Status of folate in healthy children in Almeria

Strategic use of Big Data: implementing reference intervals for serum folate and serum cobalamin

Introduction

Defining trustworthy reference intervals (RIs) for serum folate (FOL) or serum cobalamin (VITB12) is a difficult task. The purpose of this study is to use an indirect approach from the laboratory information's system to indirectly generate RIs for FOL and VITB12.

Materials and methods

A retrospective observational study was performed at a tertiary-care laboratory's hospital during 12 months. All FOL and VITB12 tests were measured using a Cobas8000 e801 system (Roche Diagnostics, Mannheim, Germany). The RIs were calculated using a non-parametric approach. The RIs established in the present study were verified by calculating the fraction of RIs that fell outside the new RIs, in two validation cohorts sampled using the direct and indirect method.

Results

A total of 19,214 (FOL) and 27,420 (VITB12) results were obtained. The RIs were 4.5 nmol/L (90% confidence intervals (CI) 4.4-4.6) to 38.4 nmol/L (CI 38.3-38.5) for FOL and 140 pmol/L (CI 139-141) to 659 pmol/L (CI 657-660) for VITB12. The verification included 8,798 FOL results and 7,365 VITB12 results. For both magnitudes was acceptable since only 0.1% of FOL and 0.02% of VITB12 results fell outside the RIs. Finally, the RIs were verified using a direct method with twenty individuals. For FOL 20/20 cases and 19/20 of VITB12 cases fell within the estimated RIs.

Conclusions

In summary, the use of an indirect data approach has enabled us to calculate RIs for FOL and VITB12. The RIs obtained in our study are lower than those proposed by the manufacturer for both FOL and VITB12.

Low utility of serum folic acid blood tests in healthy children and adolescents, a nationwide cohort

This study aimed to evaluate the utility of serum folic acid testing in children and adolescents in a developed country without mandatory folic acid food fortification and to identify patients at risk for folic acid deficiency. In this cross-sectional study, records from primary care and hospitals were reviewed for patients aged 0-18 years who underwent serum folic acid testing. Data were retrieved from the Leumit-Health-Services database over a ten-year period (January 2008 to December 2018). Clinical and laboratory data were compared between patients with folic acid deficiency to those with normal levels. Among 20,411 pediatric patients tested, 884 (4.3%) had folic acid deficiency, of whom only 26.3% had anemia. Only two patients (0.2%) had megaloblastic anemia. Multivariate analysis showed that male gender (odds ratio(OR)1.6, 95% CI 1.22-2.12), older age (OR 1.32, 95% CI 1.26-1.39), higher BMI percentile (OR 1.01, 95% CI 1-1.01), antipsychotic treatment (OR 3.23, 95% CI 1.52-6.84), celiac (OR 2.97, 95% CI 1.66-5.34), and Attention-Deficit-and-Hyperactivity-Disease (ADHD) treated with psychostimulants (OR 2.21, 95% CI 1.56-3.12) were associated with folic acid deficiency(all p < 0.01). Lower hemoglobin levels were independently associated with increased OR of folic acid deficiency (OR 0.77, 95% CI 0.66-0.90, p = 0.001), but anemia as a diagnosis was not.

CONCLUSION

Pediatric folic acid deficiency rates were low in this nationwide cohort and not linked to megaloblastic anemia, likely due to concomitant iron deficiency anemia. Although retrospective, this might suggest low utility for routine serum folic acid testing in healthy children in developed countries, except in cases of celiac disease or specific medication use such psychostimulants or antipsychotics.

WHAT IS KNOWN

• Folic acid deficiency is common among children in developing countries, causing megaloblastic anemia, growth delays, and cognitive impairments. In developed countries, the prevalence is considered low.

WHAT IS NEW

• Of 20,411 pediatric patients tested for serum folate, in a developed country, only 4.3% had folate deficiency. • Risk factors for deficiency included celiac, antipsychotics, and psychostimulant treatment for ADHD. • Routine folate testing in developed countries may have limited utility; Targeted screening is recommended.

Pediatric reference intervals for serum folate and cobalamin based on a European population without exposure to folic acid fortification

The aim of the present study was to define pediatric reference intervals for serum cobalamin and folate utilizing data generated from a population not exposed to food fortified with folic acid. Folate and cobalamin results analyzed by electrochemiluminescence immunoassay (Roche Cobas) were obtained from 2375 children (2 months to 17.99 years of age). The serum samples were collected between 2011 and 2015 as part of the LIFE (Leipzig Research Centre for Civilization Diseases) Child cohort study in Germany, where folic acid fortification of food is not mandated. These results were used to generate age- and gender-specific reference intervals presented as non-parametric 2.5 and 97.5 percentiles. Because of a subsequent restandardisation of the Roche folate assay in 2016, folate values were recalculated accordingly for adaptation to results obtained using the present calibration. In both genders, folate concentrations decreased continuously with age, whereas cobalamin concentrations peaked at five years of age and then declined. Teenage females had higher concentrations of cobalamin in the age group 12-17.99 years.

Dietary intake of folate and the frequency of its deficiency in children with type 1 diabetes mellitus and healthy children

Adequate folate intake is essential for a child’s growth. There is lack of information about the prevalence of this nutrient deficiency in the Ukrainian population, including children. The aim of the study was to evaluate the dietary intake of folate and determine the frequency of folate deficiency in children with Type 1 diabetes mellitus (T1D) and healthy children. Determination of folate in serum was performed by ELISA. Folate level <3 ng/ml was diagnosed as a folate deficiency. Among all observed children the folate deficiency was diagnosed in 23 (32.9%): in 6 (17.1%) patients with T1D and in 17 (48.6%) healthy children (P ≤ 0.01). The mean level of serum folate in patients with T1D was (5.09 ± 2.16) ng/ml and (3.72 ± 1.87) ng/ml in healthy children (P ≤ 0.01). The average daily intake of folate with food was (138.68 ± 70.37) µg, without difference between T1D (12.00 ± 3.51 yr.) and healthy groups (10.83 ± 3.24 yr.), and it was more than two times lower than age requirements (300 µg/day). However, it was self-reported that 15 (48.9%) children of T1D group received vitamin supplementation one time in six months, while in healthy children only 6 (17.1%) children received vitamins (P ≤ 0.01). In conclusion, the frequency of folate deficiency is high in the pediatric population. Nutrition does not provide the necessary intake of folate, which indicates the need for additional folate supplementation. Keywords: children., deficiency, diabetes mellitus, dietary intake, folate

Association of maternal folate use and reduced folate carrier gene polymorphisms with the risk of congenital heart disease in offspring

Although it is generally recognized that genetic and environmental factors are associated with the risk of congenital heart disease (CHD), the mechanism remains largely uncertain. This study aimed to investigate the association of maternal folate use, the time when folate use was started, and polymorphisms of the reduced folate carrier (RFC1) gene with the risk of CHD in offspring of Chinese descent, which can help provide new insight into the etiology of folate-related birth defects. A case-control study of 683 mothers of CHD patients and 740 mothers of healthy children was performed. The present study showed that mothers who did not use folate were at a significantly increased risk of CHD (OR=2.04; 95% CI: 1.42-2.93). When compared with those who started using folate prior to conception, mothers who started using folate from the first trimester of pregnancy (OR=1.90; 95% CI: 1.43-2.54) or from the second trimester of pregnancy (OR=8.92; 95% CI: 4.20-18.97) had a significantly higher risk of CHD. Maternal RFC1 gene polymorphisms at rs2236484 (AG vs AA: OR=1.79 [95% CI: 1.33-2.39]; GG vs AA: OR=1.64 [95% CI: 1.15-2.35]) and rs2330183 (CT vs CC: OR=1.54 [95% CI: 1.14-2.09]) were also significantly associated with CHD risk. Additionally, the risk of CHD was significantly decreased among mothers who had variant genotypes but used folate when compared with those who had variant genotypes and did not use folate.Conclusion: In those of Chinese descent, maternal folate use and the time when use started are significantly associated with the risk of CHD in offspring. Furthermore, maternal folate supplementation may help to offset some of the risks of CHD in offspring due to maternal RFC1 genetic variants. What is Known: • Folate use could help prevent CHD, but the relationship between the time when folate use is started and CHD has not received sufficient attention. • Studies have assessed the associations of folate metabolism-related genes with CHD, but genes involved in cellular transportation of folate, such as the RFC1 gene, have not garnered enough attention. What is New: • In those of Chinese descents, the time when folate use is started is significantly associated with the risk of CHD in offspring. • Maternal RFC1 polymorphisms were significantly associated with the risk of CHD. • Folate supplementation may help to offset some risks of CHD due to RFC1 genetic variants.