Concentrations of blood folate in Brazilian studies prior to and after fortification of wheat and cornmeal (maize flour) with folic acid: a review

Abstract

BackgroundIn July 2004, the Brazilian Ministry of Health through the National Health Surveillance Agency made the fortification of wheat flour and cornmeal (maize flour) with iron and folic acid mandatory, with the intention of reducing the rate of diseases such as neural tube defects.ObjectiveThe aim of the study was to investigate the impact of the folic acid fortified wheat flour and cornmeal on serum and red blood cell folate levels and on the reduction of neural tube defects in different Brazilian studies.MethodsIn order to compare folate concentrations in the Brazilian population prior to and following the implementation of mandatory fortification of wheat and cornmeal, studies that involved blood draws between January 1997 and May 2004 (pre-fortification period), and from June 2004 to the present (post-fortification period) were chosen. The data search included PubMed and Scopus databases as well as the Brazilian Digital Library of Theses and Dissertations. The following keywords were employed for the query: folate, folic acid, fortification, Brazil, healthy population, the elderly, children and pregnant women.ResultsA total of 47 Brazilian studies were selected; 26 from the pre-fortification period and 22 after the fortification implementation. The studies were classified according to the cohort investigated (pregnant women, children, adolescents, adults and the elderly). After the implementation of flour fortification with folic acid in Brazil, serum folate concentrations increased in healthy populations (57% in children and adolescents and 174% in adults), and the incidence of neural tube defects dropped.ConclusionFolic acid fortification of wheat flour and cornmeal increased the blood folate concentrations and reduced the incidence of neural tube defects.

Association between Serum Unmetabolized Folic Acid Concentrations and Folic Acid from Fortified Foods

“…We observed higher serum folate concentrations in our postfortification study, presenting a mean ± SD of 26.7 ±17.6 nmol/L. Our result is similar to those published in a recent review of serum folate concentrations in healthy adults after fortification [11]. We also found a folate deficiency rate of almost 7%, which is higher than in the United States, where deficiency is almost nonexistent [30].…”

“…Another consequence of food fortification is higher folate status biomarkers (serum and red blood cell) and lower total plasma homocysteine (tHcy) concentrations observed in populations from countries where food folic acid fortification is mandatory [6,10,11], followed by those with voluntary fortification [6]. A recent review of national published studies demonstrated a significant overall increase in serum folate concentrations of Brazilian healthy adults in the postfortification period [11].…”

“…A recent review of national published studies demonstrated a significant overall increase in serum folate concentrations of Brazilian healthy adults in the postfortification period [11]. A local Brazilian study showed that the main food contributors of folate intake during postfortification were fortified foods, such as breads, pasta, cakes and cookies [12].…”

A Randomized, Placebo-Controlled Trial in Women of Childbearing Age to Assess the Effect of Folic Acid and Methyl-Tetrahydrofolate on Erythrocyte Folate Levels

“…Consequently, periconceptional folate supplementation has been included in international guidelines and is recommended to WCBP worldwide [6]. In some countries such as the United States, Canada, and Brazil mandatory food fortification with folic acid was implemented after which the incidence of NTDs indeed declined [17][18][19][20]. Still, periconceptional folate supplementation is the most reliable measure to meet increased requirements at conception and in the first months of pregnancy and to reduce the risk of adverse pregnancy outcomes.…”

Efeitos do ácido fólico não metabolizado na metilação global do DNA, na expressão de RNAm dos genes de DHFR, MTHFR, interferon-γ, TNF-α e interleucina-8, e na citotoxicidade das células NK

“…No Brasil, observou-se aumento de 57% e 174% nas concentrações de folato sérico entre os períodos pré e pós-fortificação, respectivamente para o grupo crianças e adolescentes e para o grupo adultos (Britto, Cançado e Guerra-Shinohara, 2014 …”