not differ significantly among groups, values of plasma folate below the usual limits of normal were more prevalent in the migrant worker and urban clinic groups. Persons with low plasma folate levels did not have symptomatic deficiency as evaluated by hematocrit, peripheral blood smears and erythrocyte folate levels. The interpretation of the plasma folate requires reference values from a healthy population selected to be comparable to the study group. The diagnosis of deficiency, or at least the degree of deficiency, requires clinical and laboratory evaluations beyond the plasma folate.

Topics: Adult; Agriculture; Black People; Educational Status; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Humans; Male; Personnel, Hospital; Sex Factors; Socioeconomic Factors; Transients and Migrants; Urban Population; Vitamin B 12

A series of 130 consecutive outpatients with recurrent aphthous stomatitis were screened at the oral medicine department, Glasgow Dental Hospital, for deficienciesin vitamin b12, folic acid, and iron. In 23 patients (17.7%) such deficiencies werefound; five were deficient in vitamin B12, seven in folic acid, and 15 in iron. Four had more than one deficiency. Out of 130 controls matched for age and sex 11 (8.5%) were found to have deficiencies. The 23 deficient patients with recurrent aphthaewere treated with specific replacement therapy, and all 130 patients were followed up for at least one year. Of the 23 patients on replacement therapy 15 showed complete remission of ulceration and eight definite improvement. Of the 107 patientswith no deficiency receiving local symptomatic treatment only 33 had a remission or wereimproved. This difference was significant (P less than 0.001). Most patients withproved vitamin B12 or folic acid deficiency improved rapidly on replacement therapy;those with iron deficiency showed a less dramatic response. The 23 deficient patientswere further investigated to determine the cause of their deficiencies and detect the presence of any associated conditions. Four were found to have Addisonian perniciousanaemia. Seven had a malabsorption syndrome, which in five proved to be a gluten-induced enteropathy. In addition, there were single patients with idiopathic proctocolitis, diverticular disease of the colon, regional enterocolitis, and adenocarcinoma of thecaecum. We suggest that the high incidence of deficiencies found in this series andthe good response to replacement therapy shows the need for haematological screening of such patients.

Topics: Adenocarcinoma; Adolescent; Adult; Aged; Anemia, Pernicious; Cecal Neoplasms; Child; Colitis; Crohn Disease; Diverticulum, Colon; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Iron Deficiencies; Malabsorption Syndromes; Male; Middle Aged; Proctitis; Recurrence; Stomatitis, Aphthous; Vitamin B 12; Vitamin B 12 Deficiency

Cholestyramine in a mean dosage of 0-6 g/kg/day has been given to 18 children with familial hypercholesterolaemia for between one and two and a half years. With prolonged treatment folate deficiency occurred, as evidenced by a fall in the mean serum folate concentration from 7-7 ng/ml before treatment to 4-4 ng/ml for patients on treatment for over one year; a corresponding lowering of red cell folate was also seen. Oral folic acid 5 mg daily overcame this depletion, and should be given to all patients on long-term anion exchange resins. Prothrombin time has remained normal in all patients; there has been a significant decrease in the mean serum concentrations of vitamins A and E and of inorganic phosphorus over the first two years of treatment, although values remain within the normal range. The routine administration of fat-soluble vitamins appears unnecessary but it is prudent to measure prothrombin time and serum vitamins A and E at intervals. In children who were having a normal intake of dietary fat five out of seven tested had faecal fat of over 5 g/day while on cholestyramine. No chold has developed diarrhoea, and growth has been normal. The concentrations of serum iron, vitamin B12, plasma calcium, and protein did not change significantly in any patient.

Topics: Animals; Blood Proteins; Calcium; Child; Child, Preschool; Cholestyramine Resin; Dietary Fats; Erythrocytes; Feces; Folic Acid; Folic Acid Deficiency; Growth; Humans; Hypercholesterolemia; Infant; Intestinal Absorption; Iron; Phosphorus; Prothrombin Time; Rats; Vitamin A; Vitamin B 12; Vitamin E

Topics: Administration, Oral; Anemia, Macrocytic; Anemia, Megaloblastic; Diagnosis, Differential; DNA; Electroencephalography; Electromyography; Folic Acid Deficiency; Humans; Mental Disorders; Syndrome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Deficiency

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Ascorbic Acid Deficiency; Child; Female; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Infant; Intestinal Diseases; Malabsorption Syndromes; Nutritional Physiological Phenomena; Nutritional Requirements; Orotic Acid; Pregnancy; Pregnancy Complications; Tetrahydrofolate Dehydrogenase; Thiamine Deficiency; Transferases; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin E Deficiency

Topics: Anemia, Hemolytic, Autoimmune; Anemia, Pernicious; Anthraquinones; Bone Marrow; Bone Marrow Cells; Coenzyme A; Cytoplasm; Erythrocytes, Abnormal; Fluorescent Dyes; Folic Acid Deficiency; Humans; Leukemia, Erythroblastic, Acute; Megaloblasts; Microscopy, Fluorescence; NADP; Staining and Labeling; Vitamin B 12

Topics: Adolescent; Adult; Australia; Biological Assay; Breast Feeding; Diet; Ethnicity; Euglena gracilis; Female; Folic Acid; Folic Acid Deficiency; Greece; Hemoglobins; Humans; Italy; Lactation; Lacticaseibacillus casei; Pregnancy; Pregnancy Complications; Umbilical Cord; United Kingdom; Vitamin B 12

Topics: Adolescent; Adult; Aged; Biological Assay; Diet; Erythrocytes; Feeding Behavior; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Hemoglobins; Humans; Lactation; Lacticaseibacillus casei; Middle Aged; Pilot Projects; Pregnancy; Pregnancy Complications; Radioisotope Dilution Technique; Vitamin B 12; Zea mays

Topics: Anemia, Pernicious; Animals; Biological Assay; Blood Proteins; Chickens; Cobalt Radioisotopes; Euglena gracilis; Female; Folic Acid Deficiency; Humans; Intrinsic Factor; Lactobacillus; Leukemia, Myeloid; Polycythemia Vera; Postgastrectomy Syndromes; Pregnancy; Protein Binding; Radioisotope Dilution Technique; Umbilical Cord; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Alcohol Amnestic Disorder; Alcoholism; Alkaline Phosphatase; Aspartate Aminotransferases; Biological Assay; Epilepsy; Euglena gracilis; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Humans; Lacticaseibacillus casei; Liver Diseases; Male; Middle Aged; Pyridoxal; Vitamin B 12

Topics: Administration, Oral; Anemia, Megaloblastic; Child; Child, Preschool; Cobalt Radioisotopes; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Ileum; Infant; Injections; Intestinal Absorption; Male; Postoperative Complications; Puberty; Vitamin B 12; Whole-Body Counting

Topics: Anemia, Macrocytic; Anemia, Pernicious; Blood Cell Count; Diet, Vegetarian; Drug-Related Side Effects and Adverse Reactions; Folic Acid; Folic Acid Deficiency; Humans; Hydroxocobalamin; Intestinal Diseases; Potassium; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Anemia, Macrocytic; Anemia, Megaloblastic; Drug Combinations; Female; Folic Acid Deficiency; Hemorrhage; Humans; Infectious Mononucleosis; Pyrimethamine; Sulfamethoxazole; Trimethoprim; Vitamin B 12

Topics: Adult; Anemia, Megaloblastic; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinopathies; Humans; Pregnancy; Thalassemia; Vitamin B 12

Topics: Administration, Oral; Adolescent; Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Child; Diet Therapy; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Injections, Intramuscular; Intestinal Absorption; Intestine, Small; Male; Middle Aged; Nucleoproteins; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Animals; Azo Compounds; Body Weight; Diet; FIGLU Test; Folic Acid; Folic Acid Deficiency; Glutarates; Growth; Homocysteine; Liver; Male; Methionine; Methods; Rats; Tetrahydrofolates; Thyroid (USP); Thyroid Hormones; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Hypochromic; China; Ethnicity; Female; Folic Acid; Folic Acid Deficiency; Humans; India; Infant, Newborn; Iron; Malaysia; Pregnancy; Pregnancy Complications, Hematologic; Umbilical Cord; Vitamin B 12

The blood concentrations of vitamin B12 and folate, which are very useful in diagnosis of megaloblastic anemia and of these factors' dificiencies, are actually measured by precise, rapid, and specific competitive binding radioassays. Futher clinical advantages can be reached with the application of other in vitro radioisotope techniques, such as radioassay of IF, of antibodies anti-IF, of transcobalamins, and of FABP (folic acid binding protein). The major impact of the vitamin B12, folates and other related radioassays has been to permit more Hospitals and laboratories to do these determinations, replacing the more time-consuming, relatively imprecise, and often artifactual microbiological assays.

Topics: Anemia, Megaloblastic; Anemia, Sideroblastic; Antibodies; FIGLU Test; Folic Acid; Folic Acid Deficiency; Intrinsic Factor; Radioimmunoassay; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Child; Crohn Disease; Duodenal Ulcer; Female; Folic Acid; Folic Acid Deficiency; Humans; Ileitis; Intestinal Absorption; Intestine, Small; Jejunum; Male; Middle Aged; Osteomalacia; Potassium; Radiography; Serum Albumin; Vitamin B 12

Topics: Anemia, Macrocytic; Animals; Asthenia; Body Weight; Diarrhea; Feeding and Eating Disorders; FIGLU Test; Folic Acid; Folic Acid Deficiency; Gingivitis; Humans; Leukopenia; Liver; Male; Malonates; Papio; Thrombocytopenia; Vitamin B 12

Topics: Adult; Aged; Anemia; Deficiency Diseases; Erythrocyte Count; Erythrocytes; Erythrocytes, Abnormal; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Gastrectomy; Hemoglobins; Humans; Iron; Leukocyte Count; Male; Middle Aged; Neutrophils; Postgastrectomy Syndromes; Protein Binding; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Pernicious; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Hemolytic; Anemia, Macrocytic; Anemia, Pernicious; Erythrocytes, Abnormal; Folic Acid; Folic Acid Deficiency; Humans; Leukemia; Liver Cirrhosis; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anticonvulsants; Blood-Brain Barrier; Folic Acid Deficiency; Humans; Phenobarbital; Phenytoin; Primidone; Vitamin B 12

Topics: Anemia, Macrocytic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Animals; Body Weight; Brain; Dihydroxyphenylalanine; Folic Acid; Folic Acid Deficiency; Kidney; Liver; Male; Methionine; Organ Size; Organ Specificity; Rats; S-Adenosylmethionine; Time Factors; Vitamin B 12

Topics: Alcoholism; Anemia; Automation; Erythrocyte Count; Erythrocytes, Abnormal; Ethanol; Fatty Liver; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobinometry; Humans; Liver Function Tests; Male; Mass Screening; Sex Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Intestinal Absorption; Malabsorption Syndromes; Male; Middle Aged; Postgastrectomy Syndromes; Time Factors; Tritium; Vitamin B 12

Topics: Animals; Betaine; Carcinogens; Choline; Diet; Drinking; FIGLU Test; Folic Acid; Folic Acid Deficiency; Glutamates; Histidine; Liver; Male; Methionine; Nitrosamines; Rats; Stimulation, Chemical; Transferases; Urocanate Hydratase; Vitamin B 12

Topics: Anemia, Aplastic; Anemia, Macrocytic; Anemia, Sideroblastic; Bone Marrow Examination; Erythrocytes; Erythropoiesis; Folic Acid; Folic Acid Deficiency; Hematocrit; Humans; Lacticaseibacillus casei; Lactobacillus; Methods; Myxedema; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Administration, Oral; Anemia, Pernicious; Biological Assay; Chromatography, Gas; Erythrocyte Count; Folic Acid Deficiency; Humans; Isoleucine; Lacticaseibacillus casei; Lactobacillus; Leucine; Liver Cirrhosis; Malonates; Methionine; Stimulation, Chemical; Valine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Anemia, Pernicious; Chloramphenicol; Cyclic AMP; Cycloheximide; Dactinomycin; DNA; Edetic Acid; Female; Folic Acid Deficiency; Hematopoiesis; Humans; Lectins; Leukocytes; Lymphocyte Activation; Lymphocytes; Male; Middle Aged; Puromycin; RNA; Theophylline; Time Factors; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adenine; Animals; Carcinoma 256, Walker; Carcinoma, Hepatocellular; Choline; Diet; FIGLU Test; Folic Acid; Folic Acid Deficiency; Formates; Glycine; Guanine; Liver Neoplasms; Male; Methionine; Neoplasms, Experimental; Rats; Serine; Thymidine; Vitamin B 12

Thirteen cases are described of temporary malabsorption in adults presenting after an episode of apparent infective enteritis. Clinical features included diarrohea, anorexia, and weight loss. Investigations indicated diffuse impairment of function in the small bowel, including the ileum, with well-preserved mucosal morphology in the upper jejunum and a tendency to rapid folate depletion. Spontaneous recovery usually occurred within weeks but two cases ran a more prolonged and severe course.The clinical features of this syndrome are those of tropical sprue, but the outcome of the illness is probably influenced by nutritional as well as environmental factors. There may be a gradation of severity of illness from megaloblastic anaemia to florid malabsorption syndrome.

Topics: Adult; Agglutination Tests; Anemia, Macrocytic; Body Weight; Diarrhea; Enteritis; Feeding and Eating Disorders; Folic Acid Deficiency; Humans; Ileum; Intestine, Small; Jejunum; Malabsorption Syndromes; Middle Aged; Sprue, Tropical; Vitamin B 12

Topics: Administration, Oral; Anemia, Macrocytic; Child; Consanguinity; Female; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intramuscular; Intestinal Absorption; Leucovorin; Metabolism, Inborn Errors; Recurrence; Stomatitis; Vitamin B 12; Yeast, Dried

As part of a WHO collaborative programme the prevalence of anaemia was studied and the serum concentrations of iron, folate, and vitamin B(12) were measured in 1 000 pregnant women from southern India. The results of the study show a high prevalence of anaemia, resulting from iron and folate deficiency with iron deficiency predominating. Interrelationships between these nutrients and their effect on pregnancy and the fetus were investigated. The results indicate that, in comparison with populations in developed countries, there was a high prevalence of iron and vitamin B(12) deficiency in the community, but the state of folate nutrition was similar to that found elsewhere.

Topics: Adolescent; Adult; Anemia, Hypochromic; Female; Folic Acid; Folic Acid Deficiency; Humans; India; Iron; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12; Vitamin B 12 Deficiency; World Health Organization

Topics: Anemia, Macrocytic; Blood Proteins; Bone Marrow; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infant Nutrition Disorders; Kwashiorkor; Male; Myelography; Protein-Energy Malnutrition; Vitamin B 12

Topics: Animals; Disease Models, Animal; Flurothyl; Folic Acid; Folic Acid Deficiency; Male; Phenobarbital; Rats; Seizures; Vitamin B 12

Topics: Administration, Oral; Adult; Bone Marrow; Bone Marrow Cells; Celiac Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intravenous; Intestinal Mucosa; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Age Factors; Aged; Anemia, Hypochromic; Ascorbic Acid; Diet; Female; Folic Acid; Folic Acid Deficiency; Gastrointestinal Diseases; Hemoglobinometry; Humans; Iron; Male; Protein Binding; Salicylates; Scotland; Sex Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Pernicious; Bone Marrow; Bone Marrow Cells; Folic Acid; Folic Acid Deficiency; Humans; Tetrahydrofolates; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Alcoholism; Blood Cell Count; Blood Platelets; Chromium Isotopes; Diet; Erythrocytes; Erythropoiesis; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Humans; Iron; Iron Isotopes; Megakaryocytes; Pyridoxine; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Sickle Cell; Child; FIGLU Test; Folic Acid; Folic Acid Deficiency; Growth Disorders; Hemoglobinometry; Histidine; Humans; Intestinal Absorption; Male; Recurrence; Vitamin B 12

Topics: Adult; Aged; Alcoholism; Bone Marrow Cells; Bone Marrow Examination; Female; Folic Acid Deficiency; Humans; Leukocyte Count; Leukopenia; Liver Function Tests; Male; Middle Aged; Protein Binding; Vitamin B 12

In a general medical hospital population the neurological status of 24 patients with severe folate deficiency was compared with that of a control group of 21 patients with normal serum folate. A significant increase of organic brain syndrome and pyramidal tract damage was found in the folate-deficient group. These findings were independent of the degree of anaemia or the presence of alcoholism. These data are consistent with the view that severe folate deficiency may cause neurological deficits.

Topics: Alcoholism; Anemia; Brain Diseases; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Nervous System Diseases; Pyramidal Tracts; Reflex, Abnormal; Vitamin B 12

Topics: Adolescent; Adult; Anemia; Anemia, Hypochromic; Child; Child, Preschool; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infant, Newborn; Iron; Male; Nonprescription Drugs; Pregnancy; Substance-Related Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Alcoholism; Anemia, Macrocytic; Electronics, Medical; Erythrocytes; Folic Acid; Folic Acid Deficiency; Humans; Liver Diseases; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Aged; Anemia, Pernicious; Blood Proteins; Carbon Isotopes; Female; Folic Acid; Folic Acid Deficiency; Formates; Humans; Lymphocytes; Male; Methionine; Methods; Middle Aged; RNA; Serine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Bone Marrow; Deoxyuridine; DNA; Folic Acid; Folic Acid Deficiency; Humans; In Vitro Techniques; Iodine Isotopes; Methods; Thymidine; Thymine; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Epilepsy; Folic Acid; Folic Acid Deficiency; Humans; Phenobarbital; Phenytoin; Primidone; Vitamin B 12

Topics: Anemia, Macrocytic; Diagnosis, Differential; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Anemia, Macrocytic; Brain Diseases; Folic Acid Deficiency; Humans; Intestinal Obstruction; Jejunum; Malabsorption Syndromes; Male; Neurologic Manifestations; Time Factors; Vitamin B 12

Topics: Adult; Aged; Anemia; Anemia, Hypochromic; Erythrocytes; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Gastrectomy; Hematocrit; Humans; Iron; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Anemia; Breast Feeding; Child; Child, Preschool; Female; Folic Acid Deficiency; Hemoglobins; Humans; Infant; Iron; Male; Transferrin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Anemia, Macrocytic; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Mental Disorders; Vitamin B 12

Topics: Adolescent; Age Factors; Anemia; Anemia, Hypochromic; Ascariasis; Blood Proteins; Child; Deficiency Diseases; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobinometry; Humans; Intestinal Diseases, Parasitic; Iron; Male; Philippines; Transferrin; Trichuriasis; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Aplastic; Anemia, Macrocytic; Blood Cell Count; Folic Acid; Folic Acid Deficiency; Humans; Iron; Middle Aged; Nalidixic Acid; Nutrition Disorders; Pyelonephritis; Sulfamethoxazole; Trimethoprim; Urea; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Female; Folic Acid; Folic Acid Deficiency; Pregnancy; Pregnancy Complications; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Diet, Reducing; Female; Folic Acid Deficiency; Humans; Protein Deficiency; Starvation; Vitamin B 12

Topics: Anemia, Pernicious; Charcoal; Cobalt Isotopes; Cyanides; Euglena gracilis; Folic Acid Deficiency; Gastric Juice; Hemoglobins; Humans; Intrinsic Factor; Radioisotope Dilution Technique; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Biological Assay; Cobalt Isotopes; Erythrocyte Count; Euglena gracilis; Folic Acid; Folic Acid Deficiency; Gastrectomy; Hemoglobins; Humans; Lactobacillus; Methods; Reticulocytes; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Alcoholism; Anemia, Macrocytic; Anemia, Pernicious; Blood Cell Count; Bone Marrow Cells; Erythroplasia; Female; Folic Acid; Folic Acid Deficiency; Hematopoietic Stem Cells; Humans; Hypothyroidism; Kidney Diseases; L-Lactate Dehydrogenase; Male; Neutrophils; Nutrition Disorders; Pregnancy; Pregnancy Complications, Hematologic; Reticulocytes; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Bone Marrow; Bone Marrow Examination; Crohn Disease; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Male; Middle Aged; Prospective Studies; Recurrence; Transferrin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Vitamin B 12

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Bone Marrow; Bone Marrow Cells; Child; Folic Acid Deficiency; Follow-Up Studies; Humans; Infant; Iron; Neutrophils; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Animals; Female; Folic Acid; Folic Acid Deficiency; Goats; Humans; Infant; Milk; Vitamin B 12

Topics: Anemia, Macrocytic; Blood Proteins; Bone Marrow Examination; Child Nutritional Physiological Phenomena; Child, Preschool; Erythrocyte Count; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Humans; Infant; Infant Food; Infant Nutritional Physiological Phenomena; Kwashiorkor; Neutrophils; Nutrition Disorders; Nutritional Requirements; Protein Deficiency; Reticulocytes; Serum Albumin; Vitamin B 12; Vitamin E

Four consecutive patients with megaloblastic anaemia who also received therapy with trimethoprim-sulphamethoxazole all showed poor responses to specific haematinic therapy. This was attributed to trimethoprim, which suppressed reticulocyte responses in three cases and produced a pancytopenia in two and a falling haemoglobin with neutropenia in a third. A fourth patient, with pernicious anaemia, had a satisfactory reticulocyte response but experienced no clinical benefit until after withdrawal of trimethoprim.Trimethoprim seems not to be a safe form of therapy in patients with a megaloblastic process; many of the toxic reactions reported with this drug may be on the basis of an unrecognized megaloblastic form of haemopoiesis.

Topics: Adult; Aged; Agranulocytosis; Anemia, Macrocytic; Anemia, Pernicious; Anti-Infective Agents; Arthritis, Rheumatoid; Blood Platelets; Erythrocyte Count; Female; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Middle Aged; Pyrimidines; Reticulocytes; Sulfamethoxazole; Tetrahydrofolate Dehydrogenase; Trimethoprim; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Anemia; Erythrocytes; Female; Folic Acid Deficiency; Humans; Liver; Pregnancy; Vitamin B 12

Topics: Anemia, Macrocytic; Female; Folic Acid Deficiency; Humans; Pregnancy; Smoking; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Blood Proteins; Carbon Isotopes; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Isomerases; Leukocyte Count; Leukocytes; Male; Malonates; Middle Aged; Neurologic Manifestations; Protein Binding; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Bone Marrow; Culture Techniques; Deoxyuridine; DNA; Folic Acid; Folic Acid Deficiency; Humans; Nutritional Physiological Phenomena; Reticulocytes; Thymine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Aged; Biopsy; Dipeptidases; Female; Folic Acid Deficiency; Glycoside Hydrolases; Humans; Intestinal Mucosa; Intestine, Small; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aminosalicylic Acids; Carotenoids; Celiac Disease; Cholesterol; Feces; Folic Acid; Folic Acid Deficiency; Humans; Intestine, Small; Isoniazid; Lipid Metabolism; Malabsorption Syndromes; Male; Middle Aged; Radiography; Tuberculosis; Vitamin B 12

Topics: Anemia, Macrocytic; Carbon; Carbon Dioxide; Carbon Isotopes; Diet; Erythrocyte Count; Folic Acid; Folic Acid Deficiency; Hemoglobins; Histidine; Humans; Injections, Intravenous; Malonates; Oxidation-Reduction; Reticulocytes; Serine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Anemia, Hypochromic; Bone Marrow Cells; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Hemosiderin; Humans; Iron; Neutrophils; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Transferrin; Venezuela; Vitamin B 12

Topics: Adult; Aged; Carbon Isotopes; Female; Folic Acid Deficiency; Formates; Humans; In Vitro Techniques; Intestinal Absorption; Lymphocytes; Male; Methotrexate; Middle Aged; Psoriasis; RNA; Serine; Vitamin B 12

Topics: Animal Nutritional Physiological Phenomena; Animals; Body Weight; Centrifugation, Density Gradient; Chickens; Endoplasmic Reticulum; Folic Acid; Folic Acid Deficiency; Liver; Polyribosomes; Protein Biosynthesis; Rats; Ribosomes; Species Specificity; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Amino Acids; Child; Drug Synergism; Female; Folic Acid; Folic Acid Deficiency; Glycine; Homocysteine; Homocystinuria; Humans; L-Serine Dehydratase; Male; Metabolic Diseases; Methionine; Methylation; Pyridoxine; Vitamin B 12

Topics: Adolescent; Adult; Animals; Anticonvulsants; Cell Nucleus; Depression, Chemical; Epithelial Cells; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Intestine, Small; Iron; Kidney; Leukocyte Count; Liver; Male; Middle Aged; Mouth Mucosa; Neutrophils; Phenobarbital; Phenytoin; Primidone; Rats; Tritium; Vitamin B 12

Topics: Amides; Anemia; Animals; Cricetinae; Dietary Carbohydrates; FIGLU Test; Folic Acid; Folic Acid Deficiency; Food Additives; Glutathione; Imidazoles; Liver; Rodent Diseases; Sex Factors; Sulfonamides; Vitamin B 12

Topics: Abortion, Spontaneous; Anemia, Macrocytic; Blood Transfusion; Congenital Abnormalities; Female; Folic Acid; Folic Acid Deficiency; Humans; Placenta Diseases; Pregnancy; Pregnancy Complications; Prognosis; Vitamin B 12

Topics: Adult; Aged; Anemia, Sideroblastic; Biological Assay; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobinometry; Humans; Lactobacillus; Male; Middle Aged; Pregnancy; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Folic Acid; Folic Acid Deficiency; Humans; Infant; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Pernicious; Cobalt Isotopes; Erythrocytes; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intramuscular; Intestinal Absorption; Malabsorption Syndromes; Schilling Test; Vitamin B 12

Topics: Anemia, Hypochromic; Black People; Central America; Erythrocyte Count; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobinometry; Humans; Indians, South American; Iron; Population Surveillance; Pregnancy; Pregnancy Complications; Serum Albumin; South America; Transferrin; Vitamin B 12; Vitamin B 12 Deficiency; White People

Topics: Anemia; Anemia, Macrocytic; Bone Marrow; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Iron; Neutrophils; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Amino Acids; Animal Nutritional Physiological Phenomena; Animals; Arginine; Betaine; Body Weight; Chickens; Choline; Choline Deficiency; Creatine; Cystine; Deficiency Diseases; Depression, Chemical; Folic Acid; Folic Acid Deficiency; Glycine; Glycine max; Guanidines; Lipid Metabolism; Liver; Male; Methionine; Muscles; Ornithine; Stimulation, Chemical; Urea; Vitamin B 12; Vitamin B 12 Deficiency; Zea mays

Topics: Animals; Birth Weight; Cell Nucleus; Erythrocyte Count; Erythrocytes; Folic Acid; Folic Acid Deficiency; Hematology; Hemoglobinometry; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Milk; Milk, Human; Neutrophils; Vitamin B 12

Topics: Aged; Anemia, Hypochromic; Anemia, Macrocytic; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobinometry; Hemoglobins; Humans; Learning; Male; Memory; Psychological Tests; Vitamin B 12; Vitamin B 12 Deficiency; Wales

Topics: Adult; Child; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Iron; Liver; Male; Nutrition Disorders; Serum Albumin; Transferrin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Hypochromic; Dosage Forms; Drug Combinations; Drug Compounding; Folic Acid; Folic Acid Deficiency; Hematopoiesis; Hemochromatosis; Humans; Infusions, Parenteral; Iron; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Amines; Dementia; Diet Therapy; Erythrocytes; Evaluation Studies as Topic; Folic Acid; Folic Acid Deficiency; Humans; Hydroxyindoleacetic Acid; Phenylacetates; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Diet, Vegetarian; Ethnicity; Female; Folic Acid Deficiency; Glutens; Hemoglobins; Humans; India; London; Malabsorption Syndromes; Male; Middle Aged; Nutrition Disorders; Sprue, Tropical; United Kingdom; Vitamin B 12; Vitamin B 12 Deficiency

Serum and red cell folate levels and serum vitamin B(12) levels have been estimated in 33 normal controls; 34 epileptic outpatients, 19 of whom also suffered from psychiatric illness; 33 epileptic inpatients with psychiatric illness; and 30 non-epileptic inpatients with psychiatric illness. Significant lowering of serum folate and red cell folate levels was observed in epileptic patients with psychiatric illness, and a less significant fall in red cell folate levels was found in non-epileptic psychiatric patients. Serum folate levels less than 2·5 ng/ml. were found in two controls, seven outpatient epileptics, 29 inpatients, and 10 non-epileptic patients. Red cell folate levels less than 100 ng/ml. were found in two controls, nine outpatient epileptics, 23 inpatient epileptics, and seven non-epileptic patients. A significant correlation was found between serum and red cell folate values in control, epileptic, and non-epileptic patients. In the epileptic patients there was a significant association between low serum and red cell folate levels and the presence of psychiatric illness. The origin and possible significance of these findings are discussed.

Topics: Adult; Antidepressive Agents; Epilepsy; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Mental Disorders; Middle Aged; Phenobarbital; Phenothiazines; Phenytoin; Vitamin B 12

Topics: Adolescent; Adult; Anemia, Macrocytic; Bone Marrow; Bone Marrow Cells; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hookworm Infections; Humans; Malabsorption Syndromes; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Aged; Anemia, Pernicious; Autoradiography; Chromatography, Thin Layer; Diet, Vegetarian; Female; Folic Acid Deficiency; Humans; Hydroxocobalamin; Intestinal Diseases; Leukemia; Liver; Liver Cirrhosis; Liver Diseases; Male; Middle Aged; Postgastrectomy Syndromes; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Africa, Southern; Amebiasis; Anemia; Cooking and Eating Utensils; Diet; Feces; Female; Folic Acid; Folic Acid Deficiency; Giardiasis; Hematocrit; Hemoglobins; Hookworm Infections; Humans; Iron; Male; Nutrition Disorders; Pregnancy; Protein Binding; Transferrin; Trichomonas Infections; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Anemia, Macrocytic; Anticonvulsants; Antitubercular Agents; Calcium; Celiac Disease; Child; Contraceptives, Oral; Drug-Related Side Effects and Adverse Reactions; Female; Folic Acid; Folic Acid Deficiency; Humans; Iatrogenic Disease; Male; Middle Aged; Neomycin; Nutrition Disorders; Osteomalacia; Pyridoxine; Rickets; Vitamin B 12

Topics: Anemia, Hypochromic; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Iron; Leukocyte Count; Male; Neutrophils; Vitamin B 12

Topics: Achlorhydria; Anemia, Macrocytic; Anemia, Pernicious; Autoantibodies; Cobalt Isotopes; Folic Acid Deficiency; Gastric Juice; Humans; Intrinsic Factor; Radioimmunoassay; Vitamin B 12

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Erythrocyte Count; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Injections, Intravenous; Iron; Pregnancy; Pregnancy Complications, Hematologic; Reticulocytes; Urinary Tract Infections; Vitamin B 12

Topics: Acrylates; Adolescent; Adult; Aged; Aminosalicylic Acids; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Antitubercular Agents; Erythropoiesis; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Humans; Imidazoles; Iron; Isoniazid; Male; Middle Aged; Streptomycin; Tuberculosis; Vitamin B 12

Topics: Anemia, Aplastic; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Sickle Cell; Anemia, Sideroblastic; Blood Cell Count; Blood Platelets; Child; Chronic Disease; Erythrocyte Count; Erythrocytes; FIGLU Test; Folic Acid; Folic Acid Deficiency; Humans; Leukocyte Count; Vitamin B 12

Topics: Adult; Alcoholism; Carotenoids; Deficiency Diseases; Diet; Ethanol; Feces; Folic Acid; Folic Acid Deficiency; Glucose; Hemoglobins; Humans; Intestinal Absorption; Jejunum; Lipids; Male; Middle Aged; Nutrition Disorders; Perfusion; Serum Albumin; Sodium; Tritium; Vitamin B 12; Xylose

Topics: Anemia, Macrocytic; Biopsy; Folic Acid; Folic Acid Deficiency; Humans; Intestine, Small; Male; Middle Aged; Skin; Skin Manifestations; Vitamin B 12

The diagnostic value of the serum folate assay has been assessed in 90 patients, each of whom had a macrocytic anaemia and a low serum vitamin B(12) level. Twenty-nine (32%) patients were found to have anaemia due primarily to folate deficiency. The cause of the low serum vitamin B(12) levels is uncertain in the 22 (25%) patients with normal or borderline vitamin B(12) absorption. The effect of folic acid therapy was studied in four of these patients, and in each case the serum vitamin B(12) rose slowly to a normal level. The serum folate was low in only four (7.5%) of the 54 patients with pernicious anaemia, and the levels rose to normal on treatment with vitamin B(12) alone. A high serum folate occurred in eight (15%) pernicious anaemia patients. A normal serum folate indicated the diagnosis of pernicious anaemia or megaloblastic anaemia following partial gastrectomy. However, a normal serum folate and a very low vitamin B(12) level was found in two patients with idiopathic steatorrhoea. It is concluded that the serum folate assay is a valuable routine test in patients who have a macrocytic anaemia and low serum vitamin B(12). A low folate level makes the diagnosis of pernicious anaemia unlikely and is a strong indication for full investigation of small intestinal function.

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Anticonvulsants; Celiac Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Male; Middle Aged; Postgastrectomy Syndromes; Vitamin B 12

Topics: Adolescent; Adult; Anemia, Macrocytic; Atrophy; Biopsy; Bone Marrow Cells; Child; Cobalt Isotopes; Diarrhea; Edema; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Intestinal Mucosa; Jejunum; Liver Diseases; Malabsorption Syndromes; Male; Middle Aged; Protein Deficiency; Serum Albumin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Avitaminosis; Folic Acid; Folic Acid Deficiency; Humans; Middle Aged; Vitamin B 12

Topics: Adolescent; Anemia, Macrocytic; Anemia, Pernicious; Diet; Female; Folic Acid Deficiency; Humans; Intrinsic Factor; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Agammaglobulinemia; Agranulocytosis; Anemia; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Sideroblastic; Antineoplastic Agents; Bone Marrow Diseases; Elliptocytosis, Hereditary; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Myeloproliferative Disorders; Polycythemia Vera; Pregnancy; Primary Myelofibrosis; Spherocytosis, Hereditary; Thalassemia; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aminopterin; Cell Division; Cell Line; Coleoptera; Culture Techniques; Folic Acid; Folic Acid Deficiency; Methionine; Nucleic Acids; Nucleotides; Purines; Thymidine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Hypochromic; Anemia, Macrocytic; Biopsy; Bone and Bones; Calcium; Celiac Disease; Disability Evaluation; Dumping Syndrome; Female; Folic Acid Deficiency; Follow-Up Studies; Gastric Mucosa; Gastritis; Humans; Lactose Intolerance; Male; Middle Aged; Nutrition Disorders; Postgastrectomy Syndromes; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Duodenal Ulcer; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Jejunum; Male; Peptic Ulcer; Postgastrectomy Syndromes; Stomach Ulcer; Vagotomy; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Biological Assay; Diet, Reducing; Fasting; Feeding Behavior; Folic Acid; Folic Acid Deficiency; Humans; Imidazoles; Lactobacillus; Male; Obesity; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Pernicious; Biological Assay; Bone Marrow Examination; Erythrocytes; Euglena; Female; Folic Acid; Folic Acid Deficiency; Humans; Lactobacillus; Male; Polycythemia; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Bone Marrow Examination; Euglena; Fluorometry; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Hydrocortisone; Infant; Lactobacillus; Male; Melanocyte-Stimulating Hormones; Middle Aged; Pigmentation Disorders; Radioimmunoassay; Sprue, Tropical; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Anticonvulsants; Ascorbic Acid Deficiency; Contraceptives, Oral; Diagnosis, Differential; Folic Acid; Folic Acid Deficiency; Gastric Juice; Humans; Intrinsic Factor; Nutritional Requirements; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Age Factors; Aged; Anemia; Anemia, Hypochromic; Arthritis, Rheumatoid; Blood Chemical Analysis; Blood Proteins; Blood Sedimentation; Bronchitis; England; Feces; Female; Folic Acid; Folic Acid Deficiency; Health Surveys; Hematologic Diseases; Hemoglobins; Hospitalization; Humans; Iron; Middle Aged; Neoplasms; Sex Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Erythrocytes; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Iron; Vitamin B 12

Folate deficiency in 50 epileptic children aged 5 to 18 years was treated with a combination of folic acid and vitamin B(12). Improvement in mental condition occurred from five to eight weeks after beginning treatment in some of the younger children; no change was noticed, however, in 31. Similarly, in 19 children fits became less frequent and less severe. It is recommended that both folic acid and vitamin B(12) should be given as soon as a patient is started on anticonvulsant drugs to prevent mental deterioration.

Topics: Adolescent; Anticonvulsants; Child; Child, Preschool; Epilepsy; Female; Folic Acid; Folic Acid Deficiency; Humans; Intellectual Disability; Male; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Anti-Bacterial Agents; Depression, Chemical; Diet; Female; Folic Acid; Folic Acid Deficiency; Homes for the Aged; Humans; Male; Middle Aged; Sulfonamides; Vitamin B 12

1. Formiminoglutamic acid, a product of the catabolism of histidine, is excreted in abnormally large amounts in the urines of vitamin B(12)-deficient rats and of vitamin B(12)-deficient sheep; the excretion is reduced to negligible amounts after administration of vitamin B(12). 2. After administration of certain methyl donors to vitamin B(12)-deficient rats or sheep urinary excretion of formiminoglutamic acid is temporarily decreased. 3. Irrespective of the pteroylglutamic acid status of the animals neither vitamin B(12)-deficient rats nor vitamin B(12)-deficient sheep have the ability to deal efficiently with histidine. 4. In sheep, urinary excretion of formiminoglutamic acid is increased after administration of aminopterin; treatment with pteroylglutamic acid restores the ability of the animal to deal with the catabolic products of histidine. 5. The possible functions of vitamin B(12) and methionine in relieving a virtual deficiency of pteroylglutamic acid are discussed.

Topics: Aminopterin; Animals; Betaine; Female; Folic Acid; Folic Acid Deficiency; Glutarates; Histidine; Male; Methionine; Rats; Sheep; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Antidepressive Agents; Barbiturates; Chronic Disease; Epilepsy; Female; Folic Acid; Folic Acid Deficiency; Hematologic Diseases; Humans; Male; Middle Aged; Neurocognitive Disorders; Phenothiazines; Schizophrenia; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Alcoholism; Australia; Blood Cell Count; Blood Sedimentation; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobinometry; Humans; Intellectual Disability; Male; Mental Disorders; Middle Aged; Substance-Related Disorders; Vitamin B 12

Topics: Birth Weight; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant, Newborn; Infant, Newborn, Diseases; Maternal-Fetal Exchange; Methionine; Pregnancy; Vitamin B 12

Topics: Amino Acids; Diet; Folic Acid; Folic Acid Deficiency; Food Analysis; Humans; Malaria; Pharmaceutical Preparations; Pyridoxine; Vitamin B 12

Topics: Adult; Aged; Female; Folic Acid Deficiency; Humans; Male; Middle Aged; Vitamin B 12

Topics: Age Factors; Anemia, Macrocytic; Child; Child, Preschool; Diet; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Chromosomes; Culture Techniques; Deoxyuridine; DNA; Folic Acid; Folic Acid Deficiency; Humans; Lectins; Lymphocyte Activation; Lymphocytes; Thymidine; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

A technique has been developed for accurately assaying serum and urine (57)Co cyanocobalamin during the conventional Schilling test. Serum and urine radioactivity in a large number of patients has been correlated and the precise normal limits have been determined by statistical analysis. The implications of this for investigating conditions other than pernicious anaemia and the malabsorption syndromes are stressed.

Topics: Chemistry Techniques, Analytical; Cobalt Isotopes; Folic Acid Deficiency; Humans; Hypopituitarism; Methods; Myxedema; Postgastrectomy Syndromes; Schilling Test; Statistics as Topic; Vitamin B 12; Vitamin B 12 Deficiency

An assessment of vitamin B(12) absorption in neurological patients has been made by both serum and urine counting of (57)Co cyanocobalamin during the conventional Schilling test. Although patients with pernicious anaemia, some with subacute combined degeneration of the cord, have been studied, emphasis in the discussion is placed on the significantly increased excretion of the radioactive vitamin in a group of patients with pituitary insufficiency. Results are also given for epileptic patients who have developed folate deficiency (as assessed by serum folate levels) coincidental with anticonvulsant therapy, as well as for some patients who have had neurological symptoms or signs following partial gastrectomy operations.

Topics: Adult; Aged; Anemia, Pernicious; Cobalt Isotopes; Epilepsy; Female; Folic Acid Deficiency; Humans; Hypopituitarism; Intestinal Absorption; Male; Middle Aged; Postgastrectomy Syndromes; Schilling Test; Vitamin B 12

Topics: Adolescent; Age Factors; Anemia; Blood Cell Count; Child; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Humans; Infant; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Blood Proteins; Cerebrospinal Fluid Proteins; Electroencephalography; Folic Acid; Folic Acid Deficiency; Humans; Middle Aged; Phenytoin; Potassium; Seizures; Sodium; Vitamin B 12

Topics: Aged; Alcoholism; Anemia, Macrocytic; Biopsy; Blood Cell Count; Fatty Liver; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Humans; Liver; Liver Cirrhosis; Liver Function Tests; Vitamin B 12

Topics: Adult; Age Factors; Aged; Anemia, Macrocytic; Depression; Folic Acid; Folic Acid Deficiency; Gastrectomy; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Abruptio Placentae; Adult; Anemia, Macrocytic; Biological Assay; Bone Marrow Examination; Erythrocyte Count; Erythrocytes, Abnormal; Euglena; Female; FIGLU Test; Folic Acid Deficiency; Humans; Lactobacillus; Leukocyte Count; Maternal Mortality; Methods; Neutrophils; Pregnancy; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Bone Marrow Cells; Bone Marrow Examination; Child, Preschool; Deficiency Diseases; Dietary Proteins; Egypt; Erythrocytes, Abnormal; Erythropoiesis; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Infant; Iron; Iron-Dextran Complex; Kwashiorkor; Nutrition Disorders; Protein Deficiency; Reticulocytes; Vitamin B 12; Vitamin E

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Anorexia Nervosa; Bone Marrow Examination; Child; Female; Folic Acid; Folic Acid Deficiency; Histamine; Humans; Male; Mass Screening; Mental Disorders; Middle Aged; Neurocognitive Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12

Topics: Adolescent; Adult; Age Factors; Aged; Child; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Male; Mental Disorders; Middle Aged; Schilling Test; Sex Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Cholesterol; Diet Therapy; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intramuscular; Lipoproteins; Male; Mathematics; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Three patients are described, and they provide further evidence that deficiency of folic acid and vitamin B(12) may sometimes affect small intestinal function. Malabsorption of both xylose and vitamin B(12) returned to normal in one patient after treatment of a megaloblastic anaemia due to dietary deficiency of folic acid. Impaired absorption of vitamin B(12) was corrected by vitamin B(12) therapy in the other two patients. The initial cause of the vitamin B(12) deficiency in one patient was not apparent, but she was taking Gynovlar 21, which may have been an aetiological factor. In the third patient the small intestinal defect was secondary to pernicious anaemia, and in a group of 98 other patients with pernicious anaemia intrinsic factor did not improve vitamin B(12) absorption in six, and only partially corrected absorption in 30. The significance of these observations is discussed.

Topics: Adult; Anemia, Macrocytic; Anemia, Pernicious; Contraceptives, Oral; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Intestine, Small; Intrinsic Factor; Malabsorption Syndromes; Vitamin B 12; Vitamin B 12 Deficiency; Xylose

Topics: Administration, Oral; Aged; Anemia, Macrocytic; Bronchial Neoplasms; Carcinoma, Squamous Cell; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intramuscular; Male; Vitamin B 12

Topics: Aniline Compounds; Carbon Isotopes; Chromatography, Gel; Chromatography, Ion Exchange; Chromatography, Thin Layer; Folic Acid Deficiency; Humans; Malonates; Methods; Propionates; Spectrophotometry; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Amino Acids; Animals; Biological Transport, Active; Blood Proteins; Carbon Isotopes; Caseins; Diet; Folic Acid Deficiency; Growth; Intestinal Absorption; Intestine, Small; Iodine; Methionine; Oleic Acids; Organ Size; Rats; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Alkaline Phosphatase; Body Weight; Bone and Bones; Folic Acid; Folic Acid Deficiency; Gastrectomy; Hemoglobinometry; Humans; Middle Aged; Postgastrectomy Syndromes; Radiography; Vagotomy; Vitamin B 12

During the active phase of viral hepatitis urinary folate loss was found to be 8.0 to 48.3 (mean 31.1) mug./day, compared with a normal urinary folate excretion of 0.1 to 18.0 (mean 9.5) mug./day. In cirrhosis and cardiac failure with congestive hepatomegaly the corresponding values were 25.8 to 55.0 (mean 35.7) mug./day and 2.5 to 61.6 (mean 26.9) mug./day, respectively. Urinary folate loss may be a significant factor in the aetiology of folate deficiency of chronic liver disease, particularly when dietary intake is poor.After prolonged dialysis in Visking casing urinary folate was almost totally dialysable, but an appreciable fraction of serum folate was not, even after 72 hours. The dialysable (free) folate fraction of serum and urine disappeared maximally during the first six hours' dialysis, and was virtually cleared after 24 hours' dialysis; clearance curves in normal individuals and in liver disease were comparable. The non-dialysable serum folate fraction was of similar magnitude in all subjects studied, in spite of marked variation in total folate, and probably represented protein-bound folate.

Topics: Adult; Biological Assay; Dialysis; Folic Acid; Folic Acid Deficiency; Heart Failure; Humans; Lactobacillus; Liver Diseases; Vitamin B 12

Topics: Anemia, Hypochromic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Bone Marrow Examination; Child; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Infant; Leukopenia; Malabsorption Syndromes; Male; Pregnancy; Thrombocytopenia; Uganda; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Anticonvulsants; Epilepsy; Erythrocyte Count; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hematocrit; Humans; Male; Middle Aged; Neutrophils; Phenobarbital; Phenytoin; Primidone; Psychotic Disorders; Vitamin B 12

Topics: Adolescent; Adult; Aged; Dominican Republic; Female; Folic Acid; Folic Acid Deficiency; Guatemala; Humans; Intestinal Absorption; Middle Aged; Puerto Rico; Sprue, Tropical; Tetracycline; Tritium; Vitamin B 12; Xylose

Topics: Anemia, Macrocytic; Bone Marrow Cells; Bone Marrow Examination; Child, Preschool; Deficiency Diseases; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Vitamin B 12

Topics: Central Nervous System Diseases; Folic Acid; Folic Acid Deficiency; Humans; Peripheral Nervous System Diseases; Psychopathology; Spinal Cord Diseases; Vision Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Anemia; Child; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Hemosiderin; Hookworm Infections; Humans; India; Infant; Iron; Israel; Male; Mexico; Nutrition Disorders; Nutritional Requirements; Poland; Pregnancy; Pregnancy Complications, Hematologic; Venezuela; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Achlorhydria; Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Black People; Cobalt Isotopes; Female; Folic Acid Deficiency; Humans; Intrinsic Factor; Male; Middle Aged; Radiometry; Vitamin B 12; Vitamin B 12 Deficiency; White People

Topics: Adult; Aged; Anemia; Anemia, Macrocytic; Anemia, Pernicious; Biopsy; Blood Cell Count; Bone Marrow Examination; Carotenoids; Cholesterol; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; Gastric Acidity Determination; Hematocrit; Hemoglobinometry; Humans; Hypothyroidism; Iron; Jejunum; Kidney Function Tests; Liver Function Tests; Middle Aged; Myxedema; Thyroid Function Tests; Thyroidectomy; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intravenous; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Bone Marrow Examination; Child; Crohn Disease; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Iron; Male; Middle Aged; Vitamin B 12

Topics: Anemia, Macrocytic; Celiac Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Infections; Lyases; Malabsorption Syndromes; Male; Postoperative Complications; Skin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Chromosome Aberrations; Chromosome Disorders; Folic Acid Deficiency; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Bone Marrow; Bone Marrow Cells; Deoxyuridine; DNA; Female; Folic Acid; Folic Acid Deficiency; Humans; In Vitro Techniques; Methionine; Methotrexate; Thymine; Tritium; Uridine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Intrinsic Factor; Male; Pregnancy; Pregnancy Complications, Hematologic; Schilling Test; Vitamin B 12

Topics: Anemia, Pernicious; Anemia, Sideroblastic; Bone Marrow Cells; DNA; Fats; Feces; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Mucosa; Jejunum; Male; Military Medicine; Puerto Rico; Sprue, Tropical; Vitamin B 12; Xylose

Topics: Acute Disease; Adolescent; Adult; Anti-Bacterial Agents; Asia, Southeastern; Female; Folic Acid; Folic Acid Deficiency; Helminthiasis; Humans; Ileum; Indican; Jejunum; Male; Middle Aged; Military Medicine; Sprue, Tropical; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Biological Assay; Erythrocytes; Euglena; Folic Acid Deficiency; Humans; Plasma; Polycythemia; Vitamin B 12

Topics: Adult; Aged; Anemia, Macrocytic; Chromosome Aberrations; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Histones; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Bilirubin; Blood Cell Count; Blood Proteins; Child; Child, Preschool; Cholesterol; Diet Therapy; Female; Folic Acid; Folic Acid Deficiency; Health Surveys; Hematocrit; Hemoglobinometry; Humans; Intestinal Diseases, Parasitic; Iron; Male; Pregnancy; Pregnancy Complications, Hematologic; Trinidad and Tobago; Vitamin B 12

Topics: Anemia; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Folic Acid; Folic Acid Deficiency; Gastrectomy; Histidine; Humans; Iron; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Pernicious; Cobalt Isotopes; Folic Acid Deficiency; Humans; Malabsorption Syndromes; Postgastrectomy Syndromes; Schilling Test; Vitamin B 12

Topics: Age Factors; Anemia, Macrocytic; Anticonvulsants; Brain; Epilepsy; Female; Folic Acid; Folic Acid Deficiency; Humans; Intellectual Disability; Male; Mental Disorders; Peripheral Nerves; Phenobarbital; Phenytoin; Primidone; Psychotic Disorders; Sex Factors; Spinal Cord; Vitamin B 12

Topics: Anemia, Macrocytic; Blood Urea Nitrogen; Bone Marrow Examination; Folic Acid; Folic Acid Deficiency; Hematopoiesis; Humans; Kidney Failure, Chronic; Renal Dialysis; Uremia; Vitamin B 12

Topics: Adolescent; Adult; Anemia, Macrocytic; Erythrocyte Count; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Infant, Newborn; New Guinea; Pregnancy; Pregnancy Complications, Hematologic; Reticulocytes; Vitamin B 12

Topics: Adult; Anemia, Hypochromic; Anemia, Macrocytic; Bone Marrow Examination; Female; FIGLU Test; Folic Acid Deficiency; Hematocrit; Hemoglobinometry; Humans; Iron; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Cycloserine; Female; Folic Acid Deficiency; Humans; Isoniazid; Male; Middle Aged; Tuberculosis, Pulmonary; Vitamin B 12

Topics: Adult; Aged; Anemia, Hypochromic; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Male; Middle Aged; Vitamin B 12

Topics: Adult; Agranulocytosis; Anemia, Macrocytic; Anemia, Pernicious; Clinical Enzyme Tests; Folic Acid Deficiency; Humans; Muramidase; Vitamin B 12

Topics: Anemia, Macrocytic; Animals; Blood Protein Electrophoresis; Chick Embryo; Diet; Female; Folic Acid Deficiency; Hemoglobins; Humans; Phenylalanine; Pregnancy; Pregnancy Complications, Hematologic; Pteridines; Reticulocytes; Vitamin B 12

Topics: Adolescent; Anemia, Sickle Cell; Bone Marrow; FIGLU Test; Folic Acid; Folic Acid Deficiency; Humans; Iron; L-Lactate Dehydrogenase; Male; Reticulocytes; Vitamin B 12

Topics: Animals; Chickens; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Liver; Male; Vitamin B 12

Topics: Aged; Cardiac Catheterization; Chromatography; Female; Folic Acid; Folic Acid Deficiency; Gastrointestinal Diseases; Humans; Intestinal Absorption; Liver; Middle Aged; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Bone Marrow Examination; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Iron; Postgastrectomy Syndromes; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Animals; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Horse Diseases; Horses; Iron; Male; Vitamin B 12

Topics: Anemia, Pernicious; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Humans; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Blood Transfusion; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Reticulocytes; Vitamin B 12

Topics: Adult; Aminosalicylic Acids; Anemia, Macrocytic; Female; Folic Acid; Folic Acid Deficiency; Humans; Isoniazid; Male; Middle Aged; Tuberculosis, Pulmonary; Vitamin B 12

Topics: Bone Marrow Examination; Dermatitis, Exfoliative; Eczema; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Iron; Psoriasis; Stearic Acids; Vitamin B 12

Topics: Anemia, Pernicious; Female; Folic Acid; Folic Acid Deficiency; Gastrointestinal Diseases; Humans; Leukemia, Lymphoid; Leukemia, Monocytic, Acute; Leukemia, Myeloid; Leukocytes; Male; Vitamin B 12

Topics: Aged; Anemia, Macrocytic; Biological Assay; Cobalt Isotopes; Dementia; Electroencephalography; Female; FIGLU Test; Fluorescent Antibody Technique; Folic Acid; Folic Acid Deficiency; Gastric Acidity Determination; Humans; Intestinal Absorption; Vitamin B 12; Xylose

Topics: Adolescent; Adult; Anemia, Aplastic; Anemia, Sickle Cell; Bilirubin; Electrophoresis; Female; FIGLU Test; Folic Acid Deficiency; Hemoglobinometry; Histidine; Humans; Leukocytosis; Paper; Starch; Thrombocytopenia; Vitamin B 12

Intermediate megaloblastic changes occurred in six (19%) of 32 patients with multiple myeloma and trivial megaloblastic changes in a further ten (31%). Folate deficiency was the predominant cause of these changes and in at least two patients was sufficiently severe to contribute to anaemia. Folate deficiency appeared to be due to exćess folate utilization by the tumour and was related to the amount of paraprotein produced daily. Five of the 32 patients had subnormal serum B(12) levels. Reduction in the serum B(12) level was related to the reduction in the normal circulating immunoglobulins and occurred despite normal B(12) absorption. Possible explanations for this finding are discussed.

Topics: Adult; Aged; Anemia, Macrocytic; Erythropoiesis; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Male; Middle Aged; Multiple Myeloma; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Folic Acid Deficiency; Humans; Injections, Intramuscular; Injections, Intravenous; Iron; Splenectomy; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Pernicious; DNA; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hematopoiesis; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Macrogranulocytic and/or erythroid megaloblastic bone marrow changes which could not be accurately predicted from the hematologic findings in the blood were present in 25% of 305 mildly to moderately anemic pregnant women attending a public antepartum clinic in Montreal. Iron deficiency was the primary cause of anemia in most instances. Serum folate activity of less than 4.1 ng./ml. and/or serum vitamin B(12) levels of less than 100 pg./ml. were present in 90% of the 77 patients having these bone marrow changes, whereas approximately one-third of 228 patients with normoblastic marrow had these low values. Red cell folate did not correlate as well as serum folate activity with bone marrow changes. After treatment with oral folic acid in the range of 0.2 mg. to 0.8 mg., daily, for seven to 14 days, the megaloblastic and macrogranulocytic changes in patients with low serum folate activity and normal serum vitamin B(12) values disappeared in 15 of 21 patients. Of five women having both low folate and vitamin B(12) values, three failed to respond and two showed only partial improvement after 0.4 mg. of folic acid daily, per os, for 10 days. The average diet of these anemic women was suboptimal in folate and in iron.

Topics: Anemia, Hypochromic; Female; Folic Acid; Folic Acid Deficiency; Humans; In Vitro Techniques; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Arthritis, Rheumatoid; Blood; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Oxyphenbutazone; Phenylbutazone; Vitamin B 12

Topics: Anemia; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Bone Marrow Examination; Celiac Disease; Dumping Syndrome; Folic Acid Deficiency; Humans; Male; Middle Aged; Radiography; Tetracycline; Vitamin B 12; Vitamin B 12 Deficiency

Non-anemic women attending a public antenatal clinic were given, daily, a multivitamin tablet containing 78 mg. of elemental iron. The follow-up studies included an analysis of their diets. A total of 311 patients were included, of which one group received a supplement of 0.5 mg. folic acid and 0.005 mg. vitamin B(12). The incidence of megaloblastic bone marrow change in the unsupplemented group was 26% and of low blood folates approximately 50%. The incidence of megaloblastic changes was sharply reduced in the supplemented group and the blood folates were elevated to supranormal levels, indicating that the dose of folic acid used may have been above the minimal requirement. Formiminoglutamic acid (FIGLU) excretion could not be correlated with other parameters of folate deficiency. Neutrophil lobe counts did not relate to megaloblastic changes or low folate levels unless there was more than 5% hypersegmentation. The dietary intake was suboptimal in total calories, iron and food folate.

Topics: Anemia, Macrocytic; Blood Proteins; Bone Marrow Examination; Diet; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hematocrit; Humans; Iron; Plasma Volume; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12; Vitamin B Complex

Topics: Adult; Aged; Anemia, Pernicious; Female; Folic Acid Deficiency; Humans; Male; Middle Aged; Peptides; Vitamin B 12

Topics: Adult; Aminosalicylic Acids; Anemia; Anemia, Sideroblastic; Erythropoiesis; Ethionamide; Female; Folic Acid Deficiency; Glucosephosphate Dehydrogenase Deficiency; Humans; In Vitro Techniques; Isoniazid; Prednisolone; Pyrazinamide; Pyridoxine; Streptomycin; Tuberculosis, Pulmonary; Vitamin B 12

Topics: Blood; Diet Therapy; FIGLU Test; Folic Acid; Folic Acid Deficiency; Histidine; Humans; Imidazoles; Infant; Protein Deficiency; Urine; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia, Hypochromic; Anemia, Macrocytic; Antitubercular Agents; Blood; Bone Marrow Examination; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Male; Middle Aged; Tuberculosis; Tuberculosis, Lymph Node; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary; Tuberculosis, Renal; Vitamin B 12

Topics: Anemia, Macrocytic; Diagnosis, Differential; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Blood; Folic Acid; Folic Acid Deficiency; Hematinics; Humans; Malabsorption Syndromes; Nutrition Disorders; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Biological Assay; Bone Marrow Examination; Clinical Enzyme Tests; Erythropoiesis; Folic Acid; Folic Acid Deficiency; Humans; Hydroxybutyrate Dehydrogenase; L-Lactate Dehydrogenase; Lactobacillus; Vitamin B 12

Folic acid deficiency with the picture of a megaloblastic bone marrow may develop in haemolytic anaemia, and, on the other hand, both vitamin B(12) and folic acid deficiency may produce signs of haemolysis. As the correct interpretation of a positive antiglobulin reaction associated with megaloblastic erythropoiesis is particularly important, the effect of deficiency of vitamin B(12) and folic acid on the results of the test was investigated in 32 patients with vitamin B(12) or folic acid deficiency and a positive antiglobulin reaction was obtained in ten. There was no correlation between the result of the test and the degree of anaemia, and there was no significant difference between the incidence of positive results associated with deficiency of vitamin B(12) or folic acid. In determining the significance of a positive result, the time interval before agglutination occurs is sometimes of greater value than the strength of the reaction or the result of the gamma globulin neutralization test.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Antibodies, Anti-Idiotypic; Coombs Test; Folic Acid; Folic Acid Deficiency; gamma-Globulins; Hemagglutination Inhibition Tests; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Alcoholism; Anemia; Anemia, Hypochromic; Blood Chemical Analysis; Blood Volume; Bone Marrow Examination; Erythropoiesis; Folic Acid; Folic Acid Deficiency; Gastric Juice; Hematocrit; Hemochromatosis; Hemolysis; Humans; Iron; Liver; Liver Cirrhosis; Liver Diseases; Melena; Metabolism; Splenomegaly; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Blood Chemical Analysis; Bronchi; Bronchial Neoplasms; Carcinoma, Squamous Cell; Celiac Disease; Feces; Fluids and Secretions; Folic Acid; Folic Acid Deficiency; Humans; Hypokalemia; Hypoproteinemia; Jejunum; Lipid Metabolism; Malabsorption Syndromes; Pathology; Urine; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Avitaminosis; Blood Cell Count; Bone Marrow Examination; Child; FIGLU Test; Folic Acid; Folic Acid Deficiency; Glutamates; Glutamic Acid; Histidine; Humans; Imidazoles; Kwashiorkor; Metabolism; Urine; Urocanic Acid; Vitamin B 12

Topics: Alcoholism; Autoradiography; Biopsy; Biotin; Blood Chemical Analysis; DNA; Drug Therapy; Fatty Liver; Folic Acid; Folic Acid Deficiency; Liver Cirrhosis; Niacin; Nicotinic Acids; Pantothenic Acid; Pyridoxine; Rats; Riboflavin; Thiamine; Tritium; Vitamin B 12; Vitamin B Complex; Vitamin B Deficiency; Vitamins

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Blood Chemical Analysis; Diet; Diet Therapy; Drug Therapy; FIGLU Test; Folic Acid; Folic Acid Deficiency; Geriatrics; Hematinics; Hemochromatosis; Humans; Liver Cirrhosis; Liver Function Tests; Metabolism; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Biological Assay; Blood; Diet; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Histidine; Humans; Iron; Lactobacillus; Metabolism; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Urine; Vitamin B 12; Vitamin B Complex

Topics: Alcoholism; Anemia; Anemia, Macrocytic; Ankyrins; Blood Transfusion; Drug Therapy; Folic Acid; Folic Acid Deficiency; Hematinics; Humans; Injections; Spherocytosis, Hereditary; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Corrinoids; Folic Acid; Folic Acid Deficiency; Humans; Radioisotopes; Thymidine; Vitamin B 12

Topics: Animals; Animals, Newborn; Cerebral Ventricles; Corrinoids; Diet; Female; Fetus; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Hydrocephalus; Maternal-Fetal Exchange; Pathology; Pregnancy; Rats; Research; Vitamin B 12; Vitamin B Deficiency

Topics: Blood Chemical Analysis; Choline; Diet; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemochromatosis; Iron; Lipotropic Agents; Liver; Neomycin; Pancreas; Pantothenic Acid; Pharmacology; Pyridoxine; Rats; Research; Sucrose; Vitamin B 12; Vitamin B Complex

Topics: Aged; Anemia, Macrocytic; Ascorbic Acid; Blood; Diet Therapy; England; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Male; Middle Aged; Nutrition Surveys; Vitamin B 12; Vitamins

Topics: Adult; Anemia, Macrocytic; Bone Marrow Examination; Erythrocyte Count; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Injections, Intramuscular; Iron; Reticulocytes; Vitamin B 12

Topics: Anemia, Macrocytic; Ascorbic Acid; Blood; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iron; Lactobacillus; Leuconostoc; Vitamin B 12

Topics: Alkaline Phosphatase; Anemia; Anemia, Hypochromic; Blood; Cobalt Isotopes; Erythropoiesis; Folic Acid; Folic Acid Deficiency; Histidine; Humans; Iron; Primary Myelofibrosis; Tritium; Vitamin B 12; Vitamin B Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Barbiturates; Biological Assay; Blood Chemical Analysis; Folic Acid; Folic Acid Deficiency; Geriatrics; Glutamates; Toxicology; Urine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Hemolytic; Anemia, Macrocytic; Anemia, Pernicious; Anticonvulsants; Blood; Celiac Disease; Clinical Laboratory Techniques; Epilepsy; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Formiminoglutamic Acid; Glutamates; Humans; Lymphoma; Lymphoma, Non-Hodgkin; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Urine; Vitamin B 12; Vitamin B Deficiency

Topics: Blood; Corrinoids; Diet; Folic Acid; Folic Acid Deficiency; Glutamates; Liver; Metabolism; Rats; Research; Urine; Vitamin B 12; Vitamin B Deficiency

Topics: Alcoholism; Anemia; Anemia, Hypochromic; Avitaminosis; Cholestyramine Resin; Common Bile Duct; Diet; Diet Therapy; Diuretics; Folic Acid; Folic Acid Deficiency; Gastrointestinal Hemorrhage; Humans; Hydrochlorothiazide; Ion Exchange Resins; Jaundice; Liver Cirrhosis; Liver Cirrhosis, Biliary; Postoperative Complications; Prothrombin Time; Vitamin B 12; Vitamin B Complex; Vitamin K

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Celiac Disease; Classification; Folic Acid; Folic Acid Deficiency; Humans; Japan; Metabolism; Physiology; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Avitaminosis; Biological Assay; Biopsy; Blood; Bone Marrow Examination; Cerebrospinal Fluid; Clinical Laboratory Techniques; Diet; Folic Acid; Folic Acid Deficiency; Jejunum; Lactobacillus; Metabolism; Pathology; Vitamin B 12; Vitamin B Deficiency

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Avitaminosis; Clinical Laboratory Techniques; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Formiminoglutamic Acid; Geriatrics; Glutamates; Humans; Maternal-Fetal Exchange; Metabolism; Pregnancy; Primary Myelofibrosis; Urine; Vitamin B 12; Vitamin B Deficiency

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Carbachol; Celiac Disease; Cobalt Isotopes; Colonic Neoplasms; Duodenal Ulcer; Folic Acid; Folic Acid Deficiency; Gastric Acidity Determination; Gastric Juice; Histamine; Humans; Insulin; Intrinsic Factor; Male; Pharmacology; Physiology; Sprue, Tropical; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Bone and Bones; Calcium; Folic Acid; Folic Acid Deficiency; Gastrectomy; Humans; Statistics as Topic; Vitamin B 12

Topics: Absorption; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Blood Chemical Analysis; Bone Marrow Examination; Cobalt Isotopes; Folic Acid; Folic Acid Deficiency; Gastrectomy; Humans; Postgastrectomy Syndromes; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anticonvulsants; Celiac Disease; Female; FIGLU Test; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Formiminoglutamic Acid; Histidine; Humans; Intestinal Diseases; Intestine, Small; Intestines; Liver Diseases; Metabolic Diseases; Neoplasms; Postoperative Complications; Pregnancy; Sprue, Tropical; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Biopsy; Blood Chemical Analysis; Bone Marrow Examination; Erythropoiesis; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Glutamic Acid; Hemoglobins; Histidine; Lactobacillus; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Urine; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Anemia, Macrocytic; Blood Platelets; Bone Marrow Cells; Drug Therapy; Epoetin Alfa; Erythropoietin; FIGLU Test; Folic Acid; Folic Acid Deficiency; Glutamates; Hemoglobins; Humans; Infant; Infusions, Parenteral; Injections, Intravenous; Iron; Iron-Dextran Complex; Megakaryocytes; Reticulocytes; Thrombocytopenia; Thrombocytosis; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Biological Assay; Blood Chemical Analysis; Bone Marrow Examination; Celiac Disease; Cobalt Isotopes; Euglena; Feces; Fluids and Secretions; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Lactobacillus; Singapore; Sprue, Tropical; Statistics as Topic; Urine; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Black People; Blood Chemical Analysis; Bone Marrow; Deficiency Diseases; Drug Therapy; Folic Acid; Folic Acid Deficiency; Gastric Juice; Gastric Mucosa; Glutamates; Hematopoiesis; Humans; Hydrochloric Acid; Intrinsic Factor; Pathology; Pharmacology; Urine; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency; Yeast, Dried