Hostname: page-component-848d4c4894-p2v8j Total loading time: 0.001 Render date: 2024-05-28T03:48:57.124Z Has data issue: false hasContentIssue false
  • English
  • Français

Low folic acid status and its association with anaemia in urban adolescent girls and women of childbearing age in Sri Lanka

Published online by Cambridge University Press:  08 March 2007

Tharanga Thoradeniya ,
Rajitha Wickremasinghe ,
Ramani Ramanayake  and
Sunethra Atukorala
Tharanga Thoradeniya
Affiliation:
University of ColomboDepartment of Biochemistry and Molecular Biology, Faculty of Medicine, PO Box 271, Colombo 8Sri Lanka
Rajitha Wickremasinghe
Affiliation:
University of KelaniyaDepartment of Community and Family MedicineSri Lanka
Ramani Ramanayake
Affiliation:
Colombo Municipal Council, ColomboSri Lanka
Sunethra Atukorala*
Affiliation:
University of ColomboDepartment of Biochemistry and Molecular Biology, Faculty of Medicine, PO Box 271, Colombo 8Sri Lanka
*
*Corresponding author: Professor Sunethra Atukorala, fax +94 11 2691581, email sunethra@eol.lk
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Folic acid deficiency is implicated in the aetiology of nutritional anaemia and adverse pregnancy outcomes for the fetus. Data on folic acid status among adolescent girls and non-pregnant, non-lactating young women are limited. We assessed folic acid status in a random sample of 552 subjects (277 adolescent girls aged 15–18·9 years and 275 women aged 19–30 years) living in Colombo, Sri Lanka. The association of low folic acid status with anaemia was evaluated. Socio-economic, food intake and anthropometric data were obtained. Hb, serum folic acid, vitamin B12 and ferritin and plasma homocysteine concentrations were measured. Forty-three per cent of subjects studied had low serum folic acid concentrations (<3ng/ml) and 47/ had low Fe stores (serum ferritin <20μg/l). Overall prevalence of anaemia was 12·9%, and 43·9% of anaemic subjects had both low folic acid status and depleted Fe stores (serum ferritin <12μg/l). Both low folate status and depleted Fe stores were significantly associated with anaemia (odds ratio=2·32; 95% CI 1·34, 4·01 and odds ratio=5·98; 95% CI 3·36, 10·63, respectively). Serum folic acid concentration was associated (r=0·108, P=0·015) with folate intake as indicated by a computed folate index. Folate index was associated inversely with household size and positively with economic status and education level. In this study population low folic acid status, besides depleted Fe stores, was associated with anaemia. The high prevalence of low folic acid status observed highlights the need for nutrition education to improve intakes of folate, Fe and other micronutrients among adolescent girls and young women.

Keywords

Folic acidAnaemia
Type
Research Article
Information
British Journal of Nutrition , Volume 95 , Issue 3 , March 2006 , pp. 511 - 516
Copyright
Copyright © The Nutrition Society 2006

References

Ahmed, FPublic Health Nutr. Anaemia in Bangladesh: a review of prevalence and aetiology. (2000) 3 385–393.Google Scholar
Atukorala, TMS & Lanerolle, PSerum folic acid levels of adolescent schoolgirls in a rural area.Ceylon Med J. (1998) 43 238–239.Google Scholar
Ballew, C & Sugerman, SBJ Am Diet Assoc. High-risk nutrient intakes among low-income Mexican women in Chicago, Illinois. (1995) 12 1409–1413.Google Scholar
Beard, JLIron deficiency: assessment during pregnancy and its importance in pregnant adolescents.Am J Clin Nutr. (1994) 59 Suppl.S502–S510.Google Scholar
Berry, RJ, Li, Z & Erickson, JDPrevention of neural-tube defects with folic acid in China.N Engl J Med (1999) 341 1485–1490.CrossRefGoogle ScholarPubMed
Bothwell, TH, Charlton, RW, Cook, JD & Finch, CA (1979) Iron Metabolism in Man. Oxford: Blackwell Scientific Publications.Google Scholar
Casanueva, E, Pfetter, F, Drijanski, A, Fernandez-Gaxiola, AC, Gutierrez-Valenzuela, V & Rothenburg, SJIron and folate status before pregnancy and anaemia during pregnancy.Ann Nutr Metab. (2003) 47 60–63.Google Scholar
Caudill, MA, Cruz, AC, Gregory, JF, Hutson, AD & Bailey, LBFolate status in response to controlled folate intake in pregnant women.J Nutr (1997) 127 2363–2370.CrossRefGoogle ScholarPubMed
Caudill, MAGregory, JF, Hutson, AD & Bailey, LBJ Nutr. Folate catabolism in pregnant and non-pregnant women with controlled folate intakes. (1998) 128 204–208.Google Scholar
Christian, P, Khatry, SK, Katz, J, Pradhan, EK, LeClerq, SC, Shrestha, SR, Adhikari, RK, Sommer, A & West, KP JrBMJ. Effects of alternative maternal micronutrient supplements in low birth weight in rural Nepal: double blind randomized community trial. (2003) 326 571–574.Google Scholar
Clarke, R, Daly, L, Robinson, K, Naughten, E, Cahalane, SFowler, B & Graham, IN Engl J Med. Hyperhomocysteineamia: an independent risk factor for vascular disease. (1991) 324 1149–1155.Google Scholar
De Silva, LDR & Atukorala, TMSMicronutrient status of plantation workers in Sri Lanka during pregnancy and post partum.J Obstet Gynaecol Res. (1996) 22 239–246.Google Scholar
Giskes, K, Turrell, G, Patterson, C & Newman, BJ Hum Nutr Diet. Socioeconomic differences among Australian adults in consumption of fruit and vegetables and intakes of vitamins A, C and folate. (2002) 15 375–385.Google Scholar
Herbert, VThe 1986 Herman Award Lecture. Nutrition science as a continually unfolding story: the folate and vitamin B-12 paradigm.Am J Clin Nutr. (1987) 46 387–402.Google Scholar
Herbert, VFolic acid In Modern Nutrition in Health and Disease 9th ed. vol.1, pp. 433–446Olson, JAShike, M editors USA: William & Wilkins. (1999)Google Scholar
Krumdieck, CLcollab Present Knowledge in Nutrition 179–188Brown, MLWashington, DC: ILSI Press (1991)Google Scholar
Lanerolle, P & Atukorala, SCeylon J Med Sci. Iron and vitamin A status of adolescent schoolgirls in an urban and a rural area in Sri Lanka. (1998) 41 35–45.Google Scholar
Lwanga, SK & Lemeshow, SA practical manual Sample size determination in health studies Geneva: WHO (1991)Google Scholar
McDonald, SDFerguson, S, Tam, L, Lougheed, J & Walker, MCThe prevention of congenital anomalies with periconceptional folic acid supplementation.Obstet Gynaecol Can. (2003) 25 115–121.Google Scholar
Medical Research Institute, Sri Lanka Assessment of Anaemia Status in Sri Lanka 2001 – A Survey Report Colombo, Sri Lanka: Ministry of Health, Nutrition and Welfare (2003)Google Scholar
MRC Vitamin Study Group Lancet. Prevention of neural tube defects: results from the Medical Research Council Vitamin Study. (1991) 338 1–7.Google Scholar
Pathak, P, Saxena, R, Kapoor, SK, Dwivedi, SN, Singh, R & Kapil, UNepal Med Coll J. Status of serum ferritin and folate levels among young women in a rural community of Haryana, India. (2004)a 6 13–16.Google Scholar
Pathak, P, Kapil, U, Kapoor, SK, Saxena, R, Kumar, A, Gupta, N, Dwivedi, SN, Singh, R & Singh, PIndian J Pediatr. Prevalence of multiple micronutrient deficiencies among pregnant women in a rural area of Haryana. (2004)b 71 1007–1014.Google Scholar
Rahmann, MMPublic Health. Impact of health education on the feeding of green leafy vegetables at home to children on the urban poor mothers of Bangladesh. (1994) 108 211–218.Google Scholar
Ronnenberg, AG, Goldman, MB, Aitken, IW & Xu, XJ Nutr. Anaemia and deficiencies of folate and vitamin B 6 are common and vary with season in Chinese women of childbearing age. (2000) 130 2703–2710.Google Scholar
Scholl, T, Hediger, M, Schall, J, Khoo, C & Fischer, RAm J Clin Nutr. Dietary and serum folate: their influence on the outcome of pregnancy. (1996) 63 520–525.Google Scholar
Scot, JM (2001) Folate, vitamin B12 and birth defects. In Modern Aspects of Nutrition: Present Knowledge and Future Perspectives. Proceedings of the 17th International Congress of Nutrition, Elmadfa, I, Anklam, E, König, JS editors. Austria: KargeGoogle Scholar
Seshadri, S (2001) Prevalence of micronutrient deficiency particularly of iron, zinc and folic acid in pregnant women in South East Asia. Br J Nutr. 85 Suppl. 2S87–S92.Google Scholar
Sood, SK, Ramachrandran, K, Mathur, M, Gupta, K, Ramalingaswamy, V, Swarnabai, C, Ponniah, JMathan, VI & Baker, SJ (1975) WHO sponsored collaborative studies on nutritional anaemia in India. The effect of supplemental oral iron administration to pregnant women. Q J Med. 44 241–258.Google Scholar
Tucker, KL, Selhub, J, Wilson, PW & Rosenberg, IH (1996) Dietary intake pattern relates to plasma folate and homocysteine concentrations in the Framingham Heart Study. J Nutr 126, 3025–3031.CrossRefGoogle ScholarPubMed
Tudawe, I & Wikramanayake, TControlling Anaemia in Sri Lanka:Issues and Options Nutrition Coordination Division, Ministry of Plan Implementation and Parliamentary Affairs, Sri Lanka and USAID/OMNI.Sri Lanka: Government Press. (2000)Google Scholar
Wald, NJ, Law, MR, Morris, JK & Wald, DSLancet. Quantifying the effect of folic acid. (2001) 358 2069–2073.Google Scholar
World Health Organization (1996) Physical Status: Use and Interpretation of Anthropometry. Technical Report Series no. 854, pp. 283–452. Geneva: WHOGoogle Scholar
World Health Organization Nutrition Profile of the WHO South-East Asia Region New Delhi:: WHO Regional Office for South-East Asia. (2000)Google Scholar
WHO Expert Consultation (2004) Lancet. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies 363 157–163.Google Scholar
WHO/UNICEF (2004) Focusing on Anaemia, Towards an Integrated Approach for Effective Anaemia Control Joint statement by the World Health Organization and the United Nations Children's Fund. Geneva: WHO.Google Scholar