Predictors of micronutrient status in men and women over 75 years old living in the community

Serum ferritin, serum vitamin B12, erythrocyte folate, plasma vitamin C and plasma 25-hydroxycholecalciferol levels were measured in 208 men and 197 women, >75 years old and living in the community, in order to assess micronutrient status. Anthropometric measurements (height, weight, demispan and mid-upper arm circumference) were made and a 114-item questionnaire covering a wide range of health and diet-related topics was administered by an interviewer. Only 4 % of subjects had a BMI <20, but the prevalence of marginal deficiency of the micronutrients ranged from 7 % for Fe to 47 % for vitamin D. There was no association between low micronutrient status (defined as being in the lowest third of the distribution of micronutrient status) and having BMI or mid-upper arm circumference in the lowest third of the distribution for any of the nutrients. Leaving food on the plate was strongly associated with both low Fe status and low vitamin D status. Having breakfast cereal less than once per week was strongly associated with low folate status, while having fresh fruit juice less than once per week, having had less than two portions of fruits and vegetables the previous day and believing that food is not important for health were strongly associated with low vitamin C status. Low vitamin D status was strongly associated with a wide range of general health and disability measures. Having a weekly household income of less than pound 150 was associated with low status of Fe, folate, vitamin C and vitamin D.     

Low folic acid status and its association with anaemia in urban adolescent girls and women of childbearing age in Sri Lanka

Folic acid deficiency is implicated in the aetiology of nutritional anaemia and adverse pregnancy outcomes for the fetus. Data on folic acid status among adolescent girls and non-pregnant, non-lactating young women are limited. We assessed folic acid status in a random sample of 552 subjects (277 adolescent girls aged 15-18.9 years and 275 women aged 19-30 years) living in Colombo, Sri Lanka. The association of low folic acid status with anaemia was evaluated. Socio-economic, food intake and anthropometric data were obtained. Hb, serum folic acid, vitamin B12 and ferritin and plasma homocysteine concentrations were measured. Forty-three per cent of subjects studied had low serum folic acid concentrations (<3 ng/ml) and 47 % had low Fe stores (serum ferritin <20 microg/l). Overall prevalence of anaemia was 12.9 %, and 43.9 % of anaemic subjects had both low folic acid status and depleted Fe stores (serum ferritin <12 microg/l). Both low folate status and depleted Fe stores were significantly associated with anaemia (odds ratio = 2.32; 95 % CI 1.34, 4.01 and odds ratio = 5.98; 95 % CI 3.36, 10.63, respectively). Serum folic acid concentration was associated (r = 0.108, P = 0.015) with folate intake as indicated by a computed folate index. Folate index was associated inversely with household size and positively with economic status and education level. In this study population low folic acid status, besides depleted Fe stores, was associated with anaemia. The high prevalence of low folic acid status observed highlights the need for nutrition education to improve intakes of folate, Fe and other micronutrients among adolescent girls and young women.     

Low maternal vitamin B-12 status is associated with offspring insulin resistance regardless of antenatal micronutrient supplementation in rural Nepal

Questions have been raised about potentially negative effects of antenatal folic acid use in populations with a high prevalence of vitamin B-12 deficiency. Our objective was to examine the association between maternal folate and vitamin B-12 status in pregnancy on offspring insulin resistance and examine whether the effects of maternal micronutrient supplementation varied by baseline maternal folate and/or vitamin B-12 status. Pregnant women were cluster randomized to receive daily supplements containing vitamin A alone or with folic acid, folic acid+iron, folic acid+iron+zinc, or a multiple micronutrient. In a subsample (n = 1132), micronutrient status biomarkers were analyzed at baseline and late pregnancy. Children born to the women who participated in the trial were visited at 6-8 y of age. Fasting plasma glucose and insulin were used to estimate insulin resistance using the homeostasis model assessment (HOMA-IR). Children whose mothers were deficient in vitamin B-12 (<148 pmol/L, 27%) during early pregnancy had a 26.7% increase in HOMA-IR (P = 0.02), but there was no association with maternal folate status. Among children born to women who were vitamin B-12 deficient at baseline, the percent difference in HOMA-IR compared to the control group was 15.1% (95% CI: -35.9, 106.4), 4.9% (-41.6, 88.5), 3.3% (-38.4, 73.5), and 18.1% (-29.0, 96.7) in the folic acid, folic acid-iron, folic acid-iron-zinc, and multiple micronutrient supplementation groups, respectively, none of which were significant. Maternal vitamin B-12 deficiency is associated with an elevated risk of insulin resistance, but supplementation with folic acid or other micronutrients led to no significant change in insulin resistance in school-aged offspring.     

Iron, zinc, folate and vitamin B12 nutritional status and milk composition of low-income Brazilian mothers

The purpose of this study was to assess the nutritional status of low-income Brazilian mothers, who were supplemented with iron and vitamin B12 during pregnancy, in terms of iron, zinc, folate and vitamin B12, in different stages of lactation and to determine the influence of the maternal nutritional status on milk composition. The effect of folate supplementation during pregnancy on folate status of the nursing mothers and milk composition was investigated. The effect of partial weaning on maternal status and milk composition was also studied. In general, the nutritional status of iron, zinc, folate and vitamin B12 of the mothers appears adequate. However, some of the mothers had indices of status lower than normal limits for non-pregnant women. These values, particularly after 30 d post-partum, indicate that these mothers might be at nutritional risk and that the nutrient supplementation received during pregnancy was insufficient to meet demands. There was an increase with the stage of lactation for haematocrit, serum vitamin B12, serum zinc, serum albumin, milk folate and saturation of its binding protein, but there was a decrease for milk protein, total and whey-bound iron and zinc, and lactoferrin. Mothers who took folate supplements during pregnancy had higher serum folate levels immediately after birth than those not taking the supplements but no differences were found at later stages of lactation. Milk composition was not affected. Partial weaning did not affect the maternal nutritional status or the milk composition except for iron which was higher in milk from mothers who were partially breastfeeding.(ABSTRACT TRUNCATED AT 250 WORDS)     

Multiple micronutrients in pregnancy and lactation: an overview

This overview of multiple micronutrients during pregnancy and lactation emphasizes 2 relatively neglected issues. The first is that maternal micronutrient status in the periconceptional period, and throughout pregnancy and lactation, should be viewed as a continuum; too often these 3 stages are treated and discussed separately from both a scientific and a public health perspective. Iron and vitamin B-12 are included as examples to stress how status at conception affects maternal, fetal, and infant status and health until the child is weaned. The second issue is that while most attention has been focused on a few micronutrients, for example iron and folate as discussed elsewhere in this Supplement, multiple micronutrient deficiencies occur simultaneously when diets are poor. Some of these deserve more attention as causes of poor pregnancy outcome, including other B vitamin deficiencies that result in homocysteinemia, antioxidants, vitamin D, and iodine. In lactation, maternal status or intake of the B vitamins (except folate), vitamin A, selenium and iodine strongly affect the amount of these nutrients secreted in breast milk. This can result in the infant consuming substantially less than the recommended amounts and further depleting stores that were low at birth. While the optimal mode of meeting recommended micronutrient intakes is an adequate diet, in some situations supplementation is also important. Unfortunately, information is lacking on the optimal formulation of micronutrient supplements for pregnant women, and the need to continue these supplements during lactation is not recognized in many situations where maternal and infant health could benefit.     

Masked vitamin B12 and folate deficiency in the elderly

1. A high incidence of vitamin B12 or folate deficiency, or both, may be found in the elderly, particularly those in hospital. This report concerns fifty cases detected in an inner-city-area geriatric unit during the course of routine clinical investigation. The majority had none of the classical haematological signs of vitamin B12 or folate deficiency, and all the patients reported had a mean corpuscular volume (MCV) of less than 100 fl. 2. There was a significant negative correlation between the MCV and the erythrocyte folate (P less than 0.01), supporting earlier published work using a low serum folate as an index of folate deficiency. 3. There was no correlation between the MCV and the serum vitamin B12. Published work differs on this point. 4. Serum iron, total Fe-binding capacity and percentage Fe saturation results were available in forty patients in this series. There was a significant positive correlation between the serum Fe and the MCV (P less than 0.01) and 34% of patients had haematological evidence of Fe deficiency. In the majority, however, there was no evidence that associated Fe deficiency had masked the haematological signs of vitamin B12 or folate deficiency. 5. More attention should be paid to the problem of 'masked' vitamin B12 and folate deficiency in the elderly. There is a case for routine screening of the elderly for vitamin B12 and folate deficiency irrespective of the MCV.     

The Impact of Preconception Gastric Bypass Surgery on Maternal Micronutrient Status before and during Pregnancy: A Retrospective Cohort Study in the Netherlands between 2009 and 2019

Post-bariatric weight loss can cause iatrogenic malnutrition and micronutrient depletion. In this study, we evaluated the impact of gastric bypass surgery (GB) and multivitamin supplement use on maternal micronutrient status before and across pregnancy. A retrospective medical chart review of 197 singleton pregnancies after GB with a due date between 2009 and 2019 was performed at a bariatric expertise center in the Netherlands. Hemoglobin, calcium, iron status, folate, vitamin D, vitamin B12 and ferritin levels were determined before and after GB during standard follow-up and at all gestational trimesters and analyzed using linear mixed models. Patients were prescribed standard multivitamin supplements or multivitamins specifically developed for post-bariatric patients (FitForMe WLS Forte (FFM)). Overall, hemoglobin and calcium levels decreased after surgery and during pregnancy, whereas folate, vitamin D, and vitamin B12 levels increased, and iron levels remained stable. FFM use was associated with higher hemoglobin, folate, vitamin D, and ferritin levels. In conclusion, through adequate supplementation and follow-up, GB does not have to result in impaired micronutrient status. Supplements developed specifically for post-bariatric patients generally result in higher micronutrient values than regular multivitamins before and during pregnancy. These data emphasize the urgent need for nutritional counseling including dietary and multivitamin supplement advise for post-bariatric women contemplating and during pregnancy.     

Longitudinal vitamin and homocysteine levels in normal pregnancy

Evidence of the impact of maternal nutritional status on pregnancy outcome is increasing. However, reference values for vitamin and homocysteine concentrations in maternal blood during normal pregnancy are scarce, and are lacking for the preconceptional period and early pregnancy. Thus, in a longitudinal study we evaluated vitamin and homocysteine concentrations in 102 nulliparous women with an uneventful singleton pregnancy and normal outcome not using supplements. The physiological changes in vitamin and homocysteine concentrations in blood were determined from the preconceptional period throughout pregnancy until 6 weeks post-partum. The vitamins evaluated comprised retinol, thiamin, riboflavin, pyridoxal 5'-phosphate, folate in serum and erythrocytes, vitamin B12 and alpha-tocopherol. The plasma homocysteine concentration was also measured, considering the essential roles of folate, vitamin B6 and vitamin B12 in homocysteine metabolism. The concentrations of retinol, thiamin, pyridoxal 5'-phosphate serum folate and vitamin B12 decreased during pregnancy. In contrast, the concentrations of riboflavin, alpha-tocopherol, and folate in erythrocytes increased or showed only minor changes. Homocysteine concentrations also remained approximately constant during pregnancy. These observations emphasize the importance of preconceptional and post-partum concentrations of vitamins in the evaluation of pregnancy-induced changes. These data have provided valuable reference values for vitamins and homocysteine before, during and after pregnancy in order to contribute to better diagnosis of maternal deficiencies and to study further the relationship between maternal vitamin status and adverse course and outcome of pregnancy.     

Serum vitamin B12 levels in parturients, in the intervillous space of the placenta and in full-term newborns and their interrelationships with folate levels

Serum vitamin B12 levels were determined in a group of 51 parturients as well as in their babies and placentas. The results obtained showed that newborns had 2.3 times higher vitamin B12 levels than their mothers and that the concentrations of this vitamin in the intervillous space of the placenta was 1.3- and 3.2-fold those encountered in the blood of newborns and mothers, respectively. These findings indicate that vitamin B12 accumulation by the placenta may represent an important factor in providing sufficient amount of this essential nutrient to the fetus. The relationship between folate and vitamin B12 concentration in the maternal, fetal and placental sera was also investigated. The highly significant correlation coefficient encountered and significantly higher serum folate concentrations in the group of parturients who received vitamin B12 supplementation during pregnancy indicate a close metabolic interrelationship between vitamin B12 and folate.     

Antenatal supplementation with micronutrients and biochemical indicators of status and subclinical infection in rural Nepal

BACKGROUND: Previously we showed that women in rural Nepal experience multiple micronutrient deficiencies in early pregnancy. OBJECTIVE: This study examined the effects of daily antenatal micronutrient supplementation on changes in the biochemical status of several micronutrients during pregnancy. DESIGN: In Nepal, we conducted a randomized controlled trial in which 4 combinations of micronutrients (folic acid, folic acid + iron, folic acid + iron + zinc, and a multiple micronutrient supplement containing folic acid, iron, zinc, and 11 other nutrients) plus vitamin A, or vitamin A alone as a control, were given daily during pregnancy. In a subsample of subjects (n = 740), blood was collected both before supplementation and at approximately 32 wk of gestation. RESULTS: In the control group, serum concentrations of zinc, riboflavin, and vitamins B-12 and B-6 decreased, whereas those of copper and alpha-tocopherol increased, from the first to the third trimester. Concentrations of serum folate, 25-hydroxyvitamin D, and undercarboxylated prothrombin remained unchanged. Supplementation with folic acid alone or folic acid + iron decreased folate deficiency. However, the addition of zinc failed to increase serum folate, which suggests a negative inhibition; multiple micronutrient supplementation increased serum folate. Folic acid + iron + zinc failed to improve zinc status but reduced subclinical infection. Multiple micronutrient supplementation decreased the prevalence of serum riboflavin, vitamin B-6, vitamin B-12, folate, and vitamin D deficiencies but had no effect on infection. CONCLUSIONS: In rural Nepal, antenatal supplementation with multiple micronutrients can ameliorate, to some extent, the burden of deficiency. The implications of such biochemical improvements in the absence of functional and health benefits remain unclear.     

Physiologic changes in homocysteine metabolism in pregnancy: a longitudinal study in Spain

Objective

The aim was to investigate whether pregnancy-induced changes in total homocysteine (tHcy) are associated with folate and vitamin B12 nutritional status, genetic C677T polymorphism in the methylenetetrahydrofolate reductase (MTHFR) enzyme, and gestation outcome at a time when folic acid supplementation started to be recommended in the Spanish health system.

Methods

In total 154 pregnant women were recruited from among gynecologic patients of the Alcorcón Public Hospital Outpatient Clinic (Madrid, Spain). Blood tests were performed at weeks 15, 24, and 32 of pregnancy. Total Hcy, folate, and vitamin B12 serum fasting concentrations were measured using an IMx system. Genotype analyses were done by polymerase chain reaction/restriction fragment/length polymorphism analysis.

Results

Folate and vitamin B12 serum concentrations decreased significantly (P < 0.01) through pregnancy and reached the lowest values in the third trimester. Serum tHcy concentrations were significantly (P < 0.01) lower in the second trimester but increased in the third trimester. Frequencies of MTHFR C667T genotype were CC (35.7%), CT (57.2%), and TT (7.1%). Total Hcy concentration was not statistically influenced by maternal genotype. Plasma folate was the single negative predictor of maternal tHcy in the first trimester of pregnancy; 11.1% of gestations resulted in intrauterine growth restriction, 7.9% in gestational diabetes mellitus, and 4.8% in gestational hypertension. No significant differences in serum folate, vitamin B12, or tHcy concentrations were found in complicated pregnancies and these were unrelated to MTHFR genotype.

Conclusion

Although tHcy seems to be physiologically low in this Spanish population and unrelated to folate and B12 nutritional status, C677T MTHFR genotype, and some pregnancy complications, we support the statement that appropriate folate concentration may be important throughout pregnancy to prevent abnormalities associated with altered status (e.g., neural tube defects). According to our study, supplementation with folic acid seems to achieve this purpose because diet alone may be insufficient. In addition, a poor vitamin B12 status, as measured by plasma levels, may indicate that supplementation of both vitamins is needed.     

Micronutrient deficiencies in early pregnancy are common, concurrent, and vary by season among rural Nepali pregnant women

Pregnant women in developing countries are vulnerable to multiple micronutrient deficiencies. We investigated their prevalence and seasonal variation as part of a baseline assessment in a population-based, maternal micronutrient supplementation trial conducted in the rural Southeastern plains of Nepal. Serum concentrations of 11 micronutrients were assessed in 1165 pregnant women in the 1st trimester before supplementation. Using defined cutoff values, the prevalence of deficiencies of vitamins A, E, and D were 7, 25, and 14%, respectively. Nearly 33% of the women were deficient in riboflavin, and 40 and 28% had serum vitamin B-6 and B-12 deficiencies, respectively. Only 12% of the women were folate deficient, but 61% were zinc deficient. The prevalence of low serum iron concentration was 40%, and 33% were anemic (hemoglobin < 110 g/L). Multiple micronutrient deficiencies were common among pregnant women. Over 10% of the pregnant women were both anemic and deficient in B-complex vitamins, whereas 22% of women were both anemic and zinc deficient. Only 4% of women had no deficiency, whereas approximately 20% of the women had 2, 3, or 4 deficiencies. Almost 18% of women had >/=5 deficiencies. Micronutrient status varied by season; it was generally best during the winter months, except for serum vitamin D concentration, which peaked during the hot summer and monsoon months. Women in rural South Asia are likely to begin a pregnancy with multiple micronutrient deficiencies that may vary with seasonality in micronutrient-rich food availability.     

Vitamin B12 and folate status of older New Zealand women

The primary aim of this study was to assess the biochemical vitamin B12 and folate status of a representative group of elderly women (70-80 y) living in Dunedin, New Zealand. A second aim was to determine the prevalence of hyperhomocysteinaemia and to explore the determinants of homocysteine (hcy) concentration in this population. A cross-sectional study was carried out between June and August of 2000. Two hundred and fifty women were randomly selected from the 1998 electoral roll. Fasting blood samples were analysed for folate, vitamin B12, total hcy, creatinine, and haematological parameters. Of the women selected, 87 did not respond, 37 were not traceable, 23 were not eligible or had died, and 103 agreed to participate. The overall response rate was 46%. Based on a cut-off of 150 pmol/L for serum B12, 13% of participants would be classified as having sub-optimal vitamin B12 status. Of the women, 3 and 5%, respectively, had low serum (< 6.6 nmol/L) and erythrocyte folate (< 317 nmol/L) concentrations. No participant had megaloblastic anaemia. The prevalence of hyperhomocysteinaemia (> 15 mumol/L) in this population was 18%. Hyperhomocysteinaemia in this group may be partly explained by renal insufficiency because there was a significant association between serum creatinine and plasma hcy (P < 0.001). Blood folate levels but not serum B12 were significantly inversely associated with hcy. In conclusion, there was a moderately high prevalence of hyperhomocysteinaemia and suboptimal plasma vitamin B12 concentrations but not low blood folate concentrations in this elderly female population.     

A critical evaluation of the relationship between serum vitamin B, folate and total homocysteine with cognitive impairment in the elderly.

BACKGROUND: Serum homocysteine increases with age and is also considered a marker for low serum vitamin B(12) and folate. Furthermore, raised serum total homocysteine has been associated with atrophic changes in the brain. An association between serum vitamin B(12)/folate and cognitive impairment would be of considerable public health importance in view of the increasing numbers of elderly people. AIM: To systematically review published studies on the relationship between serum vitamin B(12), folate and total homocysteine and cognitive function in the elderly. DESIGN AND DATA SOURCES: A systematic review was undertaken of published evidence in English, examining the association between low serum vitamin B(12)/folate and raised total homocysteine with cognitive impairment (as indicated by low scores on neuropsychological testing) in subjects aged over 60 years. Sixteen electronic databases and cited articles were searched. Of 383 potential articles, six fulfilled the eligibility criteria: three case control and three cohort studies were identified. 'The Cochrane Non-Randomized Studies Methods Group' guidelines were used for assessment and extraction of data from these studies. RESULTS: All three case control studies found that serum total homocysteine was significantly higher in cases when compared with controls, and there was wide variation for both serum vitamin B(12) and folate in both groups of participants. The relationship of serum folate and vitamin B(12) status with cognitive impairment was heterogeneous and one case control study reported decreasing cognitive scores with increasing serum vitamin B(12). In the cohort studies, although serum total homocysteine could predict the rate of decline in neuropsychological testing, the overall odds ratio/relative risk (RR) of developing cognitive impairment in relation to levels of serum B(12) and serum folate were not significant. Although one study reported a significant RR of developing Alzheimer's disease when both serum folate and B(12) levels were low. One cohort study reported an increased prevalence of Alzheimer's type dementia in subjects who had normal serum vitamin B(12) at baseline. CONCLUSION: Serum total homocysteine is negatively correlated with neuropsychological tests scores. But the evidence does not support a correlation between serum vitamin B(12) or folate and cognitive impairment in people aged over 60 years. Hence, there is little evidence to justify treating cognitive impairment with vitamin B(12) or folate supplementation. This is consistent with the findings from recent systematic reviews of randomized double-blind trials, which have not found any evidence of potential benefit of vitamin supplementation. Further research is required in order to establish whether raised serum total homocysteine is a cause or consequence of disease.     

Nutritional status and subsequent all-cause mortality in men and women aged 75 years or over living in the community

We prospectively investigated relationships between blood markers of Fe, vitamin B12, folate, vitamin C and vitamin D status and subsequent all-cause mortality in 208 men and 191 women aged 75 years or over living in the community in Aberdeen, Scotland. The participants had been recruited for a cross-sectional study in 1999-2000 when they completed health and lifestyle questionnaires and had blood samples taken for analysis of serum ferritin, serum vitamin B12, erythrocyte folate, plasma vitamin C and serum 25-hydroxycholecalciferol. Mortality was ascertained on national databases up to December 2005, with a median time of follow up of 69.2 (range 1.0-79.9) months. Participants were divided into sex-specific quintiles of baseline levels for each nutrient, and hazard ratios were estimated with Cox proportional hazard models adjusted for age and sex with the significance of linear trends in the associations assessed by logistic regression. There was no significant association between blood markers of Fe, vitamin B12 or folate status at baseline and mortality, but vitamin D status at baseline was inversely related to mortality (P for trend < 0.001). For vitamin C there was no evidence of a linear trend but participants in the lowest quintile of plasma levels had a significantly higher risk of death than those in the highest quintile. Randomized controlled trials of lifestyle changes which improve vitamin status are needed to assess whether these associations could be causal.     

Folate and vitamin B12 status in relation to cognitive impairment and anaemia in the setting of voluntary fortification in the UK

Concerns about risks for older people with vitamin B12 deficiency have delayed the introduction of mandatory folic acid fortification in the UK. We examined the risks of anaemia and cognitive impairment in older people with low B12 and high folate status in the setting of voluntary fortification in the UK. Data were obtained from two cross-sectional studies (n 2403) conducted in Oxford city and Banbury in 1995 and 2003, respectively. Associations (OR and 95 % CI) of cognitive impairment and of anaemia with low B12 status (holotranscobalamin < 45 pmol/l) with or without high folate status (defined either as serum folate >30 nmol/l or >60 nmol/l) were estimated after adjustment for age, sex, smoking and study. Mean serum folate levels increased from 15.8 (sd 14.7) nmol/l in 1995 to 31.1 (sd 26.2) nmol/l in 2003. Serum folate levels were greater than 30 nmol/l in 9 % and greater than 60 nmol/l in 5 %. The association of cognitive impairment with low B12 status was unaffected by high v. low folate status (>30 nmol/l) (OR 1.50 (95 % CI 0.91, 2.46) v. 1.45 (95 % CI 1.19, 1.76)), respectively. The associations of cognitive impairment with low B12 status were also similar using the higher cut-off point of 60 nmol/l for folate status ((OR 2.46; 95 % CI 0.90, 6.71) v. (1.56; 95 % CI 1.30, 1.88)). There was no evidence of modification by high folate status of the associations of low B12 with anaemia or cognitive impairment in the setting of voluntary fortification, but periodic surveys are needed to monitor fortification.     

Relationship between dietary folate intakes,maternal plasma total homocysteine and B-vitamins during pregnancy and fetal growth in Japan

Background Adequate folate status in pregnancy is important for satisfactory pregnancy outcome. Aim of the Study The objective of the present study was to evaluate folate status in healthy pregnant women by assessing dietary folate intakes and measuring changes in folate-related biomarkers including plasma tHcy, serum vitamin B₁₂ (B₁₂), and serum and RBC folate concentrations in each trimester and to examine their relation to fetal growth. Methods From 94 pregnant women, 3-day-dietary records were obtained and blood was collected for plasma total homocysteine (tHcy), serum B₁₂, and serum and red-blood cell (RBC) folate measurements. Infant anthropometric measurements were made immediately after birth. Results Average folate intake was less than 300 μg/day with a mean energy intake of about 1800 kcal. Mean serum and RBC folate concentrations declined significantly during gestation (p < 0.05). Mean serum B₁₂ also significantly decreased (p < 0.01), whereas plasma tHcy increased from 5.1 in the first trimester to 5.9 μmol/l in the third trimester (p < 0.01). Multiple regression analyses, after controlling for maternal age, parity and pre-pregnancy body-mass index indicated that a 1.0 μmol/l increase in plasma tHcy in the third trimester corresponded to a 151 g decrease in birth weight (p < 0.01). Neither B₁₂ nor folate concentrations in all three trimesters showed any significant associations with birthweight. Plasma pyridoxal-5′-phosphate concentrations were markedly low, and were consistent with low intake of vitamin B₆ in our population. Conclusion Our data suggest that higher plasma tHcy in the third trimester is a predictor of lower birth weight. In general, the dietary intake of B-vitamins and energy may be inadequate in our population, suggesting intervention is necessary.     

Multiple micronutrient deficiencies persist during early childhood in Mongolia

Data on the prevalence of micronutrient deficiencies in children in Mongolia is limited. We therefore determined the prevalence of anaemia, iron deficiency anaemia (IDA), and deficiencies of iron, folate, vitamin A, zinc, selenium, and vitamin D among young Mongolian children. Anthropometry and non-fasting morning blood samples were collected from 243 children aged 6-36 months from 4 districts in Ulaanbaatar and 4 rural capitols for haemoglobin (Hb), serum ferritin, folate, retinol, zinc, selenium, and 25-hydroxyvitamin D (25-OHD) assays. Children with alpha-1-glycoprotein >1.2mg/L (n=27) indicative of chronic infection were excluded, except for folate, selenium, and 25-hydroxyvitamin D assays. Of the children 14.5% were stunted and none were wasted. Zn deficiency (serum Zn <9.9 micromol/L) had the highest prevalence (74%), followed by vitamin D deficiency 61% (serum 25-OHD<25 nmol/L). The prevalence of anaemia (24%) and iron deficiency anaemia (IDA) (16%) was lower, with the oldest children (24-36 mos) at lowest risk. Twenty one percent of the children had low iron stores, and 33% had vitamin A deficiencies (serum retinol < 0.70 micromol/L), even though two thirds had received vitamin A supplements. Serum selenium values were low, perhaps associated with low soil selenium concentrations. In contrast, no children in Ulaanbaatar and only 4% in the provincial capitols had low serum folate values (<6.8 nmol/L). Regional differences (p<0.05) existed for anaemia, deficiencies of vitamin A, folate, and selenium, but not for zinc or IDA. Of the children, 78% were at risk of > or = two coexisting micronutrient deficiencies emphasizing the need for multimicronutrient interventions in Mongolia.     

Low folate and vitamin B12 nourishment is common in Omani children with newly diagnosed autism

ObjectiveArab populations lack data related to nutritional assessment in children with autism spectrum disorders (ASDs), especially micronutrient deficiencies such as folate and vitamin B12.MethodsTo assess the dietary and serum folate and vitamin B12 statuses, a hospital-based case–control study was conducted in 80 Omani children (40 children with ASDs versus 40 controls).ResultsThe ASD cases showed significantly lower levels of folate, vitamin B12, and related parameters in dietary intake and serum levels.ConclusionThese data showed that Omani children with ASDs exhibit significant deficiencies in folate and vitamin B12 and call for increasing efforts to ensure sufficient intakes of essential nutrients by children with ASDs to minimize or reverse any ongoing impact of nutrient deficiencies.     

Haematological studies on pre-menopausal Indian and Caucasian vegetarians compared with Caucasian omnivores

Full blood counts, serum ferritin, vitamin B12 and folate, erythrocyte folate concentrations and nutrient intakes were estimated in twenty-three Indian vegetarian, twenty-two Caucasian omnivores and eighteen Caucasian vegetarian women aged 25-40 years. Energy and copper intakes were lower in the Indian women than in the Caucasians. Intakes of dietary fibre, vitamin C and folate were greater and the proportion of energy derived from fat was lower in the vegetarians than in the omnivores. Vitamin B12 and protein intakes were lower in both vegetarian groups than in the omnivores. Fe intake was similar in all the groups but haem Fe provided one-quarter of the Fe intake of the omnivores. Haemoglobin concentrations were generally inside the normal range in all groups, but were lower in the Indians as were mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH). Higher MCV, MCH and lower erythrocyte (RBC) counts were observed in Caucasian vegetarians compared with the Caucasian omnivores. In both groups of vegetarians, concentrations of serum vitamin B12 and ferritin were markedly lower than in the omnivores. RBC folate concentrations were lower in the Indians than in either of the Caucasian groups when subjects taking supplements were excluded. It is concluded that vegetarians need to ensure they have adequate intakes of Fe and vitamin B12.