Ordering folate assays is no longer justified for investigation of anemias, in folic acid fortified countries

被引:16
作者
Shojania A.M. [1 ]
Von Kuster K. [1 ]
机构
[1] St Boniface General Hospital, Winnipeg, MB R2H 2A6
关键词
Folate; Celiac Disease; Mean Corpuscular Volume; Folate Deficiency; Serum Folate;
D O I
10.1186/1756-0500-3-22
中图分类号
学科分类号
摘要
Background. Since 1998, in the countries where there is mandatory fortification of grain products with folic acid, folate deficiency has become very rare. Consequently, we decided to find out whether there is any justification for ordering folate assays for investigation of anemias. Methods. We reviewed serum folate (SF) and red cell folate (RF) data at two teaching hospitals in Canada. At the Health Sciences Centre (HSC) the folate data for the year 2001 were analyzed and the medical records of those with low SF or low RF were reviewed. At St. Boniface General Hospital(SBGH)all folate data between January 1996 and Dec 31,2004 were analyzed and the medical records of all who had low RF between January 1,1999 and December 31,2004 were reviewed. Results. In 2001, at HSC, 11 out of 2154(0.5%)SF were low(<7.0 nmol/L) and 4 out of 560 (0.7%) RF were low (<417 nmol/L). In no subject with low SF or RF could the anemia be attributed to folate deficiency. At SBGH during the 3-year-period of 1999-2001, 19 out of 991(1.9%) had low RF (<225 nmol/L) but in only 2 patients (0.2%) the low RF was in folate deficiency anemia range; but neither of them had anemia. Conclusion. In countries where there is mandatory fortification of grain products with folic acid, folate deficiency to the degree that could cause anemia is extremely rare. Ordering folate assays for investigation of anemias, in these countries, is waste of time and money. The result of these tests is more likely to mislead the physicians than to provide any useful information. © 2010 Shojania et al; licensee BioMed Central Ltd.
引用
收藏
相关论文
共 20 条
[1]  
Food standards: Amendment of standards of identity for enriched grain products to require addition of folic acid, Federal Register, 61, pp. 8781-8797
[2]  
Canada H., Food and drug rgulations, amendment, Schedule No. 1066. Ottawa, (1998)
[3]  
Lawrence J.M., Petitti D.B., Watkins M., Umekubo M.A., Trends in serum folate after food fortification, Lancet, 354, pp. 915-916, (1999)
[4]  
Choumenkovitch S.F., Jacques P.F., Nadeau M.R., Wilson P.W., Rosenberg I.H., Selhub J., Folic acid fortification increases red blood cell folate concentrations in the Framingham study, J Nutr, 131, pp. 3277-3280, (2001)
[5]  
Ray J.G., Vermeulen M.J., Boss S.C., Cole D.E., Declining rate of folate insufficiency among adults following increased folic acid food fortification in Canada, Can J Public Health, 93, pp. 249-253, (2002)
[6]  
Pfeiffer C.M., Caudill S.P., Gunter E.W., Osterloh J., Sampson E.J., Biochemical indicators of B vitamin status in the US population after folic acid fortification: Results from the National Health and Nutrition Examination Survey 1999-2000, Am J Clin Nutr, 82, pp. 442-450, (2005)
[7]  
Dietrich M., Brown C.J., Block G., The effect of folate fortification of cereal-grain products on blood folate status, dietary folate intake, and dietary folate sources among adult non-supplement users in the United States, J Am Coll Nutr, 24, pp. 266-274, (2005)
[8]  
Waters A.H., Mollin D.L., Studies on folic acid activity of human serum, J Clin Pathol, 14, pp. 335-344, (1961)
[9]  
Hoffbrand A.V., Newcombe F.A., Mollin D.L., Method of assay of red cell folate activity and the value of the assay as a test for folate deficiency, J Clin Pathol, 19, pp. 17-28, (1966)
[10]  
Quinlivan E.P., Gregory J.F., Effect of food fortification on folic acid intake in the United States, Am J Clin Nutr, 77, pp. 221-225, (2003)