Low folic acid status and its association with anaemia in urban adolescent girls and women of childbearing age in Sri Lanka

Abstract

Folic acid deficiency is implicated in the aetiology of nutritional anaemia and adverse pregnancy outcomes for the fetus. Data on folic acid status among adolescent girls and non-pregnant, non-lactating young women are limited. We assessed folic acid status in a random sample of 552 subjects (277 adolescent girls aged 15–18·9 years and 275 women aged 19–30 years) living in Colombo, Sri Lanka. The association of low folic acid status with anaemia was evaluated. Socio-economic, food intake and anthropometric data were obtained. Hb, serum folic acid, vitamin B12 and ferritin and plasma homocysteine concentrations were measured. Forty-three per cent of subjects studied had low serum folic acid concentrations (<3ng/ml) and 47/ had low Fe stores (serum ferritin <20μg/l). Overall prevalence of anaemia was 12·9%, and 43·9% of anaemic subjects had both low folic acid status and depleted Fe stores (serum ferritin <12μg/l). Both low folate status and depleted Fe stores were significantly associated with anaemia (odds ratio=2·32; 95% CI 1·34, 4·01 and odds ratio=5·98; 95% CI 3·36, 10·63, respectively). Serum folic acid concentration was associated (r=0·108, P=0·015) with folate intake as indicated by a computed folate index. Folate index was associated inversely with household size and positively with economic status and education level. In this study population low folic acid status, besides depleted Fe stores, was associated with anaemia. The high prevalence of low folic acid status observed highlights the need for nutrition education to improve intakes of folate, Fe and other micronutrients among adolescent girls and young women.