Comparison of Vitamin D, B12, and Folic Acid Levels According to Attack Frequency in Familial Mediterranean Fever Cases

BACKGROUND: Familial Mediterranean fever (FMF) is an autoinflammatory disease more commonly observed in the Eastern Mediterranean region. Studies have shown that inflammatory processes may decrease vitamin D, vitamin B12 and folate levels, but there is no clear data on the effect of attack frequency on these levels. Our study aimed to evaluate the effect of FMF attack frequency on vitamin levels.
MATERIALS AND METHODS: FMF patients aged between 4-18 years were considered as the study group, while healthy children who had vitamin levels during the same period were considered as the control group. The study group was further subgrouped according to the number of attacks. Those experiencing 2 or fewer attacks per year are classified as the attack group, while those experiencing 6 or more attacks per year are classified as the frequent attack group.
RESULTS: A total of 494 subjects were included. The study group was composed of 333 FMF patients,108 of them in the attack group and 225 in the frequent attack group. Control group included 161 children. The median and interquartile range (IQR: P25-75) in the frequent attack, attack, and control groups for 25(OH)D levels were 14.3 (9.57-18.9), 14.85 (10.12-21.77), and 14.95 (9.92-20.12) ng/ml, for B12 levels were 320 (238-415), 328 (250.25-439.25), and 373 (273.75-519.25) pg/ml, and for folate levels were 6 (5.13-8.12), 6.8 (5.36-8.9), and 7 (5.3-9.9) ng/ml, respectively. There is no significant difference between groups for 25(OH)D and folate (p=0.436 and p=0.25, respectively). Vitamin B12 levels are significantly lower in study group (p=0.001) but there is no difference according to attack frequency (p=0.92).
CONCLUSION: There is no effect of attack frequency on 25(OH)D, vitamin B12 and folate levels. The fact that vitamin B12 levels are within normal limits in patients with FMF may be explained by the adequate dietary habits of these patients.

Ailevi Akdeniz Ateþi Olgularýnda Atak Sýklýðýna Göre Vitamin D, B12 ve Folik Asit Seviyelerinin Karþýlaþtýrýlmasý

AMAÇ: Ailevi Akdeniz Ateþi (AAA) Doðu Akdeniz bölgesinde daha sýk görülen otoinflamatuar bir hastalýktýr. Literatürde inflamatuar süreçlerin vitamin D, B12 ve folat düzeylerini azalttýðýný gösteren çalýþmalar olmakla birlikte atak sýklýðýnýn vitamin düzeylere etkisi ile ilgili kýsýtlý veri mevcuttur. Çalýþmamýzda AAA atak sýklýðýnýn vitamin düzeylerine etkisinin deðerlendirilmesi amaçlandý.
YÖNTEM: Çalýþma grubuna 4-18 yaþ arasýndaki FMF hastalarý dahil edilirken ayný dönemde baþvurusu olan ve vitamin düzeylerine bakýlmýþ olan saðlýklý çocuklar da kontrol grubu olarak çalýþmaya dahil edildi. Çalýþma grubu atak sayýsýna göre 2 subgrupa bölümdü. Yýllýk atak sayýsý 2 ve altýnda olan hastalar atak grubu, 6 veya daha fazla olanlar ise sýk atak grubuna dahil edildi.
BULGULAR: Toplam 494 çocuk çalýþmaya dahil edildi. Çalýþma grubu 108’i atak, 225’i sýk atak grubunda olmak üzere toplam 333 AAA hastasýndan oluþmaktaydý. Kontrol grubuna 161 saðlýklý çocuk dahil edildi. Vitamin düzeylerinin medyan ve çeyreklikleri sýk atak, atak ve kontrol grubunda sýrasýyla vitamin D için 14.3 (9.57-18.9), 14.85 (10.12-21.77), ve 14.95 (9.92-20.12) ng/ml, Vitamin B12 için 320 (238-415), 328 (250.25-439.25), and 373 (273.75-519.25) pg/ml, ve folik asit için 6 (5.13-8.12), 6.8 (5.36-8.9), and 7 (5.3-9.9) ng/ml olarak hesaplandý. Vitamin D ve folat düzeylerinde gruplar arasýnda anlamlý fark görülmedi (Sýrasýyla p=0.436 ve p=0.25). Vitamin B12 düzeyleri çalýþma grubunda anlamlý derecede daha düþük olarak saptanmakla birlikte atak sýklýðýna göre B12 düzeylerinde farklýlýk saptanmadý (Sýrasýyla p=0.001 ve p=0.92).
SONUÇ: Atak sýklýðýnýn Vitamin D, B12 ve folat düzeylerine etkisi olmadýðý görüldü. Vitamin B12 düzeyinin çalýþma grubunda anlamlý derecede düþük olsa da bütün gruplarda normal sýnýrlarda olmasý hastalarýn dengeli beslenme alýþkanlýklarý ile açýklanabilir. (SETB-2024-03-047)