Folate Supplementation and the Risk of Masking Vitamin B12 Deficiency

Abstract Introduction/Objective To identify clinical/laboratory factors associated with folate deficiency in tertiary care patients. Methods We reviewed the medical records of 1019 patients with serum folate <7.0 ng/mL, 301 patients with serum folate of 15 ng/mL, and 300 patients with serum folate > 23 ng/mL. Results Serum prealbumin levels were subnormal in 54.8% of patients with serum folate <7.0 ng/mL. Vitamin B12, hemoglobin, and serum albumin levels were significantly lower in the <7.0 ng/mL folate group. In 62.4% of patients with serum folate <7.0 ng/mL, 1 or more markers of malnutrition were present. The low-folate group had a significantly higher prevalence of gastrointestinal (GI) disorders, sepsis, and abnormal serum creatinine level. There were no significant differences in the 2 groups regarding diabetes; behavioral/neurological disorders, including drug and alcohol abuse; bariatric surgery; or a diagnosis of malnutrition. The average body mass index (BMI) for the <7.0 ng/mL and 15 ng/mL folate groups was significantly different (28.89 and 28.31, respectively), although the difference does not appear to be clinically meaningful. Conclusion The prevalence of folate deficiency depends on what is considered a normal serum folate level. Approximately 10% of tertiary care patients have levels <7.0 ng/mL and exhibit other markers of malnutrition. It is recommended that patients with GI disorders, chronic kidney disease, and sepsis be routinely tested for serum folate levels, before administration of vitamin supplements. Patients with serum folate levels <7.0 ng/mL should be evaluated for malnutrition, despite BMI > 25. Folate supplementation should be administered only after excluding coexisting vitamin B12 deficiency.

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Folate Supplementation and the Risk of Masking Vitamin B12 Deficiency-Reply

JAMA ◽

10.1001/jama.1997.03540350034027 ◽

1997 ◽

Vol 277 (11) ◽

pp. 884 ◽

Cited By ~ 1

Author(s):

Katherine L. Tucker

Keyword(s):

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

Folate Supplementation ◽

B12 Deficiency

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Serum folate, vitamin B12 levels and clinicohematological profile in 200 anaemic children aged 1-5 years

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20184274 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2167

Author(s):

Sunita Arora ◽

Pushpjeet Singh Sheemar ◽

Mandeep Singh Khurana ◽

Jaskiran Kaur ◽

Ashwani Kumar

Keyword(s):

Vitamin B12 ◽

Tertiary Care ◽

Vitamin B12 Deficiency ◽

Folate Deficiency ◽

Serum Folate ◽

Age Group ◽

Folate Supplementation ◽

Total Prevalence ◽

B12 Deficiency ◽

Combined Deficiency

Background: This study was conducted in 200 anaemic children aged 1-5 years to check their serum folate, vitamin B12 levels and their correlation with sociodemographic parameters and clinicohaematological profile.Methods: Present study was a hospital based observational cross-sectional study carried out in paediatric OPD and IPD of tertiary care institute in Amritsar. Study subjects included 200 anaemic children aged 1-5 years attending paediatric OPD or admitted in IPD of paediatrics department of SGRDIMSAR, Amritsar. Serum folate, vitamin B12 levels were measured in 200 enrolled anaemic children and their correlation with sociodemographic parameters and clinicohaematological profile was studied.Results: Isolated vitamin B12 deficiency was present in 22 (11%), folate deficiency in 28 (14%) and combined deficiency was present in 10 (5%) cases. Isolated vitamin B12 deficiency was more prevalent in 1-2-year age group 10 (45.5%) cases, isolated folate deficiency in 2-3 years age group 12 (42.9%) cases whereas combined deficiency was more prevalent in 4-5 years age group 6 cases (60%). Statistically significant correlation was observed between severity of anaemia and poor socio-economic status, nutritional status, rural background. There was statistically significant association between vitamin B12 deficiency and poor socioeconomic status. Folate and combined deficiency had a positive correlation with age group. Combined vitamin B12 and folate deficiency had a statistically significant correlation with severity of anaemia.Conclusions: Apart from iron deficiency anaemia, vitamin B12 and folate deficiency contributes significantly in total prevalence of anaemia. Vitamin B12 and folate supplementation is equally important in prevention as well as treatment of nutritional deficiency anaemias in paediatric population.

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Serum Folate of Less than 7.0 ng/mL is a Marker of Malnutrition

Laboratory Medicine ◽

10.1093/labmed/lmz101 ◽

2020 ◽

Vol 51 (5) ◽

pp. 507-511

Author(s):

Diana Kozman ◽

Samantha Mattox ◽

Gurmukh Singh

Keyword(s):

Vitamin B12 ◽

Clinical Laboratory ◽

Tertiary Care ◽

Vitamin B12 Deficiency ◽

Folate Deficiency ◽

Normal Serum ◽

Serum Folate ◽

Folate Supplementation ◽

B12 Deficiency ◽

The Difference

Abstract Objective To identify clinical/laboratory factors associated with folate deficiency in tertiary care patients. Methods We reviewed the medical records of 1019 patients with serum folate <7.0 ng/mL, 301 patients with serum folate of 15 ng/mL, and 300 patients with serum folate > 23 ng/mL. Results Serum prealbumin levels were subnormal in 54.8% of patients with serum folate <7.0 ng/mL. Vitamin B12, hemoglobin, and serum albumin levels were significantly lower in the <7.0 ng/mL folate group. In 62.4% of patients with serum folate <7.0 ng/mL, 1 or more markers of malnutrition were present. The low-folate group had a significantly higher prevalence of gastrointestinal (GI) disorders, sepsis, and abnormal serum creatinine level. There were no significant differences in the 2 groups regarding diabetes; behavioral/neurological disorders, including drug and alcohol abuse; bariatric surgery; or a diagnosis of malnutrition. The average body mass index (BMI) for the <7.0 ng/mL and 15 ng/mL folate groups was significantly different (28.89 and 28.31, respectively), although the difference does not appear to be clinically meaningful. Conclusions The prevalence of folate deficiency depends on what is considered a normal serum folate level. Approximately 10% of tertiary-care patients have levels <7.0 ng/mL and exhibit other markers of malnutrition. It is recommended that patients with GI disorders, chronic kidney disease, and sepsis be routinely tested for serum folate levels, before administration of vitamin supplements. Patients with serum folate levels <7.0 ng/mL should be evaluated for malnutrition, despite BMI > 25. Folate supplementation should be administered only after excluding coexisting vitamin B12 deficiency.

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55: The Risk of Vitamin B12 Deficiency is Low after Ileal Orthotopic Bladder Substitution

The Journal of Urology ◽

10.1016/s0022-5347(18)37317-8 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 15-15

Author(s):

Urs E. Studer ◽

Richard Aebischer ◽

Katharina Ochsner ◽

Werner W. Hochreiter

Keyword(s):

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

B12 Deficiency ◽

Bladder Substitution

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Bioavailability of Vitamin B12

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000041 ◽

2010 ◽

Vol 80 (45) ◽

pp. 330-335 ◽

Cited By ~ 28

Author(s):

Lindsay Helen Allen

Keyword(s):

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

The Elderly ◽

Radioactive Isotopes ◽

Animal Source Foods ◽

Dietary Requirements ◽

In Vivo Labeling ◽

B12 Deficiency ◽

Vitamin B12 Malabsorption

Vitamin B12 deficiency is common in people of all ages who consume a low intake of animal-source foods, including populations in developing countries. It is also prevalent among the elderly, even in wealthier countries, due to their malabsorption of B12 from food. Several methods have been applied to diagnose vitamin B12 malabsorption, including Schillings test, which is now used rarely, but these do not quantify percent bioavailability. Most of the information on B12 bioavailability from foods was collected 40 to 50 years ago, using radioactive isotopes of cobalt to label the corrinoid ring. The data are sparse, and the level of radioactivity required for in vivo labeling of animal tissues can be prohibitive. A newer method under development uses a low dose of radioactivity as 14C-labeled B12, with measurement of the isotope excreted in urine and feces by accelerator mass spectrometry. This test has revealed that the unabsorbed vitamin is degraded in the intestine. The percent bioavailability is inversely proportional to the dose consumed due to saturation of the active absorption process, even within the range of usual intake from foods. This has important implications for the assessment and interpretation of bioavailability values, setting dietary requirements, and interpreting relationships between intake and status of the vitamin.

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Increased monocyte to HDL cholesterol ratio in vitamin B12 deficiency: is it related to cardiometabolic risk?

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000668 ◽

2020 ◽

pp. 1-8

Author(s):

Sanem Kayhan ◽

Nazli Gulsoy Kirnap ◽

Mercan Tastemur

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Uric Acid ◽

Vitamin B12 ◽

Cardiometabolic Risk ◽

Vitamin B12 Deficiency ◽

Left Ventricular ◽

Cardiometabolic Risk Factors ◽

B12 Deficiency ◽

Deficiency Group

Abstract. Vitamin B12 deficiency may have indirect cardiovascular effects in addition to hematological and neuropsychiatric symptoms. It was shown that the monocyte count-to-high density lipoprotein cholesterol (HDL-C) ratio (MHR) is a novel cardiovascular marker. In this study, the aim was to evaluate whether MHR was high in patients with vitamin B12 deficiency and its relationship with cardiometabolic risk factors. The study included 128 patients diagnosed with vitamin B12 deficiency and 93 healthy controls. Patients with vitamin B12 deficiency had significantly higher systolic blood pressure (SBP), diastolic blood pressure (DBP), MHR, C-reactive protein (CRP) and uric acid levels compared with the controls (median 139 vs 115 mmHg, p < 0.001; 80 vs 70 mmHg, p < 0.001; 14.2 vs 9.5, p < 0.001; 10.2 vs 4 mg/dl p < 0.001; 6.68 vs 4.8 mg/dl, p < 0.001 respectively). The prevalence of left ventricular hypertrophy was higher in vitamin B12 deficiency group (43.8%) than the control group (8.6%) (p < 0.001). In vitamin B12 deficiency group, a positive correlation was detected between MHR and SBP, CRP and uric acid (p < 0.001 r:0.34, p < 0.001 r:0.30, p < 0.001 r:0.5, respectively) and a significant negative correlation was detected between MHR and T-CHOL, LDL, HDL and B12 (p < 0.001 r: −0.39, p < 0.001 r: −0.34, p < 0.001 r: −0.57, p < 0.04 r: −0.17, respectively). MHR was high in vitamin B12 deficiency group, and correlated with the cardiometabolic risk factors in this group, which were SBP, CRP, uric acid and HDL. In conclusion, MRH, which can be easily calculated in clinical practice, can be a useful marker to assess cardiovascular risk in patients with vitamin B12 deficiency.

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