Folate Deficiency in an Urban Safety Net Population

Abstract

PURPOSE: Since mandatory fortification of grain products with folic acid in the United States in 1998, folate deficiency has become rare. Some have suggested that serum folate levels should be tested rarely in countries with mandatory folic acid fortification, given low rates of deficiency, high cost per deficiency diagnosis, and low rates of supplementation for those diagnosed as deficient. Given persistent racial, ethnic, and socioeconomic disparities in folate deficiency, these suggestions may not apply to all populations. We examine the rate at which serum testing detected folate deficiency in an urban safety net hospital and the characteristics of folate-deficient patients. METHODS: We reviewed the charts of all inpatients and emergency department patients with low serum folate results at a safety net hospital in Boston in 2018. We collected data concerning demographics, social determinants of health, clinical factors, and whether folate supplementation was prescribed. Finally, we performed a cost analysis. RESULTS: Of 1368 patients tested, 76 (5.5%) met criteria for folate deficiency. Overall, 86.8% of these patients were anemic, and 17.1% had macrocytic anemia; 42% were diagnosed with malnutrition. Common social determinants in folate-deficient patients included birth outside of the United States, homelessness, and alcohol use disorder. Of folate-deficient patients, 88% were newly prescribed folic acid supplementation at discharge. The estimated charge per deficient test was $1278. CONCLUSION: Compared with a nearby institution, serum folate testing at our safety net hospital detected deficiency at a higher rate, incurred a lower charge per deficient test, and was more likely to impact management.

Macrocytic anemias

“…Despite folic acid fortification of food for over 25 years, indigent urban U.S. populations with increased homelessness and food deprivation have rates of anemia with folate deficiency of 5 - 6% [10,11 ▪ ], rather than < 1% noted in earlier postfortification surveys [12,13]. These studies support routine testing for folate deficiency in anemic patients from such populations.…”

Prime Editing and DNA Repair System: Balancing Efficiency with Safety

“…Moreover, folate pathway genes might contribute to fertility complications in idiopathic (unexplained) infertility cases [41,42]. Notably, studies show that folate is the most common vitamin deficiency in general population diets [43]. Therefore, any alteration in the MMR system could potentially impact a large portion of the population, making this relevant for translational applications.…”