Lack of folate
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The Impact of Folate Deficiency on Health
Introduction to Folate and Its Importance
Folate, also known as vitamin B9, is a water-soluble vitamin essential for numerous bodily functions, including DNA synthesis, repair, and methylation, as well as amino acid metabolism. It is found naturally in foods such as leafy green vegetables, legumes, and some fruits, and is also available as folic acid in dietary supplements and fortified foods 12.
Health Consequences of Folate Deficiency
Macrocytic Anemia and Elevated Homocysteine Levels
A lack of dietary folate can lead to macrocytic anemia, characterized by the presence of abnormally large red blood cells. This condition arises because folate is crucial for DNA synthesis, and its deficiency impairs the production of red blood cells 13. Additionally, folate deficiency can result in elevated plasma homocysteine levels, which are associated with an increased risk of cardiovascular diseases 15.
Neural Tube Defects and Developmental Disorders
Folate is particularly important for women of reproductive age, as inadequate folate status can lead to neural tube defects (NTDs) in developing embryos. These defects occur early in pregnancy, often before a woman knows she is pregnant, making adequate folate intake crucial during the periconceptional period 46. Folate deficiency during pregnancy can also result in fetal loss, prematurity, and fetal growth retardation 7.
Cognitive Decline and Dementia
In adults, folate deficiency has been linked to cognitive decline and dementia. Studies have shown that low blood folate concentrations are associated with poorer cognitive function and an increased prevalence of Alzheimer's disease 9. However, the exact mechanisms by which folate deficiency affects cognitive function are not fully understood. Some research suggests that impaired brain methylation activity and homocysteine toxicity may play a role 10.
Muscle Weakness and Difficulty Walking
Folate deficiency can also lead to muscle weakness and difficulty walking. This is because folate is involved in the synthesis of essential biomolecules required for muscle function 1. Although the precise effects of folate on skeletal muscle development are still being studied, it is clear that adequate folate intake is necessary for maintaining muscle health 1.
Strategies to Combat Folate Deficiency
Dietary Supplementation and Fortification
To combat folate deficiency, two primary strategies are employed: dietary supplementation and the biofortification of staple crops. Folate pills are a common form of supplementation, but this approach can be costly and inaccessible for many populations 2. Biofortification, which involves increasing the folate content of staple crops like rice, potato, and maize, offers a more sustainable solution 2.
Monitoring and Evaluation
Effective monitoring and evaluation of folate status are essential for preventing deficiency. Blood folate levels are commonly assessed using serum/plasma folate concentrations and red cell folate content, which reflect long-term folate status 8. Additionally, measuring homocysteine levels can provide insights into folate and vitamin B12 utilization in the body 8.
Conclusion
Folate is a vital nutrient with far-reaching implications for health. Its deficiency can lead to serious health issues, including anemia, developmental disorders, cognitive decline, and muscle weakness. Addressing folate deficiency through dietary supplementation, crop biofortification, and effective monitoring is crucial for improving public health outcomes globally.
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Most relevant research papers on this topic
Roles of folate in skeletal muscle cell development and functions
Folate plays a crucial role in skeletal muscle cell development and functions, but its precise effects and the effects of folic acid supplementation on muscle cell functions remain poorly understood.
Folates in Plants: Research Advances and Progress in Crop Biofortification
Folate enhancement in staple crops is a promising strategy to combat folate deficiency and improve crop growth and productivity, while addressing environmental stresses and addressing global food security needs.
Highly CitedPhysiology of folate and vitamin B12 in health and disease.
Impaired folate metabolism increases risk for developmental anomalies and disease, but current initiatives to increase folate intakes in human populations lack predictive value for unintended adverse outcomes.
Highly CitedGlobal folate status in women of reproductive age: a systematic review with emphasis on methodological issues
Global folate status data for women of reproductive age is limited and methodologically flawed, with prevalence of folate deficiency at over 20% in many low-income countries and folate insufficiency at over 40% in most countries.
Systematic Review
Rigorous JournalHighly CitedFolic acid with or without vitamin B12 for cognition and dementia.
Folic acid supplementation, with or without vitamin B12, may improve cognitive function in elderly individuals at risk of cognitive decline or dementia.
Systematic ReviewHighly CitedConclusions of a WHO Technical Consultation on Folate and Vitamin B12 Deficiencies
Folate and vitamin B12 deficiencies are primarily caused by insufficient dietary intake or poor absorption, with higher risks in poorer countries, vegetarians, and those with dietary restrictions.
Highly CitedCobalamin and folate deficiency: acquired and hereditary disorders in children.
Maternal cobalamin deficiency and folate insufficiency are the main causes of cobalamin and folate deficiencies in newborns, with inborn errors of cobalamin transport and metabolism also contributing to these deficiencies.
Highly CitedLaboratory assessment of folate (vitamin B9) status
Folate deficiency can lead to megaloblastic anaemia, neural tube defects, cognitive decline, depression, and neuropathy, and excessive exposure to folic acid can cause adverse health effects.
Highly CitedHeterogeneity and lack of good quality studies limit association between folate, vitamins B-6 and B-12, and cognitive function.
Low blood folate concentrations are associated with poor cognitive function in the elderly, but data supporting this association is limited due to heterogeneity in cognition-assessment methodology and lack of good quality studies.
Systematic ReviewCognitive impairment in folate-deficient rats corresponds to depleted brain phosphatidylcholine and is prevented by dietary methionine without lowering plasma homocysteine.
Folate deficiency impairs cognitive function in rats, with depleted brain phosphatidylcholine being a key contributor, but supplemental methionine can prevent this impairment without lowering plasma homocysteine levels.
Non-RCT
Animal StudyHighly Cited