Excess of folate and metabolic dysfunction in post-natal life

I’ve always been concerned about the absence of widespread folate fortification of foodstuffs in Germany. And we as rheumatologists substitute folate in order to reduce possible side effects caused by methotrexate. But now an article makes me wonder, if general folate intake isn’t too high.

The study is a study on rats. Female Sprague–Dawley rats were exposed to high folic acid. Without going into the details of this study, there were metabolic changes in the offspring. The authors concluded: “The results of this work indicate that perigestational HFA exposure the affects long-term metabolic phenotype of the offspring, predisposing them to an insulin-resistant state.”

Does this have any relevance in rheumatology? Yes and no. I’ll continue substitution of folate after methotrexate, but will be stressing to patients, who want to become pregnant not to overdo folate substitution. The article leaves me less unhappy about the fact that not every food is fortified with folate in Germany.

Reference:

E. Keating et al: Excess perigestational folic acid exposure induces metabolic dysfunction in post-natal life. Journal of Endocrinology, (2015) 224, 245–259. http://joe.endocrinology-journals.org _ 2015. DOI: 10.1530/JOE-14-0448