A comprehensive evaluation of food fortification with folic acid for the primary prevention of neural tube defects

Liu, Shiliang; West, Roy; Randell, Edward; Longerich, L; O’Connor, Kathleen; Scott, Helen; Crowley, Marian; Lam, Angeline; Prabhakaran, V.; McCourt, Catherine

doi:10.1186/1471-2393-4-20

Cited by 120 publications

(109 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…27 Less than half of women surveyed in each State took periconceptional folate supplements. This finding is consistent with published studies based on Australian and overseas hospitalor service-based samples, 9,10,15,18,[28][29][30][31][32][33] and with US populationbased data. 11,12 Factors associated with not taking PFS, as in other populationbased studies, 11,12 are: being less than 25 years of age, having less education, being unmarried, having low family income, being born in non-English speaking countries, and unplanned pregnancy.…”

Section: Discussionsupporting

confidence: 82%

Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia

Watson

Brown

Davey

2006

Australian and New Zealand Journal of Public Health

View full text Add to dashboard Cite

In both surveys younger women, women with less education, less income, of nonEnglish speaking background and women who were not married were less likely to take folate supplements in the recommended period. In Victoria, multiparous women were significantly less likely to take supplements. In NSW, women with an unplanned pregnancy and those living in rural areas were significantly less likely to take periconceptional folate supplements. Fifty-three per cent of women cited a general practitioner or obstetrician as a source of folate information and 45% cited family or friends; both of these sources were significantly associated with periconceptional folate supplementation. Conclusions: Less than 50% of women took periconceptional folate supplements.Among socially disadvantaged groups, the proportion was significantly lower. Implications: Since women are unlikely to achieve adequate folate intake periconceptionally without deliberate action, there remains the need for a multifaceted approach to providing women with information about folate. Future surveys are needed to monitor usage and knowledge. (Aust N Z J Public Health 2006; 30: 42-9) N eural tube defects (NTDs) are a group of serious congenital structural abnormalities of the brain, skull, and spinal cord that are able to be detected antenatally by the use of ultrasound and maternal serum screening in the second trimester. 1 Since the routine introduction of these tests in Victoria, the birth prevalence of NTDs has reduced because pregnancies found to be affected are usually terminated. 2,3 There are also indications that since 1997, when folate awareness programs were introduced and after voluntary fortification of folate to staple foods was recommended, 4 the incidence of NTDs including pregnancies terminated after prenatal diagnosis has decreased in Victoria. 2 These data are not available for New South Wales (NSW).There is strong evidence that an adequate intake of folate periconceptionally reduces the risk of NTDs by about two-thirds, 5 and that folate (or folic acid) is only effective in reducing the risk of NTDs when recommended maternal folate levels are achieved before the critical time that neural tube closure occurs, around week four after conception. The National Health and Medical Research Council 6 has recommended that "women planning a pregnancy or likely to become pregnant should be encouraged to increase their dietary intake of folate-rich foods, particularly in the month before and in the first three months of the pregnancy. Low risk women . . . should be offered periconceptional folic acid supplementation (0.5 mg daily)." NHMRC draft documentation has this amount as 400 µg/ day, in line with overseas recommendations. The current habitual dietary intake of folate for most Australian women is well below that recommended for risk reduction of NTDs. 8,9 Primary prevention strategies to reduce the risk of NTDs include: periconceptional intake of folic acid supplements, increased consumption of foods naturally high in folate, and fortification ...

show abstract

Section: Discussionsupporting

confidence: 82%

Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia

Watson

Brown

Davey

2006

Australian and New Zealand Journal of Public Health

View full text Add to dashboard Cite

show abstract

“…15,21 Our results show that the inverse relation of plasma folate and the positive relation with homocysteine and adenoma recurrence were confined to nonusers of multivitamins in both studies.…”

Section: Discussionmentioning

confidence: 51%

“…Clearly, the optimal chemopreventive dose and timing of folate supplementation in humans has not been established. Although rates of NTDs have declined in the US and Canada following folic acid fortification of food products, 21,29 whether this mandate will also reduce rates of colorectal cancer is unknown. Furthermore, any long-term consequences of folic acid fortification are yet to be determined.…”

Section: Discussionmentioning

confidence: 99%

Folate fortification, plasma folate, homocysteine and colorectal adenoma recurrence

Martı́nez

Giovannucci

Jiang

et al. 2006

Intl Journal of Cancer

View full text Add to dashboard Cite

In 1996, the US Food and Drug Administration mandated the fortification of grain products with folic acid, a nutrient that has been associated with lower risk of colorectal neoplasia. We assessed the relation of plasma folate and homocysteine and colorectal adenoma recurrence separately in 2 studies: the first involved an intervention of a cereal supplement that contained folic acid, wheat bran fiber (WBF), and the second was conducted primarily during postfortification of the food supply using ursodeoxycholic acid (UDCA). Analyses were stratified for multivitamin use. Results show that plasma folate and homocysteine concentrations were associated with adenoma recurrence among nonusers of multivitamins only. Among nonmultivitamin users, the odds ratio [OR] (95% confidence interval [CI]) for those in the highest versus the lowest folate quartile was 0.65 (0.40-1.06) for the WBF study and 0.56 (0.31-1.02) for the UDCA; likewise, individuals in the highest versus the lowest quartile of homocysteine had higher odds of adenoma recurrence, in both the WBF (OR 5 2.25; 95% CI 5 1.38-3.66) and UDCA (OR 5 1.93; 95% CI 5 1.07-3.49) populations. Analyses comparing multivitamin users to different plasma folate concentrations among nonusers show that odds of recurrence for supplement users was lower only when compared to nonusers who had lower concentrations. Our results show that higher plasma folate or lower homocysteine levels are associated with lower odds of recurrence among nonusers of multivitamins in both studies. Our finding, suggesting that multivitamins or supplemental folate only benefit individuals with lower plasma folate concentrations, should be taken into consideration when designing and interpreting results of intervention studies. ' 2006 Wiley-Liss, Inc.Key words: colorectal adenoma; folate; homocysteine Colorectal cancer is thought to be the result of a multistep evolutionary process that involves a precursor lesion, the adenomatous polyp. Among individuals who undergo removal of their adenoma(s), recurrence of these lesions at surveillance colonoscopy is common, making adenoma recurrence an important endpoint to study in relation to lifestyle and other risk factors.Folate is a water soluble B-vitamin that functions as a coenzyme in single-carbon transfer in nucleic and amino acid metabolism. Folic acid is the fully oxidized monoglutamyl form of folate that is used in supplements and fortified foods. A recent meta analysis showed a significant 20-25% lower risk of developing colorectal cancer among individuals in the highest compared to those in the lowest category of dietary folate 1 ; inverse associations between blood folate and colorectal neoplasia (i.e., cancer and adenoma) have also been shown. [2][3][4] Mechanisms responsible for the inverse association of folate on risk of colorectal cancer are not entirely understood and may involve disturbances in DNA synthesis, methylation and repair, 5-7 albeit alternate mechanisms have been proposed. 8 Homocysteine, a biochemical marker of folate status, is an...

show abstract

“…Research has shown that such food fortification has resulted in a 20-70 % reduction in rates of pregnancies affected by NTD (3)(4)(5) .…”

mentioning

confidence: 99%

Session 1: Public health nutrition Folic acid food fortification: the Irish experience

et al. 2008

View full text Add to dashboard Cite

Adequate intake of folic acid by women during very early pregnancy can markedly reduce risk of the development of neural-tube defects (NTD). The effectiveness of advice to women to take folic acid supplements is limited, mainly because 50 % of pregnancies are unplanned. However, mandatory folic acid food fortification programmes in North America have been very successful in reducing NTD rates. In Ireland higher rates of pregnancies are affected by NTD and the option of termination is illegal. Consequently, the much higher burden of disease makes primary prevention of NTD an important public health issue in Ireland. During 2006 a decision was taken in Ireland to initiate mandatory folic acid fortification of most bread to prevent NTD. Priority work was immediately undertaken to establish reliable and comprehensive baseline information on factors that will be affected by fortification. This information included data on: the national prevalence of pregnancies affected by NTD; the current extent of voluntary folic acid fortification of food on the Irish market and how it affects folic acid intakes; blood folate status indicators assessed for various subgroups of the Irish population. In addition, scientific developments that have arisen since 2006 relating to the risks and benefits of folic acid intake are under ongoing review. The present paper summarises the rationale for mandatory folic acid food fortification in Ireland and recent scientific developments relating to risks and benefits of folic acid intake. In this context, preliminary findings of baseline monitoring investigations in Ireland are considered.

show abstract

A comprehensive evaluation of food fortification with folic acid for the primary prevention of neural tube defects

Cited by 120 publications

References 32 publications

Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia

Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia

Folate fortification, plasma folate, homocysteine and colorectal adenoma recurrence

Session 1: Public health nutrition Folic acid food fortification: the Irish experience

Contact Info

Product

Resources

About