Vitamin B-12 and homocysteine status in a folate-replete population: results from the Canadian Health Measures Survey

Biological properties of vitamin B12

Vitamin B12, cobalamin, is indispensable for humans owing to its participation in two biochemical reactions: the conversion of l-methylmalonyl coenzyme A to succinyl coenzyme A, and the formation of methionine by methylation of homocysteine. Eukaryotes, encompassing plants, fungi, animals and humans, do not synthesise vitamin B12, in contrast to prokaryotes. Humans must consume it in their diet. The most important sources include meat, milk and dairy products, fish, shellfish and eggs. Due to this, vegetarians are at risk to develop a vitamin B12 deficiency and it is recommended that they consume fortified food. Vitamin B12 behaves differently to most vitamins of the B complex in several aspects, e.g. it is more stable, has a very specific mechanism of absorption and is stored in large amounts in the organism. This review summarises all its biological aspects (including its structure and natural sources as well as its stability in food, pharmacokinetics and physiological function) as well as causes, symptoms, diagnosis (with a summary of analytical methods for its measurement), prevention and treatment of its deficiency, and its pharmacological use and potential toxicity.

Vitamin B12 status and metabolic health in women of reproductive age: Population-based biomarker survey

BACKGROUND AND AIMS

In clinical populations, vitamin B12 deficiency has been associated with adverse metabolic health (e.g., gestational diabetes). Population-level data among women of reproductive age could inform screening and interventions. The objective of this analysis was to examine the prevalence of adverse metabolic characteristics (elevated adiposity and central adiposity, hypertension, elevated glycated hemoglobin [HbA1c]) and associations of vitamin B12 status with metabolic characteristics in women as part of a population-based biomarker survey in Southern India.

METHODS

Participants (n = 980 women 15-40 y; not pregnant or lactating) were assessed for total vitamin B12, holotranscobalamin, methylmalonic acid, homocysteine, and HbA1c. Categorical anthropometry assessments and bioelectrical impedance analysis (e.g., whole body (WF%) and trunk (TF%) fat) were assessed among adults (≥18 y). Linear and binomial regressions were used to examine associations of vitamin B12 status with metabolic characteristics.

RESULTS

Overall, 25 % of participants had HbA1c ≥5.7 % (HbA1c ≥5.7-<6.5 %: 20.0 %; ≥6.5 %: 5.0 %), and 18.6 % had hypertension (Stage 1: 16.4 %; Stage 2: 2.2 %). Among adults, 23.4 % had body mass index of (BMI) 25.0-<30.0 kg/m2, 9.6 % had BMI ≥30.0 kg/m2, 13.4 % had elevated waist circumference (WC; >88.9 cm), and 20.8 % had elevated waist-hip ratio (WHR; ≥0.85 cm). Overall, higher vitamin B12 concentrations were associated with lower BMI and WC. Among adults, higher vitamin B12 concentrations were associated with lower WF% and TF%; and lower prevalence of overweight (BMI ≥25.0 kg/m2) and elevated WC, WHR, and WF%. Similarly, vitamin B12 <148 pmol/L was associated with higher BMI and WC overall and, among adults, higher WF% and TF%, and increased overweight (BMI ≥25.0 kg/m2; prevalence ratio: 1.31; 95 % confidence interval: 1.09-1.58), and elevated WC (>88.9 cm; 1.85 [1.32-2.60]), WHR (≥85.0; 1.38 [1.07-1.78]), WF% (>35 %; 1.29 [1.10-1.51]), and TF% (>35 %; 1.25 [1.06-1.49]).

CONCLUSIONS

The burden of adverse metabolic characteristics was substantial in this population of young, apparently healthy women. Among those with vitamin B12 <148 pmol/L there was increased central adiposity and overweight status. Evaluating vitamin B12 and metabolic outcomes prospectively could inform screening and interventions to improve women's health.

REGISTRATION NUMBER

NCT04048330.

Altered placental phenotype and increased risk of placental pathology in fetal spina bifida: A matched case-control study

INTRODUCTION

Spina bifida (SB) remains one of the most common congenital anomalies and associates with significant comorbidities in the fetus, which may, in part, be driven by placental maldevelopment. We hypothesised that placental pathologies would be more prevalent in fetuses with SB compared to fetuses without congenital anomalies.

METHODS

Placental pathology and transcriptome were evaluated for fetuses with isolated open SB born preterm (cases; n = 12) and control fetuses without congenital anomalies (n = 22) born at full term (FT) or preterm (PT). We evaluated associations between study group and placental histopathology, and between placental histopathology and gene expression.

RESULTS

Placental weight was lower in cases than PT controls (median [IQR]: 263 g [175, 370] vs. 455 g [378, 560], p = 0.001). Placental villi structural phenotype was different in cases, where proportion of immature intermediate villi was higher in cases than PT controls (32.5 % [6.3, 56.3] vs. 10 % [5, 13.8], p = 0.01), but cases and FT controls had similar proportions of mature intermediate (10 % [5, 10] vs. 10 % [8.75, 11.25]) and terminal villi (22.5 % [11.3, 43.8] vs. 30 % [20, 36.3]), and similar odds of having many syncytial knots (adjusted odds ratio [aOR] = 6 [0.2, 369]). Case placentae also had higher odds of having many Hofbauer cells (aOR = 16.2 [1.4, 580], p = 0.02) and a thick syncytial membrane (aOR = 146 [3, 3.46e5], p = 0.007). Gene expression in immune/inflammatory processes, spinal cord injury, and Hedgehog and Wnt signaling pathways were associated with placental maturity in cases.

DISCUSSION

Improved knowledge on placental phenotypes in SB increases our understanding of mechanisms that may drive comorbidities, and may ultimately inform efforts to reduce offspring morbidity and mortality.

Vitamin B12 concentrations vary greatly in milk donated to a large provincial milk bank, and are influenced by supplementation and parity

BACKGROUND & AIMS

Feeding parent's milk with supplemental donor milk (DM) is the optimal way to feed very low birth weight (VLBW) infants instead of formula; however, suboptimal neurodevelopment persists. This is believed due, in part, to suboptimal nutrition. Given vitamin B12's role in neurodevelopment and increased adoption of plant-based diets among females of child-bearing age, we aimed to determine the adequacy of vitamin B12 in DM (n = 380 donors) and associated donor characteristics.

METHODS

Vitamin B12 was measured in consecutive raw DM donations received at the milk bank from March 2020-2021 using a validated competitive chemiluminescent enzyme immunoassay (IMMULITE 2000, Siemens). Donor characteristics were obtained from screening records and associations with milk vitamin B12 concentrations explored using a generalized additive model.

RESULTS

Donors were 32 ± 4 years old (mean ± SD), and DM was expressed 98 ± 85 days postpartum. Vitamin B12 concentrations in DM had a median (25th, 75th percentile) of 232 (149, 373) pmol/L; 64 % had concentrations <310 pmol/L (common cut-off for inadequacy in healthy term-born infants). In a multivariable analysis, donors consuming a vitamin B12-containing supplement had higher DM vitamin B12 (β ± SE: 80.3 ± 25.4 pmol/L; p = 0.020) compared to those not taking a supplement. Primiparous donors had higher DM vitamin B12 than multiparous donors (36.7 ± 18.2 pmol/L greater; p = 0.044). No associations were observed for other donor characteristics.

CONCLUSION

Milk donated to a large human milk bank showed evidence of suboptimal vitamin B12; levels were associated with both donor vitamin B12-containing supplement use and parity. Further research as to whether and when milk bank donors are recommended to consume a supplement and the benefits and risks of routine vitamin B12 supplementation of DM-fed infants is warranted.

Total sulfur amino acid requirements are higher during late gestation compared with early gestation in healthy Canadian pregnancies in a repeated-measures trial

BACKGROUND

Dietary Reference Intake (DRI) Recommendations for total sulfur amino acids (TSAAs; methionine + cysteine) during pregnancy are based on factorial calculations using data from adult males. To date, no data exist on TSAA requirements obtained directly during pregnancy.

OBJECTIVES

The objective of this study was to examine whether TSAA requirements during early (11-20 wk) and late (31-40 wk) gestation in healthy females with singleton pregnancies are different than current recommendations, and different between early and late gestation using the indicator amino acid oxidation (IAAO) technique.

METHODS

Twenty-five females 20-40 y with a healthy singleton pregnancy were studied using the IAAO technique in a repeated measures design for a total of 70, 8-h d. On each study day a methionine test intake (range: 0-40 mg⋅kg-1⋅d-1) was provided in 8 hourly, isonitrogenous and isocaloric meals with cysteine excluded from the diet. Breath samples were collected at baseline and isotopic steady state of orally provided L-1-13C-Phenylalanine for measurement of phenylalanine oxidation. The requirement was determined using biphasic linear regression crossover analysis to identify a breakpoint in 13CO2 production, representing the estimated average requirement (EAR).

RESULTS

The TSAA requirement in healthy pregnant participants in early gestation was 11.1 mg⋅kg-1⋅d-1 {R2m = 0.79, R2c = 0.79; 95% confidence interval [CI] (8.9, 13.3 mg⋅kg-1⋅d-1)} and 15.0 mg⋅kg-1⋅d-1 (R2m = 0.72, R2c = 0.79; 95% CI [13.0, 17.0 mg⋅kg-1⋅d-1]) in late gestation. The difference between confidence intervals of the 2 breakpoints was = -3.9 ± 3.0, and statistically different.

CONCLUSIONS

We directly measured TSAA requirements in healthy pregnant mothers, and our findings suggest that requirements are lower than current DRI recommendations of 20 and 25 mg⋅kg-1⋅d-1, as the EAR, and Recommended Dietary Allowance, respectively. Late gestation TSAA needs are significantly different and increased 35% compared with early gestation. Recommendations for TSAA intake need to be tailored for gestational stage. This clinical trial was registered at clinicaltrials.gov as NCT04326322.

Vitamin D, Folate, Vitamin B12, and Iron Status in Pregnant/Postpartum Old Order Anabaptist Women in Southwestern Ontario

Purpose: To assess vitamin D, folate, vitamin B12, and iron status in Old Order Anabaptist (OOA) pregnant/postpartum women.Methods: Blood was analyzed for plasma 25 hydroxy vitamin D (25(OH)D), red blood cell (RBC) folate, serum vitamin B12, and iron status indicators. Dietary intakes (food and supplements) from 3-day estimated records were compared to Dietary Reference Intakes and Canada's Food Guide (2007).Results: Fifty women participated in this descriptive cross-sectional study. Concentrations of 25(OH)D were low (<50 nmol/L for 20% and < 75 nmol/L for 63%); 42% had total vitamin D intakes < estimated average requirement (EAR). All women had RBC folate above the 1360 mmol/L cut-off. Nineteen percent had folate intakes upper limit. One woman had low serum vitamin B12 (<148 pmol/L); serum vitamin B12 was high (>652 pmol/L) for 24%. None had vitamin B12 intakes  Collapse

Key Words

• Anabaptist
• anabaptiste
• femmes enceintes post-partum
• fer
• folate
• iron
• pregnant postpartum women
• vitamin B12
• vitamin D
• vitamine B12
• vitamine D

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MESH Headings

• Humans
• Female
• Folic Acid/blood
• Folic Acid/administration & dosage
• Vitamin B 12/blood
• Vitamin B 12/administration & dosage
• Vitamin D/blood
• Vitamin D/administration & dosage
• Vitamin D/analogs & derivatives
• Ontario
• Pregnancy
• Cross-Sectional Studies
• Adult
• Dietary Supplements
• Nutritional Status
• Postpartum Period/blood
• Iron/blood
• Iron/administration & dosage
• Protestantism
• Vitamin B 12 Deficiency/blood
• Vitamin B 12 Deficiency/epidemiology
• Young Adult
• Vitamin D Deficiency/blood
• Vitamin D Deficiency/epidemiology
• Anemia, Iron-Deficiency/blood
• Anemia, Iron-Deficiency/epidemiology

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Grants Collapse

Affiliation(s)

Janis A Randall Simpson Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
Natalee Miller Huron Perth Public Health, Stratford, ON
Taylor Hartwig Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
Jane Leach Huron Perth Public Health, Stratford, ON
Melissa Purdy Huron Perth Public Health, Stratford, ON
Emily Roth Countryside Midwifery Services, Milverton, ON
Victoria Mok Siu Department of Pediatrics, Western University, London, ON
Cynthia Soulliere Countryside Midwifery Services, Milverton, ON
Jacqui Tam Huron Perth Public Health, Stratford, ON
Ann Watt Huron Perth Public Health, Stratford, ON

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Deficiency of Energy and Nutrient and Gender Differences among Chinese Adults: China Nutrition and Health Survey (2015-2017)

Half of Chinese adults face the double burden of overweight/obesity and micronutrient deficiencies, and nearly 40% of them are severely overweight/obese or have micronutrient deficiencies. This study used the data from China Nutrition and Health Survey (CNHS) from 2015 to 2017 to estimate the prevalence of inadequate dietary micronutrient intake (including vitamin A, vitamin B1, vitamin B2, vitamin C, cCalcium, iron and sodium) in Chinese adults and further determine the differences in micronutrient intake by gender, age and BMI. A total of 61,768 subjects were included in this study, of which 33,262 (54%) were female. The intake of energy and all macronutrients decreased with age, and the intake was higher in men than in women. Inadequate energy intake occurs in adults of all ages. In terms of nutrient intake, women had a higher rate of insufficient carbohydrate intake than men in all age groups. Inadequate protein intake was more common in women aged 18-49 years (60.9%) than in men. Compared with women, men had a higher rate of vitamin B2 intake. Insufficient vitamin B3 intake was more common in women aged 18-49 years (35.6%), men aged 65-79 years (39.7%) and men aged 80 years and above (47.9%). In all age groups, insufficient vitamin C intake is higher in women than in men-up to 85.8 percent in women aged 80 years old and above. Compared with men in the same age group, insufficient intake of calcium and iron is more obvious in women. Women have significantly higher rates of inadequate intake of calcium, iron and sodium than men. In the analysis of correlations between BMI or demographic data and micronutrient intakes, the likelihood of micronutrient intakes being insufficient was higher in the central and western regions in all age groups compared to the eastern regions. The risk of insufficient micronutrient intake was higher in obese men and women aged 18-49 years and 50-64 years. Underweight and overweight women in the 65-79 age group were more likely to have inadequate micronutrient intake. Obese women over 80 years of age were less likely to have inadequate micronutrient intake. No significant difference was found between urban and rural areas for each age group.

Evaluation of vitamin B12 levels among severe obese and obese adolescents

Obesity, whose prevalence is increasing globally, is malnutrition that causes micro/macronutrients and vitamin deficiencies in adolescents. Vitamin B12 plays a prominent role in the body systems such as remethylation, deoxidation, and DNA synthesis. We aimed to examine the relationship between severe obese/obese adolescents and vitamin B12 levels in this study. This study was conducted as a case-control study consisting of 44 obese and 40 healthy control adolescents aged 11-17 years. Obesity was diagnosed using body mass index (BMI) charts defined by the World Health Organization according to age and gender. Vitamin B12 deficiency was found to be 34.1% in the patient obesity group, while it was 12.5% in the control group (p = 0.02). Homeostatic Model Assessment for Insulin Resistance levels were found to be 3.09 (1.9-5.29) higher in the severely obese group (p < 0.001). The median level of vitamin B12 in the obese group was 173 (122.5-220.7) in the severe obese group, 197 (146.5-302.7) in the obese group, and 252.5 (192.8-302) in the control group (p = 0.021). We found that obesity has a 1.6-fold decreasing effect on vitamin B12 levels. This study shows the clinician the importance of monitoring BMI and vitamin B12 levels in obese adolescents, given the effects of vitamin B12 on neuronal migration, metabolic reactions, and many systems in the body. Further researches are needed to investigate the pathophysiology and effect of low vitamin B12 levels in obese adolescents.

Altered placental immune cell composition and gene expression with isolated fetal spina bifida

PROBLEM

Fetal spina bifida (SB) is more common in pregnant people with folate deficiency or anomalies of folate metabolism. It is also known that fetuses with SB have a higher risk of low birthweight, a condition that is typically placental-mediated. We therefore hypothesized that fetal SB would associate with altered expression of key placental folate transporters and an increase in Hofbauer cells (HBCs), which are folate-dependent placental macrophages.

METHOD OF STUDY

Folate receptor-α (FRα), proton coupled folate receptor (PCFT), and reduced folate carrier (RFC) protein localization and expression (immunohistochemistry) and HBC phenotypes (HBC abundance and folate receptor-β [FRβ] expression; RNA in situ hybridization) were assessed in placentae from fetuses with SB (cases; n = 12) and in term (n = 10) and gestational age (GA) - and maternal body mass index - matched (n = 12) controls without congenital anomalies.

RESULTS

Cases had a higher proportion of placental villous cells that were HBCs (6.9% vs. 2.4%, p = .0001) and higher average HBC FRβ expression (3.2 mRNA molecules per HBC vs. 2.3, p = .03) than GA-matched controls. HBCs in cases were largely polarized to a regulatory phenotype (median 92.1% of HBCs). In sex-stratified analyses, only male cases had higher HBC levels and HBC FRβ expression than GA-matched controls. There were no differences between groups in the total percent of syncytium and stromal cells that were positive for FRα, PCFT, or RFC protein immunolabeling.

CONCLUSIONS

HBC abundance and FRβ expression by HBCs are increased in placentae of fetuses with SB, suggesting immune-mediated dysregulation in placental phenotype, and could contribute to SB-associated comorbidities.

Prevalence and Time Trends of Low Serum B12 Levels and Inadequate B12 Dietary Intake in Lebanese Adults amidst the Food Insecurity Situation: Findings from a Nationally Representative Cross-Sectional Study

Rising food insecurity (FI) and the increased prices of animal-based foods could compromise vitamin B12 (B12) intake and serum levels in food-insecure people. Our study aims to determine the prevalence of low levels of serum B12 and its inadequate dietary intake among a nationally representative sample of Lebanese adults aged 18 to 64 years, while exploring the impact of FI and identifying other potential predictors. The B12 intake was assessed using a food frequency questionnaire and the mean of two non-consecutive 24 h recalls. The B12 serum levels were also examined. To examine the time trends in the B12 serum levels and dietary intake, the data from a large representative digitized database of 6290 participants were collected, along with the examination of FAOSTAT food consumption data both before and during the economic crisis period. Our findings revealed that 47.3% of households in Lebanon experienced FI. The inadequate intake of B12 food sources was prevalent in 52.5% of participants, and 61.1% presented with low (23%) or intermediate (38.1%) levels of serum B12. The food-secure households had a higher proportion of B12 intake from meats (p = 0.004), while traditional foods contributed more to food-insecure households (p = 0.000). The participants who were female, unemployed, food-insecure, and had low dietary diversity were about two to three times more likely to have inadequate B12 intake. The predictors of low levels of serum B12 included residing in Beqaa (OR = 2.856 and 95% CI = 1.018-8.01) and having inadequate B12 intake (OR = 1.788 and 95% CI = 1.2-2.65). The findings from observing the time trends in the consumption and the serum levels of B12 indicate a considerable decline in the consumption of most animal-based foods compared to the pre-crisis period, associated with a decline in the serum levels of B12. In conclusion, an alarming prevalence of low dietary intake and low serum levels of B12 was revealed among Lebanese adults, and the indirect effect of FI on B12 serum levels mediated through B12 intake was inferred.

Fetal spina bifida associates with dysregulation in nutrient-sensitive placental gene networks: Findings from a matched case-control study

To improve outcomes in fetuses with spina bifida (SB), better understanding is needed of the molecular drivers of SB and its comorbidities. Pregnant people carrying a fetus with isolated SB (cases; n = 12) or a fetus with no congenital anomalies (controls; n = 21) were recruited at Mount Sinai Hospital, Toronto, Ontario, Canada. Clinical data and placental samples were collected. Placental transcriptome was sequenced (Clariom D microarray) and a nutrient-focused gene expression analysis pipeline was applied to determine whether fetal SB associates with placental dysfunction. Of the 391 differentially expressed genes (DEGs) in cases, 11% (n = 42) had at least one nutrient cofactor, including B vitamins (n = 7 genes), iron/heme (n = 6), and zinc (n = 11). Cases had dysregulation in genes not previously known to associate with SB, and in placental genes that have known links to SB but have not been previously identified in the placenta. Cases also had downregulated nutrient transport and upregulated branching angiogenesis and immune/inflammatory processes. Five nutrient-dependent transcription regulators, collectively predicted to target 46% of DEGs in cases, were identified and were most commonly dependent on B vitamins (n = 3) and zinc (n = 2). Placental gene expression changes were most acute in cases with poor growth. Placentae from fetuses with SB have dysregulation in several gene networks, including those that are sensitive to multiple micronutrients beyond the well-known folic acid. An improved understanding of placental phenotype in fetuses with SB may help identify novel mechanisms associated with comorbidities in fetuses with SB, and reveal new targets to improve fetal outcomes in this population.

Higher Than Recommended Folic Acid Intakes is Associated with High Folate Status Throughout Pregnancy in a Prospective French-Canadian Cohort

BACKGROUND

Folate and vitamin B12 status during pregnancy are important for maternal and neonatal health. Maternal intake and prepregnancy body mass index (ppBMI) can influence biomarker status.

OBJECTIVES

This study aimed to, throughout pregnancy; 1) assess folate and B12 status including serum total folate, plasma total vitamin B12, and homocysteine (tHcy); 2) examine how these biomarkers are associated with intakes of folate and B12 and with ppBMI; and 3) determine predictors of serum total folate and plasma total vitamin B12.

METHODS

In each trimester (T1, T2, and T3), food and supplement intakes of 79 French-Canadian pregnant individuals were assessed by 3 dietary recalls (R24W) and a supplement use questionnaire. Fasting blood samples were collected. Serum total folate and plasma total vitamin B12 and tHcy were assessed by immunoassay (Siemens ADVIA Centaur XP).

RESULTS

Participants were 32.1 ± 3.7 y and had a mean ppBMI of 25.7 ± 5.8 kg/m². Serum total folate concentrations were high (>45.3 nmol/L, T1: 75.4 ± 55.1, T2: 69.1 ± 44.8, T3: 72.1 ± 52.1, P = 0.48). Mean plasma total vitamin B12 concentrations were >220 pmol/L (T1: 428 ± 175, T2: 321 ± 116, T3: 336 ± 128, P < 0.0001). Mean tHcy concentrations were <11 μmol/L across trimesters. Most participants (79.6%-86.1%) had a total folic acid intake above the Tolerable Upper Intake Level (UL, >1000 μg/d). Supplement use accounted for 71.9%-76.1% and 35.3%-41.8% of total folic acid and vitamin B12 intakes, respectively. The ppBMI was not correlated with serum total folate (P > 0.1) but was weakly correlated with and predicted lower plasma total vitamin B12 in T3 (r = -0.23, P = 0.04; r² = 0.08, standardized beta [sβ] = -0.24, P = 0.01). Higher folic acid intakes from supplements predicted higher serum total folate (T1: r² = 0.05, sβ = 0.15, P = 0.04, T2: r² = 0.28, sβ = 0.56, P = 0.01, T3: r² = 0.19, sβ = 0.44, P < 0.0001).

CONCLUSIONS

Most pregnant individuals had elevated serum total folate concentrations, reflecting total folic acid intakes above the UL driven by supplement use. Vitamin B12 concentrations were generally adequate and differed by ppBMI and pregnancy stage.

Children Aged 5-6 Years in Vancouver, Canada Meet Dietary Recommendations for Folate and Vitamin B12 but not Choline

BACKGROUND

Choline, folate, and vitamin B12 are required for growth and development, but there is limited information on the intakes and relationships to biomarkers of status in children.

OBJECTIVES

The objective of this study was to determine the choline and B-vitamin intakes and relationship to biomarkers of status in children.

METHODS

A cross-sectional study was conducted in children (n = 285, aged 5-6 y) recruited from Metro Vancouver, Canada. Dietary information was collected by using 3 24-h recalls. Nutrient intakes were estimated by using the Canadian Nutrient File and United States Department of Agriculture database for choline. Supplement information was collected by using questionnaires. Plasma biomarkers were quantified by using mass spectrometry and commercial immunoassays, and relationships to dietary and supplement intake were determined by using linear models.

RESULTS

Daily dietary intakes of choline, folate, and vitamin B12 were [mean (SD)] 249 (94.3) mg, 330 (120) DFE μg, and 3.60 (1.54) μg, respectively. Top food sources of choline and vitamin B12 were dairy, meats, and eggs (63%-84%) and for folate, were grains, fruits, and vegetables (67%). More than half of the children (60%) were consuming a supplement containing B-vitamins, but not choline. Only 40% of children met the choline adequate intake (AI) recommendation for North America (≥250 mg/d); 82% met the European AI (≥170 mg/d). Less than 3% of children had inadequate folate and vitamin B12 total intakes. Some children (5%) had total folic acid intakes above the North American tolerable upper intake level (UL; >400 μg/d); 10% had intakes above the European UL (>300 μg/d). Dietary choline intake was positively associated with plasma dimethylglycine, and total vitamin B12 intake was positively associated with plasma B12 (adjusted models; P < 0.001).

CONCLUSIONS

These findings suggest that many children are not meeting the dietary choline recommendations, and some children may have excessive folic acid intakes. The impact of imbalanced one-carbon nutrient intakes during this active period of growth and development requires further investigation.

A Retrospective Evaluation of the Predictive Value of Newborn Screening for Vitamin B12 Deficiency in Symptomatic Infants Below 1 Year of Age

BACKGROUND

The sensitivity of newborn screening (NBS) in detecting infants that later develop symptomatic vitamin B12 deficiency is unknown. We evaluated the predictive value using NBS algorithms in detecting infants that later were clinically diagnosed with symptomatic B12 deficiency. Furthermore, we investigated whether being born in a hospital using nitrous oxide (N₂O) as pain relief in labor may have had an impact on total homocysteine at NBS.

METHODS

We retrospectively retrieved NBS data and analyzed total homocysteine, methylmalonic acid and methyl citrate on stored NBS dried blood spots (DBS) of 70 infants diagnosed with symptomatic B12 deficiency and compared them to 646 matched and 434 unmatched DBS controls to evaluate the Austrian and Heidelberg B12 NBS algorithms.

RESULTS

The sensitivity of NBS in detecting infants later diagnosed with symptomatic B12 deficiency at median age 10.9 weeks was ≤10%. Total homocysteine was higher in DBS for the unmatched controls who were born in hospitals providing N₂O compared to in hospitals not providing N₂O, with median total homocysteine 4.0 µmol/L compared to 3.5 µmol/L (n = 434, 95% CI 0.04-0.87, p = 0.03).

CONCLUSION

NBS algorithms were unable to identify most infants diagnosed with symptomatic B12 deficiency after the neonatal period. Being born in hospitals providing N₂O may impact total homocysteine at NBS.

Reduced circulating folate among older adults caused by continuous work: nested cross-sectional study conducted in a country with folic acid fortification program

Population aging is 1 of the biggest challenges facing public health today, and cognitive dysfunction is an important concern. Cognitive impairment may be associated with high folate concentrations and low vitamin B₁₂ concentrations; the latter is a common problem among elderly people. Therefore, we hypothesized there was a high circulating folate concentration among older people living in a country with a mandatory folic acid fortification program. We conducted a cross-sectional study to investigate nutritional status of folate and vitamin B₁₂ among aged people. Three dietary recalls, serum folate (sfolate), erythrocyte (red blood cell) folate (RBC folate), and serum vitamin B₁₂ and homocysteine were collected. Linear regression models were used to investigate factors associated with circulating vitamins. We interviewed 169 participants. Half reported inadequate consumption of folate. However, RBC folate deficiency was observed in 27%, 13% in the serum, and a 10% excess of sfolate. One-quarter reported inadequate consumption of B_12, but only 5% had deficiency. Factors negatively associated with circulating folate were continuous work and smoking, and positively associated with polyunsaturated fatty acid. Factor negatively associated with the circulating B₁₂ were use of a dental prosthesis and intake of saturated fatty acid. Permanent investigation of excess of sfolate and B₁₂ deficiency, especially among older adults living in countries exposed to a mandatory folic acid fortification program, is important because of the possible relation to the cognitive function.

Methylmalonic acid analysis using urine filter paper samples to screen for metabolic vitamin B12 deficiency in older adults

Aim: Methylmalonic acid (MMA) analysis in urine represents a noninvasive approach to screening for vitamin B₁₂ deficiency in older adults. A method allowing the analysis of MMA/creatinine in fasting urine collected on filter paper was developed/validated. Method: Dry urine specimens were eluted using a solution containing internal standards, filtrated and analyzed by ultra-performance LC-MS/MS. Results: The method allowed the chromatographic separation of MMA from succinic acid. Dried urine samples were stable for 86 days at room temperature. The MMA/creatinine ratios measured in urine collected on filter paper were highly correlated with values derived from the corresponding liquid specimens. Conclusion: This robust filter paper method might greatly improve the accessibility and cost-effectiveness of vitamin B₁₂ deficiency screening in older adults.

Associations of Homocysteine with B Vitamins and Zinc in Serum Levels of Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

The association of homocysteine metabolism-related nutrients along with renal function to homocysteine levels is not well known in patients with type 2 diabetes mellitus (T2DM). We investigated the relevance of kidney function, albuminuria, and nutritional factors to serum homocysteine in T2DM patients. This cross-sectional study enrolled 149 T2DM patients (96 men and 53 postmenopausal women), and patient characteristics and laboratory data including kidney-related data [glomerular filtration rate (eGFR), urinary albumin excretion (UACR), uric acid] and metabolism parameters (hemoglobin A1c and lipids) were collected from the medical record and serum levels of vitamin B12, folic acid, zinc, homocysteine and UACR were also acquired. In total subjects, serum levels of homocysteine, vitamin B12, and folic acid were within reference intervals, but zinc levels were close to lower limits of its reference interval. A multivariate-adjusted analysis showed that gender (β=-0.259, p<0.001), uric acid (β=0.267, p<0.001), eGFR (β=-0.188, p=0.001), log UACR (β=0.190, p=0.002), log folic acid (β=-0.259, p<0.001), log vitamin B12 (β=-0.224, p<0.001) and zinc (β=-0.169, p=0.006) were correlated to log homocysteine. In multiple regression analysis by gender, these correlations were found similarly in men, but neither log folic acid nor zinc showed correlations with log homocysteine in women. The present study suggests that renal function parameters and the certain nutritional factors have a possible influence on serum homocysteine, in T2DM patients including diabetes kidney disease.

Diets, nutrients, genes and the microbiome: recent advances in personalised nutrition

As individuals seek increasingly individualised nutrition and lifestyle guidance, numerous apps and nutrition programmes have emerged. However, complex individual variations in dietary behaviours, genotypes, gene expression and composition of the microbiome are increasingly recognised. Advances in digital tools and artificial intelligence can help individuals more easily track nutrient intakes and identify nutritional gaps. However, the influence of these nutrients on health outcomes can vary widely among individuals depending upon life stage, genetics and microbial composition. For example, folate may elicit favourable epigenetic effects on brain development during a critical developmental time window of pregnancy. Genes affecting vitamin B12 metabolism may lead to cardiometabolic traits that play an essential role in the context of obesity. Finally, an individual's gut microbial composition can determine their response to dietary fibre interventions during weight loss. These recent advances in understanding can lead to a more complete and integrated approach to promoting optimal health through personalised nutrition, in clinical practice settings and for individuals in their daily lives. The purpose of this review is to summarise presentations made during the DSM Science and Technology Award Symposium at the 13th European Nutrition Conference, which focused on personalised nutrition and novel technologies for health in the modern world.

The prevalence and clinical relevance of hyperhomocysteinemia suggesting vitamin B12 deficiency in presumed healthy infants

BACKGROUND

Previous studies have demonstrated a high prevalence of biochemical vitamin B12 deficiency in infants in Norway. Increased total homocysteine (tHcy) is the most important marker of B12 deficiency in infants. There is a need to evaluate its clinical relevance.

AIMS

To investigate the prevalence of hyperhomocysteinemia (S-tHcy > 8 μmol/L) suggestive of suboptimal B12 status and the prevalence of clinically relevant hyperhomocysteinemia in presumed healthy infants in Norway. Further, to evaluate risk factors, presence of symptoms and psychomotor development in these children.

METHODS

In a prospective study we clinically examined 252 infants aged 3-7 months using standardized neurological and psychomotor tests prior to analyzing biochemical B12 deficiency markers in 250 infants.

RESULTS

Twenty-five of 250 (10%) infants had hyperhomocysteinemia combined with clinically relevant symptoms suggestive of B12 deficiency. Hyperhomocysteinemia was associated with tremor, excessive sleep, and sub-normal scores in the fine motor section of the Ages and Stages Questionnaire. One-hundred and fourteen of 250 (46%) infants had hyperhomocysteinemia. Multiple regression analysis showed months of infant formula use as the strongest negative predictor for hyperhomocysteinemia.

CONCLUSION

We have demonstrated associations between symptoms suggestive of infant B12 deficiency and increased levels of tHcy in presumed healthy infants The combination of hyperhomocysteinemia and associated relevant symptoms suggestive of B12 deficiency was a common finding, albeit most infants with hyperhomocysteinemia did not show symptoms.

Homocysteine as a Predictor Tool in Multiple Sclerosis

Multiple sclerosis (MS) is a progressive and irreversible disease which affects the central nervous system (CNS) with still unknown etiology. Our study aimes to establish the homocysteine pattern that can predict the MS diseases progression and to identify a potential disease progression marker that can be easy to perform and non-invasive, in order to predict the diseases outcome. In order to achieve this goal, we included 10 adult RRMS subjects, 10 adult SPMS subjects and 10 age-matched healthy subjects. The homocysteine plasma level was measured using automated latex enhanced immunoassay and the cobalamin and folate measurements were performed using automated chemiluminescence immunoassay (CLIA). HCR was calculated by dividing the homocysteine plasma level by cobalamin plasma level. We found that the homocysteine level in plasma of both RRMS patients and SPMS group are significantly increased compared with the control group. There is a significantly higher concentration of homocysteine in SPMS group compared with the RRMS group. In addition, the HCR is significantly increased in SPMS compared with the RRMS group and is a very good index of disease severity.

Serum Homocysteine Level Is a Predictor of Relapse and Prognosis in Patients With First-Attack Neuromyelitis Optica Spectrum Disorders

Background: Many patients with neuromyelitis optica spectrum disorders (NMOSD) experience the adverse consequences of relapse and disability aggravation. Thus, it is necessary to identify sensitive and reliable biomarkers for early prognosis. This study investigated whether serum homocysteine (Hcy) level was associated with the risk of relapse or poor prognosis in first-attack NMOSD patients.

Methods: We enrolled 161 first-attack NMOSD patients in this retrospective study. We reviewed their medical records and evaluated their initial Expanded Disability Status Scale (EDSS). Clinical outcomes were measured by the final EDSS and the relapse rate. The association between Hcy levels and EDSS score at last follow-up was analyzed by binary logistic regression. The association between Hcy levels and relapse rate was assessed by Cox regression analysis. Receiver operating characteristic (ROC) curve analysis was used to predict the target value of Hcy reduction.

Results: Compared with the high Hcy group, the final EDSS score in the low Hcy group was significantly lower (median: 0.5 vs. 2.5, P < 0.001). The relapse rate differed significantly between these groups (30.6 vs. 50.0%, P = 0.023). Multivariate analysis showed that the initial EDSS score (odds ratio [OR] 3.03, 95% confidence interval [CI] 2.07–4.45, P < 0.001) and serum Hcy level (OR 1.13, 95%CI 1.04–1.22, P = 0.002) were significantly associated with poor prognosis in NMOSD patients. Additionally, multivariate analysis showed that serum Hcy level (hazard ratio 1.06, 95%CI 1.04–1.09, P < 0.001) was an independent predictor of the risk for relapse in NMOSD. The 12-month relapse rate of the high Hcy group was 34.8%, and 50% of high Hcy patients relapsed within 35 months after the first onset. A serum Hcy level exceeding 14.525 μmol/L indicated a high risk of relapse, with a sensitivity of 43.7%, specificity of 90.0%, and area under the ROC curve of 0.674 (95%CI 0.59–0.76, P < 0.001).

Conclusion: Serum Hcy level is an independent predictor of relapse and poor prognosis in first-attack NMOSD patients. Early monitoring and reduction of serum Hcy levels may be of great significance in the prevention of disease relapse and severe disability.

Anemia and Vitamin B-12 and Folate Status in Women of Reproductive Age in Southern India: Estimating Population-Based Risk of Neural Tube Defects

BACKGROUND

Women of reproductive age (WRA) are a high-risk population for anemia and micronutrient deficiencies. However, there are few representative population-level data from India, which could help inform evidence-based recommendations and policy.

OBJECTIVE

To conduct a population-based biomarker survey of anemia and vitamin B-12 and folate status in WRA as part of a periconceptional surveillance program in southern India.

METHODS

Participants were WRA (15-40 y) who were not pregnant or lactating. Whole blood (n = 979) was analyzed for hemoglobin via a Coulter counter (Coulter HMX). Plasma, serum, and RBCs were processed and stored at -80°C or less until batch analysis. Vitamin B-12 concentrations were measured via chemiluminescence; RBC and serum folate concentrations were evaluated via microbiological assay. Anemia and severe anemia were defined as hemoglobin <12.0 g/dL and <8.0 g/dL, respectively. Vitamin B-12 deficiency and insufficiency were defined as total vitamin B-12 <148 pmol/L and <221 pmol/L, respectively. Folate deficiency and insufficiency were defined as RBC folate <305 nmol/L and <748 nmol/L. A previously developed Bayesian model was used to predict neural tube defect (NTD) prevalence per 10,000 births.

RESULTS

A total of 41.5% of WRA had anemia and 3.0% had severe anemia. A total of 48.3% of WRA had vitamin B-12 deficiency and 74.3% had vitamin B-12 insufficiency. The prevalence of RBC folate deficiency was 7.6%, and 79.3% of WRA had RBC folate <748 nmol/L, the threshold for optimal NTD prevention. Predicted NTD prevalence per 10,000 births based on RBC folate concentrations was 20.6 (95% uncertainty interval: 16.5-25.5).

CONCLUSIONS

The substantial burden of anemia, vitamin B-12 deficiency, and RBC folate insufficiency in WRA in this setting suggests an opportunity for anemia and birth defects prevention. Findings will directly inform the development of a randomized trial for anemia and birth defects prevention in southern India.This study was registered at clinicaltrials.gov as NCT04048330.

Is natural (6S)-5-methyltetrahydrofolic acid as effective as synthetic folic acid in increasing serum and red blood cell folate concentrations during pregnancy? A proof-of-concept pilot study

Background

North American health authorities recommend 0.4 mg/day folic acid before conception and throughout pregnancy to reduce the risk of neural tube defects. Folic acid is a synthetic form of folate that must be reduced by dihydrofolate reductase and then further metabolized. Recent evidence suggests that the maximal capacity for this process is limited and unmetabolized folic acid has been detected in the circulation. The biological effects of unmetabolized folic acid are unknown. A natural form of folate, (6S)-5-methyltetrahydrofolic acid (Metafolin®), may be a superior alternative because it does not need to be reduced in the small intestine. Metafolin® is currently used in some prenatal multivitamins; however, it has yet to be evaluated during pregnancy.

Methods/design

This double-blind, randomized trial will recruit 60 pregnant women aged 19–42 years. The women will receive either 0.6 mg/day folic acid or an equimolar dose (0.625 mg/day) of (6S)-5-methyltetrahydrofolic acid for 16 weeks. The trial will be initiated at 8–21 weeks’ gestation (after neural tube closure) to reduce the risk of harm should (6S)-5-methyltetrahydrofolic acid prove less effective. All women will also receive a prenatal multivitamin (not containing folate) to ensure adequacy of other nutrients. Baseline and endline blood samples will be collected to assess primary outcome measures, including serum folate, red blood cell folate and unmetabolized folic acid. The extent to which the change in primary outcomes from baseline to endline differs between treatment groups, controlling for baseline level, will be estimated using linear regression. Participants will have the option to continue supplementing until 1 week postpartum to provide a breastmilk and blood sample. Exploratory analyses will be completed to evaluate breastmilk and postpartum blood folate concentrations.

Discussion

This proof-of-concept trial is needed to obtain estimates of the effect of (6S)-5-methyltetrahydrofolic acid compared to folic acid on circulating biomarkers of folate status during pregnancy. These estimates will inform the design of a definitive trial which will be powered to assess whether (6S)-5-methyltetrahydrofolic acid is as effective as folic acid in raising blood folate concentrations during pregnancy. Ultimately, these findings will inform folate supplementation policies for pregnant women.

Trial registration

ClinicalTrials.gov, ID: NCT04022135. Registered on 14 July 2019.

The determinants of maternal homocysteine in pregnancy: findings from the Ottawa and Kingston Birth Cohort

OBJECTIVE

Observational studies have linked elevated homocysteine to vascular conditions. Folate intake has been associated with lower homocysteine concentration, although randomised controlled trials of folic acid supplementation to decrease the incidence of vascular conditions have been inconclusive. We investigated determinants of maternal homocysteine during pregnancy, particularly in a folic acid-fortified population.

DESIGN

Data were from the Ottawa and Kingston Birth Cohort of 8085 participants. We used multivariable regression analyses to identify factors associated with maternal homocysteine, adjusted for gestational age at bloodwork. Continuous factors were modelled using restricted cubic splines. A subgroup analysis examined the modifying effect of MTHFR 677C>T genotype on folate, in determining homocysteine concentration.

SETTING

Participants were recruited in Ottawa and Kingston, Canada, from 2002 to 2009.

PARTICIPANTS

Women were recruited when presenting for prenatal care in the early second trimester.

RESULTS

In 7587 participants, factors significantly associated with higher homocysteine concentration were nulliparous, smoking and chronic hypertension, while factors significantly associated with lower homocysteine concentration were non-Caucasian race, history of a placenta-mediated complication and folic acid supplementation. Maternal age and BMI demonstrated U-shaped associations. Folic acid supplementation of >1 mg/d during pregnancy did not substantially increase folate concentration. In the subgroup analysis, MTHFR 677C>T modified the effect of folate status on homocysteine concentration.

CONCLUSIONS

We identified determinants of maternal homocysteine relevant to the lowering of homocysteine in the post-folic acid fortification era, characterised by folate-replete populations. A focus on periconceptional folic acid supplementation and improving health status may form an effective approach to lower homocysteine.

Serum levels of Homocysteine, Vitamin B12 and Folate in Patients with Multiple Sclerosis: an Updated Meta-Analysis

Background: Multiple sclerosis (MS) is a demyelinating and disabling inflammatory disease of the central nervous system. MS is triggered by complex environmental factors which mostly affect genetically the susceptible young people. Emerging data has suggested that changes of homocysteine (Hcy), Vitamin B12 and folate serum levels may be associated with MS. However, previous findings are not always consistent. Methods: In this study, we aimed to investigate the relationships between MS and Hcy, Vitamin B12 and folate with updated available data (until September, 2019). The diagnosis of MS was performed based on international criteria for the diagnosis of MS, including magnetic resonance imaging and cerebrospinal fluid tests. We searched the databases including PubMed, EMBASE, Cochrane Library and ScienceDirect. After data collection, separate analyses based on random-effect models were used to test for relationships between MS and Hcy, Vitamin B12 or folate blood levels. The effective sizes were estimated by the combined standardized mean difference (SMD) and associated 95% confidence interval (CI). Results: Based on the inclusion criteria, a total of 21 original studies with 1738 MS patients and 1424 controls were included in this study. There were 17 studies for measuring Hcy, 16 studies for measuring Vitamin B12 and 13 studies for measuring folate in patients with MS, respectively. Specifically, patients with MS had higher serum levels of Hcy (SMD: 0.64; 95% CI:0.33, 0.95; P <0.0001) compared with control groups. There were no significant differences of SMD for Vitamin B12 (SMD: -0.08; 95% CI: -0.35, 0.20; P=0.58) or folate (SMD: 0.07; 95% CI: -0.14, 0.28; P=0.52) between MS and controls. Subgroup analysis demonstrated that there was statistically significant difference for Hcy between relapsing-remitting MS (RRMS) patients and controls with a SMD of 0.67 (95% CI: 0.21, 1.13; P=0.004). However, no significant difference of Hcy serum levels between secondary progressive MS patients or primary progressive MS patients and controls was noted in this study. In addition, there was no significant difference of Hcy levels in females (SMD: 0.22; 95% CI: -0.16, 0.60; P=0.25) or males (SMD: 0.56; 95% CI: -0.13, 1.26; P=0.11) between MS patients and controls. Conclusions: Higher serum levels of Hcy were noted in patients with MS when compared with control groups. And the difference was especially significant between RRMS patients and controls. Hcy may play an important role in the pathogenesis of MS. Functional studies are required to assess the effects of Hcy on patients with MS at the molecular level.

Serum Betaine and Dimethylglycine Are Higher in South Asian Compared with European Pregnant Women in Canada, with Betaine and Total Homocysteine Inversely Associated in Early and Midpregnancy, Independent of Ethnicity

BACKGROUND

As a methyl donor required in the folate-vitamin B-12 independent remethylation of total homocysteine (tHcy) to methionine, betaine is critical for fetal development. Pregnant South Asian women living in Canada had a higher reported prevalence of low vitamin B-12 status compared with Europeans; betaine concentrations in this population are unknown.

OBJECTIVES

We aimed to compare serum betaine concentrations between South Asian and European pregnant women, and to determine the relation between betaine and tHcy concentrations in early pregnancy.

METHODS

A retrospective cohort study was conducted using biobanked serum samples of 723 apparently healthy pregnant women of South Asian (50%) and European ethnicity residing in British Columbia, Canada. Betaine, dimethylglycine (DMG), tHcy, and related metabolites were quantified in samples collected in the first (8-13 weeks of gestation) and second (14-20 weeks of gestation) trimesters. The relation between betaine and tHcy concentrations was assessed using a generalized regression model adjusted for weeks of gestation, ethnicity, prepregnancy BMI, maternal age, neonatal sex, parity, total vitamin B-12, folate, pyridoxal 5'-phosphate, and methionine concentrations.

RESULTS

Median serum concentrations of betaine and its metabolite DMG were higher in South Asian women in the first (19.8 [IQR: 16.3-25.0] and 1.55 [IQR: 1.30-1.96] $\mu {\rm mol/L} $, respectively) and second trimesters (16.1 [IQR: 12.9-19.8] and 1.42 [IQR: 1.14-1.81] $\mu {\rm mol/L} $, respectively) compared with European women (17.6 [IQR: 13.7-22.6] and 1.38 [IQR: 1.12-1.77] $\mu {\rm mol/L} $, respectively) and (12.9 [IQR: 10.6-16.7] and 1.19 [IQR: 0.97-1.52] $\mu {\rm mol/L} $, respectively; all P values < 0.0001). Betaine was inversely associated with tHcy concentration (β = -0.0208; 95% CI: -0.0341, -0.00742; P = 0.002). Additionally, total vitamin B-12 was associated with tHcy concentration (β = -0.0312; 95% CI: -0.0401, -0.0224), after adjusting for confounding factors.

CONCLUSIONS

Pregnant South Asian women residing in Canada had higher betaine and DMG concentrations, compared with women of European ethnicity, while betaine and total vitamin B-12 predicted tHcy independent of ethnicity. Our results emphasize the role of betaine, as methyl donor, in the remethylation of tHcy in a folate-replete population.

Suboptimal Biochemical Riboflavin Status Is Associated with Lower Hemoglobin and Higher Rates of Anemia in a Sample of Canadian and Malaysian Women of Reproductive Age

BACKGROUND

Riboflavin is required for several redox reactions. Clinical riboflavin deficiency occurs mainly in low-income countries, where it is associated with anemia. The functional significance of suboptimal riboflavin status in different populations and its role in anemia is not well understood.

OBJECTIVES

We assessed the biomarker status of riboflavin and its association with hemoglobin concentration and anemia in women living in Vancouver, Canada, and Kuala Lumpur, Malaysia.

METHODS

Healthy nonpregnant, nonbreastfeeding women (19-45 y) were recruited from Canada ( n = 206) and Malaysia (n = 210) via convenience sampling. Fasting blood was collected to assess riboflavin status [erythrocyte glutathione reductase activity coefficient (EGRac)], hematological indicators, soluble transferrin receptor (sTfR), ferritin, vitamin A, folate, and vitamin B-12 concentrations. Linear and logistic regression models were used to assess the association of riboflavin status with hemoglobin concentration and anemia.

RESULTS

EGRac (mean ± SD) values were higher, indicating poorer riboflavin status, in Malaysian compared with Canadian women (1.49 ± 0.17 compared with 1.38 ± 0.11). Likewise, riboflavin biomarker deficiency (EGRac ≥1.40) was significantly more prevalent among Malaysians than Canadians (71% compared with 40%). More Malaysian than Canadian women were anemic (hemoglobin <120 g/L; 18% compared with 7%). With use of linear regression (pooled sample; n = 416), EGRac values were negatively associated with hemoglobin concentration (r = -0.18; P < 0.001). This relation remained significant (P = 0.029) after adjusting for age, parity, ethnicity, vitamin B-12, folate, sTfR, ferritin, and vitamin A. Women with riboflavin deficiency (EGRac ≥1.40) were twice as likely to present with anemia (adjusted OR: 2.38; 95% CI: 1.08, 5.27) compared with women with EGRac <1.40.

CONCLUSIONS

Biochemical riboflavin deficiency was observed in Canadian and Malaysian women, with higher rates of deficiency among Malaysian women. Deficient biomarker status of riboflavin was a weak but significant predictor of hemoglobin and anemia, suggesting that the correction of riboflavin deficiency may potentially play a small protective role in anemia, but this requires further investigation.

Implementation of an educational province-wide intervention to reduce redundant vitamin B12 testing: A cross-sectional study

INTRODUCTION

We describe the implementation of an Alberta-wide intervention aimed at educating clinicians about redundant vitamin B₁₂ testing. We hypothesized that the introduction of an educational comment outlining recommended vitamin B₁₂ test intervals would reduce the annual number of vitamin B₁₂ tests performed.

MATERIALS AND METHODS

We performed a cross-sectional observational study that included all vitamin B₁₂ tests ordered in Alberta between May 1, 2017 and April 30, 2018. An educational comment was appended to all vitamin B₁₂ test results in Alberta beginning May 2, 2017. Using a simple seasonal model, we compared predicted versus observed vitamin B₁₂ test volumes for the 12-month period following the introduction of the educational comment. The sole outcome measured was the monthly change in volume of vitamin B₁₂ testing. A cost-analysis of the effects of the intervention on test volumes was also performed.

RESULTS

Over the sum of the first 12 months of the intervention, 18,000 more vitamin B₁₂ tests were ordered compared to the predicted value in Alberta. With an estimated cost of $7 per test, this resulted in a $126,000 increase in costs for vitamin B₁₂ testing provincially.

CONCLUSIONS

An educational intervention aimed at limiting inappropriate vitamin B₁₂ testing in Alberta did not alter testing as desired. Multiple utilization management strategies and a longer observation period may be needed to reduce redundant vitamin B₁₂ testing.

Prenatal Exposure to Environmentally-Relevant Contaminants Perturbs Male Reproductive Parameters Across Multiple Generations that are Partially Protected by Folic Acid Supplementation

The paternal environment is thought to influence sperm quality and future progeny may also be impacted. We hypothesized that prenatal exposure to environmentally-relevant contaminants impairs male reproduction, altering embryo gene expression over multiple generations. Folic acid (FA) can improve sperm quality and pregnancy outcomes, thus we further hypothesized that FA mitigates the contaminants. Sprague-Dawley F0 female rats treated with persistent organic pollutants (POPs) or corn oil and fed basal or supplemented FA diets, then used to yield four generations of litters. Only F0 females received POPs and/or FA treatments. In utero POPs exposure altered sperm parameters in F1, which were partly rescued by FA supplementation. Paternal exposure to POPs reduced sperm quality in F2 males, and the fertility of F3 males was modified by both POPs and FA. Ancestral FA supplementation improved sperm parameters of F4 males, while the POPs effect diminished. Intriguingly, F3 males had the poorest pregnancy outcomes and generated the embryos with the most significantly differentially expressed genes. Early-life exposure to POPs harms male reproduction across multiple generations. FA supplementation partly mitigated the impact of POPs. The two-cell embryo transcriptome is susceptible to paternal environment and could be the foundation for later pregnancy outcomes.

Evidence for the association between FTO gene variants and vitamin B12 concentrations in an Asian Indian population

BACKGROUND

Low vitamin B12 concentrations have been associated with major clinical outcomes, including adiposity, in Indian populations. The Fat mass and obesity-associated gene (FTO) is an established obesity-susceptibility locus; however, it remains unknown whether it influences vitamin B12 status. Hence, we investigated the association of two previously studied FTO polymorphisms with vitamin B12 concentrations and metabolic disease-related outcomes and examined whether these associations were modified by dietary factors and physical activity.

METHODS

A total of 176 individuals with type 2 diabetes, 152 with pre-diabetes, and 220 normal glucose-tolerant individuals were randomly selected from the Chennai Urban Rural Epidemiology Study. Anthropometric, clinical, and biochemical investigations, which included body mass index (BMI), waist circumference, vitamin B12, homocysteine, and folic acid were measured. A validated food frequency questionnaire was used for dietary assessment and self-reported physical activity measures were collected. An unweighted genetic risk score (GRS) was calculated for two FTO single-nucleotide polymorphisms (rs8050136 and rs2388405) by summation of the number of risk alleles for obesity. Interaction analyses were performed by including the interaction terms in the regression model.

RESULTS

The GRS was significantly associated with increased BMI (P = 0.009) and risk of obesity (P = 0.023). Individuals carrying more than one risk allele for the GRS had 13.13% lower vitamin B12 concentrations, compared to individuals carrying zero risk alleles (P = 0.018). No associations between the GRS and folic acid and homocysteine concentrations were observed. Furthermore, no statistically significant GRS-diet or GRS-physical activity interactions with vitamin B12, folic acid, homocysteine or metabolic-disease outcomes were observed.

CONCLUSION

The study shows for the first time that a genetic risk score using two FTO SNPs is associated with lower vitamin B12 concentrations; however, we did not identify any evidence for the influence of lifestyle factors on this association. Further replication studies in larger cohorts are warranted to investigate the association between the GRS and vitamin B12 concentrations.

Folate and vitamin B12 status and their relation to hematological indices in healthy adults of Iranians: Azar cohort study

BACKGROUND:

Folate and vitamin B₁₂ are essential micronutrients, the deficiency of which can be associated with public health problems worldwide.

AIM:

The aims of this study were to assess the folate and vitamin B₁₂ status of healthy adults and the effect of gender differences on their deficiency using serum folate, vitamin B₁₂ and red blood cell (RBC) folate as biomarkers and their relation to hematological indices.

METHODS:

This study was a part of the Azar cohort study, which is designed as a noncommunicable disease survey in the population of Shabestar, East Azerbaijan, Iran. A total of 95 healthy adults (35 men, 60 women) were chosen according to exclusion criteria and assessed using demographic characteristics and blood sampling.

RESULTS:

Low concentrations of serum folate, vitamin B₁₂ and RBC folate were detected in 16.8%, 61.1% and 40% of all subjects, respectively. Prevalence of low serum folate and vitamin B₁₂ was higher in men than women (25.7% versus 11.7% for serum folate, 77.1% versus 51.7% for serum vitamin B₁₂).A significant positive correlation was found between hemoglobin and serum folate, vitamin B₁₂ and RBC folate concentrations ( r = 0.279, 0.335, 0.228, respectively). No statistically significant correlation between mean corpuscular volume and serum folate, vitamin B₁₂ and RBC folate was seen ( r = -0.049, -0.030, -0.016, respectively).

CONCLUSIONS:

There was a high prevalence of low folate and vitamin B₁₂ concentrations in our community. Regarding the impact of these two vitamins deficiency on overall health, we suggest further investigations with more participants. In addition, monitoring hematological indices could be useful in people with folate and vitamin B₁₂ deficiency.

The role of maternal homocysteine concentration in placenta-mediated complications: findings from the Ottawa and Kingston birth cohort

Background

Homocysteine is an intermediate metabolite implicated in the risk of placenta-mediated complications, including preeclampsia, placental abruption, fetal growth restriction, and pregnancy loss. Large cohort and case-control studies have reported inconsistent associations between homocysteine and these complications. The purpose of this study was to investigate whether elevated maternal plasma homocysteine concentration in the early to mid-second trimester is associated with an increased risk of placenta-mediated complications. We examined the following potential moderating factors that may explain discrepancies among previous studies: high-risk pregnancy and the MTHFR 677C>T polymorphism.

Methods

We analyzed data from participants recruited to the Ottawa and Kingston (OaK) Birth Cohort from 2002 to 2009 in Ottawa and Kingston, Canada. The primary outcome was a composite of any placenta-mediated complication, defined as a composite of small for gestational age (SGA) infant, preeclampsia, placental abruption, and pregnancy loss. Secondary outcomes were, individually: SGA infant, preeclampsia, placental abruption, and pregnancy loss. We conducted multivariable logistic regression analyses with homocysteine as the primary continuous exposure, adjusting for gestational age at the time of bloodwork and explanatory maternal characteristics. The functional form, i.e., the shape of the homocysteine association with the outcome was examined using restricted cubic splines and information criteria (Akaike’s/Bayesian Information Criterion statistics). Missing data were handled with multiple imputation.

Results

7587 cohort participants were included in the study. Maternal plasma homocysteine concentration was significantly associated (linearly) with an increased risk of both the composite outcome of any placenta-mediated complication (p = 0.0007), SGA (p = 0.0010), severe SGA, and marginally with severe preeclampsia, but not preeclampsia, placental abruption and pregnancy loss. An increase in homocysteine concentration significantly increased the odds of any placenta-mediated complication (odds ratio (OR) for a 5 μmol/L increase: 1.63, 95% Confidence Interval (CI) 1.23–2.16) and SGA (OR 1.76, 95% CI 1.25–2.46). Subgroup analyses indicated some potential for modifying effects of the MTHFR 677C>T genotype and high-risk pregnancy, although the interaction was not statistically significant (high-risk subgroup OR 2.37, 95% CI 1.24–4.53, p-value for interaction =0.14).

Conclusions

Our results suggest an independent effect of early to mid-pregnancy elevated maternal homocysteine on placenta-mediated pregnancy complications.

Electronic supplementary material

The online version of this article (10.1186/s12884-019-2219-5) contains supplementary material, which is available to authorized users.

Impact of diet management and composition on vitamin B12 concentration in milk of Holstein cows

As vitamin B12 is only synthesized by bacteria, ruminant products, especially dairy products, are excellent sources of this vitamin. This study aims to identify if diet and cow characteristics could affect vitamin B12 concentration in milk of dairy cows. Information on 1484 first, 1093 second and 1763 third and greater parity Holstein cows in 100 herds was collected during three consecutive milkings. During the first morning milking, all dietary ingredients given to cows were sampled and quantities offered were recorded throughout the day. Nutrient composition of ingredients was obtained by wet chemistry to reconstitute nutrient composition of the ration. Milk samples were taken with in-line milk meters during the evening milking of the 1st day and the morning milking of the 2nd day and were analyzed for vitamin B12 concentration. Milk yields were recorded and milk components were separately analyzed for each milking. Daily vitamin B12 concentration in milk was obtained using morning and evening vitamin B12 concentrations weighted with respective milk yield, then divided by daily yield. To decrease the number of interdependent variables to include in the multivariable model, a principal component analysis was carried out. Daily milk concentration of vitamin B12 averaged 3809±80 pg/ml, 4178±79 pg/ml and 4399±77 pg/ml for first, second and third, and greater lactation cows. Out of 11 principal components, six were significantly related to daily milk concentration of vitamin B12 when entered in the multivariable model. Results suggested that vitamin B12 concentration in milk was positively related to percentage of fiber and negatively related to starch as well as energy of the diet. Negative relationships were noted between vitamin B12 concentration in milk and milk yield as well as milk lactose concentration and positive relationships were observed between vitamin B12 concentration in milk and milk fat as well as protein concentrations. The percentages of chopped mixed silage and commercial energy supplement in the diet as well as cow BW were positively related to vitamin B12 in milk and percentages of baled mixed silage, corn and commercial protein supplement in the ration were negatively related to vitamin B12 concentration in milk. The pseudo-R2 of the model was low (52%) suggesting that diet and cow characteristics have moderate impact on vitamin B12 concentration in milk. Moreover, when entering solely the principal component related to milk production in the model, the pseudo-R2 was 46%. In conclusion, it suggests that studied diet characteristics have a marginal impact on vitamin B12 concentration in milk variation.

Approaches to improving micronutrient status assessment at the population level

Optimising micronutrient status globally is a major health priority. Nutritional biomarkers are critical for the identification of nutrient inadequacies in light of the limitations of dietary assessment methods. Early diagnosis and prevention of nutrient inadequacies require sensitive, validated and harmonised methods to determine and monitor micronutrient status in individual healthcare and population-based surveys. Important criteria in the identification, validation and implementation of nutritional biomarkers include the testing of biomarker specificity and sensitivity, and their response to dietary as well as physiologic changes, e.g. age or pregnancy. Nutritional status can be categorised into deficient, suboptimal, adequate and excess status, where appropriate, and provided cut-offs are available. Cut-offs are quantitative measures to reflect health outcomes and are important in validating nutritional surveys, interventions and monitoring of populations. For many biomarkers, available cut-offs have limited interpretability and are most commonly derived in adult populations only. For the comparison of studies from across the globe, the harmonisation of analytical methods is essential and can be realised with the use of internationally available reference material and interlaboratory comparison studies. This narrative review describes current efforts on identifying and validating existing and new biomarkers, the derivation of biomarker cut-offs, and international efforts on harmonisation of laboratory methods for biomarker quantitation and their interpretation, in the example of B-vitamins. Establishing sensitive, reliable and cost-efficient biomarkers and related cut-offs for use in populations across the globe are critical to facilitating the early diagnosis of micronutrient inadequacies on the clinical and community-based level for timely intervention and disease prevention.

Biomarkers of Nutrition for Development (BOND): Vitamin B-12 Review

This report on vitamin B-12 (B12) is part of the Biomarkers of Nutrition for Development (BOND) Project, which provides state-of-the art information and advice on the selection, use, and interpretation of biomarkers of nutrient exposure, status, and function. As with the other 5 reports in this series, which focused on iodine, folate, zinc, iron, and vitamin A, this B12 report was developed with the assistance of an expert panel (BOND B12 EP) and other experts who provided information during a consultation. The experts reviewed the existing literature in depth in order to consolidate existing relevant information on the biology of B12, including known and possible effects of insufficiency, and available and potential biomarkers of status. Unlike the situation for the other 5 nutrients reviewed during the BOND project, there has been relatively little previous attention paid to B12 status and its biomarkers, so this report is a landmark in terms of the consolidation and interpretation of the available information on B12 nutrition. Historically, most focus has been on diagnosis and treatment of clinical symptoms of B12 deficiency, which result primarily from pernicious anemia or strict vegetarianism. More recently, we have become aware of the high prevalence of B12 insufficiency in populations consuming low amounts of animal-source foods, which can be detected with ≥1 serum biomarker but presents the new challenge of identifying functional consequences that may require public health interventions.

Adequate vitamin B12 and riboflavin status from menus alone in residential care facilities in the Lower Mainland, British Columbia

Older adults have potential increased risk of nutrient deficiencies because of age-related decreased dietary intake and malabsorption; it is important to ensure nutrient needs are met to avoid adverse health outcomes. B vitamins are of particular interest: vitamin B₁₂ deficiency can cause irreversible neurodegeneration; there is mandatory folic acid fortification in Canada; and suboptimal riboflavin status has been reported among older adults in the United Kingdom. In this exploratory secondary analysis study we assessed vitamin B₁₂ and riboflavin biochemical status (via microparticle enzyme immunoassay and erythrocyte glutathione reductase activity coefficient (EGRac), respectively), and the vitamin B₁₂, riboflavin, and folate content of menus served to a convenience sample of older adults (≥65 years) from 5 residential care facilities within the Lower Mainland of British Columbia, Canada. Diet was assessed from customized 28-day cycle meal plans. Participants (n = 207; 53 men and 154 women) were aged 86 ± 7 years, largely of European descent (92%), and nonsmokers (95%). The menus served had a low prevalence of inadequacy for vitamin B₁₂ and riboflavin (only 4% and 1% of menus contained less than the estimated average requirement (EAR), respectively), but 93% contained less than the EAR for folate. Mean ± SD serum total vitamin B₁₂ concentration was 422 ± 209 pmol/L, and EGRac was 1.30 ± 0.19. The majority of older adults in residential care were provided with adequate vitamin B₁₂ and riboflavin menu amounts, and only 5% were vitamin B₁₂ deficient (<148 pmol/L). However, 26% were riboflavin deficient (EGRac ≥ 1.4), which may warrant further investigation.

Nuclear Folate Metabolism

Despite unequivocal evidence that folate deficiency increases risk for human pathologies, and that folic acid intake among women of childbearing age markedly decreases risk for birth defects, definitive evidence for a causal biochemical pathway linking folate to disease and birth defect etiology remains elusive. The de novo and salvage pathways for thymidylate synthesis translocate to the nucleus of mammalian cells during S- and G2/M-phases of the cell cycle and associate with the DNA replication and repair machinery, which limits uracil misincorporation into DNA and genome instability. There is increasing evidence that impairments in nuclear de novo thymidylate synthesis occur in many pathologies resulting from impairments in one-carbon metabolism. Understanding the roles and regulation of nuclear de novo thymidylate synthesis and its relationship to genome stability will increase our understanding of the fundamental mechanisms underlying folate- and vitamin B12-associated pathologies.

Folate deficiency increases chromosomal damage and mutations in hematopoietic cells in the transgenic mutamouse model

Folate deficiency causes megaloblastic anemia and neural tube defects, and is also associated with some cancers. In vitro, folate deficiency increases mutation frequency and genome instability, as well as exacerbates the mutagenic potential of known environmental mutagens. Conversely, it remains unclear whether or not elevated folic acid (FA) intakes are beneficial or detrimental to the induction of DNA mutations and by proxy human health. We used the MutaMouse transgenic model to examine the in vivo effects of FA deficient, control, and supplemented diets on somatic DNA mutant frequency (MF) and genome instability in hematopoietic cells. We also examined the interaction between FA intake and exposure to the known mutagen N-ethyl-N-nitrosourea (ENU) on MF. Male mice were fed the experimental diets for 20 weeks from weaning. Half of the mice from each diet group were gavaged with 50 mg/kg body weight ENU after 10 weeks on diet and remained on their respective diet for an additional 10 weeks. Mice fed a FA-deficient diet had a 1.3-fold increase in normochromatic erythrocyte micronucleus (MN) frequency (P = 0.034), and a doubling of bone marrow lacZ MF (P = 0.035), compared to control-fed mice. Mice exposed to ENU showed significantly higher bone marrow lacZ and Pig-a MF, but there was no effect of FA intake on ENU-induced MF. These data indicate that FA deficiency increases mutations and MN formation in highly proliferative somatic cells, but that FA intake does not mitigate ENU-induced mutations. Also, FA intake above adequacy had no beneficial or detrimental effect on mutations or MN formation. Environ. Mol. Mutagen. 59:366-374, 2018. © 2018 Her Majesty the Queen in Right of Canada 2018.

Maternal gene-micronutrient interactions related to one-carbon metabolism and the risk of myelomeningocele among offspring

BACKGROUND

Few studies have evaluated interactions between maternal genetic variation in 5,10-methylenetetrahydrofolate reductase (MTHFR) and micronutrient intake on the risk of myelomeningocele (MM) in offspring. Therefore, we sought to determine if the role of maternal MTHFR C677T and A1298C on MM risk is altered by maternal intake of micronutrients related to one-carbon metabolism.

METHODS

The study consisted of 220 MM case-parent trios recruited from 1996 to 2006. A dietary questionnaire was used to obtain information on maternal dietary intake on eight micronutrients including folate and cobalamin. TaqMan assays were used to generate MTHFR C677T and A1298C genotypes. Log-linear models were used to evaluate the joint effects of maternal genotype and micronutrient intake dichotomized as at or above versus below the United States Recommended Dietary Allowance (US RDA) on MM.

RESULTS

There was little evidence to suggest maternal MTHFR genotypes interacted with micronutrient intake to influence the risk of MM. For instance, the effect of MTHFR 677T was similar for mothers with cobalamin intake below US RDA (relative risk [RR] = 0.97) versus at or above US RDA cobalamin intake (RR = 0.81, interaction p = 0.87). However, some differences were noted. For example, the effect of MTHFR 1298C appeared to be different between those mothers below US RDA folate intake (RR = 0.98) versus those at or above US RDA folate intake (RR = 0.68), but the interaction was not statistically significant (interaction p = 0.27).

CONCLUSION

There did not appear to be strong effects of maternal micronutrient intake on the role of maternal genetic polymorphisms in MTHFR C677T and A1298C on MM risk. Birth Defects Research 109:99-105, 2017. © 2016 Wiley Periodicals, Inc.

Maternal folic acid supplementation with vitamin B12 deficiency during pregnancy and lactation affects the metabolic health of adult female offspring but is dependent on offspring diet

Epidemiologic studies have reported relationships between maternal high folate and/or low B₁₂ status during pregnancy and greater adiposity and insulin resistance in children. The goal of this study was to determine the effects of maternal folic acid supplementation (10 mg/kg diet), with (50 μg/kg diet) and without B₁₂, on adult female offspring adiposity and glucose homeostasis. Female C57BL/6J mice were fed 1 of 3 diets from weaning and throughout breeding, pregnancy, and lactation: control (2 mg/kg diet folic acid, 50 μg/kg diet B₁₂), supplemental folic acid with no B₁₂ (SFA-B₁₂), or supplemental folic acid with adequate B₁₂ (SFA+B₁₂). Female offspring were weaned onto the control diet or a Western diet (45% energy fat, 2 mg/kg diet folic acid, 50 μg/kg diet B₁₂) for 35 wk. After weaning, control diet-fed offspring with SFA-B₁₂ dams had fasting hyperglycemia, glucose intolerance, lower β cell mass, and greater islet hepatocyte nuclear factor 1 homeobox α and nuclear receptor subfamily 1 group H member 3 mRNA than did offspring from control dams. In Western diet-fed offspring, those with SFA-B₁₂ dams had lower fasting blood glucose and plasma insulin concentrations, and were smaller than control offspring. Our findings suggest that maternal folic acid supplementation with B₁₂ deficiency during pregnancy/lactation programs the metabolic health of adult female offspring but is dependent on offspring diet.-Henderson, A. M., Tai, D. C., Aleliunas, R. E., Aljaadi, A. M., Glier, M. B., Xu, E. E., Miller, J. W., Verchere, C. B., Green, T. J., Devlin, A. M. Maternal folic acid supplementation with vitamin B₁₂ deficiency during pregnancy and lactation affects the metabolic health of adult female offspring but is dependent on offspring diet.