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Question: Discuss about the Diet Related Disease. Answer: Diet related diseases are the disorders that appear as a result of increased or decreased amount of dietary elements in body, leading to the changes in general metabolic process or developmental process, thereby leading to the onset of disease symptoms. For instance, fotale acid deficiency is a disease, which occurs, when the level of folic acid and derivatives becomes low in the body. Folate is also known as vitamin B9, which is involved the nucleic acid synthesis, i.e. the synthesis of adenosine, thymidine, guanine, which are the key parts of DNA (Cario et al., 2011). It is mainly found in green vegetables, fruits and poutry products. Folate deficiency leads to deficiency in red blood cells, developing the symptoms of anemia. Folate deficiency anemia is the term given to the anemic condition, occus due to lack of folate. The condition is identified by the appearance of large-sized, abnormal red blood cells, produced due to inadequate storage of folic acid in the body. Determinants The folate deficiency is the condition, determined by the deficiency of folate or folic acid in the body. It is dependent upon how much folate the human body is required. Medications interfering with the ability of the body to produce folate causes folate deficiency. On the other hand during lactation or pregnancy, the level of folate in the body is required. Some medical situations also determines the level of folic acid in the body, like hemorrhage, kidney dialysis, liver disease, tobacco smoking, malabsorption of folate in the body etc. The situational factors are also considered as the key determinants of the condition development. One of the key effects of folate deficiency along with vitamin B12, is elevated serum homocysteine, which may enhance the cardiovascular disease risk, which can also affect the cognitive dysfunctioning and vascular eye disease among elderly population. A study by Odewole et al., (2013) revealed that a high rate of Australians have low serum folate leve l, by enhancing the Etiology Key cause of folate deficiency is the reduced level of folate in the body, which can be due to excessive excretion of folic acid from the body or malproduction of folic acid in the body. During the conditions, when the necessity of folate increases in the body or when the body does not get adequate folate through the dietary supplements or when it is not getting absorbed in the body parts adequately (Moll Davis, 2017). There are several factors causing the folate deficiency, these are: Diet- Lack of fresh vegetables, fruits, fortified cereals in the daily diet causes folate deficiency. On the other hand, when food items are overcooked, they can destroy vitamins like B12, which is crucial for folic acid synthesis. Thus, a daily diet lacking vitamin B12 is also important factor causing folate deficiency. If body lacks folate-rich foods for few day weeks, the symptoms related to folate deficiency may occur (Brown et al., 2011). Disease- There is several kinds of diseases, which can alter the demand of folate in body or level of folate in the body. For instance, diseases, which affected the absorption of folate in the small intestine, can cause folate deficiencies, as a result of lack of folate in body cells. These kinds of diseases include crohns disease, celiac disease, kidney disease requiring dialysis, some types of cancers, entero-enteric fistulae and other inflammatory or degerative diseases of small intestine that can reduce the activity of pteroyl polyglutamas, a hydrolase required for the absorption of folate in jejunum of small intestine, may leads to the folate deficiency (Holmes et al., 2011). Vitamin B12 deficiency disease is also a key risk factor for developing folate deficiency. Genetics- Tetrahydrofolate is a key derivative of folic acid in the human body, which requires homocysteine methyltransferase. An inherited mutation in the gene of this enzyme would lead to malproduction of tetrahyrofolate or the body is unable to convert the dietary folate into a usable form, i.e. methylfolate, thereby leading to the folate deficiency disease. Side effects of medications- There are several medications which can interfere with the utilization of folate acquired through the dietary elements. For instance, anticonvulsant medications, metformin, methotrexate, sulfasalazine, triamterene, birth control pills, trimethoprim-sulfamethoxazole is some groups of medications that can cause the folate deficiency. Thus, while prescribing methotrexate by physicians, they also prescribe folic acid supplements, as methotrexate inhibits the dihydrofolate reductase, thereby reducing de nove purine and pyrimidine synthesis along with cell division (Safi, Joyeux Chalouhi, 2012). Thus, folate supplements are recommended to combat with the lack of natural process of converting foliate into usable form in the body. Excessive alcohol consumption- Alcohol also interferes with the absorption of folate in the small intestine in GI tract, whereas increases the excretion of folate through urine, thereby enhancing the risk for folate deficiency. Epidemiology In order to understand the status of a disease in the community, it is important to review and analyse the statistics or epidemiology of the disease. The prevalence of folate deficiency and vitamin B12 enhanced with age. These are the health outcomes of malnutrition or poor overall health outcomes. Folate is a B group vitamin required for production and maintenance of new cells, especially crucial during the period of rapid cell growth and division (Gopinath et al., 2012). Due to lack of folate in the body, during pregnancy, the new cell development is hampered, which interferes with the development of brain and spinal cord formation in the fetus, which leads to end of pregnancies in most of the cases. It has been revealed from the Australian burro of statistics that the neural tube defects cases are of high prevalence throughout Australia. Within the period of 2006 to 2008, the prevalence of neural tube defect was 7.2 per 10000 total births in the New South Wales, which is lower than the overall rate in Victoria, Wester Australia and South Australia (Milne et al., 2012). Another study revealed that 51 % of total study population, who are more than 50 years old, has elevated homocysteine, which is a key marker for folate deficiency. It has been revealed that during the period of 2011 to 2012, the rate of women of childbearing age had shown to consume sufficient amount of folate in order to prevent NTD in babies, whereas it has been found that less than 1% people within the age group 16 to 44 years had red cells However, studies showed that among the overall population, during 2011-2012, 4.5 % of more than 18 years population has a high risk of developing folate deficiency anemia. Women showed higher likelihood, i.e. 6.4% compared to men, i.e. 2.5 % (Australian Bureau of Statistics, 2014). National Folic Acid Program Folate deficiency in Australia is a diet related disease that needs to be prevented so that the people specially the children and adolescents as well as pregnant can lead a better lifestyle. For this purpose, the awareness among the people of Australia needs to be developed. The awareness can be developed via the national programs, in which the government needs to implement some policies or arrange some campaigns and programs so that the diet related disease can be controlled. The Ministry of Health and Family Welfare has discussed about the importance of folic acid supplement (Probst Cunningham 2015). This supplement can be provided with the food. The two important programs that can be used to reduce the folate deficiency in Australia are National Folic Acid Program and Folic Acid Fortification. Both the programs help to make the people aware and attract people to participate in the programs and reduce the harmful effect of folate deficiency. The National Council on Folic Acid improved the health. For this purpose, promotion of the program is done. The NCDA stated that folate needs to be consumed to avoid the anemia, which affects the adolescents and pregnant mothers the most. The normal rate of folate consumption in adolescent male is 300-400 mcg DFE and in female the rate is same. In case of pregnant women, they need to consume 600 mcg DFE folate and the lactating mothers need 500 mcg DFE folate (Little, 2009). The aim of the program is to improve the dietary habits to avoid the anemia. If the dietary habit is improved then it can be expected that rate of anemia can be reduced. However, Wiersinga (2014) mentioned that human body is not able o absorb the folate as it is the natural form of folic acid but it can absorb the synthetic form of folic acid. However, folate is found in various foods that include the vegetable and animal food products. The vegetables can include the fruits, beans, peas, and nuts. The animal sources include meat, poultry, dairy products, seafood, grains, and eggs. As mentioned by (Bhutta Salam, 2012) folate is present in grains such as rice, pasta, flours, cereals, and the other grain products in higher amount. The national folic acid program helps to develop the consciousness of the people. In the program, the folic acid supplements are provided to the adolescents and the pregnant women so that they can get the sufficient amount of folic acid in their diets to avoid the diet related diseases. The program focuses to reduce the number of patient, who is suffering from the folate deficiency disease. The program recommends taking folic acid in every day diet that reduces the problems related to the folic acid deficiency. In case adolescents and pregnant women, the folic acid is provided in form of multivitamins (foodstandards.gov.au 2017). The target group is provided 400 mcg of folic acid for one week in a month that is useful to prevent the problems. In some cases the dosage and time of the folic acid consumption increase. The adolescents and the pregnant women are at the high risk as they go through the crucial phases of the life cycle. In case of the adolescents, the bone becomes strong; hence, the body needs to restore the folic acid so that it can be utilized whenever, it is necessary. Folic acid is the derivatives of B vitamin as it is a synthetic form of B9. Folic acid is important for the brain function and mental health as it regulate the emotional and mental health . In case of pregnant women, the body needs to store the adequate amount of folic acid and iron, so that the fetus can be enriched with the iron and the folic acid. The national folic acid program in such way helps to make people aware so that due to lack of folic acid the mother do not face miscarriage or any other pregnant related issues (Ods.od.nih.gov 2017). Folic Acid Fortification: According to Food Standard Australia, the folic acid fortification needs to be mandatory to reduce the rate people suffering from folate deficiency disease. In 1998, the program helped to make the consumption of folic acid compulsory. The main aim of the program is to reduce the cases of the neural tube defects in Australia. This can be done via the mandatory fortification with the folic acid of the food. The program focuses on the diet and nutrition balance of the people. In the folic acid fortification, the folic acid is added to the wheat flour to make the breads (Beckett et al., 2017). Folic acid is mandatory for the improvement of the babies and the growth of them as well as the adolescents. The neural tube closes as well as fuses in the early stage of pregnancy. However, in case of the deficit of the folic acid, the neural tube cannot be closed and it becomes defective. The folic acid supplement needs to be provided to the pregnant mother before one mo nth of conceive and after 3 months of conception so that the neural tube defect can be prevented (Borradale Kimlin, 2016). The folic acid fortification is mandatory as it helps to reduce the deficiency of the folic acid. Folic acid supplementation is necessary to educate people especially women and adolescents so that they can be capable to become pregnant or continue their work by avoiding the folic acid deficiency. The responsible persons monitor the program to check the essentiality of the program and the effectiveness of the program. This monitoring approach can help the government of Australia to check the necessity of the folic acid fortification. Most of the people may not be agreed to take the folic acid fortification; but it is necessary to communicate with them and educate them so that they can understand the importance of the program and participate in the program. The government has implemented few policies regarding the folic acid fortification and identifies the places, where the number of the deficiency occurs the most. Those areas are divided in few zones so that it can be easier to supply the supplements of folic acid and the folic acid fortification to the target group (Rabovskaja, Parkinson Goodall, 2013). The program needs to include the public without any discrimination. Different communities and people from different regions need to participate in the program. There are many aboriginal people in Australia, who do not get proper treatment or care. Hence, it is necessary to include them in the pr ogram so that they can get the proper care like others. As the aboriginal people are not educated, education is necessary and folic acid fortification campaign can be done in the aboriginal region also. This can help to reduce the death rate of pregnant women and new born babies in Australia. . In the program, the folic acid supplements are provided to the adolescents and the pregnant women so that they can get the sufficient amount of folic acid in their diets to avoid the diet related diseases (Hilder, 2016). The government can include the local people as the volunteer of the program so that it can be easier for people to understand the necessity of the program as well as necessity of the folic acid consumption. The child who do not get adequate amount of folic acid in fetus stage, they have the probability to suffer from autism. Hence, the risks of autism need to be reduced. The adolescents and the pregnant women are at the high risk as they go through the crucial phases of the life cycle. The national folic acid program in such way helps to make people aware so that due to lack of folic acid the mother do not face miscarriage or any other pregnant related issues. Monitoring approach can help the government of Australia to check the necessity of the folic acid fortification (Crider, Bailey Berry, 2011). Education and training is necessary to increase the awareness among the people. The people need to know about the folate enriched foods so that they can take it in their daily diet to avoid the problems of the folate acid deficiency. Practice essay Folate is an essential B group vitamin, required for de novo nucleic acid synthesis, red blood cell development as well as overall growth and development of the body. The deficiency of this element leads t deficiency in red blood cells, folate deficiency anemia. The disease has a significant burden upon the Australian health care group, as both the young age as well as the older age people is at high risk (Crider, Bailey Berry, 2011). Whereas it has been revealed that the deficiency disease is related to the prevalence of neural tube disorder among infants, which is posing significant burden upon the health care sector. Major food source The major food source of folate is green leafy vegetables and fruits, like peas, nuts, beans, lentils and tropical fruits. On the other hand, it is also rich is dairy products like animal liver, eggs, poultry, grains and seafoods. Besides these, the fortified bread, yeast extracts, rice, soy nuts, cornmeal products contains significant amount of folate. Fruits, which have high level of folate includes papaya, mango, avocado, orange, pomegranate, kiwi, guava and banana. On the other hand, green vegetables include lettuce, broccoli, Brussels sprouts, asparagus, mustard greens and beets (Cario et al., 2011). As the natural resources are high in price, the low socioeconomic groups are at a disadvantage. Animal liver has a high amount of folate, necessary for pregnant women. It has been revealed After the mandatory folate fortification by Australian government, all flour used for bread production are fortified for ensuring that people at Australian community are meeting their folate consumption level in their daily diet. According to this program guideline, the mandatory level of folate consumption is 400g/ day for adults, who are more than 19 years old, one month prior and three months after starting the dietary guideline following (Australian Bureau of Statistics, 2014). Comment on short essay 1(major food source) A brief introduction about folate and its function in the body has been found. The essay highlighted approximately all of the major resources of natural folate. The brief discussion about the Australian governments mandatory folate fortification enhanced the quality of the essay. Comment on short essay 2(sociocultural considerations) After introducing folate as an essential element for human growth and development, the author selected sociocultural considerations for the diet related disease. Although there is a significant discussion about the mandatory folic acid fortification and recommendations for the population, a brief statistical analysis is mandatory. Reference List Australian Bureau of Statistics. (2014). Australian health survey: Nutrition first results- foods and nutrients, 2011-2012. Retrieved from https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007~2011-12~Main%20Features~Folate~712 Beckett, E. L., Martin, C., Boyd, L., Porter, T., King, K., Niblett, S., ... Lucock, M. (2017). Reduced plasma homocysteine levels in elderly Australians following mandatory folic acid fortificationA comparison of two cross-sectional cohorts.Journal of Nutrition Intermediary Metabolism,8, 14-20. 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