Prevalence of inadequate intake of folate after mandatory fortification: results from the first National Dietary Survey in Brazil

Palchetti, Cecília Zanin; Steluti, Josiane; Verly, Eliseu; Pereira, Rosângela Alves; Sichieri, Rosely; Marchioni, Dirce Maria Lobo

doi:10.1007/s00394-019-02127-w

Cited by 5 publications

(7 citation statements)

References 35 publications

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“…The mandatory fortification of wheat flour with Fe and folic acid in Brazil may be one explanation for the lower intake of these micronutrients in the post-modelled estimations, since whole-wheat flour is not enriched due to technological issues (9,45) . Consistent with this, breads (including all types of refined breads) were among the main contributors to Fe and folate intake in the post-fortification period in Brazil (46)(47)(48) . Therefore, a combination of refined and whole grain foods may be the best way to mitigate the unwanted effects observed, or alternative methods for fortification of grains should be promoted for example during food processing (49) or by biofortification (50) .…”

Section: Discussionsupporting

confidence: 66%

Opportunities for diet quality improvement: the potential role of staple grain foods

Fontanelli

Martínez-Arroyo

Sales

et al. 2021

Public Health Nutr.

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Objective: Given the high disease burden associated with the low intake of whole grains, modelling studies that estimate the impact of dietary strategies to increase more healthful grain foods consumption are essential to inform evidence-based and culturally-specific policies. This study investigated the potential nutritional impact of replacing staple grain foods with more healthful options. Design: Based on the 2015 Health Survey of São Paulo, a cross-sectional, population-based study, we modelled the substitution of white rice and white bread with brown rice and whole-wheat bread. Outcomes included changes in more healthful grain foods, energy, and nutrient intakes. Setting: Urban area of São Paulo, Brazil. Participants: Participants aged over 12 years who completed a semi-structured questionnaire and one 24-h recall (n=1741). Results: The substitution of all white rice and white bread with brown rice and whole-wheat bread, respectively, would result in more than 5% increases in zinc (+9.1%), calcium (+9.3%), vitamin E (+18.8%), dietary fibre (+27.0%), and magnesium (+52.9%) intake, while more than a 5% decrease would be seen for total carbohydrate (-6.1%), folate (-6.6%), available carbohydrate (-8.5%), iron (-8.6%), vitamin B6 (-12.5%), vitamin B2 (-17.4%), and vitamin B1 (-20.7%). A substantial increase in the amount of more healthful grain foods consumed would be seen (10g/d to 220g/d), or from 4% to 69% of total grain intake. Conclusions: Replacing white rice and white bread with their whole-grain versions has the potential to improve diet quality, suggesting they are prime targets for policy actions aiming at increasing intake of more healthful grain foods.

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Section: Discussionsupporting

confidence: 66%

Opportunities for diet quality improvement: the potential role of staple grain foods

Fontanelli

Martínez-Arroyo

Sales

et al. 2021

Public Health Nutr.

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“…These results suggest that instituted national mandatory fortification programs with folic acid to enhance the diets of reproductive-age women may be partially increasing the dietary folate intake 33 . Therefore, careful monitoring of total folate intake from food and dietary supplements is recommended 23,34,35 .…”

Section: Discussionmentioning

confidence: 99%

“…For the analysis, we selected five nutrients (calcium, folate, and vitamins C, D, and E) with the prevalence of intake inadequacy in the population > 10% above the EAR and because they are usually inadequate in the Brazilian diet 22,23 . Given that the bioavailability of synthetic folic acid used in supplements and food fortification is higher than that of natural food folate, the expression of folate intakes as µg dietary folate equivalents (DFE) was considered.…”

Section: Statistical Analysesmentioning

confidence: 99%

Diet and supplement assessment in a Brazilian urban population

Sousa

Costa

2021

Rev. saúde pública

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OBJECTIVE: To assess total usual nutrient intakes from foods and dietary supplements by age, sex, physical activity, and nutritional status, and to compare usual nutrient intakes to the Dietary Reference Intakes among non-users and users of dietary supplements in an urban population. METHODS: Cross-sectional population-based survey with 506 adults conducted in the city of Brasília, Brazil, using 24h food recalls. The 24-HR was collected on two nonconsecutive days, for which individuals reported all food, supplements, and beverages consumed in the previous 24 hours. The estimates of mean and the distribution percentiles were adjusted to reflect usual nutrient intake using the Iowa State University method. The prevalence of inadequate micronutrient intake was estimated according to sex using the Estimated Average Requirement (EAR), and values above the Tolerable Upper Intake Level (UL) were also considered. Also, a comparison was made of the total mean usual intake between supplement users and non-users according to BMI and physical activity. RESULTS: The total mean usual dietary intake was significantly higher among users than non-users of dietary supplements (p ≤ 0.02). Dietary supplement use increased intakes of nutrients and decreased prevalence of inadequacy according to sex, with only small (typically < 13%) increases in the population exceeding the Tolerable Upper Intake Level. There was a significant interaction between physical activity and BMI categories with supplement use. CONCLUSIONS: The population that consumes food supplements comprises individuals with more advanced age, female, normal BMI, and physically active. Our findings show that the use of supplements appears beneficial to attain nutrient adequacy. Careful monitoring of intake from food and supplements is recommended, and the statistical methods must be powerful enough to achieve relevant information.

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“…Epidemiological data search shows that ZIKV-associated microcephaly is more frequent in areas with poor socioeconomic background with reports of malnutrition and deficits of vitamin A [4,5] and folate [6]. A screening based on these epidemiological data will be performed through common exams for cholesterol and fractions (as a marker of nutritional status) [38], vitamin A, and folate in blood of nine mothers of microcephalic children.…”

Section: "Reverse Engineering" To Reveal Co-factor Of Zikv-associated Microcephalymentioning

confidence: 99%

“…It is possible that a poor socioeconomic background correlates with the degree of severity of ZIKVassociated brain lesions due to nutritional or environment features [3]. Populations with higher incidence of ZIKV-associated microcephaly display higher incidence of malnutrition, vitamin A deficit [4,5], and folate deficit during pregnancy, for example [6]. Through different mechanisms, these nutritional alterations can lead to alterations in the placental barrier, fetal blood-brain barrier, and neurogenesis [7,8].…”

Section: Introductionmentioning

confidence: 99%

Co-factor Influences the Severity of Zika Virus-Associated Microcephaly

Nogueira¹,

Andrade²,

Zanini³

et al. 2021

Preprint

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Microcephaly has been regarded the most remarkable consequence of the Zika virus (ZIKV) epidemic in Brazil 2015. It remains to be determined whether there are factors that contribute to the degree of brain lesion associated with ZIKV infection during pregnancy. Previous studies showed that socioeconomic conditions correlate with ZIKV-associated microcephaly. Certain nutritional deficits display the potential to interfere in the mechanistic target of rapamycin (mTOR) signaling, which plays a major role in the pathophysiology of ZIKV-associated microcephaly. We hypothesize that a nutritional or environmental co-factor that interferes in mTOR signaling correlates with ZIKV-associated birth defects. To assess this hypothesis, we plan to: 1) develop a mouse model of ZIKV-associated microcephaly through intravenous injection of ZIKV and rapamycin for a straightforward interference on mTOR receptor; 2) determine in the experimental model and in cases of ZIKV-associated microcephaly the epigenetic signature (DNA methylation pattern) in neurons and muscle cells harvested by biopsy, and in hematopoietic and mesenchymal stem cells sorted from blood; 3) analyze through mass spectrometry in serum of pregnant female mice submitted to ZIKV and rapamycin injection and in serum of mothers of children with ZIKV-associated microcephaly the metabolomic pattern of cholesterol (a nutritional status marker), vitamin A and its metabolite retinoic acid, folate, and other metabolites related to these three nutritional factors; 4) check whether pregnant female mice submitted to intravenous injection of ZIKV and feed with a deficient diet of the most likely co-factor found in this study give birth to microcephalic mice with features that mimic clinical cases. In summary, our general objective is to develop an experimental model that mimics ZIKV-associated microcephaly cases and to find a co-factor involved in the microcephaly outbreak in Brazil 2015.

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Prevalence of inadequate intake of folate after mandatory fortification: results from the first National Dietary Survey in Brazil

Cited by 5 publications

References 35 publications

Opportunities for diet quality improvement: the potential role of staple grain foods

Opportunities for diet quality improvement: the potential role of staple grain foods

Diet and supplement assessment in a Brazilian urban population

Co-factor Influences the Severity of Zika Virus-Associated Microcephaly

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