Effect of folic acid fortification on the incidence of neural tube defects

Abstract

In a few countries enriched cereal grains have been fortified with folic acid to reduce the incidence of neural tube defects. The objective of this study was to analyse the effect of folic acid fortified foods on the incidence of neural tube defects in live newborns at Princess Badea Teaching Hospital, in the north of Jordan, before and after the national food fortification with folic acid was implemented. For the 7-year period from 1 January 2000 to 31 December 2006, we retrospectively extracted the total number of births at Princess Badea Hospital, as well as the number of pregnancies affected by spina bifida and anencephaly, per 1000 births during the periods before (2000-01), during (2002-04) and after (2005-06) folic acid fortification of grain products, was implemented. Neural tube defects were defined in accordance with the International Classification of Diseases, 10th revision (ICD-10): anencephaly, encephalocele and spina bifida. A total of 78 subjects with neural tube defects were recorded among 61 447 births during the study period. The incidence of neural tube defects decreased from 1.85 per 1000 births before fortification [95% confidence interval (CI) 1.2, 2.4] to 1.07 per 1000 births during the fortification period [95% CI 0.7, 1.5], and 0.95 after full fortification [95% CI 0.5, 1.5], a 49% reduction. The difference between incidence of neural tube defects in the periods before and after food fortification with folic acid was statistically significant. We conclude that food fortification with folic acid was associated with a significant reduction in the rate of neural tube defects in north Jordan.

Ingestão de folato nos períodos pré e pós-fortificação mandatória: estudo de base populacional em São Paulo, Brasil

“…Apesar da escassez de dados nacionais representativos sobre a ingestão de folato, pesquisas em outros países já denunciavam o consumo insuficiente deste nutriente 3 . Nos países onde ocorreu a fortificação de alimentos foram observadas reduções na ocorrência de malformações do tubo neural 4,5,6,7,8,9 , aumento do folato sérico e eritrocitário na população em geral e nas mulheres em idade fértil 10,11,12,13 , tornando a fortificação mandatória com ácido fóli-co uma das mais bem-sucedidas ações de saúde pública para a redução dos defeitos de tubo neural 8 . No Brasil, foi encontrada uma redução em 39% da prevalência de espinha bífida, relacionada ao programa de fortificação mandatória de farinhas com ácido fólico 14 .…”

New born children with Encephalocele

“…Recently it is reported that food fortification with folic acid has significantly reduced neural tube defects including encephaloceles [1]. There are similar reports from different countries showing that fortifying foods and FA supplementation reduces the incidence of encephaloceles [25]. Although among our cases only two mothers irregularly used FA and three did not use any FA, which hampers the fact of FA defficiency as a possible cause of the defects.…”

Lack of data on folate in convenience foods: Should ready-to-eat products be considered relevant for folate intake? The European challenge

“…Thus, low dietary intake is the most common cause of folate deficiency. Important health problems could be related with vitamin scarcity, ranging from megaloblastic anaemia to more recently described complications such as high homocysteine levels and cardiovascular risk (Cui et al, 2010; known as neural tube defects (NTDs) (Amarin and Obeidat, 2010;Czeizel and Dudas, 1992). Epidemiological evidence suggests that a suboptimal folate intake, considering the updated dietary reference intakes, may be widespread for many worldwide populations (Herrmann and Obeid, 2011;Yeung et al, 2011).…”