Population prevalence, attributable risk, and attributable risk percentage for high methylmalonic acid concentrations in the post-folic acid fortification period in the US

BACKGROUND

Serum methylmalonic acid (MMA) is regarded as a sensitive marker of vitamin B-12 status. Elevated circulating MMA is linked to neurological abnormalities. Contribution of age, supplement use, kidney dysfunction, and vitamin B-12 deficiency to high serum MMA in post-folic acid fortification period is unknown.

METHODS

We investigated prevalence, population attributable risk (PAR), and PAR% for high MMA concentrations in the US. Data from 3 cross-sectional National Health and Nutrition Examination Surveys conducted in post-folic acid fortification period were used (n = 18569).

RESULTS

Likelihood of having high serum MMA for white relative to black was 2.5 (P < 0.0001), ≥ 60 y old persons relative to < 60 y old persons was 4.0 (P < 0.0001), non-supplement users relative to supplement users was 1.8 (P < 0.0001), persons with serum creatinine ≥ 130 μmol/L relative to those with < 130 μmol/L was 12.6 (P < 0.0001), and persons with serum vitamin B-12 < 148 pmol/L relative to those with ≥ 148 pmol/L was 13.5 (P < 0.0001). PAR% for high MMA for old age, vitamin B-12 deficiency, kidney dysfunction, and non-supplement use were 40.5, 16.2, 13.3, and 11.8, respectively. By improving serum vitamin B-12 (≥ 148 pmol/L), prevalence of high MMA would be reduced by 16-18% regardless of kidney dysfunction.

CONCLUSIONS

Old age is the strongest determinant of PAR for high MMA. About 5 cases of high serum MMA/1000 people would be reduced if vitamin B-12 deficiency (< 148 pmol/L) is eliminated. Large portion of high MMA cases are not attributable to serum vitamin B-12. Thus, caution should be used in attributing high serum MMA to vitamin B-12 deficiency.

Demographic, lifestyle, and health characteristics and serum B vitamin status are determinants of plasma total homocysteine concentration in the post-folic acid fortification period, 1999-2004

Elevated circulating total homocysteine (tHcy) concentrations are related to increased risk for cardiovascular disease. Folic acid fortification resulted in a significant decrease in circulating tHcy in the United States. In the post-folic acid fortification period, associations between plasma tHcy and demographic, health, and lifestyle factors and B vitamin status were investigated. Data from the 3 recent NHANES cycles (1999-2004) were used to study the associations among plasma tHcy and sex, race/ethnicity, age, BMI, blood pressure (BP), serum creatinine, serum cotinine, vitamin/mineral supplement use, and folate and cobalamin status in 16,254 persons (8329 men, 7925 women). Multivariate-adjusted plasma tHcy was approximately 9.7% higher in men than in women (P < 0.0001), approximately 5.3% higher in non-Hispanic whites than in non-Hispanic blacks (P < 0.0001), approximately 64.5% higher in individuals aged >or=60 y than in individuals aged <20 y (P < 0.0001), and approximately 5% higher in supplement nonusers than in supplement users (P < 0.0001). Persons in the 4th quartile for serum creatinine, serum cotinine, systolic BP, and serum methylmalonic acid (MMA) had approximately 36.1, approximately 13.4, approximately 5.6, and approximately 16.2%, respectively, higher tHcy than those in the 1st quartile (P < 0.0001). Plasma tHcy was inversely associated with serum folate (P < 0.0001), RBC folate (P < 0.0001), and serum cobalamin (P < 0.0001). In the post-folic acid fortification period, sex, race/ethnicity, age, systolic BP, supplement use, RBC folate, and serum creatinine, cotinine, folate, and cobalamin are significant determinants of plasma tHcy. Serum MMA was strongly associated with plasma tHcy.

Serum leptin concentrations are not related to dietary patterns but are related to sex, age, body mass index, serum triacylglycerol, serum insulin, and plasma glucose in the US population

Background

Leptin is known to play a role in food intake regulation. The aim of this study was to investigate the relation between serum leptin concentrations and dietary patterns and demographic, lifestyle, and health factors in the US population.

Methods

Data from the third National Health and Nutrition Examination Survey, 1988–1994 were used to study the association between fasting serum leptin and dietary patterns, sex, race-ethnicity, smoking, age, energy and alcohol intakes, body mass index (BMI), plasma glucose, serum triacylglycerol, and serum insulin in 4009 individuals. Factor analysis was used to derive three principle factors and these were labeled as Vegetable, Fruit, and Lean Meat, Western, and Mixed dietary patterns.

Results

Serum leptin concentrations were significantly higher in Vegetable, Fruit, and Lean Meat (8.5 fg/L) and Mixed patterns (8.0 fg/L) compared to Western pattern (6.29 fg/L) (P < 0.0001). When analysis was adjusted for confounding variables, no significant association was observed between serum leptin and dietary patterns (P = 0.22). Multivariate adjusted serum leptin concentrations were significantly associated with sex (higher in women than in men; β = -1.052; P < 0.0001), age (direct relation, β = 0.006, P < 0.0001), BMI, (direct relation, β = 0.082, P < 0.0001), fasting plasma glucose (inverse relation, β = -0.024, P = 0.0146), serum triacylglycerol (direct relation, β = 0.034, P = 0.0022), and serum insulin (direct relation, β = 0.003, P < 0.0001) but not with race-ethnicity (P = 0.65), smoking (P = 0.20), energy intake (P = 0.42), and alcohol intake (P = 0.73).

Conclusion

In this study, serum leptin was not independently associated with dietary patterns. Sex, age, BMI, serum triacylglycerol, plasma glucose, and serum insulin are independent predictors of serum leptin concentrations.

Glycemic load is associated with HDL cholesterol but not with the other components and prevalence of metabolic syndrome in the third National Health and Nutrition Examination Survey, 1988-1994

Background

Carbohydrate quality and quantity may affect the risk for cardiovascular diseases (CVD) and type-2 diabetes mellitus. Glycemic load (GL) is a mathematical concept based on carbohydrate quality and quantity. GL is a product of glycemic index (GI) and the carbohydrate content of a food item divided by 100.

Objective

In this study, the association between GL and components and prevalence of metabolic syndrome was investigated in a representative sample survey of US residents utilizing the data reported in the third National Health and Nutrition Examination Survey (n = 5011).

Methods

Metabolic syndrome was defined according to the criteria established by the Adult Treatment Panel III. Multivariate-adjusted means for waist circumference, triacylglycerol, systolic and diastolic blood pressures, blood glucose, and HDL cholesterol were determined according to the energy-adjusted GL intake quartiles using regression models.

Results

In all subjects and in men, high GL was associated with low HDL-cholesterol concentrations in multivariate-adjusted analysis (P for trend < 0.01). However, no association was observed between GL and any of the individual components of metabolic syndrome in women. Also, no association was observed between energy-adjusted GL and prevalence of metabolic syndrome in both men (P for trend < 0.21) and women (P for trend < 0.09) in the multivariate-adjusted logistic regression analysis.

Conclusion

It is likely that the diets low in GL may mitigate the risk for CVD through HDL cholesterol.

Hemoglobin and hematocrit values are higher and prevalence of anemia is lower in the post-folic acid fortification period than in the pre-folic acid fortification period in US adults

BACKGROUND

It is not known whether the improved folate status from mandatory folic acid fortification had any impact on indexes and prevalence of anemias in the United States.

OBJECTIVE

We investigated trends in indexes and prevalence of anemia and macrocytosis with a focus on comparison of prefortification data with postfortification data.

DESIGN

Hemoglobin, hematocrit, mean corpuscular volume (MCV) and prevalences and likelihood of anemia and macrocytosis were determined for 26,596 adults examined in the National Health and Nutrition Examination Surveys, 1988-2004.

RESULTS

From 1988-1994 to 1999-2004, hemoglobin modestly but significantly improved from 15.1 to 15.4 g/dL (approximately 2.0%; P < 0.0001) and from 13.3 to 13.6 g/dL (approximately 2.3%; P < 0.0001) in men and women, respectively. There was a significant increase in MCV from 1988-1994 to 1999-2004 in men (from 90.2 to 90.7; P = 0.0123) and older (>60 y) men (from 91.6 to 92.4; P = 0.0105) and in women (from 90.7 to 91.4; P = 0.0141). Only in women was the prevalence of anemia significantly lower in 1999-2004 than in 1988-1994 (27.9% reduction; P = 0.0005). The odds of having anemia in the postfortification period relative to the prefortification period was 0.64 (95% CI: 0.54, 0.75; P < 0.0001) in women and 0.79 (95% CI: 0.62, 0.99; P < 0.0433) in men. In general, the prevalence of macrocytosis and the odds of having macrocytosis did not change significantly from 1988-1994 to 1999-2004.

CONCLUSION

The improvement in hemoglobin and the decreased prevalence of anemia from 1988-1994 to 1999-2004, especially in women, may be attributable to improved folate status, increased vitamin/mineral supplements use, and other unknown causes after the initiation of folic acid fortification. The cause of increased MCV in men, and in older persons of both sexes, warrants further investigation.

Population reference values for plasma total homocysteine concentrations in US adults after the fortification of cereals with folic acid

BACKGROUND

Folic acid fortification has resulted in a dramatic increase in folate intake in the United States. Folate intake is inversely associated with circulating total homocysteine (tHcy). Elevated tHcy is directly associated with cardiovascular disease risk.

OBJECTIVE

The aim of this study was to present the distribution of plasma concentrations of tHcy in US adults by using data from nationally representative sample surveys conducted since folic acid fortification was implemented.

DESIGN

Data from the National Health and Nutrition Examination Surveys from 1999-2001 and 2001-2002 were used to study tHcy distribution by age, sex, and race-ethnicity in 9196 persons.

RESULTS

Plasma concentrations of tHcy were higher in men than in women and in older persons than in younger persons. In those aged 19-30, 31-50, and 51-70 y but not in those aged >70 y, men had significantly (P < 0.0001) higher mean plasma concentrations of tHcy than did women. A race-ethnicity difference in plasma tHcy existed only in persons aged >70 y. Non-Hispanic blacks aged >70 y had significantly (P < 0.05) higher tHcy concentrations than did non-Hispanic white or Mexican American or Hispanic subjects in the same age group. Age-adjusted plasma tHcy concentrations did not differ significantly between non-Hispanic white (8.39 micromol/L), non-Hispanic black (8.92 micromol/L), and Mexican American or Hispanic (8.12 micromol/L) subjects. The rate of increase in plasma tHcy was greater in non-Hispanic blacks aged >/=50 y than in persons of similar age but of other races-ethnicities.

CONCLUSIONS

These plasma tHcy data reflect the effects of folic acid fortification. Sex, age, and race-ethnicity differences persist in plasma tHcy concentrations.

Trends in serum folate, RBC folate, and circulating total homocysteine concentrations in the United States: analysis of data from National Health and Nutrition Examination Surveys, 1988-1994, 1999-2000, and 2001-2002

Folate intakes increased dramatically after folic acid fortification. We investigated the changes in serum folate, RBC folate, and total homocysteine (tHcy) concentrations utilizing data from National Health and Nutrition Examination Surveys (NHANES) 1988-2002. NHANES 1988-2002 were based on a stratified, multistage, probability sampling design conducted among civilian U.S. residents. The current study included 17,144, 17,213, and 11,415 measurements for serum folate, RBC folate, and tHcy, respectively. Overall, geometric mean serum folate concentrations were 149.6 and 129.8% higher in 1999-2000 and 2001-2002, respectively, than in 1988-1994 (P < 0.0001). Sex-, age-, and race-ethnicity-adjusted serum folate was significantly lower in 2001-2002 than in 1999-2000 (10.4%, P < 0.0002). The prevalence of low serum folate decreased from 18.4% in 1988-1994 to 0.8% in 1999-2000 and to 0.2% in 2001-2002 (P < 0.0001). RBC folate increased from 391 nmol/L in 1988-1994 to 618 nmol/L in 1999-2000, and to 611 nmol/L in 2001-2002. Consequently, the prevalence of low RBC folate decreased from 45.8% in 1988-1994 to 7.3% in 1999-2000 and to 7.1% in 2001-2002 (P < 0.0001). Although, RBC folate status improved after folic acid fortification in all race-ethnicities, the prevalence of low RBC folate ( approximately 20.5%) continues to be high in non-Hispanic blacks. Age-, sex-, and race-ethnicity-adjusted tHcy declined from 9.5 micromol/L in 1988-1994 to 7.6 mumol/L in 1999-2000 and to 7.9 micromol/L in 2001-2002. Although folic acid fortification contributed to significant improvement in folate status, serum folate concentrations have declined recently. This may be attributable to lower folic acid intakes.

Population references for plasma total homocysteine concentrations for U.S. children and adolescents in the post-folic acid fortification era

Folate intake is inversely related to circulating total homocysteine (tHcy) concentrations. Elevated tHcy is a risk factor for vascular diseases. The objectives of this study were to present plasma tHcy distributions and investigate the association between tHcy and sex, age, and race-ethnicity in U.S. children and adolescents (3264 boys and 3197 girls) using data from the National Health and Nutrition Examination Surveys, 1999-2000 and 2001-2002 conducted in the post-folic acid fortification era. Plasma tHcy was higher in boys than in girls (P < 0.0001), and higher in older children (16-18 y old) than in younger children (3-15 y old) (P < 0.0001). The difference in plasma tHcy between boys and girls was greater in the 16- to 18-y-old group than in any other age group studied (P < 0.05). Age-adjusted plasma tHcy concentrations were approximately 6.8, approximately 10.5, and approximately 8.8% higher in boys than in girls in non-Hispanic White (NHW), non-Hispanic Black (NHB), and Mexican American/Hispanic (MA/H) children, respectively. Sex- and age-adjusted plasma tHcy concentrations (geometric means +/- SE) were 5.04 +/- 0.05, 5.01 +/- 0.06, and 4.99 +/- 0.06 micromol/L in the NHW, NHB, and MA/H groups, respectively. Race-ethnicity was not related to plasma tHcy in age-adjusted analysis for boys (P < 0.77) and girls (P < 0.26), and in sex- and age-adjusted analysis (P < 0.38) for all children. The plasma tHcy concentrations begin to rise between ages 8 and 11 y, and the age-related increase is greater in boys than in girls.

Population determinants of serum lycopene concentrations in the United States: data from the Third National Health and Nutrition Examination Survey, 1988-1994

Serum lycopene is inversely related to the risk for cancer and cardiovascular diseases. We used data from the Third National Health and Nutrition Examination Survey, 1988-1994, to investigate the relation between serum lycopene concentrations and sex, age, geographical location, race-ethnicity, education, alcohol, smoking, BMI, blood pressure, serum total cholesterol and triacylglycerol, and intakes of fat, tomatoes and tomato-based products in 3413 individuals aged 17-90 y. Multivariate adjusted mean lycopene concentrations were 48.3% lower in individuals > or =70 y old than in those 17 to <30 y old (P < 0.0001), 7.6% lower in women than in men (P = 0.0045), 15.1% lower in people living in the South than those in the West (P < 0.0001), 10.3 and 61.0% lower in the 1st quartile than in the 4th quartile for dietary fat intake (P = 0.0173) and serum cholesterol (P < 0.0001), respectively, 11.1% lower in tomato noneaters than those who ate tomatoes > or =31 times/mo (P = 0.0085), 13.5% lower in pizza noneaters than those who ate pizza > or =16 times/mo (P = 0.0016), and 20.6% lower in pasta noneaters than those who ate pasta (with tomato sauce) > or =16 times/mo (P < 0.0001). Race-ethnicity, alcohol, BMI, blood pressure, and consumption of non-tomato vegetables, and fruits and juices had no association with serum lycopene concentrations. Sex, age, geographical region, socioeconomic status, serum total cholesterol, smoking, and intakes of fat, tomatoes, pizza, and pasta were significant determinants of serum lycopene concentrations in the United States.

Frequent consumption of milk, yogurt, cold breakfast cereals, peppers, and cruciferous vegetables and intakes of dietary folate and riboflavin but not vitamins B-12 and B-6 are inversely associated with serum total homocysteine concentrations in the US population

BACKGROUND

Elevated circulating total homocysteine (tHcy) is an independent risk factor for vascular diseases.

OBJECTIVE

We investigated the relation between dietary intakes and serum tHcy in the US population.

DESIGN

Data from the third National Health and Nutrition Examination Survey (1988-1994) were used to investigate the associations between food consumption frequency and dietary B vitamin intakes and serum tHcy in 5996 persons.

RESULTS

Multivariate-adjusted tHcy concentrations were approximately 15.2% higher in subjects who never consumed milk than in those who consumed milk >30 times/mo, approximately 6.4% higher in subjects who never consumed yogurt than in those who consumed yogurt >15 times/mo, approximately 7.4% higher in subjects who never consumed cold breakfast cereals than in those who consumed cold breakfast cereals >30 times/mo, approximately 6.3% higher in subjects who never consumed peppers (includes red, yellow, green, and hot chili peppers) than in those who consumed peppers >30 times/mo, and approximately 16.5% higher in subjects who never consumed cruciferous vegetables than in those who consumed cruciferous vegetables >30 times/mo. Consumption of citrus fruit and juices, cheese, meats, coffee, or tea had no significant association with tHcy. Folate (beta=-0.0017, P for trend=0.004) and riboflavin (beta=-0.2851, P for trend=0.027), but not vitamin B-6 (beta=0.0505, P for trend=0.70) and cobalamin (beta=-0.0035, P for trend=0.58), were inversely related to serum tHcy after adjustment for confounders.

CONCLUSIONS

In this population-based study, milk, yogurt, cold breakfast cereals, peppers, and cruciferous vegetables were inversely related to serum tHcy. This association may be explained by increased intakes of folate and riboflavin.

Sex, age, geographical location, smoking, and alcohol consumption influence serum selenium concentrations in the USA: third National Health and Nutrition Examination Survey, 1988-1994

Selenium has been reported to reduce the risk for heart diseases and cancer. We examined the association of sex, age, geographical location, serum cotinine concentrations, a measure of smoking intensity, and alcohol consumption with serum selenium concentrations in the third National Health and Nutrition Examination Survey (NHANES III), 1988-1994. Study sample consisted of 14,619 apparently healthy individuals (male: 7,102; female: 7,517) aged 14 to >90 years. Sex, age, geographical location, serum cotinine concentrations, and alcohol consumption significantly influenced serum selenium concentrations (P < 0.05). The mean (+/- standard error) serum selenium concentration in men (124.5 +/- 0.20 ng/mL) was significantly higher than in women (122.0 +/- 0.20 ng/mL) (P < 0.0001). Men in the 31-50 y age group had the highest mean serum selenium concentration. In the same age group, women had the lowest mean serum selenium concentration. In both sexes, participants living in the Midwest and West had significantly higher serum selenium concentrations than those living in South and Northeast geographical locations. Serum cotinine was negatively associated with serum selenium concentrations in both men (beta = -0.0108; P < 0.0001 for trend) and women (beta = -0.0097; P < 0.0001 for trend). Alcohol consumption is positively associated with serum selenium in women (beta = 0.0462; P = 0.0044 for trend) but not in men (beta = 0.0015; P = 0.8496 for trend). Although, sex, age, geographical location, smoking, and alcohol intake influenced serum selenium concentrations, clinically low serum selenium concentrations are not common in the USA.