title: 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.
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.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; jyr4@cdc.gov.
authors.forename: Jorge
authors.identifier: 0000-0001-5850-1228
authors.initials: J
authors.lastname: Rosenthal
authors.affiliation: Belize Ministry of Health, Belmopan, Belize.
authors.forename: Natalia
authors.initials: N
authors.lastname: Largaespada
authors.affiliation: University of Georgia, Athens, GA.
authors.forename: Lynn B
authors.initials: LB
authors.lastname: Bailey
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Michael
authors.identifier: 0000-0001-5776-5010
authors.initials: M
authors.lastname: Cannon
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: C J
authors.identifier: 0000-0002-1835-7599
authors.initials: CJ
authors.lastname: Alverson
authors.affiliation: University of San Carlos, Guatemala City, Guatemala.
authors.forename: Dayrin
authors.initials: D
authors.lastname: Ortiz
authors.affiliation: University of Florida, Gainesville, FL; and.
authors.forename: Gail Pa
authors.identifier: 0000-0003-0239-5942
authors.initials: GP
authors.lastname: Kauwell
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Joe
authors.initials: J
authors.lastname: Sniezek
authors.affiliation: Belize Ministry of Health, Belmopan, Belize.
authors.forename: Ramon
authors.initials: R
authors.lastname: Figueroa
authors.affiliation: Belize Ministry of Health, Belmopan, Belize.
authors.forename: Robyn
authors.initials: R
authors.lastname: Daly
authors.affiliation: Belize Ministry of Health, Belmopan, Belize.|Belize Ministry of Public Service, Belmopan, Belize.
authors.forename: Peter
authors.initials: P
authors.lastname: Allen
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000097:blood / Q000453:epidemiology; D001531:Belize / Q000453:epidemiology; D004912:Erythrocytes / Q000378:metabolism; D005260:Female; D005492:Folic Acid / Q000097:blood*; D005494:Folic Acid Deficiency / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008875:Middle Aged; D009749:Nutrition Surveys; D009752:Nutritional Status; D015995:Prevalence; D012307:Risk Factors; D014805:Vitamin B 12 / Q000097:blood*; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D014803:Vitamin B Complex / Q000097:blood*; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D014803:Vitamin B Complex; D005492:Folic Acid; D014805:Vitamin B 12
keywords: anemia; folate deficiency; folate insufficiency; vitamin B-12 deficiency; women of childbearing age