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    ‘Bris Jeune of Nariton 2006 95, 511-516 OE: 10JORYBINO0SISO © The Authars 205 Low folic acid status and its association with anaemia in urban adolescent girls and women of childbearing age in Sri Lanka Tharanga Thoradeniya', Rajitha Wickremasinghe”, Ramani Ramanayake* and Sunethra Atukorala!* Deparment of Biachoniary and Molecular Biology, Faculty of Medicine, University of Colambo, PO Box 271, Colambo 8, Sri Lanka “Department of Community and Fait Medicine, Facuity of Medicine, University of Kelaniya, Sri Lanka 2Colombo Municipal Council, Colambo, Sri Lanka (Roced 29 Monch 2005 = Revd I ly 205 = Aceped 1 Ags 2005) Folic acid deficiency is implicaod inthe aedolegy of nutional aruemia and adverse pregnancy outcomes forthe feus. Data on folic ack sus among, adlecentgirksand non-pregnant, non-lacaing young were ae nite, We assosed folic acid tts na am sample of S52 abject (277 alokescent sis aga 15~189 yeas and 275 women gaat 19-30 year) living in Colombo, Sti Lanka. The association of low folic aid staus with anemia ves eae, Socioeuinomic, food inthe and ahmopometic dha were obtain. Hb, serum folic acid, vitunin By and fenitn and plasma homocysteine ‘concenssons were messiah Forysiuee per cet of aibects sted Fax low srum folic acid concentrations (3g) and 17% Pal ow Fe Stones (Gerum feriin <20 yg), Overall proalence of anaemia Wis 129%, and 439% of anaemic subjects ha beth low Folic acd sus and depleted Fe sores Gerum fertin <2 pf}. Boh low folate status and depleted Fe sores were sgnificatly asocisted with anaemia (els ratio= 222; 95% CL 184, 401 and ods rao = 598; 95 % CL 346, 1068, respectively) Serum folic acid concentration was associted (7=0 108, P=0O15) with folie Jae a indica by computed folate index. Folate index ves asaciad imesely with household Size ane posively with econeic status and education level In this stay popubticn low folic acid stirs besides deleted Fe toes was associated with anaemia, The high pevalenoe of low folic acid stats ‘bvered highlits the med for nuidon education to improve intakes of fokwe, Fe and ober microntients among adolescent git andl young women. Folic acid Iron deficeney: Anaemia ‘Micronutrient deficiencies and nutitional anaemia are major ro bblams, especially among children and women. in South East Asian countriesincluding Sri Lanka (WHO, 2000). Othe micronu= ‘wien known to contribute tortion anaemia, Fe ang folic acid Inve been suggested to play maj roles, As in ment other develop ing countrics with a high rrevalenae of anaemia, the commonest cease of nutitional anemia in Sri Lanka is thought to be Fe deficiency (Tue & Wikramanayake, 2000), However, the contibution of Fe, folic accor ether micronutrients towards nuti= tional anaemia has not been assessed in national surveys in Si Lanka. Folic acid is a micronutrient that has been reposted to be deficient in dicts particularly of lowincome groups (Ballew & ‘Sugerman, 1995; Giskes e al, 2002), Incweaxed demand for folate during pregnancy resulting in low folic acid status is well estab- lished (Caudill eal, 1958) and is a contributing factor to maternal sanseria (Sood etal 1975; Seshat, 2001). Despiteawarenessof the signficnseof flicacidduringthe pete cconceptional period, cata en folic acid status are limited especially among adolescent girs and women of chikdbearing age. A recent study amongadokescentschooleirsina ruralareain Sri Lanka indie cated that 228% havelow folic acid status (Atukorala & Laneoll, 1998). Low folic acd status is associated with advere pregnancy outcomes, such as neural tube defects (MRC Vitamin Study Group, 1991; Berry etal, 1999), other bith defects (McDonald tal. 2008), low bisth weight (Christian er al, 2003) and preterm. delivery (Scholl eral, 1996). Low folic acid status can also leal to hhypethomocysteinsemia, an independent risk factor for CVD (Clarke eta 1991), Although national periconceytional folic ac supplementation. programmes have already been initiated, sup= pplmentation often commences afer confimation of pregnancy in ‘most cases, Antenatal Fe= folate supplementation has been shown, {toimprove micronutrient status during pregnancy but is not effec+ tive in conecting the preexisting deficits (de Siva & Alukorla, 1996; Casimueva er al, 2003). Furthermore, as folic acid status before conception detemmines folic acid satus during pregnancy (Caudill era. 1997), itis essential to maintain adequate levels in adolescent girls and women of childbearing age before they become pregnant. “The preset study was cared out to asses folic acid status in whan adolescent girls and women of childbearing age and the association of iis deficiency with anaemia, Factors kading to folic acid deficiency were also determined, ‘Methods Sample size estimation ‘Sample size was calculated based on the prevalence of folic acid deficiency reported for a selected group of adolescent Abbreviated *Canesgunling aur: Prfesce Stra Ansoey ix +94 11 09156 eal suneiraGeoL sR “T, Thoradeniya al schoolgirls (14=18 years of age) from a rural area in Sei Lanket (Awkorla & Lanarolle, 1998) asuming that the prevalence ‘would be similar in adolescent girls and women of chikibearing ‘age. The degree of precision was set at 4% and the expected prevalence at 25%. Therefore, a minimum sample size of 600 was required (Lvanga & Lemeshow, 1991) for a final rmumber of 451, assuming a drop-out rate of 25%. Stuy porudation ‘Six hundred alolescent girls and women of childbearing ave were cenrlled for the study. Ten out of forty-seven divisions in the ‘Municipality of Colombo, Sri Lanka were randomly selected. ‘The participants were selected randemly fre lists of persons available with the Medical Officer of Health at each of the ten divisions. Five hundred and sevenly-cight subjects participated ‘wilh a response rae of 95%, Adolescent girls who had attained menarche af leat 2 years prior to recruitment and women who, ‘were not pregunt in the pust 2 years or not breastfeeding during the just year were included, Exclusion criteria were evie {dence or history of any systemic illness such as CVD, hepatic die frcers renal disease, thyroid disease, cancers, arthritis, blood disonkers or diabetes mellitus, Of a toll of 578 pauticipants, weny=six were excluded (seme illness, 2; lack of Hb data, 2224) from the analysis, ‘The final sample (1 552) consised of 277 adolescent girls in the age group of 15=18 years and 275 women agad between 19 and 30 years Serum folic acid and feritin concentrations ‘were measured in 530 and 525 subjects, respectively. Five hue died and twelve subjects had complete laboratory data including Hb, serum folic acid and feritin concentrations. Dietary data fiom a food fiequency quetiomuire were available for 526 subjects. Ethical considerations ‘The Ethical Review Committee ofthe Faculty of Medicine, Uni- sensity of Colombo, Sri Lanka, approved the study, Permission, ‘yas obtained from the Colombo Municipal Council and writen informed consent was obtained fom all. puricipants. and puremisguardians of participants under 18 years of age. Results (of biochemical analyses were given to the subject, and subjects with low Hb kvels were refemel to the Medical Officer of Health for funber mangement General information and eabrepomearic measurements Information rezwviing socio-economic status, past medical and obstetic history Gif any), intake of drugs (e.g. antiepileptics, ral contraceptives), vitamins, minerals and other supplements ‘was obtained using a pretesed inleniewer-aiminisered questionnaire. ‘Weight and height were measured by trained personnel, using, Sanckized scales (weight to the newest O1 ky using an eleo= ‘uonic balance and height to the neares I mm using a sadiometer) and BMI was calculaled, Waist circumference was measured using a measuring tape. In adolescent girls the cut-off values for underweight and overweight were taken as BMI- and ferritin and left al rom temperature to cle, and then stored in ice. All samples were tansperted to the Tnboratory in ice. Serum and plasma were separated by centifugation at 2000 pm fee 7min within 3h of blood collection, than aliquoted, info small sample vials and stored al 20°C until analysis. Laboratory measurements Hib was estimated by the eyanmethaemoelobin method! (Randox, Co, Anitim, UK), within Sh of collection of blo Folic acid and Fe staus were asesed by determination of serum folic acid ‘and serum fenitin concentrations, respectively. Serum falic acid ‘and vitamin B concentrations were measured by competitive pro= {cin binding assay (SimulTRAC SNB radioassay for folate andl By: MP Biomedicals, Orangcburs, New York, USA). Serum fertin concentration was measured by an immunoradiomanic assay (Coat~A-Count Fenitin IRMA; EURODPC Ltd, Gwynedd, UK). Plasma homoeyseine concentration was measured_using an enzyme immunensay method (Abbot IMx; Abbot Diagnostics, Dundee, UK) ina randomly selected sub-sample of 253 subjects All samples were assayed in duplicate and pooled bloodéera served as intemal contra. Statistical anedysis ‘Serum folic acid, vitamin Byp, ferritin and plasma homocysteine ‘concentrations were log-trnsformed and analysed. A. variable ‘termed the folate index (FI) was computed by summing up frequen cies of intake of dark green leafy vegetables, other vegetables and fiuits to assess their combined effct. The FI ranged fiom 1 to 17, Associations were tested using the \° tes, Pearson correlation ‘coefficients, Student's test and ANOVA. As there was no differ= cence between Hb, folic acid and feriin concentrations among acdo= Jescent girls and women, the bo groups were pooled for statistical ‘analysis. Logistic regression analysis was used to model anaemia status, Oudsratios andtheir 95 % CI werecalculated. Alltestsofsige nificance were two-sided and all analyses were performed using, ‘SPSS software version 10.01 (SPSS Inc., Chicago, IL, USA). Folic add and araomia in| srs aed young women “Tebde . Generacteracarste of the sud pep (Vales ate meanany stadt eatin 5 €) Ababpcs ——Adckescet ots os) (0776) Women (275) Men Men Mn ee er crc) Tosa monty cet yt 346 180) ant (19) 20" 76) 473051) 4620127) 436013) 17568) 127) ze en 130) one +36) a1 9 7a7 (195) e719) 286 (160) 26 (73) zasie) ey 3m mT oS 8S stm EBD Fy Slaten Ares et Fo team, Nebosg tar Fajer tan aacart i "9<005 "Tose necrosis woe incite rom asennad wre Results Subject profile General characteristics of the study population are shown in ‘Table 1. Most of the subjects were from the low socio-sconmiic cass, with 825% having a total family income of less thin Si Lankan Rupees 10000 (£53) per month, Nearly 83% fof subjects were financially dependent on their parentveuu dianyspouses, Approximately 29% had tertiary education and conly seven subjects (15%) had no formal school education. Among the adolescent girls aged 15-189 years 415% (n 115) were school dropouts OF the women 19-30 yeurs of ave, 269% (n 74) were manied, whereas only ten adolescent girls were maied. Of the muried women and gids, 61.9% (ily ‘one women anki one girl) had given birth to at least one child. ‘Mean BMI and waist circumference values were higher (P<005) in women of childbearing age than in adolescent gisls (Table 1). Table 2. Fa stausand selected becharical nck ofthe study pepubaten® ‘Thecutoff values for underyeigit BMI

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