title: Folate and Vitamin B12 Deficiency Among Non-pregnant Women of Childbearing-Age in Guatemala 2009-2010: Prevalence and Identification of Vulnerable Populations.
abstract: BACKGROUND
  Information on folate and vitamin B12 deficiency rates in Guatemala is essential to evaluate the current fortification program. The objectives of this study were to describe the prevalence of folate and vitamin B12 deficiencies among women of childbearing age (WCBA) in Guatemala and to identify vulnerable populations at greater risk for nutrient deficiency.
  
  
  METHODS
  A multistage cluster probability study was designed with national and regional representation of nonpregnant WCBA (15-49 years of age). Primary data collection was carried out in 2009-2010. Demographic and health information was collected through face-to-face interviews. Blood samples were collected from 1473 WCBA for serum and red blood cell (RBC) folate and serum vitamin B12. Biochemical concentrations were normalized using geometric means. Prevalence rate ratios were estimated to assess relative differences among different socioeconomic and cultural groups including ethnicity, age, education level, wealth index and rural versus urban locality.
  
  
  RESULTS
  National prevalence estimates for deficient serum [<10 nmol per liter (nmol/L)] and RBC folate (<340 nmol/L) concentrations were 5.1 % (95 % CI 3.8, 6.4) and 8.9 % (95 % CI 6.7, 11.7), respectively; for vitamin B12 deficiency (<148 pmol/L) 18.5 % (95 % CI 15.6, 21.3). Serum and RBC folate deficiency prevalences were higher for rural areas than for urban areas (8.0 vs. 2.0 % and 13.5 vs. 3.9 %, respectively). The prevalence of RBC folate deficiency showed wide variation by geographic region (3.2-24.9 %) and by wealth index (4.1-15.1 %). The prevalence of vitamin B12 deficiency also varied among regions (12.3-26.1 %).
  
  
  CONCLUSIONS
  In Guatemala, folate deficiency was more prevalent among indigenous rural and urban poor populations. Vitamin B12 deficiency was widespread among WCBA. Our results suggest the ongoing need to monitor existing fortification programs, in particular regarding its reach to vulnerable populations.
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, MS-86, Atlanta, GA, 30333, USA. jyr4@cdc.gov.
authors.forename: Jorge
authors.identifier: http://orcid.org/0000-0001-5850-1228
authors.initials: J
authors.lastname: Rosenthal
authors.affiliation: Guatemala Ministerio de Salud Pública y Asistencia Pública, Guatemala City, Guatemala.
authors.forename: Eunice
authors.initials: E
authors.lastname: Lopez-Pazos
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, MS-86, Atlanta, GA, 30333, USA.
authors.forename: Nicole F
authors.initials: NF
authors.lastname: Dowling
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Pfeiffer
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, MS-86, Atlanta, GA, 30333, USA.
authors.forename: Joe
authors.initials: J
authors.lastname: Mulinare
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, MS-86, Atlanta, GA, 30333, USA.
authors.forename: Claudia
authors.initials: C
authors.lastname: Vellozzi
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Mindy
authors.initials: M
authors.lastname: Zhang
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Lavoie
authors.affiliation: Universidad del Valle de Guatemala, Guatemala City, Guatemala.
authors.forename: Roberto
authors.initials: R
authors.lastname: Molina
authors.affiliation: Guatemala Ministerio de Salud Pública y Asistencia Pública, Guatemala City, Guatemala.|Fundación de Alimentos y Nutrición de Centro América y Panamá (FANCAP), Guatemala City, Guatemala.
authors.forename: Nicte
authors.initials: N
authors.lastname: Ramirez
authors.affiliation: Global Maternal and Preconception Health Consultant, Healdsburg, CA, USA.
authors.forename: Mary-Elizabeth
authors.initials: ME
authors.lastname: Reeve
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005494:Folic Acid Deficiency / Q000453:epidemiology*; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D014805:Vitamin B 12 / Q000097:blood; D014806:Vitamin B 12 Deficiency / Q000453:epidemiology*; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
chemical_list: D014805:Vitamin B 12
keywords: Deficiency; Guatemala; Prevalence; Serum and red blood cell folate; Vitamin B12; Women of childbearing age