title: Folate and cobalamin deficiencies and hyperhomocysteinemia in Bangladesh.
abstract: BACKGROUND
  Indian Asian men residing in the United Kingdom have a higher prevalence of hyperhomocysteinemia than do their European counterparts. This has been largely attributed to dietary deficiencies in cobalamin associated with vegetarianism among these Indian Asians.
  
  
  OBJECTIVE
  We aimed to ascertain the prevalence of folate and cobalamin deficiencies and hyperhomocysteinemia in Bangladesh.
  
  
  METHODS
  Plasma concentrations of homocysteine, folate, and cobalamin and urinary concentrations of creatinine were assessed in 1650 adults in Bangladesh.
  
  
  RESULTS
  The prevalence of hyperhomocysteinemia (men: >11.4 micromol/L; women: >10.4 micromol/L) was markedly (P < 0.0001) greater among men (63%; x +/- SD: 15.3 +/- 9.5 micromol/L) than among women (26%; 9.5 +/- 4.7 micromol/L). Folate was lower (9.8 +/- 6.5 and 12.3 +/- 7.6 nmol/L, respectively), whereas cobalamin was higher (281 +/- 115 and 256 +/- 118 pmol/L, respectively) (P < 0.0001 for both) among men than among women. Folate explained 15% and cobalamin explained 5% of the variation in homocysteine concentrations. For men, folate (P = 0.005) and cobalamin (P = 0.03) were positively correlated with urinary creatinine. Smoking (P < 0.0003) and betelnut use (P < 0.0002) were independent negative predictors of folate.
  
  
  CONCLUSIONS
  Bangladeshi men have a high prevalence of hyperhomocysteinemia, which is more closely associated with folate than with cobalamin, although other factors, eg, smoking and betelnut use, may also contribute to its cause. The positive correlations between urinary creatinine and plasma folate and cobalamin were unanticipated and could suggest that, in marginal nutrition, these vitamins may be limiting for creatine biosynthesis.
authors.affiliation: Department of Environmental Health Sciences, School of Public Health, Columbia University, New York, NY 10032, USA. mvg7@columbia.edu
authors.forename: Mary V
authors.initials: MV
authors.lastname: Gamble
authors.forename: Habibul
authors.initials: H
authors.lastname: Ahsan
authors.forename: Xinhua
authors.initials: X
authors.lastname: Liu
authors.forename: Pam
authors.initials: P
authors.lastname: Factor-Litvak
authors.forename: Vesna
authors.initials: V
authors.lastname: Ilievski
authors.forename: Vesna
authors.initials: V
authors.lastname: Slavkovich
authors.forename: Faruque
authors.initials: F
authors.lastname: Parvez
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Graziano
mesh_terms: D000328:Adult; D000368:Aged; D001114:Areca / Q000009:adverse effects; D001459:Bangladesh / Q000453:epidemiology; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D003937:Diagnosis, Differential; D014676:Diet, Vegetarian / Q000009:adverse effects; D005260:Female; D005492:Folic Acid / Q000097:blood; D005494:Folic Acid Deficiency / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D006397:Hematinics / Q000097:blood; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D014805:Vitamin B 12 / Q000097:blood; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D006397:Hematinics; D006710:Homocysteine; D005492:Folic Acid; D003404:Creatinine; D014805:Vitamin B 12