Erythrocyte folate, serum vitamin B12, and hearing loss in the 2003-2004 National Health And Nutrition Examination Survey (NHANES)



Studies based on food frequency questionnaires suggest that folate and vitamin B12 intake could protect against hearing loss. We investigated whether erythrocyte folate and serum vitamin B12 levels are independently associated with hearing loss in humans.


Participants in the 2003–2004 US National Health and Nutrition Examination Survey who had data on hearing, folate, and vitamin B12 levels were included. Pure-tone average (PTA) at 0.5, 1.0, 2.0, and 4.0 kHz was computed for each ear. We used weighted logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the relation between quartiles of folate and vitamin B12, and hearing loss (present if PTA > 25 dB in either ear and absent if PTA ≤ 25 dB in both ears).


Participants (n = 1149) were 20–69 (mean 42) years old and 16.4% had hearing loss in at least one ear. Our data suggest a U-shaped relationship between folate and hearing loss. Compared to the 1st quartile, the ORs (95% CIs) for hearing loss were 0.87 (0.49–1.53), 0.70 (0.49–1.00), and 1.08 (0.61–1.94) for the 2nd, 3rd, and 4th quartile of erythrocyte folate in analyses adjusted for age, sex, vitamin B12, smoking, alcohol use, body mass index, race/ethnicity, exposure to noise, income, and education. Although we observed inverse associations between vitamin B12 and hearing loss, the associations were not statistically significant (P > 0.05).


Our data show a U-shaped relationship between erythrocyte folate levels and hearing loss, suggesting a need to evaluate whether optimizing blood folate levels could prevent hearing loss.

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The NHANES data used in this study were collected with funding from the US government. We acknowledge intramural support from the Bill Wilkerson Center for Otolaryngology and Communication Disorders at Vanderbilt University School of Medicine (EKK). Salary support for DOF came from grants K23DC013559 and L30DC012687 from the National Institute for Deafness and Communication Disorders of the National Institute of Health.

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Correspondence to Edmond K. Kabagambe.

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RFL reports consulting for Cochlear Corp. and Advanced Bionics Corp. in the last two years. The remaining authors declare that they have no conflict of interest.

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Kabagambe, E.K., Lipworth, L., Labadie, R.F. et al. Erythrocyte folate, serum vitamin B12, and hearing loss in the 2003-2004 National Health And Nutrition Examination Survey (NHANES). Eur J Clin Nutr 72, 720–727 (2018). https://doi.org/10.1038/s41430-018-0101-6

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