The prevalence and the magnitude of folate deficiency across the world are variable, with the condition occurring commonly in countries without folic acid fortification of cereal-grain products and rarely in countries with folic acid fortification.[3]McLean E, de Benoist B, Allen LH. Review of the magnitude of folate and vitamin B12 deficiencies worldwide. Food Nutr Bull. 2008 Jun;29(2 suppl):S38-51.
http://www.ncbi.nlm.nih.gov/pubmed/18709880?tool=bestpractice.com
[4]Metz J. Haematological implications of folate food fortification. S Afr Med J. 2013 Oct 11;103(12 Suppl 1):978-81.
http://www.ncbi.nlm.nih.gov/pubmed/24300642?tool=bestpractice.com
[5]Rogers LM, Cordero AM, Pfeiffer CM, et al. Global folate status in women of reproductive age: a systematic review with emphasis on methodological issues. Ann N Y Acad Sci. 2018 Nov;1431(1):35-57.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282622/
http://www.ncbi.nlm.nih.gov/pubmed/30239016?tool=bestpractice.com
Several national surveys have shown that folate deficiency can be a public health problem in the absence of fortification. The primary age groups affected include pre-school children (33.8% of the folate-deficient population in Venezuela), pregnant women (48.8% in Costa Rica and 25.5% in Venezuela), and older people (15% in the UK).[3]McLean E, de Benoist B, Allen LH. Review of the magnitude of folate and vitamin B12 deficiencies worldwide. Food Nutr Bull. 2008 Jun;29(2 suppl):S38-51.
http://www.ncbi.nlm.nih.gov/pubmed/18709880?tool=bestpractice.com
In the US, folate deficiency was present in school-age children (2.3% of the folate-deficient population), adults (24.5%), and older people (10.8%) before folic acid fortification.[3]McLean E, de Benoist B, Allen LH. Review of the magnitude of folate and vitamin B12 deficiencies worldwide. Food Nutr Bull. 2008 Jun;29(2 suppl):S38-51.
http://www.ncbi.nlm.nih.gov/pubmed/18709880?tool=bestpractice.com
Mandatory folic acid fortification of enriched cereal-grain products was initiated in the US in 1996 and Canada in 1998. Subsequently, surveys of regional and nationally representative populations have shown that serum and red blood cell folate concentrations have increased in the general population in these countries.[6]Pfeiffer CM, Johnson CL, Jain RB, et al. Trends in blood folate and vitamin B-12 concentrations in the United States, 1988-2004. Am J Clin Nutr. 2007 Sep;86(3):718-27.
http://ajcn.nutrition.org/content/86/3/718.full
http://www.ncbi.nlm.nih.gov/pubmed/17823438?tool=bestpractice.com
[7]Colapinto CK, O'Connor DL, Tremblay MS. Folate status of the population in the Canadian Health Measures Survey. CMAJ. 2011 Feb 8;183(2):E100-6.
http://www.cmaj.ca/content/183/2/E100.long
http://www.ncbi.nlm.nih.gov/pubmed/21149516?tool=bestpractice.com
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