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Hussain SIB, AlKhenizan A, Mahmoud A, Qashlaq H. The correlation between vitamin B12 and folate levels and bone mineral density among the Saudi population in a primary care setting. J Family Med Prim Care 2023; 12:1063-1068. [PMID: 37636170 PMCID: PMC10451589 DOI: 10.4103/jfmpc.jfmpc_1209_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/06/2022] [Accepted: 09/30/2022] [Indexed: 08/29/2023] Open
Abstract
Purpose Bone health and osteoporosis are significant health problems in Saudi Arabia. Approximately 40%-50% of women and 25%-33% of men sustain osteoporotic fractures in their lifetimes. Hence, identifying the risk factors for osteoporosis is crucial in reducing the incidence of fractures. Materials and Methods We retrospectively reviewed the electronic medical records of 557 patients (female 60%, male 40%) aged ≥18 years (mean age, 66.53 years [standard deviation ± 14.169]) who underwent bone mineral density (BMD) scans at the Department of Family Medicine & Polyclinics, King Faisal Specialist Hospital and Research Centre (KFSH&RC) between January 2004 and June 2019. Data collected included demographics, BMD values, vitamin B12 levels, and folate levels. Results This study indicated that the prevalence rates of vitamin B12 and folate deficiencies among the study population were 8.4% and 1.3%, respectively. There was a statistically significant association between vitamin B12 levels and fracture risk (P =0.044). However, no statistically significant correlation was observed between BMD at either site (lumbar spine or femoral neck) and vitamin B12 (P =0.926.,070) and folate levels (P =.683.,79). BMD showed a significant positive correlation with body mass index at the lumbar spine and femoral neck (P = 0.000). There was no statistically significant association between vitamin B12 levels and the use of metformin (P =.26). Conclusion Vitamin B12 is associated with fracture risk; however, vitamin B12 and folate levels are not correlated to BMD (femoral neck and lumbar spine).
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Affiliation(s)
- Sarah I Bin Hussain
- Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center Riyadh, Saudi Arabia
| | - Abdullah AlKhenizan
- Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center Riyadh, Saudi Arabia
| | - Ahmed Mahmoud
- Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center Riyadh, Saudi Arabia
| | - Hussain Qashlaq
- Department of Internal Medicine, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
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Beaurain M, Rioufol C, Vantard N, Teixeira A, Baudouin A, Herledan C, Souquet PJ, Couraud S, Ranchon F. Intravenous route for folate supplementation in a patient with celiac disease treated by pemetrexed-based chemotherapy for non-small-cell lung cancer. J Oncol Pharm Pract 2022; 29:750-754. [PMID: 35918825 DOI: 10.1177/10781552221117734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Oral folic acid supplementation is essential for patients treated with pemetrexed, to prevent the risk of severe hematologic toxicity. In case of intestinal absorption disorder, no recommendations exist for intravenous folic acid supplementation. CASE REPORT We describe a 74-year-old patient with multimetastatic non-small-cell lung adenocarcinoma, receiving first-line chemotherapy with carboplatin AUC5, pemetrexed 500 mg/m2 and pembrolizumab 200 mg intravenously every 3 weeks. The patient presented neglected celiac disease, resulting in malabsorption syndrome with iron and folic acid deficiency. The question was how to administer folic acid supplementation during the pemetrexed-based chemotherapy. MANAGEMENT AND OUTCOMES Intravenous injection of 200 mg levoleucovorin on day 1 of cycle 1 of pemetrexed-based chemotherapy was administered and well tolerated. During the second cycle, the levoleucovorin perfusion was not renewed by omission. The patient was hospitalized for 7 days because of febrile aplasia. Piperacillin-tazobactam was started, and then switched to amoxicillin-clavulanate plus ciprofloxacin. After this episode of post-chemotherapy febrile aplasia, it was decided to systematically supplement the patient with intravenous levoleucovorin, with blood folate concentration monitoring at each cycle. At 16 months after start of treatment, the patient was in complete remission, indicating that the immune-chemotherapy was effective, with no further febrile neutropenia. DISCUSSION/CONCLUSION This case report highlights intravenous levoleucovorin supplementation as an alternative to oral folic acid if needed during pemetrexed-antifolate-based chemotherapy.
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Affiliation(s)
- Marie Beaurain
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France.,Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Alexandre Teixeira
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Chloe Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Pierre-Jean Souquet
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Pierre-Bénite, France
| | - Sebastien Couraud
- Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France.,Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Pierre-Bénite, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France.,Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
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Vidmar Golja M, Šmid A, Karas Kuželički N, Trontelj J, Geršak K, Mlinarič-Raščan I. Folate Insufficiency Due to MTHFR Deficiency Is Bypassed by 5-Methyltetrahydrofolate. J Clin Med 2020; 9:E2836. [PMID: 32887268 DOI: 10.3390/jcm9092836] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/21/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022] Open
Abstract
Adequate levels of folates are essential for homeostasis of the organism, prevention of congenital malformations, and the salvage of predisposed disease states. They depend on genetic predisposition, and therefore, a pharmacogenetic approach to individualized supplementation or therapeutic intervention is necessary for an optimal outcome. The role of folates in vital cell processes was investigated by translational pharmacogenetics employing lymphoblastoid cell lines (LCLs). Depriving cells of folates led to reversible S-phase arrest. Since 5,10-methylenetetrahydrofolate reductase (MTHFR) is the key enzyme in the biosynthesis of an active folate form, we evaluated the relevance of polymorphisms in the MTHFR gene on intracellular levels of bioactive metabolite, the 5-methyltetrahydrofolate (5-Me-THF). LCLs (n = 35) were divided into low- and normal-MTHFR activity groups based on their genotype. They were cultured in the presence of folic acid (FA) or 5-Me-THF. Based on the cells’ metabolic activity and intracellular 5-Me-THF levels, we conclude supplementation of FA is sufficient to maintain adequate folate level in the normal MTHFR activity group, while low MTHFR activity cells require 5-Me-THF to overcome the metabolic defects caused by polymorphisms in their MTHFR genes. This finding was supported by the determination of intracellular levels of 5-Me-THF in cell lysates by LC-MS/MS. FA supplementation resulted in a 2.5-fold increase in 5-Me-THF in cells with normal MTHFR activity, but there was no increase after FA supplementation in low MTHFR activity cells. However, when LCLs were exposed to 5-Me-THF, a 10-fold increase in intracellular levels of this metabolite was determined. These findings indicate that patients undergoing folate supplementation to counteract anti-folate therapies, or patients with increased folate demand, would benefit from pharmacogenetics-based therapy choices.
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Siervo M, Shannon O, Kandhari N, Prabhakar M, Fostier W, Köchl C, Rogathi J, Temu G, Stephan BCM, Gray WK, Haule I, Paddick SM, Mmbaga BT, Walker R. Nitrate-Rich Beetroot Juice Reduces Blood Pressure in Tanzanian Adults with Elevated Blood Pressure: A Double-Blind Randomized Controlled Feasibility Trial. J Nutr 2020; 150:2460-2468. [PMID: 32729923 PMCID: PMC7467850 DOI: 10.1093/jn/nxaa170] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/11/2020] [Accepted: 05/21/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND In Sub-Saharan Africa, current strategies are struggling to control the burgeoning hypertension epidemic. Dietary interventions such as inorganic nitrate or folic acid supplementation could represent promising strategies for reducing blood pressure (BP) in this setting. OBJECTIVES This feasibility study explores the effects of dietary inorganic nitrate supplementation, alone or in combination with folic acid, on BP in Tanzanian adults with elevated BP in Tanzania. METHODS A placebo-controlled, double-blind, randomized controlled feasibility trial was conducted. Forty-seven middle-aged and older participants (age: 50-70 y, BMI: 26.3-29.1 kg/m2) were randomly assigned to 3 conditions for a period of 60 d: 1) high-nitrate beetroot juice (∼400 mg nitrate) and folic acid (∼5 mg folic acid) (N + F), 2) high-nitrate beetroot juice and placebo (N + P), or 3) nitrate-depleted beetroot juice and placebo (P + P). Clinic and 24-h ambulatory BP and measurements of compliance in plasma (nitrate and folate concentrations) and saliva (nitrate and nitrite) were obtained at baseline, 30 d, and 60 d. RESULTS Baseline resting systolic and diastolic BP (mean ± SD) was 151.0 ± 19.4 mm Hg and 91.8 ± 11.7 mm Hg, respectively. Compliance to the interventions was high (>90%) in all groups which was confirmed by the significant increase in nitrate and folic acid concentrations in plasma and saliva samples in the treatment arms. After 60 d, 24-h systolic BP dropped by -10.8 ± 9.8 mm Hg (P < 0.001), -6.1 ± 13.2 mm Hg (P = 0.03), and -0.3 ± 9.7 mm Hg (P = 0.83) in the N + P, N + F, and P + P groups, respectively. There was a significant decrease in 24-h diastolic BP in the N + P group (-5.4 ± 5.0 mm Hg, P = 0.004), whereas changes were not significant in the N + F (-1.8 ± 8.1 mm Hg, P = 0.32) and P + P (1.6 ± 8.3 mm Hg, P = 0.43) groups. CONCLUSIONS Dietary inorganic nitrate represents a potential nutritional strategy to lessen the hypertension epidemic in Sub-Saharan Africa. These findings support the rationale for future long-term investigations exploring the efficacy of dietary nitrate for lowering BP and attenuating cardiovascular disease risk in this setting.This trial was registered at isrctn.com as ISRCTN67978523.
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Affiliation(s)
| | - Oliver Shannon
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle on Tyne, United Kingdom
| | - Navneet Kandhari
- Faculty of Medical Sciences, Newcastle University, Newcastle on Tyne, United Kingdom
| | - Meghna Prabhakar
- Faculty of Medical Sciences, Newcastle University, Newcastle on Tyne, United Kingdom
| | - William Fostier
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle on Tyne, United Kingdom
| | - Christina Köchl
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle on Tyne, United Kingdom
| | - Jane Rogathi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gloria Temu
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blossom C M Stephan
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom
| | - Irene Haule
- District Medical Officer, Hai District Hospital, Bomangombe, Tanzania
| | - Stella-Maria Paddick
- Clinical and Translational Medicine, Newcastle University, Newcastle on Tyne, United Kingdom
| | | | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom,Population of Health Sciences Institute, Newcastle University, Newcastle on Tyne, United Kingdom
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Kandhari N, Prabhakar M, Shannon O, Fostier W, Koehl C, Rogathi J, Temu G, Stephan BCM, Gray WK, Haule I, Paddick SM, Mmbaga BT, Walker R, Siervo M. Feasibility and acceptability of a nutritional intervention testing the effects of nitrate-rich beetroot juice and folic acid on blood pressure in Tanzanian adults with elevated blood pressure. Int J Food Sci Nutr 2020; 72:195-207. [PMID: 32522060 DOI: 10.1080/09637486.2020.1776226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sub-Saharan African countries are experiencing an alarming increase in hypertension prevalence. This study evaluated the feasibility and acceptability of nitrate-rich beetroot and folate supplementation, alone or combined, for the reduction of blood pressure (BP) in Tanzanian adults with elevated BP. This was a three-arm double-blind, placebo-controlled, parallel randomised clinical trial. Forty-eight participants were randomised to one of three groups to follow a specific 60-day intervention which included a: (1) combined intervention (beetroot juice + folate), (2) single intervention (beetroot juice + placebo), and (3) control group (nitrate-depleted beetroot juice + placebo). Forty-seven participants (age: 50-70 years) completed the study. The acceptability of the interventions was high. Self-reported compliance to the interventions was more than 90% which was confirmed by the significant increase in nitrate and folate concentrations in plasma and saliva samples in the treatment arms. This study provides important information for the design of high-nitrate interventions to reduce BP in Sub-Saharan African countries.
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Affiliation(s)
- Navneet Kandhari
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Meghna Prabhakar
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Oliver Shannon
- Human Nutrition Research Centre, Population Health Science Institute, Newcastle University, Newcastle upon Tyne, UK
| | - William Fostier
- Human Nutrition Research Centre, Population Health Science Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christina Koehl
- Human Nutrition Research Centre, Population Health Science Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Rogathi
- Kilimanjaro Christian Medical Centre, Kilimanjaro Christian Medical University College, Tanzania, UK
| | - Gloria Temu
- Kilimanjaro Christian Medical Centre, Kilimanjaro Christian Medical University College, Tanzania, UK
| | - Blossom C M Stephan
- Institute of Mental Health, The University of Nottingham Medical School, Nottingham, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Irene Haule
- District Medical Officer, Hai District Hospital, Bomangombe, Tanzania
| | - Stella-Maria Paddick
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK.,Clinical and Translational Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Kilimanjaro Christian Medical University College, Tanzania, UK.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK.,Population of Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mario Siervo
- School of Life Sciences, Queen's Medical Centre, The University of Nottingham Medical School, Nottingham, UK
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Alam C, Kondo M, O'Connor DL, Bendayan R. Clinical Implications of Folate Transport in the Central Nervous System. Trends Pharmacol Sci 2020; 41:349-361. [PMID: 32200980 DOI: 10.1016/j.tips.2020.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 12/11/2022]
Abstract
Folates are essential for key biosynthetic processes in mammalian cells and play a crucial role in the maintenance of central nervous system homeostasis. Mammals lack the metabolic capacity for folate biosynthesis; hence, folate requirements are largely met through dietary sources. To date, three major folate transport pathways have been characterized: the folate receptors (FRs), reduced folate carrier (RFC), and proton-coupled folate transporter (PCFT). This article reviews current knowledge on the role of folate transport systems in mediating folate delivery to vital tissues, particularly the brain, and how these pathways are modulated by various regulatory mechanisms. We will also briefly highlight the clinical significance of cerebral folate transport in relation to neurodevelopmental disorders associated with folate deficiency.
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Affiliation(s)
- Camille Alam
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario M5S 3M2, Canada
| | - Misaki Kondo
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario M5S 3M2, Canada
| | - Deborah L O'Connor
- Translational Medicine Program, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada; Department of Nutritional Sciences, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Reina Bendayan
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario M5S 3M2, Canada.
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Saber Cherif L, Pourié G, Geoffroy A, Julien A, Helle D, Robert A, Umoret R, Guéant JL, Bossenmeyer-Pourié C, Daval JL. Methyl Donor Deficiency during Gestation and Lactation in the Rat Affects the Expression of Neuropeptides and Related Receptors in the Hypothalamus. Int J Mol Sci 2019; 20:E5097. [PMID: 31615150 DOI: 10.3390/ijms20205097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/04/2019] [Accepted: 10/12/2019] [Indexed: 02/07/2023] Open
Abstract
The micronutrients vitamins B9 and B12 act as methyl donors in the one-carbon metabolism involved in transmethylation reactions which critically influence epigenetic mechanisms and gene expression. Both vitamins are essential for proper development, and their deficiency during pregnancy has been associated with a wide range of disorders, including persisting growth retardation. Energy homeostasis and feeding are centrally regulated by the hypothalamus which integrates peripheral signals and acts through several orexigenic and anorexigenic mediators. We studied this regulating system in a rat model of methyl donor deficiency during gestation and lactation. At weaning, a predominance of the anorexigenic pathway was observed in deficient pups, with increased plasma peptide YY and increased hypothalamic pro-opiomelanocortin (POMC) mRNA, in line with abnormal leptin, ghrelin, and insulin secretion and/or signaling during critical periods of fetal and/or postnatal development of the hypothalamus. These results suggest that early methyl donor deficiency can affect the development and function of energy balance circuits, resulting in growth and weight deficits. Maternal administration of folic acid (3 mg/kg/day) during the perinatal period tended to rectify peripheral metabolic signaling and central neuropeptide and receptor expression, leading to reduced growth retardation.
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Socha-Banasiak A, Kamer B, Pacześ K, Ślusarek B, Pawlikowski B, Czkwianianc E. Trends in folic acid supplementation during pregnancy - the effect on allergy development in children. Postepy Dermatol Alergol 2018; 35:139-44. [PMID: 29760612 DOI: 10.5114/pdia.2017.68785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 02/01/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction The results of some previous studies suggested that maternal folate supplementation during pregnancy may contribute to allergy development in offspring. Aim This study was performed to examine the influence of maternal folic acid intake prior to and during pregnancy on the development of various types of allergy in children taking into account the timing and dosage of supplemented folate. Material and methods The retrospective study was performed between 2010 and 2014 in 307 child-mother pairs (203 allergic children and 104 children without allergy symptoms, aged 2-72 months). Allergy diagnosis was based on medical history, physical examination, positive results of allergic tests: specific IgE and/or skin prick tests and double-blind, placebo-controlled food challenge. The data concerning maternal folate supplementation prior to and during pregnancy were obtained based on a questionnaire. Results Mothers of allergic children used to take folic acid more frequently in the preconception period (42.9%), in the 1st (94.1%) and the 2nd/3rd (81.3%) trimester of pregnancy than mothers of the healthy ones (30.8%, 82.7% and 55.8%, respectively) (p < 0.05). Maternal intake of folate in a dosage higher than recommended (> 0.4 mg/day) was more often observed in the group of allergic subjects, especially in children with combined sensitization to food and inhalant allergens, than in the control group (p < 0.05). Conclusions Our results suggest an impact of maternal folic acid supplementation prior to and during pregnancy on allergy development in children. Further observations are required to establish the role of folate in fetal epigenetic modifications.
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Jaganmohan D, Subramaniam P, Krishnan N, Mahajan P. Two Cases of Craniospinal Rachischisis Totalis: Role of Magnetic Resonance Imaging in Diagnosis and Review of Neural Tube Defects in the Indian Context with Implications for Folate Fortification. J Pediatr Neurosci 2017; 12:32-35. [PMID: 28553376 PMCID: PMC5437784 DOI: 10.4103/1817-1745.205632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Craniospinal rachischisis is a rare and severe form of neural tube defects (NTDs), which is always fatal. It is characterized by anencephaly accompanied by a bony defect of the spine and exposure of neural tissue. We describe the two patients with ultrasonographic and magnetic resonance imaging appearance of craniospinal rachischisis totalis, detected antenatally at 22 and 25 weeks of gestation, and confirmed after termination of pregnancy. The multifactorial etiology of NTDs, with specific reference to folate deficiency, is discussed with possible role of folate fortification in the Indian context.
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Affiliation(s)
- Deepasree Jaganmohan
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Prema Subramaniam
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nagarajan Krishnan
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Preetam Mahajan
- Department of Community Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Ortega-García JA, Ferrís-Tortajada J, Claudio L, Soldin OP, Sanchez-Sauco MF, Fuster-Soler JL, Martínez-Lage JF. Case control study of periconceptional folic acid intake and nervous system tumors in children. Childs Nerv Syst 2010; 26:1727-33. [PMID: 20496070 DOI: 10.1007/s00381-010-1187-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 05/12/2010] [Indexed: 12/17/2022]
Abstract
PURPOSE Since 1992, the Centers for Disease Control and Prevention recommends that women of childbearing age consume 400 µg of folic acid per day to reduce the risk of neural tube defects (NTD). It has been speculated that both NTD and nervous system tumors (NST) may share common mechanisms of altered development. It examines the association between folic acid supplementation and the risk for childhood NST. METHODS Incident cases of children with cancer in Spain registered between 2004 and 2006 were identified through the MACAPE Network Group. Tumors were classified as tumors derived from the neuroectoderm (cases) and those with a mesoderm origin (controls). In a second analysis, NST were further divided into central nervous system tumors (CNST) and sympathetic nervous system tumors (SNST). We compared folic acid supplementation between the groups. RESULTS Overall, folic acid supplementation any time during pregnancy was similar between cases and controls (odds ratio (OR)=1.05; 95% confidence interval (CI) 0.92-1.20). However, supplementation before the 21st and 36th days of gestation resulted in significantly lower NST than in children with mesoderm tumors (OR=0.34; 95% CI 0.17-0.69 and OR=0.58; 95% CI 0.37-0.91, respectively). Preconceptional intakes of folic acid were also lower in NST although marginally nonsignificant (OR=0.44; 95% CI 0.10-1.02). When NST were divided into CNST and SNST, significant differences between tumors of mesoderm origin were only found for CNST. CONCLUSIONS Our results support the hypothesis that folate supplementation reduces the risk of childhood NST, especially CNST. The specific mechanism and cellular role that folate may play in the development of CNST have yet to be elucidated.
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11
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Ormond G, Nieuwenhuijsen MJ, Nelson P, Toledano MB, Iszatt N, Geneletti S, Elliott P. Endocrine disruptors in the workplace, hair spray, folate supplementation, and risk of hypospadias: case-control study. Environ Health Perspect 2009; 117:303-7. [PMID: 19270804 PMCID: PMC2649236 DOI: 10.1289/ehp.11933] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 11/05/2008] [Indexed: 05/18/2023]
Abstract
BACKGROUND Hypospadias is one of the most common urogenital congenital anomalies affecting baby boys. Prevalence estimates in Europe range from 4 to 24 per 10,000 births, depending on definition, with higher rates reported from the United States. Relatively little is known about potential risk factors, but a role for endocrine-disrupting chemicals (EDCs) has been proposed. OBJECTIVE Our goal was to elucidate the risk of hypospadias associated with occupational exposure of the mother to endocrine-disruptor chemicals, use of folate supplementation during pregnancy, and vegetarianism. DESIGN We designed a case-control study of 471 hypospadias cases referred to surgeons and 490 randomly selected birth controls, born 1 January 1997-30 September 1998 in southeast England. Telephone interviews of mothers elicited information on folate supplementation during pregnancy and vegetarianism. We used a job exposure matrix to classify occupational exposure. RESULTS In multiple logistic regression analysis, there were increased risks for self-reported occupational exposure to hair spray [exposed vs. nonexposed, odds ratio (OR) = 2.39; 95% confidence interval (CI), 1.40-4.17] and phthalate exposure obtained by a job exposure matrix (OR = 3.12; 95% CI, 1.04-11.46). There was a significantly reduced risk of hypospadias associated with of folate use during the first 3 months of pregnancy (OR = 0.64; 95% CI, 0.44-0.93). Vegetarianism was not associated with hypospadias risk. CONCLUSIONS Excess risks of hypospadias associated with occupational exposures to phthalates and hair spray suggest that antiandrogenic EDCs may play a role in hypospadias. Folate supplementation in early pregnancy may be protective.
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Affiliation(s)
- Gillian Ormond
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
- Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom
| | - Mark J. Nieuwenhuijsen
- Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom
- Center for Research in Environmental Epidemiology (CREAL), Municipal Institute of Medical Research (IMIM), CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Paul Nelson
- Independent Public Health Consultant, Phrisk Ltd, London, United Kingdom
| | - Mireille B. Toledano
- Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom
| | - Nina Iszatt
- Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom
| | - Sara Geneletti
- Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom
| | - Paul Elliott
- Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom
- Address correspondence to P. Elliott, MRC Centre for Environment and Health, Department of Epidemiology and Public Health, Imperial College London, St. Mary’s Campus, Norfolk Place, London, U.K. Telephone: 44 20 7594 3328. Fax: 44 20 7262 1034. E-mail:
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Killeen OG, Gardner-Medwin JM. In juvenile idiopathic arthritis, is folate supplementation effective against methotrexate toxicity at the expense of methotrexate's efficacy? Arch Dis Child 2006; 91:537-8. [PMID: 16714734 PMCID: PMC2082770 DOI: 10.1136/adc.2006.094219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- O G Killeen
- Paediatric Rheumatology, Department of Child Health, RHSC, Glasgow, UK.
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