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Demographic, physiologic, and lifestyle characteristics observed with serum total folate differ among folate forms: cross-sectional data from fasting samples in the National Health and Nutrition Examination Survey 2011–2016
  • Published Date:
    Apr 01 2020
  • Source:
    J Nutr. 150(4):851-860
  • Language:
Filetype[PDF-509.02 KB]

  • Alternative Title:
    J Nutr
  • Description:
    Background: Serum folate forms were measured in the US population during recent National Health and Nutrition Examination Surveys (NHANES) to assess folate status. Objective: We describe post-folic acid-fortification concentrations of serum folate forms in the fasting US population ≥1 y from the NHANES 2011–2016. Design: We measured 5 biologically active folates and 1 oxidation product (MeFox) of 5-methyltetrahydrofolate. We calculated geometric means of 5-methyltetrahydrofolate, unmetabolized folic acid (UMFA), non-methyl folate (sum of tetrahydrofolate, 5-formyltetrahydrofolate, and 5,10-methenyltetrahydrofolate), total folate (sum of above biomarkers), and MeFox by demographic, physiologic, and lifestyle variables; estimated the magnitude of variables on biomarker concentrations after covariate adjustment; and determined the prevalence of UMFA >2 nmol/L. Results: After demographic adjustment, age, sex, and race-Hispanic origin were significantly associated with most folate forms. MeFox increased with age, while 5-methyltetrahydrofolate, UMFA, and non-methyl folate displayed an U-shaped age pattern. Compared with non-Hispanic Whites, non-Hispanic Blacks had 23% lower predicted 5-methyltetrahyrofolate but comparable UMFA; non-Hispanic Asians had comparable 5-methyltetrahydrofolate but 28% lower UMFA; Hispanics, non-Hispanic Asians, and non-Hispanic Blacks had ~20% lower MeFox. After additional physiologic and lifestyle adjustment, predicted UMFA and MeFox concentrations were 43% and 112% higher, respectively in adults with chronic kidney disease and 17% and 15% lower, respectively in adults consuming daily 1–<2 alcoholic beverages; 5-methyltetrahydrofolate concentrations were 20% lower in adult smokers. The prevalence of UMFA >2 nmol/L was highest in persons ≥70 y (9.01%) and lowest in 12–19 y olds (1.14%). During 2011–2014, the prevalence was 10.6% in users and 2.22% in non-users of folic acid-containing supplements. Conclusions: In fasting persons ≥1 y, the demographic, physiologic, and lifestyle characteristics observed with serum total folate differed among folate forms, suggesting biological and/or genetic influences on folate metabolism. High UMFA was mostly observed in supplement users and older persons.
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