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Prevalence of anemia, iron, folic acid and vitamin B12 deficiency in two Bari Indian communities from western Venezuela.

The hematological status of 406 Bari indians from two communities was studied. One hundred and seventy nine individuals were from Campo Rosario a village located in a low arid plain south to the Perijá mountain range and 287 were from Saimadoyi, a fertile valley in the heart of the mountain. Anemia was found in 54% and 31% of the people from Campo Rosario and Saimadoyi respectively. Low serum iron was present in 28% of the population in both communities while low serum ferritin levels were encountered in 20% of the population from Campo Rosario and 5% of the people from Saimadoyi. A high prevalence of serum folate and vitamin B12 deficiency (91% and 64% respectively) was found in Campo Rosario, in contrast only 5% of the population from Saimadoyi had low folate and none were vitamin B12 deficient. While there was a positive significant correlation between hemoglobin and serum iron concentrations (r = 0.517, p < 0.001), no significative correlation was found between the other parameters studied. The high prevalence of anemia and nutrient deficiency among the Bari indians, can be attributed to inadequate diets and the varied diseases encountered in the population.

Adolescent↗

Radioisotope binding capacity of serum in folic acid, vitamin B12 and ferritin in haematologic and rheumatologic patients.

In addition to the usual parameters for haematologic an rheumatologic diseases folic acid, vitamin B12, and ferritin were investigated by radioisotope studies. In some groups folic acid was lower compared to controls, and it is possible that the disease causes the deficiency of folic acid absorption and distribution. Vitamin B12 was only slightly decreased, thus, the values may be assumed to be close to normals. Transferrin ankylosing spondylitis is similar to that of controls, however, transferrin increases in rheumatoid arthritis and in mixed groups containing patients various diseases. Finally, the deficiency of folic acid absorption can be assumed to be caused by the symptoms of the disease, whereas in the case of inflammatory diseases and in mixed group transferrin increased.

Adult↗

Effect of folic acid and vitamin B12 deficiencies on 5-hydroxyindoleacetic acid in human cerebrospinal fluid.

Indoles were measured in cerebrospinal fluid (CSF) from control patients, from patients suffering from folate deficiency, and from patients with vitamin B12 deficiency. The folate-deficient patients were classified according to whether they exhibited a neuropsychiatric syndrome, consisting of organic mental changes, polyneuropathy, and depression, which responded to folate administration. CSF 5-hydroxyindoleacetic acid was low in the vitamin B12-deficient patients and in those folate-deficient patients whose symptoms were not related to folate deficiency. CSF 5-hydroxyindoleacetic acid returned to normal with folate treatment in the patients exhibiting folate-responsive neuropsychiatric signs. The data indicate a close association between folate-responsive neuropsychiatric symptoms and changes in 5-hydroxytryptamine metabolism in the central nervous system.

Adolescent↗

Apoptosis and proliferation under conditions of deoxynucleotide pool imbalance in liver of folate/methyl deficient rats.

Weanling male F344 rats were fed either a semi-purified diet low in methionine and lacking in choline and folic acid (folate/methyl deficient) or a supplemented control diet for periods of 2, 5, 7 days, 3 weeks, and 9 weeks. Two days after initiating the folate/methyl deficient diet in weanling F344 rats, the incidence of apoptotic bodies, identified by in situ end-labeling of 3'-OH DNA strand breaks, was significantly increased in liver sections from the deficient rats. Apoptotic cell death was confirmed biochemically by an increase in nuclear Ca2+/Mg2+-dependent endonuclease activity that paralleled the increase in apoptotic bodies over the 9-week feeding period. There was no morphologic evidence of necrotic foci or necrosis-associated inflammatory response over the 9-week period. Confirming that cell turnover is chronically elevated in this model, the increase in apoptotic rate was accompanied by a sustained increase in the mitotic index (MI). The DNA repair-associated enzyme, poly(ADPribose) polymerase (PARP), was similarly elevated and was associated with significant decreases in the substrate for ADPribose polymer synthesis, nicotinamide adenine dinucleotide (NAD). Because folate metabolites are essential for de novo purine and thymidine biosynthesis, prolonged deficiency in folic acid can induce an imbalance in the deoxynucleotide precursors for DNA replication/repair and negatively affect the fidelity of DNA synthesis. Using an HPLC method, hepatic deoxyuridine triphosphate (dUTP) levels were increased at 3 and 9 weeks after initiation of the deficient diet and levels of thymidine triphosphate (dTTP) were reduced. An increase in dUTP/ dTTP ratio is consistent with a block in folate-dependent de novo thymidylate biosynthesis and may predispose to uracil misincorporation and DNA repair-related DNA strand breaks.

Animals↗

Micronutrient deficiencies in the aetiology of anaemia in a rural area in The Gambia.

Early studies in a rural community in The Gambia led to reports of anaemia in certain sections of the population. More recent investigations concerned with identifying micronutrient deficiencies have elaborated these earlier findings. The major determinant of anaemia is an iron deficiency, leading to a microcytic hypochromic haematological picture. However, riboflavin deficiency, which is very widespread, and which leads to clinical signs in some subjects, appears to impose some limitations on absorption and utilization of iron. A subclinical deficiency of ascorbic acid is also observed and this may further compromise iron status. In addition very poor folate status leads to a macrocytosis in some individuals and may limit the haematological response to iron supplementation.

Adolescent↗

Pregnancy as a risk factor for restless legs syndrome.

Pregnant women have at least two or three times higher risk of experiencing restless legs syndrome (RLS) than the general population. These data come from few epidemiological studies finding an 11-27% prevalence of RLS during pregnancy. Women affected by pre-existing RLS often complain of worsening symptoms during pregnancy. This is usually a benign form of RLS, with the highest degree of severity in the third trimester and a tendency to disappear around delivery. The causes of the association between RLS and pregnancy are unknown. The most debated hypotheses are: metabolic alterations, with particular regard to iron and folate deficiency; hormonal influences related to the increase of prolactin, progesterone and estrogens during late pregnancy; and the changing motor habits and psychological state of pregnant women. The importance of folate and iron supplementation during pregnancy in preventing RLS is unclear. RLS in pregnant women is frequently unrecognized; they are often worried about the symptoms and do not receive an adequate explanation by doctors.

Anemia, Iron-Deficiency↗

Vitamin nutrition in older adults.

Proper vitamin nutrition is essential for all people but especially for elderly persons, because they are at higher risk for deficiency than younger adults. A review of the clinical effects of vitamin deficiency shows how easily deficiency can masquerade as other morbidities, such as skin, neurologic, and gait abnormalities. Given the numerous readily available forms and sources of supplementation, their low cost, and their rather limited potential for harm, the goal of good vitamin nutrition for the elderly is easily attainable. To be successful in this goal, physicians must look for patients at risk and for those with features of frank vitamin deficiency. Laboratory testing is most helpful with respect to vitamin B12 and folate deficiency. Given the great value of clinical assessment, the low cost of vitamins, and the higher cost of laboratory testing, the authors do not recommend testing before instituting multivitamin use or extra supplementation with individual vitamins unless the diagnosis of deficiency is in question or the use of supplementation would put the patient at risk. The authors' general recommendations are * one multivitamin daily * extra vitamin E for patients with cardiovascular risk factors or Alzheimer's dementia * extra vitamin D for patients with known osteoporosis, osteoporosis risk factors, or strong risk factors for vitamin D deficiency * extra folate for patients with cardiovascular risk factors (especially smokers) and alcoholics * extra thiamine for alcoholics.

Aged↗

Nutritional anemia.

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Aged↗

Hospital malnutrition. A prospective evaluation of general medical patients during the course of hospitalization.

Nutrition status was evaluated in 134 consecutive admissions to a general medical service and throughout hospitalization among patients hospitalized 2 weeks or longer. Likelihood of malnutrition was determined using eight nutrition-related parameters: serum folate and vitamin C, triceps skinfold, weight/height, arm muscle circumference, lymphocyte count, serum albumin, and hematocrit. On admission 48% of patients had a high likelihood of malnutrition, which correlated with a longer hospital stay (20 versus 12 days for patients with a low likelihood of malnutrition) and an increased mortality rate (13 versus 4%). Likelihood of malnutrition increased with hospitalization in 69% of patients with paired determinations. Compared to admission, at final follow-up a greater proportion of patients fell into the depleted range of values for folate, triceps skinfold, weight/height, arm muscle circumference, lymphocyte count, and hematocrit. These parameters worsened in over 75% of patients admitted with normal values. Hematocrit fell in all patients with normal admission levels. These findings demonstrate and association between nutrition status and hospital course and a worsening trend during hospitalization.

Anthropometry↗

Methyl donors in the diet and responses to chemical carcinogens.

Dietary deficiency of labile methyl donors (choline and methionine) increases spontaneous and chemically induced hepatocarcinogenesis in rats. Chemical carcinogenesis in the colon, mammary gland, esophagus, and pancreas also may be increased. The mechanism of the dietary effect is not known but may be related to reduced methylation of DNA and RNA, hyperplasia of target cells, increased peroxidative damage, and altered carcinogen or promoter metabolism. Folate deficiency also is associated with increased carcinogenesis, an effect that may be mediated through participation in methyl metabolism; this has been less extensively studied. Deficiency of these three nutrients also may play a role in the elevated cancer risk in humans that is associated with ethanol intake.

Animals↗

Alcohol and absorption from the small intestine. 1. Impairment of absorption from the small intestine in alcoholics.

An absorption screen was performed in 10 chronic alcoholic patients within a few days of admission due to an acute alcoholic episode. Impaired absorption of d-Xylose was noted in three patients and low leucocyte ascorbic acid and serum folate levels in five. No abnormality was detected in jejunal histology. The absorption of water and electrolytes from the jejunum was studied in these patients using a triple-lumen tube perfusion system. The mean rate of absorption of water in the alcoholic subjects (50-0 +/- 2-3 ml/h) was significantly lower (P less than 0-001) than the mean value in 14 healthy control subjects (205 +/- 15-9 ml/h). A significant reduction of Na+ and Cl-absorption was also demonstrated in the alcoholic subjects. These results indicate that patients with acute-on-chronic alcoholism may have a function impairment of water and electrolyte absorption from the jejunum. This may, in part, account for some of the nutritional deficiencies in such patients and for symptoms such as diarrhoea which may be present.

Adult↗