Background

Folate is a generic term used to describe a number of related compounds that are involved in the metabolism of nucleic and amino acids, and therefore the synthesis of DNA, RNA, and proteins. Folate plays a role in the conversion of homocysteine to methionine. Folic acid is a synthetic form of the vitamin, used in vitamin supplements and food fortification. It exhibits a high degree of stability, and is more bioavailable than naturally occurring folate from food. Unlike folic acid, naturally occurring food folates are usually reduced, and contain a polyglutamate tail consisting of one to several glutamate molecules. Prior to active transport across the small intestine, this polyglutamate tail must be hydrolyzed to produce the monoglutamate form. Traditionally synthetic folic acid was thought to be completely reduced at the gut and to enter portal circulation primarily in the form of 5-methyltetrahydrofolate; however, synthetic folic acid (>200 mcg), even in very modest doses, can be absorbed by a nonsaturable mechanism involving passive diffusion. Thus, small amounts of unmetabolised folic acid (1-5%) have been shown to be present in circulation [60, 61].

The average amount of folate secreted into human milk is estimated to be 85 mcg/ liter/day [62]. With the exception of severe maternal folate deficiency (i.e., megaloblastic anemia), the content of folate in human milk remains stable and appears to be conserved at the expense of the mother's folate stores [63].

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