Folic acid and vitamin B[6] deficiencies related hyperhomocysteinemia in apparently healthy Pakistani adults; is mass micronutrient supplementation indicated in this population?

To determine the plasma/serum levels of homocysteine, and vitamins folate, B6 and B12, in Pakistani healthy adults. Cross-sectional study. The Aga Khan University, from October 2006 to April 2008. Fasting levels of plasma/serum folic acid, pyridoxal phosphate [PLP], vitamin B12 and homocysteine were determined in 290 apparently healthy hospital personnel from institutions in two cities of Pakistan. Spearman correlation test and linear regression analysis was conducted. There were 219 males and 71 females with mean age of 46 +/- 10.5 years and mean body mass index of 23.5 +/- 3.8. Mean plasma homocysteine levels in Pakistani normal adults were found to be 17.95 +/- 8.4 mol/l. Mean concentrations of plasma/serum folate, vitamin B12 and PLP were found to be 5 +/- 3.9 ng/ml, 522 +/- 296 pg/ml and 21.6 +/- 14 nmol/l, respectively. Serum/plasma levels of folate, vitamin B12 and PLP were negatively correlated with plasma homocysteine [rho coefficient=-0.367, p < 0.001; -0.173, p=0.004; -0.185, p=0.002, respectively]. Serum folate and plasma PLP levels were inversely related with plasma homocysteine, adjusted for gender, age, smoking and body mass index [p < 0.001 and p=0.003, respectively]. Percent deficiency values of folate, vitamin B6 and vitamin B12 were 39.7%, 52.8% and 6.6% respectively. The high levels of plasma homocysteine could indicate a reason for mass micronutrient supplementation to prevent the high incidence of cardiovascular disease observed in Pakistani population

N-acetyl-beta-D-glucosaminidase and inflammatory response after cardiopulmonary bypass

To determine the changes in activity of plasma N-acetyl-Beta -D-glucosaminidase, a marker for inflammation as well as renal, pulmonary and cardiac damage and proinflammatory cytokines in patients undergoing coronary artery bypass grafting and find out the relationship between their plasma levels with clinical outcome of patients. Cross-sectional study. The Aga Khan University, Karachi, from January to June 2003. N-Acetyl-Beta -D-glucosaminidase [NAG] activity and concentrations of tumor necrosis factor-alpha of [TNF alpha], interleukin 6 [IL-6], interleukin 8 [IL8] and granulocyte-macrophage colony stimulating factor [GM-CSF] were monitored in plasma samples of 12 angina patients undergoing coronary artery bypass grafting [CABG], before, immediately after and 5 days post-surgical procedure. Serum glucose concentrations were also monitored in those patients. Patient`s clinical condition was monitored during this time period. No significant increase was observed in plasma NAG activity [a marker of inflammation] or in plasma levels of TNF alpha, IL-6, IL-8 and GM-CSF immediately after surgery, indicating that cardiopulmonary bypass itself does not produce any significant amount of inflammation immediately after CABG. However, 5 days post surgery, there was a significant increase in plasma NAG activity [p=0.001], TNF alpha [p=0.047] and GM-CSF [p=0.045]. There was no relationship between plasma NAG activity and clinical outcome because various parameters of renal, cardiac and pulmonary functions, though slightly affected, remained within the normal limits. Increased levels of NAG and TNF alpha did not affect clinical outcome. However, data suggest that NAG can be a potential marker for inflammation and end organ damage following CABG. An increase in GM-CSF on day 5 following CABG indicates enhanced body`s defense mechanism against infection