Folate, also known as vitamin B9, is important for red blood cell formation, cell growth, and DNA synthesis. It is found naturally in many vegetables and fortified cereals. Folate deficiency can cause megaloblastic anemia and increase the risk of neural tube defects in newborns if a woman is deficient during pregnancy. Symptoms of deficiency include fatigue, weakness, and mouth sores. Pregnant women, breastfeeding women, and growing children have higher daily folate requirements. Folate deficiency is treated with folic acid supplements under a doctor's guidance.

1. 1
Topic : Folate Deficiency Disorder
Folate:
 Folate appears to be absorbed bothin the small intestine and colon, with a
decreasing absorptive gradient from jejunum to colon
 A form of folate, called folic acid, is used in fortified foods and most dietary
supplements
 Folate (vitamin B-9) is important in red blood cell formation and for healthy
cell growth and function.
 Women need higher amounts of folate during pregnancy because folate is
necessary for DNA formation as the fetus develops
 Folate reduce the risk of birth defects of the brain and spine
Folate food sources:
 broccoli.
 brussels sprouts.
 leafy green vegetables, such as cabbage, kale, spring greens and spinach.
 peas.
 chickpeas and kidney beans.
 liver (but avoid this during pregnancy)
 breakfast cereals fortified with folic acid.
Main cause of folate deficiency:
 Dietary- inadequate intake
 Blood loss
 Increase physiological requirements eg infant growth or pregnancy
 Malabsorption due to git problem eg celiac diseases Cohn's diseases
 Taking a medication that interferes with folate absorption or lowers folate levels
such as methotrexate ,phenytoin, sulfasalazine, and trimethoprim and oral
contraceptives

2. 2
 Having alcohol , as alcohol interferes with folate absorptionand causes the
bodyto remove folate too quickly
Absorption and circulation:
 Folate appears to be absorbed bothin the small intestine and colon, with a
decreasing absorptive gradient from jejunum to colon.
 The long absorptive pathway could be a consequenceof the very important
function of folate in maintaining genetic bodyhomeostasis.
 Once across the intestinal cell, most folate is transported in the plasma as 5-
methyl THF unbound to any specific carrier. Its entry into cells, however, is by
both carrier systems and receptors
 The total bodycontent of folate is estimated to be 15 to 30 mg; about half of
this amount is stored in the liver and the remainder in blood and bodytissues.
Symptoms:
 At first, a personmay not have obvious symptoms of folate deficiency ,but as it
becomes more severe, people may notice:
 Weakness
 Feeling lightheaded
 Fatigue
 Trouble concentrating
 Irritability
 Headaches
 Sores in the mouth or on the tongue
 In pregnant women, having a baby with specific neural tube defects
Folate requirement:
 0-6 month 65 micrograms/day Adequate Intake (AI)
 7-12 months 80 micrograms/day
 1-3 years 150 micrograms/day
 4-8 years 200 micrograms/day
 9-13 years 300 micrograms/day
 14 years 400 micrograms/day
 Pregnant women 600 micrograms/day

3. 3
 Breastfeeding women 500 micrograms/day
Folate deficiency disorder:
Megaloblastic anemia:
 Megaloblastic anemia is caused when red blood cells aren't produced properly.
Because the cells are too large, they may not be able to exit the bone marrow to
enter the bloodstream and deliver oxygen.
 Reduced erythrocyte count is the first indicator of folate deficiency associated
anemia as hematocrit and hemoglobin concentrations will remain normal for
some time due to increased erythrocyte size.
Neural tube defects and other congenital diseases:
 Spina bifida:
Spina bifida is a birth defect in which there is incomplete closing of the spine and
the membranes around the spinal cord during early development in pregnancy It is
a neural tube defect
Most cases of spina bifida can be prevented if the mother gets enough folate before
and during pregnancy
 Anencephaly:
Anencephaly is the absence of a major portion of the brain, skull, and scalp that
occurs during embryonic development
A baby born with anencephaly is usually blind, deaf, unaware of its surroundings
and unable to feel pain.
 Encephalocele – :
where a membrane or skin-covered sac containing part of the brain pushes out of a
hole in the skull
 Infertility:

4. 4
A folate deficiency can also affect your fertility. But this is only temporary and
can usually be reversed with folate supplements
Placenta abruption:
 Folate deficiency increases risk of placental abruption.
 This is a serious condition where the placenta starts to come away from the
inside of the womb wall, causing tummy (abdominal) pain and bleeding from
the vagina.
Coronary heart disease andstroke:
 Low folate intake is an important determinant of elevated blood levels of
homocysteine.
 Because elevated homocysteine has been shown to be a possiblegraded risk
factor for CHD, sufficient folate intake may be important in the prevention of
CHD.
 The magnitude of the association between folate and CHD is consistent with its
effects on homocysteine.
Folate and cancer risk:
 Epidemiologic studies have suggested that folate insufficiency may increase the
risk of several human cancers and that FA supplementation may reduce this risk
 Currently available evidence indicates that genomic DNA hypomethylation in
the colorectum is not a probable mechanism by which folate deficiency
enhances colorectal carcinogenesis.
 However, there is still a possibility that sequence-specific alterations of DNA
methylation in critical cancer-related genes might be mechanistically involved
in the folate deficiency-mediated colorectal carcinogenesis.
Treatment:
 People who are deficient in folate may need to take folic acid supplements. A
doctormight prescribe pills or injections, depending on the person’s needs.
 Women of childbearing age who have folate deficiency anemia may wish to
speak to a doctorif they plan to try getting pregnant. In some cases, a woman
may decide to postponepregnancy until her folate levels are normal.
 It is important to speak to a healthcare professional before taking any
supplements.

5. 5
 Some researchers have suggested that taking excessive amounts of folic acid
can mask a vitamin B-12 deficiency. For this reason, do not take more than
1,000 mcg per day unless a doctorrecommends a higher dose.
References:
https://www.researchgate.net/publication/291413621_Folate_in_Human_Health_a
nd_Disease
https://journals.lww.com/co-
lipidology/Abstract/1998/02000/Folate_and_coronary_heart_disease.5.aspx
https://pubmed.ncbi.nlm.nih.gov/15066913/