Low Folate Levels Research Articles

Myelomeningocele Including Fetal Prescription.

Myelomeningocele (MMC) is one of the most common birth defects, affecting 0.2 to 0.4 per 1,000 live births in the United States. The most strongly associated risk factor is low folate level in pregnancy. For this reason, 0.4- to 1.0-mg supplementation with folic acid is recommended in all pregnancies, and high-risk pregnancies are recommended to supplement with 4.0 mg of folic acid daily. The mechanism behind the development of MMC is believed to be failure of the caudal end of the neural tube to close during primary neurulation. Screening for MMC is achieved by using α-fetoprotein levels in maternal serum or amniocentesis in the first and second trimesters of pregnancy. Ultrasonography and fetal magnetic resonance imaging are used to confirm the presence of MMC as well as the location and size of the defect. Based on the results of the Management of Myelomeningocele Study, fetal repair is performed between 23 weeks and 25 weeks and 6 days of gestational age for appropriate candidates. Postnatal repair is more common and is performed 24 to 72 hours after birth. In general, patients with lesions at lower anatomical levels have a better prognosis. Most children with MMC will have neurogenic bladder and bowel dysfunction that affect the patient's and the caregiver's quality of life. Patients with higher levels of mobility, better familial support, and higher economic status report improved quality of life compared with other patients with MMC.

Adequate Intake and Supplementation of B Vitamins, in Particular Folic Acid, can Play a Protective Role in Bone Health.

In vitro and animal model studies have shown that vitamin B (VB) deficiency has negative consequences on bone as a result of direct or mediated activity of hyperhomocysteinemia. However, there are still no precise indications regarding a possible VB role in order to maintain bone health. So, the aim of this narrative review was to consider state of the art correlation between VB dietary intake, blood levels and supplementation and bone health (bone mineral density (BMD), bone turnover markers and fractures risk) in humans. This review includes 29 eligible studies. Considering VB blood levels, the 14 studies considered have shown that low serum folate can be a risk factor for reduced BMD and fractures in the elderly, particularly women; no independent association was found for other VB. Studies that evaluate the relationship between VB dietary intake and BMD are only 2; one, conducted on 1869 women, demonstrated a positive effect of folate intake on BMD. Another demonstrated a dose-dependent inverse relationship between vitamin B6 dietary intake and risk of hip fracture, but only for 35298 female participants. Regarding the relationship between BV supplementation and bone health (9 studies with only VB and 4 with other nutrients), all studies that considered patients with hyperhomocysteinemia or with low folate blood levels, are in agreement in demonstrating that folate supplementation (500mcg- 5mg) is useful in improving BMD. In conclusion, a request for folate and homocysteine blood levels in elderly patients with osteopenia/osteoporosis is mandatory. For patients with hyperhomocysteinemia or with low folate blood levels, folate supplementation (500mcg-5mg) is crucial.

Folate levels in children with sickle cell anaemia on folic acid supplementation in steady state and crises at a tertiary hospital in Enugu, Nigeria: a prospective, comparative study.

Folic acid supplementation is an integral aspect of the management of children with sickle cell anaemia (SCA) especially in Africa. In spite of this, there have been concerns about lower folate levels, especially during crisis. To determine red cell folate levels of children with sickle cell anaemia in steady state and during crisis and compare with those with haemoglobin AA genotype. This study was prospective, hospital based, and comparative. Fifty children with sickle cell anaemia were recruited during crises and followed up until they met the criteria for attaining steady state. The controls were fifty children matched with those with SCA for age and gender and had haemoglobin AA genotype. Red cell folate estimation was done with the Electrochemiluminescence Immunoassay (ECLIA) method using the automated Roche Cobas e411 equipment. The median (IQR) red cell folate level in children during sickle cell crisis was 265.95 (134.50) ng/ml, which was significantly lower than the median (IQR) of 376.30 (206.85) ng/ml obtained during steady state. Most children with SCA (41 out of 50) had significantly higher folate levels during steady state (T=1081, Z-score= -4.660, p < 0.001). Median level of red cell folate was lower during anaemic crisis compared to vaso-occlusive crisis, though not significantly so (N(50), U = 214.00, Z-score= -1.077, p = 0.305). The median red cell folate level of normal controls was 343.55 (92.90) ng/ml, which was significantly lower than the 376.30 (206.85) ng/ml obtained during steady state (N(50), U= 209.00, Z-score= -7.177, p <0.001). Median red cell folate levels of the study participants were within normal limits, though most children with SCA had significantly higher levels during steady state compared to crisis. Normal controls had significantly lower red cell folate levels than the children with SCA during steady state.

Folate Status as a Nutritional Indicator among People with Substance Use Disorder; A Prospective Cohort Study in Norway.

Substance use disorder (SUD) is associated with poor nutrition. Vitamin B9, or folate, is an important micronutrient for health. The aim of this prospective longitudinal cohort study was to assess serum folate levels among people with SUD and to investigate the impact of factors related to substance use severity on folate status. Participants were recruited from outpatient clinics for opioid agonist therapy (OAT) and municipal health-care clinics for SUD in Western Norway. They were assessed annually, including blood sampling for determination of micronutrient status. Overall, 663 participants with a total of 2236 serum folate measurements were included. A linear mixed model was applied, and measures are presented as β-coefficients with 95% confidence interval (CI). Forty-eight percent (CI: 44–51) of the population had low serum folate levels (s-folate < 10 nmol/L), and 23% (CI: 20–26) were deficient (s-folate < 6.8 nmol/L) at baseline. Sixty percent (CI: 53–65) sustained their poor folate status in at least one subsequent assessment. Except for weekly use of cannabis (mean difference in serum folate [nmol/L]: −1.8, CI: −3.3, −0.25) and alcohol (1.9, CI: 0.15, 3.6), weekly use of no other substance class was associated with baseline differences in serum folate when compared to less frequent or no use. Injecting substances was associated with a reduction in serum folate over time (−1.2, CI: −2.3, −0.14), as was higher dosages of OAT medication (−1.1, CI: −2.2, −0.024). Our findings emphasize the need of addressing nutrition among people with severe SUD.

W230 Association between low serum Vitamin B12 and high folate level in pregnant women with gestational diabetes mellitus

W230 Association between low serum Vitamin B12 and high folate level in pregnant women with gestational diabetes mellitus

Folic Acid Levels During Pregnancy Regulate Trophoblast Invasive Behavior and the Possible Development of Preeclampsia.

BackgroundOne of the unique features of placentation is its similarity to tumorigenesis yet being very well regulated. It allows rapid proliferation, migration, and invasion of mononuclear trophoblast cells into the maternal uterus and remodeling the maternal vasculature. This pseudomalignant nature of trophoblastic cells is strictly regulated and its importance becomes evident in abnormal pregnancies that are characterized by aberrant trophoblast proliferation/invasion like preeclampsia. In addition to this, the importance of folic acid supplementation during pregnancy is well documented. We aimed to analyze the molecular and epigenetic regulation of the pseudomalignant nature of placentation via folic acid levels.MethodsPlacental tissue samples were collected from different pregnancies in three different gestational stages. We estimated the impact of folic acid levels on global methylation, LINE1 methylation, and expression of DNMTs in all three gestational stages in pregnant women and preeclampsia pregnancies. We also analyzed the effect of folic acid supplementation on trophoblastic invasion using placental derived cells viz, JEG-3 and HTR-8/SVneo cell line and verified the molecular and epigenetic mechanisms involved in this regulation.ResultsDevelopment of preeclampsia was observed to be associated with lower folate levels in placental tissue, higher global methylation level, and higher expression of DNMT1and DNMT3A. Folic acid supplementation was found to increase the invasive potential of placental trophoblasts by almost two folds which were associated with the decreased expression of tumor suppressor genes and tissue inhibitors of matrix metalloproteinases; and increased expression of oncogenes, telomerase gene, and matrix metalloproteinases. These folic acid-mediated changes were observed to be regulated by CpG methylation in the case of many genes. Folic acid supplementation was also observed to significantly decrease global methylation in placental trophoblasts related to decreasing expression of DNMT1 and DNMT3A.ConclusionLower folic acid levels are associated with preeclampsia development and folic acid supplementation regulates the invasive potential of placental trophoblasts as mediated by various epigenetic changes in the placenta suggesting the protective effect of folic acid against preeclampsia.

Folate, Vitamin B12, and Homocysteine Levels in Women With Neural Tube Defect-Affected Pregnancy in Addis Ababa, Ethiopia.

BackgroundNeural tube defects (NTDs) are prevalent congenital defects associated with pre-pregnancy diet with low levels of maternal folate. They are linked to severe morbidity, disability, and mortality, as well as psychological and economic burdens.ObjectiveThe goal of this study was to determine the levels of folate, vitamin B12, and homocysteine in the blood of women who had a pregnancy impacted by NTDs.Subjects and MethodsA hospital-based case–control study was undertaken between September 2019 and August 2020. The study comprised a total of 100 cases and 167 controls. Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of folate, vitamin B12, and homocysteine in the serum.ResultsOnly 39% of the cases and 54.5% of control mothers reported periconceptional use of folic acid/multivitamin, which indicated a statistically significant difference (p = 0.014). Logistic regression indicated that periconceptional use of folic acid/multivitamin was associated with NTDs (p = 0.015, OR = 1.873, 95% CI: 1.131–3.101). We found that 57% of the cases and 33.5% of controls, as well as 43% of cases and 20.4% of controls had serum folate and vitamin B12 levels below the cut-off value, respectively. Twenty-seven percent of the cases and 6.6% of controls had hyperhomocysteinemia (HHcy). The median concentrations of folate, vitamin B12, and homocysteine in cases and controls were 4.78 and 8.86 ng/ml; 266.23 and 455 pg/ml; 13.43 and 9.7 μmol/l, respectively. The median concentration of folate (p < 0.001) and vitamin B12 (p < 0.001) were significantly lower in the cases than controls, while the homocysteine concentration (p < 0.001) was significantly lower in the controls than cases. Folate [OR (95% CI) = 1.652 (1.226–2.225; p = 0.001)], vitamin B12 [OR (95% CI) = 1.890 (1.393–2.565; p < 0.001], and homocysteine [OR (95% CI) = 0.191 (0.09–0.405; p < 0.001)] levels were associated with NTDs.ConclusionFolate and vitamin B12 are deficient in both cases and control mothers. The lower levels of folate and vitamin B12 with an elevated homocysteine level in NTD-affected pregnancy may be an indication that these biochemical variables were risk factors for NTDs. Folate/multivitamin supplementation and/or food fortification should be promoted.

Folate Deficiency: A Possible Association with Congenital Heart Defects.

Congenital heart defects continue to remain a major cause of serious morbidity and mortality, especially in the developing world. This study was planned to get some insight into the role of modifiable nutritional elements in structural CHD etiology. This cross-sectional, observational study was conducted at a hospital in Northern India from January 2017 to December 2017. Infants < 6 mo with structural CHD as cases and those without structural heart disease were enrolled as controls. Blood samples were collected from mother-child pairs and tested for serum folate, vitamin B12, and homocysteine. It was found that 46.7% infant-mother pairs, out of 45 in the cases group had folate deficiency, whereas in the control group, only 20% had folate deficiency, which was statistically significant (p = 0.013). Baby (0-6 mo) with congenital heart defects (CHD) and their mothers are more likely to have low folate levels compared to those not having CHD.

Vitamin B12 and Folic Acid Levels in Known Coronary Artery Disease Patients

Vitamin B12 and folic acid are water soluble vitamins playing a vital role in various biological processes, where their deficiency leading to hyperhomocysteinemia are closely related to the development of cardio vascular risk. This case-control study included a total of 60 participants; 30 with confirmed coronary artery disease (CAD) and 30 were age and sex matched healthy controls. Fasting blood samples were collected and analyzed for biochemical parameters. Statistical analysis was done using SPSS software. A p value &lt;0.05 was considered statistically significant. Vitamin B12 levels were found to be significantly lower in CAD patients than the controls. Based on the results, 50% of CAD patients had vitamin B12 deficiency. Vitamin B12 was positively associated with HDL-c and negatively with TC, TGL, LDL-c, VLDL-c, RLP-c, Non-HDL-c, TG/HDL-c. The study concludes that low levels of vitamin B12 and folic acid are related with risk factors of coronary artery disease

Associations of Serum Folate and Vitamin B12 Levels With Cardiovascular Disease Mortality Among Patients With Type 2 Diabetes

The associations of serum folate and vitamin B12 levels with cardiovascular outcomes among patients with type 2 diabetes (T2D) remain unclear. To investigate the associations of serum folate and vitamin B12 levels with risk of cardiovascular disease (CVD) mortality among individuals with T2D. This prospective cohort study included 8067 patients with T2D who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2014 and NHANES III (1988-1994). American Diabetes Association criteria were used to define T2D. Data were analyzed between October 1, 2020, and April 1, 2021. Serum folate and vitamin B12 levels. Multivariable Cox proportional hazards regression models were used to compute hazard ratios and 95% CIs for the associations of serum folate and vitamin B12 levels with risks of CVD and all-cause mortality. Two multivariable models were constructed. Restricted cubic spline analyses were used to examine the nonlinear association of serum folate levels and vitamin B12 levels with CVD mortality, and nonlinearity was assessed using the likelihood ratio test. This cohort study included data from 7700 participants in the folate analysis (mean [SE] age, 57.8 [0.3] years; 3882 men [weighted, 50.5%]; median serum folate level, 12.1 ng/mL [IQR, 7.1-19.5 ng/mL]) and 4860 participants for the vitamin B12 analysis (mean [SE] age, 57.8 [0.3] years; 2390 men [weighted, 50.7%]; median serum vitamin B12 level, 506.1 pg/mL [IQR, 369.1-703.5 pg/mL]). During 72 031 person-years of follow-up, 799 CVD deaths were documented for the folate analysis, and during 43 855 person-years of follow-up, 467 CVD deaths were reported for the vitamin B12 analysis. Nonlinear associations were observed for serum levels of folate (P = .04 for nonlinearity) and vitamin B12 (P = .04 for nonlinearity) with risk of CVD mortality among patients with T2D. Compared with participants in the second quartile of serum folate levels (7.1-12.1 ng/mL), the hazard ratios for CVD mortality were 1.43 (95% CI, 1.04-1.98) for participants in the lowest serum folate level quartile (<7.1 ng/mL) and 1.03 (95% CI, 0.74-1.44) for participants in the highest quartile (≥19.5 ng/mL). In addition, compared with participants in the second quartile of serum vitamin B12 levels (369.1-506.0 pg/mL), the hazard ratios for CVD mortality were 1.74 (95% CI, 1.20-2.52) for participants in the lowest quartile (<369.1 pg/mL) and 2.32 (95% CI, 1.60-3.35) for participants in the highest quartile (≥703.5 pg/mL). Similar patterns of association were observed for all-cause mortality (nonlinearity: P = .01 for folate and P = .02 for vitamin B12). This cohort study found that both low and high serum levels of vitamin B12 as well as low serum levels of folate were significantly associated with higher risk of CVD mortality among individuals with T2D.

Deficiency of folate and vitamin B12 increases oxidative stress in chronic pancreatitis patients.

Folate and vitamin B12 are involved in metabolic reactions for combating oxidative stress. We measured erythrocyte folate and plasma vitamin B12 and compared these with blood antioxidants - erythrocyte glutathione (GSH), glutathione peroxidase (GPx), superoxide dismutase (SOD), and plasma vitamin C - and marker of lipid peroxidation, thiobarbituric acid reactive substance (TBARS), in chronic pancreatitis (CP) patients. One hundred and seventy-five CP patients (91 tropical, 84 alcoholic) and 113 healthy controls were recruited. Erythrocyte folate and plasma vitamin B12 were measured using microbiological assay, and antioxidant levels and erythrocyte TBARS by spectrophotometry. Erythrocyte folate and plasma vitamin B12 were significantly lower in CP patients than controls (225.4 ± 9.13 vs. 380.38 ± 17.29 nmol/L, p < 0.001 and 233.23 ± 10.4 vs. 338.84 ± 19.01 pmol/L, p < 0.001), and in diabetic- vs. non-diabetic CP patients. Blood antioxidant levels were significantly lower and TBARS was higher in CP patients as compared to controls. Low folate level correlated with low GSH levels (r = 0.314, p < 0.001). CP patients with low folate and vitamin B12 had low GSH and GPx levels as compared to patients with normal folate and vitamin B12 levels. Low vitamin B12 level was associated with 3.24 (95% CI 1.11-9.46, p < 0.05) fold increased risk of pancreatic insufficiency. Smoking was associated with 9.82 (95% confidence interval [CI] 3.3-29.22, p < 0.05) fold increased risk of having low folate levels. Low folate and vitamin B12 levels were associated with increased oxidative stress in CP patients.

Дефицит витаминов и микронутриентов и особенности репродуктивного здоровья у женщин

Aim: to identify the content of vitamins and micronutrients in the blood of young female patients. Patients and Methods: a prospective single-center study included young female patients aged 18–24 years with complaints of menstrual disorders (MD) or manifestations of androgen-dependent dermopathy (acne, seborrhea, alopecia). Clinical, anamnestic and anthropometric parameters, hormonal profile involved in the realization of reproductive function, a number of biochemical blood parameters, and pelvic ultrasound data were evaluated. Results: the study included 133 female patients divided into 4 groups. Group 1 (n=53) consisted of female patients with MD, group 2 (n=44) — women with manifestations of hyperandrogenism (HA; acne and post-acne, alopecia, seborrhea) and MD, group 3 (n=9) — female patients with HA manifestations without MD, group 4 (n=27) — female patients without HA and MD (conditionally healthy). 41% of female patients of the 1st and 2nd groups and 44% of the 3rd group showed signs of an increase in the ovarian volume and changes in their structure (multifollicular or polycystic ovaries). Echographic signs of anovulation were detected in 26.1, 32.3 and 35.0% of female patients in groups 1, 2 and 3, respectively. Comparison of the androgenic steroid level in the groups did not reveal statistically significant differences, however, there were borderline cortisol levels and higher values of plasma 17-OH progesterone (vs the group 1) in groups 2 and 3. Values of gonadotropins did not differ significantly, but the LH/FSH ratio was higher in group 2, although unreliable. Hyperprolactinemia was detected in every fourth female patient of groups 1, 2, 3 (value range from 737 to 1079 mIU/L). 25(OH)D content was reduced in all three groups, amounting to 16.4±8.4, 24.7±13.2 and 11.4±4.5 ng/mL, respectively. Although homocysteine levels were borderline (11.5±2.9, 9.7±2.8 and 9.4±2.7 μmol/L), they differed statistically significantly (p&lt;0.0002) in the groups. Besides, borderline low levels of folic acid, vitamin B12 and serum ferritin were found in groups 1, 2 and 3. Conclusion: the disorders detected in women with MD and HA should be taken into account when forming the treatment tactics. KEYWORDS: menstrual disorders, hyperandrogenism, homocysteine, ferritin, vitamin D, B vitamins. FOR CITATION: Kudinova E.G. Deficiency of vitamins and micronutrients and reproductive health in women. Russian Journal of Woman and Child Health. 2022;5(3):182–187 (in Russ.). DOI: 10.32364/2618-8430-2022-5-3-182-187.

Folate Mediated One Carbon Metabolism in Head and Neck Squamous Cell Carcinoma: A Systematic Review

Introduction: Head and neck cancer (HNC) is one of the most prevalent cancers of upper aerodigestive tract, with squamous cell carcinomas accounting for the majority of cases. Vitamin B such as folate has been associated with carcinogenesis. Folate is essential for one carbon metabolism, which involves the transfer of one carbon units for Deoxyribonucleic Acid (DNA) and Ribonucleic Acid (RNA) production, amino acid metabolism and methylation. Aim: To evaluate the association of folate mediated One carbon metabolism with Head and Neck Squamous Cell Carcinoma (HNSCC). Materials and Methods: For this systematic review, Electronic bibliographic databases search of PubMed, Google Scholar and Scopus was done. The electronic search was performed between November 15th to November 30th, 2020 by two researchers independently. All original research, observational studies, full text articles, in which blood samples or questionnaires or both, focused on the assessment of folate mediated one carbon metabolism in HNSCC, published upto November 2020 were reviewed. Four studies published from 2005 to 2019 were included in which three studies were case-control and one study was a comparative cross-sectional study. This systematic review was carried out by two reviewers, using Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA) checklist and the New Castle Ottawa Scale (NOS) for quality assessment. Results: In this systematic review, total of four studies included, had 1504 HNSCC patients and 2970 Controls. One study was reported from Nigeria, one from the European countries, one from Japan, and one from the United States of America (USA). One study had a quality score of 8 whereas 3 studies had 7, considering all the four studies included are of good quality. Conclusion: Significant low levels of serum folate was present in HNSCC when compared to controls. Serum folate levels can differ due to tumor growth and subsequent metabolic changes, or they may precede and accelerate tumor progression.

GENETIC VARIATION OF FOLATE METABOLIC PATHWAY IN RECURRENT PREGNANCY LOSS- A SYSTEMATIC REVIEW

Introduction: Recurrent pregnancy loss (RPL) is a discrete disorder, which is defined as loss of two or more clinically recognized pregnancies. The increasing incidence of RPL in recent days may be due to, chromosomal and congenital abnormalities, antiphospholipid syndrome, uterine anomalies, hereditary thrombophilia, autoimmunity and environmental factors, but the cause of RPL still remains undetermined in the majority of cases.Folate deficiency is one the causes for congenital abnormalities which may leads to pregnancy losses. Any deficiency in the folate metabolic pathway leads to low levels of folate, which has been associated with abnormalities in both mothers (anemia) and fetuses (congenital abnormalities). Also it is associated with increased homocysteine levels which may contribute in these conditions1. Objectives: Study of folate metabolism status in RPL by correlating the association between 5, 10-methylenetetrahydrofolate reductase gene (MTHFR) Data Sources: Data from Pubmed, EMBASE, MEDLINE and many other data baseswere searched. Similar strategy were applied for each article search. Study selection: the review was restricted to studies on recurrent pregnancy loss, Folate metabolism, MTHFR gene and study statistics. Results:A hypothesis was drawn from different studies and a positive link was observed in MTHFR gene alleles mutation, hyperhomocysteinaemia and recurrent pregnancy loss. Conclusion:Understanding the molecular genetics of folate metabolic pathway will provide newer avenues in the effective management of pregnancy losses due to low folate level (in MTHFR gene polymorphism) with supplementation of folic acid or L-methylfolate.

Effect of milling and sourdough fermentation on bioactive compounds of selected multigrain blends

Blends of wheat, rye and barley were used to obtain multigrain milling fractions. The multigrain flours were further subjected to fermentation, and the metabolites profile and the nutritional potential of the obtain sourdoughs were explored. Increasing the level of rye and barley in the multigrain blends resulted in increased DPPH RSA, total phenolic and folic acid contents in flours and brans. The level of panthotenic acid decreased in flours and brans, with the increase of rye and barley levels. Both spontaneous and lactic acid bacteria assisted sourdough fermentation resulted in lower levels of folic acid compared to the corresponding flours, but the concentration increased with the level of rye and barley within blends. The metabolites biosynthesized by lactic acid bacteria varied with the levels of rye and barley in the blends. Multigrain milling and sourdough fermentation are valuable tools for modulating the nutritional profile of the cereal based food products.

Demographic and biochemical risk factors of Down Syndrome in pregnant women: A pilot study in Sylhet division of Bangladesh

Worldwide research in down syndrome have shown that advanced maternal age (˃30 years) at conception, lower folate status and/or impaired folate metabolism, maternal weight gain during pregnancy, low socioeconomic conditions, radiation exposure, use of contraceptive pills, and taking tobacco/smoking are major maternal risk factors for giving birth child with DS. However, the occurrence of those factors in pregnant women at advanced age has not yet been investigated in Bangladesh. Therefore, a large scale study was needed to explore the overall scenario in Bangladesh. This pilot cross sectional study was aimed to determine the serum folate and homocysteine status at advanced age pregnant women. We measured serum folate and homocysteine concentrations using the Enzyme-Linked Immunosorbent Assay (ELISA). Out of 70 pregnant women, serumfolate level was low (&lt;5 ng/ml) in 13 (18.57%), intermediate (5-6.9 ng/ml) in 8 (11.43%) and normal in 49 (70%) whereas homocysteine concentrations were found low (&lt;5 ng/ml) in all participants. Finally, questionnaire data indicates, low socioeconomic status, overweight during pregnancy, taking contraceptive pills and taking tobacco/smoking was higher percentage in folate-deficient pregnant women than normal serum folate level women. Additionally, women (n=13) with low folate level belongs to low socioeconomic status, overweight, taking contraceptive pills and tobacco/smoking did not give birth child with DS phenotypes. Together, our preliminary findings give an overview of DS associated risk factors in Bangladeshi pregnant women. Large scale study is going on. In next study, we might able to investigate DS risk factors, their associations with serum folate and homocysteine levels and finally with DS phenotypes in child throughout the country. Keywords: Down syndrome; risk factors; folic acid; homocysteine; pregnant women; Bangladesh.

B vitamins and prevention of cognitive decline and incident dementia: A systematic review and meta‐analysis

AbstractBackgroundElevation of homocysteine levels is a well‐established risk factor for dementia, yet controversy exists regarding whether B‐vitamin‐mediated reduction of homocysteine levels can benefit cognitive function. We aimed to investigate whether B vitamins can reduce the risk of cognitive decline and incident dementia.MethodPubMed, EMBASE, Cochrane Library, and Web of Science were searched for articles published from the inception dates to March 1, 2020. Studies were eligible if the endpoints included MMSE changes and risk of cognitive decline and/or dementia. Random‐effect or fixed‐effect models, depending on the degree of heterogeneity, were performed to calculate mean differences (MDs), hazard ratios (HRs), and odds ratios (ORs).ResultA total of 95 studies with 46175 participants (25 RCTs, 20 cohorts, and 50 cross‐sectional studies) were included. B vitamins can benefit cognitive function as measured by MMSE changes (MD, 0.13, 95% CI 0.04‐0.23), and this result was also significant in studies where placebo groups developed cognitive decline, suggesting that B vitamins slow cognitive decline. For the &gt; 12 months interventional period stratum, B vitamins decreased cognitive decline (MD, 0.15, 95% CI 0.05‐0.25) compared to placebo; no such outcome was detected for the shorter interventional stratum. In the non‐dementia population, B vitamins slowed cognitive decline (MD, 0.15, 95% CI 0.04‐0.25) compared to placebo; this outcome was not found for the dementia population. Lower folate levels (but not B12 or B6) were associated with higher risk of dementia (OR, 1.76, 95% CI 1.24‐2.50) and cognitive decline (OR, 1.26, 95% CI 1.02‐1.55). Among the population without dementia aged 50 years and above, the risk of incident dementia was significantly decreased among individuals with higher intake of folate (HR, 0.61, 95% CI 0.47‐0.78) (but not B12 or B6).ConclusionOur meta‐analysis suggests that B vitamin supplementation is associated with slowing of cognitive decline, especially in populations who received early and long‐term intervention; higher intake of dietary folate is associated with a reduced risk of incident dementia in non‐dementia aged population.

Associations of Genetic Variants of Methylenetetrahydrofolate Reductase and Serum Folate Levels with Metabolic Parameters in Patients with Schizophrenia.

The one-carbon metabolism pathway is a suitable candidate for studying the genetic and epigenetic factors contributing to metabolic abnormalities in patients with schizophrenia. We recruited 232 patients with schizophrenia and analyzed their serum folate, vitamin B12, and homocysteine levels and metabolic parameters to investigate the associations of genetic variants of methylenetetrahydrofolate reductase (MTHFR) and folate levels with metabolic parameters. MTHFR C677T and MTHFR A1298C were genotyped. Results showed that MTHFR 677T allele carriers had lower levels of total cholesterol and low-density lipoprotein cholesterol than those with the 677CC genotype. Metabolic parameters did not differ between MTHFR 1298C and 1298AA carriers. Patients with a low folate level had a lower high-density lipoprotein cholesterol level than those with a normal folate level, but the effect disappeared after adjustment for age, sex, and types of antipsychotics used. We found significant interactions between MTHFR A1298C and the folate level status (low vs. normal) in terms of body mass index and waist circumference. In conclusion, genetic variants in one-carbon metabolism might play a role in antipsychotic-induced metabolic abnormalities. Prospective studies on drug-naïve, first-episode patients with schizophrenia are warranted to identify key regions of DNA methylation changes accounting for antipsychotic-induced metabolic abnormalities.

Interaction of maternal asthma history and plasma folate levels on child asthma risk in the Boston Birth Cohort.

Previous studies on maternal folate status during pregnancy and child asthma risk yielded mixed results, and few considered maternal asthma history, a known risk factor of childhood asthma. This study examined whether the role of maternal folate in childhood asthma differs by maternal asthma history and whether there is an interaction between the two factors. This study included 1948 mother-child dyads from the Boston Birth Cohort. Childhood asthma was defined based on physician diagnosis documented in electronic medical records, and maternal asthma was based on standard questionnaire interview. Maternal plasma folate level within a few days of delivery was measured by chemiluminescent immunoassay. Logistic regression models were applied to examine individual and joint associations of maternal asthma history and plasma folate level with childhood asthma, adjusting for other covariables. When stratified by maternal asthma history, an L-shaped relationship between maternal folate level and child asthma was observed in children born to mothers with asthma history (pinteraction = 0.03). The highest risk was found in children having maternal asthma history and low maternal folate level (odds ratio = 5.93; 95% confidence interval: 2.86-12.3) compared with children without maternal asthma history and with sufficient maternal folate levels. Sensitivity analyses using different definitions of asthma and stratified by major covariables yielded similar findings. In this US prospective high-risk birth cohort, maternal asthma history and low folate level interactively increased the risk of child asthma. If further confirmed, optimizing maternal folate levels during pregnancy may mitigate child asthma risk in the setting of maternal asthma history.

COMPARISON OF SERUM HOMOCYSTEINE AND FOLIC ACID LEVELS IN ACUTE MYOCARDIAL INFARCTION AND NORMAL HEALTHY POPULATION

Background: Acute Myocardial Infarction (AMI) is a leading cause of mortality worldwide. An emerging risk factor for AMI is raised levels of Homocysteine (Hcy). Deficient levels of folic acid are associated with Hyperhomocysteinemia (HHcy).ortification of folic acid has been known to improve endothelial dysfunction. We aimed to determine the levels of Hcy and folic acid in patients with AMI and healthy individuals. Methods: This cross-sectional comparative study was conducted on 80 subjects, with 40 subjects in each group. Group A included individuals diagnosed with AMI and group B included healthy individuals. Serum Hcy and folic acid levels were measured by Enzyme Linked Immunosorbent Assay (ELISA). Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) were measured, and Body Mass Index (BMI) was calculated. Results: Increased Hcy and lower serum folic acid levels were found in group A as compared to group B (p&lt;0.001). The correlation between serum Hcy level and folic acid in group A was moderate and negative (r= -0.48, p=0.001); for group B it was also moderate and more negative (r= -0.66, p&lt;0.001). Conclusions: There were high levels of Hcy and low levels of folic acid in diseased group as compared to healthy participants.