Skip to main content
SpringerLink
Log in

Folate and Vitamin B12 Deficiency Among Non-pregnant Women of Childbearing-Age in Guatemala 2009–2010: Prevalence and Identification of Vulnerable Populations

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Introduction

Information on folate and vitamin B12 deficiency rates in Guatemala is essential to evaluate the current fortification program. The objectives of this study were to describe the prevalence of folate and vitamin B12 deficiencies among women of childbearing age (WCBA) in Guatemala and to identify vulnerable populations at greater risk for nutrient deficiency.

Methods

A multistage cluster probability study was designed with national and regional representation of nonpregnant WCBA (15–49 years of age). Primary data collection was carried out in 2009–2010. Demographic and health information was collected through face-to-face interviews. Blood samples were collected from 1473 WCBA for serum and red blood cell (RBC) folate and serum vitamin B12. Biochemical concentrations were normalized using geometric means. Prevalence rate ratios were estimated to assess relative differences among different socioeconomic and cultural groups including ethnicity, age, education level, wealth index and rural versus urban locality.

Results

National prevalence estimates for deficient serum [<10 nmol per liter (nmol/L)] and RBC folate (<340 nmol/L) concentrations were 5.1 % (95 % CI 3.8, 6.4) and 8.9 % (95 % CI 6.7, 11.7), respectively; for vitamin B12 deficiency (<148 pmol/L) 18.5 % (95 % CI 15.6, 21.3). Serum and RBC folate deficiency prevalences were higher for rural areas than for urban areas (8.0 vs. 2.0 % and 13.5 vs. 3.9 %, respectively). The prevalence of RBC folate deficiency showed wide variation by geographic region (3.2–24.9 %) and by wealth index (4.1–15.1 %). The prevalence of vitamin B12 deficiency also varied among regions (12.3–26.1 %).

Conclusions

In Guatemala, folate deficiency was more prevalent among indigenous rural and urban poor populations. Vitamin B12 deficiency was widespread among WCBA. Our results suggest the ongoing need to monitor existing fortification programs, in particular regarding its reach to vulnerable populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Yip, R., & Ramakrishnan, U. (2002). Experiences and challenges in developing countries. Journal of Nutrition, 132, 827S–830S.

    CAS  PubMed  Google Scholar 

  2. Black, R. E., Allen, L. H., Bhutta, Z. A., et al. (2008). Maternal and child undernutrition: global and regional exposures and health consequences. Lancet, 371(9608), 243–260.

    Article  PubMed  Google Scholar 

  3. Best, C., Neufingerl, N., Del Rosso, J. M., et al. (2011). Can multi-micronutrient food fortification improve the micronutrient status, growth, health and cognition of schoolchildren? A systematic review. Nutrition Reviews, 69(4), 186–204.

    Article  PubMed  Google Scholar 

  4. Shekar, M., Heaver, R., & Lee, Y. K. (2006). Repositioning nutrition as central to development. A strategy for large-scale action. Washington, DC: The International Bank for Reconstruction and Development/The World Bank.

    Google Scholar 

  5. Molloy, A. N., Kirke, P. N., Troendle, J. F., et al. (2009). Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defect prevalence and no folic acid fortification. Pediatrics, 123, 917–923.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Cordero, J. F., Do, A., & Berry, R. J. (2008). Review of interventions for the prevention and control of folate and vitamin B12 deficiencies. Food & Nutrition Bulletin, 29(Suppl 2), S188–S195.

    Google Scholar 

  7. Wald, D. S., Law, M., & Morris, J. K. (2002). Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. BMJ, 325, 1202–1209.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Ward, M., McNulty, H., Mc, Partlin J., et al. (1997). Plasma homocystein, a risk factor for cardiovascular disease, is lowered by physiological doses of folic acid. QJM, 90, 519–524.

    Article  CAS  PubMed  Google Scholar 

  9. Allen, L. H. (2004). Folate and vitamin B12 status in the Americas. Nutrition Reviews, 62, S29–S34.

    Article  PubMed  Google Scholar 

  10. David, J. L. (2004). Wheat flour fortification in Latin America and the Caribbean Region. Nutrition Reviews, 31(3), 336–347.

    Google Scholar 

  11. Sistema Integrado de Centro America (SICA) (2002). Reglamento Técnico Centroamericano RTCA 67.01.15:06 Harinas, Harina de Trigo Fortificada Especificaciones. Available at: http://www.hondurassiexporta.hn/herramientas-usa/wp-content/uploads/2012/05/reglamento-tecnico-centroamericano-harinas-harinas-de-trigo-fortificadas-especificaciones.pdf.

  12. Ramirez, N. (2009). Reporte regional de reglamentos de fortificacion de harina de trigo, maiz y arroz. Proyecto centroamericano de acido folico y otros micronutrients y la prevencion de los defectos del tubo neural y otras deficiencias por micronutrients. Fundacion de Alimentos y Nutricion de Centroamerica y Panama.

  13. Imhoff-Kunsch, B., Flores, R., Dary, O., et al. (2007). Wheat flour fortification is unlikely to benefit the neediest in Guatemala. Journal of Nutrition, 137, 1017–1022.

    CAS  PubMed  Google Scholar 

  14. World Bank (2009). Guatemala—Evaluación de la pobreza. Washington DC—The World Bank. Available at http://documents.worldbank.org/curated/en/2009/03/10792680/guatemala-poverty-assessment-good-performance-low-levels-guatemala-evaluacion-de-la-pobreza-buen-desempeno-bajo-nivel.

  15. Ministerio de Salud Pública y Asistencia Pública, Guatemala. (2012). V Encuesta Nacional de Salud Materno Infantil 2008-2010. Guatemala: Ciudad de Guatemala.

    Google Scholar 

  16. Rutstein, S. O., & Johnson, K. (2004). DHS comparative reports 6: The DHS wealth index. Calverton, Maryland: MEASURE DHS.

    Google Scholar 

  17. O’Broin, S. D., Kelleher, B. P., Davoren, A., et al. (1997). Field-study screening of blood folate concentrations: Specimen stability and finger-stick sampling. American Journal of Clinical Nutrition, 66, 1398–1405.

    PubMed  Google Scholar 

  18. Pfeiffer, C. M., Zhang, M., Lacher, D. A., et al. (2011). Comparison of serum and red blood cell folate microbiologic assays for national population surveys. Journal of Nutrition, 141, 1402–1409.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. World Health Organization (2012). Serum and red blood cell folate concentrations for assessing folate status in populations. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization. Available at http://apps.who.int/iris/bitstream/10665/75584/1/WHO_NMH_NHD_EPG_12.1_eng.pdf (Accessed January 15, 2013).

  20. Allen, L. H. (2009). How common is vitamin B-12 deficiency. American Journal of Clinical Nutrition, 89(suppl), 693S–696S.

    Article  CAS  PubMed  Google Scholar 

  21. McLean, E., de Benoist, B., & Allen, L. H. (2008). Review of the magnitude of folate and vitamin B12 deficiencies worldwide. Food & Nutrition Bulletin, 29(suppl 2), S38–S51.

    Google Scholar 

  22. Bieler, G. S., Brown, G. G., Williams, R. L., et al. (2010). Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data. American Journal of Epidemiology, 171, 618–623.

    Article  PubMed  Google Scholar 

  23. Santos, C. A., Fiaccone, R. L., Oliveira, N. F., et al. (2008). Estimating adjusted prevalence ratio in clustered cross-sectional epidemiological data. MMC Medical Research Methodology, 8, 80–89.

    Article  Google Scholar 

  24. Wolter K.M. (2007). Taylor series methods. In Introduction to Variance Estimation. Statistics for Social and Behavioral Sciences, 2nd ed, pp. 226–268 (SE Fienberg and WJ van der Linden, editors). Springer Science.

  25. Ministerio de Salud Pública y Asistencia Social, Republica Dominicana. (2011). Encuesta Nacional de Micronutrientes. República Dominicana: Ciudad de Santo Domingo.

    Google Scholar 

  26. Ministerio de Salud de Nicaragua (2011). Avances de resultados 2010 del Sistema Integrado de Vigilancia de Intervenciones Nutricionales (SIVIN). Nicaragua.

  27. Pfeiffer, C. M., Hughes, J. P., Lacher, D. A., et al. (2012). Estimation of trends in serum and RBC folate in the U.S. population from pre- and post-fortification using assay-adjusted data from the NHANES 1988-2010. J Ntr, 142, 886–893.

    CAS  Google Scholar 

  28. Pfeiffer C.M., Johnson C.L., Jain R.B., et al. (2007). Trends in blood folate and vitamin B12 concentrations in the United States, 1988–2004. Am J Clin Nutr 86,718–727. Supplemental tables: http://ajcn.nutrition.org/content/suppl/2007/09/07/86.3.718.D.

  29. Suarez, L., Hendricks, K., Felkner, M., et al. (2003). Maternal serum B12 levels and risk of neural tube defects in a Texas-Mexico border population. Annals of Epidemiology, 13, 81–88.

    Article  PubMed  Google Scholar 

  30. Ministerio de Salud, Costa Rica (2012). Encuesta Nacional de Nutrición 2008–2009. San Jose, Costa Rica. Accessed on March 2013. Available at: http://www.ministeriodesalud.go.cr/index.php/gestores-salud-tecno-ciencia-encuetas-ms.

  31. Anaya-Loyola, M. A., Rosado-Loria, J. L., & Allen, L. H. (2007). Vitamin B12 deficiency is prevalent and associated with serum gastrin in rural Mexican women. Journal of Nutrition, 21, 241.

    Google Scholar 

  32. Allen, L. H. (2008). Causes of vitamin B12 and folate deficiency. Food Nutr Bull, 29(Suppl 1), 20–34.

    Google Scholar 

  33. Allen, L. H. (2002). Impact of vitamin B12 deficiency during lactation on maternal and infant Health. Advances in Experimental Medicine and Biology, 503, 57–67.

    Article  CAS  PubMed  Google Scholar 

  34. Hertrampf, E., & Cortes, F. (2008). National food fortification program with folic acid in Chile. Food Nutr Bull, 29, S231–S237.

    PubMed  Google Scholar 

  35. Hertrampf, E., Cortes, F., Erickson, J. D., et al. (2003). Consumption of folic acid-fortified bread improves folate status in women of reproductive age in Chile. Journal of Nutrition, 133, 3166–3169.

    CAS  PubMed  Google Scholar 

  36. Arguello, M. P., & Umaña, L. (2011). Impacto de la fortificación de alimentos con ácido fólico en los defectos del tubo neural en Costa Rica. Rev Panam Salud Pública, 30, 1–6.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, MS-86, Atlanta, GA, 30333, USA

    Jorge Rosenthal, Nicole F. Dowling, Joe Mulinare & Claudia Vellozzi

  2. Guatemala Ministerio de Salud Pública y Asistencia Pública, Guatemala City, Guatemala

    Eunice Lopez-Pazos & Nicte Ramirez

  3. National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Christine M. Pfeiffer, Mindy Zhang & Donna J. Lavoie

  4. Universidad del Valle de Guatemala, Guatemala City, Guatemala

    Roberto Molina

  5. Fundación de Alimentos y Nutrición de Centro América y Panamá (FANCAP), Guatemala City, Guatemala

    Nicte Ramirez

  6. Global Maternal and Preconception Health Consultant, Healdsburg, CA, USA

    Mary-Elizabeth Reeve

Authors
  1. Jorge Rosenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eunice Lopez-Pazos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicole F. Dowling
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christine M. Pfeiffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joe Mulinare
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Claudia Vellozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mindy Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Donna J. Lavoie
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Roberto Molina
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Nicte Ramirez
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mary-Elizabeth Reeve
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jorge Rosenthal.

Additional information

The findings and conclusions in this report are those of the authors and do not necessarily represent the official views or positions of the Centers for Disease Control and Prevention.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rosenthal, J., Lopez-Pazos, E., Dowling, N.F. et al. Folate and Vitamin B12 Deficiency Among Non-pregnant Women of Childbearing-Age in Guatemala 2009–2010: Prevalence and Identification of Vulnerable Populations. Matern Child Health J 19, 2272–2285 (2015). https://doi.org/10.1007/s10995-015-1746-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-015-1746-6

Keywords

Search

Navigation