title: Assessment of vitamin B-12, folate, and vitamin B-6 status and relation to sulfur amino acid metabolism in neonates.
abstract: BACKGROUND
  Total serum homocysteine (tHcy) has been used as an indicator of intracellular vitamin B-12, vitamin B-6, and folate status in adults, but data for neonates and infants are lacking. Vitamin B-12 deficiency may have fatal effects on neurologic development in infants; therefore, early diagnosis is crucial.
  
  
  OBJECTIVE
  Our aim was to provide a reference range for tHcy in neonates and to explore the relation of tHcy to 1) serum vitamin concentrations, 2) the product of the transsulfuration pathway (cysteine), and 3) nutritional factors.
  
  
  METHODS
  tHcy, cysteine, folate, vitamin B-12, and vitamin B-6 were measured in 123 healthy, breast-fed neonates. The influence of nutrition (formula or human milk) on these variables was investigated in 60 infants.
  
  
  RESULTS
  The mean (+/-SD) tHcy concentration was 7.8 +/- 3.1 micromol/L. tHcy showed a linear association with log vitamin B-12 (r = -0.64, P: < 0. 001), red blood cell folate (r = -0.33, P: < 0.001), and cysteine (r = 0.36, P: < 0.001). The strongest linear association was found between tHcy and the ratio of log cysteine to log vitamin B-12 (r = 0.71, P: < 0.0001). We found more neonates with probable tissue deficiencies of vitamin B-12 and folate on the basis of tHcy measurements than was expected from the analysis of serum vitamin concentrations alone (15.4% compared with 9.7%). Breast-fed infants had significantly lower vitamin B-12 concentrations and significantly higher serum tHcy and cysteine concentrations and ratios of log cysteine to log vitamin B-12 than did formula-fed infants (P: < 0.001).
  
  
  CONCLUSIONS
  tHcy can be used as a functional indicator of vitamin B-12 and folate status in neonates. The ratio of cysteine to vitamin B-12 can be used as an additional index of impaired intracellular Hcy metabolism. tHcy and cysteine concentrations in infants are affected by nutritional factors.
authors.affiliation: University Children Hospital Basel (UKBB), Switzerland.
authors.forename: J C
authors.initials: JC
authors.lastname: Minet
authors.forename: E
authors.initials: E
authors.lastname: Bissé
authors.forename: C P
authors.initials: CP
authors.lastname: Aebischer
authors.forename: A
authors.initials: A
authors.lastname: Beil
authors.forename: H
authors.initials: H
authors.lastname: Wieland
authors.forename: J
authors.initials: J
authors.lastname: Lütschg
mesh_terms: D000596:Amino Acids / Q000378:metabolism*; D001942:Breast Feeding; D003430:Cross-Sectional Studies; D003545:Cysteine / Q000097:blood; D004912:Erythrocytes / Q000378:metabolism; D005260:Female; D005492:Folic Acid / Q000097:blood*; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007225:Infant Food; D007231:Infant, Newborn; D008297:Male; D011736:Pyridoxine / Q000097:blood*; D013455:Sulfur / Q000378:metabolism*; D014805:Vitamin B 12 / Q000097:blood*
chemical_list: D000596:Amino Acids; D006710:Homocysteine; D013455:Sulfur; D005492:Folic Acid; D003545:Cysteine; D011736:Pyridoxine; D014805:Vitamin B 12