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Effects of folic acid fortification and multivitamin therapy on homocysteine and vitamin B(12) status in cardiac transplant recipients.
J Heart Lung Transplant 2004; 23(4):405-12JH

Abstract

BACKGROUND

Hyperhomocysteinemia is a frequent finding after cardiac transplantation, but increased folate intake induces a decrease in total homocysteine concentrations. In 1998, food in Canada was fortified nationwide with folic acid. We assessed the impact of routine folate fortification on homocysteine concentrations in our cardiac transplant population.

METHODS

In 18 subjects, we measured total homocysteine (tHcy), serum folate, and cobalamin concentrations in 1997 (before folate fortification) and in 1998 (after fortification). We repeated the analysis after specific multivitamin supplementation for 10 weeks.

RESULTS

We found a significant decrease in baseline tHcy concentrations and in folate concentrations between 1997 and 1998. However, we also found a decrease in serum cobalamin concentrations. We found a correlation between decreased cobalamin concentrations and the methionine synthase A2756G genotype, but not with other common polymorphisms associated with homocysteine metabolism. After multivitamin supplementation, we observed a trend toward further decrease in tHcy concentrations and a significant increase in serum folate and cobalamin concentrations. Finally, we measured serum methylmalonic acid concentrations, an index of tissue cobalamin status. We did not find a correlation between increased methylmalonic acid concentrations and decreased serum cobalamin, perhaps related to the confounding effect of altered renal status on methylmalonic acid excretion.

CONCLUSIONS

National folate fortification was associated with decreased tHcy and increased folate concentrations in our cardiac transplant population. Additional administration of vitamin supplements induced a further decrease in tHcy and an increase in folate. Finally, folate fortification unveiled cobalamin deficiency in some patients, associated with the methionine synthase A2756G mutation.

Authors+Show Affiliations

Department of Medicine, University of Toronto, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

15063399

Citation

Miriuka, Santiago G., et al. "Effects of Folic Acid Fortification and Multivitamin Therapy On Homocysteine and Vitamin B(12) Status in Cardiac Transplant Recipients." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 23, no. 4, 2004, pp. 405-12.
Miriuka SG, Langman LJ, Keren ES, et al. Effects of folic acid fortification and multivitamin therapy on homocysteine and vitamin B(12) status in cardiac transplant recipients. J Heart Lung Transplant. 2004;23(4):405-12.
Miriuka, S. G., Langman, L. J., Keren, E. S., Miner, S. E., Mamer, O. A., Delgado, D. H., ... Cole, D. E. (2004). Effects of folic acid fortification and multivitamin therapy on homocysteine and vitamin B(12) status in cardiac transplant recipients. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 23(4), pp. 405-12.
Miriuka SG, et al. Effects of Folic Acid Fortification and Multivitamin Therapy On Homocysteine and Vitamin B(12) Status in Cardiac Transplant Recipients. J Heart Lung Transplant. 2004;23(4):405-12. PubMed PMID: 15063399.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of folic acid fortification and multivitamin therapy on homocysteine and vitamin B(12) status in cardiac transplant recipients. AU - Miriuka,Santiago G, AU - Langman,Loralie J, AU - Keren,Eitan S, AU - Miner,Steven E S, AU - Mamer,Orval A, AU - Delgado,Diego H, AU - Evrovski,Jovan, AU - Ross,Heather J, AU - Cole,David E C, PY - 2002/10/31/received PY - 2003/03/12/revised PY - 2003/03/12/accepted PY - 2004/4/6/pubmed PY - 2005/3/18/medline PY - 2004/4/6/entrez SP - 405 EP - 12 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J. Heart Lung Transplant. VL - 23 IS - 4 N2 - BACKGROUND: Hyperhomocysteinemia is a frequent finding after cardiac transplantation, but increased folate intake induces a decrease in total homocysteine concentrations. In 1998, food in Canada was fortified nationwide with folic acid. We assessed the impact of routine folate fortification on homocysteine concentrations in our cardiac transplant population. METHODS: In 18 subjects, we measured total homocysteine (tHcy), serum folate, and cobalamin concentrations in 1997 (before folate fortification) and in 1998 (after fortification). We repeated the analysis after specific multivitamin supplementation for 10 weeks. RESULTS: We found a significant decrease in baseline tHcy concentrations and in folate concentrations between 1997 and 1998. However, we also found a decrease in serum cobalamin concentrations. We found a correlation between decreased cobalamin concentrations and the methionine synthase A2756G genotype, but not with other common polymorphisms associated with homocysteine metabolism. After multivitamin supplementation, we observed a trend toward further decrease in tHcy concentrations and a significant increase in serum folate and cobalamin concentrations. Finally, we measured serum methylmalonic acid concentrations, an index of tissue cobalamin status. We did not find a correlation between increased methylmalonic acid concentrations and decreased serum cobalamin, perhaps related to the confounding effect of altered renal status on methylmalonic acid excretion. CONCLUSIONS: National folate fortification was associated with decreased tHcy and increased folate concentrations in our cardiac transplant population. Additional administration of vitamin supplements induced a further decrease in tHcy and an increase in folate. Finally, folate fortification unveiled cobalamin deficiency in some patients, associated with the methionine synthase A2756G mutation. SN - 1053-2498 UR - https://www.unboundmedicine.com/medline/citation/15063399/Effects_of_folic_acid_fortification_and_multivitamin_therapy_on_homocysteine_and_vitamin_B_12__status_in_cardiac_transplant_recipients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S105324980300202X DB - PRIME DP - Unbound Medicine ER -