Serum folate, vitamin B12 and cognitive impairment in Chilean older adults.

OBJECTIVE: To analyse the relationship between serum folate (SF), vitamin B12 and impaired cognitive function in the Chilean elderly. DESIGN: We analysed the relationships between impaired cognitive function and age, SF (µg/l) and vitamin B12 (pg/ml) with Student's t test, as well as between impaired cognitive function and gender, educational level, residence area, diabetes and hypertension with the χ 2 test. Multiple logistic regressions with interactions were estimated to assess the impact of SF on impaired cognitive function according to these methods. SETTING: Chile. SUBJECTS: Older adults (>65 years, n 1051), drawn from representative households of a national prevalence study, assessed using the Modified Mini Mental Status Examination (MMMSE). Individuals with altered MMMSE scores (≤13 points) were sequentially assessed using the Pfeffer Functional Activities Questionnaire (PFAQ). RESULTS: Multivariate models using the MMMSE demonstrated an increased risk of impaired cognitive function for seniors who had hypertension, diabetes and higher vitamin B12 levels. SF and its square (SF2) were statistically significant, indicating that this predictor of impaired cognitive function displays a U-shaped distribution. The interaction between SF and vitamin B12 was not statistically significant. Models using the MMMSE plus PFAQ suggested that urban residence decreased the risk of impaired cognitive function, whereas male gender, older age, vitamin B12 levels and hypertension increased this risk. The variables SF and SF2 and the SF × vitamin B12 interaction were statistically significant (P<0.05). The risk of impaired cognitive function depended on different combinations of SF and vitamin B12 levels. When SF was low, a one-unit increase in SF (1 µg/l) diminished the risk. When SF was elevated, a further increase in SF raised the risk, especially at low vitamin B12 levels. CONCLUSIONS: The relationship between folate, vitamin B12 and impaired cognitive function warrants further study.

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.

Impact of folic acid fortification of flour on neural tube defects: a systematic review.

OBJECTIVE: To review the impact of folic acid fortification of flour on the prevalence of neural tube defects (NTD). DESIGN: Systematic review of the literature on MEDLINE via PubMed, Scopus, OvidSP and LILACS (Latin American and Caribbean Health Sciences Literature) reporting the impact of folic acid fortification of flour on the prevalence of NTD in 2000-2011. Focusing on Santiago of Chile's birth defects registry (1999-2009) and the monitoring of flour fortification, we analysed the prevalence (NTD cases/10 000 births) pre and post flour fortification and the percentile distribution of folic acid content in flour (2005-2009). We explored the potential association between median folic acid in flour (mg/kg) and the prevalence of NTD. SETTING: Chile, Argentina, Brazil, Canada, Costa Rica, Iran, Jordan, South Africa and the USA. SUBJECTS: Live births and stillbirths. RESULTS: Twenty-seven studies that met inclusion criteria were evaluated. Costa Rica showed a significant reduction in NTD (∼60 %). Prevalence in Chile decreased from 18·6 to 7·3/10 000 births from 1999 to 2007 and showed a slight increase to 8·5 in 2008-2009, possibly due to changes in fortification limits. When we related the prevalence of NTD with levels of flour fortification, the lowest prevalence was observed at a folic acid level of 1·5 mg/kg. CONCLUSIONS: Fortification of flour with folic acid has had a major impact on NTD in all countries where this has been reported. Chile showed a 55 % reduction in NTD prevalence between 1999 and 2009. There is a need to constantly monitor the levels of flour fortification to maximize benefits and prevent the potential risk of folic acid excess, moreover to be vigilant for any new adverse effects associated with excess.

[Serum folate and vitamin B12 in older people: results from the Chilean National Health Survey 2009-2010]. / Nivel sérico de folato y vitamina B12 en adultos mayores chilenos: Resultados de la Encuesta Nacional de Salud ENS 2009-2010.

BACKGROUND: 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.

Determinación de residuos de pesticidas en alimentos procesados en Chile / Assessment of pesticide residues in processed foods in Chile

Fundamento: Los pesticidas pueden estar presentes en los alimentos como residuos secundarios al tratamiento de las cosechas o en niveles más altos como consecuencia de la contaminación. Si bien producen un beneficio público aumentando la productividad agrícola, los residuos determinan riesgos en la salud de las personas Objetivo: Identificar la presencia de residuos de pesticidas en una muestra de alimentos procesados en base a ingredientes de origen vegetal: frutas, verduras, hortalizas y/o cereales y revisar su cumplimiento en relación a los límites permitidos en las regulaciones de alimentos chilena y de la Comunidad Económica Europea (CEE). Método: En una muestra por conveniencia de alimentos procesados elaborados con ingredientes en base a frutas, verduras, hortalizas y/o cereales: dos muestras de jugos de naranja, dos muestras de alimentos infantiles en base a cereales y cinco en base a verduras y frutas y un producto en base a cereales y verduras, se determinó la presencia de residuos de pesticidas utilizando métodos de evaluación de multiresiduos Resultados: De los diez alimentos analizados se encontró residuo de Carbaril en una de las muestras de jugo de naranja (0,01 mg/kg); Iprodiona en las muestras de papillas de ciruela-pasa, multi-frutas y durazno (0,04; 0,01 y 0,08 mg/kg respectivamente) y pirimifos-metil (0,02 mg/kg) en la sopa instantánea de espárrago. Conclusiones: Aún cuando la muestra no es representativa del universo de alimentos procesados chilenos, los resultados sugieren la necesidad de establecer un sistema de vigilancia que asegure la inocuidad de alimentos procesados, especialmente los destinados a niños y la definición de límites máximo de residuos permitidos en este tipo de alimentos (AU)

Introduction: Pesticides can be present in food as a secondary waste treatment of the crops or contain high levels as a result of pollution. They produce public benefit by increasing agricultural productivity but also determine risks to human health. Objective: To identify in a processed food sample based on fruits, vegetables and / or cereals ingredient the presence of pesticide residues and review these results in relation with the limits allowed in the chilean and the European Economic Community food regulations. Methods: In a convenience sample of processed foods made with fruits, vegetables and / or cereal ingredients: two samples of orange juices, two samples of infant foods based on cereals, five based on vegetables or fruits and one product based on cereals and vegetables, we tested the presence of pesticide residues using for assessing a multiresidue methods. Results: Five samples showed pesticides residue. Carbaryl was found in one sample of orange juice (0.01 mg/ kg), Iprodione in three food samples: plum and raisins, multi-fruit and peach mush (0.04; 0,01 and 0.08 mg/kg respectively) and pirimiphos-methyl (0.02 mg/kg) was found in the of asparagus soup. Conclusion: Although the sample is not representative of the uiverse of the Chilean processed food, these results suggest the need to establish a surveillance system to ensure the safety of processed foods, especially in children, and define the maximum residue levels allowed in this kind of food (AU)