Folatunderskudd

Folatunderskudd, or folate deficiency, refers to an insufficient level of folate (vitamin B9) in the body. Folate is essential for DNA synthesis, cell division and growth, and is especially important during periods of rapid development such as pregnancy. Folate exists naturally in foods; folic acid is the synthetic form used in supplements and food fortification.

Causes of folate deficiency include inadequate dietary intake, malabsorption disorders (for example celiac disease or inflammatory bowel disease), malnutrition, and increased requirements during pregnancy, infancy, or illness. Alcohol misuse, certain medications (such as methotrexate, anticonvulsants like phenytoin and valproate, metformin, and some proton pump inhibitors), and dialysis can contribute to reduced folate levels.

Symptoms and signs are often nonspecific and can include fatigue, pallor, weakness, irritability, shortness of breath, and glossitis. In severe cases, macrocytic or megaloblastic anemia may develop. In pregnant individuals, folate deficiency increases the risk of neural tube defects in the fetus, particularly in early pregnancy.

Diagnosis typically involves blood tests showing low folate levels in serum or red blood cells, macrocytosis on a complete blood count, and elevated homocysteine. It is important to assess vitamin B12 status to distinguish deficiency types, as folate supplementation can mask B12 deficiency symptoms.

Treatment focuses on replenishing folate and treating underlying causes. Adults are commonly given 400–1000 micrograms of folic acid daily, with higher doses (up to 5 mg daily) used for severe deficiency. Pregnant individuals are advised 600–800 micrograms daily. Concurrent assessment and treatment of B12 deficiency are important. Prevention includes dietary intake of leafy greens, legumes, fortified grains, and the use of prenatal vitamins in pregnancy; many countries also use food fortification to reduce risk.