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Non-linear association between serum folate concentrations and dyslipidemia: Korea National Health and Nutrition Examination Survey 2016-2018
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Taiyue Jin
 , Eun Young Park, Byungmi Kim, Jin-Kyoung Oh
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Epidemiol Health. 2022;44:e2022046. Published online May 15, 2022
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DOI: https://doi.org/10.4178/epih.e2022046
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 Abstract
Summary
 PDF Supplementary Material
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Abstract
OBJECTIVES
We aimed to evaluate the association between serum folate concentrations and the prevalence of dyslipidemia.
METHODS A total of 4,477 adults (2,019 male and 2,458 female) enrolled in the Korea National Health and Nutrition Examination Survey (KNHANES) 2016-2018 were included. Serum samples were used to assess folate concentrations and total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL)-cholesterol, and high-density lipoprotein (HDL)-cholesterol levels. Multivariate logistic regression with sampling weights was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS Elevated TC, TG, LDL-cholesterol and HDL-cholesterol levels were observed in 506 (11.3%), 646 (14.4%), 434 (9.7%), and 767 (17.1%) participants, respectively. We found non-linear trends between serum folate concentrations and the prevalence of hypercholesterolemia and hyper-LDL cholesterolemia from the restricted cubic smoothing spline. A higher prevalence of hypercholesterolemia was observed among participants in the first tertile of serum folate concentrations (OR,1.38; 95% CI, 1.05 to 1.79) than among those in the second tertile. However, a higher prevalence of hyper-LDL cholesterolemia was identified for both the first and third serum folate concentration tertiles (OR, 1.49; 95% CI, 1.08 to 2.05 and OR, 1.63; 95% CI, 1.20 to 2.20, respectively); furthermore, in these tertiles, the prevalence of hyper-LDL cholesterolemia was more pronounced among obese participants.
CONCLUSIONS Non-linear associations may exist between serum folate concentrations and the prevalence of hypercholesterolemia and hyper-LDL cholesterolemia in adults. The findings suggest that more accurate recommendations about folate intake and folic acid fortification and supplementation should be provided.
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Summary
Korean summary
본 연구는 국민건강영양조사 자료를 활용하여 한국 성인에서 혈청 엽산 농도와 고콜레스테롤혈증 및 저밀도지단백 (LDL) 콜레스테롤혈증 유병률 간의 비선형 연관성을 확인하였다. 이 결과는 적정 혈청 엽산 농도와 정확한 엽산 권장섭취량을 추정하는데 근거로 활용될수 있을 것이다.
Key Message
1. The prevalence of hypercholesterolemia and hyper-LDL cholesterolemia were non-linearly associated with serum concentrations of folate in the Korean population.
2. An inverse association with a significant linear trend between serum folate concentrations and prevalence of hypo-HDL cholesterolemia was observed.
3. In relation to folate intake and folic acid fortification and supplementation, more accurate recommendations should be provided.
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