Nutritional status of iron, vitamin B12, folate, retinol and anemia in children 1 to 11 years old: Results of the Ensanut 2012 / Estado nutricional de hierro, vitamina B12, folato, retinol y anemia en niños de 1 a 11 años: Resultados de la Ensanut 2012

Objective. To describe the frequency of anemia, iron, vitamin B12, folate, retinol and predictors of anemia among Mexican children from Ensanut 2012. Materials and methods. Hemoglobin, ferritin, CRP, vitamin B12, retinol and folate concentrations were measured in 2 678 children aged 1-4 y and 4 275 children aged 5-11 y. Adjusted logistic regression models were constructed to assess the risk for anemia and micronutrient deficiencies. Results. In preschoolers and scholars, the overall prevalence of anemia was 20.4 and 9.7%, iron deficiency 14 and 9.3%, low vitamin B12 (LB12S) 1.9 and 2.6%; Folate 0.30 and 0%, and retinol depletion (VADp) 15.7 and 2.3%, respectively. ID and VADp were negatively associated with Hb (coefficient: -0.38 and -0.45, p<0.05); a higher log-CRP was associated with higher risk for anemia and VADp (OR=1.13 and OR=2.1, p<0.05, respectively). Conclusions. Iron deficiency, anemia and VADp are some of the main nutritional problems among Mexican infants.

Objetivo. Describir la frecuencia de anemia, deficiencia de hierro, vitamina B12, folato, retinol y predictores de la anemia en niños mexicanos de la Ensanut 2012. Material y métodos. Se midieron las concentraciones de hemoglobina, ferritina, PCR, vitamina B12, retinol y folato en 2 678 niños de 1-4 años y 4 275 niños de 5-11 años. Se construyeron modelos de regresión logística para evaluar el riesgo de anemia y deficiencias de micronutrientes. Resultados. La prevalencia de anemia en preescolares y escolares fue 20.4 y 9.7%; deficiencia de hierro (DH) 14 y 9.3%; baja concentración de vitamina B12 (BCB12) 1.9 y 2.6%; folato 0.30 y 0%, y depleción de vitamina A (DpVA), 15.7 y 2.3%, respectivamente. La DH y DpVA se asociaron negativamente con la Hb (coeficiente: -0.38 y -0.45, p<0.05); a mayor log-PCR, mayor riesgo de anemia y DpVA (OR=1.13 y OR=2.1, p<0.05, respectivamente). Conclusiones. DH, anemia y DpVA son algunos de los principales problemas de nutrición en niños mexicanos.

Prevalence of iron, folate, and vitamin B12 deficiencies in 20 to 49 years old women: Ensanut 2012 / Prevalencia de deficiencias de hierro, folato y vitamina B12 en mujeres de 20 a 49 años: Ensanut 2012

Objective. To describe the prevalence of iron, folate, and B12 deficiencies in Mexican women of reproductive age from the National Health and Nutrition Survey (Ensanut) 2012. Materials and methods. Data came from a national probabilistic survey, representative from rural and urban areas, and different age groups. Blood samples were obtained from 4 263, 20 to 49 years old women for serum ferritin, vitamin B12 and serum folate concentrations. The prevalence of deficiencies, was assessed using adjusted logistic regression models. Results. The deficiency of folate was 1.9% (95%CI 1.3-2.8), B12 deficiency was 8.5% (95%CI 6.7-10.1) and iron deficiency was 29.4% (95%CI 26.5-32.2). No differences were found when compared with 2006, 24.8% (95%CI 22.3-27.2). Conclusions. The vitamin B12 deficiency is still a problem for women of reproductive age and their offspring in Mexico, while folate deficiency disappeared as a problem. Iron deficiency needs prevention and fortification strategies.

Objetivo. Describir las prevalencias de deficiencias de hierro, folato y B12 en mujeres mexicanas en edad reproductiva de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2012. Material y métodos. Datos derivados de una encuesta probabilística nacional, representativa del área rural y urbana por grupos de edad. Se obtuvo una submuestra de sangre en 4 263 mujeres de 20 a 49 años de edad para medir las concentraciones séricas de ferritina, vitamina B12 y folato. Las deficiencias fueron evaluadas mediante regresiones logísticas múltiples ajustadas. Resultados. La prevalencia de deficiencias de folatos fue de 1.9% (IC95% 1.3-2.8) y vitamina B12 de 8.5% (IC95% 6.7-10.1). La deficiencia de hierro no fue diferente a la de 2006: 29.4% (IC95% 26.5-32.2) vs 24.8% (IC95% 22.3-27.2). Conclusiones. La prevalencia de deficiencias de hierro y vitamina B12 todavía representan un problema en mujeres mexicanas (20-49), mientras que la deficiencia de folato ha dejado de ser un problema de salud pública. Aún se requieren estrategias de prevención en México.

Nivel sérico de folato y vitamina B12 en adultos mayores chilenos: Resultados de la Encuesta Nacional de Salud ENS 2009-2010 / Serum folate and vitamin B12 in older people: Results from the Chilean national health survey 2009-2010

Supraphysiological levels (SFL) of serum folate (SF) derived from flour fortification with folic acid (FA) could be risky among older adults with low vitamin B12 (B12) levels. Aim: To describe and analyze SF and B12 levels in older Chileans and to identify risk groups. Material and Methods: Participants were 1.043 older people aged ≥ 65 years from the National Health Chilean Health Survey 2009-2010 (ChNHS 2009-10), a multistage stratified random sample, representative of the national population. SF (µg/L) and B12 (pg/ml) were determined in fasting samples by competitive chemoluminescence immunoassay. Mean, deciles and percentiles 5 and 95th were calculated. We defined SF categories: < 4.4 (deficit); 4.41-20 (normal) and SFL: 20.01-25.6; 25.6-29 and > 29 µg/L (80th percentile of the distribution) and vitamin B12 categories: ≤ 200 (deficit); 200.1-299.5 (marginal deficit) and > 299.5 (normal). Prevalence rates, multiple and logistic regression models were used and adjusted by sex and age, educational level and residence area. Results: SF and B12 mean and 95th percentiles were 21.2 ± 0.56/38.6 µg/L and 348.4 ± 7.6/637(pg/ml) respectively. Forty nine percent of participants had SFL. Folate and B12 deficiency were present in 0.3 and 8.1% of participants, respectively. Men had significantly lower prevalence of SFL > 29 µg/L (OR adjusted odds ratio 0.47 95% confidence intervals: 0.26-0.84). B12 showed no significant variation by age and sex. The prevalence of SFL associated with B12 deficiency was 4.1%. No statistically significant association was observed between levels of folate and B12. Conclusions: Folate deficit is almost inexistent, but a significant percentage of participants had SFL suggesting the need for revising the current wheat flour fortification levels.

High serum folate is associated with reduced biochemical recurrence after radical prostatectomy: Results from the SEARCH Database

Introduction To analyze the association between serum levels of folate and risk of biochemical recurrence after radical prostatectomy among men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Materials and Methods Retrospective analysis of 135 subjects from the SEARCH database treated between 1991-2009 with available preoperative serum folate levels. Patients' characteristics at the time of the surgery were analyzed with ranksum and linear regression. Uni- and multivariable analyses of folate levels (log-transformed) and time to biochemical recurrence were performed with Cox proportional hazards. Results The median preoperative folate level was 11.6ng/mL (reference = 1.5-20.0ng/mL). Folate levels were significantly lower among African-American men than Caucasians (P = 0.003). In univariable analysis, higher folate levels were associated with more recent year of surgery (P < 0.001) and lower preoperative PSA (P = 0.003). In univariable analysis, there was a trend towards lower risk of biochemical recurrence among men with high folate levels (HR = 0.61, 95%CI = 0.37-1.03, P = 0.064). After adjustments for patients characteristics' and pre- and post-operative clinical and pathological findings, higher serum levels of folate were independently associated with lower risk for biochemical recurrence (HR = 0.42, 95%CI = 0.20-0.89, P = 0.023). Conclusion In a cohort of men undergoing radical prostatectomy at several VAs across the country, higher serum folate levels were associated with lower PSA and lower risk for biochemical failure. While the source of the folate in the serum in this study is unknown (i.e. diet vs. supplement), these findings, if confirmed, suggest a potential role of folic acid supplementation or increased consumption of folate rich foods to reduce the risk of recurrence. .

Homocysteine and other markers of cardiovascular risk during a manic episode in patients with bipolar disorder

Objective: To evaluate serum levels of different biomarkers associated with cardiovascular disease in patients with bipolar disorder (BD). Patients were prospectively evaluated in two separate instances: during acute mania and after remission of manic symptoms. All measurements were compared with those of healthy controls. Methods: The study included 30 patients with BD and 30 healthy controls, matched for gender and age. Biochemical parameters evaluated included homocysteine (Hcy), folic acid, vitamin B12, ferritin, creatine kinase (CK) and C-reactive protein (CRP). Results: Hcy levels were significantly higher in the BD patients, both during mania and after achieving euthymia. When Hcy was adjusted for body mass index, there was no significant difference between patients and controls. Ferritin was the only marker that showed a significant decrease during mania when compared to both euthymic patients and controls. There were no significant differences for folate, vitamin B12, CK and CRP. Conclusions: These findings do not show an association between alterations of markers of cardiovascular risk during manic episodes. Further studies are necessary to determine factors and mechanisms associated with cardiovascular risk in patients with BD. .

Consumo alimentar e concentrações intra-eritrocitárias de folato em mulheres do Recife, Nordeste do Brasil / Folate food intake and red blood cell folate concentrations in women from Recife, Northeast of Brazil

Foi avaliado o consumo e concentrações intra-eritrocitárias de folato em mulheres do Recife, Nordeste, Brasil, mediante estudo de corte transversal, envolvendo 360 mulheres, de 15 a 45 anos, aleatoriamente rastreadas, por amostragem em dupla etapa, de 9 Unidades Públicas de Saúde, em 2007-2008. O consumo de folato foi avaliado pelo Questionário de Freqüência Alimentar Quantitativo e comparado com os valores da Dietary Reference Intakes-DRI's. O status orgânico de folato foi avaliado pelas concentrações intra-eritrocitárias. A media geométrica do consumo diário de folato foi 627,1[IC95%600,4-655,0] µg/dia. A freqüência de mulheres com risco de ingestão de folato abaixo da recomendação foi 16,0% para adolescentes (<330µg/dia) e 6,3% para adultas jovens (<320µg/dia). A prevalência de mulheres cujo consumo excedeu o limite máximo tolerável de ingestão foi de 48,0% (>800µg/dia) e 13,7% (>1000µg/dia) para adolescentes e adultas, respectivamente. A média das concentrações de folato eritrocitário foi de 1797,8 ± 357,1 nmol/L. O consumo de alimentos-fonte de folato não mostrou correlação com as concentrações eritrocitárias (r= 0,058 e p= 0,274). Maiores concentrações de folato eritrocitário foram observadas em mulheres adultas jovens (p= 0,004) e entre aquelas com renda até dois salários mínimos (p= 0,042). Nas mulheres do Recife, tanto o consumo de alimentos-fonte de folato como as concentrações eritrocitárias de folato elevaram-se em patamares superiores às recomendações internacionais.

Folate food intake and red blood cell folate concentrations were assess in women from Recife, Northeast Brazil. Following a two stages sampling procedure, a cross-sectional study was carried out involving 360 women, between 15-45y, attending in nine Health Care Public Unit in 2007-2008. Folate intake was evaluated by a Quantitative Food Frequency Questionnaire, and compared with the values of the Dietary Reference Intakes- DRI's. Folate status was evaluated by red blood cell folate concentrations. Geometric mean of folate intake was 627.1[IC95%600.4-655.0] µg/day. The frequency of women at risk for folate intake below the recommendation was 16.0% for adolescents (<330µg/ day) and 6.3% for young adult (<320µg/ day). The prevalence of women whose consumption exceeds the maximum tolerable intake was 48.0% (> 800µg/ day) and 13.7% (> 1000µg/ day) for adolescents and adults, respectively. The mean of red blood cell folate concentrations was 1797.8 ± 357.1nmol/L. Folate rich-food intake did not show any correlation with red blood cell folate concentrations (r= 0.058 and p= 0.274). Higher red blood cell folate concentrations were observed in adult young women (p=0.004) and among those with income up to two minimum wages (p=0.042). Folate rich-food intake as well as red blood cell folate concentrations among women from Recife were above the international recommendations.

Fortificación de la harina de trigo con ácido fólico en Chile: Consecuencias no intencionadas / Flour fortifcation with folic acid in Chile: Unintended consequences

Background: High daily intake of folic acid (FA) could determine health risks in some populations. Aim: To review the Chilean FA wheat four fortifcation and to identify the existence of populations at risk. Material and Methods: We categorized the FA levels in four samples (percentil P) (2005-2008) and estimated intake of FA (mg/d) in adults from apparent bread consumption according to different levels (P20, 50 and 95) and children consumption (8-13 years) considering socioeconomic status (SES), bread/g/d intake (P20, 50 and 75) and regulated level of four fortifcation (2.2 mg FA/100 g). Daily Dietary Folate Equivalent (DFE) consumption was estimated from serum folate in adults and elderly people (both sexes). We calculated the percentage of population with FA intakes over the estimated average requirement (EAR) and maximum level (UL) pre and post-fortifcation. Results: There is great variability in FA four: 10-20 percent samples without FA and 10-30 percent with levels > 2.2 mg/100 g. Adult daily consumption (2-4 day/loaves) could determine FA intakes close to UL. Children daily bread consumption (low socioeconomic level) > P75 have intakes close to UL. Post-fortifcation estimated daily DFE from serum folate in women, men and elderly people show: 99 percent of women, 100 percent of men and the elderly people have intakes higher than EAR. Additionally 2.3 percent of women and 6 percent of men would have intakes near the UL. Conclusions: The four FA levels and serum folate levels in some populations show increased FA post-fortifcation intakes, which could lead to greater risk suggesting a revision of the fortifcation level.

Evaluación del estado nutricional de mujeres gestantes que participaron de un programa de alimentación y nutrición / Assessment of nutritional status of a group of pregnant women who participated in a food and nutrition program

Objective: To evaluate the nutritional status of a group of pregnant women and their newborn infants participating in the MANA program. Methods: Descriptive, longitudinal and prospective study designed to follow the cohort before and after intervention. Results: 53 percent of the household showed food insecurity. With the program, food ingestion had a significant increase and the prevalence of the risk of micronutrient deficiency diminished. The low gestational weight diminished from 27.8 percent in the first trimester to 20.3 percent in the third trimester. 94 percent of the newborns weighed over 2500 g. Anemia were prevented in 86 percent of the mothers with iron deficiency. The mothers at risk of serum foliate deficiency diminished from 30,8 percent in the first trimester to 11 ,5 percent in the second. Conclusion: Since the socioeconomic conditions of the population were unchanged during the study, it is possible to conclude that the MANA program and the products received had a positive and significant impact in the nutritional status of the mothers.

Objetivo: Evaluar el estado nutricional de un grupo de gestantes y sus recién nacidos participantes del programa MANA para la vida. Método: Estudio descriptivo, longitudinal, prospectivo con seguimiento de la cohorte antes y después de una intervención. Resultados: el 53 por ciento de los hogares se percibieron en inseguridad alimentaria. La ingesta de nutrientes tuvo un incremento significativo y se redujo la prevalencia del riesgo de deficiencia de algunos micronutrientes. El bajo peso gestacional disminuyó de 27,8 por ciento en el primer trimestre a 20,3 por ciento en el tercero. El 94 por ciento de los recién nacidos tuvieron un peso superior a 2500g. La anemia se previno en el 86 por ciento de las madres con deficiencia de hierro y se disminuyó la proporción a riesgo de deficiencia de folato. Conclusión: Dado las condiciones socioeconómicas de la población, se concluye que el programa desarrollado y los productos entregados tuvieron un impacto positivo y significativo en el estado nutricional de las madres.

Relación entre los niveles de ácido fólico, vitamina B12 y homocisteína materna y los defectos de tubo neural y labio hendido / Relation between levels of folic acid, vitamin B12 and maternal homocysteine with neural tube defects and cleft lip

El objetivo del trabajo fue determinar la asociación entre los niveles de ácido fólico, vitamina B (Vit B12) y homocisteína (Hci) maternos, con defectos del tubo neural (DTN) y labio hendido (LH) con y sin paladar hendido (c/s PH). Se realizó un estudio tipo casos y controles. Casos, con diagnóstico de DTN y LH c/s PH (n=36) y cuatro controles hospitalarios por caso (n=141). Se incluyeron recién nacidos (RN) y lactantes hasta 12 meses de edad. Las variables de pareamiento fueron: edad del RN o lactante, etnia y hospital. Un 23 por ciento de etnia Tarahumara y 77 por ciento mestizos. Se determinó ácido fólico intraeritrocitario (AFI), plasmático (AFP) y Vit B12 por radioinmunoensayo, la Hci por inmunoensayo de fluorescencia polarizada. Se consideró deficiencia si el AFI fue <160 ng/mL, AFP <3.5 ng/ mL y la Vit B12 <200 pg/mL e hiperhomocisteinemia, si Hci >15 J.mol/L. El análisis estadístico se realizó a través de regresión logística condicionada. Se identificó deficiencia de AFI en el 22 por ciento de las mujeres cuyos recién nacidos o lactantes presentaron algún tipo de defecto congénito y en el 12 por ciento de los controles. La relación entre AFI y DTN, LH c/s PH ajustada por edad materna, exposición a plaguicidas y zona de residencia fue RM 2,96 (IC 95 por ciento 0,92-9,46). No se encontraron diferencias en los niveles de Hci ni de Vit B12. Conclusiones: Nuestros resultados sugieren que RN cuyas madres cursan con una deficiencia de AFI tienen mayor riesgo de presentar DTN y LH c/s PH.

Objective: To determine the association between maternal folate deficiency, neural tube defects (NTDs), and cleft lip, with and without cleft palate (CL/P). Material and methods: A case/control study was conducted. The cases included subjects with diagnoses of NTD and CL/P (n=36) and four hospital controls per case (n=141); the study included newborns (NBs) and nursing babies up to 12monthsof age. The parameter variables were the following: the age of the NB or nursing baby, the ethnic group, and the hospital of origin. The Tarahumara ethnic group made up 23 percent of the cases, while 77 percent were mestizos. The red cell folate (RCF), the plasma folie acid (PFA), and the vitamin B12 levels were determined by radioimmunoassay and the homocysteine levels by polarized fluorescence immunoassay. A deficiency was considered to be present if the RCF were <160 ng/mL, the PFA <3.5 ng/mL and the vitamin B <200 pg/ mL; hyperhomocysteinemia was defined as HC >15 J,mol/L. The statistical analysis was carried out through of conditional logistic regression. Results: An RCF deficiency was identified in 22 percent of the women whose newborn or nursing babies presented with some type of congenital defect and in 12 percent of the controls. The correlation adjusted by maternal age, exposure to pesticides and zone of residence was OR 2.96 (CI 95 percent 0.92-9.46). There was no difference in vitamin B12 or homocysteine levels between groups. Conclusions: Our results suggest that newborns whose mothers present with an RCF deficiency have an increased risk of displaying NTD and CL/P.

Preditores dietéticos das concentrações séricas ou plasmáticas de homocisteína, ácido fólico, vitaminas B12 e B6 em mulheres de baixa renda de São Paulo / Dietary predictors of serum or plasma concentrations of homocystein, folic acid, vitamins B12 and B6 in low-income women in São Paulo, Brazl

Objetivo: Examinar a correlação entre fatores dietéticos, obtidos por questionário de frequência alimentar (QFA) validado, e concentrações séricas ou plasmáticas de homocisteína (hcy), ácido fólico, vitaminas B12 e B6 em mulheres de São Paulo. População e métodos: foram analisados os dados dietéticos de 1.434 mulheres de 21 a 65 anos de um estudo caso-controle sobre consumo alimentar e lesões neoplásicas do colo uterino realizado em três hospitais públicos da cidade de São Paulo, excluindo-se os casos de câncer invasivo. Todas participantes tiveram sua ingestão alimentar usual avaliada por entrevista, usando um QFA, e forneceram amostras sangüíneas em jejum para separação de plasma e soro. Concentrações séricas de ácido fólico e vitamina B12 séricos foram analisadas por técnica de fluoroimunoensaio, enquanto concentrações plasmáticas de hcy e vitamina B6 foram analisadas por Cromatografia Reserva Líquida de Alta Pressão. Correlações entre ingestão estimada de nutrientes, ajustados pelas calorias totais, e alimentos com as variáveis bioquímicas foram avaliadas em modelos de regressão linear múltiplos, após ajustes para co-variáveis, tais como idade, Índice de Massa Corporal (IMC), estilo de vida (incluindo tabagismo), morbidade ginecológica pregressa ou atual, história obstétrica e uso de anticoncepcional oral. Resultados: Embora apenas 6,2 por cento das participantes do estudo tenham apresentados concentrações séricas de ácido fólico abaixo do valor de refêrencia (7 nmol/L), 45,7 por cento e em 97,1 por cento tiveram um consumo estimado de folato inferior a 180 micro grama/dia e 400 micro grama/dia, respectivamente. Modelos de regressão múltiplos mostraram correlação positiva entre ácido fólico sérico e ingestão estimada de proteína, ferro, folato, vitaminas B1, B3, B6, A, C e grupos de frutas/sucos cítricos e de vegetais verdes, e correlação inversa entre ácido fólico sérico e consumo estimado de gorduras, doces e leite e derivados.Resultados similares fora...

The C677T thermolabile variant of methylene tetrahydrofolate reductase on homocysteine, folate and vitamin B12 in a hemodialysis center

Homocysteine is a risk factor for cardiovascular disease. Mutations in a key enzyme in homocysteine metabolism, methylenetetrahydrofolate reductase, may contribute to hyperhomocysteinemia and alter folate and cobalamin levels. After starting hemodialysis, 10 mg oral folate daily and 500 micrograms intravenous methylcobalamin once weekly were prescribed to 27 hemodialysis patients (time on hemodialysis > or = 12 months) and two groups were defined: Group A normal; Group B heterozygous. Initial, third and twelfth month measurements of homocysteine, serum folate and vitamin B12 levels were collected and analyzed. Heterozygous state of methylenetetrahydrofolate reductase prevalence was 48

. Hyperhomocysteinemia was present in both groups. Cobalamin final levels were significantly lower in Group B compared to Group A. Homocysteine, serum folate and cobalamin levels at third and twelfth month were significantly different from baseline levels but non-different between them in both groups. In Group B, vitamin B12 at third month was significantly higher than initial, but final measurements were not different from baseline determinations. In conclusion, the heterozygous prevalence of the enzyme in hemodialysis patients is similar to that reported in the general population; hyperhomocysteinemia is frequent in hemodialysis patients and final levels in heterozygous patients are significantly higher than in normal patients. Cobalamin levels are lower in the heterozygous group. After one year of treatment, homocysteine tends to increase, suggesting a secondary resistance phenomenon to vitamin supplementation in heterozygous patients.

Nutrición de folato en escolares / Folate nutrition in school children

En un grupo de escolares de baja condición socio-económica, se encontró una prevalencia de deficiencia de ácido fólico (folato eritrocitario < 140 ng/ml) de un 6,0%. Los niveles de folato encontrados fueron más bajos que los obtenidos en un grupo de lactantes