The Prevalence of Foot Defects Among Wartime Recruits
Authors: D. Hewitt, A. M. Stewart, J. W. Webb
Journal: BMJ (1953)

FOLIC-ACID EXCRETIONMBR1TxsH 745Other modes of production of the apparent folic-acid deficiency in cases of malignant disease that merit considera- tion are deficient intake due to anorexia with resulting primary malnutrition, and diminished absorption produced by widespread metastases or some other means.It seems unlikely that either of these mechanisms could operate without significant weight loss occurring, and there was little or no weight loss in Cases 74, 76, 77, 81, 84, 88, 90, 95, and 114.Moreover, in Cases 77 and 114 there was no evidence at operation of any cause for intestinal mal- absorption.This was true also at post-mortem examination in Cases 88 and 95.In contrast, there was very severe primary malnutrition of many years' duration in Cases 40, 41, and 42, as established by a detailed dietetic investigation.An important source of calories for Case 40 was whisky.Case 41 weighed only 4 st.12 lb.(30.8 kg.): a fat-balance test in this patient revealed normal fat absorption.A post-mortem examina- tion of Case 42 revealed no abnormality other than generalized wasting.Nevertheless these patients, while excreting less of the administered folic acid than did most of the other control cases, were able to excrete 1.5 mg. or more.It is, of course, possible that several factors operate to give a diminished folic-acid excretion in some patients with malignant disease.Thus it would be reasonable to assume that intestinal malabsorption was an important cause in Case 79.Recently a folic-acid-absorption test has been devised for measurement of absorption of folic acid from the alimentar.ytract (Girdwood, 1953), and it may be that the application of this test to cases similar to those in Table II will be of value.The data given do not indicate whether the result of the folic-acid-excretion test is of help in assessing the prognosis or of value in considering the best method of treatment to adopt, especially in patients with leukaemia or some form of reticulosis.Case 63 had a normal folic-acid excretion and died within three months.Case 87 had a very abnormal excretion, but is alive and well following x-ray therapy. SummaryA test dose of 5 mg. of folic acid was given subcu- taneously to 148 patients.The urinary excret4ion of folic acid usually exceeds 30% of the test dose, and an excretion of less than 1.5 mg. is recorded as a " positive" test.The test may be positive in megaloblastic anaemia, but there is no evidence that anaemia in itself gives a diminished excretion.Where renal function is good and the patient does not suffer from megaloblastic anaemia, intestinal mal- absorption, generalized oedema, a large effusion, or severe infection of long duration, a positive test is likely to indicate the presence of advanced malignant disease.It is, however, possible to have advanced malignancy with a negative folic-acid test.This work was made possible by the kind co-operation of many physicians, surgeons, and nursing sisters in numerous hospitals in Edinburgh and district.I wish to thank them, Mr. Robert Brown, for performing many of the assays, and Professor L. S. P.