Folate deficiency natural history, complications and prognosis: Difference between revisions
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{{Folate deficiency}} | {{Folate deficiency}} | ||
{{CMG}} | {{CMG}} | ||
==Overview== | ==Overview== | ||
The symptoms of folate deficiency are very non specific and subtle.It can present with the features of anemia and can lead to severe complications if not treated. Prognosis of patients with folate deficiency is generally good and clinical and hematological parameters usually reverses after 8 weeks of treatment. | |||
==Natural History== | ==Natural History== | ||
=== Natural History === | |||
* The symptoms of folate deficiency are very non specific and subtle.It can present with the features of anemia and can lead to severe complications if not treated. | |||
* Depending upon the baseline stores, Folate deficiency develops rapidly within weeks to months and become rapidly depleted during normal cell division, as compared to the Vitamin b12 deficiency that develops over the course of years, as total body stores are large. | |||
* Although asymptomatic initially, anemia, neurocognitive and other changes have been reported with folate deficiency at the later stage. | |||
==Complications== | ==Complications== | ||
Some of the common complications include : | Some of the common complications include :<ref name="Miller2013">{{cite journal|last1=Miller|first1=J.W.|title=Folic Acid|year=2013|pages=262–269|doi=10.1016/B978-0-12-375083-9.00111-2}}</ref> | ||
*'''Hematologic deficits''' : Inadequately treated or untreated patients will | *'''Hematologic deficits''' : Inadequately treated or untreated patients will develop megaloblastic anemia, leukopenia, and thrombocytopenia. | ||
*'''Neural tube defects''' : Folate deficiency in pregnant women increases the incidence of neural tube defects in their fetuses. This can be effectively prevented by increasing folic acid intake preconceptually and during pregnancy. | *'''Neural tube defects''' : Folate deficiency in pregnant women increases the incidence of neural tube defects in their fetuses. This can be effectively prevented by increasing folic acid intake preconceptually and during pregnancy.<ref name="pmid24365361">{{cite journal| author=Reynolds EH| title=The neurology of folic acid deficiency. | journal=Handb Clin Neurol | year= 2014 | volume= 120 | issue= | pages= 927-43 | pmid=24365361 | doi=10.1016/B978-0-7020-4087-0.00061-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24365361 }}</ref> | ||
*'''Neuropathy''' : Initiation of folic acid therapy may lead to progression of neuropathy and cognitive impairment in underlying vitamin B12 deficiency. This can be prevented by prompt diagnosis and treatment of vitamin B12 deficiency before instituting folic acid therapy. | *'''Neuropathy''' : Initiation of folic acid therapy may lead to progression of neuropathy and cognitive impairment in underlying vitamin B12 deficiency. This can be prevented by prompt diagnosis and treatment of vitamin B12 deficiency before instituting folic acid therapy. | ||
*'''Cardiovascular disease''' : Moderate elevation of plasma homocysteine is an independent risk factor for cardiovascular disease, stroke, and venous thrombosis | *'''Cardiovascular disease''' : Moderate elevation of plasma homocysteine is an independent risk factor for cardiovascular disease, stroke, and venous thrombosis<ref name="pmid9930568">{{cite journal| author=Green R, Miller JW| title=Folate deficiency beyond megaloblastic anemia: hyperhomocysteinemia and other manifestations of dysfunctional folate status. | journal=Semin Hematol | year= 1999 | volume= 36 | issue= 1 | pages= 47-64 | pmid=9930568 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9930568 }}</ref> | ||
*'''Colorectal cancer''' : High folate levels inhibit malignant transformation, but high folate levels may also enhance the growth of established malignancies. Some studies have suggested a possible link between low folate status and colorectal cancer .However, scientific evidence is not sufficiently clear to recommend increased folate intake for populations at risk for developing colorectal cancer. | *'''Colorectal cancer''' : High folate levels inhibit malignant transformation, but high folate levels may also enhance the growth of established malignancies. Some studies have suggested a possible link between low folate status and colorectal cancer .However, scientific evidence is not sufficiently clear to recommend increased folate intake for populations at risk for developing colorectal cancer.<ref name="pmid10720158">{{cite journal| author=Choi SW, Mason JB| title=Folate and carcinogenesis: an integrated scheme. | journal=J Nutr | year= 2000 | volume= 130 | issue= 2 | pages= 129-32 | pmid=10720158 | doi=10.1093/jn/130.2.129 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10720158 }}</ref><ref name="pmid30099693">{{cite journal| author=Pieroth R, Paver S, Day S, Lammersfeld C| title=Folate and Its Impact on Cancer Risk. | journal=Curr Nutr Rep | year= 2018 | volume= 7 | issue= 3 | pages= 70-84 | pmid=30099693 | doi=10.1007/s13668-018-0237-y | pmc=6132377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30099693 }}</ref> | ||
*'''Toxicity''' : Evidence is emerging of possible toxicities associated with excess folate intake as a result of folic acid food fortification and use of dietary supplements containing folic acid. Toxicities include progressive neurologic damage, cognitive impairment (particularly in individuals with concomitant vitamin B12 deficiency), and enhanced growth of malignant tumors (specifically colonic tumors). Large doses of intravenous folic acid have been reported to exacerbate seizures in patients with underlying seizure disorders. | *'''Toxicity''' : Evidence is emerging of possible toxicities associated with excess folate intake as a result of folic acid food fortification and use of dietary supplements containing folic acid. Toxicities include progressive neurologic damage, cognitive impairment (particularly in individuals with concomitant vitamin B12 deficiency), and enhanced growth of malignant tumors (specifically colonic tumors). Large doses of intravenous folic acid have been reported to exacerbate seizures in patients with underlying seizure disorders. | ||
*'''Fertility''' : Folate deficiency can also affect fertility. However, the effects are only temporary and can be reversed by using vitamin supplements. | *'''Fertility''' : Folate deficiency can also affect fertility. However, the effects are only temporary and can be reversed by using vitamin supplements. | ||
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==Prognosis== | ==Prognosis== | ||
Prognosis of patients with folate deficiency is generally good, if folic acid supplementations are started early and clinical and hematological parameters usually reverses after 8 weeks of treatment.Body stores can be replenished with additional folic acid supplements for 1 month. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 03:56, 12 February 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The symptoms of folate deficiency are very non specific and subtle.It can present with the features of anemia and can lead to severe complications if not treated. Prognosis of patients with folate deficiency is generally good and clinical and hematological parameters usually reverses after 8 weeks of treatment.
Natural History
Natural History
- The symptoms of folate deficiency are very non specific and subtle.It can present with the features of anemia and can lead to severe complications if not treated.
- Depending upon the baseline stores, Folate deficiency develops rapidly within weeks to months and become rapidly depleted during normal cell division, as compared to the Vitamin b12 deficiency that develops over the course of years, as total body stores are large.
- Although asymptomatic initially, anemia, neurocognitive and other changes have been reported with folate deficiency at the later stage.
Complications
Some of the common complications include :[1]
- Hematologic deficits : Inadequately treated or untreated patients will develop megaloblastic anemia, leukopenia, and thrombocytopenia.
- Neural tube defects : Folate deficiency in pregnant women increases the incidence of neural tube defects in their fetuses. This can be effectively prevented by increasing folic acid intake preconceptually and during pregnancy.[2]
- Neuropathy : Initiation of folic acid therapy may lead to progression of neuropathy and cognitive impairment in underlying vitamin B12 deficiency. This can be prevented by prompt diagnosis and treatment of vitamin B12 deficiency before instituting folic acid therapy.
- Cardiovascular disease : Moderate elevation of plasma homocysteine is an independent risk factor for cardiovascular disease, stroke, and venous thrombosis[3]
- Colorectal cancer : High folate levels inhibit malignant transformation, but high folate levels may also enhance the growth of established malignancies. Some studies have suggested a possible link between low folate status and colorectal cancer .However, scientific evidence is not sufficiently clear to recommend increased folate intake for populations at risk for developing colorectal cancer.[4][5]
- Toxicity : Evidence is emerging of possible toxicities associated with excess folate intake as a result of folic acid food fortification and use of dietary supplements containing folic acid. Toxicities include progressive neurologic damage, cognitive impairment (particularly in individuals with concomitant vitamin B12 deficiency), and enhanced growth of malignant tumors (specifically colonic tumors). Large doses of intravenous folic acid have been reported to exacerbate seizures in patients with underlying seizure disorders.
- Fertility : Folate deficiency can also affect fertility. However, the effects are only temporary and can be reversed by using vitamin supplements.
- Premature birth : As well as affecting your baby's growth, a lack of folate during your pregnancy may also increase the risk of your baby being born prematurely (before week 37 of the pregnancy).
Prognosis
Prognosis of patients with folate deficiency is generally good, if folic acid supplementations are started early and clinical and hematological parameters usually reverses after 8 weeks of treatment.Body stores can be replenished with additional folic acid supplements for 1 month.
References
- ↑ Miller, J.W. (2013). "Folic Acid": 262–269. doi:10.1016/B978-0-12-375083-9.00111-2.
- ↑ Reynolds EH (2014). "The neurology of folic acid deficiency". Handb Clin Neurol. 120: 927–43. doi:10.1016/B978-0-7020-4087-0.00061-9. PMID 24365361.
- ↑ Green R, Miller JW (1999). "Folate deficiency beyond megaloblastic anemia: hyperhomocysteinemia and other manifestations of dysfunctional folate status". Semin Hematol. 36 (1): 47–64. PMID 9930568.
- ↑ Choi SW, Mason JB (2000). "Folate and carcinogenesis: an integrated scheme". J Nutr. 130 (2): 129–32. doi:10.1093/jn/130.2.129. PMID 10720158.
- ↑ Pieroth R, Paver S, Day S, Lammersfeld C (2018). "Folate and Its Impact on Cancer Risk". Curr Nutr Rep. 7 (3): 70–84. doi:10.1007/s13668-018-0237-y. PMC 6132377. PMID 30099693.