The biological consequences ofmalnutrition are an important public health problem; Vinicus et al. stated thatundernutrition is ‘affecting more 900 million individuals around the world.’1 Folate and vitamin B12 are important in the diet ofgrowing and matured individuals; as they regulate levels of homocysteine, whichcan be converted to methionine, an amino acid, and latter can be used in theformation of proteins in the body. These natural molecules are significant forthe development and maintenance of biological functions in the human body.Folate is a salt of folic acid, it isa B vitamin that is a vital factor in the synthesis of DNA and RNA in themaking of nucleic acid.
2 It is naturally present in an abundance offood such as citrus fruits, bread, and leafy green vegetable, making it aneasily accessible nutrient for many individuals. The British DieteticsAssociation states the importance of folate in the body is linked to theproduction and repair of DNA and RNA, aiding in the cell cycle and replacementof cells, such as red blood cells. Folate has been implicated in memoryimprovement and further evidence has seen that it can also protect hearthealth.3 Due to being a water-soluble vitamin, folate cannot bestored in fat cells, this means that an individual must maintain an intake offolate in their diet.4 Causes of folate deficiency include dietaryneglect, blood disorders (such as sickle cell anaemia and chronicmyelosclerosis), and excessive urinary excretion from conditions such as acuteliver damage and chronic dialysis. Genetic factors may also play a factor; as amutation in the SLC46A1 gene leads to folate transporter deficiency.5 Theimpact on the body from folate deficiency can lead to anaemia- a condition describedas the number of functional red blood cells is below normal in the blood6 –where an individual can experience tiredness, feeling faint, and becomingeasily breathless; which are common symptoms associated with the deficiency.
Lesscommon effects on the body include headaches, heart palpitations, and sufferingfrom tinnitus.7 Long term effects can lead to complications of thenervous system, infertility development, and serious hearing conditions.8Vitamin B12 is a nutrient that aidsalso in the production of nucleic acids; B12 helps in the formation and maintenanceof blood cells and nerve tissues.9 Dr Group states in an articlefocusing on the functions of vitamin B12, as vitamin B12 has also beendescribed to be essential for the production of energy, as it provides energyfor cells, ensuring there is an adequate balance for the day.10 Thevitamin has also been associated with the formation of neurotransmitter,serotonin, which plays an important role in the regulation of mood, andtherefore lack of B12 can lead to depression as found in a study of diabeticpatients.11 Vitamin B12 interactions with folate play an importantrole in the regulation of homocysteine levels and protection against heartdisease.12 Pernicious anaemia, an autoimmune disease that cause theimmune system to attack the cells in the stomach-that produces a factor calledintrinsic factor that aids in the absorption of vitamin B12-is known as a commoncause of vitamin B12 deficiency; other causes such as Crohn’s disease alsoaffects the lining of the intestines from absorbing vitamin B12 dueinflammation.13 A deficiency of B12 is linked to anaemia andpsychological problems more common in older individuals.
Cognitive andbehavioural changes from disorders such dementia, paranoia, and depression arecommon with vitamin B12 deficiency. Neurological changes may occur withpatients feeling weakness and extreme fatigue, and tingling in the feet andhands. 14 These changes result in permanent alterations that cannotbe easily reversed. Skin lesions and hyperpigmentation have been related todecreased levels of B12. Mori and Ando (2001) investigated the case of aforty-nine-year-old man, where histology had shown an increase of melanin inthe basal layer; that was later corrected with vitamin B12 supplementation.15Long term effects of this deficiency ensure a permanent interference of nerveactivity and destruction of the myelin sheath, this damage would still presenteven after treatment of vitamin B12 deficiency, as supplementation with B12cannot repair the damage of the myelin sheath.16 Homocysteineis an amino acid present in the blood plasma, produced as a by-product from theconsumption of meat.17 Homocysteine is broken down and convertedinto cysteine, that can be used as an amino acid during protein synthesis.
Cysteine is used as an anti-oxidant and involved in the folding and shapemaintenance of proteins; it also plays a part in metabolic reactions ofdifferent metals in the body such as iron, zinc, and copper.18Folate and vitamin B12 work together to ensure the levels of homocysteine areregulated in the blood, high levels of homocysteine are associated withdecreased levels of folate and B12; as these levels are controlled in an individual’sdiet, it has commonly been linked to malnutrition. A genetic MTHFR (methylenetetrahydrofolatereductase) mutation could also be a cause of high homocysteine levels, this affects folate and vitamin B12 interaction pathwayrequired to lower the homocysteine levels, as the genes change the wayindividuals are able to metabolize and convert the needed nutrients and vitaminsin their diet. Other causes of these elevated levels of this amino acid arerenal diseases and thyroid hormones. Major heart diseases, including coronaryheart disease and high blood pressure, are linked to high homocysteine levels,due to the hyperhomocysteinemia causing blood clotting, increased inflammation,and blockage of arteries.19 Cognitive disorders, especially in olderpatients, are symptoms of the elevated levels, including Alzheimer’s diseaseand dementia. Children with high homocysteine levels have a greater risk forskeletal and anatomical development abnormalities; behavioural and learningdisabilities may also occur, such as ADHD and autism.
20 Both folateand vitamin B12 play important role in several biological functions and one ofthese functions is maintaining a low level of homocysteine as high levels oflatter have been linked to several diseases such as diabetes, rheumatoid arthritis, and high blood pressure.21Though they work together to maintain a healthy body, they allhave different functions to make certain those multiple diseases and disorders previouslymentioned are at a lower risk of developing. This keeps the human body ahealthy functioning system without serious biological consequences occurring. Word Count: 1,020 References: 1. Martins VJB, Toledo Florêncio TMM, Grillo LP,Franco Mdo CP, Martins PA, Clemente APG, et al. Long-Lasting Effects ofUndernutrition. Int J Environ Res Public Health Internet. 2011 cited 2017Oct 26; 8(6):1817-46.
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Department of Health; 2016 updated 2016-30-11; cited 2017Oct 26. Available from: https://www.nhs.uk/conditions/Anaemia-vitamin-B12-and-folate-deficiency/Pages/Introduction.aspx14. Healthline. The Symptoms of Vitamin B DeficiencyInternet.
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Generalizedhyperpigmentation of the skin due to vitamin B12 deficiency. J DermatolInternet. 2001 cited May; 28(5):282-5. Available from: http://dx.doi.org/16.
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com/vitamin-b12-deficiency-its-longterm-effects-6144.html.17. MedicineNet. Medical Definition of HomocysteineInternet.
2017 cited 2017 Oct 26. Available from: https://www.medicinenet.com/script/main/art.asp?articlekey=1348618. eMedicineHealth. Homocysteine Levels: Normal& Elevated Ranges, Tests & Treatments Internet.
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