scholarly journals Folate and vitamin B12status in relation to cognitive impairment and anaemia in the setting of voluntary fortification in the UK

2008 ◽  
Vol 100 (5) ◽  
pp. 1054-1059 ◽  
Author(s):  
Robert Clarke ◽  
Paul Sherliker ◽  
Harold Hin ◽  
Anne M. Molloy ◽  
Ebba Nexo ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Folic Acid ◽  
Older People ◽  
Serum Folate ◽  
Vitamin B ◽  
Cross Sectional ◽  
Folic Acid Fortification ◽  
Folate Status ◽  
Cross Sectional Studies ◽  
The Uk

Concerns about risks for older people with vitamin B12deficiency have delayed the introduction of mandatory folic acid fortification in the UK. We examined the risks of anaemia and cognitive impairment in older people with low B12and high folate status in the setting of voluntary fortification in the UK. Data were obtained from two cross-sectional studies (n2403) conducted in Oxford city and Banbury in 1995 and 2003, respectively. Associations (OR and 95 % CI) of cognitive impairment and of anaemia with low B12status (holotranscobalamin < 45 pmol/l) with or without high folate status (defined either as serum folate >30 nmol/l or >60 nmol/l) were estimated after adjustment for age, sex, smoking and study. Mean serum folate levels increased from 15·8 (sd14·7) nmol/l in 1995 to 31·1 (sd26·2) nmol/l in 2003. Serum folate levels were greater than 30 nmol/l in 9 % and greater than 60 nmol/l in 5 %. The association of cognitive impairment with low B12status was unaffected by highv.low folate status (>30 nmol/l) (OR 1·50 (95 % CI 0·91, 2·46)v.1·45 (95 % CI 1·19, 1·76)), respectively. The associations of cognitive impairment with low B12status were also similar using the higher cut-off point of 60 nmol/l for folate status ((OR 2·46; 95 % CI 0·90, 6·71)v.(1·56; 95 % CI 1·30, 1·88)). There was no evidence of modification by high folate status of the associations of low B12with anaemia or cognitive impairment in the setting of voluntary fortification, but periodic surveys are needed to monitor fortification.

scholarly journals High folic acid or folate combined with low vitamin B-12 status: potential but inconsistent association with cognitive function in a nationally representative cross-sectional sample of US older adults participating in the NHANES

2020 ◽  
Vol 112 (6) ◽  
pp. 1547-1557 ◽  
Author(s):  
Regan L Bailey ◽  
Shinyoung Jun ◽  
Lisa Murphy ◽  
Ralph Green ◽  
Jaime J Gahche ◽  
...  
Keyword(s):  
Older Adults ◽  
Folic Acid ◽  
Cognitive Function ◽  
Serum Folate ◽  
Vitamin B ◽  
Digit Symbol Substitution Test ◽  
Cross Sectional ◽  
Folate Status ◽  
Normal Vitamin ◽  
Vitamin B 12

ABSTRACT Background Potential safety concerns relative to impaired cognitive function may exist when high folic acid exposures are combined with low vitamin B-12 status. Objectives We aimed to examine the relation of the coexistence of high folate and low vitamin B-12 status with cognitive function, utilizing various definitions of “high” folate status. Methods Cross-sectional data from older adults (≥60 y; n = 2420) from the 2011–2014 NHANES were analyzed. High folate status was defined as unmetabolized serum folic acid (UMFA) &gt; 1 nmol/L or serum total folate &gt; 74.1 nmol/L, and low vitamin B-12 status as methylmalonic acid &gt; 271 nmol/L or serum vitamin B-12 &lt; 150 pmol/L. Logistic regression models estimated ORs of scoring low on 1 of 4 cognitive tests: the Digit Symbol Substitution Test (DSST), the Consortium to Establish a Registry for Alzheimer's Disease Delayed Recall (CERAD-DR) and Word Learning tests, and the Animal Fluency test (AF). Results A significant interaction was observed relative to scoring low on the DSST (&lt;34; UMFA; P-interaction = 0.0071) and AF (serum folate; P-interaction = 0.0078) for low vitamin B-12 and high folate status. Among those with low vitamin B-12, high UMFA or high serum total folate was associated with higher risk of scoring low on the DSST (OR: 2.16; 95% CI: 1.05, 4.47) and the AF (OR: 1.93; 95% CI: 1.08, 3.45). Among those with “normal” vitamin B-12, higher UMFA or serum total folate was protective on the CERAD-DR. In noninteraction models, when high folate and normal vitamin B-12 status was the reference group, low vitamin B-12 combined with high UMFA was associated with greater risk based on the DSST (&lt;34, OR: 2.87; 95% CI: 1.85, 4.45; &lt;40, OR: 2.22; 95% CI: 1.31, 3.75) and AF (OR: 1.97; 95% CI: 1.30, 2.97); but low vitamin B-12 and lower UMFA (OR: 1.69; 95% CI: 1.16, 2.47) was also significantly associated for DSST &lt; 40 risk. Conclusions Low vitamin B-12 was associated with cognitive impairment both independently and in an interactive manner with high folate for certain cognitive performance tests among older adults.

scholarly journals Intake and status of folate and related B-vitamins: considerations and challenges in achieving optimal status

2008 ◽  
Vol 99 (S3) ◽  
pp. S48-S54 ◽  
Author(s):  
Helene McNulty ◽  
John M. Scott
Keyword(s):  
Folic Acid ◽  
Folic Acid Supplementation ◽  
B Vitamins ◽  
Natural Food ◽  
Vitamin B ◽  
High Dose ◽  
Folic Acid Fortification ◽  
Younger Women ◽  
Folate Status ◽  
The Uk

Folate and the metabolically related B-vitamins, vitamin B12and riboflavin, have attracted much scientific and public health interest in recent years. Apart from a well established role in preventing neural tube defects (NTDs), evidence is emerging to support other potential roles for folate and/or related B-vitamins in protecting against cardiovascular disease (especially stroke), certain cancers, cognitive impairment and osteoporosis. However, typical folate intakes are sub-optimal, in that although adequate in preventing clinical folate deficiency (i.e. megaloblastic anaemia) in most people, they are generally insufficient to achieve a folate status associated with the lowest risk of NTDs. Natural food folates have a limited ability to enhance folate status as a result of their poor stability under typical cooking conditions and incomplete bioavailability when compared with the synthetic vitamin, folic acid (as found in supplements and fortified foods). Current folate recommendations to prevent NTDs (based primarily on folic acid supplementation) have been found to be ineffective in several European countries. In contrast, in North America and Chile, the policy of mandatory folic acid-fortification has proven itself in terms of lowering the prevalence of NTD, but remains controversial because of concerns regarding potential risks of chronic exposure to high-dose folic acid. In the case of vitamin B12, the achievement of an optimal status is particularly difficult for many older people because of the common problem of food-bound B12malabsorption. Finally, there is evidence that riboflavin status is generally low in the UK population, and particularly so in younger women; this warrants further investigation.

Folate Nutritional Status among Psoriasis Patients not Exposed to Antifolate Drug

2020 ◽  
Vol 16 (4) ◽  
pp. 543-553
Author(s):  
Luciana Y. Tomita ◽  
Andréia C. da Costa ◽  
Solange Andreoni ◽  
Luiza K.M. Oyafuso ◽  
Vânia D’Almeida ◽  
...  
Keyword(s):  
Folic Acid ◽  
Linear Regression ◽  
Multiple Linear Regression Model ◽  
Folate Intake ◽  
Serum Folate ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Folic Acid Fortification ◽  
Plasma Folate ◽  
Psoriasis Severity

Background: Folic acid fortification program has been established to prevent tube defects. However, concern has been raised among patients using anti-folate drug, i.e. psoriatic patients, a common, chronic, autoimmune inflammatory skin disease associated with obesity and smoking. Objective: To investigate dietary and circulating folate, vitamin B12 (B12) and homocysteine (hcy) in psoriatic subjects exposed to the national mandatory folic acid fortification program. Methods: Cross-sectional study using the Food Frequency Questionnaire, plasma folate, B12, hcy and psoriasis severity using the Psoriasis Area and Severity Index score. Median, interquartile ranges (IQRs) and linear regression models were conducted to investigate factors associated with plasma folate, B12 and hcy. Results: 82 (73%) mild psoriasis, 18 (16%) moderate and 12 (11%) severe psoriasis. 58% female, 61% non-white, 31% former smokers, and 20% current smokers. Median (IQRs) were 51 (40, 60) years. Only 32% reached the Estimated Average Requirement of folate intake. Folate and B12 deficiencies were observed in 9% and 6% of the blood sample respectively, but hyperhomocysteinaemia in 21%. Severity of psoriasis was negatively correlated with folate and B12 concentrations. In a multiple linear regression model, folate intake contributed positively to 14% of serum folate, and negative predictors were psoriasis severity, smoking habits and saturated fatty acid explaining 29% of circulating folate. Conclusion: Only one third reached dietary intake of folate, but deficiencies of folate and B12 were low. Psoriasis severity was negatively correlated with circulating folate and B12. Stopping smoking and a folate rich diet may be important targets for managing psoriasis.

scholarly journals Serum homocysteine and folate concentrations among a US cohort of adolescents before and after folic acid fortification

2012 ◽  
Vol 15 (10) ◽  
pp. 1818-1826 ◽  
Author(s):  
Daniel A Enquobahrie ◽  
Henry A Feldman ◽  
Deanna H Hoelscher ◽  
Lyn M Steffen ◽  
Larry S Webber ◽  
...  
Keyword(s):  
Folic Acid ◽  
Cardiovascular Health ◽  
Serum Folate ◽  
Vitamin B ◽  
Serum Concentrations ◽  
Folic Acid Fortification ◽  
Serum Homocysteine ◽  
Cereal Grain ◽  
Before And After ◽  
Average Serum

AbstractObjectiveWe assessed serum homocysteine (tHcy) and folate concentrations among US adolescents before and after fortification of cereal-grain products with folic acid, and associations with demographic, behavioural and physiological factors.DesignObservational study conducted among participants of a randomized trial.SettingThe Child and Adolescent Trial for Cardiovascular Health (CATCH) study.SubjectsAdolescents (n2445) in grades 8 (pre-fortification, mean age 14 years) and 12 (post-fortification, mean age 18 years).ResultsAverage serum concentrations of tHcy, folate and vitamin B6increased by 17 %, 16 % and 14 %, respectively, while serum concentrations of vitamin B12decreased by 11 % post-fortification. Folic acid fortification provided, on average, an additional intake of 118 μg folate/d. Male sex (P< 0·0001) and white race (P= 0·0008) were associated with significantly greater increases in tHcy concentration, while increases in BMI (P= 0·006) and serum folate concentration (P< 0·0001) were associated with significant decreases in tHcy concentration. Female sex (P< 0·0001), non-smoking (P< 0·0001), use of multivitamins (P< 0·0001) and higher dietary intake of folate (P= 0·001) were associated with significantly greater increases in serum folate concentrations. From grade 8 to grade 12, the upward age trend in serum tHcy concentration was uninterrupted in its course (P> 0·50); whereas serum folic acid concentration showed a downward trend that incurred a discrete jump upward (17 % higher;P< 0·0001) with fortification. These trends differed significantly for malesv. females (P< 0·001 for interaction).ConclusionsFortification had a significant impact on improving folate status but not serum tHcy concentrations among US adolescents.

scholarly journals Interactions between plasma concentrations of folate and markers of vitamin B12status with cognitive performance in elderly people not exposed to folic acid fortification: the Hordaland Health Study

2013 ◽  
Vol 111 (6) ◽  
pp. 1085-1095 ◽  
Author(s):  
Esmée L. Doets ◽  
Per M. Ueland ◽  
Grethe S. Tell ◽  
Stein Emil Vollset ◽  
Ottar K. Nygård ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Folic Acid ◽  
Cognitive Performance ◽  
Sex Education ◽  
Plasma Concentrations ◽  
Health Study ◽  
Vitamin B ◽  
Plasma Vitamin ◽  
Folic Acid Fortification ◽  
Plasma Folate

A combination of high folate with low vitamin B12plasma status has been associated with cognitive impairment in a population exposed to mandatory folic acid fortification. The objective of the present study was to examine the interactions between plasma concentrations of folate and vitamin B12markers in relation to cognitive performance in Norwegian elderly who were unexposed to mandatory or voluntary folic acid fortification. Cognitive performance was assessed by six cognitive tests in 2203 individuals aged 72–74 years. A combined score was calculated using principal component analysis. The associations of folate concentrations, vitamin B12markers (total vitamin B12, holotranscobalamin (holoTC) and methylmalonic acid (MMA)) and their interactions in relation to cognitive performance were evaluated by quantile regression and least-squares regression, adjusted for sex, education, apo-ɛ4 genotype, history of CVD/hypertension and creatinine. Cross-sectional analyses revealed an interaction (P= 0·009) between plasma concentrations of folate and vitamin B12in relation to cognitive performance. Plasma vitamin B12concentrations in the lowest quartile ( < 274 pmol/l) combined with plasma folate concentrations in the highest quartile (>18·5 nmol/l) were associated with a reduced risk of cognitive impairment compared with plasma concentrations in the middle quartiles of both vitamins (OR 0·22, 95 % CI 0·05, 0·92). The interaction between folate and holoTC or MMA in relation to cognitive performance was not significant. In conclusion, this large study population unexposed to mandatory folic acid fortification showed that plasma folate, but not plasma vitamin B12, was associated with cognitive performance. Among the elderly participants with vitamin B12concentrations in the lower range, the association between plasma folate and cognitive performance was strongest.

Plasma concentrations of vitamin B12 and folate and global cognitive function in an older population: cross-sectional findings from The Irish Longitudinal Study on Ageing (TILDA)

2020 ◽  
Vol 124 (6) ◽  
pp. 602-610 ◽  
Author(s):  
Deirdre M. A. O’Connor ◽  
Eamon J. Laird ◽  
Daniel Carey ◽  
Aisling M. O’Halloran ◽  
Robert Clarke ◽  
...  
Keyword(s):  
Older Adults ◽  
Folic Acid ◽  
Longitudinal Study ◽  
Cognitive Function ◽  
Cognitive Performance ◽  
Vitamin B ◽  
Plasma Vitamin ◽  
Cross Sectional ◽  
Folate Status ◽  
Global Cognitive Function

AbstractThe uncertainty surrounding high intakes of folic acid and associations with cognitive decline in older adults with low vitamin B12 status has been an obstacle to mandatory folic acid fortification for many years. We estimated the prevalence of combinations of low/normal/high vitamin B12 and folate status and compared associations with global cognitive function using two approaches, of individuals in a population-based study of those aged ≥50 years in the Republic of Ireland. Cross-sectional data from 3781 men and women from Wave 1 of The Irish Longitudinal Study on Ageing were analysed. Global cognitive function was assessed by the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Prevalence estimates for combinations of vitamin B12 (plasma vitamin B12 < or ≥258 pmol/l) and folate (plasma folate ≤ or >45·3 nmol/l) concentrations were generated. Negative binomial regression models were used to investigate the associations of vitamin B12 and folate status with global cognitive function. Of the participants, 1·5 % (n 51) had low vitamin B12 (<258 pmol/l) and high folate (>45·3 nmol/l) status. Global cognitive performance was not significantly reduced in these individuals when compared with those with normal status for both B-vitamins (n 2433). Those with normal vitamin B12/high folate status (7·6 %) had better cognitive performance (MMSE: incidence rate ratio (IRR) 0·82, 95 % CI 0·68, 0·99; P = 0·043, MoCA: IRR 0·89, 95 % CI 0·80, 0·99; P = 0·025). We demonstrated that high folate status was not associated with lower cognitive scores in older adults with low vitamin B12 status. These findings provide important safety information that could guide fortification policy recommendations in Europe.

scholarly journals Folate and vitamin B12: friendly or enemy nutrients for the elderly

2007 ◽  
Vol 66 (4) ◽  
pp. 548-558 ◽  
Author(s):  
Geraldine J. Cuskelly ◽  
Kathleen M. Mooney ◽  
Ian S. Young
Keyword(s):  
Folic Acid ◽  
Serum Vitamin ◽  
The Elderly ◽  
Megaloblastic Anaemia ◽  
Vitamin B ◽  
Folic Acid Fortification ◽  
The Usa ◽  
Criteria For Diagnosis ◽  
Folate And Vitamin B12 ◽  
The Uk

In the UK vitamin B12deficiency occurs in approximately 20% of adults aged >65 years. This incidence is significantly higher than that among the general population. The reported incidence invariably depends on the criteria of deficiency used, and in fact estimates rise to 24% and 46% among free-living and institutionalised elderly respectively when methylmalonic acid is used as a marker of vitamin B12status. The incidence of, and the criteria for diagnosis of, deficiency have drawn much attention recently in the wake of the implementation of folic acid fortification of flour in the USA. This fortification strategy has proved to be extremely successful in increasing folic acid intakes pre-conceptually and thereby reducing the incidence of neural-tube defects among babies born in the USA since 1998. However, in successfully delivering additional folic acid to pregnant women fortification also increases the consumption of folic acid of everyone who consumes products containing flour, including the elderly. It is argued that consuming additional folic acid (as ‘synthetic’ pteroylglutamic acid) from fortified foods increases the risk of ‘masking’ megaloblastic anaemia caused by vitamin B12deficiency. Thus, a number of issues arise for discussion. Are clinicians forced to rely on megaloblastic anaemia as the only sign of possible vitamin B12deficiency? Is serum vitamin B12alone adequate to confirm vitamin B12deficiency or should other diagnostic markers be used routinely in clinical practice? Is the level of intake of folic acid among the elderly (post-fortification) likely to be so high as to cure or ‘mask’ the anaemia associated with vitamin B12deficiency?

scholarly journals High-dose folic acid supplementation in rats: effects on gestation and the methionine cycle

2000 ◽  
Vol 83 (2) ◽  
pp. 177-183 ◽  
Author(s):  
M. Achón ◽  
E. Alonso-Aperte ◽  
L. Reyes ◽  
N. Úbeda ◽  
G. Varela-Moreiras
Keyword(s):  
Folic Acid ◽  
Dietary Supplementation ◽  
Folic Acid Supplementation ◽  
Serum Folate ◽  
Vitamin B ◽  
High Dose ◽  
Acid Supplementation ◽  
Folate Status ◽  
Methionine Cycle ◽  
Acid Administration

There is new evidence that a good folate status may play a critical role in the prevention of neural-tube defects and in lowering elevated homocysteine concentrations. This adequate folate status may be achieved through folic acid dietary supplementation. Folate is a water-soluble vitamin with a low potential toxicity. However, the possible consequences of long-term high-dose folic acid supplementation are unknown, especially those related to the methionine cycle, where folate participates as a substrate. With the aim of evaluating such possible effects, four groups of Wistar rats were classified on the basis of physiological status (virgin v. pregnant) and the experimental diet administered (folic-acid-supplemented, 40 mg/kg diet v. control, 2 mg folic acid/kg diet). Animals were fed on the diets for 3 weeks. Results showed that gestation outcome was adequate in both groups regardless of the dietary supplementation. However, there were reductions (P < 0·001) in body weight and vertex-coccyx length in fetuses from supplemented dams v. control animals. Folic acid administration also induced a higher (P < 0·01) S-adenosylmethionine : S-adenosylhomocysteine value due to increased S-adenosylmethionine synthesis (P < 0·01). However, hepatic DNA methylation and serum methionine concentrations remained unchanged. Serum homocysteine levels were reduced in supplemented dams (P < 0·05). Finally, pregnancy caused lower serum folate, vitamin B6 and vitamin B12 levels (P < 0·05). Folic acid administration prevented the effect of pregnancy and raised folate levels in dams, but did not change levels of vitamins B12 and B6. These new findings are discussed on the basis of potential benefits and risks of dietary folic acid supplementation.

scholarly journals Folate status of Ghanaian populations in London and Accra

2009 ◽  
Vol 103 (3) ◽  
pp. 437-444 ◽  
Author(s):  
Matilda Owusu ◽  
Jane Thomas ◽  
Edwin Wiredu ◽  
Maria Pufulete
Keyword(s):  
Methylenetetrahydrofolate Reductase ◽  
Plasma Homocysteine ◽  
Folate Intake ◽  
Serum Folate ◽  
Cross Sectional ◽  
Folate Status ◽  
Supplement Use ◽  
Increased Risk ◽  
Erythrocyte Folate ◽  
The Uk

Migration to the UK is associated with higher incidence of stroke in African populations. A low folate status has been associated with increased risk of stroke, likely to be mediated through raised plasma homocysteine concentrations. We conducted a cross-sectional study to compare blood folate and homocysteine concentrations in eighty healthy Ghanaian migrants living in London matched by sex, age and occupation to 160 individuals from an urban population in Accra, Ghana. Folate intake was determined using three 24 h recalls. Fasting blood samples were collected for the determination of serum and erythrocyte folate and plasma homocysteine concentrations and the methylenetetrahydrofolate reductase (MTHFR) 677C → T polymorphism. Reported mean folate intake was 20 % lower in London compared with Accra (P < 0·001). However, serum folate was 44 % higher, erythrocyte folate 30 % higher and plasma homocysteine was 26 % lower in subjects from London compared with those from Accra (P < 0·001). These differences persisted after adjusting for confounders including the MTHFR 677C → T mutation, which was rare in both populations. Although there were no associations between dietary folate intake and blood folates (P>0·05), folic acid supplement use, which was more prevalent in London than Accra (25 and 10 %, respectively,P = 0·004) was associated with erythrocyte folate in both populations (P < 0·01). The main predictors of plasma homocysteine concentrations were erythrocyte folate and male sex (P < 0·001). Findings from the present study suggest that migration from Ghana to the UK results in improvement of biomarkers of folate status despite the fact that reported dietary intake of folate was apparently lower in subjects from London.

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