Association between Serum Folate and Vaginal High-Risk Human Papillomavirus Infections in United States Women.

ABSTRACT

BACKGROUND: Serum concentration of folate was inversely associated with cervical intraepithelial neoplasia and cervical cancer in some studies. The association between folate and human papillomavirus (HPV) infection, a necessary cause of cervical cancer, has not been well elucidated. OBJECTIVES: We evaluated whether serum folate concentrations were associated with high-risk HPV (hrHPV) infection. METHODS: The study population was 11,801 females, aged 18-59 y, enrolled in the National Health and Nutrition Examination Survey (NHANES), from 2003 to 2016, in the United States. In this cross-sectional study, prevalence ratios (PRs) of vaginal hrHPV were calculated using logistic regression models, by quintiles of serum folate. RESULTS: Females in the lowest quintile had <21.3 nmol/L of folate. Approximately 23% of the females (2733/11,801) were hrHPV positive. In age-adjusted models, folate was significantly associated with hrHPV infection. The PRs and 95% confidence intervals (CIs) were (PR 1.52; 95% CI 1.37, 1.70) for the first, (PR 1.29; 95% CI 1.15, 1.44) for the second, (PR 1.19; 95% CI 1.06, 1.34) for the third, and (PR 1.09; 95% CI 0.96, 1.23) for the fourth quintiles, compared with the females in the highest quintile, with a significant P value for trend, <0.0001. The association remained statistically significant after the models were further adjusted for lifestyle and sexual risk factors for hrHPV infection; the females in the lowest quintile were more likely to have hrHPV infection than those in the highest quintile (PR 1.40; 95% CI 1.11, 1.53). CONCLUSIONS: Results from this sample of females in the United States suggest that serum folate concentration is inversely associated with hrHPV infection.