Folate Levels Research Articles

The use of nutrigenomics and nutritional biomarkers with standard care of long-term recurrent metastatic rectal cancer: a case report

IntroductionDistant metastases following standard treatment for locally advanced rectal cancer (LARC) are typically associated with poor disease-free survival. We report on a 52-year-old Australian male of Dutch ancestry with no family history of colorectal cancer or significant medical history who experienced bleeding per rectum for several months prior to a colonoscopy in July 2010. He was subsequently diagnosed with Stage IIb LARC.Case presentationDespite treatment with curative intent, a distant recurrence to his left lung was detected in May 2012, upstaging him to Stage IV rectal cancer. He had repeated distant metastatic recurrences over the next 8 years, and treatment included multiple surgeries, chemotherapies, radiation treatments, a “watch and wait” period of 20 months, and personalised dietary management. Genetic and nutrigenomic testing identified that the case had KRAS and MTHFR mutations. As part of his dietary management, the case also had his levels of folate, vitamin B12, and vitamin D regularly monitored because of his genetic predisposition and history of deficiency for these key nutrients. Apart from changes in his CEA levels, sudden increases in the patient’s folate levels, inconsistent with dietary exposures preceded detection of each new distant recurrence, with significant decreases in the levels at the next follow-up measurement.ConclusionA multimodal approach to this patient’s management appeared to contribute to his long-term survival of nearly 10 years from the initial diagnosis. Multidisciplinary management, including the use of additional biomarkers, may enhance survival rates in other similar cases with advanced disease resistant to differing therapies, and with potentially poor prognosis.

Association between serum folate and sleep duration in American adults: A cross-sectional analysis of the National Health and Nutrition Examination Survey 2005 to 2010.

Folate is a vitamin that is exclusively derived from diet sources. Low folate levels are typically associated with cardiovascular disease, cognitive impairment, and cancer risk. However, few studies have examined the direct relationship between serum folate levels and sleep duration. Accordingly, we aimed to examine the relationship between serum folate levels and sleep duration. Using data from the National Health and Nutrition Examination Survey (NHANES), we examined the association between serum folate levels and sleep duration. We used laboratory data to obtain independent serum folate, and covariate data, including total cholesterol, high-density lipoprotein, blood glucose, and glycated hemoglobin; dependent variable sleep duration and covariate data including race, family income, marital status, education, and country of birth from questionnaire data; and other covariate data such as systolic blood pressure, diastolic blood pressure, waist circumference, and body mass index data from the measured data. Data was primarily analyzed using multiple regression analysis, stratified analysis with interactions, restricted cubic splines (RCS), and threshold effect analysis. A total of 14,072 participants over 19 years of age were enrolled, comprising 6923 (49.2%) males and 7149 (50.8%) females, with a median age of 48 years. The association between serum folate levels and sleep duration exhibited an inverted L-shaped curve (P = .033) in RCS. In the threshold analysis, for participants with serum folate of <32.208 nmol/L (β = 0.608, 95% CI: (0.275, 0.942), P < .001), the sleep duration was significantly increased by 0.608 minutes, with every 1 nmol/L in serum folate increased. At serum folate of ≥32.208 nmol/L, no significant association between serum folate and sleep duration was detected [β = 5.686, 95% CI: (-1.508, 12.88), P = .118]. Our findings revealed an inverted L-shaped relationship and saturation effects between serum folate levels and sleep duration in adults in the United States.

Serum folate levels, but not vitamin B12, are associated with slower progression in carotid intima-media thickness in a population exposed to mandatory folic acid fortification

Background&AimsFolate and vitamin B12 are vitamins involved in one carbon metabolism. Carotid intima-media thickness (cIMT) is a non-invasive test and an early atherosclerosis marker. The relationship between these vitamins and cIMT is not well established. This study aimed to investigate the association between baseline vitamins and cIMT changes during a median follow-up of 8 years. MethodsProspective cohort study involving 5,061 ELSA-Brasil participants from São Paulo state aged 35-74 years at baseline. Serum folate and vitamin B12 levels and dietary intake were assessed at baseline. Ultrasound cIMT measurements were performed at baseline and wave 3. Linear mixed-effects models, adjusted for covariables, assessed the association between vitamins at baseline and changes in cIMT. Results4,260 participants were included; mean (SD) age was 51.4 (8.9) years and 54.5% were women. Folate (0.02%) and vitamin B12 (2.6%) deficiencies were almost nonexistent. Participants in the 4th quartile of serum folate had a slower cIMT increase during 8 years of follow-up than those in the 1st quartile (1st vs. 4th quartile comparison: β (95% CI): -0.015 (-0.026; -0.004), P: 0.006 for model 3). These findings remained the same after sensitivity analysis for overall dietary supplements and specifically multivitamins use. No association was found between vitamin B12 biomarker and the outcome. Dietary folate intake was also not associated with cIMT changes. ConclusionIn this population exposed to mandatory folic acid food fortification, prevalence of vitamins deficiencies was very low. Highest quartile of serum folate seemed to slow down the increment of cIMT measurements over time.

Folate Biosynthesis is Boosted in Legume Nodules.

Symbiotic nitrogen fixation (SNF) profoundly alters plant and bacteroid metabolism; however, SNF impact on folates and one-carbon (1C) metabolism are unknown. To explore this, SNF was induced in Phaseolus Vulgaris with Rhizobium etli. Nodules accumulated the highest folate concentration yet reported in a plant tissue (60 nmol/g fresh weight). Folate upregulation was not exclusive of determinate nodules, moderate to high folate contents were also encounter in Medicago truncatula and sativa. Moreover, folates correlated partial and positively with N2-fixation. 1C metabolism-associated amino acids (Ser, Gly, Cys, Thr, and Met) accumulated more in nodules than roots. Subcellular profiling of nodule folates revealed that the cytosol fraction primarily contained 5-methyl-tetrahydrofolate, cofactor for Met synthesis. 10-formyl-tetrahydrofolate, required for purine synthesis, was most abundant in nodule plastids, while bacteroids contained low folate levels. Differential transcriptome analysis from nodule legume studies revealed that only a few biosynthetic folate genes expression was increased in nodules whereas several genes for 1C reactions were upregulated. For the first time folates were detected in the xylem sap, with higher concentrations during SNF. We postulate that folates are needed during SNF to sustain purines, thymidylate, and Met synthesis, during both N2-fixation and nodule growth; nodule metabolism is then a 1C-unit sink.

Human skin colour evolution and adaptation relates to folate and vitamin D

Human skin colour has evolved independently in different regions as an adaptation to varing geographic environments, closely related to ultraviolet radiation (UVR) exposure. For example, white skin color tends to become lighter at higher altitudes, UVR level typically decrease with altitude. Since human skin is directly exposed to sunlight, UVR significantly impacts its characteristics. This paper primarily examines the effects of UVR on skin and its relationship to the skin colour evolution through the lens of natural selection. Additionally, we explore the roles of folate and vitamin D in skin colour variation, noting that UVR influences their levels, which in turn can lead to health conditions. We conclude that folate, vitamin D, and UVR levels are critical factors in human skin colour evolution.

Comparative analysis of plasma folate, homocysteine and erythrocyte folate levels in pregnant women after folic acid administration during different pregnancies

Background: To examine and evaluate the alterations in plasma folate, homocysteine (HCY), and erythrocyte folate (FOA) concentrations among expectant mothers following folic acid supplementation in distinct pregnancies. Methods: A retrospective analysis was conducted on clinical data from 416 pregnant women admitted to our hospital between October 2020 and October 2023. These women were selected as the subjects of observation and divided into two groups based on their folic acid intake duration: an observation group (n=210) who consumed folic acid before and during early pregnancy, and continued taking it throughout mid and late pregnancy (≥ 20 days per month), and a control group (n=206) who took folic acid before and during early pregnancy but did not continue taking it in mid and late pregnancy (≥ 20 days per month). The prenatal levels of folate, HCY, and FOA were compared among the different groups of pregnant women. Pearson correlation analysis was used to explore the relationship between changes in folate, HCY, and FOA levels in pregnant women. Moreover, the fasting blood glucose (FBG) and 2-hour postprandial blood glucose (P2BG) levels were compared between the two groups of pregnant women. The incidence of gestational diabetes (GDM), gestational hypertension (HIP), and gestational anemia were also compared. Additionally, comparisons were made regarding the changes in delivery mode, newborn height, weight, head circumference, and chest circumference between the two groups of pregnant women. Results: The control group exhibited significantly lower levels of plasma folate and FOA compared to the observation group, while the levels of HCY were significantly higher in the control group than in the observation group, with statistically significant differences (P&lt;0.05). Results from Pearson correlation analysis indicated a significant positive correlation between plasma folate and FOA (r=0.116, P&lt;0.05), a significant negative correlation between plasma folate and HCY (r=-0.411, P&lt;0.05), and a significant negative correlation between plasma FOA and HCY (r=-0.286, P&lt;0.05). The levels of FBG and P2BG during pregnancy were found to be significantly lower in the observation group compared to the control group, with statistically significant differences (P&lt;0.05). Furthermore, the incidence of gestational anemia and HIP was significantly lower in the observation group than in the control group, with statistically significant differences (P&lt;0.05). The occurrence of cesarean section was significantly lower in the observation group compared to the control group. The newborns in both groups exhibited normal height, weight, head circumference, and chest circumference. Notably, the newborns in the observation group had significantly higher values for height, weight, head circumference, and chest circumference compared to those in the control group, with statistically significant differences (P&lt;0.05). Conclusion: By consuming folic acid before and during early pregnancy, and consistently throughout mid and late pregnancy, it is possible to increase the levels of folic acid and FOA in pregnant women's bodies. This, in turn, facilitates rapid foetal development, enhances the nutritional status of newborns, and decreases the likelihood of cesarean section. Additionally, early supplementation of folic acid can effectively reduce the occurrence of pregnancy-related complications, thereby improving the prognosis for both mothers and infants.

Increased potentiation of 5-fluorouracil induced thymidylate synthase inhibition by 5,10-methylenetetrahydrofolate (arfolitixorin) compared to leucovorin in patients with colorectal liver metastases; The Modelle-001 Trial

Background5-Fluorouracil (5-FU) is a cornerstone in treatment of colorectal cancer (CRC) and is usually combined with leucovorin (LV) to enhance the antitumour effect by increase thymidylate synthase (TS) inhibition, the key target enzyme for 5-FU. Arfolitixorin (Arfo) is an active form of the reduced folate, [6 R]-5,10-methylenetetrahydrofolate ([6 R]-MeTHF and in contrast to LV, does not need to be metabolized. The Modelle-001 was designed to explore whether a single intravenous bolus injection of Arfo as compared to LV, together with 5-FU increases the inhibition of TS, levels of folate concentrations and polyglutamylation in CRC liver metastases (CRLM) and liver parenchyma.Patients and methodsThirty patients with CRLM received either LV (60 mg/m2) or Arfo (30 mg/m2 or 120 mg/m2) in combination with 5-FU preoperatively. Levels of folates and and TS inhibition were measured.ResultsSignificantly higher MeTHF levels and higher TS inhibition were measured in the Arfo groups compared to LV60, and there was a difference in folate poly-glutamylation between the groups.ConclusionThe Modelle-001 Trial demonstrated significantly higher levels of MeTHF in metastases following Arfo compared to LV. This resulted in a greater increase TS inhibition in metastases although not statistically significant.

Enrichment of trimethyl histone 3 lysine 4 in the Dlk1 and Grb10 genes affects pregnancy outcomes due to dietary manipulation of excess folic acid and low vitamin B12

The aberrant expression of placental imprinted genes due to epigenetic alterations during pregnancy can impact fetal development. We investigated the impact of dietary modification of low vitamin B12 with varying doses of folic acid on the epigenetic control of imprinted genes and fetal development using a transgenerational model of C57BL/6J mice. The animals were kept on four distinct dietary combinations based on low vitamin B12 levels and modulated folic acid, mated in the F0 generation within each group. In the F1 generation, each group of mice is split into two subgroups; the sustained group was kept on the same diet, while the transient group was fed a regular control diet. After mating, maternal placenta (F1) and fetal tissues (F2) were isolated on day 20 of gestation. We observed a generation-wise opposite promoter CpG methylation and gene expression trend of the two developmental genes Dlk1 and Grb10, with enhanced gene expression in both the sustained and transient experimental groups in F1 placentae. When fetal development characteristics and gene expression were correlated, there was a substantial negative association between placental weight and Dlk1 expression (r = − 0.49, p < 0.05) and between crown-rump length and Grb10 expression (r = − 0.501, p < 0.05) in fetuses of the F2 generation. Consistent with these results, we also found that H3K4me3 at the promoter level of these genes is negatively associated with all fetal growth parameters. Overall, our findings suggest that balancing vitamin B12 and folic acid levels is important for maintaining the transcriptional status of imprinted genes and fetal development.

Anaemia prevalence, its determinants and profile of micronutrient status among rural school adolescent girls aged 14-19 years: a cross-sectional study in Nagpur district, Maharashtra, India.

The objective of our study was to determine the prevalence of anaemia among 14-19 years school going girls, risk factors for it and profile of micronutrient status among rural girls from western state of India. Using a cross-sectional design, we obtained information on socio-demography, menstruation, dietary habits, knowledge and daily consumption of the government recommended iron and folic acid (IFA) tablets, and anthropometry. Blood was collected to assess Hb, red blood cell indices, serumFe, folate and vitamin B12 levels. Nagpur district, Maharashtra, India. A total of 221 girls aged 14-19 years studying in twenty-four government institutes included. 57 % girls were anaemic, 84 % had deficiency of one or more micronutrients and 60 % were malnourished based on body mass index (BMI). The prevalence of Fe, vitamin B12 and folate deficiency was 37·7 %, 69·8 % and 1·4 %, respectively. Among anaemic girls, Fe and vitamin B12 deficiency was observed in 45·5 % and 67·5 %, respectively, v. among non-anaemic girls it was 27 % and 73 %, respectively. Fe deficiency was a predictor of anaemia and its severity. Girls residing in non-nuclear family were more likely to have anaemia. The consumption of daily non-vegetarian food and green leafy vegetables was 3 % and 3·6 %, respectively. Only 9 % consumed IFA tablets in the past 2 weeks. Anaemia is common in adolescent girls, particularly associated with Fe and vitamin B12 deficiency. There is need to reconsider the approach to prevention of anaemia in adolescent girls, particularly before they become pregnant.

The unique presentation of the relationship between red blood cell folate and appendicular skeletal muscle mass: a cross-sectional study

The overconsumption of folic acid has been associated with deleterious health effects; however, the extant body of research on this matter remains controversial. The principal objective of our investigation was to scrutinize the correlation between red blood cell (RBC) folate levels and appendicular skeletal muscle mass (ASM) among adult individuals. A total of 4117 adults aged over 20 years were included. The weighted prevalence of low muscle mass status (LMMS) was 14.50%. The correlation between RBC folate and ASM showed an inverted U-shaped curve. When the RBC folate concentration is below 500 nmol/L, ASM increases with increasing RBC folate concentration. However, when the RBC folate level exceeds 500 nmol/L, ASM decreases with increased RBC folate level. After correcting multiple confounding factors, a positive correlation was found between RBC folate and LMMS (p < 0.001). Compared with the RBC folate first quartile, the multivariable-adjusted ORs and 95% CIs of the second quartile, third quartile, and highest quartile were 1.08(0.81–1.44), 1.06(0.79–1.43), and 1.96(1.47–2.61), respectively. Our research suggested that excessive levels of RBC folate may be associated with an increased risk of LMMS in adults. Thus, being more cautious when considering folic acid supplementation is recommended.

Association between serum folate levels and migraine or severe headaches: A nationwide cross-sectional study.

Migraine and severe headaches are common neurological disorders with significant societal impact. Previous research indicates a potential link between serum folate levels and migraine occurrence, yet there is a lack of sufficient relevant studies and more are required. This study aimed to determine the association between a severe headache or migraine and serum folate levels in large populations. Using data from the National Health and Nutrition Examination Survey, we conducted a cross-sectional study. Using multivariable logistic regression models, we investigated the association between serum folate and severe headache or migraine. In a subsequent subgroup analysis, several confounding factors were also explored to investigate the association between migraine and serum folate. A total of 13,351 individuals participated in the study, with 2742 reporting severe headache or migraine in the previous 3 months. Serum folate was negatively associated with severe headache or migraine (odds ratio [OR] = 0.5, 95% confidence interval [CI] = 0.28-0.89, P = .018). The stratified analysis revealed this association persisted among female (OR = 0.38, 95% CI = 0.18-0.82, P < .001), individuals aged 20 to 50 years (OR = 0.53, 95% CI = 0.28-0.99, P < .001), and non-Hispanic White participants (OR = 0.38, 95% CI = 0.17-0.87, P < .001). We found that greater levels of serum folate were significantly related to a decreased likelihood of migraine onset, especially among women, young and middle-aged populations, and non-Hispanic White participants. Further research is required to validate and expand upon our results.

Genetic variants in folate metabolism-related genes, serum folate and hepatocellular carcinoma survival: the Guangdong Liver Cancer Cohort study.

Folate metabolism is involved in the development and progression of various cancers. We investigated the association of single nucleotide polymorphisms (SNP) in folate-metabolising genes and their interactions with serum folate concentrations with overall survival (OS) and liver cancer-specific survival (LCSS) of newly diagnosed hepatocellular carcinoma (HCC) patients. We detected the genotypes of six SNPin three genes related to folate metabolism: methylenetetrahydrofolate reductase (MTHFR), 5-methyltetrahydrofolate-homocysteine methyltransferase reductase (MTRR) and 5-methyltetrahydrofolate-homocysteine methyltransferase (MTR). Cox proportional hazard models were used to calculate multivariable-adjusted hazard ratios (HR) and 95 % CI. This analysis included 970 HCC patients with genotypes of six SNP, and 864 of them had serum folate measurements. During a median follow-up of 722 d, 393 deaths occurred, with 360 attributed to HCC. In the fully-adjusted models, the MTRR rs1801394 polymorphism was significantly associated with OS in additive (per G allele: HR = 0·84, 95 % CI: 0·71, 0·99), co-dominant (AG v. AA: HR = 0·77; 95 % CI: 0·62, 0·96) and dominant (AG + GG v. AA: HR = 0·78; 95 % CI: 0·63, 0·96) models. Carrying increasing numbers of protective alleles was linked to better LCSS (HR10–12 v. 2–6 = 0·70; 95 % CI: 0·49, 1·00) and OS (HR10–12 v. 2–6 = 0·67; 95 % CI: 0·47, 0·95). Furthermore, we observed significant interactions on both multiplicative and additive scales between serum folate levels and MTRR rs1801394 polymorphism. Carrying the variant G allele of the MTRR rs1801394 is associated with better HCC prognosis and may enhance the favourable association between higher serum folate levels and improved survival among HCC patients.

Maternal Nutritional Factors Enhance Birthweight Prediction: A Super Learner Ensemble Approach

Birthweight (BW) is a widely used indicator of neonatal health, with low birthweight (LBW) being linked to higher risks of morbidity and mortality. Timely and precise prediction of LBW is crucial for ensuring newborn health and well-being. Despite recent machine learning advancements in BW classification based on physiological traits in the mother and ultrasound outcomes, maternal status in essential micronutrients for fetal development is yet to be fully exploited for BW prediction. This study aims to evaluate the impact of maternal nutritional factors, specifically mid-pregnancy plasma concentrations of vitamin B12, folate, and anemia on BW prediction. This study analyzed data from 729 pregnant women in Tarragona, Spain, for early BW prediction and analyzed each factor’s impact and contribution using a partial dependency plot and feature importance. Using a super learner ensemble method with tenfold cross-validation, the model achieved a prediction accuracy of 96.19% and an AUC-ROC of 0.96, outperforming single-model approaches. Vitamin B12 and folate status were identified as significant predictors, underscoring their importance in reducing LBW risk. The findings highlight the critical role of maternal nutritional factors in BW prediction and suggest that monitoring vitamin B12 and folate levels during pregnancy could enhance prenatal care and mitigate neonatal complications associated with LBW.

Investigation of homocysteine level after bariatric metabolic surgery, effect on vitamin B12 and folate levels

BackgroundObesity is a serious health problem with increasing incidence. worldwide and remains one of the most important causes of preventable deaths. We aimed to examine the relationship between Vitamin B12 and Folic acid, which have an important role for human life, and homocysteine is widely recognized for its association with the development of cardiovascular disease, although its role as an independent risk factor remains a topic of ongoing debate.Materials and methodsWe evaluated 126 patients who underwent bariatric metabolic surgery between September 2019-September 2020. In addition to demographic characteristics of the patients, weight, Vitamin B12, folate, HbA1c, cholesterol, triglyceride, ferritin, serum iron, albumin levels at preoperative, postoperative 1st month, 6th month, 12th month follow-ups were analyzed.ResultsPatients with the desired biochemical parameters at the determined follow-up points were identified and two groups were formed as RYGB(n = 43) and SG(n = 7) patients. When biochemical parameters were analyzed between the groups, homocysteine, HbA1c, HDL Cholesterol, VLDL Cholesterol, Total Cholesterol, Triglycerides, Ferritin, Serum Iron levels showed a statistical difference (p < 0.001). Folate (p = 0.064) and albumin (p = 0.257) did not show a significant difference over time. The change in vitamin B12 (p = 0.409) over time was not significant in the SG group, whereas a significant difference was observed in the RYGB group (p < 0.001). When we established a marginal model to determine the factors affecting the change in homocysteine over time, vitamin B12 and folate values.ConclusionsThe relationship between Vitamin B12, folate and homocysteine is important in order to better understand the complications that develop in bariatric metabolic surgery patients, to prevent possible complications and to better manage the process.

Associations of polycyclic aromatic hydrocarbons exposure with mortality and effect modification by folate biomarkers in a prospective population

The associations of folate biomarkers and polycyclic aromatic hydrocarbons (PAHs) in the general population remain unclear. Therefore, this study aimed to examine whether folate biomarkers are associated with PAHs, and whether folate biomarkers can mitigate adverse health outcome caused by PAHs. This prospective cohort study included 11,246 participants from the National Health and Nutrition Examination Survey (NHANES), which documented 1,303 deaths over a mean follow-up of 9.1 years. Multivariable linear regression models were used to examine the relationship between urinary individual PAHs and folate biomarkers. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios and 95 % CIs for the associations of PAHs and folate biomarkers with CVDs mortality and all-cause mortality. We found negative associations between folate in red blood cells (RBC) and urinary 1-Hydroxyphenanthrene (percentage change for a 2·7 fold-increase in folate −4.19 %, 95 % CI -5.80 % to −2.56 %CI), 2-Hydroxyfluorene (−6.66 %, −7.84 % to −5.49 %), 3-Hydroxyfluorene (−5.78 %, −6.77 % to −4.78 %)) and 1-Hydroxynapthalene (−2.75 %, −3.48 % to −2.01 %). The associations between serum folate and PAHs were consistent with those observed for RBC folate, and negative associations were also found between serum folate and 2-Hydroxynapthalene (−4.10 %, −5.26 % to −2.94 %). Within the lowest quartile of folate levels in RBC, there are strong associations of 2-Hydroxyfluorene, 3-Hydroxyfluorene, 1-Hydroxynapthalene, and 2-Hydroxynapthalene with elevated risk of CVDs mortality [HRs (95 % CI) >1]. As folate levels in RBC increase to the third and fourth quartiles, these associations no longer exist [HRs (95 % CI) <1, P-interaction<0.05]. The positive associations between urinary PAHs and CVDs mortality are also eliminated as serum folate levels rise [HRs (95 % CI) <1, P-interaction<0.05]. Furthermore, we also found higher levels of folate in both RBC and serum can greatly reduce the adverse impact of 1-Hydroxynapthalene on all-cause mortality. Consistent results were also validated in daily dietary folate and the folic acid supplement intake. Our study highlighted a robust negative relationship between urinary PAHs and folate. Additionally, folate was found to effectively mitigate mortality caused by PAHs, although we did not observe a direct reduction in mortality attributable to folate.

Impact of Serum Folate and Vitamin B12 on Mental Health in Patient Admitted at Razi Psychiatric Hospital

Vitamin B12 (cobalamin) is one of the essential vitamins that affect various systems in the body, including the central nervous system and plays an important role in the metabolism of the nervous system, although its exact role under pathological conditions is not fully understood. The present study aimed to assessing vitamin B12 &amp; serum folate in patient admitted at Razi psychiatric hospital. A cross section study subjects were inpatients with psychiatric disorder, patients from 21 to 60 years old. In this group of 40 psychiatric patients, there is no evidence of clinically relevant changes in serum vitamin B12 and folate level. Vitamin B12 deficiency can occur despite “normal” serum cobalamin levels; therefore, measuring homocysteine and methyl malonic acid can decrease false-negative findings.

Association of Vitamin B12 and Polymorphism of TCN2 with Early-Onset Post-Stroke Depression.

Post-stroke depression (PSD) is a common neuropsychiatric complication after a stroke with complex mechanisms. However, few studies have identified the role of vitamin B12 and folate in the occurrence and pathophysiology of PSD. The aim of our study is to investigate the relationship among vitamin B12, folate, their transporter genes, and early-onset PSD. A total of 173 ischemic stroke patients were recruited in Xiangya Hospital of Central South University. We collected peripheral blood samples, clinical data, and demographics at admission. The 17-item Hamilton Depression Scale was used for screening for the existence of depression at 2weeks after stroke onset. Serum vitamin B12 and folate level were measured based on double-antibody sandwich enzyme-linked immune-sorbent assay. Four single nucleotide polymorphisms (SNP) of transcobalamin 2 (TCN2) and solute carrier family 19 member 1 were genotyped using SNPscanTM multiplex SNP typing Kit. Eighty-four patients were diagnosed with PSD at 2weeks after stroke onset, and the incidence rate was 48.6%. Serum vitamin B12 level in PSD group was significantly lower than those in the non-PSD group (p=0.018). Binary logistic regression revealed that TCN2 rs1801198 GG genotype and G allele were associated with an increased risk of PSD after adjustment for confounding factors (for GG genotype, OR = 4.253, 95% CI = 1.711~10.572, p = 0.002; for G allele, OR = 2.134, 95% CI = 1.362~3.343, p = 0.001). Moreover, individuals with the rs1801198 G allele in the PSD group exhibited lower vitamin B12 level than those with the rs1801198 G allele in the non-PSD group (p=0.045). TCN2 rs1801198 and vitamin B12 are associated with the risk of early-onset PSD, and they may be involved in the development of PSD. Our study presents a novel standpoint for the treatment of PSD and gains insights into the mechanistic underpinnings of PSD.

Anemias carenciales y anemia megaloblástica

Deficiency anemia, defined as a deficiency of essential factors for red blood cell formation and maturation, is a global health problem. The main cause is iron deficiency, followed by megaloblastic anemia, which is mainly due to a deficiency of folic acid or vitamin B12, both essential coenzymes for DNA synthesis. Vitamin B12 requires complex absorption in the gastrointestinal system that involves different phases, as does folic acid, whose main absorption occurs in the duodenum and jejunum. The clinical manifestations of megaloblastic anemia include the typical symptoms of anemia, which is common regardless of the cause, and neurological symptoms that are specific to vitamin B12, or cobalamin, deficiency. The diagnosis is made via blood tests which reveal macrocytic anemia with low reticulocytes. The definitive diagnosis is made when decreased levels of vitamin B12 or folic acid, respectively, are observed. Treatment involves replenishment of the deficient nutrients either orally or parenterally, depending on severity and etiology. Approved formulations available in Spain are included in the text.

Anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody positivity in 588 patients with oral lichen planus

Background/purposeOur previous study found that 21.9 %, 13.6 %, 7.1 %, 0.3 %, and 14.8 % of 352 oral lichen planus (OLP) patients have anemia, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia, respectively. This study mainly evaluated the anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity in a large group of 588 OLP patients. Materials and methodsThe blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 588 OLP patients were measured and compared with the corresponding levels in 588 age- and sex-matched healthy control subjects. ResultsWe found that 148 (25.2 %), 99 (16.8 %), 60 (10.2 %), 7 (1.2 %), 124 (21.1 %), and 139 (23.6 %) OLP patients had blood Hb, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Moreover, 588 OLP patients had significantly higher frequencies of blood Hb and serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 588 healthy control subjects (all P-values <0.001 except P = 0.023 for folic acid deficiency). Of 148 anemic OLP patients, 68 had normocytic anemia, 32 had iron deficiency anemia, 19 had thalassemia trait-induced anemia, 17 had pernicious anemia, 7 had macrocytic anemia other than pernicious anemia, and 5 had microcytic anemia other than iron deficiency anemia and thalassemia trait-induced anemia. ConclusionOLP patients have significantly higher frequencies of blood Hb and serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than healthy control subjects.

The Critical Role of Folate in Prenatal Health and a Proposed Shift from Folic Acid to 5-Methyltetrahydrofolate Supplementation

Folate, or vitamin B9, is a water-soluble vitamin essential in periconceptional nutrition. In its active form, tetrahydrofolate, it plays a vital role in DNA methylation and homocysteine breakdown. Maintenance of normal serum folate levels is crucial during pregnancy; deviation from these levels, either in dearth or excess, can lead to various pregnancy and infant complications. This article analyzes existing literature on folate’s absorption pathway in human physiology and reviews the evidence surrounding prenatal supplementation guidelines for folic acid. Prior research supports these guidelines because, in the absence of folate during pregnancy, research has shown an increased incidence of neurodevelopmental defects, food allergies, ophthalmic deficits, and other adverse effects for both mother and child. This significant body of evidence has driven most developed countries to implement folic acid supplementation initiatives, with the World Health Organization recommending a daily 400-µg folic acid supplementation for periconceptional women. As progress continues on a global scale, further efforts should be made to improve folic acid levels in pregnant populations among demographic subgroups. Research supports the use of 5-methyltetrahydrofolate in place of traditional folic acid prenatal supplements based on the increased bioavailability, resistance to genetic polymorphisms, and avoidance of several potential risks associated with folic acid supplements. More research and product development should be done to drive and support this shift in prenatal supplementation trends.