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Folate Food Source, Usual Intake, and Folate Status in Korean Adults

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Folate Food Source, Usual Intake, and Folate Status in Korean Adults Nutrition Research and Practice 2018;12(1):47-51 ⓒ2018 The Korean Nutrition Society and the Korean Society of Community Nutrition http://e-nrp.org Folate food source, usual intake, and folate status in Korean adults Young-Nam Kim1 and Youn-Ok Cho2§ 1Department of Food and Nutrition, Songwon University, Gwangju 61756, Korea 2Department of Food and Nutrition, Duksung Women’s University, 33 Samyangro, 114 Gill, Dobonggu, Seoul 01369, Korea BACKGROUND/OBJECTTIVES: The purposes of the study were to investigate folate intakes and plasma folate concentrations as well as estimate folate status in Korean healthy adults. SUBJECTS/METHODS: A total of 254 healthy 19- to 64-year-old adults (68 men and 186 women) living in Seoul metropolitan area, Gumi, and Kwangju, Korea participated. Three consecutive 24-hour dietary recalls, information on folate supplementation, and fasting blood samples were collected from the subjects. RESULTS: The mean dietary folate intakes were 587.4 and 499.2 μg dietary folate equivalent (DFE)/day for men and women, respectively. The median dietary intakes of men and women were 566.6 and 474.6 μg DFE/day, respectively. Forty subjects (16.7% of total) less total folate than the estimated average requirement (EAR). Folate intakes of 23.3% of men and 34.8% of women aged 19-29 years did not meet the EAR for folate. Major food sources consumed for dietary folate were baechukimchi (Chinese cabbage kimchi), rice, spinach, eggs, and laver, which provided 44% of dietary folate intake for the subjects. Plasma folate concentrations were 23.4 nmol/L for men and 28.3 nmol/L for women, and this level was significantly lower in men than in women. Approximately 13% of men and 3% of women were folate-deficient, and the percentages of subjects showing folate concentrations lower than 10 nmol/L were 27.9% of men and 6.4% of women. CONCLUSIONS: Folate intakes of Korean adults in this study were generally adequate. However, one-third of young adults had inadequate folate intakes. Nutrition Research and Practice 2018;12(1):47-51; https://doi.org/10.4162/nrp.2018.12.1.47; pISSN 1976-1457 eISSN 2005-6168 Keywords: Folate, folic acid, nutritional status, dietary reference intake INTRODUCTION6) in which blood folate concentrations were measured as well as data from population-based studies [7]. The use of an Adequate folate intake is important to maintain one-carbon appropriate cutoff is essential to accurately assess folate status. transfer reactions, including synthesis of nucleic acids and A plasma (serum) folate level less than 6.8 nmol/L is commonly amino acid metabolism. Resynthesis of methionine from used a cutoff to assess folate status [1,7,8]. However, in 2005, homocysteine is one of the most folate-dependent reactions the World Health Organization (WHO) Technical Consultation [1]. Inadequate dietary intake is a major factor associated with recommended a new cutoff for possible deficiency on the basis folate deficiency [2]. The primary sign of folate deficiency is of rising plasma homocysteine levels as a metabolic indicator megaloblastic anemia, and folate deficiency can promote (plasma folate concentration < 10 nmol/L) [9,10]. Although the elevation of the blood concentration of homocysteine, which dietary folate intake status of Koreans has been recently is related with cardiovascular disease. Low folate intakes are reported, current population-based studies on the current folate also associated with the development of certain types of cancer, status of Korean adults including biochemical index are limited. including colorectal, prostate, and breast cancer [3-4]. Folate Prior studies conducted in Korea have reported the folate status plays a vital role in mechanisms that mediate the transfer of of non-pregnant women of childbearing age [11], pregnant or one-carbon moieties required for DNA synthesis, stability and lactating women [12-14], university students [5,15], and the integrity, and repair [5]. Folate is widely distributed in foods elderly [16]. The latest study regarding the folate status of such as dark green leafy vegetables, fruits, nuts, liver, and yeast. Korean healthy adults including men was reported in 2001, and Major folate-containing food sources for Koreans have been 13% of Koreans indicated folate deficiency based on plasma reported as kimchi, rice, eggs, laver, spinach, and strawberries folate concentration [17]. Currently, no study has reported the [5,6]. folate status of Korean adults using a metabolic indicator The Dietary Reference Intakes for Koreans include recom- proposed by the WHO. Moreover, as sources of folate may have mendations based on data from controlled metabolic studies changed among younger generations in Korea, it is necessary This research was supported by the 2015 research fund of National Research Foundation of Korea (NRF-2011-0021273). § Corresponding Author: Youn-Ok Cho, Tel. 82-2-901-8376, Fax. 82-2-901-8372, Email. [email protected] Received: October 12, 2017, Revised: December 14, 2017, Accepted: December 15, 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 48 Folate status of Korean adults to evaluate the current diet of adults using dietary intake and and women aged 19-64 years [19]. The quantitative contribu- biomarkers in order to address public health interventions. tions of various foods to the subjects’ daily dietary folate intakes Therefore, the aims of this study were to determine folate were determined, as previously described [20]. The percentage intakes and food sources in adults living in South Korea as well of subjects’ consumption of each major source was also reported. as assess folate status. Blood samples and plasma measurements SUBJECTS AND METHODS After overnight fasting, venous blood was collected from subjects for assessment of folate status. Immediately following Participants blood drawing in an EDTA-containing vacutainer, blood was A total of 275 Korean adults aged 19-64 years were recruited centrifuged for 10 minutes at 3,000 rpm at 5°C. The plasma by advertisement in a convenience sampling of universities, samples were stored at -70°C until analysis. Plasma folate gyms, and welfare centers in the Seoul metropolitan area, concentrations were estimated using a microbiological method Kwangju, and Gumi from 2009 to 2011. All procedures were using Lactobacillus casei (ATCC 7469) with a 96-well microplate approved by the Institutional Review Board of Duksung Women’s reader, and each sample was analyzed in triplicate [21] and University (No. 2011-04-0001). Written informed consent was expressed as nmol/L. The interpretive criterion for plasma folate obtained from all subjects. The participants were interviewed concentration was less than < 6.8 nmol/L for folate deficiency to collect information regarding age, previous and current [9] and a cutoff < 10 nmol/L was also used to indicate folate illnesses, recent changes of appetite and food intake, and deficiency as a metabolic indicator based on the plasma folate medications being taken by well-trained interviewers. Subjects concentration below which total homocysteine becomes with current diagnosed diseases such as diabetes, cancer, elevated [9,10,22]. cardiovascular disease, and kidney disease, subjects taking medications affecting folate metabolism, subjects showing Statistical analyses recent changes appetite and food intake, and subjects that did The subjects were grouped into three age groups: 19-29 not finish their 3-day food recall were excluded; therefore, final years, 30-49 years, and 50-64 years and also grouped by gender. subjects were 253 adults. Characteristics of the participants are Student’s t-test was used to investigate the differences between given in Table 1. men and women in general characteristics. Folate intakes were reported as means ± standard deviations (SD) by age groups Assessment of folate intakes in male and female subjects. One-way ANOVA followed by A 3-day recall method was used to record the dietary intakes Duncan’s multiple range test was used determine differences of the subjects: 2 days during the week and 1 day on the in intake and plasma concentrations of folate among age groups. weekend. Dietary intakes were converted by using the compu- Pearson’s partial correlation coefficient was calculated to terized dietary analysis program Can-pro 4.0 [18]. Subjects were determine possible relationships among folate intakes and asked whether or not they had taken any dietary supplements plasma folate level after controlling for age, gender, body mass within the last 30 days prior to the interviews. Forty-three index, and energy intake [16]. Statistically significant differences subjects (16.9% of total subjects) took supplements containing were considered at P values < 0.05. Statistical analyses were folic acid; therefore, folate intakes in this study were reported performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). as dietary folate and total (dietary plus supplemental) folate. Due to differences in the bioavailability of food folate and folic RESULTS acid, folate intake in this study was expressed as dietary folate equivalents (DFE) [19]. Folate intake of the subjects Table 2 lists folate intakes of Korean adults. Daily dietary folate μg DFE = μg of food folate + (1.7 × μg of folic acid) intakes of men
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