Peru's national folic acid fortification program and its effect on neural tube defects in Lima

Ricks, Daniel; Rees, Chris A.; Osborn, Katharine A; Crookston, Benjamin T.; Leaver, Katherine; Merrill, Samuel B.; Velásquez, Carlos Alberto Agudelo; Ricks, Jane H.

doi:10.1590/s1020-49892012001300001

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…Pooled analyses showed a strong association between folic acid fortification and the decreased prevalence of total NTDs (OR: 0.59; 95% CI: 0.49, 0.70) ( Figure 5 ) and NTD subtype, including spina bifida (OR: 0.66; 95% CI: 0.53, 0.82) ( Supplemental Figure 8 ), anencephaly (RR: 0.49; 95% CI: 0.40, 0.60) ( Supplemental Figure 9 ), and cephalocele (OR: 0.64; 95% CI: 0.47, 0.88) ( Supplemental Figure 10 ). A single study conducted in Peru (57) was, however, associated with an apparent increase in spina bifida following implementation of the national folic acid fortification program. Among WRA, folic acid fortification of flour was associated with a significant decline in the prevalence of folate deficiency (RR: 0.20; 95% CI: 0.15, 0.25) ( Supplemental Figure 11 ), as well as improvements in serum/plasma folate levels (SMD: 1.25; 95% CI: 0.50, 1.99) ( Supplemental Figure 12 ).…”

Section: Resultsmentioning

confidence: 99%

Improved micronutrient status and health outcomes in low- and middle-income countries following large-scale fortification: evidence from a systematic review and meta-analysis

Keats

Neufeld

Garrett

et al. 2019

The American Journal of Clinical Nutrition

143

138

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Background Micronutrient malnutrition is highly prevalent in low- and middle-income countries (LMICs) and disproportionately affects women and children. Although the effectiveness of large-scale food fortification (LSFF) of staple foods to prevent micronutrient deficiencies in high-income settings has been demonstrated, its effectiveness in LMICs is less well characterized. This is important as food consumption patterns, potential food vehicles, and therefore potential for impact may vary substantially in these contexts. Objectives The aim of this study was to determine the real-world impact of LSFF with key micronutrients (vitamin A, iodine, iron, folic acid) on improving micronutrient status and functional health outcomes in LMICs. Methods All applicable published/unpublished evidence was systematically retrieved and analyzed. Studies were not restricted by age or sex. Meta-analyses were performed for quantitative outcomes and results were presented as summary RRs, ORs, or standardized mean differences (SMDs) with 95% CIs. Results LSFF increased serum micronutrient concentrations in several populations and demonstrated a positive impact on functional outcomes, including a 34% reduction in anemia (RR: 0.66; 95% CI: 0.59, 0.74), a 74% reduction in the odds of goiter (OR: 0.26; 95% CI: 0.16, 0.43), and a 41% reduction in the odds of neural tube defects (OR: 0.59; 95% CI: 0.49, 0.70). Additionally, we found that LSFF with vitamin A could protect nearly 3 million children per year from vitamin A deficiency. We noted an age-specific effect of fortification, with women (aged >18 y) attaining greater benefit than children, who may consume smaller quantities of fortified staple foods. Several programmatic/implementation factors were also reviewed that may facilitate or limit program potential. Conclusions Measurable improvements in the micronutrient and health status of women and children are possible with LSFF. However, context and implementation factors are important when assessing programmatic sustainability and impact, and data on these are quite limited in LMIC studies.

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Section: Resultsmentioning

confidence: 99%

Improved micronutrient status and health outcomes in low- and middle-income countries following large-scale fortification: evidence from a systematic review and meta-analysis

Keats

Neufeld

Garrett

et al. 2019

The American Journal of Clinical Nutrition

143

138

View full text Add to dashboard Cite

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“…This finding was similar to the findings of other studies [ 4 , 7 ]. Moreover, many studies suggested that iron folate prevents/reduces the occurrence of certain types of CMs, for example, neural tube defects [ 5 , 12 , 28 – 33 ]. This indicates that few participants were aware that folic acid/iron folate protects from some CMs.…”

Section: Discussionmentioning

confidence: 99%

Parents’ perceived knowledge and beliefs on congenital malformations and their causes in the Amhara region, Ethiopia. A qualitative study

Taye

2021

PLoS ONE

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Introduction Knowledge and beliefs of people on congenital malformations and their causes differ from society to society. As a result, there is a paucity of understanding community perceived knowledge and beliefs towards congenital malformations and their risk factors among children’s parents. Therefore, I sought to identify perceived knowledge and beliefs of parents on congenital malformations and their causes. Methods An in-depth discussion and interview were carried out on purposively selected forty participants (women and men) in the Amhara region, Ethiopia. The data were collected from June to July, 2015. Semi-structured guiding topics/questions were used during the discussions and in-depth interviews. Note and audio records were taken while the participants discussed the topics. After the discussions and in-depth interviews were completed, the transcripts were read repeatedly to understand the participant’s words, phrases, ideas, and concepts. Then notes were taken to combine pieces of similar transcripts. I have employed thematic framework analysis. The relevant transcripts were scrutinized, labeled and coded manually based on their relevance to the objective of the study. Then the coded transcripts were determined and categorized according to the type of thematic variables. Results The participants responded on three aspects of lived experience, perceived knowledge and beliefs on congenital malformations and their causes. Nearly half of the participants’ beliefs on the causes of congenital malformations were related to sin, contraceptive pills, un-prescribed drugs/medication use, and fertilizers (that is eating crops grown by using fertilizers). Almost all said that raising a child with a major congenital malformation was very difficult. About half of the participants’ belief on congenital malformations were traditional and resulted from poor awareness. Conclusion The findings of the present study highlight the challenges and impacts of congenital malformations on parents who had children with and without congenital malformation. Lived experience, perceived knowledge and beliefs of children parents on congenital malformation and their causes can be helpful information for designing preventive actions. Hence, planning a preventive strategy and providing health education on congenital malformations and their causes for children parents are very necessary.

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“…Consequently, folic acid supplements are recommended before pregnancy. Implementation of food fortification has been associated with reduced neural tube defect prevalence in several countries (Mills and Signore, 2004; Ricks et al , 2012). Nevertheless, data from clinical trials, epidemiological studies and reported occurrences of sequential affected pregnancies in some individuals despite use of folic acid all show that a proportion of neural tube defects are unresponsive to folic acid (Wald et al ,1991; Blom et al , 2006; Mosley et al , 2009).…”

Section: Introductionmentioning

confidence: 99%

Nucleotide precursors prevent folic acid-resistant neural tube defects in the mouse

Leung

Castro

Savery

et al. 2013

Brain

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Closure of the neural tube during embryogenesis is a crucial step in development of the central nervous system. Failure of this process results in neural tube defects, including spina bifida and anencephaly, which are among the most common birth defects worldwide. Maternal use of folic acid supplements reduces risk of neural tube defects but a proportion of cases are not preventable. Folic acid is thought to act through folate one-carbon metabolism, which transfers one-carbon units for methylation reactions and nucleotide biosynthesis. Hence suboptimal performance of the intervening reactions could limit the efficacy of folic acid. We hypothesized that direct supplementation with nucleotides, downstream of folate metabolism, has the potential to support neural tube closure. Therefore, in a mouse model that exhibits folic acid-resistant neural tube defects, we tested the effect of specific combinations of pyrimidine and purine nucleotide precursors and observed a significant protective effect. Labelling in whole embryo culture showed that nucleotides are taken up by the neurulating embryo and incorporated into genomic DNA. Furthermore, the mitotic index was elevated in neural folds and hindgut of treated embryos, consistent with a proposed mechanism of neural tube defect prevention through stimulation of cellular proliferation. These findings may provide an impetus for future investigations of supplemental nucleotides as a means to prevent a greater proportion of human neural tube defects than can be achieved by folic acid alone.

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Peru's national folic acid fortification program and its effect on neural tube defects in Lima

Cited by 4 publications

References 11 publications

Improved micronutrient status and health outcomes in low- and middle-income countries following large-scale fortification: evidence from a systematic review and meta-analysis

Improved micronutrient status and health outcomes in low- and middle-income countries following large-scale fortification: evidence from a systematic review and meta-analysis

Parents’ perceived knowledge and beliefs on congenital malformations and their causes in the Amhara region, Ethiopia. A qualitative study

Nucleotide precursors prevent folic acid-resistant neural tube defects in the mouse

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