Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
권호 표지
DOI QR코드

DOI QR Code

Folate: 2020 Dietary reference intakes and nutritional status of Koreans

엽산: 2020 영양소 섭취기준과 한국인의 영양상태

  • Han, Young-Hee (Department of Food and Nutrition, Chungbuk National University) ;
  • Hyun, Taisun (Department of Food and Nutrition, Chungbuk National University)
  • Received : 2022.05.16
  • Accepted : 2022.06.17
  • Published : 2022.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Folate, a water-soluble vitamin, acts as a coenzyme for one-carbon metabolism in nucleic acid synthesis and amino acid metabolism. Adequate folate nutritional status during the periconceptional period is known to prevent neural tube defects. In addition, insufficient folate intake is associated with various conditions, such as anemia, hyperhomocysteinemia, cardiovascular disease, cancer, cognitive impairment, and depression. This review discusses the rationale for the revision of the 2020 Korean dietary reference intakes for folate, and suggestions for future revisions. Based on the changes in the standard body weight in 2020, the adequate intake (AI) for infants (5-11 months) and the estimated average requirements (EARs) for 15-18 years of age were revised, but there were no changes in the recommended nutrient intakes (RNIs) and tolerable upper intake levels (ULs) for all age groups. Mean folate intake did not reach RNI in most age groups and was particularly low in women aged 15-29 years, according to the results of the 2016-2018 Korea National Health and Nutrition Examination Survey (KNHANES). The percentages of folate intake to RNI were lower than 60% in pregnant and lactating women, but serum folate concentrations were higher than those in other age groups, presumably due to the use of supplements. Therefore, total folate intake, from both food and supplements, should be evaluated. In addition, the database of folate in raw, cooked, and fortified foods should be further expanded to accurately assess the folate intake of Koreans. Determination of the concentrations of erythrocyte folate and plasma homocysteine as well as serum folate is recommended, and quality control of the analysis is critical.

엽산은 비타민 B군에 속하는 수용성 비타민으로, 핵산 합성과 아미노산 대사에서 단일탄소를 전달해 주는 반응의 조효소 역할을 한다. 엽산은 새로운 세포가 형성되어 성장하는 임신기와 성장기에 매우 중요한 영양소이며, 여성의 임신 전 적절한 엽산 영양상태는 신경관 결손증을 예방한다고 알려져 있다. 이 외에도 엽산 섭취 부족은 빈혈, 고호모시스테인혈증, 심혈관질환, 암, 인지 장애, 우울증 등 다양한 질병과도 관련이 있다고 보고되어, 엽산은 전 생애주기 동안 건강을 유지하기 위해 충분히 섭취해야 하는 영양소이다. 본 연구에서는 2020 한국인 엽산 섭취기준의 개정 근거를 살펴보고, 국민건강영양조사로부터 엽산 섭취량과 혈청 엽산 농도를 성별, 연령대별로 분석하였으며, 향후 엽산 섭취기준 개정에 참고할 만한 내용을 제언하였다. 표준체중의 변경에 따라 영아 후기의 충분섭취량과 15-18세의 평균필요량이 2015년과 달리 변경되었으나, 권장섭취량과 상한섭취량에는 변화가 없었다. 2016-2018년 국민건강영양조사 결과에서 대부분의 연령에서 엽산 섭취량은 권장섭취량에 미치지 못하였으며 특히 15-29세 여성의 섭취량이 권장섭취량 대비 매우 낮았다. 임신부와 수유부의 엽산 섭취량도 권장섭취량 대비 60% 이하로 낮았으나, 혈액수준은 다른 연령층에 비해 높아 보충제를 섭취한 결과로 보인다. 앞으로 국민건강영양조사에서 보충제 섭취량도 조사해야 할 것이며, 엽산의 섭취량 평가를 위해서는 생식품, 조리된 식품, 강화식품 중의 엽산 함량에 대한 DB가 구축되어야 할 것이다. 또한 혈청 엽산 뿐 아니라 적혈구 엽산 농도와 혈장 호모시스테인 농도도 분석할 필요가 있으며, 분석방법에 대한 질 관리가 필요하다.

Keywords

References

  1. Combs GF Jr, McClung JP. The vitamins: fundamental aspects in nutrition and health. London: Academic Press; 2016.
  2. Lamers Y. Folate recommendations for pregnancy, lactation, and infancy. Ann Nutr Metab 2011; 59(1): 32-37. https://doi.org/10.1159/000332073
  3. Bailey LB. Folate in health and disease. Boca Raton (FL): CRC Press; 2009.
  4. McNulty H, Pentieva K, Hoey L, Strain J, Ward M. Nutrition throughout life: folate. Int J Vitam Nutr Res 2012; 82(5): 348-354. https://doi.org/10.1024/0300-9831/a000130
  5. Ebara S. Nutritional role of folate. Congenit Anom (Kyoto) 2017; 57(5): 138-141. https://doi.org/10.1111/cga.12233
  6. Ministry of Health and Welfare; The Korean Nutrition Society. 2020 Dietary reference intakes for Koreans. Sejong: Ministry of Health and Welfare; 2020.
  7. National Institute of Agricultural Sciences, Rural Development Administration. Korean food composition table. 9th version. Wanju: National Institute of Agricultural Sciences, Rural Development Administration; 2017.
  8. Ministry of Health and Welfare, Korea Disease Control and Prevention Agency. Korea Health Statistics 2019: Korea National Health and Nutrition Examination Survey (KNHANES VIII-1). Cheongju: Korea Disease Control and Prevention Agency; 2020.
  9. Korea Disease Control and Prevention Agency. Korea National Health and Nutrition Examination Survey Guidelines for using raw data (2016-2018) [Internet]. Cheongju: Korea Disease Control and Prevention Agency; 2021 [cited 2022 Mar 28]. Available from: https://knhanes.kdca.go.kr/knhanes/sub03/sub03_02_05.do.
  10. Scaglione F, Panzavolta G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica 2014; 44(5): 480-488. https://doi.org/10.3109/00498254.2013.845705
  11. Sobczynska-Malefora A, Harrington DJ. Laboratory assessment of folate (vitamin B9) status. J Clin Pathol 2018; 71(11): 949-956. https://doi.org/10.1136/jclinpath-2018-205048
  12. Bailey LB, Stover PJ, McNulty H, Fenech MF, Gregory JF 3rd, Mills JL, et al. Biomarkers of nutrition for development-folate review. J Nutr 2015; 145(7): 1636S-1680S.
  13. World Health Organization. Serum and red blood cell folate concentrations for assessing folate status in populations (No. WHO/NMH/NHD/EPG/15.01). Geneva: World Health Organization; 2015.
  14. Gregory JF 3rd. Bioavailability of folate. Eur J Clin Nutr 1997;51 Suppl 1: S54-S59.
  15. Martin JI, Landen WO Jr, Soliman AG, Eitenmiller RR. Application of a tri-enzyme extraction for total folate determination in foods. J Assoc Off Anal Chem 1990; 73(5): 805-808.
  16. Hyun TH, Tamura T. Trienzyme extraction in combination with microbiologic assay in food folate analysis: an updated review. Exp Biol Med (Maywood) 2005; 230(7): 444-454. https://doi.org/10.1177/153537020523000702
  17. Hyun T, Han YH. Comparison of folate intake and food sources in college students using the 6th vs. 7th nutrient database. Korean J Nutr 2001; 34(7): 797-808.
  18. Yon M, Hyun TH. Folate content of foods commonly consumed in Korea measured after trienzyme extraction. Nutr Res 2003; 23(6): 735-746. https://doi.org/10.1016/S0271-5317(03)00069-1
  19. Lee SS, Kim JI, Jeong YJ, Cho YO, Hyun T. A new paradigm of dietary reference intakes: dietary reference intakes (DRIs) of United States/Canada. - vitamin B complex and choline. Korean J Nutr 2004; 37(8): 739-749.
  20. Lim HS, Mackey AD, Tamura T, Wong SC, Picciano MF. Measurable human milk folate is increased by treatment with α-amylase and protease in addition to folate conjugase. Food Chem 1998; 63(4): 401-407. https://doi.org/10.1016/S0308-8146(98)00054-5
  21. Ministry of Health and Welfare; The Korean Nutrition Society. 2015 Dietary reference intakes for Koreans. Sejong: Ministry of Health and Welfare; 2015.
  22. Han YH, Yon M, Han HS, Kim KY, Tamura T, Hyun TH. Folate contents in human milk and casein-based and soya-based formulas, and folate status in Korean infants. Br J Nutr 2009; 101(12): 1769-1774. https://doi.org/10.1017/S0007114508158974
  23. Han YH. A three-year longitudinal study of folate, iron, zinc and copper status in infants fed human milk, casein-based, or soy-based formula [dissertation]. Cheongju: Chungbuk National University; 2009.
  24. Smith AM, Picciano MF, Deering RH. Folate supplementation during lactation: maternal folate status, human milk folate content, and their relationship to infant folate status. J Pediatr Gastroenterol Nutr 1983; 2(4): 622-628. https://doi.org/10.1097/00005176-198311000-00009
  25. Ernawati T, Bardosono S, Sekartini R. Serum folate levels among healthy infants aged 6-8 months: relation to infants' nutritional status indicators and maternal knowledge-attitude-practice. Med J Indones 2011; 20(2): 138-142. https://doi.org/10.13181/mji.v20i2.443
  26. Hay G, Johnston C, Whitelaw A, Trygg K, Refsum H. Folate and cobalamin status in relation to breastfeeding and weaning in healthy infants. Am J Clin Nutr 2008; 88(1): 105-114. https://doi.org/10.1093/ajcn/88.1.105
  27. Kim YN, Lee JY, Driskell JA. Marginal folate inadequacy observed in a group of young children in Kwangju, Korea. Nutr Res Pract 2007; 1(2): 120-125. https://doi.org/10.4162/nrp.2007.1.2.120
  28. Kim HY. Folate status of adolescent athletes. Bull Nat Sci 2004; 8(2): 99-104.
  29. O'Keefe CA, Bailey LB, Thomas EA, Hofler SA, Davis BA, Cerda JJ, et al. Controlled dietary folate affects folate status in nonpregnant women. J Nutr 1995; 125(10): 2717-2725.
  30. Institute of Medicine. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. Washington, D.C.: National Academy Press; 1998.
  31. Lim HS, Jin HO, Lee JA. Dietary intakes and status of folate in Korean women of child-bearing potential. Korean J Nutr 2000; 33(3): 296-303.
  32. Ahn HS, Jeong EY, Kim SY. Studies on plasma homocysteine concentration and nutritional status of vitamin B6, B12 and folate in college women. Korean J Nutr 2002; 35(1): 37-44.
  33. Eom H, Kim KN, Chang N. Effect of folic acid supplementation on serum homocysteine and B vitamins in infertile women. Korean J Nutr 2005; 38(3): 211-218.
  34. Han YH, Yon M, Hyun TH. Folate intake estimated with an updated database and its association to blood folate and homocysteine in Korean college students. Eur J Clin Nutr 2005; 59(2): 246-254. https://doi.org/10.1038/sj.ejcn.1602065
  35. Kim HA, Lim HS. Dietary folate intake, blood folate status, and urinary folate catabolite excretion in Korean women of childbearing age. J Nutr Sci Vitaminol (Tokyo) 2008; 54(4): 291-297. https://doi.org/10.3177/jnsv.54.291
  36. Jang HB, Han YH, Piyathilake CJ, Kim H, Hyun T. Intake and blood concentrations of folate and their association with health-related behaviors in Korean college students. Nutr Res Pract 2013; 7(3): 216-223. https://doi.org/10.4162/nrp.2013.7.3.216
  37. Hwang EJ. Development of a screening tool for identifying risk of folate deficiency among women of child-bearing age [dissertation]. Cheongju: Chungbuk National University; 2014.
  38. Lee SJ. Factors associated with serum folate and homocysteine concentrations in Korean adults [dissertation]. Cheongju: Chungbuk National University; 2016.
  39. Kim YN, Cho YO. Folate food source, usual intake, and folate status in Korean adults. Nutr Res Pract 2018; 12(1): 47-51. https://doi.org/10.4162/nrp.2018.12.1.47
  40. Kim HJ, Kim H, Kim KN, Kim G, Son JI, Kim SY, et al. Relationship among plasma homocysteine, folate, vitamin B12 and nutrient intake and neurocognitive function in the elderly. Korean J Nutr 2011; 44(6): 498-506. https://doi.org/10.4163/kjn.2011.44.6.498
  41. Caudill MA, Cruz AC, Gregory JF 3rd, Hutson AD, Bailey LB. Folate status response to controlled folate intake in pregnant women. J Nutr 1997; 127(12): 2363-2370. https://doi.org/10.1093/jn/127.12.2363
  42. Ahn HS, Kim JS, Lee GJ, Kim YT. Serum folate levels of maternal-umbilical cord blood and pregnancy outcomes. Korean J Nutr 2000; 33(8): 840-847.
  43. Lee JI, Lim HS. A Longitudinal study on maternal iron and folate status during and after pregnancy in Korean women. Korean J Community Nutr 2001; 6(2): 182-191.
  44. Lee JA, Lee JI, Lim HS. Maternal folate status and its influencing factors in early pregnancy. J Korean Soc Food Sci Nutr 2004; 33(2): 331-338. https://doi.org/10.3746/JKFN.2004.33.2.331
  45. Lee GJ, Jang HM, Ahn HS. A change of serum folate and vitamin B12 concentrations of maternal and umbilical cord blood during pregnancy. Korean J Community Nutr 2005; 10(5): 615-622.
  46. Kim H, Kim KN, Hwang JY, Ha EH, Park H, Ha M, et al. Relation between serum folate status and blood mercury concentrations in pregnant women. Nutrition 2013; 29(3): 514-518. https://doi.org/10.1016/j.nut.2012.08.012
  47. Jeong DW, Lim HS. Folate content of human milk during extended lactation and folate nutritional status of lactating women in Korea. Korean J Nutr 2008; 41(6): 518-529.
  48. Field MS, Stover PJ. Safety of folic acid. Ann N Y Acad Sci 2018; 1414(1): 59-71. https://doi.org/10.1111/nyas.13499
  49. MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet 1991; 338(8760): 131-137. https://doi.org/10.1016/0140-6736(91)90133-A
  50. Public Health England. Government dietary recommendations [Internet]. London: Public Health England; 2016 [cited 2022 Apr 29]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/618167/government_dietary_recommendations.pdf.
  51. Ministry of Health, Labour and Welfare of Japan. Overview of the dietary reference intakes for Japanese (2020) [Internet]. Tokyo: Ministry of Health, Labour and Welfare of Japan; 2020 [cited 2022 Apr 29]. Available from: https://www.mhlw.go.jp/content/10900000/000862500.pdf.
  52. EFSA Panel on Dietetic Products; Nutrition and Allergies (NDA). Scientific opinion on dietary reference values for folate. EFSA J 2014; 12(11): 3893.
  53. National Health and Medical Research Council. Nutrient reference values for Australia and New Zealand, updated September 2017. Canberra: Department of Health and Ageing, Australian Government; 2006.
  54. Cawley S, Mullaney L, McKeating A, Farren M, McCartney D, Turner MJ. A review of European guidelines on periconceptional folic acid supplementation. Eur J Clin Nutr 2016; 70(2): 143-154. https://doi.org/10.1038/ejcn.2015.131
  55. FIGO Working Group on Best Practice in Maternal-Fetal Medicine; International Federation of Gynecology and Obstetrics. Best practice in maternal-fetal medicine. Int J Gynaecol Obstet 2015; 128(1): 80-82. https://doi.org/10.1016/j.ijgo.2014.10.011
  56. Park E, Lee HC, Han JY, Choi JS, Hyun T, Han Y. Intakes of iron and folate and hematologic indices according to the type of supplements in pregnant women. Clin Nutr Res 2012; 1(1): 78-84. https://doi.org/10.7762/cnr.2012.1.1.78
  57. Kim J, Yon M, Kim CI, Lee Y, Moon GI, Hong J, et al. Preconceptional use of folic acid and knowledge about folic acid among low-income pregnant women in Korea. Nutr Res Pract 2017; 11(3): 240-246. https://doi.org/10.4162/nrp.2017.11.3.240
  58. Hong J, Jeong BG, Chun J, Lee J, Hyun T. Folate content of Korean vegetable dishes prepared outside the home: comparison between analyzed and calculated values. J Food Compos Anal 2021; 103: 104088. https://doi.org/10.1016/j.jfca.2021.104088
  59. Kim MJ, Kim J, Hwang EJ, Song Y, Kim H, Hyun T. Awareness, knowledge, and use of folic acid among non-pregnant Korean women of childbearing age. Nutr Res Pract 2018; 12(1): 78-84. https://doi.org/10.4162/nrp.2018.12.1.78
  60. Han YH, Seo JH, Shin GR, Shin JY, Jo YY, Hyun T. Nutrient composition and content of vitamin and mineral supplements and their appropriateness for pregnant and lactating women in Korea. Korean J Community Nutr 2018; 23(4): 341-351. https://doi.org/10.5720/kjcn.2018.23.4.341
  61. Yetley EA, Pfeiffer CM, Phinney KW, Fazili Z, Lacher DA, Bailey RL, et al. Biomarkers of folate status in NHANES: a roundtable summary. Am J Clin Nutr 2011; 94(1): 303S-312S.