Review of current evidence for folate in the prevention of neural tube defects

The incidence of neural tube defects (NTD) among black South Africans living in urban areas is low compared with reports of NTD incidence in rural areas  A NTD incidence of 0.95 per 1000 live births was reported in Cape Town,l while an incidence of 0.99 per 1 000 live births was reported in a study performed at Kalafong Academic Hospital, Pretoria.' In contrast, the prevalence of NTD in the black population in rural Transkei was 6.13 per 1 000 live births,' and in rural Northern Province it was 3.55 per 1 000 live births.' In view of the association between folic acid status and NiD, we  performed a study in rural and urban communities to determine whether folate or vitamin B12 status and/or abnormal homocyst(e)ine metabolism could explain why the incidence of NTD in rural areas is so high. (Homocyst(e)me (tHcy) refers to the sum of concentrations of free homocysteine, protein-bound homocysteine, the disulphide homocystine, and the mixed disulphide homocysteine-cysteine.

Biological variation of Myeloperoxidase

A research grant was granted by the National Health Laboratory Service Research Trus

Hyperhomocyst(e)inemia is an important risk factor for vascular disease in subjects with high-molecular weight apo(a) isoforms

Background: Homocyst(e)ine is reported to increase the binding of lipoprotein(a) [Lp(a)] to fibrin, which may increase the thrombogenic effects of Lp(a) in vivo. The aim of this study was to investigate whether there is a relationship between homocyst(e)ine and Lp(a) levels and vascular disease risk, and if the relationship depends on the apo(a) isoforms. Methods: A case-control study was performed in 91 Caucasian male subjects with vascular disease due to athersclerosis, and in 100 healthy age- and sex-matched control subjects. Results: Both hyperhomocyst(e)inemia and elevated Lp(a) were significantly more prevalent in patients. Concordant elevated Lp(a) and hyperhomocyst(e)inemia were not associated with increased vascular disease risk (relative odds 2.96; 95% CI: 0.90-9.80), while hyperhomocyst(e)inemia in the absence of elevated Lp(a) was associated with increased vascular disease risk (relative odds 7.20; 95% CI: 2.37-21.91). Hyperhomocyst(e)inemia in individuals with high-molecular weight apo(a) isoforms [smaller apo(a) isoform > S3] was observed to be associated with increased vascular disease risk (relative odds 11.02; 95% CI: 3.54-34.30), while vascular disease risk in subjects with low-molecular weight apo(a) isoforms [smaller apo(a) isoform < S3] was not significantly increased, the relative odds being 1.92; 95% CI: 0.51-7.24. Conclusions: We conclude that hyperhomocyst(e)inemia is an important risk factor in individuals with highmolecular weight apo(a) isoforms