Folate and vitamin B12 status is associated with insulin resistance and metabolic syndrome in morbid obesity. Issue 5 (October 2018)

• Record Type: Journal Article
• Authors: Li, Zhen; Gueant-Rodriguez, Rosa-Maria; Quilliot, Didier; Sirveaux, Marie-Aude; Meyre, David; Gueant, Jean-Louis; Brunaud, Laurent
• Is Part Of: Clinical nutrition. Volume 37:Issue 5(2018)
• Page Start: 1700
• Page End: 1706
• Publication Date: 2018-10
• Subjects: Obesity -- Folates -- HOMA-IR; APRI Aspartate aminotransferase-to-platelet ratio -- ALAT Alanine Aminotransferase -- ASAT Aspartate Aminotransferase -- CHD Coronary heart disease -- DBP Diastolic blood pressure -- HOMA-IR Homeostasis model assessment of insulin resistance -- IDF International Diabetes Federation -- NASH Non-alcoholic steatohepatitis -- NCEP-ATP National Cholesterol Education Program Adult Treatment Panel -- MMA Methyl malonic acid -- OSAS Obstructive sleep apnea syndrome -- RBC Red blood cell -- SBP Systolic blood pressure -- SIRT1 Sirtuin-1; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2017.07.008
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background: Low vitamin B12 and high folate during pregnancy are associated with visceral obesity and insulin resistance in offspring. In the general population, high folate exacerbates the increase of methylmalonic acid, a marker of vitamin B12 deficiency. However, the influence of vitamin B12 and folate and their related markers on insulin resistance and metabolic syndrome remains unknown in severe obesity. Aim: To evaluate the influence of vitamin B12 and folate on HOMA-IR and components of metabolic syndrome in severe obesity. Methods: 278 consecutive obese patients were assessed prospectively for HOMA-IR, red blood cell (RBC) folates, homocysteine and methylmalonic acid. We compared the associations with the components of metabolic syndrome during the preoperative multidisciplinary evaluation (period-1) and before bariatric surgery (period-2). Results: The HOMA-IR was higher in patients with highest tertile of RBC and either lowest tertile of plasma B12 or highest tertile of MMA (p < 0.034 and 0.011, respectively). Lg HOMA-IR was negatively correlated with Lg homocysteine (p < 0.0001) and positively correlated with Lg serum folate (p < 0.001). The independent predictors for HOMA-IR at period 2 were either BMI and homocysteine (model 1 without serum folate, p = 0.010 and p = 0.002, respectively) or BMI and MMA (model 2 without homocysteine, p = 0.030 and p = 0.004, respectively). Age and RBC folate remained independently associated with the number of metabolic syndrome components (p = 0.006 and 0.020, respectively). Conclusions: RBC folate, homocysteine, and MMA predict HOMA-IR in severe obesity. Our findings challenge the benefit of folate fortified food in severe obesity, in particular in patients with a deficit of vitamin B12. The cohort study was registered at clinicaltrials.gov asNCT02663388 . Graphical abstract: