The Association between Serum/RBC Folate Levels, Serum Vitamin B12 Concentrations, and Malaria in non-Pregnant Women of Reproductive Age in Malawi Público

Abstract

Abstract

The Association between Serum/RBC Folate Levels, Serum Vitamin B12 Concentrations, and Malaria in non-Pregnant Women of Reproductive Age in Malawi

By Ben Redpath

Background

Folate deficiency is a known cause of anemia and severe birth defects of the brain and spine known as neural tube defects. In the setting of vitamin B12 deficiency, there is concern that serum folate measurements may be measured as artificially high. Malaria infection can also raise serum folate measurements. We sought to investigate the association between serum/RBC folate and serum vitamin B12 in women of reproductive age (WRA) in Malawi. We further sought to report the association between malaria and serum/RBC folate measurements and if there is interaction between malaria and vitamin B12 in this association.

Methods

The data analyzed are from the 2015-2016 Malawi Micronutrient Survey, a cross-sectional survey administered by the government of Malawi with support from several other institutions including the Biomarkers Reflecting Inflammation and Nutritional Determinates of Anemia (BRINDA) work group at the Centers for Disease Control and Prevention. Possible serum folate deficiency was defined as serum folate <14.0nmol/L and vitamin B12 deficiency was defined as serum vitamin B12 <150pmol/L. We analyzed crude and adjusted associations between folate and vitamin B12, and folate and malaria using logistic regression. We also tested for interaction between vitamin B12 levels and malaria status.

Results

Of the 742 women studied, prevalence of possible serum folate deficiency, serum folate deficiency, and RBC folate insufficiency were 34.0%, 7.0%, and 81.2%, respectively. Prevalence of serum vitamin B12 insufficiency or deficiency was 18.7% and serum vitamin B12 deficiency was 2.7%. There was no significant association between possible folate deficiency and vitamin B12 deficiency prevalence odds ratio = 0.55 (95%CI = 0.16, 1.92), and there was a near significant association between malaria and possible serum folate deficiency prevalence odds ratios = 0.64 (95%CI = 0.39, 1.04), controlling for wealth.

Conclusions

Our analysis did not show a significant association between vitamin B12 deficiency and serum/RBC folate levels. For both vitamin B12 deficiency and malaria, one must first treat the known underlying condition before an accurate assessment of folate levels can be made. It may be beneficial to recommend supplementing all individuals with low vitamin B12 or malaria infection with 400µg of folic acid daily.

Table of Contents

TABLE OF CONTENTS

                       

CHAPTER

I.               BACKGROUND AND PUBLIC HEALTH SIGNIFICANCE..………1

II.             LITERATURE REVIEW………………………………………………. 3

Folate Biomarkers………………..…………..………………………… 4

Vitamin B12 and its Impact on Folate Concentrations………………… 4

Malaria and its Impact on Folate Concentrations……………………… 6

Micronutrient Malnutrition in Malawi…………………………………. 7

III.           METHODS…………………………………………………………… 10

Outcome Variables…………………………………………………… 11

Predictor Variables…………………………………………………… 11

Laboratory Analysis for Nutritional Biomarkers and Anemia…..….... 11

Co-Variables………………….………………………………………. 12

Statistical Analysis…………………………………………………… 13

IV.           RESULTS...………….……………………………………………….. 15

V.             DISCUSSION………………………………………………………… 17

REFERENCES…………………………………………………………………………. 23

FIGURES……………………………………………………………………………….. 27

TABLES………………………………...……………………………………………… 29

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Nutrition
Palavra-chave	Birth Defects Malawi Neural Tube Defects Malaria Folic Acid Vitamin B12 Folate Cobalamin
Committee Chair / Thesis Advisor	Dr. Vijaya Kancherla, PhD, Emory University
Committee Members	Dr. Godfrey P. Oakley Jr., MD, MSPM, Emory University

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