Nutritional deficiency |
Substance use disorders that lead to inadequate dietary intake |
Chronic excessive alcohol use, which may be associated with malnutrition and increased metabolic demands |
Inadequate dietary intake due to severe malnutrition or restrictive diets |
Consumption of overcooked foods (cooking inactivates folates) |
Reduced intake of green leafy vegetables if residing in a country where cereals and grains are not supplemented with folic acid |
Malabsorption |
Celiac disease (sprue) |
Inflammatory bowel disease |
Infiltrative bowel disease |
Short bowel syndrome |
Bariatric surgery |
Drugs (various mechanisms) |
Methotrexate |
Trimethoprim |
Ethanol |
Phenytoin |
Increased requirements |
Pregnancy, lactation |
Chronic hemolysis |
Exfoliative dermatitis or severe eczema |
Other conditions with high cellular turnover |
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