Effects of Folate Intake on Folate Status of Obese/Overweight Women after Weight Loss

BMI & Plasma Folate Levels are Inversely Proportional to Each Other

Folate has been quite popular among pregnant women as these nutritional supplements are what goes into the prescription as soon as the woman is shared with the good news by her gynecologist or even before pregnancy when she plans to start a family. That’s mainly because neural tube defects (NTDs), a disorder stemming out as a result of folate deficiency, is the second most cause of serious birth defect affecting around 0.2-10 per 1000 pregnancies worldwide. While recommendations to nourish the body with supplements even before pregnancy sounds overcautious its mainly because defects of the brain and spine happen in the first few weeks of pregnancy even before the woman starts realizing that she is pregnant. It might be too late when she realizes that she is pregnant and starts on supplements. So, better be cautious than careless. The folate-NTD link is quite new and it was not until 1960s that its predominance came into limelight. Besides pregnancy, it is recommended that every woman gets around 400 mcg of folic acid every day apart from consuming it from a variety of foods rich in this nutrient as our bodies use folic acid to make new cells like skin, hair and nails.
​
Folate: Pregnancy at its Best
Folate is a water-soluble B vitamin that’s naturally available in some foods, fortified in others and also extensively available as dietary supplements. An insufficient intake of folates owing to poor dietary intake, presence of conditions such as celiac disease or likewise can cause greater troubles to the individual in the form of NTDs, cancer and occlusive vascular disease. This is the case that’s possible in any woman and, obese/overweight women in childbearing age are at an even greater risk of giving birth to children with defects and are at a higher risk of NTDs.

Folate Intake Impairs Growing Weight Issues
Generally, obese/overweight women eat less of folate-rich produce and foods and we have evidences showing an inverse relationship between folate intake and BMI range and increased plasma homocysteine levels in these women. Researchers started a study to analyze the effect of increased folate intake through a diet that also enabled weight loss on a group of obese/overweight women.

A group of 67 young women aged between 20 and 35 years were involved in the study after a thorough assessment of their eligibility criteria that included BMI ranges between 24-35, absence of conditions such as diabetes, BP, hyperthyroidism, metabolic disease, glucose intolerance, etc., did not lose more than 4.5 kg weight in the past two months and did not gain more than 3 kg weight between the assessment interview and start of study, did not miss out period cycles, not pregnant or breastfeeding and did not consume more than two alcoholic drinks per day.

Each of the participant was randomly assigned to two types (diet C or V) of diets both of which provided them with 20% less than their theoretical energy requirements and increased intake of cereals and fruits-two foods that many of us lack in our daily diets for a period of 6 weeks. Diet C was based heavily on cereal intake which included cereal bars too that could be taken thrice a day based on the idea that these foods are rich in carbohydrates, fiber, minerals and vitamins, especially folic acid. Diet V was based on increasing intake of vegetables. Both the diets were based on the fact that they contained abundant folic acid. Every participant was asked questions pertaining to their activity levels, sleep durations and eating habits, and measurements of their height and weight were recorded before and after the study. Folate consumption levels were recorded in the form of dietary folate equivalents (DFE) which measures the presence of straight folic acid compared to food folate. The weight loss achieved were noted and the women were grouped further based on their weight loss results (greater or lesser than 2.5 kg). Results showed that:
​

1. Obese women having a BMI greater than 30 were at a risk of having serum folate levels lesser than 14.9 despite no differences in folate intake between the two groups (BMI greater or lesser than 30).
2. At the end of the study, all women increased their consumption of fruits and vegetables while decreasing their consumption of meat. Among those who lost maximum weight (greater than 2.5 kg) those who consumed the C diet ate more of cereals but less of vegetables compared to those who ate the V diet.
3. Women who ate the C diet showed increased intake of folates compared to those who ate the other diet showing that fortified cereals are a greater source of folate compared to vegetables-natural sources of folate.
4. Blood showed increased serum folate concentration and lower blood plasma homocysteine in those women who lost more than 2.5 kg body weight. Greatest serum folate levels were recorded in those who showed greatest weight loss.
5. Women belonging to both diet groups ate more fish, meat and eggs compared to fruits, vegetables, pulses and cereals at the beginning of the study.

 
Studies show that women with a BMI greater than 30 require an additional 350 mcg daily compared to others. This study is a clear indicator that weight loss has the ability to elevate serum folate levels.

Cohort Studies
A UK study found that lower folate concentrations was associated with higher BMI irrespective of diet, age, supplements and BMI. We have studies showing that maternity obesity puts a woman at a two-time increased risk of NTD and that pre-pregnancy obesity and low-quality diet were factors associated with an increased risk of severe birth defects.

A long-term analysis was conducted on 8 different studies that were selected based on several criteria conducted on women of childbearing age with obesity. Research conducted on 12 women affected by obesity versus 12 women of normal weight using a single-dose folic acid supplementation. While median plasma folate levels did not differ in these women prior to the supplementation, after consuming the supplement it was found that folic acid does not distribute freely into adipose tissues and individuals with obesity not only weight more and have fat but also have more lean mass. A study by Baltaci et al showed that there was no difference in mean folate concentrations between women with or without obesity. The study by Tinker et al showed that BMI was inversely associated with plasma folate among women who did not use supplements containing folate acid. The fact that these levels were significantly lower in women with obesity compared to women with BMI in normal/overweight ranges clearly proves it. Also, the mean distribution of erythrocyte folate was higher in women with obesity comparatively suggesting that BMI affects the body distribution of folate.

While nutrient intake during pregnancy was important quite some time back, nutrient needs before pregnancy and after childbirth have become extremely important nowadays. Folate levels in obese women may be altered and can also be a contributing factor in the increased risk of NTD. There are not many studies that analyze the folate status in childbearing-age obese/overweight women. Even these studies that do analyze show differences in their results-some of them do show decreased levels of plasma folate in a high percentage of women with increased weight whereas some don’t show any differences in folate levels between the two groups-overweight/obese or normal weight.

Lifestyle factors too play an integral role in affecting folate levels in individuals. Excessive intake of empty-calorie, energy-laden foods, smoking, alcohol consumption and increased caffeine intake too can affect folate levels in the body. Eat more of veggies, especially dark green veggies, asparagus and Brussels sprouts, fruits, nuts, beans, peas, eggs, lean meats, grains and seafood for increased folate content. Still, evidences are conflicting supporting that folate status in women with obesity/overweight may be altered and may be a possible contributing factor in risk of NTD. Still, starting the woman on supplements before pregnancy is mandatory for the well-being of the mother and child as women with obesity/overweight are at a maximum risk of folate deficiency.
 
References
Folate Status in Young Overweight & Obese Women: Changes Associated with Weight Reduction & Increased Folate Intake: https://www.jstage.jst.go.jp/article/jnsv/55/2/55_2_149/_pdf/-char/en

Folate Status in Women of Childbearing Age with Obesity: A Review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232191/
​
Folic Acid for the Prevention of Neural Tube Defects: https://pediatrics.aappublications.org/content/104/2/325