Effect of metformin on serum level of vitamin B12 and folate in patients of type-2 diabetes mellitus

Background: Several types of DM are caused by a complex interaction of genetic and environmental factors. Depending on the etiology of the DM, factors contributing to hyperglycaemia include- reduced insulin secretion, decreased glucose utilization, and increased glucose production.Objective of the current study was to study the effect of metformin on the level of vitamin B12 and folate in patients of type 2 DM.Methods: This is hospital based study before and after metformin therapy randomized controlled trial was conducted in medicine ward of M. B. hospital, Udaipur. Baseline serum vitamin B12 and folate level of all patients were measured and treatment with metformin 500 mg twice a day was given for 6 months. After 6 months serum vitamin B12 and folate level of all patients were re-evaluated.Results: There was a significant positive correlation (r=0.824, p<0.001) between decrease in vitamin B12 and decrease in folate level after metformin treatment. When analysis for change in vitamin B12 is compared with change in MCV values after 6 months, negative correlation (r=-0.08, p>0.05) was obtained. A non significant correlation (r=-0.08, p>0.05) with change in level of serum folate and change in MCV values or haemoglobin level was obtained.Conclusions: Low serum vitamin B12 level is associated with longer duration and higher dose of metformin use. Routine determination of vitamin B12 level in patients with type 2 DM on high dose of metformin and those with prolonged use of metformin might help in identifying patients that would benefit from vitamin B12 supplements.

TO STUDY OF ASSOCIATION OF CLINICAL PROFILE WITH SERUM VITAMIN B12 AND FOLATE LEVEL IN CHILDREN WITH INFANTILE TREMOR SYNDROME

Background-We planned the present study with objective of to find out correlation in vitamin B and folate levels with 12 clinical profile in children with ITS Methods- This Hospital based cross sectional observational study was conducted in, Sir Padampat Mother and Child Health Institute (SPMCHI),SMS Medical College,Jaipur. Results- Vitamin B and folate were reduced in children with generalized tremors, psychomotor retardation, delayed 12 milestones,presence of hepatomegaly and splenomegaly. Conclusion- All children with Infantile Tremor Syndrome should be screened for vitamin B and folate levels,high risk 12 children should be supplemented B and folic acid.

TO ESTIMATE VITAMIN B LEVEL AND FOLATE IN CHILDREN WITH INFANTILE 12 TREMOR SYNDROME

BACKGROUND- Exact incidence of ITS is not known but it was accounted for 0.2 to 2% pediatric hospital admissions in 1962 and reduced to 0.2% currently in India. Aims of this study to estimate Vitamin B level 12 and folate in children with Infantile Tremor Syndrome METHODS- This Hospital based cross sectional observational study was conducted in, Sir Padampat Mother and Child Health Institute (SPMCHI), SMS Medical College, Jaipur. RESULTS- The mean serum B level was highest in children aged 13-18 months (117.40 pg/ml) and was lowest in children aged 12 6-12 months (67.90 pg/ml). This difference in B level in different age groups was statistically not signicant (p>0.05). The mean 12 serum folate level was highest in children aged 6-12 months (17.32 ng/ml) followed by children aged 13-18 months (15.53 ng/ml) and was lowest in children aged >18 months (13.70 ng/ml). This difference in folate level in different age groups was statistically not signicant (p>0.05). CONCLUSION- Present study ndings suggest that serum vitamin B and folate levels are decreased in children with Infantile 12 Tremor Syndrome.

Can Homocysteine Be Used to Identify Vitamin B12 or Folate Deficiencies During Pregnancy in Low Resource Settings?

Objectives With universal iron supplementation during pregnancy, role of other nutritional causes of anemia such as Vitamin B12 and folate deficiencies are increasingly coming to light. Testing vitamin B12 and folate levels is costly and inconvenient in low and middle income settings. Serum Homocysteine level is proposed as a cheaper and more feasible alternative to indicate vitamin B12/folate deficiency. We evaluated the role of Homocysteine as a predictor of B12/folate level among anaemic pregnant women in Sri Lanka. Methods We measured fasting serum total Homocysteine in a randomly selected sub sample of anaemic pregnant women (hemoglobin less than 11g/dl) from the Rajarata Pregnancy Cohort (RaPCo), Anuradhapura, Sri Lanka. They were referred to a special hospital clinic for B12 and folate assessment within 2 weeks of the initial assessment. Homocysteine levels &gt; 6.9 µmol/L in first and &gt; 9.6 µmol/L in second trimesters were defined as Hyperhomocysteinaemia. B12 levels below 203 pg/ml and folate levels below 4ng/ml were defined as deficiency. Sensitivity and specificity were calculated and Spearmen correlation was performed. Results Twenty two anaemic pregnant women in 6 to 18 weeks of gestation were included in the assessment. Median haemoglobin level of the selected sample was 10.2 g/dl (Range 8.2–10.9). Homocysteine (Range 4.43–17, median 8 µmol/L), B12 (Range 149.6–721, median 299.8 pg/ml) and folate (Range 5.5–40, median 16.6 ng/ml) showed skewed distribution. Hyperhomocysteinaemia was observed in 12/22 (50%) pregnant women and B12 deficiency was observed in five participants (22.7% CI 10.1–43.4). None had folate deficiency. Hyperhomocysteinaemia was present in 2/5 (40%) B12 deficient and 10/17 (58.8%) B12 normal participants. Sensitivity of Homocysteine to indicate B12 deficiency was 40% (95% CI 11.8 to 76.9) and specificity was 41.2% (21.6, 67). Predictive values of positive and negative tests were 16.7% and 70% respectively. Homocysteine levels did not correlate with B12 level (Spearmen r = -0.26, p = 0.24) or folate level (spearmen r = 0.04, p = 0.86). Conclusions Elevated Homocysteine levels cannot be used as a reliable indicator of B12 or Folate deficiency in anaemic pregnant women. Funding Sources Accelerating Higher Education Expansion and Development (AHEAD) Operation of the Ministry of Higher Education, Sri Lanka.

An observational study to find association of serum vitamin B12 and folate level with neonatal weight at a tertiary care centre

Background: In developing countries like India, low birth weight is a challenging and important public health problem as it has adverse effect on growth and development of children. Vitamin B12 and folate are micronutrients essential for normal foetal growth and development. Maternal folate and B12 concentrations have been positively associated with birth weight. The aim of this study was to evaluate maternal folate and vitamin B12 status in pregnant women in third trimester of pregnancy and to find their relation with foetal birth weight.Methods: 171 pregnant women in their third trimester with live singleton pregnancy were included in the study. S. vitamin B12 and folate levels were measured and results were analysed.Results: Mean maternal vitamin B12 level in mothers with LBW infants was significantly lower than that of mothers of ABW infants (143.23±91.79 vs 188.8±109.64 respectively p≤0.001) and mean maternal folate level in mothers with LBW infants was lower than that of mothers of ABW infants (8.46±8.94 vs 9.96±12.57 respectively p=0.054). There was a weak positive but statistically significant correlation between baby weight (kg) and S. vitamin B12 (rho=0.24, p=0.002) and S. folate (rho=0.17, p=0.029).Conclusions: The present study confirms that maternal low vitamin B12 level and low S. folate levels are associated with low birth weight so during antenatal visit women should be screened for vitamin B12 and folate deficiency and vitamin supplementation should be continued throughout the pregnancy.

Serum Folate, Vitamin B12 Levels, and Systemic Immune-Inflammation Index Correlate With Motor Performance in Parkinson's Disease: A Cross-Sectional Study

This study aimed to investigate the influence of serum folate, vitamin B12 (VitB12) levels, and inflammation-based scores on the motor performance status in Parkinson's disease (PD). We retrospectively collected data from 148 consecutive patients with idiopathic PD first admitted to our hospital. We measured whole blood count, albumin, lactate dehydrogenase, C-reactive protein, folate, and VitB12 levels and calculated the inflammation-based scores. The following scales were applied to assess the motor performance status: activity of daily living scale (ADL, the Barthel Index), the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III), and Hoehn–Yahr (H–Y) classification. The geometric mean of folate and VitB12 levels were 11.87 (ng/ml) and 330.52 (pmol/L), respectively. Folate deficiency (serum level &lt; 4.0 ng/ml) and VitB12 deficiency (serum level &lt; 133 pg/ml) were present in 0.7 and 5.4% of the patients, respectively. The mean prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) were 47.78 ± 4.42 and 470.81 ± 254.05, respectively. The multivariate analyses showed that serum VitB12 level (P = 0.002) and SII (P = 0.005) were significant factors for ADL score; serum folate (P = 0.027) and VitB12 (P = 0.037) levels for UPDRS-III score; and serum folate (P = 0.066) and VitB12 (P = 0.017) levels for H–Y classification. The elevated folate level did correlate with greater decline in UPDRS-III score (P = 0.023) and H–Y classification (P = 0.003), whereas there was an obvious increase in ADL score (P = 0.048). SII was negatively associated (P &lt; 0.001) with the ADL score. The three-dimensional drawing, combined with the effect of folate and VitB12 levels, showed that the lowest level of folate was associated with the lowest ADL score and the highest UPDRS-III score and H–Y classification. This study indicates that serum folate, VitB12 levels, and SII are significant factors influencing the motor performance status in patients with PD. SII is negatively associated with ADL. Elevated serum folate level correlates with mild motor impairment in patients with PD.

Folate supplementation in pregnancy

Objectives: To determine the prevalence of low, normal and high folate levels in Omani population. Folate supplement given routinely during pregnancy. Folate added into multi-vitamins supplement as well as into food products. This leads to decrease the prevalence of low folate or increase prevalence of people with excess folate. Low and high folate level leads to adverse side effects. Methods: 3706 folate samples analyzed in Cobas e 601 chemical analyzer. The results separated into three main groups (low, normal and high). Results: Only 0.3% of the study sample shows low folate level. Five (0.2%) out of 2335 female samples show low folate level. Three (0.2%) out of 1371 male samples shows low folate level. Conclusion: Routine folate intake during pregnancy, supplement to the general population for wellbeing and food fortification might lead to excess folate status. Folate testing before supplementation help in avoiding high folate adverse effects.

Effects of Periconceptional Multivitamin Supplementation on Folate and Homocysteine Levels Depending on Genetic Variants of Methyltetrahydrofolate Reductase in Infertile Japanese Women

Methylenetetrahydrofolate reductase (MTHFR) has various polymorphisms, and the effects of periconceptional folic acid supplementation for decreasing neural tube defects (NTDs) risk differ depending on the genotypes. This study analyzed the effectiveness of multivitamin supplementation on folate insufficiency and hyperhomocysteinemia, depending on MTHFR polymorphisms. Of 205 women, 72 (35.1%), 100 (48.8%) and 33 (16.1%) had MTHFR CC, CT and TT, respectively. Serum folate and homocysteine levels in women with homozygous mutant TT were significantly lower and higher, respectively, than those in women with CC and CT. In 54 women (26.3% of all women) with a risk of NTDs, multivitamin supplementation containing folic acid and vitamin D for one month increased folate level (5.8 ± 0.9 to 19.2 ± 4.0 ng/mL, p < 0.0001) and decreased the homocysteine level (8.2 ± 3.1 to 5.8 ± 0.8 nmol/mL, p < 0.0001) to minimize the risk of NTDs in all women, regardless of MTHFR genotype. Regardless of MTHFR genotype, multivitamin supplements could control folate and homocysteine levels. Tests for folate and homocysteine levels and optimal multivitamin supplementation in women with risk of NTDs one month or more before pregnancy should be recommended to women who are planning a pregnancy.

Interactions Between Handgrip Strength and Serum Folate and Homocysteine Levels on Cognitive Function in the Elderly Chinese Population

Background: Handgrip strength (HGS) and serum folate and homocysteine (Hcy) levels were associated with cognitive function. However, little was known whether there were interactions between HGS and serum folate and Hcy levels on cognitive function. Objective: To examine the interactions between HGS and serum folate and Hcy levels on cognitive function. Methods: This study analyzed the baseline data of the Tianjin Elderly Nutrition and Cognition Cohort study. All participants aged ≥60 years were potential eligible. HGS was measured using a grip strength dynamometer. Serum folate and Hcy levels were assayed using standard laboratory protocol. A Mini-Mental State Examination was used to assess cognitive function. Linear regressions were employed to examine the interactions between HGS and serum folate and Hcy levels on cognitive function. Results: 4,484 participants were included in this study. There were interactions between HGS and serum folate and Hcy levels on cognitive function. Furthermore, subjects with strong HGS and sufficient folate level had the best cognitive function (β= 2.018), sequentially followed by those with strong HGS and insufficient folate level (β= 1.698) and with poor HGS and sufficient folate level (β= 0.873). Similarly, cognitive function was ranked in the descending order of subjects with strong HGS and normal Hcy level (β= 1.971), strong HGS and high Hcy level (β= 1.467), and poor HGS and normal Hcy level (β= 0.657). Conclusion: There were interactions between HGS and serum folate and Hcy levels on cognitive function. However, the temporal associations cannot be examined in a cross-sectional study. Further cohort study should be conducted to confirm these associations in the future.