Folic Acid Deficit Research Articles

On paleoepidemiology of spina bifida sacralis: prevalence of the anomaly in Late Scythians of lower Dnieper region

Spina bifida is a developmental anomaly that is thought to be caused by a combination of hereditary and en-vironmental factors. Though the most significant association was found with the folic acid deficit during early em-bryogenesis, numerous genetic variants were also found to be in some association with the development of neu-ral tube defects, but this data is inconsistent. It is still debated whether the unremarkable anomaly (spina bifida occulta) often observed in osteological samples is truly a form of neural tube defects forming in early embryo-genesis, or is a minor variation that is forming later in postnatal life. Also, data is equivocal regarding the neuro-logical consequences of sacral spina bifida occulta, some pointing to its clinical significance, others stating that it does not affect the wellbeing in any way. Though paleopathological studies on spina bifida are numerous, the frequency of the anomaly remains largely unknown for the Early Iron Age population of the Eurasian steppes. This study examines presence of sacral spina bifida in a Late Scynthian sample (3rd c. BC — 3rd с. AD) from the northern Black Sea region. Totally, 89 skeletons were examined, originating from cemeteries near Nikolayevka and Zolotaya Balka villages (Kherson Oblast, Ukrain). These cemeteries are located along the Dnieper river bank about 90 km apart. The people they represent were settled agriculturalists. The defect was scored when either or all of the three upper sacral vertebrae were affected (S1–S3), its level was recorded. Totally, 16 % of individuals were affected. The majority of defects were observed solely on S1 level. Only two cases of spina bifida sacralis totalis were recorded. The frequency of the anomaly was not significantly different either between males and fe-males, or between younger (<35 years) and older (>35 years) adults. In two instances, two individuals buried in a common grave both had spina bifida sacralis which may point to a biological relationship between them. The fre-quency of spina bifida sacralis is very close to the mean values, reported in the literature. Thus, no evidence of an increased selection against individuals in this group with this form of skeletal anomaly, or a significant impact of envi-ronmental factors, leading to its development in ontogenesis, is present. Also, contrary to literature data, it seems that in this sample age and sex were not the factors significantly contributing to the trait’s variation, though the age dynamics of this trait needs further consideration using a sample with higher proportion of senile individuals.

Incidence and Trends of Neural Tube Defects in Babies Delivered at Dera Ghazi Khan Tertiary Care Center

Objective: A cross-section study was conducted to determine the incidence and trends of neural tube defects in babies delivered at a tertiary care center. And those babies who were delivered elsewhere and were brought to a tertiary care center for treatment.
 Material and Methods: The Study was conducted at neurosurgery and pediatric surgery departments, Ghazi Khan Medical College and Teaching Hospital. Two thousand (n = 2000) women delivered their babies at a tertiary care hospital were enrolled, out of them 52 women who delivered babies with neural tube defects (NTDs) were further assessed. Women were interviewed and history of folic acid intake, previous baby with NTDs and family history were recorded. Tests of significance were applied to assess the significant results.
 Results: Folic acid intake was occurred in n = 298 (14.9%) subjects. Association of folic acid on neural tube defects. Odds ratio showed that if a baby without intake of folic acid had 7.8 times at risk to suffer from a neural tube defect. The association was also significant (p = 0.000).
 Conclusion: Neural tube defects are common in tertiary care centers its incidence was 2%. Increased incidence of NTDs was observed in babies who delivered by folic acid deficit mothers. Early childhood marriages in rural areas and cousin marriages are the main contributing factors.
 Keywords: Neural tube defect, Anencephaly, Spina bifida, Hydrocephalus, Meningocele.

M2-like cells from the macrophage lineage might play a central role in closure of the embryonic neural tube

Herein it is hypothesized that M2-like macrophages or pre-macrophages of fetal origin might play a central role in development and closure of the neural tube. Early in embryonic development, pre-macrophages arise from the fetal yolk sac and track through the bloodstream to reach diverse embryonic tissues, where they mature. Most of these macrophages exhibit an M2-like phenotype. The critical period for neural tube closure is contained within the period of yolk sac-derived pre-macrophage tracking and distribution, which poses a question: might these pre-macrophages or macrophages exert an influence on the closing neural tube? Evidence suggests that perturbations in macrophage polarization or M2 macrophage function might contribute to the failure of neural tube closure associated with diabetes mellitus, one carbon metabolism (including folic acid deficit), inositol, arachidonic acid, and sphingosine-1-phosphate, as well as in the teratogenicity of nitric acid, valproic acid, and fumonisin. The influence of each of these factors is interpreted in light of potential interactions with M2-like macrophages or macrophage progenitors on the developing neural tube. By placing these anti inflammatory macrophages at the center of various epigenetic, neurochemical, and signaling processes suspected to be involved in neural tube closure, potential associations are revealed between macrophages and embryonic structural developmental processes such as collagen and actin dynamics. The choice of this model is also an attempt to explain why some etiologies for failure of neural tube closure are rescued by folic acid, whereas other etiologies are rescued only by formate, inositol, or not at all.

Alteration of lens and retina textures from mice embryos with folic acid deficiency: image processing analysis

Folic acid (FA) is an essential vitamin for embryonic development. It plays particularly a critical role in RNA, DNA and protein synthesis. On the other hand, the collagen IV and laminin-1 are important proteins during embryonic development. This study was done to find if FA deficiency at a short and a long term in mothers could alter the tissue texture of retina and lens of the progeny. Collagen IV and laminin-1 were localized by immunohistochemistry in the lens and retina of the FA-deficient embryos. To carry out the image processing, texture segmentation was performed through canny edge detection and Fourier transform (FT). We defined a parameter, the grain size, to describe the texture of the lens and retina. A bootstrap method to estimate the distribution and confidence intervals of the mean, standard deviation, skewness and kurtosis of the grain size has been developed. Analysis through image processing using Matlab showed changes in the grain size between control- and FA-deficient groups in both studied molecules. Measures of texture based on FT exhibited changes in the directionality and arrangements of type IV collagen and laminin-1. Changes introduced by FA deficiency were visible in the short term (2weeks) and evident in the long term (8weeks) in both grain size and orientation of fibre structures in the tissues analysed (lens and retina). This is the first work devoted to study the effect of FA deficit in the texture of eye tissues using image processing techniques.

A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders.

ObjectiveThe purpose of this review was to identify risk factors, prognostic factors, and comorbidities associated with common spinal disorders.MethodsA scoping review of the literature of common spinal disorders was performed through September 2016. To identify search terms, we developed 3 terminology groups for case definitions: 1) spinal pain of unknown origin, 2) spinal syndromes, and 3) spinal pathology. We used a comprehensive strategy to search PubMed for meta-analyses and systematic reviews of case-control studies, cohort studies, and randomized controlled trials for risk and prognostic factors and cross-sectional studies describing associations and comorbidities.ResultsOf 3,453 candidate papers, 145 met study criteria and were included in this review. Risk factors were reported for group 1: non-specific low back pain (smoking, overweight/obesity, negative recovery expectations), non-specific neck pain (high job demands, monotonous work); group 2: degenerative spinal disease (workers’ compensation claim, degenerative scoliosis), and group 3: spinal tuberculosis (age, imprisonment, previous history of tuberculosis), spinal cord injury (age, accidental injury), vertebral fracture from osteoporosis (type 1 diabetes, certain medications, smoking), and neural tube defects (folic acid deficit, anti-convulsant medications, chlorine, influenza, maternal obesity). A range of comorbidities was identified for spinal disorders.ConclusionMany associated factors for common spinal disorders identified in this study are modifiable. The most common spinal disorders are co-morbid with general health conditions, but there is a lack of clarity in the literature differentiating which conditions are merely comorbid versus ones that are risk factors. Modifiable risk factors present opportunities for policy, research, and public health prevention efforts on both the individual patient and community levels. Further research into prevention interventions for spinal disorders is needed to address this gap in the literature.

Collagen IV and laminin-1 expression in embryonic mouse lens using principal components analysis technique.

Immunohistochemistry section staining is not always easy to interpret. Manual quantification of immunohistochemical staining is limited by the observer visual ability to detect changes in level staining. Hence, the quantification of immunostaining by means of digital image analysis allows us to measure accurately protein expression percentages in immunobiological stained tissues and ensures to overcome the visual limitations. We perform an experimental study to analyse the impact of folic acid (FA) deficiency into collagen IV and laminin-1 expression in the embryonic mouse lens. The study starts with microscope images of embryos mouse lens whose mothers fed a diet deficient in FA during 2 and 8 weeks. A principal component analysis (PCA) image processing is used to analyse these images coming from control and FA deficit groups. The method permits to define an index of over- or infraexpression of collagen IV and laminin-1 associated to different spatial organisation structures (PC processes). Additionally, it permits to determine in precise percentage the exact quantity of the overexpression or infraexpression and finally to comprehend molecular regionalisation and expression in both control and deficient groups. The results suggest that even with 2 weeks of deficit of FA the expression and distribution of both molecules is affected.

Malnutrition in Very Old Hospitalized Patients: A New Etiologic Factor of Anemia?

Anemia and malnutrition are highly prevalent, frequently concomitant and associated with negative outcomes and mortality in the elderly. To evaluate the association between these two entities, and test the hypothesis that protein-energy deficit could be etiology of anemia. Prospective case-control study. Geriatric and Rehabilitation Hospital, Geneva University Hospitals, Switzerland. 392 patients (mean age 84.8 years old, 68.6% female). Hematological (hemoglobin (Hb)), chemical (iron work up, cyanocobalamin, folates, renal function, C-Reactive Protein (CRP)) and nutrition (albumin, prealbumin) parameters, and mini nutritional assessment short form (MNA-SF). The prevalence of anemia (defined as Hb<120 g/l) was 39.3%. Anemic patients were more frequently malnourished or at risk of malnutrition according to the MNA-SF (p=0.047), with lower serum albumin (p <0.001) and prealbumin (p <0.001) levels. Thirty-eight percent of these patients had multiple causes and 14.3% had no cause found for anemia. Among the latter 90.9% of patients with unexplained anemia had albumin levels lower than 35g/l. After exclusion of iron,vitamin B12 and folic acid deficits, anemic patients had lower albumin (p<0.001) and prealbumin (p 0.007) levels. Albumin level explained 84.5% of the variance in anemia. In multivariate analysis albumin levels remain associated with Hb only in anemic patients, explaining 6.4% of Hb variance (adj R2) and 14.7% (adj R2) after excluding inflammatory parameters (CRP>10). Albumin levels are strongly associated with anemia in the elderly. Screening for undernutrition should be included in anemia assessment in those patients. Further prospective studies are warranted in order to explore the effect of protein and energy supplementation on hemoglobin level.

Características clínicas y sociodemográficas en pacientes con anemia megaloblástica. Hospitales de San José e infantil universitario de San José

Deficiency of vitamin B 12 is the most frequent cause of anemia after the origin of iron deficiency. Objective: to establish the sociodemographic and clinical profile in megaloblastic anemia. Materials and methods: series of patients hospitalized with megaloblastic anemia between January 2010 and December 2011 in the San José and Infant University hospitals of San José, Bogotá DC. Results: 17 cases, 11 in men. Average age 59 years (DE: 15.8 years, range: 37-82), 88% married, stratum two 76.4%, pensioners 17%, with income of two legal minimum wages in force 94.1% monthly and live with more than two people 75.4% . Seven patients (41.1%) with a combined deficit of folic acid and vitamin B12, of vitamin B 12 three (17.6%) and of folic acid two (14.2%). The most frequent manifestations were anorexia (70.5%), dry skin (62.5%), atrophic glossitis (29.4%) and jaundice (23.5%). Association with autoimmune disease was observed in 17.6%, neoplasias of non-haematological origin 11.7% and chronic alcohol consumption 35.3%. Conclusion: the majority belonged to low socioeconomic status, with limited income and families made up of more than two people. The most frequent manifestations were digestive, dermatological and neurological. A combined deficit of vitamin B12 and folic acid was found, exclusive of folic acid associated with chronic alcohol consumption and only of vitamin B 12. Abbreviations: AM, megaloblastic anemia.

Micronutrient deficiencies one year after sleeve gastrectomy

Obesity is one of the largest problems in public health worldwide today. For patients with severe obesity and associated comorbidities, surgical treatment is recommended. To analyze the frequency of micronutrient deficiencies and food intake at least 12 months after sleeve gastrectomy (SG). This is a cross sectional study carried out between October and December 2009 with measure of serum levels of vitamin B12, vitamin D, folate, calcium, ferritin, zinc, parathyroid hormone and bone mineral density on patients underwent SG at least 12 months before the study. A food intake questionnaire was also performed. For the statistical analysis, the Pearson or Spearman tests was used. Forty patients were evaluated with a mean age of 40 ± 10 years and mean time post surgery of 26 ± 6 months. Mean plasma level of 25 OH-vitamin D was 20.9 ± 10.5 ng/ml. Forty-three percent had low levels of vitamin D (< 20 ng/ml), and 68% showed low levels of calcium (< 1,1 mmol/L) without secondary hyperparathyroidism. Anemia was present in 28% and iron deficiency occurred in 38% of these patients. Deficit of folic acid and vitamin B12 were observed in 13% of the patients. Average daily food intake was 1,256 kcal, 54% of total calories as carbohydrates, 26% as fat and 21% as protein. Iron, calcium and vitamin D are the most prevalent micronutrient deficiencies after SG. Long-term vitamin and mineral supplementation should be considered on every patient. Additional long-term studies are needed to establish specific supplementation recommendations after SG.

Epilepsy in coeliac disease: not just a matter of calcifications

The clinical spectrum of epilepsy related to celiac disease (CD) ranges from benign syndromes to intractable epilepsy with evolution to a severe encephalopathy, including progressive myoclonic epilepsy (PME). A more specific syndrome characterised by the association of CD, epilepsy, and occipital calcifications (CEC) has also been reported. This study describes the clinical, neuroradiological and neurophysiological features of eight consecutive epileptic patients with a diagnosis of CD confirmed by laboratory tests and duodenal biopsy, referring to our Epilepsy Centre. Despite its small size, this series reflects the broad spectrum of the association between the two diseases, since it includes four cases of CEC and a more heterogeneous group of patients without cerebral calcifications comprising one case of limbic encephalitis and a case of PME. Our cohort suggests that more complex pathogenic mechanisms may be involved in the association between epilepsy and CD, and that CD should be included in the screening for PME etiology. Our data also confirm the major involvement of the occipital lobe, and minimise both the importance of calcifications in epileptogenesis and folic acid deficit in the development of calcifications.

Anaemia, Iron and Vitamin Deficits in Patients with Peripheral Arterial Disease

Introduction Anaemia can compromise muscle and organ function. Related iron and vitamin body stores have seldom been assessed in patients with peripheral arterial disease. Report We retrospectively analysed basal prevalence of anaemia, iron, B 12-vitamin and folic acid deficits in 420 patients with claudication and 204 patients with critical limb ischaemia (CLI). The prevalence of the evaluated parameters was 9.8%, 6.7%, 6.7% and 2.9% among patients with claudication but 49.5%, 31.9%, 15.7% and 6.4% among CLI patients, respectively ( p < 0.05 for all). Discussion Anaemia, iron and vitamin deficits are uncommon among patients with ischemic claudication but very prevalent among patients with CLI.

Developmental Origins of Health and Disease: Environmental Exposures

The developmental origins of health and disease (DOHaD) approach has evolved over the past 20 years, and the current hypothesis proposes that fetal adaptations to intrauterine and maternal conditions during development shape structure and function of organs. Here we present a review of some environmental exposures that may trigger fetal maladaptations in these processes, including three examples: exposures to tobacco smoke, antidepressant medication, and folic acid deficits in the food supply. We provide a selected review of current research on the effects of each of these exposures on fetal development and birth outcomes, and use the DOHaD approach to suggest how these exposures may alter long-term outcomes. In the interpretation of this literature, we review the evidence of gene-environment interactions based on evaluation of biological pathways and evidence that some exposures to the fetus may be moderated by maternal and fetal genotypes. Finally, we use the design of the National Children's Study (now in progress) to propose how the DOHaD approach could be used to address questions that have emerged in this area that are relevant to reproductive medicine and subsequent health outcomes.

Evidence that folic acid deficiency is a major determinant of hyperhomocysteinemia in Parkinson´s disease

In the present work we measured blood levels of total homocysteine ((t)Hcy), vitamin B(12) and folic acid in patients with Parkinson s disease (PD) and in age-matched controls and searched for possible associations between these levels with smoking, alcohol consumption, L-DOPA treatment and disease duration in PD patients. We initially observed that plasma (t)Hcy levels were increased by around 30 % in patients affected by PD compared to controls. Linear correlation, multiple regression and comparative analyses revealed that the major determinant of the increased plasma concentrations of (t)Hcy in PD patients was folic acid deficiency, whereas in controls (t)Hcy levels were mainly determined by plasma vitamin B(12) concentrations. We also observed that alcohol consumption, gender and L-DOPA treatment did not significantly alter plasma (t)Hcy, folic acid and vitamin B(12) levels in parkinsonians. Furthermore, disease duration was positively associated with (t)Hcy levels and smoking was linked with a deficit of folic acid in PD patients. Considering the potential synergistic deleterious effects of Hcy increase and folate deficiency on the central nervous system, we postulate that folic acid should be supplemented to patients affected by PD in order to normalize blood Hcy and folate levels, therefore potentially avoiding these risk factors for neurologic deterioration in this disorder.

Rank Prize Lecture Global nutrition challenges for optimal health and well-being

Optimal health and well-being are now considered the true measures of human development. Integrated strategies for infant, child and adult nutrition are required that take a life-course perspective to achieve life-long health. The major nutrition challenges faced today include: (a) addressing the pending burden of undernutrition (low birth weight, severe wasting, stunting and Zn, retinol, Fe, iodine and folic acid deficits) affecting those individuals living in conditions of poverty and deprivation; (b) preventing nutrition-related chronic diseases (obesity, diabetes, CVD, some forms of cancer and osteoporosis) that, except in sub-Saharan Africa, are the main causes of death and disability globally. This challenge requires a life-course perspective as effective prevention starts before conception and continues at each stage of life. While death is unavoidable, premature death and disability can be postponed by providing the right amount and quality of food and by maintaining an active life; (c) delaying or avoiding, via appropriate nutrition and physical activity interventions, the functional declines associated with advancing age. To help tackle these challenges, it is proposed that the term ‘malnutrition in all its forms’, which encompasses the full spectrum of nutritional disorders, should be used to engender a broader understanding of global nutrition problems. This term may prove particularly helpful when interacting with policy makers and the public. Finally, a greater effort by the UN agencies and private and public development partners is called for to strengthen local, regional and international capacity to support the much needed change in policy and programme activities focusing on all forms of malnutrition with a unified agenda.

Mortalidad por defectos del tubo neural en México, 1980-1997

To describe the mortality due to neural tube defects (NTD) in Mexico for the 1980-1997 period. The annual NTD mortality rates per 10000 liveborn infants were calculated by state and for the country. The time trend was evaluated with the annual percent change (APC) obtained using a Poisson regression model. The NTD mortality ratio was calculated using the average national rate as reference. NTD mortality rates and ratios were graphically displayed on maps. During the 1980-1997 period the gross NTD mortality rate was 5.8 per 10000 live-born infants. Anencephaly (International Classification of Diseases ICD-9 740.0) was the most frequent type of NTD (37.7%), followed by spina bifida without hydrocephaly (CIE9 741.9) (31.6%). The national trend of NTD mortality increased between 1980 and 1990 (APC 7.5 95% CI 6.5, 8.6) and decreased between 1990 and 1997 (APC-2.3 95% CI-3.6, -0.9). The high NTD mortality rates were related to the high frequency of anencephaly. Also, the increase observed is not only attributable to diagnostic factors or to improved reporting. In Mexico, the influence of some NTD-associated factors such as specific genetic polymorphisms, folic acid deficit, maternal obesity, occupational exposure to pesticides, and poverty, should be assessed in specific studies.

Mieloneuropatía periférica y óptica en un paciente alcohólico deficiente en ácido fólico

In Western countries, neurological disorders secondary to toxic nutritional problems usually present as isolated cases that are generally associated to identifiable causes (alcoholism, eating disorders, absorption disorders, use of medicines) that reduce the availability of basic nutrients, especially B group vitamins, but also folic acid (FA). The optic nerves and the peripheral axons are frequent target organs in this type of pathology, but leukoencephalopathy and spinal cord involvement may also appear, often in combination. We describe the case of a 38-year-old female smoker with a heavy alcohol habit, who developed a subacute clinical pattern of, predominantly axonal, sensitive peripheral polyneuropathy, with vegetative fibre involvement. She also presented involvement of the posterior spinal cord, which gave rise to an ataxic disorder in the gait, as well as a severe bilateral retrobulbar optic neuropathy. Likewise, she presented macrocytosis (MCV: 118) due to megaloblastosis. She was also found to have a FA deficit but a normal vitamin B12 metabolism. With the help of supplementary vitamins, stopping drinking and the regularisation of her diet, the patient presented progressive clinical improvement, and was able to walk without support at 3 months and almost completely recovered her sight, which was corroborated by an improvement in the studies of both visual and somatosensorial evoked potentials. In our community, alcoholism is a frequent cause of nutritional deficiencies, which lead to neurological problems. FA is one of the nutrients that become deficient in alcoholics. More and more descriptions are being reported of peripheral polyneuropathy, retrobulbular optic neuropathy, myelopathy or leukoencephalopathy associated to FA deficiency, above all in patients with a history of alcoholism.

Distribución de la concentración sérica de vitamina C, ácido fólico y vitamina B12 en una muestra representativa de la población adulta de Cataluña

The subclinical deficiency of certain micronutrients (vitamin C, folic acid, vitamin B12) has been associated with disorders as cardiovascular diseases, cancer, cataracts, immunodepression and fetal neural tube defects. The purpose of this study was to determine the serum concentration of vitamin C, folic acid and vitamin B12 in the Catalan population and to examine the prevalence of deficits of these micronutrients. We studied a subsample of individuals (n = 378) from a representative sample of people aged 18 to 75 years who had participated in the study of the Nutritional Status of the Catalan Population (1992-93). Serum concentrations of vitamin C, folic acid and vitamin B12 were determined. The serum concentration of vitamin C was lower in men than in women. 4.6 and 0.5% subjects were found to have marginal and severe deficits of vitamin C, respectively. 4 and 1.6% subjects had marginal and severe deficits of folic acid, respectively. Folic acid deficit involved up to 12.9% women aged 18-34 years and up to 9.1% men within the same age group. Subjects who had a severe deficit of folic acid consumed more than 20 g/day of alcohol. The serum concentration of vitamin B12 was greater in women than in men. 1.9% individuals had a marginal deficit of this vitamin. The sample of individuals studied were found to have a correct nutritional status with regard to vitamin C, folic acid and vitamin B12. This may explain the lower incidence of cancer and ischemic heart disease associated with the Mediterranean diet.