A case–control analysis of maternal diet and risk of neural tube defects in Bangladesh

Abstract

Objectives: Mothers need a nutrient-rich diet for healthy neural tube development. Neural tube defect risk can be reduced through fortifying grain products with folic acid and taking folic acid supplements. Fortification is not required in Bangladesh. Maternal supplement use rates are low, similar to other countries.This study evaluates maternal dietary intake during pregnancy to identify possible interventions. Methods: A food frequency questionnaire (FFQ) assessed maternal diet. The primary aim compared dietary intake (calories, fat, carbohydrate, protein, fiber, vitamins, and minerals) between mothers of infants with myelomeningocele (cases) and mothers of controls. Secondary aims included (i) comparing foods consumed and (ii) evaluating if rice intake correlated with arsenic exposure. Paired t-tests, Wilcoxon signed rank tests, McNemar's chi-squared test, and linear regression were used. Results: This study included 110 matched mother-infant pairs (55 cases/55 controls). Mothers of cases and mothers of controls had similar caloric intake [median 2406 kcal/day vs. 2196 kcal/day (p = 0.071)]. Mothers in both groups consumed less than half the daily recommended 600 μg of folate. Diets were potentially deficient in vitamins A, D, E, potassium, sodium, and iron. Steamed rice was the primary food consumed for both groups, and this rice intake was not associated with toenail arsenic. Conclusions: Dietary interventions should increase folate, vitamins A, D, E, potassium, sodium, and iron intake in Bangladeshi mothers. Folic acid fortification of grain products maybe the only viable strategy to achieve adequate folate intake for mothers. Given the central role of rice to the Bangladeshi diet, fortifying rice may be a viable option.

A importância do ácido fólico para prevenção da meningomielocele. Uma revisão integrativa da literature

“…A exemplo disso, o Brasil, em que a prevalência geral de defeitos do tubo neural caiu de 0,79 acometidos a cada 1000 nascidos no período de pré-fortificação para 0,55 a cada 1000 nascidos no período de pós-fortificação. (De la Fournière et al, 2020;Obrycki et al, 2019;Blencowe et al, 2018;Santos et al, 2016;Bannink et al, 2015;Idowu et al, 2008;Mitchell, 2005;Jooma, 2004).…”

“…A alimentação rica em vitaminas e minerais variados é de extrema importância como fator de proteção para uma série de doenças, principalmente aquelas do sistema nervoso central. (Obrycki et al, 2019). Em consonância a essa informação, o estudo Deb et al (2018) descobriu que na Índia, país de base vegetariana, as taxas de defeitos no tubo neural são 1,6 vezes mais altas que no restante do mundo e que esse estilo de alimentação sem carnes representa mais um fator de risco para a ocorrência de meningomielocele.…”

“…Essa atitude garante que ambos sejam avaliados por especialistas e que várias doenças e complicações sejam prevenidas ou tenham sua detecção precoce, podendo ser tratadas de maneira mais eficaz e diminuindo as chances de sequelas. (Obrycki et al, 2019).…”

Gene Environment Interactions in the Etiology of Neural Tube Defects

“…Research conducted globally has provided strong evidence linking maternal arsenic exposure with an increased risk for NTD affected offspring. Studies conducted in Bangladesh have been particularly informative, given that Bangladesh has one of the highest prevalence rates of NTDs in the world ( Mazumdar, 2017 ), and the large segments of the Bangladeshi population suffers from excessive exposure to arsenic from drinking well water ( Mazumdar et al, 2015 ; Kancherla et al, 2017 ; Obrycki et al, 2019 ). As arsenic is methylated during its biotransformation, there is a concern that in populations that are highly exposed to arsenic, folate status would be an important confounding variable with respect to NTD prevalence.…”

The complex interaction between vitamin D, folate, and heavy metals: potential for attenuation of blood pressure effects

“…Additionally, a study conducted by Obrycki et al in 2019 [7] found that mothers in Bangladesh were consuming less than half the RDA for folate. Combined with Bangladesh's lack of formal legislation for folic acid fortification in foods and high prevalence of malnutrition [8], the apparent differences in folate intake in this study may have played a clinically significant role.…”