Research goals for folate and related B vitamin in Europe

Characteristics of Dietary Supplements with Folic Acid Available on the Polish Market

One way of increasing folate status, especially in a state of increased demand (e.g., women of childbearing age), is dietary supplementation with folic acid (FA). The dietary supplements market in Poland shows a controversial situation and, for many reasons (the ease of placing them on the market, the lack of control of chemical composition), the possibility of inaccurate information provided on the supplement’s label arises. We questioned whether FA supplements available in Poland are indeed complying with regulations and if they could actually improve folate status amongst the target population groups consuming them. Almost 500 products containing FA were identified and available for sale in pharmacies, all of them including specific information provided by manufacturers on the packaging, such as the amount of FA, their intended use and daily dosage. HPLC analysis of FA content in 30 randomly purchased supplements exposed that in four of the tested products, FA content was less than 4% of the declared value (DV). Another 11 samples exposed that the difference with declared FA content varied from 25% up to 80% of the DV. The obtained results are in agreement with the ones from inspections previously conducted on the Polish dietary supplements market and indicate the urgent need to implement improvements in the notification system as well as the monitorization of these product’s authenticity.

Review of the Analytical Methods Based on HPLC-Electrochemical Detection Coupling for the Evaluation of Organic Compounds of Nutritional and Environmental Interest

This review would like to show the state of the art regarding the coupling of High-Performance Liquid Chromatography (HPLC) with Electrochemical Detection (ED). Since a universal detector for HPLC is not available, the electrochemical detection methods, thanks to their versatility and specificity, are competitive with respect to the detectors currently used. The papers present in literature on HPLC-ED technique are analyzed and discussed: for example, they regard the development of analytical determinations of resveratrol, rosmarinic acid, aromatic heterocyclic amines and glyphosate in food matrices such as meat, aromatic plants, vegetables, fruit and tomato juices. These papers show that electrochemical sensors used as detectors for HPLC can offer better sensitivity values than other detectors. Furthermore, the use of specific working potentials allows avoid matrix interferences to be avoided by almost exclusively determining the analytes of interest. It should be underlined that HPLC-ED methods have a selectivity that allows for limitation of the sample preparation and clean-up procedures to a minimum, making them quick and easy to apply. In addition, these methods offer advantages such as the possibility of direct analysis, that derivatization is often not necessary, the cost-effectiveness of the instrumentation and the possibility of regenerating the electrodes which allows numerous analyses in succession.

Folic acid and autism: What do we know?

Autism spectrum disorders (ASD) consist in a range of neurodevelopmental conditions that share common features with autism, such as impairments in communication and social interaction, repetitive behaviors, stereotypies, and a limited repertoire of interests and activities. Some studies have reported that folic acid supplementation could be associated with a higher incidence of autism, and therefore, we aimed to conduct a systematic review of studies involving relationships between this molecule and ASD. The MEDLINE database was searched for studies written in English which evaluated the relationship between autism and folate. The initial search yielded 60 potentially relevant articles, of which 11 met the inclusion criteria. The agreement between reviewers was κ = 0.808. The articles included in the present study addressed topics related to the prescription of vitamins, the association between folic acid intake/supplementation during pregnancy and the incidence of autism, food intake, and/or nutrient supplementation in children/adolescents with autism, the evaluation of serum nutrient levels, and nutritional interventions targeting ASD. Regarding our main issue, namely the effect of folic acid supplementation, especially in pregnancy, the few and contradictory studies present inconsistent conclusions. Epidemiological associations are not reproduced in most of the other types of studies. Although some studies have reported lower folate levels in patients with ASD, the effects of folate-enhancing interventions on the clinical symptoms have yet to be confirmed.

How folate metabolism affects colorectal cancer development and treatment; a story of heterogeneity and pleiotropy

Folate was identified as an essential micronutrient early in the twentieth century and anti-folate chemotherapy such as 5-fluorouracil (5-FU) has been central to the medical management of solid tumours including colorectal cancer for more than five decades. In the intervening years, evidence has been gathered which shows that folate deficiency leads to many human diseases throughout the life-course. However, we still do not know all of the mechanisms behind functional folate deficiency, or indeed its rescue through supplementation with natural and particularly synthetic folates. There is growing evidence that one adverse effect of folic acid fortification programmes is an increased risk of colorectal cancer within populations. The complexity of folate-dependent, one-carbon metabolism and the heterogeneity that exists between individuals with respect to the enzymes involved in the anabolic pathways, and the catabolism of 5-FU, are explored in this review. The enzyme products of some genes such as MTHFR exert multiple and perhaps unrelated effects on many phenotypes, including cancer development. We describe this pleiotropy and the common genetic variants that affect folate metabolism; and discuss some of the studies that have investigated their potential as predictive biomarkers.

Folate, vitamin B12 and homocysteine status in an Italian blood donor population

BACKGROUND AND AIMS

The relevance of folate, other B-vitamins and homocysteine (Hcy) for the occurrence or prevention of several diseases has induced growing interest. Unfortunately, little evidence is available regarding B-vitamin concentrations in Italy. This study evaluated in a region of middle-southern Italy, folate, vitamin B12 and Hcy concentrations and the prevalence of their ideal blood levels. The main determinants of B-vitamins and Hcy were also considered.

METHODS AND RESULTS

Male and female blood donors (n=240), aged 18-66 years and living in Molise region (Italy), were enrolled in the study. They completed a brief questionnaire concerning fruit and vegetables intake, physical activity and smoking; serum and red blood cell (RBC) folate and serum vitamin B12 were measured by an immunoassay on an automated analyzer. Total Hcy was measured by high performance liquid chromatography (HPLC). Geometric means of serum folate, RBC folate and serum vitamin B12 were 10.8nmoll(-1), 426.0nmoll(-1) and 245.0pmoll(-1), respectively. Only 22.5%, 24.2% and 16.3% of blood donors showed an adequate level of serum folate, RBC folate or serum vitamin B12 respectively. When a cut-off of RBC folate ≥906nmoll(-1) was used no women of childbearing age had adequate levels. A geometric mean of 14.0μmoll(-1) was found for total Hcy, with an ideal concentration in 12.1% of subjects. Folate concentration was higher in women and non-smokers and in subjects with higher consumption of fruit and vegetable.

CONCLUSION

This study shows a low-moderate B-vitamins status in middle-southern Italy, associated with an inadequate fruit and vegetable consumption. A public health strategy should be undertaken to encourage a B-vitamin-rich diet with the addition of vitamin supplements or vitamin fortified foods in population subgroups with special needs.

Utility of transporter/receptor(s) in drug delivery to the eye

The eye is a highly protected organ, and designing an effective therapy is often considered a challenging task. The anatomical and physiological barriers result in low ocular bioavailability of drugs. Due to these constraints, less than 5% of the administered dose is absorbed from the conventional ophthalmic dosage forms. Further, physicochemical properties such as lipophilicity, molecular weight and charge modulate the permeability of drug molecules. Vision-threatening diseases such as glaucoma, diabetic macular edema, cataract, wet and dry age-related macular degeneration, proliferative vitreoretinopathy, uveitis, and cytomegalovirus retinitis alter the pathophysiological and molecular mechanisms. Understanding these mechanisms may result in the development of novel treatment modalities. Recently, transporter/receptor targeted prodrug approach has generated significant interest in ocular drug delivery. These transporters and receptors are involved in the transport of essential nutrients, vitamins, and xenobiotics across biological membranes. Several influx transporters (peptides, amino acids, glucose, lactate and nucleosides/nucleobases) and receptors (folate and biotin) have been identified on conjunctiva, cornea, and retina. Structural and functional delineation of these transporters will enable more drugs targeting the posterior segment to be successfully delivered topically. Prodrug derivatization targeting transporters and receptors expressed on ocular tissues has been the subject of intense research. Several prodrugs have been designed to target these transporters and enhance the absorption of poorly permeating parent drug. Moreover, this approach might be used in gene delivery to modify cellular function and membrane receptors. This review provides comprehensive information on ocular drug delivery, with special emphasis on the use of transporters and receptors to improve drug bioavailability.

Influence of high-pressure processing on the profile of polyglutamyl 5-methyltetrahydrofolate in selected vegetables

In plants, folate occurs predominantly as 5-methyltetrahydrofolate (5MTHF) polyglutamyl forms. Differences in stability and bioavailability of food folate compared to synthetic folic acid have been attributed to the presence of the polyglutamyl chain. High-pressure processing (HPP) was tested for whether it might shorten polyglutamyl chains of 5MTHF species in fresh vegetables by enabling action of native γ-glutamylhydrolase (GGH). A validated ultrahigh-performance reversed-phase liquid chromatography-tandem mass spectrometry method using stable isotope as internal standard was applied for characterizing 5MTHF polyglutamyl profiles. HPP conditions included 300, 450, and 600 MPa at 30 °C for 0 or 5 min, and vegetables were vacuum-packed before treatment. Investigated vegetables included cauliflower (Brassica oleracea), baby carrots (Daucus carota), and carrot greens (D. carota). HPP treatment caused conversion of polyglutamyl 5MTHF species to short-chain and monoglutamyl forms. Maximal conversion of polyglutamyl folate to monoglutamyl folate occurred at the highest pressure/time combination investigated, 600 MPa/30 °C/5 min. Under this condition, cauliflower monoglutamyl folate increased nearly 4-fold, diglutamyl folate 32-fold, and triglutamyl folate 8-fold; carrot monoglutamyl increased 23-fold and diglutamyl 32-fold; and carrot greens monoglutamyl increased 2.5-fold and the diglutamyl form 19-fold. Although some folate degradation was observed at certain intermediate HPP conditions, total 5MTHF folate was largely preserved at 600 MPa/5 min. Thus, HPP of raw vegetables is a feasible strategy for enhancing vegetable monoglutamate 5MTHF.

Not all cases of neural-tube defect can be prevented by increasing the intake of folic acid

Some countries have introduced mandatory folic acid fortification, whereas others support periconceptional supplementation of women in childbearing age. Several European countries are considering whether to adopt a fortification policy. Projections of the possible beneficial effects of increased folic acid intake assume that the measure will result in a considerable reduction in neural-tube defects (NTD) in the target population. Therefore, the objective of the present study is to evaluate the beneficial effects of different levels of folic acid administration on the prevalence of NTD. Countries with mandatory fortification achieved a significant increase in folate intake and a significant decline in the prevalence of NTD. This was also true for supplementation trials. However, the prevalence of NTD at birth declined to approximately five cases at birth per 10 000 births and seven to eight cases at birth or abortion per 10 000 births. This decline was independent of the amount of folic acid administered and apparently reveals a ‘floor effect’ for folic acid-preventable NTD. This clearly shows that not all cases of NTD are preventable by increasing the folate intake. The relative decline depends on the initial NTD rate. Countries with NTD prevalence close to the observed floor may have much smaller reductions in NTD rates with folic acid fortification. Additionally, potential adverse effects of fortification on other vulnerable population groups have to be seriously considered. Policy decisions concerning national mandatory fortification programmes must take into account realistically projected benefits as well as the evidence of risks to all vulnerable groups.

Photodegradation of 5-methyltetrahydrofolate in the presence of Uroporphyrin

The main form of folate in human plasma is 5-methyltetrahydrofolate (5MTHF). The observation that folate in human serum is photosensitive supports the hypothesis that humans developed dark skin in high ultraviolet fluences areas in order to protect folate in the blood from UV radiation. However, folates alone are quite photostable. Therefore, in this study, we examined for the first time the photodegradation of 5MTHF in the presence of the endogenous photosensitizer uroporphyrin (Uro), which is sometimes present in low concentration in human serum, under UV and near-UV light exposure. We found strong indications that while 5MTHF alone is rather photostable, it is degraded quickly in the presence of Uro. Using deuterium oxide (D(2)O) as an enhancer of the lifetime of singlet oxygen and the singlet oxygen sensor green reagent (SOSG) as a scavenger of singlet oxygen, we have found that the photodegradation most likely proceeds via a type II photosensitization. Our results show that singlet oxygen is likely to be the main intermediate in the photodegradation of 5MTHF mediated by Uro. Our findings may be useful for further studies the evolution of human skin colours.

High-Performance Liquid Chromatography Method for the Determination of Folic Acid in Fortified Food Products

Reversed-phase high-performance liquid chromatography, coupled with coulometric electrochemical detection, was successfully applied for the quantification of added folic acid (FA) in fortified fruit juices and cereal products. The method allowed good separation of the 5-HCO-H(4) folate and folic acid in cereal samples. The retention times of vitamins were repeatedly determined by isocratic elution using 40 mM sodium phosphate dibasic, heptahydrate buffer, and 8% acetonitrile (v/v) (0.9 mL/min, pH 5.5) as mobile phase with the Supelco LC 18 column 5 mum (25 cm x 4.6 mm). Folate concentrations were measured using a trienzyme (hog kidney folate conjugase, alpha-amylase, and protease) folate extraction method.

Integrated risk-benefit analyses: method development with folic acid as example

With the introduction of novel and functional foods, there is increasing need for an integrated quantitative risk-benefit assessment of foods. Consensus about a quantitative risk-benefit assessment mirroring the risk assessment approach has been reached during a recent EFSA workshop. In line, we propose a risk-benefit model that consists of: (1) hazard and benefit identification, (2) hazard and benefit characterization through dose-response functions, (3) exposure assessment, and (4) risk-benefit integration. The DALY, which combines morbidity and mortality serves as common health measure. The overall health impact of bread fortified with folic acid in the Netherlands has been simulated. The case study showed how the risk-benefit approach may assist a policy maker in decisions on food fortification programs. It illustrates general problems regarding the data demands, the assumptions and uncertainties. A simple sensitivity analysis showed which assumptions were most crucial. Modest fortification (140 microg/100 g bread) seems reasonable to improve public health but the results hinge on the assumptions one makes for the association between colorectal cancer and high folate intake. A precautious policymaker may very well decide against folic acid fortification. The often debated increase in masked vitamin B(12)-deficiency appears negligible compared to the health gain resulting from prevented neural tube defects.

Dietary intake and status of folate and vitamin B12 and their association with homocysteine and cardiovascular disease in European populations

BACKGROUND/OBJECTIVES

Folate and vitamin B12 have been suggested to play a role in chronic diseases like cardiovascular diseases. The objectives are to give an overview of the actual intake and status of folate and vitamin B12 in general populations in Europe, and to evaluate these in view of the current vitamin recommendations and the homocysteine concentration.

METHODS

Searches in Medline with 'folic acid', 'folate' and 'vitamin B12', 'B12' or 'cobalamin' as key words were combined with the names of the European countries. Populations between 18 and 65 years were included.

RESULTS

Sixty-three articles reporting on studies from 15 European countries were selected. Low folate intakes were observed in Norway, Sweden, Denmark and the Netherlands. Low intakes of vitamin B12 were not common and only seen in one small Greek study. In the countries with a low intake of folate, the recommended levels were generally not achieved, which was also reflected in the folate status. Vitamin B12 intake was not strongly associated with the vitamin B12 status, which can explain why in the Netherlands and Germany the vitamin B12 status was inadequate, despite sufficient intake levels. In countries with a low folate intake in particular, the Hcy concentration was higher than ideal.

CONCLUSIONS

Populations from the Nordic countries, the Netherlands, Germany and Greece may need to improve their intakes of folic acid, B12 or both to either meet the recommendations or to optimize their statuses. This could be achieved via a food-based approach, food fortification or supplements.

Genetic modification of plant metabolism for human health benefits

There has been considerable research progress over the past decade on elucidating biosynthetic pathways for important human health components of crops. This has enabled the use of genetic modification (GM) techniques to develop crop varieties with increased amounts of essential vitamins and minerals, and improved profiles of 'nutraceutical' compounds. Much of the research into vitamins and minerals has focused on generating new varieties of staple crops to improve the diet of populations in developing nations. Of particular note is the development of new rice lines with increased amounts of provitamin A and iron. Research on modifying production of nutraceuticals has generally been aimed at generating new crops for markets in the developed nations, commonly to deliver distinctive cultivars with high consumer appeal. Most progress on nutraceuticals has been made with just a few types of metabolites to date, in particular in the production of novel long-chain polyunsaturated fatty acids in oil-seed crops and to increase amounts of flavonoids and carotenoids in tomato and potato. However, given the rapid progress on elucidating plant metabolite biosynthetic pathways, wide-ranging success with metabolic engineering for levels of human health-related compounds in plants would be expected in the near future. A key aspect for future success will be better medical information to guide metabolic engineering endeavors. Although the desired levels of many vitamins are known, detailed information is lacking for most of the nutraceuticals that have attracted much interest over the past few years.

Vitamin B12 and the risk of neural tube defects in a folic-acid-fortified population

BACKGROUND

Low maternal vitamin B(12) status may be a risk factor for neural tube defects (NTDs). Prior studies used relatively insensitive measures of B(12), did not adjust for folate levels, and were conducted in countries without folic acid food fortification. In Canada, flour has been fortified with folic acid since mid-1997.

METHODS

We completed a population-based case-control study in Ontario. We measured serum holotranscobalamin (holoTC), a sensitive indicator of B(12) status, at 15 to 20 weeks' gestation. There were 89 women with an NTD and 422 unaffected pregnant controls. A low serum holoTC was defined as less than 55.3 pmol/L, the bottom quartile value in the controls.

RESULTS

The geometric mean serum holoTC levels were 67.8 pmol/L in cases and 81.2 pmol/L in controls. There was a trend of increasing risk with lower levels of holoTC, reaching an adjusted odds ratio of 2.9 (95% confidence interval = 1.2-6.9) when comparing the lowest versus highest quartile.

CONCLUSIONS

There was almost a tripling in the risk for NTD in the presence of low maternal B(12) status, measured by holoTC. The benefits of adding synthetic B(12) to current recommendations for periconceptional folic acid tablet supplements or folic-acid-fortified foods need to be considered. It remains to be determined what fraction of NTD cases in a universally folate-fortified environment might be prevented by higher periconceptional intake of B(12).

Determination of folate concentrations in diverse potato germplasm using a trienzyme extraction and a microbiological assay

Folate deficiency is a leading cause of birth defects and is implicated in several other diseases. We are interested in how much folate concentrations vary among potato germplasm. We determined total folate concentrations of potato tubers from 67 cultivars, advanced breeding lines, or wild species. Folates were extracted by a tri-enzyme treatment and analyzed by using a Lactobacillus rhamnosus microbiological assay. Folate concentrations varied from 521 +/- 96 to 1373 +/- 230 ng/g dry weight and were genotype and location dependent. The highest folate concentrations were mostly found in color-fleshed potatoes. Variations of folate concentrations within either color- or white-fleshed tubers were similar ( approximately 2-fold). Skin contained approximately 30% higher folate concentrations than flesh. Storage of tubers for 7 months generally led to an increase in folate contents. Semiquantitative RT-PCR analyses showed that higher folate contents were correlated with lower mRNA expression of some folate genes.

Folate status and S-adenosylmethionine/S-adenosylhomocysteine ratio in colorectal adenocarcinoma in humans

OBJECTIVES

This study reports the influence of colorectal neoplasia on methylation intermediates and folate concentrations in human colonic mucosa, as well as systemic measures of folate status, to examine biomarkers and possible mechanisms of folate-related carcinogenesis.

SUBJECTS

A total of 47 patients were selected from those previously diagnosed with adenocarcinoma of the colorectum undergoing surgery. For each individual, we obtained a biopsy of the adenocarcinoma and a biopsy of normal appearing mucosa, to perform an intra-individual comparison.

RESULTS

The 'methylation' ratio (S-adenosylmethionine/S-adenosylhomocysteine (SAH)) was lower in pathological tissue vs normal mucosa (P=0.08), mainly due to a much higher SAH concentration (P<0.005). Colonic folate concentration was significantly diminished in malignant tissue (P<0.0001). Plasma homocysteine concentration was within the normal to high range, and folate and vitamin B12 plasma concentrations were within the low to normal range as compared with normative values.

CONCLUSION

Our results contribute to the hypothesis that altered DNA methylation and methyl metabolism is associated with colorectal neoplasia.

An examination of income-related disparities in the nutritional quality of food selections among Canadian households from 1986–2001

Socio-economic disparities in nutrition have been documented in numerous countries, and have been linked to health inequalities. Social and economic policy changes occurring over the last several years have resulted in growing levels of income inequality in many countries. However, the extent to which these temporal changes have affected nutrition disparities is largely unknown. Our research examined income-related disparities in the nutritional quality of food selections among Canadian households from 1986 to 2001. Data from the 1986, 1992, 1996 and 2001 Family Food Expenditure surveys were pooled together (n=35048). The relationships between household income and the nutritional quality of food purchases (considering nutrients both as absolute amounts and adjusted for energy, and total energy density) were estimated using general linear models, including tests of significance for differences across the survey years. Results revealed significant positive relationships between income and most nutrients, which persisted over time, and for some nutrients grew stronger. One exception was folate, where the positive relationship between income and folate (independent of energy) was no longer apparent in 2001; this could be attributed to the mandatory fortification of some cereal grain products with folic acid, which came into effect in 1998, resulting in greater availability of folate from grain products. There was also a significant negative relationship between income and total energy density (ratio of food energy to food weight), which persisted across the survey years. At a time of growing income inequality and worsening problems of poverty, food policy makers need to pay attention to the potential for policy interventions to exacerbate or improve nutrition disparities.

Nutridynamics--studying the dynamics of food components in products and in the consumer

The concentrations and biological effects of nutrients, antinutrients and bioactive compounds, including microbes and their constituents, are affected by production and processing steps, the food matrix in which they reside, the way they are digested and metabolized in the human body, and whether or not and in what form they subsequently reach their target site. A new scientific concept, denoted here as 'nutridynamics', aims to unravel the dynamics of these processes by using a systematic approach to study how a food component is affected by the food matrix itself and what it does in the body. This holistic concept has potential synergy with the areas of food technology and nutrigenomics, and provides a link between food production and the mechanistic effects of bioactive ingredients.