Prenatal folic acid supplementation and folate status in early pregnancy: ECLIPSES study

This research evaluates the prevalence of inadequate folate status in early pregnancy, the pattern of prenatal folic acid (FA) supplementation and associated factors in Spanish pregnant women from the ECLIPSES study, which included 791 participants prior gestational week 12. A cross-sectional evaluation of red blood cell (RBC) folate levels was performed at recruitment and used to calculate the prevalence of folate deficiency (RBC folate<340 nmol/L) and insufficiency (RBC folate<906 nmol/L). Sociodemographic and lifestyle data, as well as information on prenatal FA supplementation were recorded. Descriptive and multivariate statistical analyses were performed. The prevalence of folate deficiency and insufficiency were 9.6% and 86.5%, respectively. Most of women used prenatal FA supplements but only 6.3% did so as recommended. Supplementation with FA during the periconceptional period abolished folate deficiency and reduced folate insufficiency. Prenatal folic acid supplementation with ≥1000 µg/d in periconceptional time and pregnancy planning increased RBC folate levels. The main risk factor for folate insufficiency in early pregnancy were getting prenatal FA supplementation out of the periconceptional time (OR 3.32, 95%CI 1.02–15.36), while for folate deficiency they were young age (OR 2.02, 95%CI 1.05–3.99), and smoking (OR 2.39, 95%CI 1.30–4.37). In addition, social and ethnic differences according to folate status were also identified. As conclusion, periconceptional FA use is crucial for achieving optimal folate levels in early pregnancy. Pregnancy planning should focus on young women, smokers, those with low consumption of folate-rich foods, low socioeconomic status or from ethnic minorities.

Compliance with the National Comprehensive Cancer Network guidelines for evaluation and treatment of anemia among patients with solid tumors.

11 Background: Anemia is associated with increased morbidity, mortality and decreased quality of life among oncology patients. The National Comprehensive Cancer Network (NCCN) recommends evaluation and treatment of anemia in patients with cancer. There is a paucity of data investigating compliance with the NCCN guidelines. Methods: A retrospective study of patients diagnosed with any malignant solid tumor at our institution from 2008-2017 was performed. Tumor-registry-confirmed cancer cases were identified using International Classification of Disease-Oncology (ICD-O) codes in the Synthetic Derivative (SD) database, a de-identified copy of the electronic medical record. Patients were included if they were between the ages of 18 and 89 and had a hemoglobin (hgb) within 6 months of diagnosis. Patients were excluded if they had more than one tumor registry entry. Anemia was defined as hgb ≤11g/dL and graded using the CTCAE v.5.0. Absolute and possible functional iron deficiency were defined by NCCN guidelines. B12 and folate deficiency were defined by institutional reference values. Chi-squared tests were conducted in R (Version 3.4.4). P <.05 was interpreted as statistically significant. Results: A total of 25,018 patients met inclusion criteria. The median age was 60 years, and the most common malignancies were respiratory tract, prostate, and urologic (11% each, respectively). Of the 25,018 patients, 1,484 (17%) were noted to be anemic at time of diagnosis and 11,019 (44%) were anemic within 6 months of diagnosis. Of these patients, a plurality (N = 4,686, 43%) had grade 2 anemia and a majority (N = 9,623, 87%) had normocytic anemia. Patients with retroperitoneal/peritoneal cancers had the highest prevalence of anemia (N = 83, 75%). A total of 4,125 (37%) underwent any evaluation of their anemia, of which 1,742 (16%) had iron studies performed and 1,528 (14%) had B12 or folate studies performed. Of those with iron studies performed, 197 (11%) patients had absolute iron deficiency and 103 (6%) had possible functional iron deficiency. Of those with B12 labs, 74 (5%) had B12 deficiency and of those with folate labs, 69 (12%) had folate deficiency. Less than half of anemic patients (N = 4,318, 39%) received treatment for anemia, including blood transfusion (N = 3,528, 32%), oral iron (N = 1,279, 12%), or IV iron (N = 97, 1%). However, treatment of anemia significantly increased as grade of anemia increased (any treatment among mild: 12%; moderate: 31%; severe: 77%; χ2 [2, N = 11,019] = 3020.6; P <.001). Patients with male reproductive tract cancers had the highest prevalence of anemia evaluation (N = 57, 79%). Conclusions: Anemia is common in patients with solid tumors, yet compliance with NCCN guidelines for evaluation and treatment of anemia remains low. There are opportunities to improve compliance with NCCN guidelines for management of anemia across the spectrum of cancer care.

Genome-Wide Association Study of Seed Folate Content in Common Bean

Plant-derived folates (Vitamin B9) are essential components of the human diet. They provide one-carbon units that are required for the synthesis of nucleic acids and proteins, and folate deficiency is associated with numerous adverse health conditions. The development of high-folate cultivars of common bean (Phaseolus vulgaris L.) and other staple crops is an important tool to combat folate deficiency. A population of 96 P. vulgaris accessions, representing major North American market classes, was grown in 2 years in Ontario, Canada. The population was genotyped for 5,361 molecular markers with an Illumina Infinium platform. Total folate was extracted from mature seeds using the tri-enzyme extraction method and quantified based on a microbiological assay with Lactobacillus rhamnosus. Significant genetic diversity for folate content was observed among the population in both years of study, and folate content had a range 113–222 μg per 100 g of seeds. Quantitative trait loci (QTL) for seed folate content were identified based on a genome-wide association study (GWAS). Six QTL were identified on Chr. 4, 6, 8, and 11, with three in each year of field trials. Both QTL on Chr. 11 occurred in genomic regions that were syntenic to seed folate QTL detected in previous work with P. vulgaris, Z. mays, and O. sativa. Candidate genes were identified for these QTL that might be targets for the development of molecular markers for selecting P. vulgaris cultivars with improved seed folate content. This work reports the largest survey of genetic diversity for seed folate content in P. vulgaris and identified several genotypes, including SCN4, Bat 93, OAC Redstar, and Pompadour 1014, that would be useful for breeding beans with higher than average folate levels.

Relationship between disease severity and folate status of children with sickle cell anaemia in Enugu, South East Nigeria

Background: Repeated crises in children with sickle cell anaemia (SCA), which is a manifestation of disease severity, results in depletion of their minimal tissue folate stores, with higher likelihood of folate deficiency. The study aimed to determine the relationship between disease severity and the folate status of children with SCA attending University of Nigeria Teaching Hospital (UNTH), Enugu. Methods: This was a hospital based, cross-sectional study conducted between September 2018 and March 2019. One hundred participants were recruited, consisting of 50 children having sickle cell crisis and 50 age and gender matched hae- moglobin AA genotype controls. Relevant information was documented using a pretested questionnaire. Sickle cell severity score was determined using frequency of crisis, admissions and transfusions in the preceding one year, degree of liver and splenic enlargement, life-time cummulative frequency of specific complications of SCA, leucocyte count and haematocrit. Results: Folate deficiency was observed in eight percent of the subjects and none of the controls. The difference was not significant (Fisher’s exact = 4.167, p=0.117). The odds of being folate deficient was 8.5 times more likely during anaemic crisis than in vaso-occlusive crisis, though not significant (95% C.I 0.05 – 89.750, p = 0.075). The mean SCA severity score was 8.06 ± 3.64, signifying a moderate SCA severity in the study population. There was a no relationship between folate status and severity of SCA (Fisher’s exact = 0.054, p = 0.949) Conclusion: Folate status in children with SCA is not affected by their disease severity. Therefore, there may be no need for additional folate supplementation with increasing severity of sickle cell anaemia. Keywords: Sickle cell anaemia; disease severity; folate status; children; Enugu.