Research goals for folate and related B vitamin in Europe

Abstract

In the past decade, the understanding of folate bioavailability, metabolism and related health issues has increased, but several problems remain, including the difficulty of delivering the available knowledge to the populations at risk. Owing to the low compliance of taking folic acid supplements, for example, among women of child-bearing age who could lower the risk of having a baby with a neural tube defect, food-based strategies aimed at increasing the intake of folate and other B-group vitamins should be a priority for future research. These should include the development of a combined strategy of supplemental folate (possibly with vitamin B 12 ), biofortification using engineered plant-derived foods and micro-organisms and food fortification for increasing folate intakes in the general population. Currently, the most effective population-based strategy to reduce NTDs remains folic acid fortification. However, the possible adverse effect of high intakes of folic acid on neurologic functioning among elderly persons with vitamin B 12 deficiency needs urgent investigation. The results of ongoing randomized controlled studies aimed at reducing the prevalence of hyperhomocysteinemia and related morbidity must be available before food-based total population approaches for treatment of hyperhomocysteinemia can be recommended. Further research is required on quantitative assessment of folate intake and bioavailability, along with a more thorough understanding of physiological, biochemical and genetic processes involved in folate absorption and metabolism.

Dietary intake and status of folate and vitamin B12 and their association with homocysteine and cardiovascular disease in European populations

“…To achieve health benefits, intakes should probably be higher than the recommendations. Several approaches to increase the intake of folate and vitamin B12 are possible (Finglas et al, 2006); (a) a food-based approach which includes a healthy lifestyle consisting of a diet rich in green leafy vegetables (rich in folate and betaine), meat and dairy products (rich in vitamin B12), together with a moderate coffee and protein intake. It should also be emphasized to select foods with high folate content and advice should be given which household preparation method can be used (McKillop et al, 2002).…”

The significance of folate supplementation

“…In real life, however, due to the high numbers of unplanned pregnancies, it is recommended that all women of childbearing age continuously take oral supplements of folic acid at a dose of 0.4 mg per day. For those women who have already given birth to one child with neural tube defects, a preventive daily dose of 5 mg of folic acid is recommended [4,6,10,11].…”

“…Vitamin and mineral supplements are recommended during pregnancy for women not following an appropriate diet as well as of women in high-risk groups due to multiple pregnancies, smoking cigarettes, and alcohol and drug abuse. For pregnant women and those lactating, the recommended daily intake of iodine is 200 g; however, increasing the dietary salt intake is not recommended, and therefore products containing iodine are recommended only at a level of 200 μg/day [7,10,11]. According to the recommendations of the Polish Gynaecological Society the daily dose of folic acid for preventing CNS defects is 40 mg daily.…”

“…Nutritional folate deficiencies in expectant mothers may cause such neonatal birth defects as anencephaly or a herniated spinal cord [4,6,10,11]. Despite the high folate content in some food products, the bioavailability of folic acid can be low.…”

“…In light of recent studies on women planning a pregnancy, it is recommended that the diet be supplemented with folate at 0.4 mg/day for a month before the planned conception, as well as during the first trimester of pregnancy. In cases where high-risk factors are present for neural tube defects, then the folic acid dose should be increased to 4 mg/day during the entire period of pregnancy [4,10,11].…”