Folic Acid Fortification and Neural Tube Defect Risk: Analysis of the Food Fortification Initiative Dataset

The United States implemented mandatory fortification of cereal grains with folic acid in 1998 to prevent neural tube defects (NTDs) during pregnancy. The health benefits of folate (vitamin B9) are well documented; however, there are potential risks of exceeding the upper tolerable limit, particularly in vulnerable populations. We conducted a population-based analysis of the Food Fortification Initiative dataset to determine the strength of the evidence regarding reports of decreased NTDs at the national level in response to mandatory folic acid fortification of cereal grains. We found a very weak correlation between NTD prevalence and the level of folic acid fortification, irrespective of the cereal grain fortified (wheat, maize or rice). Stratification of the data based on socioeconomic status (SES) indicated a strong linear relationship between reduced NTDs and better SES. We conclude that national fortification with folic acid is not associated with a significant decrease in the prevalence of NTDs at the population level.

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The Fallacy of Using Administrative Data in Assessing the Effectiveness of Food Fortification. Comment on: “Folic Acid Fortification and Neural Tube Defect Risk: Analysis of the Food Fortification Initiative Dataset. Nutrients 2020, 12, 247”

Nutrients ◽

10.3390/nu12051352 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1352 ◽

Cited By ~ 2

Author(s):

Vijaya Kancherla ◽

Helena Pachón ◽

Hannah Blencowe ◽

Homero Martinez ◽

Godfrey P. Oakley ◽

...

Keyword(s):

Folic Acid ◽

Neural Tube ◽

Large Scale ◽

Population Level ◽

Cost Effective ◽

Food Fortification ◽

Policy Makers ◽

Folic Acid Fortification ◽

Many Sources ◽

Country Specific

Our objective in this comment is to highlight several limitations in an ecological research study that was published in Nutrients by Murphy and Westmark (2020) in January 2020. The study used data from the Food Fortification Initiative (FFI) website, and applying an ecological study design, made an error of “ecologic fallacy” in concluding that “national fortification with folic acid is not associated with a significant decrease in the prevalence of neural tube defects (NTDs) at the population level”. We list study limitations that led to their erroneous conclusions, stemming from incorrect considerations regarding NTD prevalence, the average grain availability for a country, the fortification coverage in a country, the population reach of fortified foods within a country, and the absence of the consideration of fortification type (voluntary vs. mandatory), country-specific policies on elective terminations for NTD-affected pregnancies, stillbirth proportions among those with NTDs, and fortification implementation. FFI data are derived from many sources and intended for fortification advocacy, not for hypothesis testing. The flawed study by Murphy & Westmark (2020) in Nutrients promotes a confusing and incorrect message to stakeholders, misguides policy makers, and hinders progress in global NTD prevention through a cost-effective, safe, and effective intervention: the mandatory large-scale folic acid fortification of staple foods.

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Role of Folate and Folic Acid During Pregnancy

International Journal for Research in Applied Science and Engineering Technology ◽

10.22214/ijraset.2021.39295 ◽

2021 ◽

Vol 9 (12) ◽

pp. 1488-1492

Author(s):

Saniya Sahar

Keyword(s):

Folic Acid ◽

Neural Tube ◽

Maternal Nutrition ◽

Tissue Growth ◽

Food Fortification ◽

Nucleotide Synthesis ◽

Folic Acid Fortification ◽

C1 Metabolism ◽

Pteroylglutamic Acid

Abstract: Pregnancy represents a period of fast tissue growth of maternal and foetal tissues that's related to enhanced energy and nutrient needs. Maternal nutrition throughout gestation period, has being essential for best offspring development, reducing long unwellness burden and for general health throughout life. Maternal Folate throughout pregnancy might have numerous roles in offspring health, as well as neurodevelopment and psychological feature performance in childhood. Folate is crucial for C1 metabolism, a network of pathways concerned in many biological processes as well as nucleotide synthesis, deoxyribonucleic acid repair and methylation reactions. The periconceptional use of pteroylglutamic acid (Folic Acid ) containing supplements reduces the primary incidence, as well as recurrence of neural tube defects. Folic Acid (FA) are artificial form of a necessary vitamin generically considered Folates or B9. It is concerned in one-carbon metabolism, and it's been connected to lowering neural tube Defect (NTD). National programs to mandate fortification of food with Folic Acid have reduced the prevalence of NTDs worldwide . The indisputable protecting role of Folic Acid in the hindrance of NTD, in addition to the low compliance of women to Folic Acid recommendations, has aroused the choice of mandatory Folic Acid fortification, a policy currently in place in over eighty countries worldwide. Mandatory food fortification needs food makers to feature Folic Acid to certain foods (e.g. starch or grain products), whereas voluntary fortification permits Folic Acid to be added to foods at the discretion of manufacturers. Food fortification with Folic Acid because the intervention is likely to achieve increasing Folic Acid intake among populations throughout the world. The objective of this article is to discuss the Role of Folic Acid and Folate during pregnancy and to review the role of Folate and Folic Acid , metabolism , absorption and Folic Acid effects on maternal on the basis of recent findings that are important for implementation of fortified food to design future studies. Keywords: Neurodevelopment, Methylation Reactions, Pteroylglutamic Acid, Bioavailability, Monoglutamates.

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Folic Acid Fortification for Neural Tube Defect Prevention: A Public Health Success in the United States

Undergraduate Journal of Public Health ◽

10.3998/ujph.17872072.0004.004 ◽

2020 ◽

Vol 4 (20210521) ◽

Author(s):

Claire Sandler

Keyword(s):

Public Health ◽

United States ◽

Folic Acid ◽

Neural Tube ◽

Neural Tube Defect ◽

The United States ◽

Folic Acid Fortification ◽

Defect Prevention

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Modeling the impact of folic acid fortification and supplementation on red blood cell folate concentrations and predicted neural tube defect risk in the United States: have we reached optimal prevention?

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy065 ◽

2018 ◽

Vol 107 (6) ◽

pp. 1027-1034 ◽

Cited By ~ 24

Author(s):

Krista S Crider ◽

Yan Ping Qi ◽

Owen Devine ◽

Sarah C Tinker ◽

Robert J Berry

Keyword(s):

United States ◽

Folic Acid ◽

Blood Cell ◽

Neural Tube ◽

Neural Tube Defect ◽

Red Blood Cell ◽

The United States ◽

Folic Acid Fortification ◽

The Impact

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Impact of Voluntary Folic Acid Fortification of Corn Masa Flour on RBC Folate Concentrations in the U.S. (NHANES 2011–2018)

Current Developments in Nutrition ◽

10.1093/cdn/nzab046_124 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 827-827

Author(s):

Arick Wang ◽

Charles Rose ◽

Yan Ping Qi ◽

Jennifer Williams ◽

Christine Pfeiffer ◽

...

Keyword(s):

Folic Acid ◽

The United States ◽

Reproductive Age ◽

Fortified Foods ◽

Folic Acid Fortification ◽

Folate Status ◽

Funding Sources ◽

Cereal Grain ◽

The Us ◽

Corn Masa

Abstract Objectives Surveillance data have highlighted continued disparities in neural tube defects (NTDs) among infants of Hispanic women of reproductive age (HWRA) in the United States. Starting in 2017, the US Food and Drug Administration implemented voluntary folic acid fortification of corn masa flour to reduce the risk of NTDs. We assessed folate status, using red blood cell (RBC) folate concentrations, in HWRA (aged 12–49 y) before (2011–2016) and after (2017–2018) voluntary fortification of corn masa, stratified by acculturation factors (i.e., primary language spoken at home, length of time residing in the US). Methods Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2011–2018 with available RBC folate concentrations for HWRA were analyzed. Additional analyses were conducted among HWRA whose only folic acid source was fortified foods (enriched cereal grain products (ECGP) only), including usual intake and NTD prevalence estimations based on previously published models. Results Overall, RBC folate concentrations (adjusted geometric means) among HWRA remained similar from 2011–2016 to 2017–2018, though RBC folate significantly increased in 2017–2018 among lesser acculturated HWRA consuming ECGP only. Concentrations for those who were born outside the US and resided in the US < 15 y increased from 894 nmol/L (95% CI: 844–946) in 2011–2016 to 1018 nmol/L (95% CI: 982–1162; p < 0.001) in 2017–2018. Primarily Spanish speaking HWRA who consumed ECGP only increased from 941 nmol/L (95% CI: 895–990) in 2011–2016 to 1034 nmol/L (95% CI: 966–1107; p = 0.03) in 2017–2018. We observed no significant changes in the proportion at risk of NTD (<748 nmol/L) and no changes in Bayesian model-based estimated NTD rates. Conclusions This early analysis following voluntary corn masa fortification found an increase in RBC folate concentrations in lesser acculturated groups relying on fortified foods as their primary folic acid source, though HWRA overall had no significant increase in folate concentrations. These early data suggests that there is remaining risk among Hispanics for folate sensitive NTDs; continued monitoring of folate status with NHANES will help assess the long-term efficacy of voluntary fortification. Funding Sources No funding sources outside of salaries.

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