2. Water-soluble B-vitamin, discovered in 1930 by Lucy
Wills.
identified folate in prevention of anemia during pregnancy
Vitamin also known as Folate or Folic Acid
Natural vs synthetic
Must be ingested in diet (cannot be synthesized by body)
3.
4. Folate
Metabolically active form found in body
Folic acid
Used commercially in supplements and fortified foods
In 1998 FDA mandated
Folic acid be added to all items labelled “enriched” cereal grain products (bread,
pasta, wheat fours etc)
To reduce prevalence of neural tube defects-(NTDs)
140 mcg FA per 100 grams of flour
Some cereals are fortified with 100% DV
(400 mcg) folic acid per serving
https://www.youtube.com/watch?v=ouMi5z1vwbE
5. Neural tube defects:
Fetal growth and development is
characterized by widespread cell division
Adequate folate is critical because of its
role in DNA synthesis
Neural tube defects (NTD) results in either
anencephaly
spina bifida
defects occur between the 21st and 27th
days after conception, a time when many
women do not realize they are pregnant
Risk of NTD in US prior to fortification of
foods with folic acid was estimated to be 1
per 1000 pregnancies
Anencephaly
(no-in head or brain)
Spina bifida
6. Results of randomized trials have demonstrated
60% to 100% reductions in NTD cases when women consumed folic acid supplements in
addition to a varied diet
during the periconceptional period (about 1 month before and 1 month after
conception)
U.S. Public Health Service - recommends that all women capable of
becoming pregnant consume 400 mcg of folic acid daily to prevent NTD
Recommendation was made to all women of childbearing age, because
adequate folic acid must be available very early in pregnancy
7. Folate is the natural (complex) form found
in foods such as:
dark-green leafy vegetables, broccoli, asparagus,
lentils, beans, peanuts, strawberries, kiwi, orange
juice, liver
Folate in foods can be lost through processing and
cooking, reducing amount of available folate
8. Folic acid is synthetic (simple) form of folate
1. Used in nutritional supplements and food
fortification
2. Only form that can be transported across
membranes
3. Most oxidized and stable form of folate
4. It is biologically inactive until cells convert it to
active form
• tetrahydrofolate
5. Once activated it serves same functions as Folate
10. Pteridine- precursor in the synthesis of folic acid in many
microorganisms
Pteridine compound + Aminobenzoic acid (enzyme- dihydro-
pteroate synthetase)-----→into folic acid in presence of
glutamate
Glutamate
11. FOLYL CONJUGASE
BODY FOLATE 5-
10mg (1/2 in liver)
FA transportation-FBP,
Albumin, free)
Folic acid is metabolically inactive until it is converted into tetrahydrofolate
12. Average daily intake of folate from foods is about 200 mcg
Efficacy of folate absorption is estimated at 50%
Of the 200 mcg consumed, only about 100 mcg actually used by the
body
Alcohol-reduces activity of Folyl conjugase
Impairs absorption, transport, release and metabolism of folates
Reduces absorption by 80%
13. Folic acid is metabolically inactive until it is
converted into tetrahydrofolate
Primary metabolic function of tetrahydrofolate is -
a carrier molecule for the transfer of one carbon
groups
1. provides one-carbon groups (such as methyl groups)
for the biosynthesis of other molecules
2. source of these one- carbon groups is from the
metabolism of some amino acids
DHR-(Dihydro folate
reductase)
14. One-carbon metabolism
Mediating transfer of 1 carbon units
Folate coenzymes act as acceptors and donors of one-carbon
units in a variety of reactions critical to metabolism of nucleic
acids and amino acids
15. MTHFR
Methyl donor for DNA methylation
produces purines and pyrimidines required for DNA synthesis
18. Nucleic acid metabolism:
Folate coenzymes play a vital role in Nucleic acid metabolism
Involves 2 pathways
Nucleic acids
–involves purine (A,G) and pyrimidine (T,C) synthesis
which makes folic acid essential for cell division and
DNA synthesis
–2nd pathway includes synthesis of methyl donor (1
Carbon unit) S-adenosylmethionine (SAM)
– used in methylation reactions
– including methylation of DNA (which plays a key role in gene expression)
19. Amino acid metabolism
synthesis of methionine from homocysteine requires a folate
coenzyme as well as a vitamin B12 dependent enzyme
folate deficiency can result in decreased synthesis of methionine
and a build up of homocysteine.
Increased levels of homocysteine
may be a risk factor for heart disease
& Alzheimer’s disease
21. Healthy individuals utilize two different pathways to metabolize
homocysteine
One pathway (methionine synthase) results in synthesis of
methionine from homocysteine, and is dependent on a folate
coenzyme and a vitamin B12 dependent enzyme
Other pathway converts homocysteine to another amino acid,
cysteine, and requires two vitamin B6 dependent enzymes
Amount of homocysteine in the blood is regulated by three vitamins: folic
acid, vitamin B12, and vitamin B6
22. Cysteine and taurine and tri-peptide glutathione (glutamine,
cysteine and glycine)
Sulfur compounds very important -under conditions of absolute
deficiency of sulfur, there is no living material
Every cell in body contains sulfur compounds
SAM is the Precursor for Sulfur-Containing Amino
Acids
Polyamine synthesis
(cell growth)
23. Folate status is influenced by presence of genetic variations in folate
metabolism, particularly those found in the 5,10-methylenetetrahydrofolate
reductase (MTHFR) gene.
Genetic variation in folate requirements
A common polymorphism or variation in the sequence of the gene for
the enzyme, 5, 10-methylenetetrahydrofolate reductase (MTHFR), known
as the MTHFR c.677C>T polymorphism, results in a thermolabile enzyme.
substitution of a cytosine (C) by a thymine (T) at nucleotide 677 in the exon 4 of MTHFR gene
leads to an alanine-to-valine transition in the catalytic domain of enzyme.
Depending on population, 20% to 53% of individuals may have inherited one T
copy (677C/T genotype), and 3% to 32% of individuals may have inherited two
T copies (677T/T genotype) for the MTHFR gene.
MTHFR catalyzes reduction of 5,10-methylenetetrahydrofolate (5,10-
methylene THF) into 5-methyl tetrahydrofolate (5-MeTHF).
folate coenzyme required to form methionine from homocysteine
24. Bioavailability
Dietary folates exist
predominantly in the
polyglutamyl form (containing
several glutamate residues),
whereas folic acid—the
synthetic vitamin form—is a
monoglutamate, containing just
one glutamate moiety.
natural folates are reduced
molecules, whereas folic acid is
fully oxidized.
These chemical differences
have major implications for
the bioavailability of
the vitamin such that folic acid is
considerably more bioavailable
than naturally occurring food
folates at equivalent intake
levels.
25. Bioavailability of folates from various foods considered
to be dependent on a number of factors including:
1. Intestinal de-conjugation of polyglutamyl folates
2. Food matrix
3. Instability of certain labile folates during digestion (or
before ingestion)
4. Presence of certain dietary constituents that may enhance
folate stability during digestion (e.g. folate-binding protein
ascorbate)
Factors Contributing to Incomplete Bioavailability
of Natural Food Folates
26. 1. Chemical structure of FA renders it very stable to oxidation and resistant to
destruction
2. Natural folates are labile and prone to oxidative cleavage
3. Reduced forms, particularly unsubstituted dihydro- and tetrahydro- forms, are
unstable chemically
are easily split between the C-9 and N-10 bond to yield a substituted pteridine
and p-aminobenzoylglutamate, which have no biologic activity
Substituting a carbon group at N-5 or N-10 decreases tendency of molecule
to split; however, substituted forms are also susceptible to oxidative
chemical rearrangements and, consequently, loss of activity
4. Extensive losses of folate can occur during cooking and preparation of foods
May considerably reduce amount of folate ingested
Folate losses in the range of 50–80% have been reported in green vegetables
after boiling and in processed legumes
27. Unstable to oxygen under aerobic conditions of processing & storage
Heat, light, metal ions
Major loss-Leaching in cooking water
Vitamin C
Enhances utilization of 5 Methyl FH4 by preventing oxidation to 5 Methyl FH2 (which does not
enter metabolic process)
FH4 Oxidized
FH2 (dihydrofolic
acid, partially
oxidized)
Folic acid (fully
oxidized, but
physiologically
active)
Further oxidation
(physiologically
inactive
products)
28. Food matrix as a whole and its components can also
influence folate bioavailability by:
entrapment in the matrix - hinders diffusion to the
absorptive surface during digestion
Incomplete release from plant cellular structure may be a
factor affecting folate bioavailability in certain plants
29. Folate plays animportant role in pathogenesis of several disorders
in humans
1. Anemia - megaloblastic
2. cardiovascular disease
3. neural tube defects (NTDs) and other congenital defects
4. neuropsychiatric disorders
5. cancer
6. osteoporosis
30. DNA is constantly damaged by a host of endogenous and exogenous
factors
sophisticated repair mechanisms available in cells to eliminate such
damage
Folate deficiency
imbalance and uracil mis-incorporation into DNA
Results in abnormal DNA replication
imposes greater dependence on the repair system
Folate essential for regenerating methionine
Methyl donor for DNA methylation
produces purines and pyrimidines required for DNA synthesis
Inadequate availability of folate may contribute to aberrations in DNA
methylation
May lead to abnormalities in DNA synthesis or repair
31.
32. DNA methylation plays an integral role in
oncogenesis
Decreased level of genomic methylation
universal cause in tumorigenesis
Folate depletion has been shown to induce
hypomethylation of p53 tumor suppressor gene
Altered DNA Methylation
33. DEFICIENCY
Causes
Folate deficiency occurs in a number of situations
low dietary intake and diminished absorption, as in alcoholism, can
result in a decreased supply of folate.
Certain conditions like pregnancy or cancer result in increased rates of
cell division and metabolism, leading to an increase in the body's
demand for folate
Several medications may also contribute to deficiency
Elderly people - due to conditions such as ill-fitting dentures, physical
disabilities
Patients with renal and liver failure, anorexia
Restriction of foods rich in protein, potassium, and phosphate
34. • Megaloblastic Anemia
Decreased DNA synthesis
Failure of bone marrow cells to divide
Normal protein synthesis
Results in large immature RBC’s
contrast with microcytic hypochromic anemia
Megaloblastic anemia is a condition in which bone marrow produces unusually
large, structurally abnormal, immature red blood cells (megaloblasts).
When DNA synthesis is impaired, cell cycle cannot progress--- leads to continuing cell growth
without division, which presents as macrocytosis
35. Symptoms
Individuals in early stages of folate deficiency may not show obvious symptoms, but
blood levels of homocysteine may increase
Rapidly dividing cells are most vulnerable to effects of folate deficiency
When folate supply to rapidly dividing cells of bone marrow is inadequate, blood cell
division becomes abnormal resulting in fewer but larger red blood cells
type of anemia is called megaloblastic or macrocytic anemia, referring to large immature red blood cells
Because normal red blood cells have a lifetime in circulation of approximately 4
months, it can take months for folate deficient individuals to develop characteristic
megaloblastic anemia.
Progression of such an anemia leads to a decreased oxygen carrying capacity of
blood and may ultimately result in symptoms of fatigue, weakness, and shortness
of breath
36. • Homocysteine
–Coronary Heart Disease risk factor
genetic homocystinuria - premature CHD
high [homocys] related to high CHD risk
low [folate, B-12, B-6] related to high CHD risk
low intake of B-vit related to high CHD risk
37. Homocysteine undergoes autooxidation and
oxidation
Resulting in reactive oxygen species
hydrogen peroxide and superoxide anion radical
generate oxidative stress
linked to damage of endothelial lining of arterial
vessels
38. Examples of molecular cascades induced by
homocysteine that can lead to cell dysfunction and/or
death in cardiovascular disease, and neurodegenerative
diseases
Homocysteine in Neurodegenerative Disorders
39. Congenital malformations due to failure
of closure of the neural tube which
eventually forms central nervous system
anencephaly-failure of closure at end
of neural tube
spina bifida- caudal neuropore end
2nd most prevalent congenital
malformation associated with mortality
in immediate prenatal period
42. Researchers are studying other potential benefits of
multivitamins containing folic acid
Heart Defects
Cleft Lip/Cleft Palate
Limb Defects
Urinary Defects
43. Dietary Folate Equivalents (DFE)
FNB of Institute of Medicine set new dietary recommendations for folate
Dietary Folate Equivalent (DFE) (introduced a new unit)
Use of DFE reflects higher bioavailability of synthetic folic acid found in
supplements and fortified foods compared to naturally occurring food
folates
1 microgram (mcg) of food folate provides 1 mcg of DFE
1 mcg of folic acid taken with meals or as fortified food provides 1.7 mcg
of DFE
1 mcg of folic acid (supplement) taken on an empty stomach provides 2
mcg of DFE
Eg. a serving of food containing 60 mcg of folate would provide 60 mcg of DFE, while a serving
of pasta fortified with 60 mcg of folic acid would provide 1.7 x 60 = 102 mcg DFE due to the
higher bioavailability of folic acid
A folic acid supplement of 400 mcg taken on an empty stomach would provide 800 mcg of DFE
44. Recommended Dietary Allowance for Folate in Dietary Folate
Equivalents (DFE)
Life Stage Age Males (mcg/day)
Females
(mcg/day)
Infants 0-6 months 65 (AI) 65 (AI)
Infants 7-12 months 80 (AI) 80 (AI)
Children 1-3 years 150 150
Children 4-8 years 200 200
Children 9-13 years 300 300
Adolescents 14-18 years 400 400
Adults 19-years and older 400 400
Pregnancy all ages - 600
Breastfeeding all ages - 500
45. Food Serving Folate (mcg)
Fortified breakfast cereal 1 cup 200-400
Orange juice (from
concentrate)
6 ounces 82
Spinach (cooked) 1/2 cup 131
Asparagus (cooked) 1/2 cup (~ 6 spears) 131
Lentils (cooked) 1/2 cup 179
Garbanzo beans (cooked) 1/2 cup 141
Lima beans (cooked) 1/2 cup 78
Bread 1 slice 20 (Folic acid)*
Pasta (cooked) 1 cup 60 (Folic acid)*
Rice (cooked) 1 cup 60 (Folic acid)*
*In order to help prevent neural tube defects the FDA required 1.4
milligrams (mg) of folic acid per kilogram (kg) of grain to be added to
refined grain products, which are already enriched with niacin, thiamin,
riboflavin, and iron, as of January 1, 1998
46. Factors that increase the metabolic rate
1. Infancy (a period of rapid growth)
2. Pregnancy (rapid fetal growth)
3. Lactation (uptake of folate into breast milk)
4. Malignancy (increased cell turnover)
5. Chronic hemolytic anemia (increased hematopoiesis) all can
result in an increased folate requirement