Folate increased requirement during

Folate deficiency can occur in alcoholics, pregnancy and dietary insufficiency. Deficiency results in changes in the red and white blood cells. Changes in the red blood cells lead to the same symptoms as pernicious anaemia which are observed in vitamin B12 deficiency. Increased levels of folate are required during pregnancy, lactation and rapid growth. 

Folate is a water-soluble vitamin. The recommended daily allowances (RDAs) of folate for the adult man and woman are 20fJ and 101) pg, respectively. The RDA is defined in the Preface. Folate is critically important for growth, and for this reason it is required in increased amounts during pregnancy (400 pg. The need for dietary folate remains elevated after pregnancy and during lactation because of the Irans-... 

As has already been stated there is an increased requirement for the vitamin during pregnancy. This means that large numbers of women in the lower socioeconomic groups in many if not most countries will become folate deficient during pregnancy unless they are given additional folate to supplement that present in their diets. A similar problem exists with iron, and several pharmaceutical companies market a capsule which contains both iron and folic acid. 

Folic acid deficiency, unlike vitamin B12 deficiency, is often caused by inadequate dietary intake of folates. Patients with alcohol dependence and patients with liver disease can develop folic acid deficiency because of poor diet and diminished hepatic storage of folates. Pregnant women and patients with hemolytic anemia have increased folate requirements and may become folic acid-deficient, especially if their diets are marginal. Evidence implicates maternal folic acid deficiency in the occurrence of fetal neural tube defects, eg, spina bifida. (See Folic Acid Supplementation A Public Health Dilemma.) Patients with malabsorption syndromes also frequently develop folic acid deficiency. Patients who require renal dialysis develop folic acid deficiency because folates are removed from the plasma during the dialysis procedure. 

In chronic haemolytic states, where erythropoiesis is accelerated, and in myelofibrosis, where haemopoiesis is inefficient, folate requirement is increased. Extensive shedding of skin cells in exfoliative dermatitis, inflammatory states, e.g. rheumatoid arthritis, and malignant disease (lymphoma), can similarly lead to folate deficiency. Folate loss during chronic haemodialysis may be sufficient to require replacement. 

Pancytopenia is a rare but potentially fatal complication, and numerous reports have been published. The characteristics and incidence of pancytopenia have been carefully re-evaluated from case reports and clinical trials published from 1980 to 1995 (38). Of 70 reported cases, 12 patients died (17%). Impaired renal function was the most important contributing factor (54%), particularly in fatal cases (10/12). Other important susceptibility factors included advanced age (over 65 years), hypoalbuminemia, concurrent infection, and/or concomitant multiple medications (particularly co-trimoxazole). The mean cumulative dosage was 675 (10-4800) mg, and the minimal cumulative methotrexate dose leading to fatal pancytopenia was 10 mg. This confirms that pancytopenia can occur at any time during treatment, even in the absence of known susceptibility factors. Bone marrow biopsy showed megaloblastosis and hypocellularity. Eosinophilia and increased mean corpuscular volume were rarely observed. In an overall review of five long-term prospective studies (511 patients), the calculated incidence of methotrexate-induced pancytopenia was 1.4%. Although severe myelo-suppression sometimes required folinic acid, there are as yet no data to determine whether prophylactic folate supplementation can reduce the incidence of pancytopenia. 

Idli is a very popular fermented breakfast food consumed in India that is made mainly of rice and black gram. It was shown that riboflavin, thiamine, and folate concentrations were increased during the fermentation of idli batter due to the presence of yeast, Lactobacillus ssp., and Leuconostoc mesenteroides (Ghosh and Chattopadhyay 2012). In terms of riboflavin, the concentrations reached 7.6 0.8 ng B /ml compared to the initial concentration (2.2 1.1 mg B /ml). Further studies are required to identify the riboflavin-producing strains in this product. 

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