Epidemiology

The prevalence and the magnitude of folate deficiency across the world are variable. The condition occurs commonly in countries without folic acid fortification of cereal-grain products, and rarely in countries with folic acid fortification.[3][4][5]

Several national surveys have shown that folate deficiency can be a public health problem in the absence of fortification. The primary age groups affected include preschool children (33.8% of the folate-deficient population in Venezuela), pregnant women (48.8% in Costa Rica and 25.5% in Venezuela), and older people (15% in the UK).[3] One large review of global folate deficiency in women of reproductive age, who are at increased risk of neural tube defect-affected pregnancies when maternal folate levels are low, reported folate deficiency <5% in higher-income countries and >20% in many low-income countries.[5] 

Mandatory folic acid fortification of enriched cereal-grain products was initiated in the US in 1996 and Canada in 1998. Subsequently, surveys of regional and nationally representative populations have shown that serum and red blood cell folate concentrations have increased in the general population in these countries.[6][7]

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