Assessment of Dietary Folate Intake and Pill Burden among Saudi Patients on Maintenance Hemodialysis

The aim of this study was to assess the adequacy of dietary folate intake and perceptions of pill burden among Saudi patients on maintenance hemodialysis (MHD). This was a cross-sectional study of adults (>18 years) on MHD (>3 months) attending the dialysis unit at King Saud University Medical City. Patient demographics, dietary folic acid intake, and perceptions of pill burden were collected. Fifty-four patients met the eligibility criteria, with a mean age of 57 ± 15.5 years. The majority were females (63%), and the most prevalent comorbidities were diabetes (43%) and hypertension (76%). The average number of medications/patients was 11 ± 2.9, and most patients were receiving folate supplementation (68.5%). The average dietary folate intake was 823 ± 530 mcg/day. Pill burden was bothersome, primarily due to taking too many medications (57%) while taking medications at the workplace was the least bothersome burden (17%). The reported high pill burden and adequate dietary folate intake by Saudi patients on MHD indicates that the omission of folate supplementation may be advantageous for this special population.

Consumption of dietary folate estimates and its implication for reproductive outcome among women of reproductive age in Kersa: cross-sectional survey

Background Dietary folate inadequacy is one the most common micronutrient deficiencies that cause neural tube defect (NTD) among infants in Sub-Saharan African countries. This study aims to determine the dietary intake of folate among women of reproductive age (WRA) of Kersa, Eastern Ethiopia. Methods A cross-sectional study took place among voluntary women that were selected from 1140 random households. Using a validated Food Frequency Questionnaire, participant’s weekly dietary intake history of Ethiopian foods and dietary folate intake was worked out. Statistical analysis was done at a 95% confidence interval. Modified Poisson regression was used to identify factors associated with dietary folate consumption. Result The estimated median usual intake of folate was 170 μg/d (IQR: 118.3; 252.2) and about 33% of WRA had low folate intake and 73.9% were at risk for folate inadequacy. From the reported food groups, Beans and Peas, Starchy staples, and Vitamin-A rich dark-green leafy vegetables were the top three ranked foods that contributed much of the dietary folate. The following conditions were statistically related to dietary folate inadequacy; women’s age, being in poor wealth index, low dietary diversity, having seasonal employment, and reliance on market food sources. Conclusions We found that women’s dietary intake of folate in Kersa is very low and cannot protect their offspring from the risk of having NTD. They could also potentially be predisposed to poor health outcomes. Diversifying and fortification of Ethiopian wheats and salts could decrease the burden of folate deficiency in the country.

Dose-Response Association Between Dietary Folate and Niacin Intakes With Diabetes Among Chinese Adults: A Cross-Sectional Study

Background This study aimed to examine the relationships between dietary vitamin intakes and the risk of diabetes among Chinese adults. Methods This is a cross-sectional observational study. Demographic and anthropometric data along with information on dietary vitamin intakes were collected and eligible participants were recruited to complete a questionnaire. Binary logistic regression analysis was conducted to examine the associations between dietary vitamin intakes and the risk of diabetes, with adjustment for potential confounders. We also evaluated non-linear dose-response relationships between dietary vitamin intakes and diabetes using adjusted restricted cubic splines. Results Of the 3106 eligible participants, 15.9% had prevalent diabetes, 19.0% in male and 13.7% in female, respectively. The median folate was significantly higher in diabetic patients than in controls (32.030 vs 27.600 µg), while median niacin was significantly lower (7.000 vs 7.900 mg). The binary logistic regression analysis also showed a significant association between dietary folate (Odds ratio (OR)=1.002; 95% confidence interval (CI): 1.000-1.004; P=0.022) and niacin intakes (OR=0.965; 95% CI: 0.944-0.986; P=0.001) with the risk of diabetes after controlling for potential confounders. The plots of restricted cubic splines presented an atypical inverted U-shaped association between dietary folate intake and diabetes. Conclusions The data presented here showed that diabetics had a low intake of vitamins, especially B group vitamins. Dietary folate and niacin intakes tended to be independently related to the risk of diabetes. Nevertheless, this study is observational, and there yet to be large-scale randomized controlled trials which would increase the evidence of the findings.

Prevalence of inadequate intake of folate in the post-fortification era: data from the Brazilian National Dietary Surveys 2008-2009 and 2017-2018

The objectives were to compare the evolution of dietary folate intake, to estimate the prevalence of folate inadequacy (POFI) and the contribution of food groups to folate intake (dietary folate plus folic acid from fortified foods) in two post-fortification periods in the Brazilian population, according to life stages, geographic regions and per capita income. Population-based study including representative data from the National Dietary Survey - Brazilian Household Budget Surveys (NDS-HBS) 2008-2009 and 2017-2018, with a total of 32,749 (2008-2009) and 44,744 (2017-2018) individuals aged ≥10 years old, excluding pregnant and lactating women. The National Cancer Institute method was used to estimate the distributions of usual dietary folate intake. POFI was estimated according to Estimated Average Requirement (EAR) cut-off point method. After 10 years of the first NDS-HBS, POFI has increased in all sex-age groups, except for 10 to 13 y old. POFI among women of reproductive age was around 30% and 40% in 2008-2009 and 2017-2018, respectively. Higher POFI was observed in the North region. The top five food groups contributors to folate intake in Brazil were beans, breads, pasta & pizza, cakes & cookies and non-alcoholic beverages groups in both periods, differing in the rank order of the last two groups. Although being a country that has adopted mandatory folic acid flour fortification for almost two decades, increased POFI was observed in 2017-2018. This study brings significant scientific information, which can help understand folate dietary data in different contexts and consequently, guide the approach for public health fortification strategies.

Non-linear association between daily dietary folate intake and cognitive performance in elder America: A population-based cross-sectional study

Background The association between daily dietary folate intake and cognitive performance in older populations is unclear. Methods This study aimed to investigate whether a dose-dependent association exists between dietary folate levels and cognition performance. The 2011–2014 datasets from the National Health and Nutrition Examination Survey were collected. Data from adults aged ≥ 60 years who completed all three cognitive tests with daily dietary data were analyzed. Weighted smooth curve fitting and multiple linear regression models were applied to study the association between folate intake and cognitive performance. Age, sex, race, education, smoking status, alcohol intake, body mass index, hypertension, stroke, diabetes, and depression were adjusted using a weighted multiple regression model. Results Data from 1,255 participants were analyzed. The mean age of the study population was 69.3 years. Males accounted for a weighted 48.8% of the total population. Daily dietary folate was not significantly associated with delayed recall (per 10 mcg/day increment, β 0.003, 95% CI -0.002–0.009, P = 0.23). Below the cut-off of 250 mcg/day, dietary folate intake was positively associated with immediate recall (per 10 mcg/day increment, β 0.01, 95% CI 0.00–0.02, P = 0.05) and animal fluency test score (per 10 mcg/day increment, β 0.02, 95% CI 0.00–0.03, P = 0.05). However, above this cut-off, the association was not significant. Dietary folate intake was not significantly associated with an increase in the digit symbol substitution test score until dietary the folate intake reached 250 mcg/d (per 10mcg/d increment, β 0.29, 95% CI 0.05-0.53, P = 0.04). Conclusion Daily dietary folate intake was non-linearly associated with cognitive performance in the older American population.

Methylation levels of LEP and POMC genes after intervention with dietary folate and hazelnut oil in the lipid profile of overweight women

BackgroundObesity contributes to several cardiometabolic diseases, such as dyslipidemia, as a result of an unhealthy lifestyle and genetic factors. The methylation profile of genes involved in appetite control and metabolism, such as LEP (leptin) and POMC (proopiomelanocortin) and altered lipid levels can contribute to obesity, and these epigenetic changes have been associated with the effects of diet composition. The objective of this study was to evaluate the methylation levels of LEP and POMC genes and lipid profile values after intervention with dietary folate and hazelnut oil in overweight women.MethodsDouble-blind, placebo, controlled intervention study with 40 overweight adult women. Participants were randomized into four groups for 8 weeks: G1, 300 g of vegetables and 191 µg / day of folate and hazelnut oil; G2, 300 g of vegetables and 191 µg / day of folate and placebo; G3, 300 g of vegetables and 94 µg / day of folate and hazelnut oil; G4, the individuals were only accompanied. In addition to the levels of methylation, food consumption, anthropometric measurements, biochemical variables of lipid profile were evaluated.ResultsAfter the intervention, the participants presented reduction in the methylation levels of the studied genes in the three intervention groups in the LEP gene: G1 (p = 0.00), G2 (p = 0.00) and G3 (p = 0.00); in the POMC gene: G1 (p = 0.01), G2 (p = 0.02) and G3 (p = 0.01), and in the lipid profile, G1 reduced the levels of LDL-c (p = 0.04), HDL-c (p = 0.00) and Triglycerides (p = 0.04); in G3 there was a reduction in total cholesterol levels (p = 0.00), LDL-c (p = 0.00) and HDL-c (p = 0.00), and in G4 there was a reduction in total cholesterol values (p = 0.00), LDL-c (p = 0.00), HDL-c (p = 0.00) and triglycerides (p = 0.00), and also, an association in G2 between the POMC methylation levels with triglycerides (p = 0.00).ConclusionThe study provided evidence of a normocaloric intervention with dietary folate and hazelnut oil supplementation on the methylation levels of LEP and POMC genes and the role they can play in lipid metabolism.Trial registrationISRCTN, NCT04523532. Registered 21 August 2020, https://clinicaltrials.gov/ct2/show/NCT04523532

Consumption of Dietary Folate Estimates and Its Implication for Reproductive Outcome among Women of Reproductive Age in Kersa: Cross-Sectional Survey

Background: Dietary folate inadequacy is one the most common micronutrient deficiencies that causes neural tube defect (NTD) among infants in Sub-Saharan African countries. This study aims to determine the dietary intake of folate among women of reproductive age (WRA) of Kersa, Eastern Ethiopia.Methods: A cross-sectional study took place among voluntary women that were selected from 1140 random households. Using a validated Food Frequency Questionnaire, participants weekly dietary intake history of Ethiopian foods and dietary folate intake was worked out. Statistical analysis was done at 95% confidence interval. Modified Poisson regression was used to identify factors that associated with dietary folate consumptionResult: The estimated median usual intake of folate was 170 ug/d (IQR: 118.3; 252.2) and about 33% WRA had low folate intake and 73.9% were at risk for folate inadequacy. From the reported food groups, Beans and Peas, Starchy staples, and Vitamin-A rich dark-green leafy vegetables were the top three ranked foods that contributed much of the dietary folate. The following conditions were statistically related with dietary folate inadequacy; women’s age, being in poor wealth index, low dietary diversity, having seasonal employment, and reliance on market food source.Conclusions: We found that women’s dietary intake of folate in Kersa is very low and cannot protect their offspring from having NTD. They could also potentially be predisposed poor health outcomes. Diversifying and fortification Ethiopian wheats and salts could decrease the burden of folate deficiency in the country.

Effect of Folate Diet on Liver Metabolomics in Wild Type and Aldh1l1 Knockout Mice

Objectives The goal of the present study was to investigate whether dietary folate restriction exacerbates the metabotype associated with the KO. Methods Hepatic tissues from wildtype (Aldh1l1+/+) and KO (Aldh1l1−/−) mice fed a control (CD), or folate deficient diet (FDD) for 16 weeks were profiled using untargeted metabolomics to identify metabolite changes and affected pathways. Results PCA plots of the 6595 peaks in the preprocessed liver datasets show tight clustering of samples within the groups and clear separation between genotypes, and diets. OPLS-DA analysis showed strong separation between pairwise comparisons of the groups with model statistics (R2X, R2Y, and Q2) all greater than 0.5, indicating that dietary folate and Aldh1l1 alone or in combination have a significant effect on the liver metabolomes in male and female mice. Using MetaboAnalyst for pathway analysis significant differences in bile acid metabolism, nucleotide metabolism, and protein synthesis/amino acid metabolism (aminoacyl-tRNA biosynthesis; alanine, aspartate and glutamate metabolism; valine, leucine and isoleucine biosynthesis) were observed in males. Similarly, in females many perturbations in amino acid metabolism, nucleotide metabolism, carbohydrate metabolism (pyruvate metabolism; fructose and mannose metabolism), sphingolipid metabolism, bile acid metabolism and microbiome metabolism (propanoate metabolism; butanoate metabolism) were noted. Conclusions Dietary folate elicits liver metabolome response depending on Aldh1l1 genotype. Funding Sources NIH, R01

Preconception Dietary Folate Intake and Risk of Spontaneous Abortion

Objectives Previous studies suggest a beneficial effect of supplemental folic acid use and dietary folate intake on fertility, while results for fetal loss are conflicting. Most previous research on fetal loss focused on folic acid supplement use. We therefore, investigated the association between dietary folate intake and spontaneous abortion (SAB) in a Danish preconception cohort of couples trying to conceive. Methods We recruited couples who were trying to conceive and did not receive fertility treatment. Pregnancies were ascertained through bimonthly follow-up questionnaires completed up to 12 months after study entry. SABs were identified by self-report on the follow-up questionnaires and through the Danish National Patient Registry. Dietary folate intake at study entry was estimated using a validated food frequency questionnaire (FFQ). Folate intake was adjusted for total energy intake using the residual method and categorized as < 250,250–399 and > = 400µg/day. We used Cox proportional hazards regression models with gestational weeks as time scale to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for SAB, adjusting for age, partner's age, educational attainment, smoking status, anthropometry, physical activity, alcohol intake, folic acid supplement use, time-to-pregnancy, gravidity and parity. In sensitivity analyses, we stratified by folic acid supplement use, body mass index (BMI) and alcohol intake. Results Of the 2,957 women who became pregnant within 12 months of study entry and completed the FFQ, we identified 432 SABs. HRs for an SAB among women who consumed 250–399 and >= 400 µg/day of dietary folate compared with <250 µg/day were 0.83 (95% CI: 0.53; 1.29) and 0.87 (95% CI: 0.54; 1.39), respectively. Comparing intake > = 400 with <250 µg/day, the association was stronger when the analysis was restricted to folic acid supplement users, 0.74 (95% CI: 0.39; 1.40), to women with a BMI >= 25, 0.67 (95% CI: 0.31; 1.43), and to a reported alcohol intake >4 drinks/week, 0.66 (95% CI: 0.16; 2.66). Conclusions Our study may suggest that high dietary folate intake among folic acid supplement users is associated with a lower risk of SAB, although our estimates are imprecise. Funding Sources National Institute of Child Health and Human Development.