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Samson KLI, Loh SP, Lee SS, Sulistyoningrum DC, Khor GL, Mohd Shariff ZB, Ismai IZ, Makrides M, Hutcheon JA, Roche ML, Green TJ, Karakochuk CD. The Inclusion of Folic Acid in Weekly Iron-Folic Acid Supplements Confers no Additional Benefit on Anemia Reduction in Nonpregnant Women: A Randomized Controlled Trial in Malaysia. J Nutr 2021; 151:2264-2270. [PMID: 33978167 DOI: 10.1093/jn/nxab115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/02/2021] [Accepted: 03/31/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Weekly iron-folic acid (IFA) supplements are recommended for all menstruating women in countries where anemia prevalence is ≥20%; however, it is unknown whether the inclusion of folic acid in weekly IFA supplements reduces anemia. OBJECTIVES We examined whether the inclusion of folic acid in weekly IFA supplements conferred any benefit on hemoglobin (Hb) concentration, anemia reduction, or iron status [ferritin and soluble transferrin receptor (sTfR)], over iron alone. METHODS In this secondary analysis of a randomized controlled trial in Malaysia, n = 311 nonpregnant women (18-45 y old) received 60 mg Fe with either 0, 0.4, or 2.8 mg folic acid once-weekly for 16 wk. Fasting blood was collected at baseline and 16 wk. A generalized linear model (normal distribution with identity link) was used to assess Hb concentration at 16 wk (primary outcome). RESULTS At baseline, 84% of women had low folate status (plasma folate < 14 nmol/L). At 16 wk, marginal mean (95% CI) Hb was 131 (130, 133), 131 (129, 132), and 132 (130, 133) g/L; ferritin was 58.2 (53.9, 62.5), 56.5 (52.2, 60.9), and 58.0 (53.7, 62.3) μg/L; and sTfR was 5.8 (5.5, 6.1), 5.8 (5.5, 6.1), and 5.9 (5.6, 6.2) mg/L in the 0, 0.4, and 2.8 mg/wk groups, respectively, with no differences between groups (P > 0.05). Baseline plasma folate concentration did not modify the effect of treatment on Hb concentration at 16 wk. Among all women, the risks of anemia [risk ratio (RR): 0.65; 95% CI: 0.45, 0.96; P = 0.03] and iron deficiency based on ferritin (RR: 0.30; 95% CI: 0.20, 0.44; P < 0.001) were lower at 16 wk than at baseline. CONCLUSIONS Despite the low folate status among these nonpregnant Malaysian women, the inclusion of folic acid in weekly IFA supplements did not reduce anemia or improve iron status, over iron alone. However, the benefits of folic acid for neural tube defect prevention still warrant its retention in weekly IFA supplements.This trial was registered at www.anzctr.org.au as ACTRN12619000818134.
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Affiliation(s)
- Kaitlyn L I Samson
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Su Peng Loh
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Siew Siew Lee
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Dian C Sulistyoningrum
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Geok Lin Khor
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | | | - Irmi Zarina Ismai
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Maria Makrides
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Jennifer A Hutcheon
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Timothy J Green
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Crystal D Karakochuk
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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A missense mutation in TCN2 is associated with decreased risk for congenital heart defects and may increase cellular uptake of vitamin B12 via Megalin. Oncotarget 2017; 8:55216-55229. [PMID: 28903415 PMCID: PMC5589654 DOI: 10.18632/oncotarget.19377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 06/29/2017] [Indexed: 12/05/2022] Open
Abstract
Deregulation of folate and vitamin B12 (VB12) metabolism contributes to the risk of congenital heart defects (CHDs). Transcobalamin (TCN2) is essential for transporting VB12 from blood to cells as TCN2-bound VB12 (holo-TC) is the only form for somatic cellular uptake. In this study, we performed an association study between common polymorphisms in 46 one carbon metabolism genes and CHD in 412 CHDs and 213 controls. Only two significant association signals in coding regions were identified: FTCD c.1470C>T & TCN2 c.230A>T. The only missense mutation, TCN2 c.230A>T, was further validated in 412 CHDs and 1177 controls. TCN2 c.230T is significantly associated with reduced CHD risk in North Chinese (odds ratio = 0.67, P = 4.62e-05), compared with the 230A allele. Interestingly, the mean level of plasma holo-TC in women with the TA genotype was 1.77-fold higher than that in women with the AA genotype. Further analysis suggested that c.230A>T enhanced the cellular uptake of holo-TC via the LRP2 receptor. Our results determined that a functional polymorphism in TCN2 contributes to the prevalence of CHDs. TCN2 c.230A>T is significantly associated with a reduced CHD risk, likely due to TCN2 c.230T improving the interaction between holo-TC and its LRP2 receptor.
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Vitamin B12 concentrations in pregnant Colombian women: analysis of nationwide data 2010. BMC Pregnancy Childbirth 2016; 16:26. [PMID: 26832149 PMCID: PMC4736095 DOI: 10.1186/s12884-016-0820-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 12/19/2022] Open
Abstract
Background Vitamin B12 deficiency is associated with many adverse health outcomes and is highly prevalent worldwide. The present study assesses the prevalence and socio-demographic factors associated with vitamin B12 deficiency in a representative sample of pregnant women in Colombia. Method We used data from the cross-sectional, nationally representative survey (ENSIN, 2010). A total of 1.781, (13–49 years old) pregnant women were enrolled. Serum Vitamin B12 a concentration was determined by chemiluminescence and sociodemographic date was assessed by computer-assisted personal interview technology. Multivariate analyses using unordered multinomial logistic regression models were conducted in the main analysis. Results Vitamin B12 concentrations ranged from 45 to 1000 pg/mL (mean 299.2 pg/mL, 95 % CI 290.6 to 303.7 pg/mL). A total of 18.6 % of pregnant women had vitamin B12 concentrations below 200 pg/mL and 41.3 % had concentrations between 200 and 300 pg/mL. Being of indigenous ethnicity, living in the east and living in a rural area showed the lowest mean values (273.2 pg/mL, 270.8 pg/mL and 290.1 pg/mL, respectively). The multivariate logistic regression shows that pregnant women belonging to the indigenous ethnic group OR 2.2, (95 % CI 1.1 to 4.3), living in the pacific region (west) OR 4.4, (95 % CI 2.8 to 6.9), or national territories (south) OR 2.3, (95 % CI 1.4 to 3.7) were associated with a higher probability of serum vitamin B12 deficiency. Conclusion The prevalence of vitamin B12 deficiency in Colombian pregnant women is substantial. Factors associated with depletion among pregnant women should be considered for future interventions in countries experiencing nutritional transition.
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Laillou A, Berger J, Le BM, Pham VT, Le TH, Nguyen CK, Panagides D, Rohner F, Wieringa F, Moench-Pfanner R. Improvement of the Vietnamese diet for women of reproductive age by micronutrient fortification of staples foods and condiments. PLoS One 2012; 7:e50538. [PMID: 23226308 PMCID: PMC3511532 DOI: 10.1371/journal.pone.0050538] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 10/26/2012] [Indexed: 11/18/2022] Open
Abstract
Background A micronutrient survey carried out in 2010 among randomly selected Vietnamese women in reproductive age indicated that anemia and micronutrient deficiencies are still prevalent. The objective of this study was thus to analyze the dietary micronutrient intakes of these women, to select the food vehicles to be fortified and to calculate their contributions to meet the recommended nutrient intake (RNI) for iron, zinc, vitamin A and folic acid. Main Findings Consumption data showed that the median intake was 38.4% of the RNI for iron, 61.1% for vitamin A and 91.8% for zinc. However, more than 50% of the women had daily zinc consumption below the RNI. Rice and vegetable oil were consumed daily in significant amounts (median: 320.4 g/capita/day and 8.6 g/capita/day respectively) by over 90% of the women, making them suitable vehicles for fortification. Based on consumption data, fortified vegetable oil could contribute to an additional vitamin A intake of 27.1% of the RNI and fortified rice could increase the intake of iron by 41.4% of the RNI, zinc by 15.5% and folate by 34.1%. Other food vehicles, such as fish and soy sauces and flavoring powders, consumed respectively by 63% and 90% of the population could contribute to increase micronutrient intakes if they are properly fortified and promoted. Wheat flower was consumed by 39% of the women and by less than 20% women from the lowest socioeconomic strata. Conclusion The fortification of edible vegetable oils with vitamin A and of rice with iron, zinc and folic acid are the most promising fortification strategies to increase micronutrient intakes of women in reproductive age in Vietnam. While rice fortification will be implemented, fortification of fish and soy sauces with iron, that has been proven to be effective, has to be supported and fortification of flavouring powders with micronutrients investigated.
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Affiliation(s)
- Arnaud Laillou
- Global Alliance for Improved Nutrition-GAIN, Geneva, Switzerland.
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Yang J, Hu X, Zhang Q, Cao H, Wang J, Liu B. Homocysteine level and risk of fracture: A meta-analysis and systematic review. Bone 2012; 51:376-82. [PMID: 22749888 DOI: 10.1016/j.bone.2012.05.024] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 05/31/2012] [Indexed: 01/22/2023]
Abstract
AIMS Previous studies have reported inconsistent findings regarding the association between elevated plasma Hcy levels and fracture risk. We investigated this association between homocysteine (Hcy) levels in patients with fracture and unaffected controls by conducting a meta-analysis and systematic review. METHODS We conducted a systematic literature search (up to April 2012) of the PubMed database and Embase. We selected observational studies that evaluated Hcy levels in subjects with fracture compared to unaffected controls. We also included randomized clinical trials (RCTs) on the effect of Hcy-lowering therapy in fracture patients. Criteria for inclusion were the assessment of baseline Hcy and risk of fracture as an outcome. The results were presented as relative risk (RR) and corresponding 95% confidence intervals (CI) comparing fracture patients to the control subjects or the highest Hcy quartile group to the lowest Hcy quartile group. RESULTS Nine studies with 14,863 participants were identified and analyzed. The pooled RR from a random effect model of participants with all fractures compared with the control subjects was 1.59 (95% CI 1.30-1.96). The pooled RR from a random model for hip fractures in the highest Hcy quartile group compared with the lowest Hcy quartile group was 1.67 (95% CI 1.17-2.38). The effect of Hcy-lowering therapy on fracture was tested in two clinical trials, but clinically important end points were not reported in a consistent way. CONCLUSIONS This meta-analysis and systematic review suggested that Hcy significantly increased the risk of fracture, and the increase was independent of risk factors.
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Affiliation(s)
- Jun Yang
- Department of Surgery, First Affiliated Hospital of China Medical University, Shenyang 110001, China
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Micronutrient deficits are still public health issues among women and young children in Vietnam. PLoS One 2012; 7:e34906. [PMID: 22529954 PMCID: PMC3328495 DOI: 10.1371/journal.pone.0034906] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 03/07/2012] [Indexed: 11/19/2022] Open
Abstract
Background The 2000 Vietnamese National Nutrition Survey showed that the population's dietary intake had improved since 1987. However, inequalities were found in food consumption between socioeconomic groups. As no national data exist on the prevalence of micronutrient deficiencies, a survey was conducted in 2010 to assess the micronutrient status of randomly selected 1526 women of reproductive age and 586 children aged 6–75 mo. Principal Findings In women, according to international thresholds, prevalence of zinc deficiency (ZnD, 67.2±2.6%) and vitamin B12 deficiency (11.7±1.7%) represented public health problems, whereas prevalence of anemia (11.6±1.0%) and iron deficiency (ID, 13.7±1.1%) were considered low, and folate (<3%) and vitamin A (VAD, <2%) deficiencies were considered negligible. However, many women had marginal folate (25.1%) and vitamin A status (13.6%). Moreover, overweight (BMI≥23 kg/m2 for Asian population) or underweight occurred in 20% of women respectively highlighting the double burden of malnutrition. In children, a similar pattern was observed for ZnD (51.9±3.5%), anemia (9.1±1.4%) and ID (12.9±1.5%) whereas prevalence of marginal vitamin A status was also high (47.3±2.2%). There was a significant effect of age on anemia and ID prevalence, with the youngest age group (6–17 mo) having the highest risk for anemia, ID, ZnD and marginal vitamin A status as compared to other groups. Moreover, the poorest groups of population had a higher risk for zinc, anemia and ID. Conclusion The prevalence of anemia and ID in Vietnam has been markedly reduced over the last decade, but a large part of the population is still at risk for other deficiencies such as zinc, vitamin A, folate and vitamin B12 especially the youngest children aged 6–17 mo. Consequently specific interventions to improve food diversity and quality should be implemented, among them food fortification of staple foods and condiments and improvement of complementary feeding.
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Hien VTT, Lam NT, Skeaff CM, Todd J, McLean JM, Green TJ. Vitamin D status of pregnant and non-pregnant women of reproductive age living in Hanoi City and the Hai Duong province of Vietnam. MATERNAL AND CHILD NUTRITION 2011; 8:533-9. [PMID: 22117931 DOI: 10.1111/j.1740-8709.2011.00327.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Vitamin D insufficiency during pregnancy has been associated with a number of adverse outcomes for both mother and child. Vitamin D insufficiency has been well described in many populations of both pregnant and non-pregnant women of childbearing age, but there is a lack of data on women living in South-East Asia. We measured plasma 25-hydroxyvitamin D in a representative sample of pregnant (n=64) and non-pregnant (n=477) women (15-49 years) living in Hanoi City (n=270) and rural Hai Duong Province (n=271) in northern Vietnam. Mean 25-hydroxyvitamin D (95% confidence interval) concentration was 81 (79, 84)nmolL(-1) . Mean 25-hydroxyvitamin D concentration differed between urban and rural (78 vs. 85nmolL(-1) ; P=0.016), farming and non-farming (89 vs. 77nmolL(-1) ; P<0.001) but not pregnant and non-pregnant or older vs. younger women. Only one woman had a 25-hydroxyvitamin D less than 25nmolL(-1) , a concentration indicative of vitamin D deficiency. Of the women, 7% and 48% of the women were vitamin D insufficient based on cut-offs for plasma 25-hydroxyvitamin D of 50 and 75nmolL(-1) , respectively. Mean plasma 25-hydroxyvitamin D concentrations of these Vietnamese women were much higher than those reported in other studies of pregnant and non-pregnant women in the region.
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Affiliation(s)
- Vu Thi Thu Hien
- National Institute of Nutrition, Hanoi, Vietnam Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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Abstract
Neural tube defects are serious birth defects of the brain and the spinal cord due to interference with neural tube closure about the 28th day after fertilization. Seasonal variation in the development of neural tube defects has been reported. The objective of this study was to demonstrate any association between the season of conception and the development of neural tube defects in the north of Jordan. For a 7-year period between January 2000 and December 2006, data of 78 neonates born with neural tube defect were analyzed regarding dates of conception in relation to the development of neural tube defects. More affected babies were conceived in the late summer and early autumn. The study demonstrated that seasonality affected the incidence of neural tube defects in the north of Jordan.
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Affiliation(s)
- Ahmed Z Obeidat
- Department of Obstetrics and Gynecology, Jordan University of Science and Technology, Irbid, Jordan
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