Dietary Folate Intake and Blood Biomarkers Reveal High-Risk Groups in a Mediterranean Population of Healthy Women of Childbearing Potential

Abstract

Background/Aims: An important public health issue is monitoring folate inadequacy in women of childbearing potential. The aim of the present study was to investigate associations between folate intake, red blood cell (RBC) folate, total homocysteine (tHcy) and the MTHFR 677T allele. Methods: A total of 204 women were enrolled in a cross-sectional study. Folate intake was assessed by a food frequency questionnaire, and RBC folate, tHcy and MTHFR C677T genotype were determined. Results: About half of the women had a decreased RBC folate level (<305 nmol/l) and all were <906 nmol/l, even though 51% of the subjects reported use of supplements. Overall 91.5% had a high Hcy concentration. Notably, younger women, and those with a low level of education, were shown to be at higher risk of inadequate RBC folate levels. Additionally, younger women were also at higher risk of carrying the TT genotype, particularly unfavorable in the setting of a low folate status. Conclusions: Our study revealed significant folate deficiency in our Mediterranean population and higher than ideal Hcy concentrations, thus emphasizing that in these groups an improvement in the folate status is needed via a food-based approach or supplement. Consequently, public health policy strategies aiming at improved supplementation are required.

Multiple Micronutrient Needs in Pregnancy in Industrialized Countries

“…A recent English study on 466,860 women showed that the proportion of women taking folic acid supplements before pregnancy declined from 35% (95% CI 34-35) in 1999-2001 to 31% (95% CI 30-31) in 2011-2012, with an increase in supplementation use with maternal age [58]. Table 2 shows the folate status in some industrialized countries, with all studies underlining an inadequate status in pregnant and nonpregnant women [59,60,61,62,63,64,65]. All these data show that the policy of folic acid supplementation is failing in industrialized countries and has led to health inequalities.…”

The impact of MTHFR 677 C/T genotypes on folate status markers: a meta-analysis of folic acid intervention studies

“…studies[56,96,58,33], particularly combined with low folate intake.Overall the baseline results showed that groups with the TT genotype had statistically significant higher plasma Hcy levels compared to the CC and CT genotype (recessive model) at 2.79 µm/L and at 2.93 µm/L when compared to the CC genotype (homozygote model). In CC) and 6.08 µm/L (TT vs CC), with Hcy levels >15 µm/L in TT groups in 3 of the 4 studies.…”

A Randomized, Placebo-Controlled Trial in Women of Childbearing Age to Assess the Effect of Folic Acid and Methyl-Tetrahydrofolate on Erythrocyte Folate Levels

“…In fact, this percentage was significantly lower in our study (13%) and about 5% were even below the general normal range for adults. We are not aware of any other study that recently investigated prevalence of folate deficiency in Germany, however, in Italy regionally 49% of WCBP and 33% of pregnant women were reported to have Fol-E levels even below normal [22]. Thus, dissemination and implementation of the WHO guidelines on achieving optimal Fol-E levels in WCBP to prevent NTDs still appear insufficient in Europe.…”