Prevalence Of Folate Deficiency Research Articles

Folate, vitamin B12 and vitamin D status in healthy and active home-dwelling people over 70 years

BackgroundAgeing is characterised by physiological changes that can affect the nutrient availability and requirements. In particular, the status of vitamin D, cobalamin and folate has often been found to be critical in older people living in residential care. However, there is a lack of studies investigating the status of these nutrients in healthy and active home-dwelling elderly people.MethodsThe aim of this cross-sectional study was to assess the status of vitamin D based on serum concentrations of 25-hydroxycholecalciferol [25-(OH)D], cobalamin based on serum concentrations of holotranscobalamin (holoTC) and folate based on red blood cell (RBC) folate in unsupplemented, healthy and active German home-dwelling subjects ≥ 70 years of age (n = 134, mean ± SD: 75.8 ± 4.5 years). Dietary intake was assessed by 3-day food recalls. The study was conducted between March and November of 2021 (during the COVID-19 pandemic).ResultsThe mean 25-(OH)D concentration was high at 85.1 ± 26.0 nmol/L, while the majority of women (92%) and men (94%) had 25-(OH)D concentrations ≥ 50 nmol/L. Less than 10% of men and women had 25-(OH)D concentrations < 50 nmol/L. The mean holoTC concentration was 88.9 ± 33.7 pmol/L (94.8 ± 34.6 pmol/L in women and 73.6 ± 25.6 in men). Only 8% of the women were cobalamin deficient (< 50 pmol/L holoTC) compared to 22% of the men. The mean RBC folate concentration was 831 ± 244 nmol/L, while the prevalence of folate deficiency was 10%. Linear regression analysis showed that only folate equivalent intake was associated with the relevant nutrient status marker.ConclusionOur findings suggest that healthy, independently living older people with high levels of education, physical activity, and health awareness are not necessarily at higher risk of vitamin D, folate and cobalamin deficiency. Further studies are needed to verify these findings and to identify lifestyle and dietary patterns that can predict adequate nutrient status for healthy ageing.Trial registrationThis study is officially recorded in the German Clinical Trials Register (DRKS00021302).

Folate deficiency may increase the risk for elevated TSH in patients with type 2 diabetes mellitus

BackgroundType 2 diabetes mellitus (T2DM) and thyroid dysfunction (TD) are two common chronic endocrine disorders that often coexist. Folate deficiency has been reported to be related with the onset and development of T2DM. However, the relationship between folate deficiency and TD remains unclear. This study aims to investigate the association of serum folate with TD in patients with T2DM.MethodsThe study used data on 268 inpatients with T2DM in the Beijing Chao-yang Hospital, Capital Medical University from October 2020 to February 2021. Thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), and serum folate were measured with chemiluminescence immunoassay (CLIA), and folate deficiency was defined as a serum folate concentration < 4.4 ng/mL. Ordinary least squares regression models were used to assess the association of serum folate with TSH concentration. Multivariable logistic regression models were performed to explore the correlation of folate deficiency and the risk for elevated TSH.Results15.3% of T2DM patients had TD. Among those patients with TD, 80.5% had elevated TSH. Compared with the normal-TSH and low-TSH groups, the prevalence of folate deficiency was significantly higher in the elevated-TSH group (P < 0.001). Serum folate level was negatively associated with TSH (β=-0.062, 95%CI: -0.112, -0.012). Folate deficiency was associated with the higher risk for elevated TSH in patients with T2DM (OR = 8.562, 95%CI: 3.108, 23.588).ConclusionsA low serum folate concentration was significantly associated with a higher risk for elevated TSH among T2DM patients.

Associations of Serum Folate and Homocysteine Concentrations with All-Cause, Cardiovascular Disease, and Cancer Mortality in Men and Women in Korea: the Cardiovascular Disease Association Study

BackgroundEvidence on the association of serum folate and homocysteine concentrations with risk of mortality in the general population is unclear. ObjectivesThis study aimed to examine the associations of serum folate and homocysteine concentrations with all-cause, CVD, and cancer mortality risk in Korean men and women aged ≥40 y. MethodsIn this population-based prospective cohort study, serum folate and homocysteine concentrations were measured in a subset of participants enrolled between 2005 and 2012. A total of 21,260 participants were linked to mortality data from the survey date to 31 December 2019. Cox proportional hazards models and restricted cubic splines were used to identify the associations of serum folate and homocysteine concentrations with mortality. ResultsDuring a median follow-up of 12.3 y, 2501, 549, and 842 deaths were attributed to all-cause, CVD, and cancer, respectively. The prevalence of folate deficiency and hyperhomocysteinemia were higher in men than in women. In men, a nonlinear inverse association was observed between serum folate concentrations and all-cause mortality. Men in the third quartile of serum folate concentrations exhibited a lower risk of all-cause mortality (HR: 0.85; 95% CI: 0.73, 0.99) than those in the lowest quartile. Serum homocysteine concentration was positively associated with all-cause and CVD mortality. Men and women in the highest compared with those in the lowest serum homocysteine quartile showed a higher risk of CVD mortality (HR: 1.60; 95% CI: 1.07, 2.39; and HR: 1.79; 95% CI: 1.11, 2.89, respectively). Hyperhomocysteinemia combined with folate deficiency was associated with increased all-cause, CVD, and cancer-related mortality rates. ConclusionsHigher serum homocysteine and lower serum folate concentrations were associated with an increased risk of all-cause, CVD, and cancer-related mortality in Korean adults. The finding of a nonlinear inverse relationship between serum folate concentration and mortality in men warrants further investigation.

Daily supplementation of a multiple micronutrient powder improves folate but not thiamine, riboflavin, or vitamin B12 status among young Laotian children: a randomized controlled trial

PurposeTo assess the effects of intervention with a daily multiple micronutrient powder (MNP) on thiamine, riboflavin, folate, and B12 status among young Laotian children.MethodsChildren (n = 1704) aged 6–23 mo, participating in a double-blind placebo-controlled randomized trial were individually randomized to receive daily either MNP (containing 0.5 mg of thiamine, 0.5 mg riboflavin, 150 μg folic acid, and 0.9 μg vitamin B12 along with 11 other micronutrients) or placebo and followed for ~ 36 weeks. In a randomly selected sub-sample of 260 children, erythrocyte thiamine diphosphate (eThDP), plasma folate and B12 concentrations, and erythrocyte glutathione reductase activation coefficient (EGRac; riboflavin biomarker) were assessed at baseline and endline.ResultsThere was no treatment effect on endline eThDP concentrations (110.6 ± 8.9 nmol/L in MNP vs. 109.4 ± 8.9 nmol/L in placebo group; p = 0.924), EGRac (1.46 ± 0.3 vs. 1.49 ± 0.3; p = 0.184) and B12 concentrations (523.3 ± 24.6 pmol/L vs. 515.9 ± 24.8 pmol/L; p = 0.678). Likewise, the prevalence of thiamine, riboflavin, and B12 deficiencies did not differ significantly between the two groups. However, endline folate concentration was significantly higher in the MNP compared to the placebo group (28.2 ± 0.8 nmol/L vs 19.9 ± 0.8 nmol/L, respectively; p < 0.001), and correspondingly, the prevalence of folate deficiency was significantly lower in the MNP group (1.6% vs 17.4%; p = 0.015).ConclusionsCompared to a placebo, daily MNP for 9 months increased only folate but not thiamine, riboflavin, or B12 status in young Laotian children.Trial registrationThe trial was registered at www.clinicaltrials.gov (NCT02428647) on April 29 2015.

Exploring the prevalence of multiple forms of malnutrition in children 6–18 years living in the Eastern Cape, South Africa

Background: The existence of multiple forms of malnutrition is a growing problem in developing countries. Children living in the Eastern Cape have a relatively high prevalence of cardiovascular disease (CVD) risk factors and food insecurity, suggesting the possibility of the several coexisting forms of malnutrition. Due to the negative long-term consequences of undernutrition, overnutrition and, to a greater extent, a combination of both, it is important for this issue to be identified early in children and addressed. Aim: This study was undertaken to investigate the prevalence of the different forms of malnutrition in children living in the Eastern Cape province. Methods: Secondary analysis of a cross-sectional sample of 237 school-aged children, aged 6–18 years, in the Eastern Cape province of South Africa was conducted. The variables included in the analysis were the demographic data, anthropometric data and biochemical data, specifically blood profiles related to micronutrient deficiencies and CVD risk factors. Fisher’s exact test was used to compare the prevalence rates of several coexisting forms of malnutrition in the children. All data analysis was conducted in R version 4.0.3 and statistical significance was set at 0.05. Results: In children with overweight/obesity, 13.6% had a micronutrient deficiency, while 37.71% of the children within the normal weight range had coexisting micronutrient deficiencies and CVD risk factors. The prevalence of folate deficiency was 73.0%, iron deficiency 6.3%, and hyperglycaemia was at 10.6%. Fisher’s exact test was used to compare the prevalence rates between genders and no statistically significant differences were observed. Conclusion: Further research is needed to understand the relatively high prevalence of CVD risk factors in these children within the normal weight range and to investigate how dietary intake contributes to the overall double burden of malnutrition in children.

Nutrition status of pregnant women and lactating mothers in rural areas of four counties in Guizhou and Henan Provinces

To analyze the levels of serum ferritin(SF), transferrin receptor(sTfR), vitamin D(VD), folate(FOL), vitamin B_(12)(VB_(12)) and homocysteine(Hcy) of pregnant women and lactating mothers in rural areas, aiming to evaluate the nutritional status of pregnant women and lactating mothers. By using a cluster sampling method, the subjects were the pregnant women at 10-20 weeks& apos; gestation and lactating mothers at 42±7 days& apos; postpartum who have been to the maternal and children health hospital in the county for examination from August 2019 to March 2020. SF, VD, VB_(12) and FOL concentrations were determined using the chemiluminescence assay. Hypersensitive C-reactive protein(hsCRP) and sTfR levels were determined using the immunoturbidimetry assay. Hcy levels were determined using the enzymatic assay. The rates of iron, vitamin D, folic acid, VB_(12) deficiency and hyperhomocysteinemia(HHcy) were calculated. There were 1050 pregnant women and 309 lactating mothers involved. The levels of ferritin and sTfR were 49. 6(47. 1-52. 3) ng/mL and 2. 51(2. 46-2. 56) mg/L for the pregnant women, and 51. 0(46. 6-55. 9) ng/mL and 3. 53(3. 40-3. 67) mg/L for the lactating mother, respectively. The prevalence of iron deficiency in lactating mothers was significantly higher than the pregnant women(33. 0% vs. 24. 7%). The levels of VD were 17. 0(16. 6-17. 4) ng/mL for pregnant women and 16. 7(16. 0-17. 4) ng/mL for lactating mothers. The prevalence of VD deficiency was 64. 5% and 68. 9%, respectively. The level of FOL for pregnant women was significantly higher than the lactating mothers(11. 3(10. 9-11. 7)vs. 5. 7(5. 3-6. 1) ng/mL). The levels of VB_(12) for pregnant women was significantly lower than the lactating mother(282. 7(276. 1-289. 5) vs. 437. 7(418. 7-457. 6) pg/mL). The levels of Hcy for pregnant women was significantly lower than the lactating mother(7. 1(7. 0-7. 3) vs. 10. 5(10. 0-10. 9) μmol/L). The prevalence of FOL deficiency, VB_(12) deficiency and HHcy were 5. 0%, 17. 2% and 5. 0% for pregnant women and 29. 8%, 2. 3% and 27. 8% for lactating mothers, which were significant different between pregnant women and lactating mothers(P& lt; 0. 05). Among the four nutrients including iron, VD, folate and VB_(12), 75. 8% of pregnant women were deficient in at least one nutrient and 28. 1% were deficient in at least two nutrients. 81. 9% of lactating mothers were deficient in at least one nutrient and 41. 4% were deficient in at least two nutrients. There were various degrees of nutrient deficiency. Iron deficiency rates were high and VD deficiency were severe in both pregnant women and lactating mothers. In addition, the rates of folate deficiency and HHcy were high in lactating mothers in rural areas.

The prevalence of low serum levels of Vitamin D, Vitamin B12, folate and ferritin in adolescents: Single center experience.

In this study, the aim was to evaluate the prevalence of vitamin D, vitamin B12, ferritin, and folate deficiencies in adolescence to clarify the need for early diagnosis and therapy. The medical records of adolescents between 10 and 18 years of age between 01 September 2018 and 28 February 2019 as healthy with non-specific complaints, or due to well-child care visits, were analyzed retrospectively. A total of 1847/2507 (73.6%) adolescents were included in the study. The prevalence of vitamin D deficiency was 25.7% (n: 178/691). Vitamin B12 deficiency prevalence was 69.2% (n: 753/1088). The prevalence of anemia and ferritin deficiency was 4.8% and 13.26%. The prevalence of folate deficiency was 37.9% (n: 413/1088). VDD prevalence was statistically significantly higher in females than males (F/M:116/62). VB12D prevalence, the number and mean age of females with hemoglobin deficiency, and low ferritin levels was found to be statistically significantly higher in females than males. The prevalence of vitamin D, vitamin B12, folate deficiency and low ferritin levels was found to be high among adolescents. In particular, adolescents admitting with non-specific complaints and for control purposes in big cities must be considered to be at risk for the deficiency of these vitamins and low level of ferritin.

Awareness of Folic Acid Intake among Women of Childbearing Age in Ha’il region, Kingdom of Saudi Arabia

Background: Folic acid deficiency is one of the most common vitamin deficiencies among women of childbearing-age. Folic acid is a water-soluble B-complex vitamin. Although the deficiency is easily corrected by administration of folic acid, but still the prevalence of folic acid deficiency is high. It can lead to neural tube defects (NTDs) in fetus, which are a major cause of severe disability and mortality among infant population, occurring in over one quarter of a million new-borns per year, worldwide. NTDs occur in the very early phase of pregnancy when the mother herself does not know that she is pregnant. This study has assessed awareness of women of childbearing age on folic acid i.e., timing of folic acid supplementation, different sources, symptoms of its deficiency, toxicity and its effect on fetus. Study was conducted in Ha’il region and its suburbs, Kingdom of Saudi Arabia in the period between October 2020 and February 2021.&#x0D; Methodology: An analytical cross-sectional community-based study was carried out among 842 women aged between18 and 45 years using a close-ended questionnaire.&#x0D; Results: In total, Folic Acid was taken by just 23.87% of participants. Only 33% knew that Folic Acid deficiency causes neural tube defects in fetus. Further it was revealed that postgraduates had a significantly better knowledge on Folic Acid 0.000) than others. Similarly, those who belonged to household where total monthly income was 5000 Saudi Riyals or more had better awareness on Folic Acid than participants who belonged to low socioeconomic status ( 0.05).&#x0D; Conclusion: It’s concluded that in Ha’il and its suburb area, women of childbearing age do not possess adequate knowledge on Folic Acid. Neural tube defects in fetus due to folic acid deficiency were not known by a large majority of respondents. However, awareness has a strong association with educational level and socioeconomic status. Hence it is recommended that female literacy and female employment should be promoted, encouraged and supported in Kingdom in order to improve our health indicators.

Prevalence of Folate Deficiency in Korean Women of Reproductive Age Using a Serum Folate Assay Traceable to the WHO International Standard

We aimed to investigate serum folate level in Korean women of reproductive age and to evaluate the prevalence of folate deficiency by age using different cutoffs. We retrospectively reviewed data obtained with a serum folate assay traceable to World Health Organization international standard reference material 03/178. Between September 2017 and June 2019, data from a total of 8,380 Korean women aged 15 - 49 years were obtained. Mean (standard deviation) serum folate concentration for all women was 9.1 (6.7) ng/mL. Prevalence of folate deficiency using the cutoff of < 3 ng/mL was 6.2% and that for < 4 ng/mL was 14.9%. The prevalence of folate deficiency was higher in women of younger age (15 to < 25 years, even > 30% using the cutoff of 4 ng/mL) compared to other age groups. This study suggests that women aged 15 to < 25 years are at high risk of folate deficiency.

Reference Interval for Korean Serum Folate Assay Traceable to the WHO International Standard.

Little is known about the reference interval of serum folate concentration if using recently re-standardized assays traceable to the World Health Organization (WHO) international standard reference 03/178 in a Korean population. This study aimed to investigate serum folate levels in Korean subjects without macrocytic anemia or increased homocysteine, for the assessment of folate deficiency. We retrospectively reviewed data from Korean adults whose hemoglobin, mean corpuscular volume, and serum total homocysteine values were within reference limits. The median (interquartile range) serum folate level was 7.8 (5.4 - 12.6) ng/mL in men and 10.2 (6.9 - 15.6) ng/mL in women. The reference interval for serum folate (2.5th and 97.5th percentiles) ranged from 2.9 to 38.0 ng/ mL. From among 723 Korean adults, the lower limit of reference intervals of serum folate for folate deficiency, defined as the 2.5th percentile, was 2.9 ng/mL. The prevalence of folate deficiency was higher in men (6.5%) than in women (1.2%, p < 0.05) when a cutoff value of 3.0 ng/mL was applied. Using the cutoff value of 4 ng/mL for folate deficiency, which is in accordance with the instructions from the manufacturer of the new assay and the WHO 2012 guideline for homocysteine as a metabolic indicator before assay standardization, about 5% of subjects were reclassified as folate deficient. Our study suggests that any change of reference limits using a re-standardized assay needs to be verified in clinical laboratories.

Serum Folate of Less than 7.0 ng/mL is a Marker of Malnutrition

Abstract Folate is an essential nutrient that humans are unable to synthesize. We investigated clinical/laboratory factors associated with folate deficiency in tertiary care patients. We reviewed medical records of 1019 patients with serum folate &amp;lt;7.0 ng/mL, 301 patients with serum folate of 15 ng/mL, and 300 patients with serum folate &amp;gt;23 ng/mL. Serum prealbumin levels were subnormal in 54.8% of patients with serum folate &amp;lt;7.0 ng/mL. Vitamin B12, hemoglobin, and serum albumin levels were significantly lower in the &amp;lt;7.0 ng/mL folate group. In 62.4% of patients with serum folate &amp;lt;7.0 ng/mL, one or more markers of malnutrition were present. The low-folate group had a significantly higher prevalence of gastrointestinal (GI) disorders, sepsis, and abnormal serum creatinine level. There were no significant differences in the two groups regarding the prevalence of diabetes; behavioral/neurological disorders, including drug and alcohol abuse; bariatric surgery; or a diagnosis of malnutrition. The average body mass index (BMI) for the &amp;lt;7.0 ng/mL and 15 ng/mL folate groups was significantly different (28.89 and 28.31, respectively), although the difference does not appear to be clinically meaningful. The prevalence of folate deficiency depends on what is considered a normal serum folate level. Approximately 10% of tertiary care patients have levels &amp;lt;7.0 ng/mL and exhibit other markers of malnutrition. It is recommended that patients with GI disorders, chronic kidney disease, and sepsis be routinely tested for serum folate levels, before administration of vitamin supplements. Patients with serum folate levels &amp;lt;7.0 ng/mL should be evaluated for malnutrition, despite BMI &amp;gt;25. Folate supplementation should be administered only after excluding coexisting vitamin B12 deficiency.

Serum Folate of Less than 7.0 ng/mL is a Marker of Malnutrition

Abstract Introduction/Objective To identify clinical/laboratory factors associated with folate deficiency in tertiary care patients. Methods We reviewed the medical records of 1019 patients with serum folate &amp;lt;7.0 ng/mL, 301 patients with serum folate of 15 ng/mL, and 300 patients with serum folate &amp;gt; 23 ng/mL. Results Serum prealbumin levels were subnormal in 54.8% of patients with serum folate &amp;lt;7.0 ng/mL. Vitamin B12, hemoglobin, and serum albumin levels were significantly lower in the &amp;lt;7.0 ng/mL folate group. In 62.4% of patients with serum folate &amp;lt;7.0 ng/mL, 1 or more markers of malnutrition were present. The low-folate group had a significantly higher prevalence of gastrointestinal (GI) disorders, sepsis, and abnormal serum creatinine level. There were no significant differences in the 2 groups regarding diabetes; behavioral/neurological disorders, including drug and alcohol abuse; bariatric surgery; or a diagnosis of malnutrition. The average body mass index (BMI) for the &amp;lt;7.0 ng/mL and 15 ng/mL folate groups was significantly different (28.89 and 28.31, respectively), although the difference does not appear to be clinically meaningful. Conclusion The prevalence of folate deficiency depends on what is considered a normal serum folate level. Approximately 10% of tertiary care patients have levels &amp;lt;7.0 ng/mL and exhibit other markers of malnutrition. It is recommended that patients with GI disorders, chronic kidney disease, and sepsis be routinely tested for serum folate levels, before administration of vitamin supplements. Patients with serum folate levels &amp;lt;7.0 ng/mL should be evaluated for malnutrition, despite BMI &amp;gt; 25. Folate supplementation should be administered only after excluding coexisting vitamin B12 deficiency.

Folate and the association between maternal arsenic exposure and birth outcomes in the Biomarkers of Exposure to ARsenic (BEAR) cohort

Inorganic arsenic (iAs) is a ubiquitous metalloid, carcinogen, and reproductive toxicant commonly found in drinking water at levels exceeding the World Health Organization’s (WHO) recommended limit of 10 ppb. Upon ingestion, iAs is biotransformed to monomethylated (MMA) and dimethylated (DMA) arsenic through the addition of methyl groups. As a methyl-donor nutrient, folate contributes to the methylation process, and folic acid supplementation among adults exposed to iAs has been shown to improve methylation efficiency. Since maternal iAs exposure has been linked to adverse birth outcomes, we sought to evaluate whether serum folate concentrations modified the relationship between maternal iAs exposure and various birth outcomes in a cross-sectional cohort of 193 women residing in Gómez Palacio, State of Durango, Mexico between 2011 and 2012. Folate intake was measured in maternal serum, and indicators of arsenic exposure were evaluated in drinking water and maternal urine samples. In evaluating effect modification by folate, likelihood ratio tests were implemented to evaluate the goodness-of-fit of interaction models as compared to main effects models. The prevalence of folate deficiency, defined as &lt; 9 nM, was minimal, still effect modification by folate was significant (p &lt; 0.1) on the additive scale for associations between several indicators of maternal iAs exposures and birth outcomes, namely birth weight and head circumference. In many cases, increased serum folate concentrations attenuated or changed the direction of associations. This cross-sectional study suggests that higher serum folate concentrations attenuate the negative association between maternal iAs exposure and anthropometric measures at birth.

Prevalence of Folate deficiency among elderly population

Prevalence of Folate deficiency among elderly population

Prevalence of folate deficiency among adolescent school girls in rural areas of Mysuru district, Karnataka, India

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Folic acid deficiency declined substantially after introduction of the mandatory fortification programme in Queensland, Australia: a secondary health data analysis.

To investigate the prevalence of folic acid deficiency in Queensland-wide data of routine laboratory measurements, especially in high-risk sub-populations. Secondary health data analysis. Analysis of routine folic acid tests conducted by Pathology Queensland (AUSLAB). Female and male persons aged 0-117 years with routine folic acid testing between 1 January 2004 and 31 December 2015. If repeat tests on the same person were conducted, only the initial test was analysed (n 291 908). Overall the prevalence of folic acid deficiency declined from 7·5 % before (2004-2008) to 1·1 % after mandatory folic acid fortification (2010-2015; P < 0·001) reflecting a relative reduction of 85 %. Levels of erythrocyte folate increased significantly from a median (interquartile range) of 820 (580-1180) nmol/l in 2008 before fortification to 1020 (780-1350) nmol/l in 2010 (P < 0·001) after fortification. The prevalence of folic acid deficiency in the Indigenous population (14 792 samples) declined by 93 % (17·4 v. 1·3 %; P < 0·001); and by 84 % in non-Indigenous residents (7·0 v. 1·1 %; P < 0·001). In a logistic regression model the observed decrease of folic acid deficiency between 2008 and 2010 was found independent of gender, age and ethnicity (ORcrude = 0·20; 95 % CI 0·18, 0·23; P < 0·001; ORadjusted = 0·21; 95 % CI 0·18, 0·23; P < 0·001). While voluntary folic acid fortification, introduced in 1995, failed especially in high-risk subgroups, the 2009 mandatory folic acid fortification programme coincided with a substantial decrease of folic acid deficiency in the entire population.

Low proportions of folic acid deficiency after introduction of mandatory folic acid fortification in remote areas of northern Queensland, Australia: a secondary health data analysis

Background: Australia implemented mandatory folic acid fortification of bread-making flour in 2009.Objective: To assess the impact of folic acid fortification in remote vs. regional urban areas and Indigenous vs. non-Indigenous populations in northern Queensland.Methods: Routinely collected data on folic acid measurements in remote areas and two regional urban centres in northern Queensland between 2004 and 2015 were analysed (n = 13,929) dichotomously (folic deficient vs. non-deficient).Results: Overall prevalence of folic acid deficiency was 3.2% (235/7282) in urban centres compared with 7.2% (480/6647) in remote areas (p < 0.001), and 9.3% (393/4240) in the Indigenous population compared with 3.2% (273/8451) in the non-Indigenous population (p < 0.001). Prevalence of folic acid deficiency dropped from 12.2% (n = 481) in 2004–2008 to 1.5% (n = 126) in 2010–2015 (p < 0.001). This translates into a relative risk reduction (RRR) of 88%. RRR was 79% (7.2% vs. 1.5%) in urban centres, 91% (17.3% vs. 1.5%) in remote areas, 92% (20.5% vs. 1.6%) in the Indigenous population and 80% (7.4% vs. 1.5%) in the non-Indigenous population (p < 0.001 for all).Conclusions: Substantial declines of folic acid deficiency to low and comparable proportions in former high-risk populations indicate that mandatory folic acid fortification of flour has had a population-wide benefit in northern Queensland.

The prevalence of folate deficiency in the adult population in Turkey: The association with prediabetes and diabetes

The prevalence of folate deficiency in the adult population in Turkey: The association with prediabetes and diabetes

Prevalence of Folic Acid Deficiency and Cost Effectiveness of Folic Acid Testing: A Single Center Experience

Study ObjectiveAccording to the National Health and Nutrition Examination Survey (NHANES) data from 2003-2006 the prevalence of folic acid deficiency in the United States has decreased from 16% to 0.5% since the dietary folic acid fortification program started in the late 1990s. Routine testing for folic acid deficiency remains quite common in the workup of anemia, dementia, alcoholism and other high risk populations. The objective for this study were to determine the prevalence of folic acid deficiency in order to analyze whether routine testing for deficiency should be discouraged or targeted to specific patient populations. In addition to this, we want to assess the economic burden that folic acid level testing adds to the high cost of care of our health system.MethodsCross sectional chart review of all adults tested for folic acid level from March 2014 to March 2015 from the Hospital and Ambulatory Care Center of the Community Hospital was undertaken. Folic acid deficiency was defined as ≤4ng/dl. Folic acid level were further classified as low (≤10ng/dl ), intermediate (10-20ng/dl) and high (>20ng/dl). Age, race, body mass index, hemoglobin, mean corpuscular volume levels and billing details were recorded of all patients and information was also collected regarding known conditions correlated to the folic acid levels including Vitamin B12 deficiency( <300 ng/dl), dementia, alcoholism, pregnancy malabsorption, sickle cell disease, bariatric surgery, inflammatory bowel syndrome, and drug therapy with HAART (Highly Active Anti-Retroviral Therapy) , TMP-SMX(Trimethoprim/sulfamethoxazole), phenytoin, valproic acid and/or methotrexate (Table 1). Statistical testing using t-test, logistic / linear regressions with α level at 0.05 was used for analysis of data.ResultsA total of 957 charts of patients who were tested for folic acid between March 2014 to March 2015 at our Heath- Care System were reviewed. 413 (43%) patients were male and 544 (57%) were female. There were 394 (41 %) Hispanics, 325 (34%) African American, 202 (21%) Caucasian and 36 (4%) were from other ethnicity. The mean age was 59.7 years and a mean Hb was 11. 6 g/ dl.Mean folic acid level was 14.5 ng/dl. 16 patients from total of 957 (2 %) had folic acid deficiency with value ≤4ng/dl . Additional results from the study are described in Table 1, Table 2 and Table 3.ConclusionThe prevalence of folic acid deficiency was 2%, About 33,000 dollars per year were used to identify such a low prevalent disease which can be treated at a low cost (2 cents/day) by oral supplementation. Low levels of folic acid were statistically associated with male sex, African American race, dementia and coexistence of vitamin B12 deficiency. Empiric supplementation of folic acid and possibly limiting testing for folic acid level to this group of patients may represent a more cost effective strategy. DisclosuresNo relevant conflicts of interest to declare.

Folate Testing and Deficiency in Hospitalized Cancer Patients

Background: Folate deficiency is classically taught as a cause of anemia; with the advent of widespread dietary fortification, the prevalence of folate deficiency in the general population has decreased significantly. Recent studies have examined the yield of testing for folate deficiency and questioned its value, demonstrating negligible clinical yield across multiple care settings. However, patients with cancer are at increased high risk of folate deficiency. To our knowledge, no studies have specifically examined patterns and yield of folate testing among inpatients at a cancer institution. We sought to determine the yield of folate testing in this setting, and to characterize the patients found to have folate deficiency.Methods: We used our institutional clinical database to identify all inpatient folate and red blood cell folate (RBCF) tests done at our institution in calendar-year 2017. We included testing done in our Urgent Care Center in patients who were subsequently admitted to the hospital. We defined folate deficiency as < 4.0 ng/mL according to our lab reference. Among patients with folate deficiency, we performed manual chart review to evaluate the presence of known risk factors for folate deficiency: alcohol abuse, gastrointestinal malabsorption, pancreatic insufficiency, culprit medications, end-stage renal disease requiring hemodialysis, malnutrition (defined as BMI <18.5), and hemolytic anemia.Results: A total of 1013 serum folate level tests were performed in 960 patients; one patient underwent RBCF testing alone. A majority of tests were done on medical rather than surgical patients (85% vs 13%). Overall, 69 (6.8%) of patients were found to have folate deficiency. Almost all patients with folate deficiency were anemic. Surprisingly, macrocytosis was infrequent in patients with folate deficiency in cancer; over 90% of patients had normal or even low MCV. Among 69 patients with folate deficiency, less than half the patients (N=28, 41%) had an identifiable risk factor for folate deficiency, most commonly medications. Identified malabsorption/ malnutrition, hemolysis, and hemodialysis collectively accounted for 7.2%, and no case was attributed to alcoholism. The degree of anemia was not significantly different between the patients with folate deficient and those with adequate folate levels. The mean MCV values were normal in both the folate deficient and folate replete patients. Co-testing of vitamin B12 levels was performed in 859 (85%) of testing instances; 23 (2.7%) had isolated B12 deficiency and 3 (0.3%) had concurrent folate and B12 deficiency.Conclusions: In our cohort of hospitalized cancer patients, folate testing identified deficiency in 6.8%, notably higher than in other studies of general populations. A higher rate of folate deficiency may have been present in this study due to the comorbidities associated with advanced malignancies and their treatments. Surprisingly, folate deficiency did not correlate with macrocytosis, which is characteristic of the folate deficiency-associated anemia in non-cancer patients. This may reflect more acute development of deficiency, or the presence of multiple factors affecting red cell production, thus “masking” the macrocytosis. Neither the degree of anemia nor the MCV provided guidance as to the presence of folate deficiency and a minority of deficient patients had identifiable risk factors. Folate deficiency, while not common in hospitalized cancer patients, needs to be considered in the presence of anemia, even in the absence of macrocytosis. DisclosuresSoff:Amgen: Research Funding; Janssen: Research Funding.