Evaluation of nutritional status in children with amblyopia / Avaliação do estado nutricional de crianças com ambliopia

ABSTRACT Purpose: We aimed to compare the body mass index and vitamin and mineral status of children with and without amblyopia. Methods: Amblyopic children aged between 5 and 18 years (n=46) and age-matched control children (n=32) were evaluated in terms of anthropometric parameters, including height, weight, body mass index and demographic features. Serum vitamin B12 and folate were measured using an Advia Centaur XP (Siemens, Ireland) biochemistry analyzer. We evaluated the inorganic mineral elements from hair samples with inductively coupled plasma-mass spectrometry using a Thermo XSeries 2 analyzer (Thermo Fisher Scientific, Bremen, Germany). Results: No significant difference was found between the two groups in terms of height, weight, and body mass index or serum B12 and folate concentrations (p>0.05). Children with severe amblyopia had lower vitamin B12 and folate and higher body mass index. The levels of phosphorus (p=0.012), selenium (p=0.002), molybdenum (p<0.001), iodine (p=0.002), chromium (p=0.022), boron (p<0.001), and beryllium (p=0.005) were all significantly lower in the amblyopia group compared to the control group. All of these minerals, except phosphorus, were also significantly lower in those with severe amblyopia compared to those with milder amblyopia and controls (p<0.05). Conclusion: Amblyopic children are significantly deficient in some inorganic elements. Inorganic elements, vitamin B12, and folate may play an important role in the visual development of amblyopic children.

RESUMO Objetivo: Nosso objetivo foi comparar o índice de massa corporal e o nível de vitaminas e minerais de crianças com e sem ambliopia. Métodos: Crianças amblióticas com idades entre 5 e 18 anos (n=46) e crianças controle pareadas por idade (n=32) foram avaliadas quanto a parâmetros antropométricos, incluindo altura, peso, índice de massa corporal e características demográficas. A vitamina B12 e o folato séricos foram medidos utilizando um analisador bioquímico Advia Centaur XP (Siemens, Irlanda). Avaliamos os elementos minerais inorgânicos de amostras de cabelo com espectrometria de massa de plasma indutivamente acoplado usando um analisador Thermo XSeries 2 (Thermo Fisher Scientific, Bremen, Alemanha). Resultados: Não houve diferença significativa entre os dois grupos em relação à altura, peso e índice de massa corporal ou concentrações séricas de B12 e folato (p>0,05). Crianças com ambliopia severa tinham menor vitamina B12 e folato e maior índice de massa corporal. Os níveis de fósforo (p=0,012), selênio (p=0,002), molibdênio (p<0,001), iodo (p=0,002), cromo (p=0,022), boro (p<0,001) e berílio (p=0,005) foram todos significativamente menores no grupo com ambliopia em comparação com o grupo controle. Todos esses minerais, exceto o fósforo, também foram significativamente menores naqueles com ambliopia em comparação com aqueles com ambliopia leve e grupo controle (p<0,05). Conclusão: As crianças amblíopes são significativamente deficientes em alguns elementos inorgânicos. Elementos inorgânicos, vitamina B12 e folato podem desempenhar um papel importante no desenvolvimento visual de crianças com ambliopia.

Is there any change in phenotypic characteristics comparing 5 to 10 years of follow-up in obese patients undergoing roux-en-y gastric bypass? / Características fenotípicas de pacientes com obesidade submetidos a derivação gástrica em y-de-roux: qual as reais mudanças comparando-se 5 a 10 anos de acompanhamento?

ABSTRACT Background : Bariatric surgery promotes significant weight loss and improvement of associated comorbidities; however, nutrients deficiencies and weight regain may occur in the middle-late postoperative period. Aim: To investigate nutritional status in 10 years follow-up. Methods : Longitudinal retrospective study in which anthropometric, biochemical indicators and nutritional intake were assessed before and after one, two, three, four, five and ten years of Roux-en Y gastric bypass through analysis of medical records. Results : After ten years there was a reduction of 29.2% of initial weight; however, 87.1% of patients had significant weight regain. Moreover, there was an increase of incidence of iron (9.2% to 18.5%), vitamin B12 (4.2% to 11.1%) and magnesium deficiency (14.1% to 14.8%). Folic acid concentrations increased and the percentage of individuals with glucose (40.4% to 3.7%), triglycerides (38% to 7.4%), HDL cholesterol (31 % to 7.4%) and uric acid (70.5% to 11.1%) abnormalities reduced. Also, there is a reduction of food intake at first year postoperative. After 10 years, there was an increase in energy, protein and lipid intake, also a reduction in folid acid intake. Conclusions : Roux-en Y gastric bypass is an effective procedure to promote weight loss and improve comorbidities associated with obesity. However, comparison between postoperative period of five and 10 years showed a high prevalence of minerals deficiency and a significant weight regain, evidencing the need for nutritional follow-up in the postoperative period.

RESUMO Racional: A cirurgia bariátrica promove importante perda ponderal e melhora das comorbidades associadas; entretanto, deficiências nutricionais e reganho de peso podem ocorrer no pós-operatório médio e tardio. Objetivo: Investigar a evolução do estado nutricional de pacientes após cinco e 10 anos de pós-operatório. Método: Estudo retrospectivo longitudinal, no qual indicadores antropométricos, bioquímicos e a ingestão alimentar foram avaliados no período pré-operatório e após um, dois, três, quatro, cinco e dez anos da operação, por meio de revisão de prontuários. Resultados: Após 10 anos observou-se redução de 29,2% do peso inicial; no entanto, 87,1% dos pacientes tiveram reganho significativo de peso. Além disso, houve aumento da incidência de deficiência de ferro (9,2% para 18,5%), vitamina B12 (4,2% para 11,1%) e magnésio (14,1% para 14,8%). As concentrações de ácido fólico aumentaram e a porcentagem de indivíduos com alterações na glicemia (40,4% a 3,7%), triglicérides (38% a 7,4%), colesterol HDL (31% a 7,4%) e ácido úrico (70,5% a 11,1%) diminuiu. Além disso, houve redução na ingestão alimentar no primeiro ano de pós-operatório. Após 10 anos, houve aumento na ingestão de energia, proteína e lipídios, e redução na de ácido fólico. Conclusões: A derivação gástrica em Y-de-Roux é procedimento eficaz para promover perda de peso e melhorar as comorbidades associadas à obesidade. Entretanto, a comparação entre os períodos pós-operatórios de cinco e 10 anos mostrou que uma porcentagem de pacientes apresenta deficiências de vitaminas e minerais e reganho de peso significativo, evidenciando a necessidade do acompanho nutricional no período pós-operatório.

Relação entre níveis de fumonisina B1 e ácido fólico em farinha de milho e a concentração de ácido fólico no soro humano / Relationship between fumonisin B1 and folic acid levels in foods and the folic acid concentration in human serum

Neste trabalho foram determinados os níveis de ácido fólico e de fumonisina B1 (FB1) em farinha de milho consumida por 24 voluntários residentes em um campus universitário no estado de São Paulo, bem como sua relação com as concentrações de ácido fólico sérico nos indivíduos. As análises de ácido fólico e de FB1 em farinha de milho foram realizadas por cromatografia líquida de alta eficiência (CLAE), enquanto a determinação de ácido fólico sérico foi feita por kit de imunoensaio. Detectou-se a FB1 em 100% das amostras de farinha de milho, em níveis que variaram de 142 a 3.037 µg kg-1 (média: 738 ± 591 µg kg-1). As concentrações de ácido fólico nas amostras de farinha de milho ficaram entre < 0,3 µg kg-1 (limite de quantificação) e 1.705 µg kg-1, com média de 713 ± 435 µg kg-1, o que representa 47% do limite mínimo exigido pela Agência Nacional de Vigilância Sanitária (ANVISA) para farinhas de milho comercialmente disponíveis. Nas amostras de soro humano, os níveis de ácido fólico variaram de 6,7 a 24,0 ng mL-1 (média: 13,4 ± 5,4 ng mL-1). Não houve correlação (p < 0,05) entre os níveis de ácido fólico no soro dos indivíduos e as concentrações de FB1 ou ácido fólico nas amostras de farinha de milho. Outros estudos são necessários para estimar a ingestão total de FB1 por meio da dieta para averiguar os efeitos das fumonisinas sobre a absorção de ácido fólico nos indivíduos avaliados.(AU)

In the present study, folic acid and fumonisin B1 (FB1) levels were determined in corn flour consumed by 24 volunteers, residents in a university campus in São Paulo State, as well as its relationship with folic acid in serum of individuals. Analyses of folic acid and FB1 in corn flour were performed by high-performance liquid chromatography (HPLC), while the determination of folic acid in serum was accomplished using an immunoassay kit. FB1 was detected in 100% of corn samples, at levels ranging from 142 to 3,037 µg kg-1 (which means: 738 ± 591 µg kg-1). The concentrations of folic acid in corn flour samples ranged from < 0.3 µg kg-1 (limit of quantification) to 1,705 µg kg-1, with a mean of 713 ± 435 µg kg-1, which represents 47% of the minimum required by National Agency of Health Surveillance (ANVISA) for corn flour commercially available. The levels of folic acid in human serum samples ranged from 6.7 to 24.0 ng mL-1 (meaning: 13.4 ± 5.4 ng mL-1). No correlations were observed (p < 0.05) between the folic acid levels in serum of individuals and the concentrations of FB1 or folic acid in corn flour samples. Further studies are needed to estimate the total intake of FB1 in the diet to assess the effects fumonisins on the absorption of folic acid in the individuals evaluated.(AU)

Nutritional status of iron, vitamin B12, folate, retinol and anemia in children 1 to 11 years old: Results of the Ensanut 2012 / Estado nutricional de hierro, vitamina B12, folato, retinol y anemia en niños de 1 a 11 años: Resultados de la Ensanut 2012

Objective. To describe the frequency of anemia, iron, vitamin B12, folate, retinol and predictors of anemia among Mexican children from Ensanut 2012. Materials and methods. Hemoglobin, ferritin, CRP, vitamin B12, retinol and folate concentrations were measured in 2 678 children aged 1-4 y and 4 275 children aged 5-11 y. Adjusted logistic regression models were constructed to assess the risk for anemia and micronutrient deficiencies. Results. In preschoolers and scholars, the overall prevalence of anemia was 20.4 and 9.7%, iron deficiency 14 and 9.3%, low vitamin B12 (LB12S) 1.9 and 2.6%; Folate 0.30 and 0%, and retinol depletion (VADp) 15.7 and 2.3%, respectively. ID and VADp were negatively associated with Hb (coefficient: -0.38 and -0.45, p<0.05); a higher log-CRP was associated with higher risk for anemia and VADp (OR=1.13 and OR=2.1, p<0.05, respectively). Conclusions. Iron deficiency, anemia and VADp are some of the main nutritional problems among Mexican infants.

Objetivo. Describir la frecuencia de anemia, deficiencia de hierro, vitamina B12, folato, retinol y predictores de la anemia en niños mexicanos de la Ensanut 2012. Material y métodos. Se midieron las concentraciones de hemoglobina, ferritina, PCR, vitamina B12, retinol y folato en 2 678 niños de 1-4 años y 4 275 niños de 5-11 años. Se construyeron modelos de regresión logística para evaluar el riesgo de anemia y deficiencias de micronutrientes. Resultados. La prevalencia de anemia en preescolares y escolares fue 20.4 y 9.7%; deficiencia de hierro (DH) 14 y 9.3%; baja concentración de vitamina B12 (BCB12) 1.9 y 2.6%; folato 0.30 y 0%, y depleción de vitamina A (DpVA), 15.7 y 2.3%, respectivamente. La DH y DpVA se asociaron negativamente con la Hb (coeficiente: -0.38 y -0.45, p<0.05); a mayor log-PCR, mayor riesgo de anemia y DpVA (OR=1.13 y OR=2.1, p<0.05, respectivamente). Conclusiones. DH, anemia y DpVA son algunos de los principales problemas de nutrición en niños mexicanos.

Prevalence of iron, folate, and vitamin B12 deficiencies in 20 to 49 years old women: Ensanut 2012 / Prevalencia de deficiencias de hierro, folato y vitamina B12 en mujeres de 20 a 49 años: Ensanut 2012

Objective. To describe the prevalence of iron, folate, and B12 deficiencies in Mexican women of reproductive age from the National Health and Nutrition Survey (Ensanut) 2012. Materials and methods. Data came from a national probabilistic survey, representative from rural and urban areas, and different age groups. Blood samples were obtained from 4 263, 20 to 49 years old women for serum ferritin, vitamin B12 and serum folate concentrations. The prevalence of deficiencies, was assessed using adjusted logistic regression models. Results. The deficiency of folate was 1.9% (95%CI 1.3-2.8), B12 deficiency was 8.5% (95%CI 6.7-10.1) and iron deficiency was 29.4% (95%CI 26.5-32.2). No differences were found when compared with 2006, 24.8% (95%CI 22.3-27.2). Conclusions. The vitamin B12 deficiency is still a problem for women of reproductive age and their offspring in Mexico, while folate deficiency disappeared as a problem. Iron deficiency needs prevention and fortification strategies.

Objetivo. Describir las prevalencias de deficiencias de hierro, folato y B12 en mujeres mexicanas en edad reproductiva de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2012. Material y métodos. Datos derivados de una encuesta probabilística nacional, representativa del área rural y urbana por grupos de edad. Se obtuvo una submuestra de sangre en 4 263 mujeres de 20 a 49 años de edad para medir las concentraciones séricas de ferritina, vitamina B12 y folato. Las deficiencias fueron evaluadas mediante regresiones logísticas múltiples ajustadas. Resultados. La prevalencia de deficiencias de folatos fue de 1.9% (IC95% 1.3-2.8) y vitamina B12 de 8.5% (IC95% 6.7-10.1). La deficiencia de hierro no fue diferente a la de 2006: 29.4% (IC95% 26.5-32.2) vs 24.8% (IC95% 22.3-27.2). Conclusiones. La prevalencia de deficiencias de hierro y vitamina B12 todavía representan un problema en mujeres mexicanas (20-49), mientras que la deficiencia de folato ha dejado de ser un problema de salud pública. Aún se requieren estrategias de prevención en México.

La metilación global del ADN y los niveles de homocisteína en plasma se encuentran disminuidos en pacientes con diabetes mellitus tipo 1 / Global DNA methylation and homocysteine levels are lower in type 1 diabetes patients

Background: The worldwide rise in the incidence of Type 1 Diabetes (T1D), and the concordance rate between monozygotic twins (50%), indicate a strong effect of the environment as an underlying factor of this disease. This process can occur throughout epigenetic modifications of gene expression such as DNA methylation, in which several nutrients participate as cofactors. Aim: To determine DNA methylation status in T1D patients and if it is related to plasma levels of folates and homocysteine (Hcy). Material and Methods: We obtained blood samples from 25 T1D patients aged 13.7 ± 5.9 years (11 males) and 25 healthy subjects aged 31.1 ± 7.8 years (16 males). DNA methylation was measured using a colorimetric kit in extracted DNA. Results are expressed as median (interquartile range). Results: Compared with healthy controls, T1D patients had lower global DNA methylation (0.85 (0.91) % and 1.25 (1.16) % respectively, p < 0.02) and Hcy levels (4.8 (1.1) µmol/L and 7.3 (1.4) µmol/L respectively p < 0.01). There were no differences in folate levels between groups. A significant association between folates and global DNA methylation status was observed in T1D patients (r = -0.564, p < 0.01) and healthy subjects (r = 0.440, p = 0.03). Conclusions: TD1 patients had lower levels of Hcy and global DNA methylation. It is relevant to further investigate if this imbalance also induces epigenetic changes in a gene-specific manner, especially in key genes involved in T1D pathogenesis.

Consumo dietético, variantes genéticas e relação com níveis sanguíneos de folato, ácido fólico não metabolizado e homocisteína após a fortificação mandatória de ácido fólico: estudo de base populacional - ISA - Capital / Dietary intake and genetic variants of folate and its relation to folate, unmetabolized folic acid and homocysteine blood concentrations after mandoty folic acid fortification population based study ISA-Capital

Em diversos países, inclusive no Brasil, a fortificação de alimentos com ácido fólico (AF) foi adotada como política pública de prevenção e combate à deficiência nutricional da vitamina, motivados principalmente pela redução da incidência dos defeitos do tubo neural. No período pós-fortificação observa-se tanto a evolução positiva do consumo e nível sérico da vitamina quanto a diminuição da concentração plasmática de homocisteína, e ainda, o aumento do ácido fólico não metabolizado na maioria desses países. Não se conhece ainda os efeitos biológicos do AFNM, no entanto, considera-se que o AFNM pode ser um fator relevante nas questões de segurança associadas com alto consumo de AF. Objetivo: Avaliar o consumo dietético e nível de folato, homocisteína e ácido fólico não metabolizado após a fortificação mandatória de alimentos com ácido fólico, e a interação com os polimorfismos envolvidos no metabolismo do folato e homocisteína. Metodologia: Os dados foram oriundos do estudo transversal de base populacional ISA Capital 2008 conduzido em uma amostra representativa de residentes do município de São Paulo, de ambos os sexos, e com idade acima de 14 anos. Coletou-se recordatórios alimentares de 24 horas e amostra de sangue em jejum de 12 horas para análises bioquímicas e moleculares. As análises estatísticas foram realizadas no programa STATA®, versão 13.0, com nível de significância de 5 por cento . Resultados: O estudo foi conduzido em 750 indivíduos, sendo 53,1 por cento mulheres e média de idade 40,7 (IC95 por cento 38,8-42,5) anos. A média de consumo e nível de folato foi de 375,8 (IC95 por cento 363,0-388,6) mcg/dia e 13 (IC95 por cento 12,0-13,9) ng/ml, respectivamente...

Food fortification is an important strategy in public health policy for controlling micronutrient malnutrition, and a major contributory factor in the eradication of micronutrients deficiencies. Motivated by the reduction in the occurrence of neural tube defects, countries worldwide, including Brazil, adopted food fortification with folic acid (FA). Folic acid fortification has increased dietary intakes of folic acid and folate status, but it is also associated with the presence of circulating FA. Although the metabolism and biological effects of circulating of folic acid are not well known, it may be a contributing factor in safety concerns associated with high oral doses of folic acid. Objective: To assess the folate intake and status, homocysteine and circulating FA after mandatory fortification with folic acid, and interaction with polymorphisms involved in 1-carbon metabolism. Material and Methods: Data were from 750 individuals aged > 14 years old who participated of a cross-sectional population-based survey in Sao Paulo City-Brazil. Fasting blood samples and information about food intake based on two measures of 24 hour food recall were collected. All analyses were carried out using STATA (version 13.0) and p-value <.05 was considered to be statistically significant in all tests. Results: Results were from 750 individuals...

Association of Vitamin B12 Deficiency and Metformin Use in Patients with Type 2 Diabetes

We evaluated the prevalence of vitamin B12 deficiency and associated factors in type 2 diabetes patients using metformin. A total of 799 type 2 diabetes patients using metformin was enrolled. Vitamin B12 and folate levels were quantified by chemiluminescent enzyme immunoassay. Vitamin B12 deficiency was defined as vitamin B12 4 ng/mL). The prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes patients was 9.5% (n = 76), and the mean vitamin B12 level was 662.5 +/- 246.7 pg/mL. Vitamin B12 deficient patients had longer duration of metformin use (P or = 2,000 mg were 2.52 (95% CI, 1.27-4.99, P = 0.008) and 3.80 (95% CI, 1.82-7.92, P or = 10 yr were 4.65 (95% CI, 2.36-9.16, P 1,000 mg) and longer durations (> or = 4 yr) of treatment.

Methylenetetrahydrofolate Reductase 677 Genotype-Specific Reference Values for Plasma Homocysteine and Serum Folate Concentrations in Korean Population Aged 45 to 74 Years: The Namwon Study

The reference interval for plasma total homocysteine (tHcy) and serum folate concentrations were estimated. Total of 3,154 reference individuals (1,029 men and 2,125 women) were selected based on stringent exclusion criteria. For plasma tHcy concentration (microM/L), reference values (median [5-95 percentile]) were 7.72 (5.03 to 13.80) and 6.09 (3.95-10.19) in men and women, respectively. For serum folate concentration (nM/L), reference values were 23.71 (11.73-38.44) and 28.95 (15.23-40.44) in men and women, respectively. The tHcy levels of both genders in the present study were lower than those in previous reports from other countries and Korea.

Nivel sérico de folato y vitamina B12 en adultos mayores chilenos: Resultados de la Encuesta Nacional de Salud ENS 2009-2010 / Serum folate and vitamin B12 in older people: Results from the Chilean national health survey 2009-2010

Supraphysiological levels (SFL) of serum folate (SF) derived from flour fortification with folic acid (FA) could be risky among older adults with low vitamin B12 (B12) levels. Aim: To describe and analyze SF and B12 levels in older Chileans and to identify risk groups. Material and Methods: Participants were 1.043 older people aged ≥ 65 years from the National Health Chilean Health Survey 2009-2010 (ChNHS 2009-10), a multistage stratified random sample, representative of the national population. SF (µg/L) and B12 (pg/ml) were determined in fasting samples by competitive chemoluminescence immunoassay. Mean, deciles and percentiles 5 and 95th were calculated. We defined SF categories: < 4.4 (deficit); 4.41-20 (normal) and SFL: 20.01-25.6; 25.6-29 and > 29 µg/L (80th percentile of the distribution) and vitamin B12 categories: ≤ 200 (deficit); 200.1-299.5 (marginal deficit) and > 299.5 (normal). Prevalence rates, multiple and logistic regression models were used and adjusted by sex and age, educational level and residence area. Results: SF and B12 mean and 95th percentiles were 21.2 ± 0.56/38.6 µg/L and 348.4 ± 7.6/637(pg/ml) respectively. Forty nine percent of participants had SFL. Folate and B12 deficiency were present in 0.3 and 8.1% of participants, respectively. Men had significantly lower prevalence of SFL > 29 µg/L (OR adjusted odds ratio 0.47 95% confidence intervals: 0.26-0.84). B12 showed no significant variation by age and sex. The prevalence of SFL associated with B12 deficiency was 4.1%. No statistically significant association was observed between levels of folate and B12. Conclusions: Folate deficit is almost inexistent, but a significant percentage of participants had SFL suggesting the need for revising the current wheat flour fortification levels.

High serum folate is associated with reduced biochemical recurrence after radical prostatectomy: Results from the SEARCH Database

Introduction To analyze the association between serum levels of folate and risk of biochemical recurrence after radical prostatectomy among men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Materials and Methods Retrospective analysis of 135 subjects from the SEARCH database treated between 1991-2009 with available preoperative serum folate levels. Patients' characteristics at the time of the surgery were analyzed with ranksum and linear regression. Uni- and multivariable analyses of folate levels (log-transformed) and time to biochemical recurrence were performed with Cox proportional hazards. Results The median preoperative folate level was 11.6ng/mL (reference = 1.5-20.0ng/mL). Folate levels were significantly lower among African-American men than Caucasians (P = 0.003). In univariable analysis, higher folate levels were associated with more recent year of surgery (P < 0.001) and lower preoperative PSA (P = 0.003). In univariable analysis, there was a trend towards lower risk of biochemical recurrence among men with high folate levels (HR = 0.61, 95%CI = 0.37-1.03, P = 0.064). After adjustments for patients characteristics' and pre- and post-operative clinical and pathological findings, higher serum levels of folate were independently associated with lower risk for biochemical recurrence (HR = 0.42, 95%CI = 0.20-0.89, P = 0.023). Conclusion In a cohort of men undergoing radical prostatectomy at several VAs across the country, higher serum folate levels were associated with lower PSA and lower risk for biochemical failure. While the source of the folate in the serum in this study is unknown (i.e. diet vs. supplement), these findings, if confirmed, suggest a potential role of folic acid supplementation or increased consumption of folate rich foods to reduce the risk of recurrence. .

Homocysteine and other markers of cardiovascular risk during a manic episode in patients with bipolar disorder

Objective: To evaluate serum levels of different biomarkers associated with cardiovascular disease in patients with bipolar disorder (BD). Patients were prospectively evaluated in two separate instances: during acute mania and after remission of manic symptoms. All measurements were compared with those of healthy controls. Methods: The study included 30 patients with BD and 30 healthy controls, matched for gender and age. Biochemical parameters evaluated included homocysteine (Hcy), folic acid, vitamin B12, ferritin, creatine kinase (CK) and C-reactive protein (CRP). Results: Hcy levels were significantly higher in the BD patients, both during mania and after achieving euthymia. When Hcy was adjusted for body mass index, there was no significant difference between patients and controls. Ferritin was the only marker that showed a significant decrease during mania when compared to both euthymic patients and controls. There were no significant differences for folate, vitamin B12, CK and CRP. Conclusions: These findings do not show an association between alterations of markers of cardiovascular risk during manic episodes. Further studies are necessary to determine factors and mechanisms associated with cardiovascular risk in patients with BD. .

Redução dos níveis séricos de ácido fólico em pacientes com a doença de Alzheimer / Serum folic acid is reduced in patients with Alzheimer's disease

CONTEXTO: Deficiência de vitaminas do complexo B tem sido associada a deterioração cognitiva e quadros demenciais em idosos. OBJETIVO: Neste trabalho, foi avaliado se pacientes com doença de Alzheimer (DA) e com comprometimento cognitivo leve (CCL) apresentam níveis séricos de ácido fólico e cobalamina (vitamina B12) menores que idosos controles. MÉTODOS: Foram recrutados 146 idosos (40 com DA, 56 com CCL e 49 idosos controles) para este estudo. Os níveis séricos de ácido fólico e vitamina B12 foram avaliados pelo método de eletroquimioluminescência. RESULTADOS: Os pacientes com DA apresentaram redução estatisticamente significativa nos níveis de ácido fólico em relação aos idosos com CCL e controles (p = 0,02). Esses resultados mantiveram-se estatisticamente significativos após controlar por variáveis sociodemográficas e desempenho cognitivo. Não se observaram diferenças estatisticamente significativas nos níveis de vitamina B12 nem em variáveis hematológicas entre os grupos. CONCLUSÃO: Esses resultados reforçam a importância de anormalidades em aspectos nutricionais, em particular do metabolismo de um-carbono, na fisiopatologia da DA.

BACKGROUND: Complex B vitamin deficiency has been associated to cognitive impairment and dementing disorders in the elderly. OBJECTIVE: This work aims to assess whether patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) have lower levels of folic acid and cobalamin (vitamin B12) compared to age and gender-matched controls. METHODS: One hundred and forty six elderly subjects (40 AD, 56 MCI and 49 healthy older adults) were recruited for this study. Serum folic acid and vitamin B12 levels were measured by electrochemoluminescence. RESULTS: Compared to MCI and healthy controls a statistically significant reduction in serum concentrations of folic acid in AD patients was found (p = 0.02). This result remained statistically significant after controlling for socio-demographic and cognitive performance variables (p = 0.01). No significant differences were found in serum concentrations of vitamin B12 in patients with AD, MCI and healthy controls. No significant changes in hematologic parameters were observed across these diagnostic groups. DISCUSSION: The present study provides additional evidence that folic acid is reduced in patients with AD and reinforces the importance of nutritional changes, in particular the one-carbon metabolism, in the physiopathology of AD.

Association of Homocysteine Levels With Blood Lead Levels and Micronutrients in the US General Population / 예방의학회지

OBJECTIVES: Even though several epidemiological studies have observed positive associations between blood lead levels and homocysteine, no study has examined whether this association differs by the levels of micronutrients, such as folate, vitamin B6, and vitamin B12, which are involved in the metabolism of homocysteine. In this study, we examined the interactions between micronutrients and blood lead on homocysteine levels. METHODS: This study was performed with 4089 adults aged > or =20 years old in the US general population using the National Health and Nutrition Examination Survey 2003-2004. RESULTS: There were significant or marginally significant interactions between micronutrients and blood lead levels on mean homocysteine levels. Positive associations between blood lead and homocysteine were clearly observed among subjects with low levels of folate or low vitamin B6 (p-trend 15 micromol/L) as the outcome, there were similar patterns of interaction, though p-values for each interaction failed to reach statistical significance. CONCLUSIONS: In the current study, the association between blood lead and homocysteine differed based on the levels of folate, vitamin B6, or vitamin B12 present in the blood. It may be important to keep sufficient levels of these micronutrients to prevent the possible harmful effects of lead exposure on homocysteine levels.

Vitamin B12 deficiency & levels of metabolites in an apparently normal urban south Indian elderly population.

Background & objectives: There is no published literature on the extent of vitamin B12 deficiency in elderly Indians as determined by plasma vitamin B12 levels and methylmalonic acid (MMA) levels. Vitamin B12 deficiency is expected to be higher in elderly Indians due to vegetarianism, varied socio-economic strata and high prevalence of Helicobacter pylori infection. We therefore, studied the dietary habits of south Indian urban elderly population and measured vitamin B12, MMA red cell folate and homocysteine (Hcy) levels. Methods: Healthy elderly urban subjects (175, >60 yr) were recruited. Detailed history, physical examination and neurological assessment were carried out. Food Frequency Questionnaire (FFQ) for dietary analysis for daily intake of calories, vitamin B12, folate and detailed psychological assessment for cognitive functions was carried out. Blood samples were analyzed for routine haematology and biochemistry, vitamin B12, red cell folate, MMA and Hcy. Results: The mean age of the study population was 66.3 yr. Median values for daily dietary intake of vitamin B12 and folate were 2.4 and 349.2 μg/day respectively. Sixty two (35%) participants consumed multivitamin supplements. Plasma vitamin B12 level and the dietary intake of vitamin B12 was significantly correlated (P=0.157). Plasma vitamin B12 and Hcy were inversely correlated (P= -0.509). Red cell folate was inversely correlated with Hcy (P= -0.550). Significant negative correlation was observed between plasma vitamin B12 and MMA in the entire study population (P= -0.220). Subjects consuming vitamin supplements (n=62) had significantly higher plasma vitamin B12 levels, lower MMA levels and lower Hcy levels. There was no significant correlation between plasma vitamin B12, MMA, Hcy and red cell folate and any of the 10 cognitive tests including Hindi Mental Status Examination (HMSE). Interpretation & conclusions: Our study is indicative of higher vitamin B12 (2.4 μg/day) intakes in urban south Indian population. Thirty five per cent of the study population consumed multivitamin supplements and therefore, low plasma vitamin B12 levels were seen only in 16 per cent of the study subjects. However, MMA was elevated in 55 per cent and Hcy in 13 per cent of the subjects.

Modulatory effect of plasma folate and polymorphisms in one-carbon metabolism on catecholamine methyltransferase (COMT) H108L associated oxidative DNA damage and breast cancer risk.

The present study was aimed to investigate the modulatory role of plasma folate and eight putatively functional polymorphisms of one-carbon metabolism on catecholamine methyltransferase (COMT)-mediated oxidative DNA damage and breast cancer risk. Plasma folate and 8-oxo-2’-deoxyguanosine (8-oxodG) were estimated by commercially available kits, while polymorphisms were screened by PCR-RFLP and PCR-AFLP methods. COMT H108L polymorphism showed independent association with breast cancer (OR: 1.73, 95% CI: 1.31-2.30). No significant interaction was observed between folate status and COMT genotype. Multifactor dimensionality reduction (MDR) analysis gave evidence for the significant epistatic (gene-gene) interactions (p<0.0001) of COMT H108L with reduced folate carrier 1 (RFC1) G80A, thymidylate synthase (TYMS) 5’-UTR 3R2R, TYMS 3’-UTR ins6/del6. Increased plasma 8-oxodG were observed in cases compared to controls (mean ± SE: 5.59 ± 0.60 vs. 3.50 ± 0.40 ng/ml, p<0.004). Plasma folate deficiency alone was not a significant predictor of 8-oxodG elevation. The genotype combinations namely, RFC1 G80A/methionine synthase reductase (MTRR) A66G, RFC1 G80A/SHMT C1420T/TYMS 3R2R and serine hydroxymethyltransferase (SHMT) C1420T/TYMS 3R2R/methionine synthase (MTR) A2756G/COMT H108L were strong predictors of 8-oxodG elevation in the order of risk. To conclude, the current study provides substantial evidence for a cross talk between one-carbon metabolism and COMT catalysis that might influence oxidative DNA damage and breast cancer risk.

Cuestionario de frecuencia de consumo de alimentos para estimación de ingestión de folato en México / Validity and reproducibility of a food frequency questionnaire to estimate folate intake in a Mexican population

OBJETIVO: Evaluar la reproducibilidad y validez de la ingestión de folato (IF),estimada a partir de un cuestionario de frecuencia de consumo (CFC), considerando el factor de retención (FR) correspondiente al método de preparación empleado. MATERIAL Y MÉTODOS: Al inicio del estudio se entrevistó a 497 adultos sanos; un año después se realizó una segunda entrevista a una muestra de 100 individuos seleccionados aleatoriamente,quenohubieran modificadosudietadurante el año previo; adicionalmente, para evaluar la validez de la IF, mediante radioinmunoensayo,se determinaron los niveles de folato sérico (FS). RESULTADOS: La reproducibilidad de la IF fue de 0.36 y 0.34 para el folato sin y con FR,respectivamente. Se observó una correlación significativa entre la IF y el FS de 0.18 con FR y 0.21 sin FR (p<0.05, respectivamente). CONCLUSIONES: Incorporar el FR en las estimaciones de la IF no mejora la reproducibilidad ni la validez de las mismas.

OBJECTIVE: To evaluate the reproducibility and validity of folate intake (FI) estimated from a food frequency questionnaire (FFQ), taking into account the retention factor (RF) associated with meal preparation processes. MATERIAL AND METHODS: A total of 497 healthy adult participants were interviewed with a FFQ.A second interview was performed one year later of a sample of 100 randomly selected individuals who had not modified their diet during the previous year. In addition,serum folate (SF) concentrations were measured by radioimmunoassay to evaluate the validity of FI. RESULTS: Reproducibility of IF was 0.36 and 0.34 for folate without FR and with FR, respectively. SF concentration significantly correlated with FI (0.18 with RF; 0.21 without RF, p<0.05). CONCLUSION: Incorporating the folate RF in estimates of FI does not improve the reproducibility and validity of those estimates.

Folato, B6 e B12 na adolescência: níveis séricos, prevalência de inadequação de ingestão e alimentos contribuintes / Folate, vitamin B6 and vitamin B12 in adolescence: serum concentrations, prevalence of inadequate intakes and sources in food

OBJETIVO: Investigar os níveis séricos e a prevalência de inadequação da ingestão dietética de folato e das vitaminas B6 e B12, identificando os alimentos contribuintes para a ingestão desses nutrientes. MÉTODOS: Estudo observacional, transversal, em adolescentes de 16 a 19 anos, de ambos os sexos, conduzido em Indaiatuba (SP). Coletou-se o registro alimentar de 3 dias não consecutivos. A dieta habitual foi estimada pela remoção da variabilidade intrapessoal, e a prevalência de inadequação da ingestão, pelo método da estimated average requirement como ponto de corte. As análises bioquímicas de folato, B6 e B12 foram conduzidas de acordo com os métodos aceitos na literatura. RESULTADOS: O estudo foi conduzido com 99 adolescentes, a maioria do sexo feminino (58,6 por cento), com média de idade de 17,6 (desvio padrão, DP 0,9) anos. As médias da concentração sérica de folato, B6 e B12 foram de 9,2 (DP 3,4) ng/mL, 18,7 (DP 5,1) nmol/L e 397,5 (DP 188,4) pg/mL, respectivamente; e a prevalência de inadequação da ingestão das vitaminas foi de 15,2, 10,2 e < 1 por cento, respectivamente. Os alimentos que mais contribuíram para a ingestão dos nutrientes foram, para folato: pão francês, macarrão e feijões; para B6: arroz branco, carne de frango e carne bovina; e para B12: carne bovina magra, leite integral e carne bovina gorda. CONCLUSÕES: As prevalências de inadequação de folato, B6 e B12 mostraram-se baixas, possivelmente em decorrência da melhoria do acesso e da disponibilidade de alimentos, fontes dietéticas das vitaminas. Os feijões, presentes na dieta tradicional brasileira, ainda estão entre os principais alimentos que contribuíram para a ingestão de folato, mesmo após a fortificação mandatória com ácido fólico no Brasil.

OBJECTIVE: To investigate serum concentrations and the prevalence of inadequate folate intake and also vitamin B6 and vitamin B12 intakes and to identify those foods that make a major contribution to intake levels of these nutrients. METHODS: This was a cross-sectional, observational study of adolescents of both sexes aged 16 to 19 years from the town of Indaiatuba, SP, Brazil. Data collection was by non-consecutive 3-day dietary record. The samples’ habitual diet was estimated by removing intraindividual variability, and the prevalence rates of inadequate intakes were calculated using the estimated average requirement as cutoff points. Biochemical assays for folate, vitamin B6 and vitamin B12 were conducted in accordance with the methods accepted in the literature. RESULTS: The study sample comprised 99 adolescents, the majority of whom were female (58.6 percent), with a mean age of 17.6 [standard deviation, (SD) 0.9]. Mean serum concentrations for folate, vitamin B6 and vitamin B12 were 9.2 (SD 3.4) ng/mL, 18.7 (SD 5.1) nmol/L and 397.5 (SD 188.4) pg/mL, respectively; and the prevalence rates of inadequate intake for these vitamins were 15.2, 10.2 and < 1 percent, respectively. The foods that made a major contribution to vitamin intakes were French bread, pasta and beans for folate; white rice, chicken and beef for vitamin B6; and lean beef, whole milk and fatty beef for vitamin B12. CONCLUSIONS: The prevalence rates of inadequate folate, vitamin B6 and vitamin B12 intakes were low, which is possibly the result of improved access to and availability of foods that are dietary sources of these vitamins. Beans, which are a part of the traditional Brazilian diet, remain one of the primary food items that contribute to folate intake, even after mandatory fortification with folic acid in Brazil.

Diferencias en el metabolismo lipídico, niveles de homocisteína, folato y vitamina B12 entre gestaciones gemelares y únicas / Differences in lipid metabolism, homocysteine levels, serum folic acid and vitamin B12 between single and twin pregnancies

Antecedentes: Se están usando diferentes tipos de suplementación nutricional durante la gestación, sin embargo, existen escasez de estudios que se centren en los resultados metabólicos de los mismos. Objetivos: Comprobar si mediante la suplementación se logra el control del impacto de los múltiples cambios metabólicos que conlleva una gestación múltiple, usando análisis comunes. Método: Comparamos tres diferentes grupos de pacientes entre la semana gestacional 25 y 27. Un grupo de 46 gestaciones únicas, un grupo de 38 gestaciones gemelares espontáneas y otro grupo de 32 gestaciones gemelares tras técnicas de reproducción asistida. Comparamos niveles de colesterol LDL, HDL, triglicéridos, folato sérico, vitamina B12, homocisteína, hemoglobina, creatinina y plaquetas. Resultados: Los niveles de triglicéridos fueron más altos en ambos grupos de gemelares (p<0,001) y los niveles de colesterol fueron similares en los tres grupos. Las concentraciones de folato sérico fueron mayores en las gestaciones gemelares (p<0,001). El resto de parámetros estudiados fueron similares en los tres grupos. Conclusión: La suplementación siguiendo las recomendaciones de la ACOG y la SEGO es efectiva en el control de colesterol LDL, HDL, folato sérico, vitamina B12, homocisteína, hemoglobina, creatinina y plaquetas. Sólo los niveles de triglicéridos no se relacionan con la suplementación y pueden estar relacionados con mayor incidencia de colestasis y preeclampsia en gestaciones múltiples.

Background: Different ways of nutritional supplementation are being advised by physicians during pregnancy, but there is a lack of literature focused on its metabolical results. Aims: Check if the control of the impact that the multiple metabolic changes related to multiple pregnancies have on the mother's homeostasis is achieved with the supplementation, through common used blood tests. Method: We compare three different groups of patients between the 25 and 27th week of gestation. One group of 46 single pregnancies, a second group of 38 spontaneous twin pregnancies and another group of 32 twin pregnancies after assisted reproduction techniques. We compare the levels of LDL, HDL-cholesterol, triglycerides, serum folic acid, Vit B12, homocysteine, haemoglobine, creatinine and platelets. Results: The levels of triglycerides were higher in both groups of twin pregnancies (p<0.001), but the levels of cholesterol remain similar. Folic acid concentrations were higher in the groups of twin pregnancies (p<0.001). The rest of levels studied were similar in the 3 groups. Conclusion: The supplementation following the ACOG and SEGO recommendations seems to be effective in controlling the values of LDL, HDL-cholesterol, serum folic acid, Vit B12, homocysteine, haemoglobine, creatinine and platelets. Only the levels of triglycerides appear unaffected by the supplementation and can be related with the higher incidence of preeclampsia and cholestasis seemed among twin pregnancies.