Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
Am J Epidemiol. 2019 Jun 1;188(6):1136-1143. doi: 10.1093/aje/kwz040.
We aimed to investigate associations between individual and concurrent (≥2) intakes of one-carbon cofactors vitamins B6 and B12, choline, betaine, and methionine and neural tube defect (NTD) outcomes among mothers meeting the folic acid recommendations. In the Slone Birth Defects Study (case-control design; North America, 1998-2015), mothers of 164 NTD cases and 2,831 nonmalformed controls completed food frequency questionnaires and structured interviews. Estimated intakes of one-carbon cofactors were dichotomized (high vs. low) for all except betaine (low or middle vs. high). We used logistic regression models to estimate odds ratios and 95% confidence intervals adjusted for center, age, and race. The analysis was restricted to mothers with estimated daily total folate intake of ≥400 μg during periconception. Fewer cases, compared with controls, had high intakes for each one-carbon cofactor except betaine, where the starkest contrast occurred in the middle group. Women with concurrent high intakes of B6, B12, choline, and methionine and moderate intake of betaine had approximately half the risk of an NTD-affected pregnancy (odds ratio = 0.49, 95% confidence interval: 0.23, 1.08). These findings suggest that, in the presence of folic acid, one-carbon cofactors-notably when consumed together-might reduce NTD risk. Additional research should inform any changes to clinical recommendations.
我们旨在研究在符合叶酸推荐摄入量的母亲中，单一（≥2 种）摄入叶酸代谢相关营养素（维生素 B6 和 B12、胆碱、甜菜碱和蛋氨酸）与神经管缺陷（NTD）结局之间的关联。在 Slone 出生缺陷研究（病例对照设计；北美，1998-2015 年）中，164 例 NTD 病例和 2831 名非畸形对照的母亲完成了食物频率问卷和结构化访谈。除甜菜碱外（低或中 vs. 高），所有其他营养素的摄入量均进行了二分法（高 vs. 低）估计。我们使用逻辑回归模型，根据中心、年龄和种族调整了比值比和 95%置信区间。该分析仅限于估计围孕期每日总叶酸摄入量≥400μg 的母亲。与对照组相比，较少的病例有高摄入量，除了甜菜碱，其中中间组的差异最为明显。同时高摄入 B6、B12、胆碱和蛋氨酸以及中等量摄入甜菜碱的女性，NTD 相关妊娠的风险大约降低一半（比值比=0.49，95%置信区间：0.23，1.08）。这些发现表明，在叶酸存在的情况下，一碳代谢相关营养素（特别是同时摄入时）可能降低 NTD 风险。需要进一步的研究来为任何临床建议的改变提供信息。
