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Folate concentrations in pediatric patients with newly diagnosed inflammatory bowel disease
Melvin B Heyman1, Elizabeth A Garnett, Nishat Shaikh
1Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143-0136, USA. mheyman@peds.ucsf.edu
Insights
Children newly diagnosed with inflammatory bowel disease (IBD) showed higher folate levels than healthy children, contrary to expectations. Further research is needed to understand the implications of these elevated folate concentrations in pediatric IBD.
Area of Science:
- Pediatric Gastroenterology
- Nutritional Science
- Biochemistry
Background:
- Folate plays a role in preventing cell injury and cancer risk.
- Folate deficiency is linked to inflammatory bowel disease (IBD).
- Folate levels in children with IBD are not well-understood.
Purpose of the Study:
- To compare folate concentrations in children with newly diagnosed IBD versus healthy controls.
Main Methods:
- Measured red blood cell folate (RBCF) and whole-blood folate (WBF) in 78 children (22 IBD, 41 controls).
- Recorded vitamin supplementation and dietary intake via food-frequency questionnaire.
- Included children with Crohn disease, ulcerative colitis, and indeterminate colitis.
Main Results:
- Children with newly diagnosed IBD had significantly higher RBCF (19.4% higher) and WBF (11.1% higher) than controls.
- Total folate intake was higher in controls, but not statistically significant.
- A notable percentage of all subjects had folate intake below the Recommended Dietary Allowance.
Conclusions:
- Contrary to adult studies, newly diagnosed pediatric IBD patients exhibited higher folate concentrations.
- This finding was unexpected given higher dietary folate intake and hematocrit in controls.
- Further investigation is required on IBD therapy's impact on folate metabolism and long-term clinical significance of high folate levels at diagnosis.
Background:
Folate is postulated to protect against cell injury and long-term risk of cancer. Folate deficiency has been shown to be associated with inflammatory bowel disease (IBD). However, folate concentrations are poorly delineated in children with IBD.
Objective:
The objective was to compare folate concentrations between children with newly diagnosed IBD and healthy controls.
Design:
Red blood cell folate (RBCF) and whole-blood folate (WBF) concentrations were measured in 78 children (mean age: 12.8 +/- 2.7 y): 22 patients with newly diagnosed untreated Crohn disease, 11 patients with ulcerative colitis, 4 patients with indeterminate colitis, and 41 controls. Vitamin supplementation and dietary intakes determined by food-frequency questionnaire were recorded for 20 IBD patients and 28 controls.
Results:
RBCF concentrations were 19.4% lower in controls (587.0 +/- 148.6 ng/mL) than in patients (728.7 +/- 185.8 ng/mL; P = 0.0004), and WBF concentrations were 11.1% lower in controls (218.2 +/- 49.7 ng/mL) than in patients (245.3 +/- 59.1 ng/mL; P = 0.031). Total folate intake was 18.8% higher in controls (444.7 +/- 266.7 microg/d) than in IBD patients (361.1 +/- 230.6 microg/d), but this difference was not statistically significant (P = 0.264). Folate intakes were below the Recommended Dietary Allowance (200-400 microg/d), adjusted for age and sex, in 35.4% of study subjects.
Conclusions:
In contrast with previous evidence of folate deficiency in adult IBD patients, our data indicate higher folate concentrations in children with newly diagnosed untreated IBD than in controls. This finding was unexpected, especially in light of the higher dietary folate intakes and hematocrit values in children without IBD. The influence of IBD therapy on folate metabolism and the long-term clinical implications of high RBCF and WBF concentrations at the time of IBD diagnosis should be explored further.
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