Spina bifida before and after folic acid fortification in Canada

Wals, Philippe De; Tairou, Fassiatou; Allen, Margot I. Van; Lowry, R. Brian; Evans, Jane; Hof, Michiel C. Van den; Crowley, Marian; Uh, Soo-Hong; Zimmer, Pamela; Sibbald, Barbara; Fernandez, Bridget A.; Lee, Nora S.; Niyonsenga, Théophile

doi:10.1002/bdra.20485

Cited by 81 publications

(60 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The smallest decrease occurred in the state of California in the USA (15?5 %) (23) . Twenty-one articles reported on the prevalence of spina bifida before and after flour fortification (15,16,19,(21)(22)(23)25,26,28,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) . The largest reductions reported were in Costa Rica (61 %) (28) , Canada (55 %) (21) and Chile (55 %) (25) The latter study examined the number of NTD cases between the years 1998 and 2007.…”

Section: Resultsmentioning

confidence: 99%

“…This country not only fortifies wheat flour but also maize flour, cow's milk and rice (28) . Other countries showed NTD reductions of about 50 % (16,20,21,57) and similar reductions in spina bifida (21,25,38) and anencephaly (16,35,39) . The results varied by country and depended on the integrity and quality of the country's surveillance system.…”

Section: References Identified Medline Viamentioning

confidence: 87%

See 1 more Smart Citation

Impact of folic acid fortification of flour on neural tube defects: a systematic review

Castillo-Lancellotti

Tur

Uauy

2012

Public Health Nutr.

168

144

View full text Add to dashboard Cite

Objective: To review the impact of folic acid fortification of flour on the prevalence of neural tube defects (NTD). Design: Systematic review of the literature on MEDLINE via PubMed, Scopus, OvidSP and LILACS (Latin American and Caribbean Health Sciences Literature) reporting the impact of folic acid fortification of flour on the prevalence of NTD in 2000-2011. Focusing on Santiago of Chile's birth defects registry (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009) and the monitoring of flour fortification, we analysed the prevalence (NTD cases/ 10 000 births) pre and post flour fortification and the percentile distribution of folic acid content in flour (2005)(2006)(2007)(2008)(2009). We explored the potential association between median folic acid in flour (mg/kg) and the prevalence of NTD. Setting: Chile, Argentina, Brazil, Canada, Costa Rica, Iran, Jordan, South Africa and the USA. Subjects: Live births and stillbirths. Results: Twenty-seven studies that met inclusion criteria were evaluated. Costa Rica showed a significant reduction in NTD ( , 60 %). Prevalence in Chile decreased from 18?6 to 7?3/10 000 births from 1999 to 2007 and showed a slight increase to 8?5 in 2008-2009, possibly due to changes in fortification limits. When we related the prevalence of NTD with levels of flour fortification, the lowest prevalence was observed at a folic acid level of 1?5 mg/kg. Conclusions: Fortification of flour with folic acid has had a major impact on NTD in all countries where this has been reported. Chile showed a 55 % reduction in NTD prevalence between 1999 and 2009. There is a need to constantly monitor the levels of flour fortification to maximize benefits and prevent the potential risk of folic acid excess, moreover to be vigilant for any new adverse effects associated with excess. Keywords Folic acid Neural tube defects Spinal dysraphism Food fortification Systematic reviewThe importance of nutrition in the aetiology of neural tube defects (NTD) was suggested by Hibbard and Smithells, who found that women deficient in folate had an increased number of abortions, placental abruptions and fetal malformations and intra-uterine growth retardation (1) . The first reports on folate deficiency and NTD, published by Smithells et al. (2,3) , showed the protective effect of folic acid on the recurrence of NTD. A randomised study by Czeizel and Dudas (4) showed a decrease in first NTD occurrence in women supplemented with twelve vitamins containing 0?8 mg of folic acid, but not in women supplemented with trace elements and a very low dose of vitamin C. A rigorous double-blind randomised controlled trial supported by the UK Medical Research Council showed that supplementing women who had a history of children with NTD with 4 mg of folic acid daily decreased recurrence by 72 % (5) . Although some studies were retrospective, their results revealed an inverse relationship between NTD and folic acid consumption of 100-400 mg/d (6,7) . Based on this information, in 1992 the US Public Health Service r...

show abstract

Section: Resultsmentioning

confidence: 99%

Section: References Identified Medline Viamentioning

confidence: 87%

Impact of folic acid fortification of flour on neural tube defects: a systematic review

Castillo-Lancellotti

Tur

Uauy

2012

Public Health Nutr.

168

144

View full text Add to dashboard Cite

show abstract

“…30,31 Estimates of costs for subtypes of spina bifida, including by lesion level, were not available. Post-infancy hospitalization costs for children with spina bifida who have another major birth defect are roughly 1.5 times greater than for isolated spina bifida (E Radcliff, University of South Carolina, personal communication, 2014).…”

Section: Methodsmentioning

confidence: 99%

Retrospective Assessment of Cost Savings From Prevention

Grosse

Berry

Tilford

et al. 2016

American Journal of Preventive Medicine

View full text Add to dashboard Cite

Introduction Although fortification of food with folic acid has been calculated to be cost saving in the U.S., updated estimates are needed. This analysis calculates new estimates from the societal perspective of net cost savings per year associated with mandatory folic acid fortification of enriched cereal grain products in the U.S. that was implemented during 1997–1998. Methods Estimates of annual numbers of live-born spina bifida cases in 1995–1996 relative to 1999–2011 based on birth defects surveillance data were combined during 2015 with published estimates of the present value of lifetime direct costs updated in 2014 U.S. dollars for a live-born infant with spina bifida to estimate avoided direct costs and net cost savings. Results The fortification mandate is estimated to have reduced the annual number of U.S. live-born spina bifida cases by 767, with a lower-bound estimate of 614. The present value of mean direct lifetime cost per infant with spina bifida is estimated to be $791,900, or $577,000 excluding caregiving costs. Using a best estimate of numbers of avoided live-born spina bifida cases, fortification is estimated to reduce the present value of total direct costs for each year's birth cohort by $603 million more than the cost of fortification. A lower-bound estimate of cost savings using conservative assumptions, including the upper-bound estimate of fortification cost, is $299 million. Conclusions The estimates of cost savings are larger than previously reported, even using conservative assumptions. The analysis can also inform assessments of folic acid fortification in other countries.

show abstract

“…NTD births in Canada have been reduced by 46% since the implementation of fortification with folic acid, demonstrating the success of this intervention (De Wals et al 2008). In addition, folate deficiency (red blood cell (RBC) folate <305 nmol·L -1 ) is virtually nonexistent in the general Canadian population (Colapinto et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Folic acid supplement use is the most significant predictor of folate concentrations in Canadian women of childbearing age

Colapinto

O'Connor

Dubois

et al. 2012

Appl. Physiol. Nutr. Metab.

View full text Add to dashboard Cite

One-fifth of Canadian women of childbearing age (WCBA) have red blood cell (RBC) folate concentrations below those considered optimal for neural tube defect risk reduction (≥906 nmol·L -1 ). Determinants of optimal concentrations have not been examined in a nationally representative sample of Canadian WCBA since food fortification with folic acid was implemented. This study explored correlates of optimal RBC folate concentrations and characteristics of folic acid supplement users in a sample of Canadian WCBA. RBC folate concentrations from the 2007-2009 Canadian Health Measures Survey were assessed in women aged 15 to 45 years (n = 1162). Sociodemographic, behavioural, and clinical determinants of RBC folate ≥906 nmol·L -1 were examined using univariate and separate multiple logistic regression models that controlled for age and household income. t tests were used to study differences between folic acid supplement users and nonusers. WCBA not taking folic acid supplements were less likely to achieve a RBC folate concentration ≥906 nmol·L -1 compared with folic acid supplement users (odds ratio, 0.47; 95% confidence interval, 0.24, 0.92). Twenty-five percent of WCBA reported folic acid supplement use, and there was a higher percentage of folic acid supplement users in the highest income group. Folic acid supplement users were also more frequent consumers of supplemental vitamin B12 and of fruit and vegetables (>3 times per day). Folic acid supplement use was the most significant predictor of WCBA achieving optimal RBC folate concentrations. These results indicate a need for targeted strategies to improve compliance with folic acid supplement recommendations among WCBA.Key words: red blood cell (RBC) folate, folic acid, supplementation, Canadian Health Measures Survey (CHMS).Résumé : Un cinquième des Canadiennes en âge de procréer (WCBA) présente une concentration érythrocytaire (RBC) de folate sous le seuil considéré optimal pour diminuer le risque d'anomalie du tube neural (≥906 nmol·L -1 ). Il n'y a pas eu d'études sur les déterminants de la concentration optimale dans un échantillon représentatif des WBCA sur le plan national depuis la mise en oeuvre de l'enrichissement des produits alimentaires en acide folique. Cette étude analyse les corrélats de la concentration optimale d'acide folique dans les RBC et les caractéristiques des consommatrices de supplément d'acide folique dans un échantillon canadien de WBCA. On évalue la concentration érythrocytaire de folate dans un échantillon de l'Enquête canadienne sur les mesures de la santé 2007-2009 (CHMS) comprenant des femmes âgées de 15 à 45 ans (n = 1162). On cherche les déterminants sociodémographiques, comportementaux et cliniques d'une concentration érythrocytaire de folate ≥906 nmol·L -1 au moyen de modèles de régression univariée et de régression logistique multiple prenant en compte l'âge et le revenu du ménage. On utilise des tests t pour analyser les différences entre les consommatrices de supplé-ment en acide folique et celles qui n'en consomm...

show abstract

Spina bifida before and after folic acid fortification in Canada

Abstract: Results confirmed the etiologic heterogeneity of spina bifida and the more pronounced effect of folic acid in decreasing the risk of the more severe clinical presentations.

Cited by 81 publications

References 24 publications

Impact of folic acid fortification of flour on neural tube defects: a systematic review

Impact of folic acid fortification of flour on neural tube defects: a systematic review

Retrospective Assessment of Cost Savings From Prevention

Folic acid supplement use is the most significant predictor of folate concentrations in Canadian women of childbearing age

Contact Info

Product

Resources

About