WordNet

street name for lysergic acid diethylamide (同)back breaker, battery-acid, dose, dot, Elvis, loony toons, Lucy in the sky with diamonds, pane, superman, window pane, Zen
any of various water-soluble compounds having a sour taste and capable of turning litmus red and reacting with a base to form a salt
having the characteristics of an acid; "an acid reaction"

PrepTutorEJDIC

〈U〉〈C〉(…の)(量・額などの)不足,欠乏《+『of』(『in』)+『名』》 / 〈C〉不足分,不足量,不足額 / 〈C〉(精神・肉体などの)欠陥
酸性の / 酸味のある,すっぱい(sour) / (言葉・態度などが)厳しい,しんらつな / 酸 / すっぱいもの / 《俗》=LSD

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/05/05 21:09:03」(JST)

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Folate deficiency is a low level of folate (and not necessarily a low level of folic acid ) in the body. Also known as vitamin B9, it is one of the B group vitamins. Adequate folate should be present in a person's diet. Signs of Folate deficiency are often subtle. Anemia is a late finding in folate deficiency. Folate deficiency anemia is the term given for this medical condition.^[1]

Symptoms

Loss of appetite and weight loss can occur. Additional signs are weakness, sore tongue, headaches, heart palpitations, irritability, and behavioral disorders.^[2]

In adults, anemia (macrocytic, megaloblastic anemia) can be a sign of advanced folate deficiency.

In infants and children, folate deficiency can slow growth rate. Women with folate deficiency who become pregnant are more likely to give birth to low birth weight and premature infants, and infants with neural tube defects.

Late studies suggested an involvement in tumorogenesis (especially in colon) through demethylation/hypomethylation of fast replicating tissues.

Some of the symptoms can also result from a variety of medical conditions other than folate deficiency. It is important to have a physician evaluate these symptoms so that appropriate medical care can be given.

Depression

Studies suggest that folate and vitamin B₁₂ status may play a role in depression.^[3] The role of vitamin B₁₂ and folate in depression is due to their role in transmethylation reactions, which are crucial for the formation of neurotransmitters (e.g. serotonin, epinephrine, nicotinamides, purines, phospholipids).^[3]^[4]

Low levels of folate or vitamin B₁₂ can disrupt transmethylation reaction, leading to an accumulation of homocysteine (hyperhomocisteinemia) and to impaired metabolism of neurotransmitters (especially the hydroxylation of dopamine and serotonin from tyrosine and tryptophan), phospholipids, myelin, and receptors. Hyperhomocysteinemia could also lead to vascular injuries by oxidative mechanisms which can contribute to cerebral dysfunction. All of these can lead to the development of various disorders, including depression.^[3]^[4]

Low plasma B₁₂ and low plasma folate has been found in studies of depressive patients. Furthermore, some studies have shown that low folate levels are linked to a poor response of antidepressant treatment, and other studies also suggest that a high vitamin B₁₂ status may be associated with better treatment outcomes. Therefore, not only does adequate consumption of these two vitamins help decrease the risks of developing depression, but they can also help in the treatment of depression when antidepressant drugs are used. ^[3]^[4]

Causes

A deficiency of folate can occur when the body's need for folate is increased, when dietary intake of folate is inadequate, or when the body excretes (or loses) more folate than usual. Medications that interfere with the body's ability to use folate may also increase the need for this vitamin.^[5]^[6]^[7]^[8]^[9]^[10] Some research indicates that exposure to ultraviolet light, including the use of tanning beds, can lead to a folic acid deficiency. [1]

Additionally, a defect in homocysteine methyltransferase or a deficiency of B-12 may lead to a so-called "methyl-trap" of tetrahydrofolate (THF), in which THF is converted to a reservoir of methyl-THF which thereafter has no way of being metabolized, and serves as a sink of THF that causes a subsequent deficiency in folate.^[11] Thus, a deficiency in B-12 can generate a large pool of methyl-THF that is unable to undergo reactions and will mimic folate deficiency.

Folate (pteroylmonoglutamate) is absorbed throughout the small intestine, binding to specific receptor proteins. Diffuse inflammatory or degenerative diseases of small intestine like Crohn's disease, coeliac disease, chronic enteritis or entero-enteric fistulae may reduce activity of pteroyl polyglutamase (PPGH), a specific hydrolase required for the purpose, and thereby reduce folate absorption leading to folate deficiency. Folate deficiency does not occur after resection of the terminal ileum as rest of small intestine is preserved.

Situational

Some situations that increase the need for folate include:

certain anemias
kidney dialysis
liver disease
malabsorption, including celiac disease
pregnancy and lactation (breastfeeding)
tobacco smoking
alcohol consumption

Pharmacological

Medications can interfere with folate utilization, including:

anticonvulsant medications (such as phenytoin, primidone, carbamazepine or valproate )
metformin (sometimes prescribed to control blood sugar in type 2 diabetes)
methotrexate, an anti-cancer drug also used to control inflammation associated with Crohn's disease, ulcerative colitis and rheumatoid arthritis.
sulfasalazine (used to control inflammation associated with Crohn's disease, ulcerative colitis and rheumatoid arthritis)
triamterene (a diuretic)
oral contraceptives

When methotrexate is prescribed, folic acid supplements are sometimes given with the methotrexate. The purpose of methotrexate is to inhibit dihydrofolate reductase and thereby reduce the rate de novo purine and pyrimidine synthesis and cell division. Folate supplementation is beneficial in patients being treated with long-term, low-dose methotrexate for rheumatoid arthritis (RA) or psoriasis to avoid macrocytic anemia caused by folic acid deficiency. However, it is counter-productive to take a folic acid supplement with methotrexate in cancer treatment.^[12] Although the folic acid inhibition of methotrexate is normally seen as a side effect in Rheumatoid Arthritis, it is a part of the therapeutic effect of the drug in cancer. Methotrexate inhibits cell division and is particularly toxic to fast dividing cells, such as rapidly dividing cancer cells. It would therefore be wise to consult with a physician before taking a folic acid supplement while concurrently prescribed methotrexate.

Prevention and treatment

When cooking, use of steaming or of a food steamer can help keep more folate content in the cooked foods, thus helping to prevent folate deficiency (see USDA reference in the steaming article).

Folate deficiency during human pregnancy has been associated with an increased risk of infant neural tube defects. Such deficiency during the first four weeks of gestation can result in structural and developmental problems. NIH guidelines^[13] recommend oral B vitamin supplements to decrease these risks near the time of conception and during the first month of pregnancy.

References

^ Huether, Sue; McCance, Kathryn (2004). "20". Understanding Pathophysiology (3rd ed.). Mosby. p. 543. ISBN 0-323-02368-1.
^ Haslam N and Probert CS. (1998). "An audit of the investigation and treatment of folic acid deficiency". Journal of the Royal Society of Medicine 91 (2): 72–3. PMC 1296488. PMID 9602741.
^ ^a ^b ^c ^d Coppen A, Bolander-Gouaille C. (2005). "Treatment of depression: time to consider folic acid and vitamin B₁₂.". J Psychopharmacol 19 (1): 59–65. doi:10.1177/0269881105048899. PMID 15671130.
^ ^a ^b ^c Karakuła H, Opolska A, Kowal A, Domański M, Płotka A, Perzyński J. (2009). "Does diet affect our mood? The significance of folic acid and homocysteine". Pol Merkur Lekarski 26 (152): 136–41. PMID 19388520.
^ Oakley GP Jr, Adams MJ, Dickinson CM (1996). "More folic acid for everyone, now". Journal of Nutrition 126 (3): 751S–755S. PMID 8598560.
^ McNulty H (1995). "Folate requirements for health in different population groups". British Journal of Biomedical Science 52 (2): 110–9. PMID 8520248.
^ Stolzenberg R (1994). "Possible folate deficiency with postsurgical infection". Nutrition in Clinical Practice 9 (6): 247–50. doi:10.1177/0115426594009006247. PMID 7476802.
^ Pietrzik KF and Thorand B (1997). "Folate economy in pregnancy". Nutrition 13 (11–12): 975–7. doi:10.1016/S0899-9007(97)00340-7. PMID 9433714.
^ Kelly GS (1998). "Folates: Supplemental forms and therapeutic applications". Altern Med Rev 3 (3): 208–20. PMID 9630738.
^ Cravo ML, Gloria LM, Selhub J, Nadeau MR, Camilo ME, Resende MP, Cardoso JN, Leitao CN, Mira FC (1996). "Hyperhomocysteinemia in chronic alcoholism: correlation with folate, vitamin B-12, and vitamin B-6 status". The American journal of clinical nutrition 63 (2): 220–4. PMID 8561063.
^ Hoffbrand, AV; Weir, DG (2001). "The history of folic acid". Br J Haematol 113 (3): 579–589. doi:10.1046/j.1365-2141.2001.02822.x. PMID 11380441.
^ "Mayo Clinic - Folate".
^ NIH Dietary Supplement Fact Sheet: Folate url=http://ods.od.nih.gov/factsheets/folate.asp

External links

496631815 at GPnotebook

UpToDate Contents

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1. ビタミンB12および葉酸欠乏症の診断および治療 diagnosis and treatment of vitamin b12 and folic acid deficiency
2. ビタミンB12および葉酸欠乏症の病因および臨床症状 etiology and clinical manifestations of vitamin b12 and folic acid deficiency
3. ビタミンB12および葉酸欠乏症の生理学 physiology of vitamin b12 and folic acid deficiency
4. 無脳症 anencephaly
5. アルコール乱用と血液疾患 alcohol abuse and hematologic disorders

English Journal

The role of dietary supplements in inflammatory bowel disease: a systematic review.

Rossi RE1, Whyand T, Murray CD, Hamilton MI, Conte D, Caplin ME.
European journal of gastroenterology & hepatology.Eur J Gastroenterol Hepatol.2016 Dec;28(12):1357-1364.
Inflammatory bowel diseases (IBD) are chronic immune disorders of unclear aetiology. Dietary deficiencies may be a potential pathogenic factor in their development. Patients often take food supplements without knowledge of any evidence base. We have therefore assessed the evidence for food supplemen
PMID 27769076

Comparative Assessment of Vitamin-B12, Folic Acid and Homocysteine Levels in Relation to p53 Expression in Megaloblastic Anemia.

Yadav MK1, Manoli NM1, Madhunapantula SV2.
PloS one.PLoS One.2016 Oct 25;11(10):e0164559. doi: 10.1371/journal.pone.0164559. eCollection 2016.
BACKGROUND: Megaloblastic anemia (MBA), also known as macrocytic anemia, is a type of anemia characterized by decreased number of RBCs as well as the presence of unusually large, abnormal and poorly developed erythrocytes (megaloblasts), which fail to enter blood circulation due to their larger size
PMID 27780269

Nutrient Intake Is Insufficient among Senegalese Urban School Children and Adolescents: Results from Two 24 h Recalls in State Primary Schools in Dakar.

Fiorentino M1, Landais E2, Bastard G3, Carriquiry A4, Wieringa FT5, Berger J6.
Nutrients.Nutrients.2016 Oct 20;8(10). pii: E650.
Due to rapid urbanization and high food prices and in the absence of nutrition programs, school children from urban areas in West Africa often have insufficient and inadequate diet leading to nutrient deficiencies that affect their health and schooling performance. Acute malnutrition and micronutrie
PMID 27775598

Japanese Journal

Supplementation with carnitine reduces the severity of constipation: a retrospective study of patients with severe motor and intellectual disabilities

Ｊｏｕｒｎａｌ　ｏｆ　Ｃｌｉｎｉｃａｌ　Ｂｉｏｃｈｅｍｉｓｔｒｙ　ａｎｄ　Ｎｕｔｒｉｔｉｏｎ 60(2), 121-124, 2017
NAID 130005398597

Periconceptional folic acid supplementation and vitamin B<sub>12</sub> status in a cohort of Chinese early pregnancy women with the risk of adverse pregnancy outcomes

Ｊｏｕｒｎａｌ　ｏｆ　Ｃｌｉｎｉｃａｌ　Ｂｉｏｃｈｅｍｉｓｔｒｙ　ａｎｄ　Ｎｕｔｒｉｔｉｏｎ 60(2), 136-142, 2017
NAID 130005398536

Alcoholic Myelopathy and Nutritional Deficiency

Internal Medicine 56(1), 105-108, 2017
NAID 130005239492

Related Pictures

★リンクテーブル★

リンク元	「葉酸欠乏症」
拡張検索	「folic acid deficiency following gastric surgery」「postgastrectomy folic acid deficiency」
関連記事	「deficiency」

「葉酸欠乏症」

Folate deficiency
	Classification and external resources
	Folic acid (B9)
ICD-10	D52 E53.8
ICD-9	266.2
DiseasesDB	4894
MedlinePlus	000354
eMedicine	med/802
MeSH	D005494

　　[★]

英: folic acid deficiency
関: 葉酸欠乏、葉酸

原因

HIM.649

1. 食事

[高頻度]老人、幼児、貧困、アルコール中毒、病弱、精神障害(psychiatrically disturbed)
[可能性]壊血病やクワシオコワ(kwashiorkor)

2. 吸収不良(malabsorption)

メジャーな原因

熱帯スプルー、グルテン腸症、疱疹状皮膚炎にともなうもの、葉酸特異的な吸収不良、重度のコバラミン・葉酸欠乏による腸性巨赤芽球症

マイナーな原因

広範囲腸切除、クローン病、胃部分切除、うっ血性心不全、ウィップル病、強皮症、アミロイドーシス、糖尿病性腸症、全身性細菌感染症、リンパ腫、サラゾスルファピリジン

3. 過剰な生体内利用あるいは喪失

生理的

妊娠、授乳、未熟児

病的

血液学的疾患：慢性溶血性貧血、鎌状赤血球貧血、thalassemia major(βサラセミア)
悪性疾患：癌腫、リンパ腫、白血病、骨髄腫
炎症性疾患：結核、クローン病、感染、剥脱性皮膚炎、マラリア
代謝性疾患：ホモシスチン症
尿からの過剰消失：うっ血性心不全、活動性肝疾患
その他：血液交換、腹膜透析

4. 抗葉酸薬

抗痙攣薬(フェニトイン、primidone, バルビツール酸)、サラゾスルファピリジン、ニトロフラントイン、テトラサイクリン、抗結核薬(あまり記載がない)

5. 複合要因Mixed causes

肝疾患、アルコール中毒、ICU

「folic acid deficiency following gastric surgery」

　　[★] 胃切除後葉酸欠乏症

「postgastrectomy folic acid deficiency」