Pulse Heath Netritons 97), 9286827 DOE 10:1017/PHN2D05921 Folate deficiency is associated with nutritional anaemia in Lebanese women of childbearing age lynn Al Khatib, Omer Obeid! AblaMehio Sibai2, Malek Batal’, Nada Adra” and Nahla Hwalla!“* Deportmentof Nutrition and Food Science, Faculty of Agricutyraland Food Sciences, American University of Beit, POBox 11-0236, Riod El Soh, Beiut 1107-2020, lebanon: “Department cf Epidemiology and Population Heath, Facully of Health Sciences, American University of Beirut, Beirut, lebanon Sadie 26 Sly 200: cpted 73 Hoveber 205 Abstract Objective: The objective of this stuly as to identify the determinants of anaemia in Lebanese women of childbearing age attending health ccnires in Lebanon, Designs Crosesecional study Guried out between Anthropometic mexaiemenis as well as sociodemographic, health a | vitamin By were assessed using ‘Setting: Govemmental health centres in Lebanon. anckael aboratcry methods. ‘Subjects: Four hundred and seventy nen-pregrant Lebanese womer y aged 1 Results: Araemia (Hb <12gal~) and iron deficiency (Raritin 200p9mi~") 19 Deficient (=200 gm) 1106-19) Food neko of vierin Be 19 1006-17) 19. ar(1s69) Underweight and nonmel (25k 0 ence ser —— eses p= ramogebir OR ~ aids rao; Cl ~ cortenoo terval FDA = reo (atrmended ceeay abnor, NM = body mess ee Sprau. Conta for educator. ‘The presnt results also show a lower prevalence of anaemia than reported ina previous study"', possibly due to improved health care or to eifferences in. sumpling the present study was conducted! on ending health cenures, Sodoseconomic varie ables, which induced education level employment status, ‘number of reoms in the househokd, number of household residents and others, were not significantly associated with anaemia, This agrees with previous: observations that anaemia cuts across clferent sectors of the population inchiding high and low socio-economic groups. Cem- pared 10 cther developing and developed counties (Fg, 1), Lebanese: women have a lower prevalence of anaemia than women in India’, Mexico! Kuwait!” and Fayp??; however, this level of anaemia is still higher than that in the USA and Europe? Lebanese women of childbearing age have a Tower, prevalence of femiin deficiency than women of Jordan?" and Mexico!’ On the ther hand, ferritin deficiency in Lebancn i higher than in Turkey, Sauxli Arabia, Spain’, New Zealane?* and Denmatk?. Itshould be notee that although fersitin deficiency ws present in 27.2%0oF the women this number cauld F Underestimation, since markers of infection were not measured in the present study. It i documented that ferritin san acutesphase proicin and its level rises in cases of infection, thus leading 10 underestimation of iron deficiency". ‘The present studyalso examined folate and vitamin By» as ather determinants of anaemia. Thirtysnine of the ‘women hal anemia but not iron deficiency. Of these, 12.806 badd Folate deficiency only and anether 12.5% had both folate and vitamin By, deficiencies, Plasma folate w. ‘Significant cktenminant of Hb status (OR= 1.9, 95% Cl 1.13.5) and approximately 2500 of the anaemia experienced by Lebanese women could be explained by fobite deficiency. However, the high prevalence of vitamin Byzdeficiency observed in our suey was not shown tobe sSenificantly comelated to anemia. Thismay be due tothe fact that 95.0% of the vitamin By-deficient women had moderate to lowckficiency, while only 4 3?4of the women hal severe cliniadl deficiency. When analysis was doneFolate deficency in Lebanese women gen New zeae Urea Se dot Leanne, 2209 ataron te saute o 10 2 es 2 o Pa @ Peroantage Fig. 1. Hagmedotin and fein cbfences in Lebanese women of chikbearng age in comparison to other developed ant developing counties using the cutoff value"! of 211 pami™, vitamin By2 ficency was prevalent in 11,5 of the sample of ‘women. ‘When deficiencies were combined, the percentage of women who had Hb or fersitin or folate or vitamin Biz ficiency was G8.1%, Thus, more tharrtwo thircl of the Iebanese women of chikibearing ae are either anaemic or suffer from deficiency of a mejor micronutrient, This important public health concem, particulary that ficiency of either irorvfolate or vitamin Byz puts the -woman and her foetus at risk of perinatal complications, spontaneous miscarige, intrauterine grenth retarcation, premature delivery, stunted growth, low birth weight, neural tube defects and pre-eclampsia, ‘Comparing food intake: data with the plasma levels of selected! nutrients showed that more than 50% of the ‘women had inackquate intake of iron and folte, and plasma folate was significantly and directly comeksted with folate intake, Moreover, the median 214mg) folate intake was approximately equal 10 50% of the esiimated averige requirement for folate®, Plasma folate is an indicator of recent folate intake and the food intake clatt wer colleded through a 2hour recall, representing, recent intake as well, Furthermore, although it is: not ‘enriched with folite, bread was a good source of folate in the diets of the women stuxlic as its consumption is very high in Lebanon, especially among people of low 10 moderate socioeconomic status, Plasma By Was not significantly correated with By2 intake. This is in line with revent data showing that vitamin By dficiency may be due to, in addition to insufficent dietary intake, food cobalamin makahscrption syndrome (60% of all cases) for pernicious anaemia 5=20% OF all cases), ancl malabsorption, Food cobalamin malabserption has only recently been klentified asa significant cause of cobalamin deficiency among people, and i characterised by the inability to rekease cobalamin fram food or a deficiency of intestinal cobalamin transpon pecteins or both ‘The presence o determinant of Hib status (OR= 31, 9%CI 18-55). tis less likely that disorders such as sickkecell anaemia and BAhalassiemia are strong contuibution factors to anaemiin in this population, ‘The frequency of Behulassiemia in Lebanon is among the lowest in the Mediterranean, being O04", and the prevalence of sickle-cell disease is less than 16", Conclusion and recommendations “The present study described the status of Hb and femitin, folate ancl vitamin By2 deficiencies in Lebanese women Of childbearing age. According to the WHO classification of anaamia (Hb <12gdI7, the Lebanese women of childbearing age fall in the citegory of mil anaemia, In this stuly, anaemia (Hb <12gdl) not related to iron deficency (lemitin < 15 pgI) was masly explained by folate deficiency. Ferritin clficiency ancl family history of anacmia were the strongest determinants of Fb deficiency in the studied women, Combating iron cleficieney in Lebanon is very hard, owing to lack of resources, Since bead was significant source of folate in the cet of the ‘women even though it is not Ferified, the fertfication of pita breacl with iron and folate, as well as promoting the intake of green leafy vesetables, woukl help increase the me folate intakes in these women, More research shoul be canied out t confirm the magnitude of vitamin By, deficiency via the assessment ot methylmalonic ac, homocysteine, intrinsic factors and76 holotranscebikmin receptor? Adlitionally, assessment (of Greactive protein would also rule out the presence of infection anel this valiiate the actual level of feritin eficiency in the stucied| women, Furthermore, the high prevalence of folate deficiency in these women should cencourige researchers to investigite the prevalence of ‘neural tube defects in Lebanon, Limitations Methylmalonic ackl, a good indicator of vitamin By deficiency, wasnotaseessed in thisstuel; thisisa limitation, Since we couldthus be underestimating the acual extentof vitumin By2 deficiency in the women". The dietury dats in this stucly were derived froma single 24+hour reall, which is a limitation for precise assessment of food intake. Acknowledgements ‘This study was supperted by the Lebanese National (Council for Scientific Research and the University Research Bourd, American University of Beirut. 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