American Journal of Clinical Nutrition, Vol 19, 27-36, Copyright © 1966 by The American Society for Clinical Nutrition, Inc.

Folic Acid Deficiency Secondary to Iron Deficiency in Man

Remission with Iron Therapy and a Diet Low in Folic Acid

¹ From the Department of Medicine, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia; the Department of Nutrition, Harvard School of Public Health; and the Department of Pathology, Harvard Medical SChool, Boston, Massachusetts

Six male patients with severe iron deficiency anemia due to hookworm infection and megaloblastic dysplasia were admitted to a metabolic unit. They were given a diet low in folic acid (<8 µg. per day) and treated with parenterally administered iron. On this regimen the megaloblastic marrow became normoblastic. Two of the six patients with megaloblastic dysplasia had normal serum folic acid levels on admission. Two of six patients had low serum folic acid levels later in their course despite a normoblastic marrow. Thus the value of serum folic acid levels as a predictive criterion for megaloblastic dysplasia is questioned.

Iron deficiency probably plays an important role in the production of a secondary folic acid deficiency. In patients ingesting a diet providing less than 8 µg. of folic acid per day for up to four months, folic acid deficiency and megaloblastosis did not develop.