Efficacy of Flour Fortification with Folic Acid in Women of Childbearing Age in Iran

Abstract

Background: Flour fortification with folic acid is one of the main strategies for improving folate status in women of childbearing age. No interventional trial on the efficacy of folic acid fortification has been conducted so far in Iran. Objectives: To study the effects of flour fortification with folic acid on any reduction in neural tube defects (NTDs) and folate status of women of childbearing age. Methods: In a longitudinal hospital-based study, 13,361 postpartum women were studied after admission for childbirth before and after fortification. In addition, two cross-sectional surveys were conducted before (2006) and after flour fortification (2008). The cluster sampling method was used and 580 women, 15–49 years old, were studied as a representative sample of Golestan province in the north of Iran. Fasting blood samples were collected to measure serum vitamin B₁₂, folate and plasma homocysteine. Sociodemographic data, health characteristics and dietary intake were determined. Results: The mean daily intakes of folate from natural food before and after flour fortification were 198.3 and 200.8 µg/day, respectively. The total folate intake increased significantly from 198.3 to 413.7 µg/day after fortification (p < 0.001). Folate intake increased by an average of 226 µg/day from fortified bread. The mean serum folate level increased from 13.6 to 18.1 nmol/l; folate deficiency decreased from 14.3 to 2.3% (p < 0.001). The incidence rate of NTDs declined by 31% (p < 0.01) in the post-fortification period (2.19 per 1,000 births; December 2007 to December 2008) compared to the pre-fortification period (3.16 per 1,000 births; September 2006 to July 2007). Conclusions: Implementation of mandatory flour fortification with folic acid can lead to a significant increase in serum folate and a significant decrease in NTDs.

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

“…Dos principais achados, destaca-se um declínio importante, entre 60% a quase 100%, na prevalência de inadequação de ingestão de folato, considerada como o percentual da população que não atinge o valor de recomendação correspondente a EAR, em todas as faixas etárias e em ambos os sexos, similar a outros países que adotaram a fortificação com ácido fólico de caráter mandatório 13,34,35,36 . Em relação aos grupos estudados, nota-se que os adolescentes apresentaram as maiores reduções, possivelmente em decorrência do consumo de alimentos fortificados.…”

Risk of Anaemia in Population of Healthy Young People Inhabiting a Region in Central Europe

“…It is especially important because whole Europe, as well as USA, deal more often with the issue of excessive intake of nutrients and increased percentage of obese people among the youth than with diseases connected to malnutrition [1, 2]. With respect to this, particularly dangerous is the deficiency in folacin in women's diets, particularly for women planning pregnancy, because it can lead to underdeveloped placenta and, in consequence, to miscarriage or neural tube defects in neonates [3]. In Poland, neural tube defects occur in 2-3 cases per 1000 births [4].…”

Prevention of NTDs - Proposal of a New Concept

“…In addition, one has to bear in mind whether total prevalence or live birth prevalence is reported. Live birth prevalence published by Lopez-Camelo et al (2010), Abdollahi et al (2011), or Amarin & Obeidat (2010 is not the best variable to deduce progress in prevention of NTD from FA fortification. Other factors than FA may be responsible for the decline like high-quality prenatal screening and medical termination of pregnancy following diagnosis of NTD.…”

“…In Iran, FA fortification became active in 2008. Abdollahi et al (2011) evaluated the effect of fortification on folate status in postpartum women recruited from hospitals. While intake of dietary folate was stable over time (2006: 198.3 µg/day; 2008: 200.8 µg/day), a significant increase in total folate intake was observed after fortification (2006: 198.3 µg/day; 2008: 413.7 µg/day).…”