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Zhao Q, Lv X, Liu Q, Hu Z, Zhan Y. Association between serum folate concentrations and all-cause mortality in U.S. adults: a cohort study based on National Health and Nutrition Examination Survey III. Front Nutr 2024; 11:1408023. [PMID: 39055385 PMCID: PMC11270589 DOI: 10.3389/fnut.2024.1408023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024] Open
Abstract
The association between serum folate and all-cause mortality in general population remains unclear. The objective of this study was to investigate the potential association between serum folate concentrations and all-cause mortality in a large, prospective, long-term U.S. cohort. Our study included adults from the National Health and Nutrition Examination Survey (NHANES) III, and mortality data was obtained by linking with the National Death Index (NDI) until December 31, 2019. Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) to assess the association between serum folate concentrations and all-cause mortality. A total of 12,862 participants were included in this cohort study. After a median follow-up of 26.4 years [interquartile range (IQR), 15.4-28.7 years], a total of 5,299 deaths were recorded. The risk of death was lower by 12% per 1.0 g/L increase in log-transformed serum folate concentrations (HR, 0.88; 95% CI, 0.83-0.94). Compared with the lowest quartiles of serum folate level, the risk of death was lower in the second (HR, 0.84; 95% CI, 0.72-0.97), third (HR, 0.78; 95% CI, 0.68-0.91) and the highest quartiles (HR, 0.78; 95% CI, 0.69-0.88) in multivariable-adjusted model. In subgroup analyses, the inverse association between serum folate and all-cause mortality remained statistically significant for women, men and non-Hispanic White people. Higher serum folate levels were found to be significantly associated with reduced risk of all-cause mortality. However, further studies are needed to verify these findings and explore the underlying mechanism.
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Affiliation(s)
- Qingya Zhao
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Xiaogang Lv
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Qi Liu
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Zhao Hu
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Yiqiang Zhan
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Fallah M, Karim Dehnavi M, Lotfi K, Aminianfar A, Azadbakht L, Esmaillzadeh A. Folate Biomarkers, Folate Intake, and Risk of Death From All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Nutr Rev 2024:nuae077. [PMID: 38950416 DOI: 10.1093/nutrit/nuae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
CONTEXT Existing evidence on the relation between folate intake and biomarkers with mortality risk is controversial. OBJECTIVE Previous cohort studies were examined regarding folate intake and biomarkers in relation to risk of all-cause, cardiovascular disease- (CVD), and cancer-related mortality through a systematic review and meta-analysis. DATA SOURCES A systematic search was performed of the PubMed, Scopus, and ISI Web of Science databases up to July 2023. DATA EXTRACTION Prospective cohort studies examining the association of folate biomarkers (in serum, plasma, red blood cells) and intake with risk of all-cause, CVD-, and cancer-related mortality were considered. A random-effects model was applied to combine study-specific risk estimates. Dose-response relations were assessed by 1-stage weighted mixed-effects meta-analysis. DATA ANALYSIS A total of 25 cohorts with 423 304 participants, 36 558 all-cause, 12 662 CVD-, and 2426 cancer-related deaths were included. No significant association was observed between the highest levels of folate biomarkers and all-cause mortality risk (hazard ratio [HR], 0.91; 95% CI, 0.77-1.06; n = 17; I2 = 89.4%; P < .001), CVD-related mortality risk (HR, 0.97; 95% CI, 0.87-1.06; n = 11; I2 = 0.0%; P = .57), and cancer-related mortality risk (HR, 0.85; 95% CI, 0.69-1.05; n = 6; I2 = 57.8%; P = .04) compared with the lowest. Furthermore, each 10 nmol/L increase was marginally related to a 12% reduced all-cause mortality risk but not to CVD- and cancer-related mortality risk. A significant inverse association was found between highest intake of dietary folate and the lowest, and risk of all-cause (HR, 0.87; 95% CI, 0.78-0.96; n = 3; I2 = 63.6%; P = .06) and CVD (HR, 0.77; 95% CI, 0.57-0.93; n = 4; I2 = 80.2%; P = .002) mortality. CONCLUSIONS This meta-analysis revealed a significant inverse relation between dietary folate intake and risk of all-cause and CVD mortality. Such an association was not found in the case of folate biomarkers. Further prospective studies are warranted to confirm these findings. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42023401700.
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Affiliation(s)
- Melika Fallah
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, 14155-6117, Iran
| | - Maryam Karim Dehnavi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, 14155-6117, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, 14155-6117, Iran
| | - Keyhan Lotfi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, 14155-6117, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, 14155-6117, Iran
| | - Azadeh Aminianfar
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, 14155-6117, Iran
- Diabetes Research Centre, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, 14155-6117, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, 14155-6117, Iran
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, 14155-6117, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, 81745, Iran
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Wang P, Yu J, Zhao Y, Simayi R, Shi D. The independent and joint associations of vitamin B12 and methylmalonic acid on the risk of mortality in individuals with metabolic dysfunction-associated steatotic liver disease. Eur J Nutr 2024:10.1007/s00394-024-03448-1. [PMID: 38864864 DOI: 10.1007/s00394-024-03448-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/23/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE To investigate the independent and joint associations of vitamin B12 and methylmalonic acid (MMA) with all-cause, cardiovascular disease (CVD), and cancer mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS We included 6797 individuals with MASLD from the U.S. National Health and Nutrition Examination Survey. Serum MMA was measured using gas/liquid chromatography-mass spectrometry. Serum vitamin B12 was measured using commercial kits. The separate and joint associations of dietary intake and serum vitamin B12 (cutoff: 400 pg/mL) and MMA (cutoff: 250 nmol/L) levels with mortality were assessed by Cox proportional hazards regression. RESULTS During a median follow-up of 9.3 years, 1604 deaths were documented, including 438 from CVD and 365 from cancer. In MASLD patients, dietary intake and serum vitamin B12 did not associate with mortality, while MMA was associated with a 1.35-fold increased risk of all-cause mortality (P-trend < 0.001). The adjusted hazard ratios for the joint association of vitamin B12 and MMA with all-cause and CVD mortality were 1 in the B12lowMMAlow group (reference), 1.02 (0.87-1.20) and 1.15 (0.90-1.47) in the B12highMMAlow group, 1.55 (1.29-1.86) and 1.84 (1.28-2.65) in the B12lowMMAhigh group, and 1.82 (1.49-2.21) and 2.28 (1.40-3.71) in the B12highMMAhigh group, respectively. The joint association was modified by serum folate (P-interaction = 0.001). CONCLUSIONS In MASLD patients, MMA rather than dietary and serum vitamin B12 was positively associated with all-cause mortality. The joint effect of high levels of MMA and vitamin B12 showed the strongest associations with all-cause and CVD mortality, with a significant interaction with serum folate.
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Affiliation(s)
- Peng Wang
- Department of Nutrition Food and Children's Health, School of Public Health, Weifang Medical University, Weifang, China
| | - Jing Yu
- Department of Nutrition and Food Hygiene, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yaxuan Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Rukiya Simayi
- Department of Nutrition and Food Hygiene, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Dan Shi
- Department of Nutrition and Food Hygiene, School of Public Health, Chongqing Medical University, Chongqing, China.
- Research Centre for Environment and Human Health, School of Public Health, Chongqing Medical University, Chongqing, China.
- Nutrition Innovation Platform-Sichuan and Chongqing, School of Public Health, Chongqing Medical University, Chongqing, China.
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Sun Y, Zhang H, Qi G, Tian W. Nutrient deficiency patterns and all-cause and cardiovascular mortality in older adults with hypertension: a latent class analysis. BMC Public Health 2024; 24:1551. [PMID: 38853236 PMCID: PMC11163810 DOI: 10.1186/s12889-024-19003-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 05/30/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Previous researches examining the impact of dietary nutrition on mortality risk have mainly focused on individual nutrients, however the interaction of these nutrients has not been considered. The purpose of this study was to identify of nutrient deficiencies patterns and analyze their potential impact on mortality risk in older adults with hypertension. METHODS We included participants from the National Health and Nutrition Examination Survey (NHANES) study. The latent class analysis (LCA) was applied to uncover specific malnutrition profiles within the sample. Risk of the end points across the phenogroups was compared using Kaplan-Meier analysis and Cox proportional hazard regression model. Multinomial logistic regression was used to determine the influencing factors of specific malnutrition profiles. RESULTS A total of 6924 participants aged 60 years or older with hypertension from NHANES 2003-2014 was followed until December 31, 2019 with a median follow-up of 8.7 years. Various nutrients included vitamin A, vitamin B1, vitamin B12, vitamin C, vitamin D, vitamin E, vitamin K, fiber, folate, calcium, magnesium, zinc, copper, iron, and selenium, and LCA revealed 4 classes of malnutrition. Regarding all-cause mortality, "Nutrient Deprived" group showed the strongest hazard ratio (1.42 from 1.19 to 1.70) compared with "Adequate Nutrient" group, followed by "Inadequate Nutrient" group (1.29 from 1.10 to 1.50), and "Low Fiber, Magnesium, and Vit E" group (1.17 from 1.02 to 1.35). For cardiovascular mortality, "Nutrient Deprived" group showed the strongest hazard ratio (1.61 from 1.19 to 2.16) compared with "Adequate Nutrient" group, followed by "Low Fiber, Magnesium, and Vit E" group (1.51 from 1.04 to 2.20), and "Inadequate Nutrient" group (1.37 from 1.03 to 1.83). CONCLUSIONS The study revealed a significant association between nutrients deficiency patterns and the risk of all-cause and cardiovascular mortality in older adults with hypertension. The findings suggested that nutrients deficiency pattern may be an important risk factor for mortality in older adults with hypertension.
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Affiliation(s)
- YuJiao Sun
- Department of Geriatric, The First Hospital of China Medical University, 155 Nanjing North Street, Heping Ward, Shenyang, 110001, NO, China
| | - HuanRui Zhang
- Department of Geriatric, The First Hospital of China Medical University, 155 Nanjing North Street, Heping Ward, Shenyang, 110001, NO, China
| | - GuoXian Qi
- Department of Geriatric, The First Hospital of China Medical University, 155 Nanjing North Street, Heping Ward, Shenyang, 110001, NO, China
| | - Wen Tian
- Department of Geriatric, The First Hospital of China Medical University, 155 Nanjing North Street, Heping Ward, Shenyang, 110001, NO, China.
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Ruan Y, Zhang P, Jia X, Hua S, Yao D. Association of vitamin B6 intake with the risk and prognosis of diabetic retinopathy: a NHANES-based study. Clin Exp Optom 2024:1-10. [PMID: 38194486 DOI: 10.1080/08164622.2023.2300298] [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: 07/26/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024] Open
Abstract
CLINICAL RELEVANCE Investigating the role of dietary vitamin B6 intake in the risk and prognosis of diabetic retinopathy (DR) could facilitate the management of DR. BACKGROUND This study aimed to assess the association between dietary vitamin B6 intake and the risk of DR and further explore the association between vitamin B6 intake and mortality in patients with DR. METHODS This retrospective cohort study gained data from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 and 2007-2008. The intake of dietary vitamin B6 was assessed by two 24-h dietary recall interviews. Mortality information in the National Death Index was recorded from the date of survey participation through 31 December 2019. Multivariate regression analyses were employed to assess the association between vitamin B6 intake and the risk of DR, and the association between vitamin B6 intake and the risk of mortality in patients with DR. RESULTS A total of 5559 subjects were included, of which 693 (12.47%) had DR. Among these patients with DR, 429 (61.90%) were survivors. Multivariate analyses showed that the intake of vitamin B6 was negatively associated with the risk of DR (odds ratio = 0.81, 95% confidence level: 0.69-0.95, p = 0.012), and patients with DR with an increased intake of vitamin B6 had a significantly decreased risk of all-cause death (hazard ratio = 0.81, 95% confidence level: 0.66-0.99, p = 0.041) or cardiovascular disease-related death (hazard ratio = 0.76, 95% confidence level: 0.58-0.98, p = 0.037). CONCLUSION The intake of vitamin B6 was negatively associated with the risk of DR, and in patients with DR, a higher intake of vitamin B6 was associated with a lower risk of all-cause death and cardiovascular disease-related death, indicating the possible protective role of increased vitamin B6 intake.
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Affiliation(s)
- Yimeng Ruan
- Department of Ophthalmology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Ping Zhang
- Department of Ophthalmology, Ningbo Eye Center Hospital, Ningbo, Zhejiang, China
| | - Xinru Jia
- Department of Ophthalmology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Shanshan Hua
- Department of Ophthalmology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Dongwei Yao
- Department of Ophthalmology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
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Kato N, Kimoto A, Zhang P, Bumrungkit C, Karunaratne S, Yanaka N, Kumrungsee T. Relationship of Low Vitamin B6 Status with Sarcopenia, Frailty, and Mortality: A Narrative Review. Nutrients 2024; 16:177. [PMID: 38202006 PMCID: PMC10780671 DOI: 10.3390/nu16010177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024] Open
Abstract
Marginal vitamin B6 (B6) deficiency is a widespread global concern. Inadequate B6 levels have been linked to an increased risk of age-related chronic diseases such as cardiovascular diseases and cancers. In recent years, the growing concern over sarcopenia (the age-related loss of muscle mass and strength) and frailty (a decline in physiological resilience and increased vulnerability associated with aging) is particularly relevant due to the emergence of super-aged societies in developed countries. Notably, among the thirty-one studies included in this review, twenty-five showed a significant association of B6 status with sarcopenia, frailty, and all-cause mortality in adults (p < 0.05), while six showed no association. Emerging studies have suggested novel mechanisms underlying this association. These mechanisms involve P2X7 receptor-mediated NLRP3 inflammasome signaling, AMPK signaling, PD-L1 signaling, and satellite cell-mediated myogenesis. Furthermore, the modulation of PLP-dependent enzymes due to B6 deficiency is associated with impaired metabolic processes, affecting energy utilization, imidazole peptide production, and hydrogen sulfide production, as well as the kynurenine pathway, all of which play vital roles in skeletal muscle health and pathophysiology. This narrative review provides an up-to-date assessment of our current understanding of the potential role of nutritional B6 status in combating sarcopenia, frailty, and mortality.
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Affiliation(s)
- Norihisa Kato
- Graduate School of Integrated Sciences for Life, Hiroshima University, Higashi-Hiroshima 739-8528, Japan; (C.B.); (S.K.); (N.Y.)
| | - Akiko Kimoto
- Faculty of Health of Sciences, Hiroshima Shudo University, Hiroshima 731-3166, Japan;
| | - Peipei Zhang
- State Key Laboratory of Cellular Stress Biology, School of Life Science, Xiamen University, Xiamen 361102, China;
- School of Medicine, Xiamen University, Xiamen 361102, China
| | - Chanikan Bumrungkit
- Graduate School of Integrated Sciences for Life, Hiroshima University, Higashi-Hiroshima 739-8528, Japan; (C.B.); (S.K.); (N.Y.)
| | - Sajith Karunaratne
- Graduate School of Integrated Sciences for Life, Hiroshima University, Higashi-Hiroshima 739-8528, Japan; (C.B.); (S.K.); (N.Y.)
| | - Noriyuki Yanaka
- Graduate School of Integrated Sciences for Life, Hiroshima University, Higashi-Hiroshima 739-8528, Japan; (C.B.); (S.K.); (N.Y.)
| | - Thanutchaporn Kumrungsee
- Graduate School of Integrated Sciences for Life, Hiroshima University, Higashi-Hiroshima 739-8528, Japan; (C.B.); (S.K.); (N.Y.)
- Graduate School of Innovation and Practice for Smart Society, Hiroshima University, Higashi-Hiroshima 739-8528, Japan
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Tian S, Yu X, Wu L, Zheng H, Zhong X, Xie Y, Wu W. Vitamin B 6 and folate intake are associated with lower risk of severe headache or migraine in adults: An analysis based on NHANES 1999-2004. Nutr Res 2024; 121:51-60. [PMID: 38042023 DOI: 10.1016/j.nutres.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 12/04/2023]
Abstract
Previous studies have shown that B vitamins can relieve migraine. However, the association between vitamin B6 and folate, 2 important B vitamins consumed in the diet, with migraine have received minimal attention. This study explored the independent relationships between dietary vitamin B6 and folate intake with migraine and the interaction effect of these 2 nutrients on migraine in US adults. We hypothesized that vitamin B6 and folate intake would be inversely associated with migraine. This study included cross-sectional data from participants aged 20 years and older who participated in the National Health and Nutrition Examination Survey from 1999 to 2004. We conducted multivariate logistic regression and restricted cubic spline regression to explore the association between dietary vitamin B6 and folate intake on migraine. Also, relative excess risk due to interaction, attributable proportion of interaction, and synergy index were used to assess additive interactions. A total of 7017 participants were included in this study, 1350 of whom were migraineurs. We determined that vitamin B6 and folate intake revealed a negative association with severe headache or migraine (0.66; 95% confidence interval [CI], 0.47-0.89; P = .01 and 0.57; 95% CI, 0.42-0.78; P = .002]), respectively. Also, a significant interaction effect between a high mass of vitamin B6 and folate intake was observed for a lower risk of migraine (relative excess risk due to interaction, 0.28 [95% CI, 0.05-0.51]; attributable proportion of interaction: 0.45 [95% CI, 0.05-0.86]; synergy index: 0.58 [95% CI, 0.40-0.83]). A high mass of vitamin B6 and folate intake (vitamin B6 intake ≥ 2.39 mg/day and folate intake ≥ 502.01 µg/day) presented a synergistic interaction with migraine, suggesting that these 2 nutrients might be beneficial in preventing migraine.
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Affiliation(s)
- Sheng Tian
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P.R. China; Institute of Neuroscience, Nanchang University, Nanchang, 330006, P.R. China
| | - Xinping Yu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P.R. China; Institute of Neuroscience, Nanchang University, Nanchang, 330006, P.R. China
| | - Lanxiang Wu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P.R. China; Institute of Neuroscience, Nanchang University, Nanchang, 330006, P.R. China
| | - Heqing Zheng
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P.R. China; Institute of Neuroscience, Nanchang University, Nanchang, 330006, P.R. China
| | - Xianhui Zhong
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P.R. China; Institute of Neuroscience, Nanchang University, Nanchang, 330006, P.R. China
| | - Yonggang Xie
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P.R. China; Institute of Neuroscience, Nanchang University, Nanchang, 330006, P.R. China
| | - Wei Wu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P.R. China; Institute of Neuroscience, Nanchang University, Nanchang, 330006, P.R. China.
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Huang J, Khatun P, Xiong Y, Liu B, Zhao Y, Lyu Q. Intakes of folate, vitamin B6, and vitamin B12 and cardiovascular disease risk: a national population-based cross-sectional study. Front Cardiovasc Med 2023; 10:1237103. [PMID: 38034370 PMCID: PMC10686214 DOI: 10.3389/fcvm.2023.1237103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023] Open
Abstract
Background Only a few studies that investigated dietary intakes of folate, vitamin B6, and vitamin B12 in relation to cariovascular disease (CVD). This study aimed to assess the association of dietary folate, vitamin B6, and vitamin B12 with CVD in the United States population. Methods A cross-sectional analysis of 65,322 adults aged ≥ 20 years who participated in the Third National Health and Nutrition Examination Survey (NHANES III) and NHANES 1999-2018. Before 2003, dietary intake data were assessed using a 24-hour dietary call, and two 24-hour dietary calls were used during 2003 and 2018. Odds ratios and 95% confidence intervals (CIs) for CVD associated with dietary folate, vitamin B6, and vitamin B12 were estimated using multivariate logistic regression models. Results Dietary vitamin B6 intake were inversely associated with the odds of CVD. In males, the multivariable OR for the highest vs. lowest quartiles of vitamin B6 was 0.77 (95%CI: 0.61-0.97, Ptrend = 0.013) for the odds of CVD. In females, the adjusted OR for the highest quartile of vitamin B6 compared with the lowest quartile was 0.73 (95%CI: 0.56-0.95, Ptrend = 0.038) for the odds of CVD. No significant association was observed between dietary folate and vitamin B12 intakes and the odds of CVD. Conclusions Our findings indicate that higher intake of dietary vitamin B6 may be associated with lower prevalence of CVD, suggesting that dietary vitamin B6 has major public health implications in the prevention of CVD in the United States population.
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Affiliation(s)
- Jiamin Huang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Pipasha Khatun
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuqing Xiong
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Bingrui Liu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yisu Zhao
- Department of Clinical Nutrition, The First Affiliated Hospital of Henan Polytechnic University, Jiaozuo, China
| | - Quanjun Lyu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
- Department of Public Health, Zhengzhou Shuqing Medical College, Zhengzhou, China
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Fardous AM, Heydari AR. Uncovering the Hidden Dangers and Molecular Mechanisms of Excess Folate: A Narrative Review. Nutrients 2023; 15:4699. [PMID: 37960352 PMCID: PMC10648405 DOI: 10.3390/nu15214699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
This review delves into the intricate relationship between excess folate (vitamin B9) intake, especially its synthetic form, namely, folic acid, and its implications on health and disease. While folate plays a pivotal role in the one-carbon cycle, which is essential for DNA synthesis, repair, and methylation, concerns arise about its excessive intake. The literature underscores potential deleterious effects, such as an increased risk of carcinogenesis; disruption in DNA methylation; and impacts on embryogenesis, pregnancy outcomes, neurodevelopment, and disease risk. Notably, these consequences stretch beyond the immediate effects, potentially influencing future generations through epigenetic reprogramming. The molecular mechanisms underlying these effects were examined, including altered one-carbon metabolism, the accumulation of unmetabolized folic acid, vitamin-B12-dependent mechanisms, altered methylation patterns, and interactions with critical receptors and signaling pathways. Furthermore, differences in the effects and mechanisms mediated by folic acid compared with natural folate are highlighted. Given the widespread folic acid supplementation, it is imperative to further research its optimal intake levels and the molecular pathways impacted by its excessive intake, ensuring the health and well-being of the global population.
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Affiliation(s)
- Ali M. Fardous
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA;
| | - Ahmad R. Heydari
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA;
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI 48202, USA
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Shi L. Association of energy-adjusted dietary inflammatory index and frailty in older adults with nonalcoholic fatty liver disease. Exp Gerontol 2023; 182:112296. [PMID: 37734669 DOI: 10.1016/j.exger.2023.112296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Energy-adjusted dietary inflammatory index (E-DII) can represent daily inflammatory dietary components and chronic inflammatory response is an important pathogenesis of aging, nonalcoholic fatty liver disease (NAFLD) and frailty. Therefore, the purpose of this study is to explore the association of E-DII and frailty in older adults with NAFLD. METHODS This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (2005-2016) to investigate the association between E-DII and frailty. The NAFLD status was determined using the US Fatty Liver Index (FLI) value ≥30. The relationship between E-DII and frailty was examined through multivariate weighted logistic regression analysis and smooth curve fitting. Subgroup analyses were conducted, considering various demographic and clinical variables. RESULTS Our final analysis included 1586 individuals, with an average age of 69.42 years, and 53.15 % of them were males. The overall prevalence of frailty in the study population was 39.42 %. Smooth curve fitting analysis demonstrated a nearly linear relationship between E-DII and H. pylori. Utilizing multivariate weighted logistic regression analysis, we found that the odds ratio (OR) of E-DII for frailty was 1.08 (95%CI, 1.03-1.15). Subgroup analysis further confirmed that E-DII independently increased the risk of frailty. CONCLUSION Higher E-DII levels were found to be associated with an increased risk of frailty in older adults with NAFLD. However, further studies are required to fully elucidate the precise mechanisms underlying the relationship between E-DII and frailty.
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Affiliation(s)
- Lin Shi
- Department of Gastroenterology, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China.
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Zhong Q, Zhou W, Lin J, Sun W, Qin Y, Li X, Xu H. Independent and Combined Associations of Blood Manganese, Cadmium and Lead Exposures with the Systemic Immune-Inflammation Index in Adults. TOXICS 2023; 11:659. [PMID: 37624164 PMCID: PMC10457758 DOI: 10.3390/toxics11080659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
Manganese (Mn), cadmium (Cd) and lead (Pb) have toxic effects on the immune system. However, their independent and combined effects on immune-inflammation responses are unclear. In recent years, the systemic immune-inflammation index (SII) has been developed as an integrated and novel inflammatory indicator. A retrospective cross-sectional study of 2174 adults ≥20 years old from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 was conducted. Generalized linear models were used to evaluate the independent and combined associations of SII with blood Mn, Cd and Pb levels. As continuous variables, both blood Cd and Mn showed dose-dependent relationships with the SII before and after adjusting for all potential confounding factors. Metal concentrations were then converted into categorical variables. Compared with the adults in the lowest Cd or Mn tertile, those in the highest tertile had higher risks of elevated SII. Furthermore, co-exposure to Mn and Cd also showed a positive relationship with the SII after adjusting for all confounding factors. However, the single effect of Pb exposure and the joint effect of Pb and other metal exposures on the SII were not observed. This study provides important epidemiological evidence of the associations of SII with single and co-exposure effects of blood Mn, Cd, and Pb.
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Affiliation(s)
- Qiya Zhong
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China;
| | - Wenxin Zhou
- School of Public Health, Hangzhou Medical College, Hangzhou 310013, China; (W.Z.); (J.L.); (W.S.); (Y.Q.)
| | - Jiaqi Lin
- School of Public Health, Hangzhou Medical College, Hangzhou 310013, China; (W.Z.); (J.L.); (W.S.); (Y.Q.)
| | - Wen Sun
- School of Public Health, Hangzhou Medical College, Hangzhou 310013, China; (W.Z.); (J.L.); (W.S.); (Y.Q.)
| | - Yao Qin
- School of Public Health, Hangzhou Medical College, Hangzhou 310013, China; (W.Z.); (J.L.); (W.S.); (Y.Q.)
| | - Xiang Li
- School of Nursing, Yanbian University, Yanji 133000, China;
| | - Huadong Xu
- School of Public Health, Hangzhou Medical College, Hangzhou 310013, China; (W.Z.); (J.L.); (W.S.); (Y.Q.)
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12
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Mohan A, Kumar R, Kumar V, Yadav M. Homocysteine, Vitamin B12 and Folate Level: Possible Risk Factors in the Progression of Chronic Heart and Kidney Disorders. Curr Cardiol Rev 2023; 19:e090223213539. [PMID: 36757031 PMCID: PMC10494275 DOI: 10.2174/1573403x19666230209111854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 02/10/2023] Open
Abstract
Cobalamin is an essential molecule for humans; it is exceptionally important for various body functions, including deoxyribonucleic acid synthesis and cellular energy production. Vegans are more vulnerable to vitamin B12 deficiency than natives with moderate consumption of animal dietary supplements or people with inadequate nutritional patterns. However, the long-term effects of sub-medical deficiency have not been thoroughly studied, but they may have a negative impact on the cardiovascular system, pregnancy outcomes, and vascular, renal, cognitive, bone, and eye health. Alongside the statin remedy, that is a powerful approach for CVD prevention. Another approach is related to the B nutrition substitution remedy with folic acid, and vitamins B6 and B12 are extensively practised nowadays. There is a tremendous interest in plasma homocysteine (tHcy) as a cardiovascular hazard factor. However, current research in the field of its prevention is more inclined toward confirming the benefit of tHcy-reducing remedy with vitamin B12. Thus, while folic acid fortification is primarily aimed at reducing neural-tube defects, it may also play a significant role in the primary prevention of CVD by lowering tHcy. Folate and B-vitamins play important roles in CVD prevention and nutrition policy implementation. Patients affected with Chronic Kidney Disease (CKD) or end-stage Stage Renal Disease (ESRD) experience a tremendous cardiovascular threat that may also further lead to death. As a result, routine monitoring of vitamin B12 levels is likely to be beneficial for the early detection and treatment of metabolic vitamin B12 deficiency, as well as the prevention of heart-related diseases.
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Affiliation(s)
- Aditi Mohan
- Amity Institute of Biotechnology, Amity University, Noida Sector 125, Uttar Pradesh, India
| | - Ravi Kumar
- Department of Life Sciences, Bharathiyar University, Coimbatore, Tamil Nadu 641046, India
| | - Vivek Kumar
- Delhi Pharmaceutical Sciences and Research University, New Delhi 110017, India
| | - Mahendra Yadav
- Narayan Institute of Pharmacy, Gopal Narayan Singh University, Sasaram, Rohtas, Bihar 821305, India
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Riboflavin Intake Inversely Associated with Cardiovascular-Disease Mortality and Interacting with Folate Intake: Findings from the National Health and Nutrition Examination Survey (NHANES) 2005-2016. Nutrients 2022; 14:nu14245345. [PMID: 36558504 PMCID: PMC9785396 DOI: 10.3390/nu14245345] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
The association between intakes of riboflavin and mortality has not been examined intensively in general populations. In this study, 10,480 adults in the 2005-2016 National Health and Nutrition Examination Survey (NHANES) were followed-up until 2019 for their vital status. Riboflavin and folate were assessed by two-day 24 h recall. The date and cause of death were obtained from the US Mortality Registry. The risks of all-cause mortality and cardiovascular disease (CVD) mortality were investigated using a Cox regression analysis. During a mean of 8.5 years follow-up, there were 1214 deaths registered (including 373 deaths from CVD and 302 from cancer). Compared to low level (quartile 1, Q1) of riboflavin intake, the hazard ratios (HRs) (95% confidence interval (CI)) for high level (quartile 4, Q4) were 0.53 (0.31-0.90) for CVD mortality and 0.62 (0.48-0.81) for all-cause mortality. The inverse association between riboflavin intake and CVD mortality was only significant among those with a high intake of folate (p for interaction 0.045). Those with a high folate intake (Q4) and low intake of riboflavin (Q1) had the highest risk of CVD mortality (HR 4.38, 95% CI 1.79-10.72), as compared with a high intake of both riboflavin and folate. In conclusion, riboflavin intake was inversely associated with all-cause mortality and CVD mortality, and the association was modified by folate intake.
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Su H, Bo Y, Zhang X, Zhang J, Gao Z, Yu Z. Associations of folate intake with all-cause and cause-specific mortality among individuals with diabetes. Front Nutr 2022; 9:1021709. [PMID: 36313088 PMCID: PMC9614259 DOI: 10.3389/fnut.2022.1021709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background and aims The evidence regarding folate intake and mortality risk among patients with type 2 diabetes (T2D) remains unclear. This study aimed to investigate the association of folate intake with the risk of mortality among individuals with T2D. Methods A total of 9,196 participants with T2D from the Third National Health and Nutrition Examination Survey (NHANES III) and NHANES 1999–2014 were included. The data of survival were obtained by the cohort database linked with the national death index up to 31 December 2015. The Cox proportional hazard model was used to evaluate the relationship between dietary folate with all-cause and cause-specific mortality. Results Among patients with T2D, dietary folate intake was negatively correlated with all-cause mortality, cardiovascular mortality, and cancer mortality in men, and for women with all-cause mortality and cardiovascular mortality. The multivariate adjustment hazard ratio (HR) (95% CIs) for men of highest vs. lowest quartile was 0.77 (0.66–0.90), 0.61 (0.45–0.83), and 0.70 (0.49–0.99) for all-cause, cardiovascular, and cancer mortality, respectively. Among women, the multivariate adjustment HR (95% CIs) of highest vs. lowest quartile was 0.77 (0.64–0.92), 0.52 (0.33–0.83), and 0.78 (0.50–1.22) for all-cause, cardiovascular, and cancer mortality, respectively. Conclusion Higher dietary intake of folate was significantly associated with lower all-cause and cardiovascular mortality. This cohort study suggested that increasing the dietary folate intake may reduce mortality risk among U.S. adults with T2D.
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Affiliation(s)
- Hexin Su
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China,School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yacong Bo
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- The Third Hospital of Zhengzhou University, Zhengzhou, China
| | - Junxi Zhang
- NHC Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China
| | - Zhan Gao
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zengli Yu
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China,School of Public Health, Zhengzhou University, Zhengzhou, China,NHC Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China,*Correspondence: Zengli Yu
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