目的 分析山东荣成老年慢性病人群叶酸缺乏的三间分布特征及相关影响因素。方法 基于2024年荣成市慢性病防控精准营养干预的真实世界观察性研究,纳入15 604例研究对象。收集人口学特征、生活方式及叶酸补充情况等基线资料,并检测血清叶酸水平。采用卡方检验及方差分析比较不同时间、地区及人群特征间叶酸水平差异,采用Logistic回归分析各因素与叶酸缺乏的关系。结果 研究人群叶酸缺乏率为16.5%。时间分布上,夏季叶酸缺乏率高于春季(18.8% 比 16.0%),其中4—5月叶酸缺乏人数占比较高。地区分布上,内陆镇街人群叶酸缺乏率高于沿海镇街人群(17.5% 比 15.9%)。人群分布上,男性叶酸缺乏率高于女性(23.0% 比 12.9%);≥70岁人群高于＜70岁人群(18.1% 比 14.5%);未补充叶酸者高于补充叶酸者(24.7% 比 7.9%);当前吸烟者高于戒烟者及从未吸烟者(26.4% 比 20.5% 比 13.9%)(均P＜0.05)。结论 山东荣成老年人群叶酸缺乏现象较为常见,并存在明显的时间及人群分布差异。男性、≥70岁、当前吸烟者及未补充叶酸者是叶酸缺乏的重点高危人群。应结合季节特点及人群差异,加强老年人群叶酸营养监测与健康宣教,推动健康生活方式及规范叶酸补充等针对性干预措施,以降低叶酸缺乏风险并促进慢性病综合防控。
Abstract
Objective To investigate the temporal, geographic, and population distribution characteristics of folate deficiency and its associated factors among elderly individuals with chronic diseases in Rongcheng, Shandong Province. Method This study was based on data from the 2024 Rongcheng City Precision Nutrition Intervention for Chronic Diseases: Real-World Study (R-RWS). A total of 15,604 participants were included. Baseline information, including demographic characteristics, lifestyle factors, and folic acid supplementation status, was collected, and serum folate concentrations were measured. Differences in folate status across temporal, geographic, and population characteristics were assessed using chi-square tests and analysis of variance. Multivariable logistic regression models were applied to identify factors associated with folate deficiency.Result The overall prevalence of folate deficiency was 16.5%. Regarding temporal distribution, the prevalence of folate deficiency was higher in summer than in spring (18.8% vs. 16.0%), with the highest proportion of deficient individuals observed during April and May. In terms of geographic distribution, participants residing in inland townships exhibited a higher prevalence of folate deficiency than those living in coastal townships (17.5% vs. 15.9%). Regarding population distribution, folate deficiency was more prevalent among males than females (23.0% vs. 12.9%), among individuals aged ≥70 years than those aged <70 years (18.1% vs. 14.5%), among participants without folic acid supplementation than those receiving supplementation (24.7% vs. 7.9%), and among current smokers than former smokers and never smokers (26.4% vs. 20.5% vs. 13.9%, respectively) (all P < 0.05). Conclusion Folate deficiency was common among elderly individuals with chronic diseases in Rongcheng, China, and exhibited marked temporal and population-level variations. Males, individuals aged ≥70 years, current smokers, and those not receiving folic acid supplementation were identified as key high-risk groups. Targeted public health strategies, including strengthened nutritional surveillance, health education, promotion of healthy lifestyles, and appropriate folic acid supplementation, should be implemented according to seasonal and population-specific characteristics to reduce the burden of folate deficiency and support comprehensive chronic disease prevention and management.
关键词
叶酸缺乏 /
沿海地区 /
三间分布 /
老年人群 /
影响因素 /
补充叶酸 /
疾病预防
Key words
Folate deficiency /
Coastal area /
Three-dimensional distribution /
Tumor prevention and control /
Elderly population
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Chen H, Lu J, Li Y. Secular trends in the prevalence of and disability-adjusted life years due to common micronutrient deficiencies in China from 1990 to 2019: an age-period-cohort study and joinpoint analysis [J]. Front Nutr,2022,9:754351.
[2] Ducker G S, Rabinowitz J D. One-carbon metabolism in health and disease [J]. Cell Metab,2017,25(1):27-42.
[3] Greene N D, Copp A J. Neural tube defects [J]. Annu Rev Neurosci,2014,37:221-242.
[4] Wang X, Qin X, Demirtas H, et al. Efficacy of folic acid supplementation in stroke prevention: a meta-analysis [J]. Lancet,2007,369(9576):1876-1882.
[5] Green R, Datta Mitra A. Megaloblastic anemias: nutritional and other causes [J]. Med Clin North Am,2017,101(2):297-317.
[6] Araújo J R, Martel F, Borges N, et al. Folates and aging: Role in mild cognitive impairment, dementia and depression [J]. Ageing Res Rev,2015,22:9-19.
[7] Zsigrai S, Kalmár A, Barták B K, et al. Folic acid treatment directly influences the genetic and epigenetic regulation along with the associated cellular maintenance processes of HT-29 and SW480 colorectal cancer cell lines [J]. Cancers (Basel), 2022, 14(7).
[8] Ni Y, Du J, Yin X, et al. Folate intake, serum folate, and risk of esophageal cancer: a systematic review and dose-response meta-analysis [J]. Eur J Cancer Prev,2019,28(3):173-180.
[9] 李建平, 卢新政, 霍勇, 等. H型高血压诊断与治疗专家共识[J]. 中华高血压杂志. 2016, 24(2): 123-127.
[10] Liu M, Gan X, He P, et al. Dietary folate status among Chinese adults and its association with chronic kidney disease prevalence [J]. 2024, 3(3): e00079.
[11] 郝玲, 田熠华, 章斐然, 等. 我国部分地区成年人血浆叶酸的地区和季节差异比较 [J]. 中华预防医学杂志,2002,36(5):308-310.
[12] Fazili Z, Sternberg M R, Potischman N, et al. Demographic, physiologic, and lifestyle characteristics observed with serum total folate differ among folate forms: cross-sectional data from fasting samples in the NHANES 2011-2016 [J]. J Nutr,2020,150(4):851-860.
[13] Delchier N, Ringling C, Cuvelier M E, et al. Thermal degradation of folates under varying oxygen conditions [J]. Food Chem,2014,165:85-91.
[14] Guignard L, Nembrini C, Moulin J, et al. A rapid chemiluminescence assay for measurement of folate in small volumes of breast milk [J]. Molecules, 2019, 24(15).
[15] Liu M, Zhang Z, Zhou C, et al. Relationship of several serum folate forms with the risk of mortality: a prospective cohort study [J]. Clin Nutr,2021,40(6):4255-4262.
[16] Xu J, Sui Y, Li J, et al. Patterns and correlates of concurrent serum vitamin D, folate, and vitamin B(12) status in a rural Chinese population [J]. J Nutr, 2025.
[17] Dang S, Yan H, Zeng L, et al. The status of vitamin B12 and folate among Chinese women: a population-based cross-sectional study in northwest China [J]. PLoS One, 2014, 9(11): e112586.
[18] Bidoli E, Franceschi S, Montella M. Cancer mortality by urbanization and proximity to the sea coast in Campania Region, southern Italy [J]. Tumori,1998,84(4):460-466.
[19] Makwana B, Khadke S, Kumar A, et al. Marine microplastic levels and the prevalence of cardiometabolic diseases in US coastline counties [J]. J Am Heart Assoc, 2025, 14(13): e039891.
[20] Song S, Song B M, Park H Y. Folate, vitamin B12, and homocysteine status in the Korean population: data from the 2013-2015 Korea National Health and Nutrition Examination Survey [J]. Epidemiol Health, 2024, 46: e2024007.
[21] Report of the scientific committee of the food safety authority of Ireland . Update Report on Folic Acid and the Prevention of Birth Defects in Ireland [Z]. https://wwwfsaiie/getmedia/2b1deb65-0bc9-416a-b0db-7cf46355db2f/folic-acid-report-2016pdf?ext=pdf. 2016
[22] Tan H Z, Lin W J, Huang J Q, et al. Updated incidence rates and risk factors of esophageal cancer in Nan'ao Island, a coastal high-risk area in southern China [J]. Dis Esophagus,2017,30(1):1-7.
[23] Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480,687 adults [J]. Circulation,2017,135(8):759-771.
[24] Ni W, Li H, Wu A, et al. Lack of association between genetic polymorphisms in three folate-related enzyme genes and male infertility in the Chinese population [J]. J Assist Reprod Genet,2015,32(3):369-374.
[25] Scaglione F, Panzavolta G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing [J]. Xenobiotica,2014,44(5):480-488.
[26] Clarke R, Grimley Evans J, Schneede J, et al. Vitamin B12 and folate deficiency in later life [J]. Age Ageing,2004,33(1):34-41.
[27] Gross. E B K C, Wang. C Y, Saltveit. M. The Commercial Storage of Fruits, Vegetables, and Florist and Nursery Stocks [J]. https://wwwarsusdagov/ARSUserFiles/oc/np/CommercialStorage/CommercialStoragepdf, 2016.
PDF(1490 KB)
