Integrated Nursing, Nutritional, and Health Information Perspectives on Folic Acid Deficiency: An Updated Review

Background: Folic acid (Vitamin B9) is a water-soluble micronutrient essential for DNA synthesis, erythropoiesis, and one-carbon metabolism. Deficiency disrupts these processes, leading to clinical consequences such as megaloblastic anemia, elevated homocysteine levels, and, critically, neural tube defects (NTDs) in developing fetuses. Despite public health measures like food fortification, deficiency remains a significant global health concern, particularly in vulnerable populations. Aim: This review aims to provide an integrated, multidisciplinary perspective on folic acid deficiency, synthesizing its etiology, pathophysiology, clinical manifestations, and management strategies from nursing, nutritional, and medical viewpoints to guide comprehensive patient care and public health initiatives. Methods: The approach is a comprehensive literature review and clinical synthesis. It details the diagnostic evaluation, including clinical assessment, complete blood count analysis, and biochemical testing (serum/red blood cell folate, homocysteine, and methylmalonic acid levels). Management strategies, from oral and parenteral supplementation to dietary modification and public health fortification, are examined. Results: Folic acid deficiency has a multifactorial etiology, including inadequate dietary intake, malabsorption syndromes, medications, and increased physiological demand. Diagnosis is confirmed through characteristic macrocytic anemia and low folate levels. Treatment with oral folic acid (1-5 mg/day) is highly effective, leading to hematological recovery within weeks. Public health fortification programs have successfully reduced the prevalence of deficiency and NTDs in many countries. Conclusion: A collaborative, interprofessional approach is fundamental to the effective prevention, diagnosis, and management of folic acid deficiency. Integrating medical treatment, nursing care, nutritional counseling, and public health strategies is essential to mitigate its hematological, neurological, and developmental consequences.