Folate and Vitamin B12 Deficiency Among Non-pregnant Women of Childbearing-Age in Guatemala 2009–2010: Prevalence and Identification of Vulnerable Populations

Abstract

Introduction Information on folate and vitamin B12 deficiency rates in Guatemala is essential to evaluate the current fortification program. The objectives of this study were to describe the prevalence of folate and vitamin B12 deficiencies among women of childbearing age (WCBA) in Guatemala and to identify vulnerable populations at greater risk for nutrient deficiency. Methods A multistage cluster probability study was designed with national and regional representation of nonpregnant WCBA (15–49 years of age). Primary data collection was carried out in 2009–2010. Demographic and health information was collected through face-to-face interviews. Blood samples were collected from 1,473 WCBA for serum and red blood cell (RBC) folate and serum vitamin B12. Biochemical concentrations were normalized using geometric means. Prevalence rate ratios were estimated to assess relative differences among different socioeconomic and cultural groups including ethnicity, age, education level, wealth index and rural versus urban locality. Results National prevalence estimates for deficient serum (<10 nanomoles per liter [nmol/L]) and RBC folate (<340 nmol/L) concentrations were 5.1% (95% CI 3.8, 6.4) and 8.9% (95% CI 6.7, 11.7), respectively; for vitamin B12 deficiency (<148 pmol/L) 18.5% (95% CI 15.6, 21.3). Serum and RBC folate deficiency prevalences were higher for rural areas than for urban areas (8.0% vs. 2.0% and 13.5% vs. 3.9%, respectively). The prevalence of RBC folate deficiency showed wide variation by geographic region (3.2%–24.9%) and by wealth index (4.1%–15.1%). The prevalence of vitamin B12 deficiency also varied among regions (12.3% –26.1%). Conclusions In Guatemala, folate deficiency was more prevalent among indigenous rural and urban poor populations. Vitamin B12 deficiency was widespread among WCBA. Our results suggest the ongoing need to monitor existing fortification programs, in particular regarding its reach to vulnerable populations.

Folate Deficiency Is Prevalent in Women of Childbearing Age in Belize and Is Negatively Affected by Coexisting Vitamin B-12 Deficiency: Belize National Micronutrient Survey 2011

“…Also, we observed lower RBC folate and/or plasma vitamin B-12 concentrations in urban areas, among WCBA of Mayan origin, and in the West and South regions. These results were consistent with published results from Guatemala, other Latin American countries, and the United States (35–40), where variability of blood folate and vitamin B-12 concentrations within the population, as well as across racial and ethnic groups and regions, was observed. These differences could be explained in part by cultural differences and/or differences in access to or availability of fortified wheat flour for vulnerable populations (35).…”

“…National serum and RBC folate and vitamin B-12 concentrations among nonpregnant WCBA in our study were similar to or slightly lower than those reported from the postfortification period in Guatemala (28 compared with 30 nmol/L, 719 compared with 725 nmol/L, and 233 compared with 341 pmol/L, respectively) (35). Also, we observed lower RBC folate and/or plasma vitamin B-12 concentrations in urban areas, among WCBA of Mayan origin, and in the West and South regions.…”

Trends and characteristics of fetal and neonatal mortality due to congenital anomalies, Colombia 1999–2008

“…Colombia passed folic acid food fortification legislation in 1996 [16], but our data were collected after fortification was implemented, so we cannot determine whether deaths due to neural tube defects decreased after implementation. Therefore, it would be important to collect other data to assess whether rates of neural tube defects have reached optimal levels achievable through food fortification [17] across all population groups [18]. …”

Lactic acid fermentation as a tool for increasing the folate content of foods

“…To our knowledge, no global data are available on the prevalence of folate deficiency worldwide, although the deficiency has been detected in countries as different as Burkina Faso, Guatemala, Iran, Ireland, Thailand and United States (Arsenault et al, 2014;Assantachai and Lekhakula, 2007;Brunst et al, 2014;Harrington et al, 2008;Rosenthal et al, 2015;Sedehi, 2013 …”

“…In an urban US population, Brunst et al (2014) estimated that 16% of pregnant women have inadequate folate intake. Analyses of the serum level of folate in women of childbearing age showed that 5.1% of women in Guatemala and around 30% of women in Iran had folate deficiency (Rosenthal et al, 2015;Sedehi, 2013). In Thailand, Assantachai and Lekhakula (2007) evaluated the serum level of folate of subjects aged 60 years and over, and detected folate deficiency in 39% of this population group.…”