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==Overview==
==Overview==
Folic acid supplementation can prevent folate deficiency in states of increased demand (e.g., pregnancy and lactation) and in conditions with folate malabsorption (e.g., celiac disease) or loss (e.g., chronic hemolytic disorder). Preconception folic acid supplementation in women can also prevent fetal neural tube defects (NTDs).
There are multiple primary ways to reduce the incidence of [[macrocytic anemia]]. Green leafy vegetables, milk, and meat are a good source of [[vitamin B12]]. [[Alcohol]] consumption can lead to [[macrocytic anemia]], so avoidance is a preventive measure.


Pregnancy and lactation
== Prevention ==
 
The following steps can be done to prevent macrocytic anemia:<ref name="pmid26024497">{{cite journal |vauthors=Gille D, Schmid A |title=Vitamin B12 in meat and dairy products |journal=Nutr. Rev. |volume=73 |issue=2 |pages=106–15 |date=February 2015 |pmid=26024497 |doi=10.1093/nutrit/nuu011 |url=}}</ref><ref name="pmid23398393">{{cite journal |vauthors=Sharma S, Sheehy T, Kolonel LN |title=Contribution of meat to vitamin B₁₂, iron and zinc intakes in five ethnic groups in the USA: implications for developing food-based dietary guidelines |journal=J Hum Nutr Diet |volume=26 |issue=2 |pages=156–68 |date=April 2013 |pmid=23398393 |pmc=5023012 |doi=10.1111/jhn.12035 |url=}}</ref><ref name="pmid20607069">{{cite journal |vauthors=Kwak CS, Lee MS, Lee HJ, Whang JY, Park SC |title=Dietary source of vitamin B(12) intake and vitamin B(12) status in female elderly Koreans aged 85 and older living in rural area |journal=Nutr Res Pract |volume=4 |issue=3 |pages=229–34 |date=June 2010 |pmid=20607069 |pmc=2895704 |doi=10.4162/nrp.2010.4.3.229 |url=}}</ref><ref name="pmid24300642">{{cite journal |vauthors=Metz J |title=Haematological implications of folate food fortification |journal=S. Afr. Med. J. |volume=103 |issue=12 Suppl 1 |pages=978–81 |date=October 2013 |pmid=24300642 |doi=10.7196/samj.7022 |url=}}</ref><ref name="pmid9040515">{{cite journal |vauthors=Swain RA, St Clair L |title=The role of folic acid in deficiency states and prevention of disease |journal=J Fam Pract |volume=44 |issue=2 |pages=138–44 |date=February 1997 |pmid=9040515 |doi= |url=}}</ref>
Evidence suggests that folic acid supplementation during pregnancy reduces megaloblastic anemia in mothers, but there is no conclusive evidence it has any beneficial effect on pregnancy outcomes, such as preventing premature birth, stillbirth, neonatal mortality, or miscarriage. [35] [36]
*Dietary modification: Green leafy vegetables, milk, and meat are a good source of [[vitamin B12]].
 
*[[Alcohol]] abstinence: [[Alcohol]] consumption can lead to [[macrocytic anemia]]<ref name="pmid9715215">{{cite journal |vauthors=Fernando OV, Grimsley EW |title=Prevalence of folate deficiency and macrocytosis in patients with and without alcohol-related illness |journal=South. Med. J. |volume=91 |issue=8 |pages=721–5 |date=August 1998 |pmid=9715215 |doi= |url=}}</ref>. The combination of poor nutritional intake and excess alcohol consumption can cause megaloblastic anemia.
There is conclusive evidence that use of folic acid supplementation preconceptually and during pregnancy can prevent fetal NTDs. [26] [37] [38] Therefore, preconception folic acid supplementation is recommended at a dose of 400-800 micrograms/day for women who are planning to or are capable of becoming pregnant, with higher doses (up to 4 mg/day) recommended for certain risk groups. [27] [28] [29]  For maximal protection against fetal NTDs, the optimal calculated red blood cell folate level is 442-574 nanograms/mL at the end of the first 4 weeks of pregnancy, when neural tube closure is achieved. [39] The oral intake of folate to achieve these folate levels will vary significantly depending upon diet, folic acid fortification, socioeconomic status, and individual medical history. [US Dept of Agriculture/US Dept of Health and Human Services: dietary guidelines for Americans] [NIH: dietary supplement fact sheet - folate]
==References==
 
A review of European guidelines found large variations in recommendations for periconceptional folic acid supplementation, including when to begin supplementation. [40] However, there were no recommendations that supplementation should begin at 3 months prior to conception, which is recommended by some guidelines outside of Europe (e.g., Canada and Australia). [27] [41] The US Preventive Services Task Force advises that the critical period for beginning supplementation is at least 1 month before conception. [28]
 
Canadian guidelines use the following risk stratification for women at risk for a fetal NTD or other folic acid-sensitive congenital anomaly: [27]
 
Low risk: no personal or family history of fetal NTD or folate-related congenital abnormalities
 
Medium risk: family history of fetal NTD; personal history in the patient or male partner of folate-related congenital abnormality; or diabetes, teratogenic medication, or malabsorption in the patient
 
High risk: personal history of fetal NTD in the patient or her male partner; or previous fetal NTD birth by the patient.
 
The recommended dietary allowance (RDA) for folate during pregnancy and lactation varies from 400-600 micrograms/day depending upon factors such as diet, folic acid fortification, socioeconomic status, and individual medical history. [US Dept of Agriculture/US Dept of Health and Human Services: dietary guidelines for Americans] [NIH: dietary supplement fact sheet - folate]
 
Folate malabsorption and loss
 
Correction of the underlying cause and/or folic acid supplementation can prevent folate deficiency in patients with malabsorptive disorders, such as tropical sprue and celiac disease (nontropical sprue).
 
Increased folate loss occurs in patients with chronic hemolytic disorder (due to increased cell turnover), and in those undergoing chronic dialysis (due to loss of folate in dialysis fluid). Daily folic acid supplementation is required in these patients to prevent folate deficiency.
 
Patients taking drugs that interfere with folate absorption and metabolism (e.g., methotrexate, pyrimethamine, and trimethoprim) may require supplementation with oral or parenteral leucovorin to prevent folate deficiency. In some cases, where a drug has reduced efficacy when administered with leucovorin, a change to another drug may be required.==References==
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Latest revision as of 00:06, 3 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Omer Kamal, M.D.[3]

Overview

There are multiple primary ways to reduce the incidence of macrocytic anemia. Green leafy vegetables, milk, and meat are a good source of vitamin B12. Alcohol consumption can lead to macrocytic anemia, so avoidance is a preventive measure.

Prevention

The following steps can be done to prevent macrocytic anemia:[1][2][3][4][5]

  • Dietary modification: Green leafy vegetables, milk, and meat are a good source of vitamin B12.
  • Alcohol abstinence: Alcohol consumption can lead to macrocytic anemia[6]. The combination of poor nutritional intake and excess alcohol consumption can cause megaloblastic anemia.

References

  1. Gille D, Schmid A (February 2015). "Vitamin B12 in meat and dairy products". Nutr. Rev. 73 (2): 106–15. doi:10.1093/nutrit/nuu011. PMID 26024497.
  2. Sharma S, Sheehy T, Kolonel LN (April 2013). "Contribution of meat to vitamin B₁₂, iron and zinc intakes in five ethnic groups in the USA: implications for developing food-based dietary guidelines". J Hum Nutr Diet. 26 (2): 156–68. doi:10.1111/jhn.12035. PMC 5023012. PMID 23398393.
  3. Kwak CS, Lee MS, Lee HJ, Whang JY, Park SC (June 2010). "Dietary source of vitamin B(12) intake and vitamin B(12) status in female elderly Koreans aged 85 and older living in rural area". Nutr Res Pract. 4 (3): 229–34. doi:10.4162/nrp.2010.4.3.229. PMC 2895704. PMID 20607069.
  4. Metz J (October 2013). "Haematological implications of folate food fortification". S. Afr. Med. J. 103 (12 Suppl 1): 978–81. doi:10.7196/samj.7022. PMID 24300642.
  5. Swain RA, St Clair L (February 1997). "The role of folic acid in deficiency states and prevention of disease". J Fam Pract. 44 (2): 138–44. PMID 9040515.
  6. Fernando OV, Grimsley EW (August 1998). "Prevalence of folate deficiency and macrocytosis in patients with and without alcohol-related illness". South. Med. J. 91 (8): 721–5. PMID 9715215.

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