Effect of folic acid fortification of foods on folate intake in female smokers with cervical dysplasia

Background: Folic acid fortification program has been established to prevent tube defects. However, concern has been raised among patients using anti-folate drug, i.e. psoriatic patients, a common, chronic, autoimmune inflammatory skin disease associated with obesity and smoking. Objective: To investigate dietary and circulating folate, vitamin B12 (B12) and homocysteine (hcy) in psoriatic subjects exposed to the national mandatory folic acid fortification program. Methods: Cross-sectional study using the Food Frequency Questionnaire, plasma folate, B12, hcy and psoriasis severity using the Psoriasis Area and Severity Index score. Median, interquartile ranges (IQRs) and linear regression models were conducted to investigate factors associated with plasma folate, B12 and hcy. Results: 82 (73%) mild psoriasis, 18 (16%) moderate and 12 (11%) severe psoriasis. 58% female, 61% non-white, 31% former smokers, and 20% current smokers. Median (IQRs) were 51 (40, 60) years. Only 32% reached the Estimated Average Requirement of folate intake. Folate and B12 deficiencies were observed in 9% and 6% of the blood sample respectively, but hyperhomocysteinaemia in 21%. Severity of psoriasis was negatively correlated with folate and B12 concentrations. In a multiple linear regression model, folate intake contributed positively to 14% of serum folate, and negative predictors were psoriasis severity, smoking habits and saturated fatty acid explaining 29% of circulating folate. Conclusion: Only one third reached dietary intake of folate, but deficiencies of folate and B12 were low. Psoriasis severity was negatively correlated with circulating folate and B12. Stopping smoking and a folate rich diet may be important targets for managing psoriasis.

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Folic Acid Fortification and Women’s Folate Levels in Selected Communities in Brazil - A First Look

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000215 ◽

2014 ◽

Vol 84 (5-6) ◽

pp. 286-294 ◽

Cited By ~ 5

Author(s):

Hrishikesh Chakraborty ◽

Kwame A. Nyarko ◽

Norman Goco ◽

Janet Moore ◽

Danilo Moretti-Ferreira ◽

...

Keyword(s):

Folic Acid ◽

Folate Intake ◽

Serum Folate ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Folate Supplementation ◽

Folic Acid Fortification ◽

Folic Acid Supplements ◽

Two Samples ◽

Reproductive Aged Women

Abstract. Background: Several countries have implemented mandatory folic acid fortification of wheat flour and selected grain products to increase the folate intake of reproductive-aged women. Brazil implemented a folic acid fortification program in 2004. No previous studies have examined folate differences among Brazilian women following the mandate. Objective: We evaluate differences in serum and red blood cell (RBC) folate concentrations between two samples of women of childbearing age from selective communities in Brazil, one tested before (N = 116) and the other after the mandate (N = 240). Methods: We compared the baseline folate levels of women enrolled in a prevention study shortly before the fortification mandate was implemented, to baseline levels of women from the same communities enrolled in the same study shortly after fortification began. The participants were women enrolled in a folate supplementation clinical trial, at a hospital specializing in treating craniofacial anomalies in the city of Bauru from January 29, 2004 to April 27, 2005. We only compared baseline folate levels before the women received oral cleft prevention program (OCPP) folic acid supplements. Results: Women enrolled after the fortification mandate had higher means of serum folate (20.3 versus 11.2 nmol/L; p < 0.001) and RBC folate (368.3 versus 177.6 nmol/L; p < 0.001) than women enrolled before the mandate. Differences in folate levels between the two groups remained after adjusting for several co-variables. Conclusions: The results suggest that serum and RBC folate levels among women of childbearing age increased after implementing the folic acid fortification mandate in Brazil.

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Dietary intake of folate by adolescents and the potential effect of flour fortification with folic acid

British Journal Of Nutrition ◽

10.1079/bjn2001425 ◽

2001 ◽

Vol 86 (4) ◽

pp. 529-534 ◽

Cited By ~ 7

Author(s):

P. J. Moynihan ◽

A. J. Rugg-Gunn ◽

T. J. Butler ◽

A. J. Adamson

Keyword(s):

Folic Acid ◽

Dietary Intake ◽

Potential Effect ◽

Folate Intake ◽

Folic Acid Intake ◽

Folic Acid Fortification ◽

Acid Intake ◽

Department Of Health ◽

White Flour ◽

The Uk

The UK Department of Health recently recommended that flour be fortified with folic acid, at 2400 μg/kg. The objectives of the present paper were: to determine the consequence of this on folic acid intake of adolescents; to determine the level of fortification necessary to achieve an intake of 400 μg/d in adolescent girls (the amount recommended periconceptionally); to estimate the consequence of fortification on folic acid intake of high flour consumers; and to report on folate intake of adolescents. Dietary intake of folate and flour were determined by analysis of an existing database of the diets of 379 English adolescents. The folic acid intake that would result from white flour fortification with folic acid at 2400 μg/kg was determined and the level of folic acid fortification necessary to achieve an intake of 400 μg/d in girls from this source was also calculated. Without flour fortification, 6·9 % of girls failed to reach the UK lower reference nutrient intake for total folate. Fortification of white flour with folic acid at 2400 μg/kg would result in an additional folic acid intake of 191(SEM 6) μg/d in girls. To ensure 97 % of girls received 400 μg/d from white flour, white flour would need to be fortified at a level of 10 430 μg/kg, resulting in intakes of 1260 μg/d from flour in the highest (97·5 centile) female white flour consumers and 1422 μg/d from flour in the highest (97·5 centile) male white flour consumers.

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The determinants of maternal homocysteine in pregnancy: findings from the Ottawa and Kingston Birth Cohort

Public Health Nutrition ◽

10.1017/s1368980019004002 ◽

2020 ◽

Vol 23 (17) ◽

pp. 3170-3180

Author(s):

Shazia H Chaudhry ◽

Monica Taljaard ◽

Amanda J MacFarlane ◽

Laura M Gaudet ◽

Graeme N Smith ◽

...

Keyword(s):

Folic Acid ◽

Birth Cohort ◽

Subgroup Analysis ◽

Folic Acid Supplementation ◽

Folate Intake ◽

Chronic Hypertension ◽

Folic Acid Fortification ◽

Acid Supplementation ◽

Homocysteine Concentration ◽

Randomised Controlled

AbstractObjective:Observational studies have linked elevated homocysteine to vascular conditions. Folate intake has been associated with lower homocysteine concentration, although randomised controlled trials of folic acid supplementation to decrease the incidence of vascular conditions have been inconclusive. We investigated determinants of maternal homocysteine during pregnancy, particularly in a folic acid-fortified population.Design:Data were from the Ottawa and Kingston Birth Cohort of 8085 participants. We used multivariable regression analyses to identify factors associated with maternal homocysteine, adjusted for gestational age at bloodwork. Continuous factors were modelled using restricted cubic splines. A subgroup analysis examined the modifying effect of MTHFR 677C>T genotype on folate, in determining homocysteine concentration.Setting:Participants were recruited in Ottawa and Kingston, Canada, from 2002 to 2009.Participants:Women were recruited when presenting for prenatal care in the early second trimester.Results:In 7587 participants, factors significantly associated with higher homocysteine concentration were nulliparous, smoking and chronic hypertension, while factors significantly associated with lower homocysteine concentration were non-Caucasian race, history of a placenta-mediated complication and folic acid supplementation. Maternal age and BMI demonstrated U-shaped associations. Folic acid supplementation of >1 mg/d during pregnancy did not substantially increase folate concentration. In the subgroup analysis, MTHFR 677C>T modified the effect of folate status on homocysteine concentration.Conclusions:We identified determinants of maternal homocysteine relevant to the lowering of homocysteine in the post-folic acid fortification era, characterised by folate-replete populations. A focus on periconceptional folic acid supplementation and improving health status may form an effective approach to lower homocysteine.

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Population-Level Changes in Folate Intake by Age, Gender, and Race/Ethnicity after Folic Acid Fortification

American Journal of Public Health ◽

10.2105/ajph.2005.067371 ◽

2006 ◽

Vol 96 (11) ◽

pp. 2040-2047 ◽

Cited By ~ 53

Author(s):

Tanya G.K. Bentley ◽

Walter C. Willett ◽

Milton C. Weinstein ◽

Karen M. Kuntz

Keyword(s):

Folic Acid ◽

Population Level ◽

Folate Intake ◽

Folic Acid Fortification ◽

Gender And Race ◽

Race Ethnicity

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Not all cases of neural-tube defect can be prevented by increasing the intake of folic acid

British Journal Of Nutrition ◽

10.1017/s0007114508149200 ◽

2008 ◽

Vol 102 (2) ◽

pp. 173-180 ◽

Cited By ~ 75

Author(s):

Helmut B. Heseker ◽

Joel B. Mason ◽

Jacob Selhub ◽

Irwin H. Rosenberg ◽

Paul F. Jacques

Keyword(s):

Folic Acid ◽

Neural Tube ◽

Target Population ◽

Folate Intake ◽

Vulnerable Groups ◽

Childbearing Age ◽

Floor Effect ◽

Folic Acid Fortification ◽

Beneficial Effects ◽

Relative Decline

Some countries have introduced mandatory folic acid fortification, whereas others support periconceptional supplementation of women in childbearing age. Several European countries are considering whether to adopt a fortification policy. Projections of the possible beneficial effects of increased folic acid intake assume that the measure will result in a considerable reduction in neural-tube defects (NTD) in the target population. Therefore, the objective of the present study is to evaluate the beneficial effects of different levels of folic acid administration on the prevalence of NTD. Countries with mandatory fortification achieved a significant increase in folate intake and a significant decline in the prevalence of NTD. This was also true for supplementation trials. However, the prevalence of NTD at birth declined to approximately five cases at birth per 10 000 births and seven to eight cases at birth or abortion per 10 000 births. This decline was independent of the amount of folic acid administered and apparently reveals a ‘floor effect’ for folic acid-preventable NTD. This clearly shows that not all cases of NTD are preventable by increasing the folate intake. The relative decline depends on the initial NTD rate. Countries with NTD prevalence close to the observed floor may have much smaller reductions in NTD rates with folic acid fortification. Additionally, potential adverse effects of fortification on other vulnerable population groups have to be seriously considered. Policy decisions concerning national mandatory fortification programmes must take into account realistically projected benefits as well as the evidence of risks to all vulnerable groups.

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The Effect of Folic Acid Fortification on Folate Intake in Rural Women

Journal of the American Dietetic Association ◽

10.1016/s0002-8223(99)00441-1 ◽

1999 ◽

Vol 99 (9) ◽

pp. A12 ◽

Cited By ~ 1

Author(s):

J. Edmonds ◽

C.J. Boushey ◽

S.L. Anderson

Keyword(s):

Folic Acid ◽

Rural Women ◽

Folate Intake ◽

Folic Acid Fortification

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Sources of Folate Intake in Women at Risk for Cervical Cancer (CC) in an Era of Folic Acid Fortification

The FASEB Journal ◽

10.1096/fasebj.23.1_supplement.898.16 ◽

2009 ◽

Vol 23 (S1) ◽

Author(s):

Suguna Badiga ◽

Chandrika J Piyathilake

Keyword(s):

Cervical Cancer ◽

At Risk ◽

Folic Acid ◽

Folate Intake ◽

Folic Acid Fortification

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Folate Status in Germany 1997–2000

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.72.6.351 ◽

2002 ◽

Vol 72 (6) ◽

pp. 351-359 ◽

Cited By ~ 7

Author(s):

Marcela Gonzalez-Gross ◽

Reinhild Prinz-Langenohl ◽

Klaus Pietrzik

Keyword(s):

Folic Acid ◽

Adult Population ◽

Age Groups ◽

Folate Intake ◽

German Population ◽

Childbearing Age ◽

Folic Acid Fortification ◽

Folate Status ◽

Food Composition Tables ◽

Erythrocyte Folate

Data about folate intake and blood values of the German population, published between 1997 and 2000, have been reviewed. Median folate intake is about 250 mug/day in the adult population, which indicates a high likelihood of inadequate intake when compared to the Estimated Average Requirement (EAR) of 320 mug/day. Only a few studies have evaluated serum and erythrocyte folate or plasma homocysteine as a marker of folate status. The most representative data show that 25% of German women of childbearing age have an inadequate recent folate intake. Only 13.3% of the women have red blood cell folate values above the critical value of 400 mug/day established by Daly et al (1995). Folic acid fortification of food is shown to be responsible for about 25% of folate intake in the German child and adolescent population in one study. If we extrapolate these data to the general population, folic acid fortification could be the explanation for the differences observed between folate intake and blood values. The discrepancy might also be explained by slight inaccuracies in food composition tables. Folate intake from fortified food or from supplements is not taken into account in most of the studies, which is a variable that can lead to confusion. Nutrition surveys should adapt official composition tables for local food patterns, and include fortified commercial foods, in order to make folate intake data more accurate. However, representative serum and erythrocyte folate values are lacking for most age groups. Before taking public health measures concerning folate fortification of food, the real folate status of the German population should be established.

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