Folate and B12 Levels Correlate with Histological Severity in NASH Patients

Nutrients. 2018 Apr 2;10(4):440. doi: 10.3390/nu10040440.


Background: The correlation between abnormal vitamin serum levels and chronic liver disease has been previously described in literature. However, the association between the severity of folate serum levels (B9), vitamin B12 and nonalcoholic steatohepatitis (NASH) has not been widely evaluated. Therefore, the aim of this study was to investigate the existence of such a correlation in a cohort of NASH patients.

Methods: All patients aged 18 years and older who were diagnosed with biopsy-proven NASH at the EMMS hospital in Nazareth during the years 2015-2017 were enrolled in this study. Data regarding demographic, clinical and laboratory parameters was collected. Patients with other liver diseases were excluded.

Results: Eighty-three NASH patients were enrolled during the study period. The mean age was 41 ± 11 years and the majority of patients were male. Mean values of folate and B12 were 9.85 ± 10.90 ng/mL and 387.53 ± 205.50 pg/mL, respectively. Half of the patients were presented with a grade 1 steatosis (43.4%), a grade 2 fibrosis (50.6%) and a grade 3 activity score (55.4%). The fibrosis grade was significantly correlated with low folate levels on multivariate analysis (p-value < 0.01). Similarly, low B12 levels were significantly associated with a higher fibrosis grade and NASH activity (p-value < 0.001 and p-value < 0.05 respectively).

Conclusion: Our study demonstrated a statistically significant correlation between low levels of folate and vitamin B12 with the histological severity of NASH. These findings could have diagnostic and therapeutic implications for patient management and follow-up.

Keywords: NAFLD; NASH; folate; nonalcoholic fatty liver disease; nonalcoholic steatohepatitis; vitamin B12; vitamin B9.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biopsy
  • Cohort Studies
  • Female
  • Folic Acid / blood*
  • Folic Acid Deficiency / blood
  • Folic Acid Deficiency / complications*
  • Humans
  • Liver / pathology*
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / pathology
  • Male
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease / blood
  • Non-alcoholic Fatty Liver Disease / pathology*
  • Severity of Illness Index*
  • Vitamin B 12 / blood*
  • Vitamin B 12 Deficiency / blood
  • Vitamin B 12 Deficiency / complications*
  • Young Adult


  • Folic Acid
  • Vitamin B 12