Association between folic acid deficiency and disease and prevention strategies: a critical view
Keywords:
Folic acid, Food fortification, Non-transmissible chronic diseases, Dietary supplementsAbstract
Folic acid deficiency is associated with non-communicable chronic diseases, pregnancy-associated complications and neurodegenerative diseases. The objective of this paper was to discuss the role of folic acid in disease prevention, the epidemiological aspects of its deficiency and food fortification and supplementation. Articles were searched in the following databases: MedLine, SciELO, PubMed, Highwire Press and Science Direct. Only original studies with humans published between 2004 and 2010 were included. Folic acid is important for DNA methylation and prevention of hyperhomocysteinemia. It also presents antioxidant activity. Folic acid deficiency has been described in adolescents, women of childbearing age, pregnant women and the elderly. It is difficult to meet the folic acid requirement with diet alone, so fortified foods and supplements are necessary.
It is important to assess folic acid levels before and after the implementation of such strategies to enable the development of better and more effective public strategies. It is also important to provide nutrition education for the Brazilian population for them to increase their consumption of dietary sources of folic acid.
References
Martinez CA, Northrup H, Lin JI, Morrison AC, Fletcher JM, Tyerman GH, et al. Genetic association study of putative functional single nucleotide polymorphisms of genes in folate metabolism and spina bifida. Am J Obstet Gynecol. 2009; 201(4): 394-411. doi:10.1016/j.ajog.2009.06.042.
DiBello PM, Dayal S, Kaveti S, Zhang D, Kinter M, Lentz SR, et al. The Nutrigenetics of hyperhomocysteinemia. Mol Cel Proteomics. 2010; 9:471-85. doi: 10.1074/mcp.M900406-MCP200.
Sturm I, Hennermann JB, von Arnim-Baas A, Driever PH, Massenkeil G. Thromboembolic events, abortions and a sick infant- unusual presentation of a vitamin deficiency. Internist. 2008; 49(12): 1507-11. doi: 10.1007/s00108-008-2170-4.
Casas JP, Bautista LE, Smeeth L, Sharma P, Hingorani A. Homocysteine and stroke: evidence on a causal link from mendelian randomisation. Lancet. 2005; 365, 224-32. doi: 10.1016/S0140-6736(05)17742-3.
McGuire M, Cleary B, Sahm L, Murphy DJ. Prevalence and predictors of periconceptional folic acid uptake - prospective cohort study in an Irish urban. Hum Reprod. 2010; 25(2):535-43. doi:10.1093/humrep/dep398.
Wright AJA, Dainty JR, Finglas PM. Folic acid metabolism in human subjects revisited: potencial implications for proposed mandatory folic acid fortification in the US. Br J Nutr. 2007; 98(4): 667-75. doi:10.1017/S0007114507777140.
Bazzano LA. Folic acid supplementation and cardiovascular disease: the state of the art. Am J Med Sci . 2009; 338(1):48-9. doi: 10.1097/MAJ.0b013e3181aaefd6.
Pintó X, Vilaseca MA, Balcells S, Artuch R, Corbella E, Meco JF, et al. A folate-rich diet is as effective as folic acid from supplements in decreasing plasma homocysteine concentrations. Int J Med Sci. 2005; 2(2):58-63.
Morris MS, Jacques PF, Selhub J. Relation between homocysteine and B-vitamin status indicators and bone mineral density in older Americans. Bone. 2005; 37: 234-42. doi: 10.1016/j.bone.2005.04.017.
Schdey P. Homocisteína e transtornos psiquiátricos. Rev Bras Psiquiatr. 2004; 26(1):50-6. doi: 10.1590/S1516-44462004000100013.
Rytter E, Vessby B, Asgård R, Johansson C, Sjödin A , Abramsson-Zetterberg L, et al. Glycaemic status in relation to oxidative stress and inflammation in well-controlled type 2 diabetes subjects. Br J Nutr. 2009; 101(10):1423-6.
Ebbing M, Bønaa KH, Nygård O, Arnesen E, Ueland PM, Nordrehaug JE, et al. Cancer incidence and mortality after treatment with folic acid and vitamin B12. JAMA. 2009; 302(19): 2119-26. doi:10.1001/jama.2009.1622.
Duthei SJ, Horgan G, de Roos B, Rucklidge G, Reid M, Duncan G, et al. Blood folate status and expression of protein involved in immune function, inflammation, and coagulation: biochemical and proteomic changes in the plasma of humans in response to long-term synthetic folic acid supplementation. J Proteome Res. 2010; 9(4): 1941-50.
Ebisch IMW, Thomas CMG, Peters WHM, Braat DDM, Steegers-Theunisse RPM. The importance of folate, zinc and antioxidants in the pathogenesis and prevention of subfertility. Hum Reprod Update. 2007; 13(2):163-74. doi:10.1093/humupd/dml054.
Chanson A, Rock E, Martin JF, Liotard A, Brachet P. Preferential response of glutathione-related enzymes to folate-dependent changes in the redox state of rat liver. Eur J Nutr. 2007; 46(4):204-12. doi.org/101007/S00394-007-0651-1.
Song Y, Cook NR, Albert CM, Van Denburgh M, Manson JE. Effect of homocysteine-lowering treatment with folic Acid and B vitamins on risk of type 2 diabetes in women: a randomized, controlled trial. Diabetes. 2009; 58(8):1730-1. doi: 10.2337/db09-0087.
Tchantchou F, Shea TB. Folate deprivation, the methionine cycle, and Alzheimer’s disease Vitam Horm. 2008; 79:83-97. doi:10.1016/S0083-6729 (08)00403-2.
Wani NA, Hamid A, Kaur J. Folate status in various pathophysiological conditions. Life. 2008; 60(12): 834-42. doi: 10.1002/iub.133.
Wu X, Liang Z, Zou T, Wang X. Effects of folic acid deficiency and MTHFRC677T polymorphisms on cytotoxicity in human peripheral blood lymphocytes. Biochem Biophys Res Commun. 2009; 379(3):732-7. doi:10.1016/j.bbrc.2008.12.130.
Novakovic P, Stempak JM, Sohn KJ, Kim YI. Effects of folate deficiency on gene expression in the apoptosis and cancer pathways in colon cancer cells. Carcinogenesis. 2006; 27(5):916-24. doi:10.1093/carcin/bgi312.
Martinez JJG, Ruiz FA, Candil SD. Baseline serum folate level may be a predictive factor of weight loss in a morbid-obesity-management programme. Br J Nutr. 2006; 96(5):956-64.
Ortega RM, López-Sobaler AM, Andrés P, Rodríguez-Rodríguez E, Aparício A, Bermejo LM, et al. Changes in folate status in overweight/obese women following two different weight control programmes based on an increased consumption of vegetables or fortified breakfast cereals. Br J Nutr. 2006; 96(4):712-8.
Forges T, Monnier-Barbarino P, Alberto JM, GuéantRodriguez RM, Daval JL, Guéant JL. Impact of folate and homocysteine metabolism on human reproductive health. Hum Reprod Update. 2007; 13(3):225-38. doi:10.1093/humupd/dml063.
Dary O. Nutritional interpretation of folic acid interventions. Nutr Rev. 2009; 67(4): 235-44. doi:10.1111/j.1753-4887.2009.00193.x.
Nasser C, Nobre C, Mesquita S, Ruiz JG, Carlos HR, Prouvot L, et al. Semana da conscientização sobre a importância do ácido fólico. J Epilepsy Clin Neurophysiol. 2005;11(4):199-203. doi: 10.1590/S1676-26492005000400009.
American Dietetic Association. Position of the American Dietetic Association: Functional Foods. J Am Diet Assoc. 2004; 104(5):814-26. doi:10.1016/j.jada.2004.03.015.
Patterson D. Folate metabolism and the risk of Down syndrome. Downs Syndr Res Pract. 2008; 12(2):93-7. doi:10.3104/updates.2051.
Silva LRJ, Vergani N, Galdieri LC, Porto MPR, Longhitano SN, Brunoni D, et al. Relationship between polymorphisms in genes involved in homocysteine metabolism and maternal risk for Down syndrome in Brazil. Am J Med Genet. 2005; 135:263-7. doi:10.1002/ajmg.a.30591.
Santos LMP, Pereira MZ. Efeito da fortificação com ácido fólico na redução dos defeitos do tubo neural. Cad Saúde Pública. 2007; 23(1):17-24. doi: 10.1590/S0102-311X2007000100003.
Instituto Brasileiro de Geografia e Estatística. Pesquisa de Orçamentos Familiares (POF): análise de disponibilidade domiciliar de alimentos e do estado nutricional no Brasil. Rio de Janeiro: IBGE; 2004 [acesso 2009 dez 6]. Disponível em: <http://www.ibge.gov.br/home/presidencia/noticias/noticia_impressao.php?id _noticia=278>.
Brasileiro RS, Escrivão MAMS, Taddei JAAC, D’Almeida V, Ancona-Lopez F, Carvalhaes JTA. Plasma total homocysteine in Brazilian overweight and non-overweight adolescents: a case-control study. Nutr Hosp. 2005; 20(5):313-9.
Vitolo MR, Canal Q, Campagnolo PDB, Gama CM. Factors associated with risk low folate intake among adolescents. J Pediatr. 2006; 82(2):121–6.
Rosa G. Relação da homocisteinemia com o estado nutricional de folato e outros determinantes em mulheres em idade reprodutiva e gestantes [tese]. Rio de Janeiro: Universidade Federal do Rio de Janeiro; 2003.
Rosa G, Pereira SEA, Trugo NMF. Longitudional change in plasma total homocysteine during pregnancy and postpartum in Brazilian women and its relation with folate status and other factors. Int J Vitam Nutr Res. 2004; 74(2):95-101.
Esmaillzadeh A, Samareh S, Azadbakht L. Dietary patterns among pregnant women in the westnorth of Iran. Pak J Biol Sci. 2008;11(5):793-6. doi: 10.3923/pjbs.2008.793.796.
Nogueira NN, Parente JV, Cozzolino SM. Changes in plasma zinc and folic acid concentrations in pregnant adolesce.nts submitted to different supplementation regimens Cad Saúde Pública. 2003; 19(1):155-60. doi: 10.1590/S0102-311X2003000100017.
Moran VH. Nutritional status in pregnant adolescents: a systematic review of biochemical markers. Matern Child Nutr. 2007; 3(2):74-93.
Barros DC, Pereira RA, Gama SGN, Leal MC. O consumo alimentar de gestantes adolescentes no Município do Rio de Janeiro. Cad Saúde Pública. 2004; 20 (supl.1):S121-S9. doi: 10.1590/S0102-311X2004000700013.
Agência Nacional de Vigilância Sanitária. RDC n. 344, de 13 de dezembro de 2002. Aprova o regulamento técnico para a fortificação das farinhas de trigo e das farinhas de milho com ferro e ácido fólico. [acesso 2009 jan 16]. Disponível em: <http://www.anvisa.gov.br/legis/resol/2002/344_02rdc.htm>.
Nazer HJ, Cifuentes OL, Aguila RA, Juarez HME, Cid RMP, Godoy VML et al. Efecto de la fortificación de la harina com ácido fólico sobre la evolución de las tasas de prevalencia al nacimiento de malformaciones congênitas en los hospitales chilenos Del ECLAMC. Rev Med Chil. 2007; 135(2): 198-204.
Yang Q, Botto LD, Erickson JD, Berry RJ, Sambell C, Johansen H, et al. Improvement in stroke mortality in Canada and the United States, 1990 to 2002. Circulation. 2006; 113(10):1335-43. doi: 10.1161/CIRCULATIONAHA.105.570846
Boen TR, Soeiro BT, Pereira Filho ER, Lima-Pallone JA. Folic acid and iron evaluation in Brazilian enriched corn and wheat flours. J Braz Chem Soc. 2008; 19(1):53-9. doi: 10.1590/S0103-505320 08000100009.
Achanta K, Boeneke CA, Aryana KJ. Characteristics of reduced fat milks as influenced by the incorporation of folic acid. J Dairy Sci. 2007; 90 (1): 90-8.
Pacheco SS, Braga C, Souza AI, Figueiroa JN. Efeito da fortificação alimentar com ácido fólico na prevalência de defeitos do tubo neural. Rev Saúde Pública. 2009; 43(4):565-71. doi: 10.1590/S0034-89102009005000033.
Tanya GK, Willett WC, Weinstein MC, Kuntz KM. Populatio level changes in folate intake by age, gender and race/ethnicity after folic acid
fortification. Am J Public Health. 2006; 96(11):2040-7. doi: 10.2105/AJPH.2005.067371.
Schlindwein MM, Kassouf AL. Mudanças no padrão de consumo de alimentos tempo-intensivos e de alimentos poupadores de tempo, por região do Brasil. In: Gasto e consumo das famílias brasileiras contemporâneas. Brasília: IPEA; 2006-2007. v.2, p.423-462.
Uehara SK, Rosa G. Association of homocysteinemia with high concentrations of serum insulin and uric acid in Brazilian subjects with metabolic syndrome genotyped for C677T polymorphism in the methylenetetrahydrofolate reductase gene. Nutr Res. 2008; 28(11):760-6. doi:10.1016/j.nutres.2008.09.006.
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