Assessment of Dietary Folate Intake and Pill Burden among Saudi Patients on Maintenance Hemodialysis

The aim of this study was to assess the adequacy of dietary folate intake and perceptions of pill burden among Saudi patients on maintenance hemodialysis (MHD). This was a cross-sectional study of adults (>18 years) on MHD (>3 months) attending the dialysis unit at King Saud University Medical City. Patient demographics, dietary folic acid intake, and perceptions of pill burden were collected. Fifty-four patients met the eligibility criteria, with a mean age of 57 ± 15.5 years. The majority were females (63%), and the most prevalent comorbidities were diabetes (43%) and hypertension (76%). The average number of medications/patients was 11 ± 2.9, and most patients were receiving folate supplementation (68.5%). The average dietary folate intake was 823 ± 530 mcg/day. Pill burden was bothersome, primarily due to taking too many medications (57%) while taking medications at the workplace was the least bothersome burden (17%). The reported high pill burden and adequate dietary folate intake by Saudi patients on MHD indicates that the omission of folate supplementation may be advantageous for this special population.

Prevalence of inadequate intake of folate in the post-fortification era: data from the Brazilian National Dietary Surveys 2008-2009 and 2017-2018

The objectives were to compare the evolution of dietary folate intake, to estimate the prevalence of folate inadequacy (POFI) and the contribution of food groups to folate intake (dietary folate plus folic acid from fortified foods) in two post-fortification periods in the Brazilian population, according to life stages, geographic regions and per capita income. Population-based study including representative data from the National Dietary Survey - Brazilian Household Budget Surveys (NDS-HBS) 2008-2009 and 2017-2018, with a total of 32,749 (2008-2009) and 44,744 (2017-2018) individuals aged ≥10 years old, excluding pregnant and lactating women. The National Cancer Institute method was used to estimate the distributions of usual dietary folate intake. POFI was estimated according to Estimated Average Requirement (EAR) cut-off point method. After 10 years of the first NDS-HBS, POFI has increased in all sex-age groups, except for 10 to 13 y old. POFI among women of reproductive age was around 30% and 40% in 2008-2009 and 2017-2018, respectively. Higher POFI was observed in the North region. The top five food groups contributors to folate intake in Brazil were beans, breads, pasta & pizza, cakes & cookies and non-alcoholic beverages groups in both periods, differing in the rank order of the last two groups. Although being a country that has adopted mandatory folic acid flour fortification for almost two decades, increased POFI was observed in 2017-2018. This study brings significant scientific information, which can help understand folate dietary data in different contexts and consequently, guide the approach for public health fortification strategies.

Non-linear association between daily dietary folate intake and cognitive performance in elder America: A population-based cross-sectional study

Background The association between daily dietary folate intake and cognitive performance in older populations is unclear. Methods This study aimed to investigate whether a dose-dependent association exists between dietary folate levels and cognition performance. The 2011–2014 datasets from the National Health and Nutrition Examination Survey were collected. Data from adults aged ≥ 60 years who completed all three cognitive tests with daily dietary data were analyzed. Weighted smooth curve fitting and multiple linear regression models were applied to study the association between folate intake and cognitive performance. Age, sex, race, education, smoking status, alcohol intake, body mass index, hypertension, stroke, diabetes, and depression were adjusted using a weighted multiple regression model. Results Data from 1,255 participants were analyzed. The mean age of the study population was 69.3 years. Males accounted for a weighted 48.8% of the total population. Daily dietary folate was not significantly associated with delayed recall (per 10 mcg/day increment, β 0.003, 95% CI -0.002–0.009, P = 0.23). Below the cut-off of 250 mcg/day, dietary folate intake was positively associated with immediate recall (per 10 mcg/day increment, β 0.01, 95% CI 0.00–0.02, P = 0.05) and animal fluency test score (per 10 mcg/day increment, β 0.02, 95% CI 0.00–0.03, P = 0.05). However, above this cut-off, the association was not significant. Dietary folate intake was not significantly associated with an increase in the digit symbol substitution test score until dietary the folate intake reached 250 mcg/d (per 10mcg/d increment, β 0.29, 95% CI 0.05-0.53, P = 0.04). Conclusion Daily dietary folate intake was non-linearly associated with cognitive performance in the older American population.

Preconception Dietary Folate Intake and Risk of Spontaneous Abortion

Objectives Previous studies suggest a beneficial effect of supplemental folic acid use and dietary folate intake on fertility, while results for fetal loss are conflicting. Most previous research on fetal loss focused on folic acid supplement use. We therefore, investigated the association between dietary folate intake and spontaneous abortion (SAB) in a Danish preconception cohort of couples trying to conceive. Methods We recruited couples who were trying to conceive and did not receive fertility treatment. Pregnancies were ascertained through bimonthly follow-up questionnaires completed up to 12 months after study entry. SABs were identified by self-report on the follow-up questionnaires and through the Danish National Patient Registry. Dietary folate intake at study entry was estimated using a validated food frequency questionnaire (FFQ). Folate intake was adjusted for total energy intake using the residual method and categorized as < 250,250–399 and > = 400µg/day. We used Cox proportional hazards regression models with gestational weeks as time scale to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for SAB, adjusting for age, partner's age, educational attainment, smoking status, anthropometry, physical activity, alcohol intake, folic acid supplement use, time-to-pregnancy, gravidity and parity. In sensitivity analyses, we stratified by folic acid supplement use, body mass index (BMI) and alcohol intake. Results Of the 2,957 women who became pregnant within 12 months of study entry and completed the FFQ, we identified 432 SABs. HRs for an SAB among women who consumed 250–399 and >= 400 µg/day of dietary folate compared with <250 µg/day were 0.83 (95% CI: 0.53; 1.29) and 0.87 (95% CI: 0.54; 1.39), respectively. Comparing intake > = 400 with <250 µg/day, the association was stronger when the analysis was restricted to folic acid supplement users, 0.74 (95% CI: 0.39; 1.40), to women with a BMI >= 25, 0.67 (95% CI: 0.31; 1.43), and to a reported alcohol intake >4 drinks/week, 0.66 (95% CI: 0.16; 2.66). Conclusions Our study may suggest that high dietary folate intake among folic acid supplement users is associated with a lower risk of SAB, although our estimates are imprecise. Funding Sources National Institute of Child Health and Human Development.

Dietary Methyl-Group Donor Intake and Breast Cancer Risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)

(1) Background: Methyl-group donors (MGDs), including folate, choline, betaine, and methionine, may influence breast cancer (BC) risk through their role in one-carbon metabolism; (2) Methods: We studied the relationship between dietary intakes of MGDs and BC risk, adopting data from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort; (3) Results: 318,686 pre- and postmenopausal women were followed between enrolment in 1992–2000 and December 2013–December 2015. Dietary MGD intakes were estimated at baseline through food-frequency questionnaires. Multivariable Cox proportional hazards regression models were used to quantify the association between dietary intake of MGDs, measured both as a calculated score based on their sum and individually, and BC risk. Subgroup analyses were performed by hormone receptor status, menopausal status, and level of alcohol intake. During a mean follow-up time of 14.1 years, 13,320 women with malignant BC were identified. No associations were found between dietary intakes of the MGD score or individual MGDs and BC risk. However, a potential U-shaped relationship was observed between dietary folate intake and overall BC risk, suggesting an inverse association for intakes up to 350 µg/day compared to a reference intake of 205 µg/day. No statistically significant differences in the associations were observed by hormone receptor status, menopausal status, or level of alcohol intake; (4) Conclusions: There was no strong evidence for an association between MGDs involved in one-carbon metabolism and BC risk. However, a potential U-shaped trend was suggested for dietary folate intake and BC risk. Further research is needed to clarify this association.

Maternal Folic Acid Supplementation, Dietary Folate Intake and Low Birth Weight: A Birth Cohort Study

ObjectivesTo investigate the independent and collective effects of maternal folic acid supplementation or dietary folate intake upon the risk of low birth weight (LBW), and to further comprehensively examine the joint associations of folic acid supplementation and dietary folate intake with LBW by various clinical subtypes.DesignParticipants were recruited in Gansu Provincial Maternity and Child Care Hospital. A standardized and structured questionnaire was distributed to collect demographic factors, reproductive and medical history, occupational and residential history, physical activity and diet. Data on pregnancy-related complications and birth outcomes were extracted from medical records. Unconditional logistic regression models were used to estimate odds ratio (OR) and 95% confidence interval (95%CI) for single and joint associations of folic acid supplementation and dietary folate intake with LBW. SettingA birth cohort data analysis using the 2010–2012 Gansu Provincial Maternity and Child Care Hospital in Lanzhou, China.Participants9231 pregnant women and their children were enrolled in the study. ResultsCompared to non-users, folic acid supplementation was associated with a reduced risk of LBW (OR: 0.80, 95%CI: 0.66-0.97), and the reduced risk was mainly seen for term-LBW (OR: 0.59, 95%CI: 0.41-0.85), and multiparous-LBW (OR: 0.72, 95%CI: 0.54-0.94). For dietary folate intake, there were no significant associations with LBW, and there was no interaction of folic acid supplement and dietary folate intake on LBW.ConclusionsOur study results indicated that folic acid supplementation was associated with a reduced risk of LBW, and there was not interaction of folic acid supplement and dietary folate intake on LBW.

Association between plasma levels of homocysteine, folate, and vitamin B12, and dietary folate intake and hypertension in a cross-sectional study

There are few studies examining the association between homocysteine (Hcy) level and the risk of hypertension with consideration for folate and vitamin B12 as related to Hcy level. We simultaneously examined the associations of plasma levels of Hcy, folate, and vitamin B12, and dietary folate intake with the prevalence of hypertension. Participants included 1046 men and 1033 women (mean age ± standard deviation: 56.0 ± 8.9 years) in the Japan Multi-Institutional Collaborative Cohort Study. Dietary folate intake was estimated using a validated food frequency questionnaire. Hypertension was defined based on measured blood pressure and use of antihypertensive medication. A total of 734 participants (35.3%) had hypertension. Multivariate-adjusted odds ratios of hypertension for the highest quartile group of Hcy were 2.36 (95% CI 1.41–3.96) in men and 1.86 (95% CI 1.11–3.11) in women, as compared with the lowest group (P for trend = 0.014 and 0.005, respectively). Dietary folate intake was not correlated with hypertension in both men and women (P for trend = 0.099 and 0.703, respectively). Plasma vitamin B12 was positively associated with hypertension only in women (P for trend = 0.027). Plasma Hcy level was positively linked with hypertension after controlling for covariates, including folate and vitamin B12.