Dietary and lifestyle predictors of folate insufficiency in non-supplemented German women

Int J Food Sci Nutr. 2019 May;70(3):367-376. doi: 10.1080/09637486.2018.1511686. Epub 2018 Sep 7.


Low folate status is a risk factor for birth defects. We studied concentrations of red blood cell (RBC)- and serum folate in 198 German women in relation to information on dietary folate intake, demographic and lifestyle factors. Median serum- and RBC-folate levels were; (14.7 and 589 nmol/L, respectively. Serum < 7.0 nmol/L or RBC-folate < 405 nmol/L were observed in 3.5% and 18.7% of the women, respectively. Three per cent of the women had both lowered serum and RBC-folate. Whereas RBC-folate > 952 nmol/L (optimal levels around conception) were observed in 9.6%. Serum- and RBC-folate were positively associated; they showed the expected correlations with homocysteine, but only weak correlations with folate intake. Younger age, lower fibre and higher carbohydrate intakes were associated with lower blood folate. Thus, folate intake of approximately 278 µg/d was not sufficient to achieve optimal folate status in young women. In conclusion, in the absence of fortification with folic acid, the majority of the women did not achieve folate status that is optimal for prevention of birth defects.

Keywords: Folate intake; RBC-folate; preconceptional; pregnancy.

MeSH terms

  • Adult
  • Biomarkers / blood
  • Diet*
  • Dietary Supplements*
  • Female
  • Folic Acid / administration & dosage*
  • Folic Acid / blood
  • Folic Acid Deficiency / epidemiology*
  • Germany
  • Homocysteine / blood
  • Humans
  • Life Style*


  • Biomarkers
  • Homocysteine
  • Folic Acid