Preoperative folate and homocysteine status in patients undergoing major surgery.
OBJECTIVE
Patients with folate deficiency and elevated homocysteine (Hcy) levels have increased risk of cerebrovascular and cardiovascular disease. They may also be at increased risk of complications after surgery because nitrous oxide interferes with folate metabolism. The aim of this study was to assess the incidence of folate deficiency and hyperhomocysteinemia in patients presenting for major surgery. We also tested the utility of a brief preoperative medical and dietary questionnaire to identify those with low folate or elevated Hcy levels.


METHODS
We enrolled 390 patients and obtained a preoperative fasting blood sample from each of the study participants (folate [n=386], homocysteine [n=387]).


RESULTS
Although only one patient had folate deficiency preoperatively (incidence +/-SD folate and Hcy concentrations were 23.7+/-5.2 nmol/l and 9.4+/-4.2 micromol/l, respectively. There was a negative correlation between folate and Hcy, r=-0.27, P<0.001. Multivariate analyses indicated that vegan status and folate supplementation prevented low folate status (P<0.05), while age of the patient, and history of heart failure and anaemia predicted elevated Hcy concentration.


CONCLUSIONS
Some factors identified by a brief medical and dietary questionnaire are associated with folate and homocysteine status. Hyperhomocysteinaemia occurs in about 7.5% of surgical patients; however, both low folate status and elevated Hcy concentration are less likely in those taking folate or vitamin B supplements. This has implications for patients undergoing nitrous oxide anaesthesia because of its inhibition of folate metabolism, and should prompt clinicians to consider folate and other nutritional supplementation before elective surgery.
Myles
Paul S
PS
Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Commercial Road, Academic Board of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Vic., 3004, Australia. p.myles@alfred.org.au
Chan
Matthew T V
MT
Forbes
Andrew
A
Leslie
Kate
K
Paech
Michael
M
Peyton
Philip
P
D018685:Anesthetics, Inhalation / Q000009:adverse effects; D019587:Dietary Supplements; D005215:Fasting; D005260:Female; D005492:Folic Acid / Q000097:blood* / Q000378:metabolism; D005494:Folic Acid Deficiency / Q000453:epidemiology* / Q000378:metabolism; D006710:Homocysteine / Q000097:blood* / Q000378:metabolism; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009609:Nitrous Oxide / Q000009:adverse effects; D015596:Nutrition Assessment; D009752:Nutritional Status; D011300:Preoperative Care; D011795:Surveys and Questionnaires
D018685:Anesthetics, Inhalation; D006710:Homocysteine; D005492:Folic Acid; D009609:Nitrous Oxide