[The importance of folic acid deficiency in the pathogenesis of vascular, mixed and Alzheimer's disease dementia]

Alzheimer's disease (AD), vascular dementia (VaD) and mixed dementia (MD) are the most common dementia diseases among the elderly. Currently, there is no effective treatment of these diseases and, therefore, it seems justified to develop the principles of prevention, taking into account the elimination of risk factors. Among them folic acid deficiency may play an important role.

THE AIM OF THE STUDY

To evaluate possible relationship of folate deficiency with the development of selected dementia diseases: vascular dementia (VaD), Alzheimer's disease (AD), mixed dementia (MD).

MATERIAL AND METHODS

The study involved 166 people, including 47 people with the diagnosis of AD, 41 with VaD and 36 with MD. The control group consisted of 42 persons without cognitive impairment. All patients underwent a general physical, neurological, psychiatric and extensive neuropsychological examination, as well as routine blood and biochemical screening tests and neuroimaging. The level of serum folate (Fol) was measured by electrochemiluminescence immunoassay. To assess the correlation of Fol level with the cognitive impairment neuropsychometric scales: Mini Mental State Examination (MMSE) and Clinical Dementia Rating (CDR) were used.

RESULTS

In patients with dementia, compared with the control group, there were significantly lower levels of folic acid (p = 0.04). There was no difference in the concentration of Fol in groups of patients (p = 0.0889). In people without cognitive impairment (CDR 0) levels of folic acid were significantly higher compared to the group with moderate dementia (CDR 2, p = 0.0475).

CONCLUSIONS

The results may suggest that folic acid deficiency is one of the possible causes of dementia, but does not determine its type. Determination of serum Fol in the elderly and supplementation of this vitamin deficiency may play an important role in the prevention of the most common dementias.

Influence of maternal vitamin B12 and folate on growth and insulin resistance in the offspring

The burden of chronic noncommunicable diseases (NCDs) such as diabetes, obesity and cardiovascular disease is shifting rapidly to low- and middle-income countries. It calls for a review of the classic 'dogma' of genetic predisposition, precipitated by adult lifestyle. The paradigm of early life origins of chronic disease has focused attention on maternal health and nutrition as major determinants of the health of the offspring. India has high burden of maternal ill health and also of diabetes and cardiovascular disease, offering unique opportunities to study the links between the two. Pune studies showed that the Indian babies were thin but fat (more adipose) compared to European babies, and that maternal micronutrient status during pregnancy was a determinant of offspring size and body composition. Two thirds of the mothers had low vitamin B12 concentrations, while folate deficiency was rare. Higher circulating concentrations of homocysteine predicted smaller baby size. Follow-up studies revealed that higher maternal folate in pregnancy predicted higher adiposity and insulin resistance in the child at 6 years of age, and that low maternal vitamin B12 exaggerated the risk of insulin resistance. Low maternal vitamin B12 status is also associated with increased risk of neural tube defects and poor offspring cognitive functions. Our results suggest an important role for maternal one-carbon metabolism in offspring growth and programming of NCD risk. These ideas are supported by animal studies. Improvement of adolescent nutrition could effect intergenerational prevention of chronic diseases.

Low clinical utility of folate determinations in primary care setting

BACKGROUND

Fortification of cereal products with folic acid is not mandatory in Israel, yet folate deficiency remains rare and is usually associated with poor diet, malabsorption, alcoholism, or use of certain drugs. A retrospective review of all folate level determinations performed between January 2004 and January 2007 in the central district of Clalit Health Services in Israel revealed that only 4.3% of the 43,176 tests ordered were below the norm (5.6 nmol/L).

OBJECTIVES

To determine parameters that identify folate-deficient patients without known risk factors and to establish principles that aid the physician in deciding when to order folate determinations.

METHODS

Study population included 152 patients from 13 large primary care clinics with folate deficiency but without known risk factors for folate deficiency (37 with anemia). They were matched with 556 controls (141 with anemia).The medical records were reviewed for the indication of the test and treatment that followed the results.

RESULTS

Hematologic indices, vitamin B12, ferritin, and transferrin saturation levels were similar in the study and control groups. Subgroup comparisons based on anemia status showed similar results. The clinical indications for folate determinations were similar in the folate-deficient patients and the control group. Only 68 of 152 patients (44.7%) were prescribed a folate supplement.

CONCLUSIONS

Neither laboratory parameters nor clinical findings in patients' charts were capable of distinguishing folate-deficient patients from controls. It seems that folate determinations in patients without known risk factors for folate deficiency are of little clinical significance.

Utility, charge, and cost of inpatient and emergency department serum folate testing

BACKGROUND

Serum folate levels are commonly ordered for multiple indications in the inpatient and emergency department settings. Since mandatory folic acid fortification in 1998, there has been a decreasing prevalence of folate deficiency in the United States.

OBJECTIVE

Our objective was to determine the indications, rate of deficiency, charge and cost per deficient result, and change in management per deficient result in serum folate testing in inpatients and emergency department patients.

DESIGN

Retrospective analysis of all inpatient and emergency department serum folate tests.

METHODS

We analyzed all inpatient and emergency department serum folate tests performed over a 12-month period. We reviewed the charts of 250 patients and all low-normal or deficient serum folate levels to determine indications, comorbidities, and change in management based on result. Charge and cost analyses were performed.

SETTING/PATIENTS

All inpatient and emergency department patients with a serum folate test performed at a major medical center in Boston, Massachusetts.

RESULTS

A total of 2093 serum folate tests were performed in 1944 patients with 2 deficient levels. The most common indications were anemia without macrocytosis and anemia with macrocytosis. The amount charged per deficient result was $158,022. The cost to the hospital per deficient result was less than $2093.

CONCLUSIONS

In folic acid fortified countries, serum folate testing has low utility and poor cost effectiveness for all indications in inpatients and emergency department patients.

Prospective study of genomic hypomethylation of leukocyte DNA and colorectal cancer risk

BACKGROUND

Systematic genome-wide reductions of methylated cytosine (5-mC) levels have been observed in colorectal cancer tissue and are suspected to play a role in carcinogenesis, possibly as a consequence of inadequate folate intake. Reduced 5-mC levels in peripheral blood leukocytes have been associated with increased risk of colorectal cancer and adenoma in cross-sectional studies.

METHODS

To minimize disease- and/or treatment-related effects, we studied leukocyte 5-mC levels in prospectively collected blood specimens of 370 cases and 493 controls who were cancer-free at blood collection from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Leukocyte 5-mC level was determined by a high-pressure liquid chromatography (HPLC)/tandem mass spectrometry method and expressed as the relative amount of methyl to total cytosine residues, or %5-mC. We estimated the association between colorectal cancer risk and %5-mC categories by computing ORs and 95% confidence intervals (CI) through logistic regression modeling.

RESULTS

We observed no dose-dependent association between colorectal cancer and%5-mC categories (lowest vs. highest tertile: OR, 1.14; 95% CI, 0.80-1.63; P(trend) = 0.51). However, among subjects whose 5-mC levels were at the highest tertile, we observed an inverse association between natural folate intake and colorectal cancer (highest tertile of natural folate vs. lowest: OR, 0.35; 95% CI, 0.17-0.71; P(trend) = 0.003; P(interaction) = 0.003).

CONCLUSIONS

This prospective investigation show no clear association between leukocyte 5-mC level and subsequent colorectal cancer risk but a suggestive risk modification between 5-mC level and natural folate intake.

IMPACT

Adequate folate status may protect against colorectal carcinogenesis through mechanisms involving adequate DNA methylation in the genome.

No increased mortality risk in older persons with unexplained anaemia

BACKGROUND

in older persons, anaemia is associated with a number of unfavourable outcomes. In approximately 30% of older persons with anaemia, the cause of the anaemia is unexplained. We assessed the clinical differences between subjects with explained and unexplained anaemia and investigated whether these subjects have different mortality patterns compared with subjects without anaemia.

DESIGN

observational prospective follow-up study.

SETTING

the Leiden 85-plus study.

PARTICIPANTS

four hundred and ninety-one persons aged 86 years.

METHODS

the study population was divided in three groups: (i) no anaemia (reference group, n=377), (ii) explained anaemia (iron deficiency, folate deficiency, vitamin B12 deficiency, signs of myelodysplastic syndrome or renal failure, n=74) and (iii) unexplained anaemia, (n=40). Mortality risks were estimated with Cox-proportional hazard models.

RESULTS

haemoglobin levels were significantly lower in subjects with explained anaemia than in subjects with unexplained anaemia (P<0.01). An increased risk for mortality was observed in subjects with explained anaemia [HR: 1.93 (95% CI: 1.47-2.52), P<0.001], but not in subjects with unexplained anaemia [HR: 1.19 (95% CI: 0.85-1.69), P=0.31]. Adjusted analyses (sex, co-morbidity, MMSE, institutionalised and smoking) did not change the observed associations for both explained and unexplained anaemic subjects.

CONCLUSION

older subjects with unexplained anaemia had similar survival compared with non-anaemic subjects. Increased mortality risks were observed in subjects with explained anaemia compared with non-anaemic subjects.

Healthcare-related characteristics of low vs normal folate levels among women of child-bearing age

OBJECTIVE

Despite the institution of mandatory folic acid fortification in the US, folate deficiencies still occur and are associated with an increased risk of several conditions. Since little is known regarding the relationship between folate status and other clinical, demographic, and healthcare-related characteristics, the objective of the study was to compare healthcare-related characteristics among US child-bearing age women with low vs normal red blood cell (RBC) folate levels.

RESEARCH DESIGN AND METHODS

Data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES) were used to conduct a retrospective cohort study. Women (aged 18-45 when surveyed) were categorized in two cohorts for comparison: normal RBC folate level (≥ 140 ng/ml, NFL) and low RBC folate level (<140 ng/ml, LFL).

RESULTS

Of the 2816 subjects, 5.9% were assigned to the LFL cohort and were significantly younger (28 vs 30 years, p=0.01); a greater proportion were 18-25 years old (55.7% vs 39.9%, p<0.001) or African-American (55.1% vs 22.3%, p<0.01). A lower proportion of LFL women were insured (67.3% vs 75.5%, p=0.01) with low rates of private insurance (39.5% vs 53.1%, p<0.01), while Medicaid/SCHIP coverage was similar (16.8% vs 15.1%, p=0.56). Predictors of low folate levels included aged 36-45 years (OR: 2.14 [95% CI: 1.04, 4.39]) and never being married (2.65 [1.34, 5.24]), while a household income ≥ $75,000 reduced the likelihood of having low folate levels (0.20 [0.06, 0.73]).

LIMITATIONS

The proportion of women with low folate levels was small, with the sample size limiting the ability to adjust for other factors during analysis. Medical histories were based on patient interviews and are subject to recall bias.

CONCLUSION

LFL women are younger and have low rates of private insurance coverage compared to women with normal folate levels. Differences in age, marital status, and household income are associated with folate status.

Lack of folate improvement in high risk indigenous Australian adults over an average of 6.5 years: a cohort study

Socioeconomically vulnerable groups in developed countries suffer excess chronic disease due in large part to an energy dense but nutrient poor diet. Low folate can be a marker of poor dietary quality and is also affected by smoking and chronic alcohol intake, all of which cluster in groups with a low socioeconomic position. A 4.5 to 9 year follow-up study of 567 indigenous adults from remote communities in far north Queensland, Australia, from 1998 to 2007 was conducted. Analysis of the effects of demographic factors, smoking, risky alcohol drinking, fruit and vegetable intake and waist circumference on changes in red cell folate (RCF) status was conducted. Prevalence of low red cell folate doubled in the cohort from a high baseline over this seven year period: 36.9% deficient in 2007, 15.9% at baseline (p<0.001). Smoking was associated with lower folate levels. People with a normal RCF were less likely to be smokers, and were more likely to have a greater number of serves of vegetables (RR 1.06, 95% CI 1.02-1.10) than those who were deficient at follow-up. The introduction of voluntary folate fortification since 1995 does not appear to have impacted on the already poor folate status of this cohort of adults. The increased prevalence of low folate has occurred despite improvements in the food supply, indicating the need for nutrition promotion, and subsidies for healthy food in remote communities. The impact of mandatory folate fortification of flour since 2009 should be assessed in this high risk population.

Monitoring folate status in population-based surveys

Folate status assessments depend primarily on the measurement of biomarkers such as serum and red blood cell folate. Lessons learned from a large national monitoring system such as the National Health and Nutrition Examination Survey and a public health intervention such as the implementation of folic acid fortification in the United States have provided useful insights into the challenges of assessing folate status and possible solutions for addressing these challenges. © 2011 International Union of Biochemistry and Molecular Biology, Inc. 2011.

Association between folate status, diabetes, antihypertensive medication and age-related cataracts in elderly Taiwanese

OBJECTIVE

To evaluate possible risk factors for cataract in elderly Taiwanese, and to investigate whether the relationship between age and cataract in older persons is modified by other cataract-associated risk factors.

PARTICIPANTS

A cross-sectional study of 661 males and 645 females aged ≥ 65 yrs was conducted as part of the Elderly Nutrition and Health Survey in Taiwan (1999-2000) (Elderly NAHSIT).

METHODS

Self-reported cataracts were defined as any incidence of cataract that was diagnosed by a physician and treated by anticataractic drugs based on the medical history section of the Elderly NAHSIT. Potential risk factors for cataract were determined by multiple logistic regression analysis of data obtained from the health examination, blood biochemistry and interviewer-administered questionnaires.

RESULTS

Results showed that the prevalence of self-reported cataract increased with age and was significantly higher in older women than in older men. Cataracts were associated with age, diabetes, antihypertensive medication and folate insufficiency in older men, and with age and antihypertensive medication in older women. Folate insufficiency remained associated with cataract in older men who had adequate vitamin B2, B6 and B12 status. Folate insufficiency was associated with cataract after adjustment for other risk factors in older men aged ≥ 75 yrs, while in older men aged 65-74 yrs, only diabetes and antihypertensive medication remained associated with cataract. In addition, age ≥ 75 yrs remained a risk factor for cataract in those without diabetes, not taking hypertensive medication and with normal folate status. Further analysis showed that the strength of the association between age ≥ 75 yrs in older men and cataracts was increased about 1.5-fold when combined with folate insufficiency (interaction p= 0.0198), and increased about 1.8-fold when combined with use of antihypertensive medication (interaction p = 0.0214).

CONCLUSION

Our results suggest that the combination of age ≥ 75 yrs in older men with either folate insufficiency or use of antihypertensive medication had an additive effect on the risk of cataract. Maintenance of good folate status should be emphasized to reduce the risk of cataract in the Taiwanese elderly, especially men.

Trends in folate status in the Taiwanese population aged 19 years and older from the Nutrition and Health Survey in Taiwan 1993-1996 to 2005-2008

To investigate ten year trends in folate status in Taiwanese aged >=19 yrs by three Nutrition and Health Survey in Taiwan (NAHSIT) in 1993-1996, 1999-2000 and 2005-2008. Women had higher blood folate levels than men in all three surveys. The prevalence of folate deficiency (5.2% <3 ng/mL) and insufficiency (34.1% <=6 ng/mL) in men was highest in 2005-2008. Adults aged 19-30 yrs had the lowest blood levels and the highest prevalence of deficiency (8.1% in men; 3.5% in women) and insufficiency (48.6% in men; 25% in women) as compared to other age groups in 2005-2008. Folate insufficiency rate in those aged 31-44 yrs was twice as high in men and three times as high in women in 2005-2008 compared to 1993-1996. In the elderly, folate insufficiency rate (28%) in 2005-2008 was not higher than that of 1993-1996, although it was higher than that found in 1999-2000 (18.4%). Men aged >=80 yrs had the poorest folate status in 2005-2008, and men were twice as likely to have inadequate status as women. Plasma homocysteine (Hcy) levels were higher in older men than older women in both surveys. The elderly had significantly higher plasma tHcy in 2005-2008 compared to the 1999-2000 survey. Dark green vegetables and fruit intake frequency in young adults (19-30 yrs) was the lowest among all age groups. This study suggests that folate status in Taiwan has not improved during the past fifteen years, and has worsened in the young population.

Age-related hearing loss, vitamin B12, and folate in the elderly

OBJECTIVE

Determine the correlation between the hearing threshold and the serum levels of vitamin B12 (cobalamin) and folic acid among elderly subjects (> 60 years) with age-related hearing loss (ARHL).

STUDY DESIGN

Cross-sectional.

SETTING

Community.

SUBJECTS AND METHODS

Subjects included elderly who were found apparently healthy following repeated examination by physicians. The pure tone average (PTA) for the speech and high frequencies, and the serum folate and cobalamin were determined and the correlation found.

RESULTS

The mean ± SD values of serum folate among the subjects with normal PTA in the speech frequencies (0-30 dB) was 412.3 nmol/L ± 17.6 nmol/L, while among those with hearing loss (HL), it was 279.1 nmol/L ± 17.2 nmol/L (P = 0.01). In the high frequencies, the mean ± SD values among the subjects with normal PTA was 426.3 nmol/L ± 17.6 nmol/L, while among those with HL, it was 279.14 nmol/L ± 171.2 nmol/L. The serum cobalamin among the subjects with normal PTA within the speech frequencies was 49.7 pmol/L ± 9.4 pmol/L, while among those with speech-frequency HL, it was 42.6 pmol/L ± 10.2 pmol/L. However, for high frequencies, the mean ± SD values among the subjects with normal PTA was 47.4 pmol/L ± 7.3 pmol/L, while among those with HL, it was 41.3 pmol/L ± 9.2 pmol/L. Spearman's correlation revealed that low folate (correlation coefficient = -0.27, P = 0.01) and cyanocobalamin (correlation coefficient = -0.35, P = 0.02) were significantly associated with increasing hearing threshold in the high frequencies. After adjusting for age, serum folate (correlation coefficient = -0.01, P = 0.01) was significant, while vitamin B12 (correlation coefficient = -0.01, P = 0.74) was not.

CONCLUSION

Serum folate was significantly lower among elderly with ARHL. Trials on nutritional supplementation may substantiate the role of serum folate in ARHL.

Serum vitamin B12 and folate status in patients with inflammatory bowel diseases

BACKGROUND

The aims of this study were to investigate the prevalence of serum vitamin B(12) and folate abnormalities in patients with inflammatory bowel diseases (IBD) and to identify risk factors associated with B12 and folate abnormalities in this entity.

METHODS

138 patients with IBD (45 Crohn's disease and 93 ulcerative colitis) and 53 healthy subjects were enrolled into the study. Fasting serum B12 and folic acid levels were measured and clinical data regarding inflammatory bowel diseases were gathered.

RESULTS

While the mean serum B(12) concentration in CD patients was 281+/-166pg/ml, the mean serum vitamin B12 concentration in UC patients was 348+/-218pg/ml (p=0.224). The number of patients with vitamin B12 deficiency in the CD group was greater than the number of patients with UC [n=10 (22%) vs. n=4 (7.5%), p=0.014]. The number of patients (n=10, 22%) with B12 deficiency in the CD group was also greater than controls (n=4, 7.5%) (p=0.039). With regard to folate levels, the median serum folate level was 7.7+/-5.3ng/ml in CD patients, 8.6+/-8.3ng/ml in UC patients and 9.9+/-3.3ng/ml in the control group (p=n.s.). Patients with a prior ileocolonic resection had an abnormal B12 concentration compared to patients without surgery (p=0.008). In CD patients, ileal involvement was the only independent risk factor for having a low folate level.

CONCLUSION

Serum vitamin B12 and folate deficiencies are common in patients with CD compared to UC patients and controls. In CD patients, prior small intestinal surgery is an independent risk factor for having a low serum vitamin B12 level.

Prevalence of anaemia, deficiencies of iron and folic acid and their determinants in Ethiopian women

A cross-sectional community-based study with analytic component was conducted among Ethiopian women during June-July 2005 to assess the magnitude of anaemia and deficiencies of iron and folic acid and to compare the factors responsible for anaemia among anaemic and non-anaemic cases. In total, 970 women, aged 15-19 years, were selected systematically for haematological and other important parameters. The overall prevalence of anaemia, iron deficiency, iron-deficiency anaemia, deficiency of folic acid, and parasitic infestations was 30.4%, 50.1%, 18.1%, 31.3%, and 13.7% respectively. Women who had more children aged less than five years but above two years, open-field toilet habits, chronic illnesses, and having intestinal parasites were positively associated with anaemia. Women who had no formal education and who did not use contraceptives were negatively associated with anaemia. The major determinants identified for anaemia were chronic illnesses [adjusted odds ratio (AOR) = 1.1, 95% confidence interval (CI) 1.15-1.55), deficiency of iron (AOR = 0.4, 95% CI 0.35-0.64), and deficiency of folic acid (AOR = 0.5, 95% CI 0.50-0.90). The odds for developing anaemia was 1.1 times more likely among women with chronic illnesses, 60% more likely in the iron-deficient and 40% more likely in the folic acid-deficient than their counterparts. One in every three women had anaemia and deficiency of folic acid while one in every two had iron deficiency, suggesting that deficiencies of both folic acid and iron constitute the major micronutrient deficiencies in Ethiopian women. The risk imposed by anaemia to the health of women ranging from impediment of daily activities and poor pregnancy outcome calls for effective public-health measures, such as improved nutrient supplementation, health education, and timely treatment of illnesses.

Deficiencies of folate and vitamin B12 do not affect fracture healing in mice

PURPOSE

Recently, hyperhomocysteinemia has been shown to be associated with impaired fracture healing in mice. The main causes for hyperhomocysteinemia are deficiencies of folate and vitamin B12. However, there is no information on whether deficiencies of these B vitamins are affecting bone repair, too.

METHODS

We used two groups of mice to investigate the impact of folate and vitamin B12 deficiency on fracture healing: mice of the first group were fed a folate- and vitamin B12-deficient diet (n=14), while mice of the second group received an equicaloric control diet (n=13). Four weeks after stabilizing a closed femur fracture, bone repair was analyzed by histomorphometry and biomechanical testing. In addition, serum concentrations of homocysteine, folate, vitamin B12, the bone formation marker osteocalcin (OC), and the bone resorption marker collagen I C-terminal crosslaps (CTX) were measured.

RESULTS

Serum analyses revealed significantly decreased concentrations of folate and vitamin B12 in animals fed the folate- and vitamin B12-deficient diet when compared to controls. This was associated with a moderate hyperhomocysteinemia in folate- and vitamin B12-deficient mice, while no hyperhomocysteinemia was found in controls. Three-point bending tests showed no significant differences in callus stiffness between bones of folate- and vitamin B12-deficient animals and those of control animals. In accordance, the histomorphometric analysis demonstrated a comparable size and tissue composition of the callus, and also serum markers of bone turnover did not differ significantly between the two groups.

CONCLUSIONS

We conclude that folate and vitamin B12 deficiency does not affect bone repair in mice.

[Prevalence of vitamin B-12 deficiency in older adults]

BACKGROUND

There is a correlation between aging and the decrease of plasma levels of vitamin B-12.

AIM

To determine the prevalence of vitamin B-12 and folate deficiency and its hematological impact among older adults (AM).

MATERIAL AND METHODS

Cross-sectional study, in 1028 subjects aged 65 to 87years, living in community and evaluated between 2005 and 2008. Percentile distribution of vitamin B-12, folate, hemoglobin, packed red cell volume and mean cell volume by gender and age were analyzed. Deficiency was defined as vitamin B-12 levels < 148 pmol/L, marginal deficiency as vitamin B-12 levels < 221 pmol/L, anemia was defined as a hemoglobin < 13 and 12 g/dL among men and women, respectively.

RESULTS

The prevalence of vitamin B-12 deficiency was 12% and the figure for marginal deficiency was 25.4%. Males were more affected than females (p < 0.001). The frequency of anemia was 8.6%o, and was higher among women (p = 0.004).

CONCLUSIONS

There is a high prevalence of full blown and marginal deficit of vitamin B-12 among the elderly. This deficiency should be considered for correction through public nutrition policies.

Anaemia, folate, zinc and copper deficiencies among adolescent schoolgirls in eastern Sudan

Anaemia is a widespread problem especially in the tropics. Among adolescent girls, it has negative consequences on growth, school performance, morbidity and reproductive performance. A cross-sectional study was conducted to investigate the prevalence of anaemia, iron, folate, zinc and copper deficiencies amongst adolescent schoolgirls in New Halfa, eastern Sudan, and to examine the relationship of these micronutrients with haemoglobin (Hb) levels. Out of 187 adolescent schoolgirls, 181 (96.8%) had anaemia (Hb<12 g/dl); 21% had mild anaemia (Hb 11.0-11.9 g/dl); 66.8.1% had moderate anaemia (Hb 8.0-10.9 g/dl), and 12.1% had severe anaemia (Hb<8 g/dl), respectively. Iron deficiency (S-ferritin<12 μg/l), iron deficiency anaemia (<12 m/dl and S- ferritin<12 μg/l) and folate deficiency (S-folate<3 ng/ml) were prevalent in 17.6%, 16.5% and 69% of these girls, respectively. Nine percent and 5.9% of these girls had zinc (<75 μg/ml) and copper deficiency (<75 μg/ml), respectively. Twenty-six (14%) girls had ≥ 2 micronutrient deficiencies. S-ferritin and zinc were significantly lower in patients with severe anaemia. Haemoglobin levels were significantly positively correlated with zinc levels (r=0.161, P=0.03) and with copper levels (r=0.151, P=0.03). Thus, interventions are required to prevent and control anaemia in this setting. Further research is needed.

Serum folate and vitamin B12 status in healthy Iranian adults

To assess the serum folate and vitamin B12 status in healthy Iranian adults, we designed a population-based cross-sectional study of 1200 individuals aged 20-80 years. Finally 984 participants (507 men and 477 women) were assessed. The mean serum folate was 4.61 (SD 2.40) ng/mL and the mean serum vitamin B12 level was 265.6 (SD 170.9) pg/mL. Overall 1.0% were folate deficient and 25.8% had low vitamin B12 levels according to the manufacturer's reference ranges (folate < 1.5 ng/mL and vitamin B12 < 160 pg/mL). The mean serum folate and vitamin B12 levels were significantly lower in men. The prevalence of vitamin B12 deficiency was considerably higher than folate deficiency. Implementation of preventive measures seems to be necessary.

Psychotic disorder and extrapyramidal symptoms associated with vitamin B12 and folate deficiency

Vitamin B12 and folate deficiency causing neuropsychiatric and thrombotic manifestations, such as peripheral neuropathy, subacute combined degeneration of cord, dementia, ataxia, optic atrophy, catatonia, psychosis, mood disturbances, myocardial infarction and portal vein thrombosis are well known. This present report highlights an unusual presentation of vitamin B12 deficiency-psychotic disorder, extrapyramidal symptoms in a 12-year-old boy. His symptoms responded to parenteral vitamin B12 therapy. So with this report we emphasized that serum vitamin B12 and folate levels should be measured, especially in those patients who present with other known neuropsychiatric features of vitamin B12 and folate deficiency.