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Association between folate status and cervical intraepithelial neoplasia.

Zhao W, Hao M, Wang Y, Feng N, Wang Z, Wang W, Wang J, Ding L - Eur J Clin Nutr (2016)

Bottom Line: To investigate the effect of folate status on cervical intraepithelial neoplasia (CIN) progression and its relationship with high-risk human papillomavirus (hrHPV).Patients with abnormal TCT results (other than glandular cell abnormalities) who were willing to provide informed consent were further diagnosed using colposcopy and histopathological examination.Furthermore, potential synergy may exist between low serum folate levels and hrHPV infection to promote CIN development.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan, China.

ABSTRACT

Background/objectives: To investigate the effect of folate status on cervical intraepithelial neoplasia (CIN) progression and its relationship with high-risk human papillomavirus (hrHPV).

Subjects/methods: We evaluated 20 000 sexually active women aged <65 years in Yangqu County by using a questionnaire; the subjects were also screened using the ThinPrep cytologic test (TCT). Patients with abnormal TCT results (other than glandular cell abnormalities) who were willing to provide informed consent were further diagnosed using colposcopy and histopathological examination. We investigated 247 cases of low-grade cervical squamous intraepithelial lesions (LSIL), 125 cases of high-grade cervical squamous intraepithelial lesions (HSIL) and 877 controls. A 24-item food frequency questionnaire was filled out by the investigator to estimate the consumption of dietary folate. Positivity for hrHPV from residual exfoliated cervical cells was tested; serum folate was also measured.

Results: The hrHPV infection rate in HSIL patients (77.6%) was higher than that in LSIL (33.2%) and control (32.0%) patients. Dietary folate intakes in controls, LSIL and HSIL were 306.9±176.6, 321.8±168.0 and 314.7±193.8 μg/kcal, respectively. The levels of serum folate in controls, LSIL and HSIL were 18.2±7.9, 15.9±7.1 and 14.3±7.5 nmol/l, respectively. Increased CIN correlated with higher rates of hrHPV infection and lower levels of serum folate.

Conclusions: Low levels of serum folate may increase the risk of CIN progression. Furthermore, potential synergy may exist between low serum folate levels and hrHPV infection to promote CIN development.

No MeSH data available.


Related in: MedlinePlus

Study flow diagram. Abbreviations: TCT, ThinPrep cytologic test; NILM, negative for intraepithelial lesion or malignancy; ASC-US, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesions; HSIL, high-grade squamous intraepithelial lesions; SCC, squamous cell carcinoma.
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fig1: Study flow diagram. Abbreviations: TCT, ThinPrep cytologic test; NILM, negative for intraepithelial lesion or malignancy; ASC-US, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesions; HSIL, high-grade squamous intraepithelial lesions; SCC, squamous cell carcinoma.

Mentions: Between September and December 2014, a free cervical cancer screening program was organized for 20 000 eligible women permanently residing in Yangqu County of Taiyuan city. The inclusion criteria were as follows: sexually active woman, age <65 years, of the Han ethnic group, ⩾1 year of continuous residence in Yangqu County and willingness to participate in the screening program. The exclusion criteria included having a history of nutritional megaloblastic anemia, hemolytic disease, leukemia, liver disease, other malignant tumors and uterine surgery resection or cervical lesion treatment; moreover, those who used B vitamins within the previous 3 months were excluded. A total of 20 000 women were investigated with a demographic characteristics-related questionnaire and screened using the TCT in conjunction with gynecologic examinations. There were 1325 women diagnosed with atypical squamous cells of undetermined significance and above, among which 1257 women provided their signed, informed consent to undergo the screening program prior to enrollment. Dietary folate intake in these women was determined, and blood specimens were collected. They further underwent colposcopy and histopathological examination; all these procedures were completed under double-blind conditions. According to the final histopathological results, 247 patients were histologically diagnosed with LSIL (CIN1), 125 with HSIL (96 with CIN2 and 29 with CIN3) and 877 had normal cervixes. The final study population consisted of 1249 women, after 8 cases of invasive cervical cancer were excluded because they were beyond the scope of this study. Serum folate was also measured in all subjects, and HPV testing was performed in the residual TCT specimens (Figure 1). The study was approved by the ethics committee of the Second Hospital, Shanxi Medical University, and was registered in the Chinese Clinical Trial Register (ChiCTR), number ChiCTR-ROC-15006479.


Association between folate status and cervical intraepithelial neoplasia.

Zhao W, Hao M, Wang Y, Feng N, Wang Z, Wang W, Wang J, Ding L - Eur J Clin Nutr (2016)

Study flow diagram. Abbreviations: TCT, ThinPrep cytologic test; NILM, negative for intraepithelial lesion or malignancy; ASC-US, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesions; HSIL, high-grade squamous intraepithelial lesions; SCC, squamous cell carcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940925&req=5

fig1: Study flow diagram. Abbreviations: TCT, ThinPrep cytologic test; NILM, negative for intraepithelial lesion or malignancy; ASC-US, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesions; HSIL, high-grade squamous intraepithelial lesions; SCC, squamous cell carcinoma.
Mentions: Between September and December 2014, a free cervical cancer screening program was organized for 20 000 eligible women permanently residing in Yangqu County of Taiyuan city. The inclusion criteria were as follows: sexually active woman, age <65 years, of the Han ethnic group, ⩾1 year of continuous residence in Yangqu County and willingness to participate in the screening program. The exclusion criteria included having a history of nutritional megaloblastic anemia, hemolytic disease, leukemia, liver disease, other malignant tumors and uterine surgery resection or cervical lesion treatment; moreover, those who used B vitamins within the previous 3 months were excluded. A total of 20 000 women were investigated with a demographic characteristics-related questionnaire and screened using the TCT in conjunction with gynecologic examinations. There were 1325 women diagnosed with atypical squamous cells of undetermined significance and above, among which 1257 women provided their signed, informed consent to undergo the screening program prior to enrollment. Dietary folate intake in these women was determined, and blood specimens were collected. They further underwent colposcopy and histopathological examination; all these procedures were completed under double-blind conditions. According to the final histopathological results, 247 patients were histologically diagnosed with LSIL (CIN1), 125 with HSIL (96 with CIN2 and 29 with CIN3) and 877 had normal cervixes. The final study population consisted of 1249 women, after 8 cases of invasive cervical cancer were excluded because they were beyond the scope of this study. Serum folate was also measured in all subjects, and HPV testing was performed in the residual TCT specimens (Figure 1). The study was approved by the ethics committee of the Second Hospital, Shanxi Medical University, and was registered in the Chinese Clinical Trial Register (ChiCTR), number ChiCTR-ROC-15006479.

Bottom Line: To investigate the effect of folate status on cervical intraepithelial neoplasia (CIN) progression and its relationship with high-risk human papillomavirus (hrHPV).Patients with abnormal TCT results (other than glandular cell abnormalities) who were willing to provide informed consent were further diagnosed using colposcopy and histopathological examination.Furthermore, potential synergy may exist between low serum folate levels and hrHPV infection to promote CIN development.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan, China.

ABSTRACT

Background/objectives: To investigate the effect of folate status on cervical intraepithelial neoplasia (CIN) progression and its relationship with high-risk human papillomavirus (hrHPV).

Subjects/methods: We evaluated 20 000 sexually active women aged <65 years in Yangqu County by using a questionnaire; the subjects were also screened using the ThinPrep cytologic test (TCT). Patients with abnormal TCT results (other than glandular cell abnormalities) who were willing to provide informed consent were further diagnosed using colposcopy and histopathological examination. We investigated 247 cases of low-grade cervical squamous intraepithelial lesions (LSIL), 125 cases of high-grade cervical squamous intraepithelial lesions (HSIL) and 877 controls. A 24-item food frequency questionnaire was filled out by the investigator to estimate the consumption of dietary folate. Positivity for hrHPV from residual exfoliated cervical cells was tested; serum folate was also measured.

Results: The hrHPV infection rate in HSIL patients (77.6%) was higher than that in LSIL (33.2%) and control (32.0%) patients. Dietary folate intakes in controls, LSIL and HSIL were 306.9±176.6, 321.8±168.0 and 314.7±193.8 μg/kcal, respectively. The levels of serum folate in controls, LSIL and HSIL were 18.2±7.9, 15.9±7.1 and 14.3±7.5 nmol/l, respectively. Increased CIN correlated with higher rates of hrHPV infection and lower levels of serum folate.

Conclusions: Low levels of serum folate may increase the risk of CIN progression. Furthermore, potential synergy may exist between low serum folate levels and hrHPV infection to promote CIN development.

No MeSH data available.


Related in: MedlinePlus