Population RBC folate concentrations can be accurately estimated from measured whole blood folate, measured hemoglobin, and predicted serum folate—cross-sectional data from the NHANES 1988–2010

Details

• Alternative Title:
  Am J Clin Nutr
• Personal Author:
  Zhang, Ming ; Sternberg, Maya R ; Yeung, Lorraine F ; Pfeiffer, Christine M
• Description:
  Background:
  
  RBC folate (RBF) is an indicator of folate status and risk of neural-tube defects. It is calculated from whole blood folate (WBF), serum folate (SFOL), and hematocrit (Hct). SFOL and/or Hct are sometimes unavailable; hemoglobin (Hb) is generally available in surveys.
  
  Objectives:
  
  We assessed the ability of different RBF approximations to generate population data in women aged 12–49 y.
  
  Methods:
  
  Using SFOL, RBF, Hct, Hb, and mean corpuscular Hb content (MCHC) from prefortification (1988–1994) and postfortification (1999–2006, 2007–2010) NHANES we applied 6 approaches: #1) assume SFOL = 0; #2) impute SFOL (population median); #3) impute Hct (population median); #4) estimate Hct (Hb/MCHC); #5) assume SFOL = 0 and estimate Hct; and #6) predict SFOL (from WBF) and estimate Hct. For each approach, we calculated the paired percentage difference to the “true” RBF and estimated various statistics.
  
  Results:
  
  For 2007–2010 (unweighted data), the median relative difference from “true” RBF was lowest for approaches #2 (−0.74%), #4 (−0.96%), and #6 (−1.15%), intermediate for #3 (−3.36%), and highest for #5 (4.96%) and #1 (5.78%). The 95% agreement limits were smallest for approach #1 (2.33%, 13.0%) and largest for #3 (−20.8%, 11.3%). Approach #2 showed concentration-dependence (negative compared with positive differences at low compared with high RBF). Using weighted data, we found similar patterns across approaches for mean relative differences by demographic subgroup for all 3 time periods.
  
  Conclusions:
  
  We obtained the best agreement between estimated and “true” RBF when we predicted SFOL using a regression equation obtained from a subset of samples (approach #6). Alternatively, the consistent overestimation of RBF when assuming SFOL = 0 (~6%) could be addressed by adjusting the data (approach #5). Similar observations for pre- and postfortification periods suggest applicability to low and high folate status situations, but should be confirmed elsewhere. To estimate RBF, at least WBF and Hb are needed. Am J Clin Nutr 2020;111:601–612.
  
  
• Subjects:
  Adolescent Adult Child Cross-Sectional Studies Erythrocytes Female Folic Acid Hemoglobins Humans Male Middle Aged Nutrition Surveys Young Adult

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• Source:
  Am J Clin Nutr. 111(3):601-612
• Pubmed ID:
  31858145
• Pubmed Central ID:
  PMC10059072
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Name as Subject:
  National Health and Nutrition Examination Survey (U.S.)
• Place as Subject:
  United States
• Volume:
  111
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:a4f95e0d05911ed012dd1b14999f60690fc8b9feed82ad7c51297e2692d7d342
• Download URL:
  https://stacks.cdc.gov/view/cdc/126386/cdc_126386_DS1.pdf
• File Type:
  [PDF - 633.98 KB ]