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

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S6-S6
Author(s):  
Samantha Mattox ◽  
Diana Kozman ◽  
Gurmukh Singh
Keyword(s):  
Vitamin B12 ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Vitamin B12 Deficiency ◽  
Folate Deficiency ◽  
Normal Serum ◽  
Serum Folate ◽  
Folate Supplementation ◽  
Essential Nutrient ◽  
The Difference

Abstract Folate is an essential nutrient that humans are unable to synthesize. We investigated clinical/laboratory factors associated with folate deficiency in tertiary care patients. We reviewed 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. 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, one 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 two groups regarding the prevalence of 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. 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.

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

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S87-S87
Author(s):  
S N Mattox ◽  
D Kozman ◽  
G 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 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.

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

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.

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

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.

scholarly journals Holotranscobalamin Is a Useful Marker of Vitamin B12 Deficiency in Alcoholics

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Alberto Fragasso ◽  
Clara Mannarella ◽  
Angela Ciancio ◽  
Oronzo Scarciolla ◽  
Nicoletta Nuzzolese ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Serum Levels ◽  
Normal Serum ◽  
Serum Folate ◽  
Gamma Glutamyl Transpeptidase ◽  
B12 Deficiency ◽  
Male Patients ◽  
Positive Correlations ◽  
Glutamyl Transpeptidase

Background. Measurement of serum cobalamin (Cbl) levels is the standard investigation for assessing vitamin B12 deficiency. Falsely increased values of Cbl can be caused by alcoholic liver disease. Measurement of total vitamin B12 serum levels might be misleading in alcoholics, because a tissue metabolic deficiency is possible even with normal serum Cbl levels. Holotranscobalamin (HoloTC), the Cbl metabolically active fraction, is considered as a better index of vitamin B12 deficiency.Methods. For assessing vitamin B12 status, we evaluated 22 adult alcoholic male patients by measuring in parallel serum Cbl, serum folate and red blood cell folate levels, HoloTC levels by the AxSYM assay.Results. HoloTC values were reduced in 3 alcoholics with borderline-low Cbl values. Significant positive correlations were found between serum Cbl and HoloTC levels, serum Cbl and gamma-glutamyl transpeptidase (GGT).Conclusion. HoloTC measurement is a useful option for assessing vitamin B12 status in alcoholics, particularly in the subjects with borderline Cbl values and may be considered an early marker of vitamin B12 deficiency.

scholarly journals Folate and Vitamin B12 Status in Women of Reproductive Age in Rural Areas in Haryana, Northern India (P10-117-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Reena Das ◽  
Mona Duggal ◽  
Manmeet Kaur ◽  
Hari Kishan Senee ◽  
Gursharan Singh Dhanjal ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Wheat Flour ◽  
Rural Areas ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Folate Deficiency ◽  
Reproductive Age ◽  
Serum Folate ◽  
Women Of Reproductive Age ◽  
B12 Deficiency

Abstract Objectives To conduct a household and biomarker survey to assess the baseline prevalence of folate deficiency and insufficiency and vitamin B12 deficiency in women of reproductive age prior to the start of a wheat flour fortification program in the Ambala District in Haryana, India. Methods A multistage cluster probability household and biomarker survey was conducted. Participants were women of reproductive age (18–49 y) who were not pregnant and resided in rural areas of two subdistricts in Ambala District in Haryana. Venous blood samples were collected among 866 women. Plasma, serum, and red blood cells (RBC) were separated by centrifugation, processed, and stored at <-80ºC until analysis. RBC and serum folate concentrations were measured using microbiologic assay and serum vitamin B12 was measured via chemiluminescence. Serum folate deficiency was defined as serum folate <7 nmol/L and RBC folate deficiency and insufficiency were defined as RBC folate <305 nmol/L and <748 nmol/L, respectively. Vitamin B12 deficiency was defined as vitamin B12 <200 pg/mL and vitamin B12 marginal deficiency was defined as vitamin B12 ≥200 and <300 pg/mL. Results The geometric mean concentrations for serum folate, RBC folate, and serum vitamin B12 were 12.3 (95% confidence interval [CI]: 11.8, 12.9) nmol/L, 544 (95% CI: 516, 573) nmol/L, and 190 (95% CI: 176, 206) pg/mL, respectively. The prevalence of folate deficiency was 11.3% (95% CI: 9.2, 13.9) for serum folate and 9.7% (95% CI: 7.8, 12.0) for RBC folate, and the prevalence of RBC folate insufficiency was 78.6% (95% CI: 74.8, 82.5). A total of 58.3% (95% CI: 54.2, 62.5) of women were vitamin B12 deficient (<200 pg/mL) and an additional 22.9% (95% CI: 19.7, 26.1) were marginally deficient for vitamin B12. Conclusions The magnitude of folate insufficiency and vitamin B12 deficiency in this Northern Indian population is a substantial public health concern. The findings from the survey help establish the baseline for a planned wheat flour fortification program aimed at reducing these micronutrient deficiencies. Funding Sources Centers for Disease Control and Prevention.

Adopting an Evidence-Based Approach for Folate Testing in a Tertiary Care Center

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S33-S34
Author(s):  
Rehan Rais ◽  
Jeffrey Szymanski ◽  
Ronald Jackups
Keyword(s):  
Vitamin B12 ◽  
Care Center ◽  
Tertiary Care ◽  
Folate Deficiency ◽  
The United States ◽  
Inpatient Setting ◽  
Evidence Based ◽  
Care Hospital ◽  
Folate Supplementation ◽  
Plasma Folate

Abstract Plasma folate is a very commonly ordered test, despite evidence that folate deficiency is extremely rare following universal fortification of grains mandated in the United States in 1998. The objective of our study was to adopt an evidence-based approach for plasma folate testing and identify in what clinical and hospital settings folate may be an informative test. We performed a retrospective laboratory information system/patient chart review between 10/31/17 and 10/31/18 and identified folate-deficient patients. Folate testing data were collected over a 1-year period from a tertiary care hospital and associated allied centers. Data included total tests ordered, age and gender of patient, location of where testing was performed, plasma folate, vitamin B12, hemoglobin, and mean corpuscular volume (MCV). In addition, we looked at association in folate-deficient patients with history of alcohol use, immigrant status, gastric surgery, birth defects, and if any presented with neurological symptoms. Associated patient comorbidities and therapeutic interventions to treat folate deficiency were also noted. Our results show that 14,542 total tests were ordered during this time period, from which 408 patients (2%) had folate below the reference range of 5 ng/mL, with only 92 (0.6%) patients having results below 3 ng/mL (true folate deficiency). Five ICU patients were folate deficient, none of whom was below 3 ng/mL. The average age of folate-deficient patients was 58.3 (age range: 7-97), with a female predominance of 251 patients (61.5%). Hemoglobin results showed only 21 (5%) patients with values less than 7 g/dL, with 231 (56%) patients showing normal and 142 (34.8%) patients showing elevated MCV values (mean MCV: 93.1 fL, SD: 10.2). No clinically relevant association between concurrent folate deficiency and comorbid conditions was identified. Concurrent vitamin B12 testing performed in these patients showed normal levels in 299 (73.2%), while 27 (6%) and 70 (17%) patients showed B12 deficiency and elevation, respectively. Interestingly, only 176 (43%) of patients subsequently received folate supplementation. Our study highlights that folate testing following mandatory grain fortification is almost nonexistent. In addition, the vast majority of folate tests ordered provided no additional clinical information, particularly in the inpatient setting. In addition, our data suggest that elevated MCV values should not be used as a marker to suspect a diagnosis of folate deficiency. Folate testing should therefore be reserved for severely anemic patients without a clear etiology for anemia; however, even in this patient population, supplementation rather than testing may be a more effective option.

scholarly journals Cobalamin and folate status in malnourished children

2017 ◽  
Vol 4 (4) ◽  
pp. 1480 ◽  
Author(s):  
Suresh Goyal ◽  
Kavita Tiwari ◽  
Pradeep Meena ◽  
Sunny Malviya ◽  
Mohd. Asif
Keyword(s):  
Vitamin B12 ◽  
Severe Acute Malnutrition ◽  
Vitamin B12 Deficiency ◽  
Folate Deficiency ◽  
Acute Malnutrition ◽  
Serum Folate ◽  
Plasma Vitamin ◽  
Folate Status ◽  
Malnourished Children ◽  
B12 Deficiency

Background: Vitamin B12 and folate are essential micronutrients which are critical especially during infancy and early childhood as these are periods of rapid growth, development, and increased demand. Malnutrition further increases the risk of these micronutrient deficiency due to poor socioeconomic status, inadequate intake and poor absorption. Aim of present work was to study the cobalamin and folate status in malnourished children.Methods: A hospital based observational study on 80 children suffering from severe acute malnutrition (SAM) aged 6-60 months. Detailed socio-economic, feeding and development history with complete anthropometric evaluation was done. Blood samples sent for measurement of plasma vitamin B12 and serum folate levels. Statistical analysis was done using SPSS version 20.0.Results: Mean age of SAM children was 17.25±12.60 months. 30 (37.5%) had vitamin B12 deficiency (vitamin B12 levels<100pg/ml) and 9 (11.25%) had borderline vitamin B12 levels (100-200pg/ml). Folate deficiency was found in only 7 (8.75%) children. Mean vitamin B12 and folate levels were found to be 353.65±330.76pg/ml, 11.18±4.17ng/ml respectively. Among vitamin B12 deficient children, majority (26, 86.66%) belong to lower socio-economic status, 17 (56.66%) were still predominantly on breast feeding and 11 (36.66%) had delayed introduction of complementary feeding. Among B12 deficient children 23 (76.66%) had delayed development (DQ <70). 100% of B12 deficient children were anemic with majority (21,70%) having severe anemia. 17 (56.66%) B12 deficient children also had associated thrombocytopenia (PC <1.5 lakh/cumm).Conclusions: There was a high prevalence of vitamin B12 deficiency among malnourished children. Folate deficiency was found only in few. Efforts should be directed to prevent its deficiency in pregnant and breastfeeding women and their infants with special attention on malnourished children.

scholarly journals The prevalence of low serum levels of Vitamin D, Vitamin B12, folate and ferritin in adolescents: Single center experience

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110076
Author(s):  
Nazmi Mutlu Karakaş
Keyword(s):  
Vitamin D ◽  
Vitamin B12 ◽  
Medical Records ◽  
Vitamin B12 Deficiency ◽  
Serum Levels ◽  
Folate Deficiency ◽  
Well Child Care ◽  
Single Center Experience ◽  
B12 Deficiency ◽  
Prevalence Of Anemia

Background: In this study, the aim was to evaluate the prevalence of vitamin D, vitamin B12, ferritin, and folate deficiencies in adolescence to clarify the need for early diagnosis and therapy. Methods: The medical records of adolescents between 10 and 18 years of age between 01 September 2018 and 28 February 2019 as healthy with non-specific complaints, or due to well-child care visits, were analyzed retrospectively. Results: A total of 1847/2507 (73.6%) adolescents were included in the study. The prevalence of vitamin D deficiency was 25.7% (n: 178/691). Vitamin B12 deficiency prevalence was 69.2% (n: 753/1088). The prevalence of anemia and ferritin deficiency was 4.8% and 13.26%. The prevalence of folate deficiency was 37.9% (n: 413/1088). VDD prevalence was statistically significantly higher in females than males (F/M:116/62). VB12D prevalence, the number and mean age of females with hemoglobin deficiency, and low ferritin levels was found to be statistically significantly higher in females than males. Conclusions: The prevalence of vitamin D, vitamin B12, folate deficiency and low ferritin levels was found to be high among adolescents. In particular, adolescents admitting with non-specific complaints and for control purposes in big cities must be considered to be at risk for the deficiency of these vitamins and low level of ferritin.

scholarly journals Vitamin B12 in HIV-Infected Patients with Insulin Resistance and Visceral Adiposity in a Randomized Trial of Recombinant Human Growth Hormone and Rosiglitazone (OR12-05-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Heather Guetterman ◽  
Bryan Gannon ◽  
Saurabh Mehta ◽  
Marshall Glesby ◽  
Julia Finkelstein
Keyword(s):  
Insulin Resistance ◽  
Growth Hormone ◽  
Vitamin B12 ◽  
Randomized Trial ◽  
Recombinant Human Growth Hormone ◽  
Vitamin B12 Deficiency ◽  
Visceral Adiposity ◽  
Serum Folate ◽  
Recombinant Growth Hormone ◽  
B12 Deficiency

Abstract Objectives To 1) examine the burden of vitamin B12 deficiency, 2) determine the effects of recombinant growth hormone and rosiglitazone on vitamin B12 status, and 3) investigate vitamin B12 status as a risk factor for changes in insulin sensitivity (SI) and visceral adipose tissue (VAT), among HIV-infected patients with insulin resistance and visceral adiposity participating in a randomized controlled trial. Methods Participants were 72 HIV-infected adults (median [IQR]: 48 [43, 53] y) with insulin resistance and visceral adiposity who participated in a 12-week randomized trial of recombinant growth hormone (GH) and rosiglitazone (R). Venous blood samples were collected at baseline, 4, and 12 weeks, and samples were centrifuged, processed, and stored <−80°C until analysis. Total vitamin B12, methylmalonic acid (MMA), homocysteine, and serum folate were measured in a subset. Vitamin B12 deficiency and insufficiency were defined as <148.0 pmol/L and <221.0 pmol/L, respectively. Elevated MMA was defined as >0.26 µmol/L.Generalized estimating equations were used to evaluate the effects of treatment on vitamin B12 status. Generalized linear models were used to assess the associations of vitamin B12 concentrations with SI and VAT. Results A total of 2.3% of patients were vitamin B12 deficient and 13.6% were vitamin B12insufficient at baseline (median [IQR]: 419.8 [287.0, 538.6] pmol/L); 5.4% had elevated MMA concentrations. The GH + R intervention significantly lowered vitamin B12 concentrations at 4 (β: −66.6, 95% CI: −119.6, −13.6, P = 0.01) and 12 (β: −73.3, 95% CI: −117.8, −28.7, P = 0.001) weeks, compared to placebo. The GH-only intervention significantly lowered vitamin B12concentrations at 12 weeks (β: −89.1, 95% CI: −143.0, −35.3, P = 0.001), compared to placebo. Vitamin B12 concentrations did not significantly change in the R-only group. There were no significant changes in MMA concentrations. Vitamin B12 concentrations at baseline were not significantly associated with changes in SI or VAT (P > 0.05). Conclusions The prevalence of vitamin B12 deficiency was low in HIV-infected individuals with insulin resistance and visceral adiposity. However, interventions containing recombinant growth hormone decreased vitamin B12 status during follow-up. Funding Sources BG was supported by NIH/NCATS Grant # TL1-TR-002386; Division of Nutritional Sciences, Cornell University.

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