Folate, vitamin B12 and Homocysteine status in the post-folic acid fortification era in different subgroups of the Brazilian population attended to at a public health care center.

Aline Barnabé,Ana Cláudia Morandi Aléssio,Angélica M Bicudo,Luis Fernando Bittar,Bruna de Moraes Mazetto,Joyce M Annichino-Bizzacchi,Nelci Fenalti Höehr,Erich V de Paula

doi:10.1186/s12937-015-0006-3

Aline Barnabé, Ana Cláudia Morandi Aléssio + Show 6 more

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https://doi.org/10.1186/s12937-015-0006-3

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Journal: Nutrition journal	Publication Date: Feb 19, 2015
Citations: 91	License type: CC BY 4.0

Affiliation: Universidade Estadual de Campinas

Abstract

BackgroundFolate and vitamin B12 are essential nutrients, whose deficiencies are considerable public health problems worldwide, affecting all age groups. Low levels of these vitamins have been associated with high concentrations of homocysteine (Hcy) and can lead to health complications. Several genetic polymorphisms affect the metabolism of these vitamins. The aims of this study were to assess folate, vitamin B12 and homocysteine status in distinct Brazilian individuals after the initiation of folic acid fortification by Brazilian authorities and to investigate the effects of RFC1 A80G, GCPII C1561T and MTHFR C677T polymorphisms on folate, vitamin B12 and Hcy levels in these populations.MethodsA total of 719 individuals including the elderly, children, as well as pregnant and lactating women were recruited from our health care center. Folate, vitamin B12 and Hcy levels were measured by conventional methods. Genotype analyses of RFC1 A80G, GCPII C1561T and MTHFR C677T polymorphisms were performed by PCR-RFLP.ResultsThe overall prevalence of folate and vitamin B12 deficiencies were 0.3% and 4.9%, respectively. Folate deficiency was observed only in the elderly (0.4%) and pregnant women (0.3%), whereas vitamin B12 deficiency was observed mainly in pregnant women (7.9%) and the elderly (4.2%). Plasma Hcy concentrations were significantly higher in the elderly (33.6%). Pregnant women carrying the MTHFR 677TT genotype showed lower serum folate levels (p = 0.042) and higher Hcy levels (p = 0.003). RFC1 A80G and GCPII C1561T polymorphisms did not affect folate and Hcy levels in the study group. After a multivariate analysis, Hcy levels were predicted by variables such as folate, vitamin B12, gender, age and RFC1 A80G polymorphism, according to the groups studied.ConclusionOur results suggest that folate deficiency is practically nonexistent in the post-folic acid fortification era in the subgroups evaluated. However, screening for vitamin B12 deficiency may be particularly relevant in our population, especially in the elderly.

Highlights

Folate and vitamin B12 are essential nutrients, whose deficiencies are considerable public health problems worldwide, affecting all age groups
The present study suggests that fortification of flour with folic acid has been effective, as folate deficiency was practically nonexistent (0.3%), whereas vitamin B12 deficiency was present in 4.9% of the studied group
Atrophy of the gastric mucosa, the presence of autoantibodies against intrinsic factors, or the presence of H. pylori may play a role as an etiological factor of vitamin B12 deficiency in this age group, because it results in malabsorption of vitamin B12. Almost all of these individuals in our study showed no anemia, it should be emphasized that symptoms such as depression, dementia and impaired cognitive function, which have been associated with vitamin B12 deficiency, may be misinterpreted as aging-related co-morbidities rather than vitamin B12 dependent co-morbidities [24,25,26]

Summary

Introduction

Folate and vitamin B12 are essential nutrients, whose deficiencies are considerable public health problems worldwide, affecting all age groups Low levels of these vitamins have been associated with high concentrations of homocysteine (Hcy) and can lead to health complications. Vitamin B12 deficiency results mainly from gastrointestinal conditions leading to vitamin B12 malabsorption, and less frequently from intestinal parasitosis and genetic polymorphisms [5]. Genetic polymorphisms such as reduced folate carrier (RFC1) A80G and glutamate carboxypeptidase II (GCPII) C1561T have been shown to impair folate transport and absorption, respectively, affecting the bioavailability of the dietary folate [6,7]. The methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism is associated with elevated Hcy levels and reduced folate and vitamin B12 levels [8,9]

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