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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.
J Nutr. 2017 06; 147(6):1183-1193.JN

Abstract

Background:

Folate deficiency, vitamin B-12 deficiency, and anemia can have adverse effects on birth outcomes. Also, low vitamin B-12 reduces the formation of metabolically active folate.

Objectives:

We sought to establish the baseline prevalence of and factors associated with folate deficiency and insufficiency, vitamin B-12 deficiency, and anemia among women of childbearing age (WCBA) in Belize.

Methods:

In 2011, a national probability-based survey was completed among Belizean nonpregnant WCBA aged 15-49 y. Blood samples for determination of hemoglobin, folate (RBC and serum), and vitamin B-12 (plasma) and sociodemographic and health information were collected from 937 women. RBC and serum folate concentrations were measured by microbiologic assay (MBA). Folate status was defined based on both the WHO-recommended radioproteinbinding assay and the assay adjusted for the MBA.

Results:

The national prevalence estimates for folate deficiency in WCBA, based on serum and RBC folate concentrations by using the assay-matched cutoffs, were 11.0% (95% CI: 8.6%, 14.0%) and 35.1% (95% CI: 31.3%, 39.2%), respectively. By using the assay-matched compared with the WHO-recommended cutoffs, a substantially higher prevalence of folate deficiency was observed based on serum (6.9% absolute difference) and RBC folate (28.9% absolute difference) concentrations. The prevalence for RBC folate insufficiency was 48.9% (95% CI: 44.8%, 53.1%). Prevalence estimates for vitamin B-12 deficiency and marginal deficiency and anemia were 17.2% (95% CI: 14.2%, 20.6%), 33.2% (95% CI: 29.6%, 37.1%), and 22.7% (95% CI: 19.5%, 26.2%), respectively. The adjusted geometric means of the RBC folate concentration increased significantly (P-trend < 0.001) in WCBA who had normal vitamin B-12 status relative to WCBA who were vitamin B-12 deficient.

Conclusions:

In Belize, the prevalence of folate and vitamin B-12 deficiencies continues to be a public health concern among WCBA. Furthermore, low folate status co-occurred with low vitamin B-12 status, underlining the importance of providing adequate vitamin B-12 and folic acid intake through approaches such as mandatory food fortification.

Authors+Show Affiliations

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; jyr4@cdc.gov.Belize Ministry of Health, Belmopan, Belize.University of Georgia, Athens, GA.National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.University of San Carlos, Guatemala City, Guatemala.University of Florida, Gainesville, FL; and.National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.Belize Ministry of Health, Belmopan, Belize.Belize Ministry of Health, Belmopan, Belize.Belize Ministry of Health, Belmopan, Belize. Belize Ministry of Public Service, Belmopan, Belize.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28404832

Citation

Rosenthal, Jorge, et al. "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." The Journal of Nutrition, vol. 147, no. 6, 2017, pp. 1183-1193.
Rosenthal J, Largaespada N, Bailey LB, et al. 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. J Nutr. 2017;147(6):1183-1193.
Rosenthal, J., Largaespada, N., Bailey, L. B., Cannon, M., Alverson, C. J., Ortiz, D., Kauwell, G. P., Sniezek, J., Figueroa, R., Daly, R., & Allen, P. (2017). 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. The Journal of Nutrition, 147(6), 1183-1193. https://doi.org/10.3945/jn.116.242628
Rosenthal J, et al. 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. J Nutr. 2017;147(6):1183-1193. PubMed PMID: 28404832.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Rosenthal,Jorge, AU - Largaespada,Natalia, AU - Bailey,Lynn B, AU - Cannon,Michael, AU - Alverson,C J, AU - Ortiz,Dayrin, AU - Kauwell,Gail Pa, AU - Sniezek,Joe, AU - Figueroa,Ramon, AU - Daly,Robyn, AU - Allen,Peter, Y1 - 2017/04/12/ PY - 2016/10/24/received PY - 2016/11/28/revised PY - 2017/03/15/accepted PY - 2017/4/14/pubmed PY - 2017/7/6/medline PY - 2017/4/14/entrez KW - anemia KW - folate deficiency KW - folate insufficiency KW - vitamin B-12 deficiency KW - women of childbearing age SP - 1183 EP - 1193 JF - The Journal of nutrition JO - J Nutr VL - 147 IS - 6 N2 - Background: Folate deficiency, vitamin B-12 deficiency, and anemia can have adverse effects on birth outcomes. Also, low vitamin B-12 reduces the formation of metabolically active folate.Objectives: We sought to establish the baseline prevalence of and factors associated with folate deficiency and insufficiency, vitamin B-12 deficiency, and anemia among women of childbearing age (WCBA) in Belize.Methods: In 2011, a national probability-based survey was completed among Belizean nonpregnant WCBA aged 15-49 y. Blood samples for determination of hemoglobin, folate (RBC and serum), and vitamin B-12 (plasma) and sociodemographic and health information were collected from 937 women. RBC and serum folate concentrations were measured by microbiologic assay (MBA). Folate status was defined based on both the WHO-recommended radioproteinbinding assay and the assay adjusted for the MBA.Results: The national prevalence estimates for folate deficiency in WCBA, based on serum and RBC folate concentrations by using the assay-matched cutoffs, were 11.0% (95% CI: 8.6%, 14.0%) and 35.1% (95% CI: 31.3%, 39.2%), respectively. By using the assay-matched compared with the WHO-recommended cutoffs, a substantially higher prevalence of folate deficiency was observed based on serum (6.9% absolute difference) and RBC folate (28.9% absolute difference) concentrations. The prevalence for RBC folate insufficiency was 48.9% (95% CI: 44.8%, 53.1%). Prevalence estimates for vitamin B-12 deficiency and marginal deficiency and anemia were 17.2% (95% CI: 14.2%, 20.6%), 33.2% (95% CI: 29.6%, 37.1%), and 22.7% (95% CI: 19.5%, 26.2%), respectively. The adjusted geometric means of the RBC folate concentration increased significantly (P-trend < 0.001) in WCBA who had normal vitamin B-12 status relative to WCBA who were vitamin B-12 deficient.Conclusions: In Belize, the prevalence of folate and vitamin B-12 deficiencies continues to be a public health concern among WCBA. Furthermore, low folate status co-occurred with low vitamin B-12 status, underlining the importance of providing adequate vitamin B-12 and folic acid intake through approaches such as mandatory food fortification. SN - 1541-6100 UR - https://www.unboundmedicine.com/medline/citation/28404832/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_ L2 - https://academic.oup.com/jn/article-lookup/doi/10.3945/jn.116.242628 DB - PRIME DP - Unbound Medicine ER -