Folate Testing in Hospital Inpatients

Gudgeon, Patrick; Cavalcanti, Rodrigo B.

doi:10.1016/j.amjmed.2014.08.020

Cited by 21 publications

(16 citation statements)

References 17 publications

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“…In agreement with previous reporting claiming an overuse/misuse of serum folate testing [1,4], we confirmed an excess of test requests in our institution quite equally distributed between different population subsets and often consistent with screening purposes. Furthermore, according to our data, the proportion of subjects undergoing folate testing during or just after vitamin supplementation seems to be quite relevant, even if testing folate in these patients is probably useless for some consolidated reasons: (a) except for patients with pernicious anemia, an intake of synthetic folic acid is unlikely to be associated with adverse events [21]; (b) there are no data assuring that the available assays can reliably detect serum folate absolute concentrations related to the maximum tolerable intake level of folic acid (i.e.…”

Section: Appropriateness Of Test Requestsupporting

confidence: 80%

“…Several US authors are now seeking for phase out folate testing according to the mentioned evidence of low utility and poor cost-effectiveness for both inpatients and outpatients [1,4,20]. It is also noteworthy that for several populations of individuals at risk for deficiency, folic acid supplementation is highly recommended or suggested, but folate testing is not required or is not accounted for prior initiating supplementation [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, several authors have debated the utility of serum folate testing, also in face of the high rate of misuse and of the associated costs [1][2][3][4][5]. From the retrospective analysis of data, a shared position on the utility and cost-effectiveness of folate testing has emerged.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Tackling serum folate test in European countries within the health technology assessment paradigm: request appropriateness, assays and health outcomes

Ferraro

Panzeri

Panteghini

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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Several authors have recently claimed an excess in serum folate test ordering, suggesting phasing out it from clinical use. According to studies performed in countries undergoing folic acid fortification policies, it is indeed no more cost-effective to test folate in the face of deficiency prevalence < 1%. In this paper, we sought to evaluate request appropriateness, analytical issues, and cost-effectiveness of serum folate determination for clinical purposes in the European context, considering if evidence retrieved in fortified countries may be generalized. Studies performed in non-fortified countries have generally reported a suboptimal folate intake and suggest a remarkable prevalence of folate deficiency. Our internal data suggest that ~ 20%-25% of the subjects undergoing serum folate test are at risk for deficiency. However, a reliable evaluation of the risk for deficiency implies the knowledge of all issues related to the total testing process of folate measurement as well as the identification of the appropriate population in which to perform the test. The cost-effectiveness of the test is maximized when the request is oriented to subjects suggestive/at risk for deficiency, becoming low if the test is used as a screening tool or for monitoring of vitamin intake/supplementation. Because the individual folate status has a key role in ensuring normal development, physiologic growth, and maintenance of optimal health, the evaluation of its serum levels has to be retained in the clinical use in non-fortified countries, boosting for more appropriate request, and evidence from countries following fortification policies should be cautionary interpreted.

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Section: Appropriateness Of Test Requestsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Tackling serum folate test in European countries within the health technology assessment paradigm: request appropriateness, assays and health outcomes

Ferraro

Panzeri

Panteghini

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…In an evaluation of 2093 serum folate tests performed on hospitalized or emergency room patients (98.1% of whom were admitted) in 2011, only 2 (0.1%) deficient levels (<3 ng/mL) were identified, 1 of which was associated with a macrocytic anemia . A similar study of RBC folate levels in 2562 patients at 3 Canadian hospitals found just 4 (0.16%) levels to be low (<254 nmol/L), only 1 of which was associated with macrocytic anemia …”

Section: Why There Is No Reason To Order Folate Testingmentioning

confidence: 99%

Serum and red blood cell folate testing on hospitalized patients

Breu

Theisen‐Toupal

Feldman

2015

Journal of Hospital Medicine

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“…In Canada, this was realized in 1998 after which cereal grain products were fortified with folic acid, a synthetic form of folate. Today, clinical folate deficiencies are rare among Canadians (Gudgeon and Cavalcanti, 2014) as folate intakes are considered to be adequate, yet highly variable (Shakur et al, 2010). Furthermore, it is expected that most Canadian neonates are folate replete due to the folic acid fortification program, and folic acid supplementation during pregnancy and periconception (Houghton et al, 2009).…”

Section: Folatementioning

confidence: 99%

The effects of dietary methyl donors on methionine partitioning in the neonatal piglet

Robinson

2015

Appl. Physiol. Nutr. Metab.

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The metabolism of the indispensable amino acid methionine is critical during development. Methionine is used to synthesize protein for growth and, using the methionine cycle, it is the precursor of >50 critical nutrients and contributes to epigenetic regulation. Therefore, the dietary methionine requirement must factor all the potential roles of methioine. Three major processes summarize the methionine cycle: transmethylation (TM), which transfers methyl groups to nutrient precursors and DNA; transsulfuration (TS), which represents methionine disposal; and remethylation (RM), which resynthesizes methionine using the dietary methyl donors folate and choline (via betaine). Dietary intakes of folate vary drastically, and choline intakes are often below the adequate intakes during preganancy and in early life, which we hypothesized would influence the methionine requirement. To test our hypothesis, we fed 4--8 day old neonatal piglets a low--methionine diet that was either deficient (MD-), or replete (MS+), in dietary methyl donors. We evaluated how methionine was balanced between the major TM reactions and protein synthesis. The MD-group exhibited marked differences in TM as creatine synthesis was ≈30% less (p<0.05), and phosphatidylcholine synthesis was ≈60% more (p<0.05) during MD-feeding. Interestingly, while MD-feeding did not affect liver protein synthesis, the methionine availablity and protein synthesis were lower in skeletal muscle of the MD-vs. MS+ animals (p<0.05). Furthermore, whole body protein turnover was also reduced during MD-feeding (p<0.05), which is significant as protein turnover is especially critical during infancy. Next, we measured the effect of methyl donors on the rates of TM, TS, and RM. The rates of RM and TM were iii reduced by ≈75% in the MD-group (p<0.05), while TS was unchanged. In order to evaluate the effectiveness of individual methyl donors on RM, we 'rescued' a second group of MD-animals with betaine (MD+B), folate (MD+F) or both (MD+FB). The rate of RM and TM increased by ≈2--fold after rescue (p<0.05) and reduced protein breakdown (p<0.05). These studies showed that dietary methyl donors affect neonatal methionine metabolism, which should be considered when defining the dietary requirements of methionine during development.iv

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Folate Testing in Hospital Inpatients

Cited by 21 publications

References 17 publications

Tackling serum folate test in European countries within the health technology assessment paradigm: request appropriateness, assays and health outcomes

Tackling serum folate test in European countries within the health technology assessment paradigm: request appropriateness, assays and health outcomes

Serum and red blood cell folate testing on hospitalized patients

The effects of dietary methyl donors on methionine partitioning in the neonatal piglet

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