Folic Acid Fortification and Neural Tube Defect Risk: Analysis of the Food Fortification Initiative Dataset

Abstract

The United States implemented mandatory fortification of cereal grains with folic acid in 1998 to prevent neural tube defects (NTDs) during pregnancy. The health benefits of folate (vitamin B9) are well documented; however, there are potential risks of exceeding the upper tolerable limit, particularly in vulnerable populations. We conducted a population-based analysis of the Food Fortification Initiative dataset to determine the strength of the evidence regarding reports of decreased NTDs at the national level in response to mandatory folic acid fortification of cereal grains. We found a very weak correlation between NTD prevalence and the level of folic acid fortification, irrespective of the cereal grain fortified (wheat, maize or rice). Stratification of the data based on socioeconomic status (SES) indicated a strong linear relationship between reduced NTDs and better SES. We conclude that national fortification with folic acid is not associated with a significant decrease in the prevalence of NTDs at the population level.

Prevention of Neural Tube Defects by Folic Acid Supplementation: A National Population-Based Study

“…The socioeconomic status has been reported as strongly associated with NTDs prevalence, thus questioning the actual contribution of food folate fortification in several countries [ 28 , 29 , 30 ]. However, mandatory fortification can be considered one of the most effective and cost-effective public health measures to date: the estimated annual economic gain in the USA is 603 million dollars [ 31 ].…”

Reply to “The Fallacy of Using Administrative Data in Assessing the Effectiveness of Food Fortification. Comment on: Folic Acid Fortification and Neural Tube Defect Risk: Analysis of the Food Fortification Initiative Dataset. Nutrients 2020, 12, 247”

“…We would like to thank Kancherla et al for carefully reading and commenting [1], on our recent publication, "Folic Acid Fortification and Neural Tube Defect Risk: Analysis of the Food Fortification Initiative Dataset" [2]. Kancherla et al disagree with our statistical analysis and conclusions.…”

“…The main objective of our paper [2] was to retrospectively address the question of whether folic acid fortification improved NTD at the population level. Toward that goal, we extracted and analyzed relevant data from the Food Fortification Initiative (FFI) dataset.…”

Novel genes associated with folic acid-mediated metabolism in mouse: A bioinformatics study

“…Folic acid (vitamin B9), as a necessary micronutrient, has a crucial role in DNA biosynthesis and integrity, controlling the homocysteine level and inflammation response, and reducing the risk of cancers such as colon cancer [1][2][3][4][5]. This also plays an essential role in the central nervous system, and prevents a neural-tube defect (NTD), which is a major birth defect of the brain and spine that occurs early during the embryonic period [3,6].…”