Adequate folate intake and levels are advisable throughout life but are of particular importance during adolescence, a period of rapid growth. However, folate insufficiency in economically deprived Indian adolescents is understudied.
Objective
This cross-sectional study examined the prevalence of folate deficiency and adequacy of folate intake of 224 tribal Indian adolescents (10 to 17 years of age). The secondary aim was to study the association between anemia status and folate status.
Methods
Radioimmunoassay, multiple-pass 24-hour dietary recall, and HemoCue were used to measure red blood cell (RBC) folate, folate intake, and anemia status, respectively.
Results
The geometric mean (95% CI) RBC folate concentration (nmol/L) was 360.2 (329.7 to 393.6), and the mean ± SD folate intake (μg/day) and hemoglobin level (g/L) were 159.9 ± 44.7 and 125.4 ± 13.0, respectively. Almost half of boys and girls aged 10 to 12 and 13 to 15 years and 66.7% of girls aged 16 to 17 years were deficient in RBC folate (< 340 nmol/L). The mean ± SD folate intake (μg/day) of girls (139.4 ± 34.5) was lower than that of boys (173.8 ± 45.5) (p < .001). With respect to adequacy of folate intake, a greater proportion of girls in the age group of 13–15 years (78.5% vs 38.6%, p < 0.001) and 16–17 years (100.0% vs 76.9%, p = 0.04) had intakes below their Recommended Dietary Allowance (RDA). No association was observed between folate intake and RBC folate deficiency or between anemia status and RBC folate deficiency.
Conclusions
Folate insufficiency was widespread in tribal Indian adolescents. There is an urgent need to develop culturally sensitive strategies for improvement.
National Family Health Survey. Nutrition and anaemia. Mumbai: International Institute for Population Sciences and Macro International, 2005–06:267–309.
2.
SwaminathanSEdwardBKurpadA. Micronutrient deficiency and cognitive and physical performance in Indian children. Eur J Clin Nutr2013;67:467–74.
3.
National Nutrition Monitoring Bureau. Diet & nutritional status of population and prevalence of hypertension among adults in rural areas: report of second repeat survey. Hyderabad: Indian Council of Medical Research, 2009:117–28.
4.
VitoloRCanalQCampagnoloDGamaM. Factors associated with risk of low folate intake among adolescents. J Pediatr2006;82:121–6.
5.
KerrALivingstoneBBatesJBradburyIScottMWardMPentievaKMansoorAMcNultyH. Folate, related B vitamins, and homocysteine in childhood and adolescence: potential implications for disease risk in later life. Pediatrics2009;123:627–35.
6.
ChenJShawSPanHLinF. Evaluation of folate status by serum and erythrocyte folate levels and dietary folate intake in Taiwanese schoolchildren. Asia Pac J Clin Nutr2007;16:572–8.
7.
González-GrossMBenserJBreidenasselCAlbersUHuybrechtsIValtueñaJSpinnekerASegovianoMWidhalmKMolnarD. Gender and age influence blood folate, vitamin B12, vitamin B6, and homocysteine levels in European adolescents: The Helena Study. Nutr Res2012;32:817–26.
8.
ÖnerNVatanseverÜKarasalihoğluSEkukluGÇeltikCBinerB. The prevalence of folic acid deficiency among adolescent girls living in Edirne, Turkey. J Adolesc Health2006;38:599–606.
9.
BhidePSagooSMoorthieSBurtonHKarA. Systematic review of birth prevalence of neural tube defects in India. Birth Defects Res A Clin Mol Teratol2013;97:437–43.
10.
ThurlowAWinichagoonPGreenTWasantwisutEPongcharoenTBaileyBGibsonS. Only a small proportion of anemia in northeast Thai schoolchildren is associated with iron deficiency. Am J Clin Nutr2005;82:380–7.
11.
SivakumarBNairMSreeramuluDSuryanarayanaPRavinderPShatrugnaVKumarARaghunathMVikasRaoVBalakrishnaN. Effect of micronutrient supplement on health and nutritional status of schoolchildren: biochemical status. Nutrition2006;22:S15–25.
12.
KapilUSareenN. Prevalence of ferritin, folate and vitamin B12 deficiencies amongst children in 5–18 years of age in Delhi. Indian J Pediatr2013;81:312.
13.
JackM. A high prevalence of biochemical evidence of vitamin B12 or folate deficiency does not translate into a comparable prevalence of anemia. Food Nutr Bull2008;29:S74–85.
14.
de OnisMOnyangoWBorghiESiyamANishidaCSiekmannJ. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ2007;85:660–7.
15.
GopalanCSastriRBalasubramanianS. Nutritive value of Indian foods. Hyderabad: National Institute of Nutrition, 1971:29–32.
16.
GalluccioMChalmersA. Assay of serum folate is not required for assessment of tissue folate stores. AJMS1996;17:148–9.
17.
BadiouSBarioletSLaurensCAillaudNBargnouxSMariano-GoulartDDupuyMCristolP. Comparison of isotopic and immunoenzymatic methods for folate and vitamin B12 determination. Clin Lab2010;56:547–52.
18.
NkrumahBNguahSSarpongNDekkerDIdrissAMayJAdu-SarkodieY. Hemoglobin estimation by the HemoCue® portable hemoglobin photometer in a resource poor setting. BMC Clin Pathol2011;11:1–5.
19.
World Health Organization. Serum and red blood cell folate concentrations for assessing folate status in populations. Vitamin and Mineral Nutrition Information System. Geneva: WHO, 2012:1–5.
20.
Indian Council of Medical Research. Revised RDA for Indians. Report of the expert group of ICMR. Hyderabad: National Institute of Nutrition, 2010:271–7.
21.
World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and mineral nutrition information system. Geneva: WHO, 2011:1–6.
22.
VanderJagtJSpelmanKAmbeJDattaPBlackwellWCrosseyMGlewH. Folate and vitamin B12 status of adolescent girls in northern Nigeria. J Natl Med Assoc2000;92:334–40.
23.
Garcia-CasalMOsorioCLandaetaMLeetsIMatusPFazzinoFMarcosE. High prevalence of folic acid and vitamin B12 deficiencies in infants, children, adolescents and pregnant women in Venezuela. Eur J Clin Nutr2005;59:1064–70.
24.
StelutiJMartiniAPetersSMarchioniM. Folate, vitamin B6 and vitamin B12 in adolescence: serum concentrations, prevalence of inadequate intakes and sources in food. J Pediatr2011;87:43–9.
25.
AkanjiAThalibLAl-IsaA. Folate, vitamin B12 and total homocysteine levels in Arab adolescent subjects: reference ranges and potential determinants. Nutr Metab Cardiovasc Dis2012;22:900–6.
26.
StangerO. Physiology of folic acid in health and disease. Curr Drug Metab2002;3:211–23.
27.
Centers for Disease Control and Prevention. Second national report on biochemical indicators of diet and nutrition in the US population. Atlanta, GA, USA: National Center for Environmental Health, 2012:30–5.
28.
BialostoskyKWrightDKennedy-StephensonJMcDowellMJohnsonL. Dietary intake of macronutrients, micronutrients, and other dietary constituents: United States 1988–94. Vital and health statistics. Washington, DC: National Center for Health Statistics2002;11:48–50.
29.
HewittMCroweWNavinWMillerE. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. Atlanta, GA, USA: Centers for Disease Control and Prevention1992;41:980–4.
30.
Al-SahabBArdernCHamadehMTamimH. Age at menarche in Canada: results from the National Longitudinal Survey of Children & Youth. BMC Public Health2010;10:736–43.
31.
Weekly Iron and Folic Acid Supplementation Programme. Operational framework for weekly iron and folic acid supplementation for adolescents. New Delhi: Ministry of Health and Family Welfare, Government of India, 2012:1–42.
32.
YatesA. Which dietary reference intake is best suited to serve as the basis for nutrition labeling for daily values?J Nutr2006;136:2457–62.
33.
Food and Nutrition Board. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. Washington, DC: National Academy Press, 1998:29–38.
34.
ErvinBWangYWrightD. Dietary intake of selected minerals for the United States population: 1999–2000. Advance data from vital and health statistics. Hyattsville, MD, USA: National Center for Health Statistics, 2004:1–5.
