169Folic acid intake and dementia - a 27-year global longitudinal study

Background Folate deficiency increases serum homocysteine and may cause cognitive impairment. However, there have been no international longitudinal studies that examined the association between folic acid intake and dementia. We investigated the longitudinal association between folate intake and the prevalence of dementia using global data during 27 years. Methods Prevalence of Alzheimer’s disease and other dementias and folic acid intake by country were obtained from the Global Burden of Disease (GBD) 2017 database. The longitudinal associations between folic acid intake and prevalence of dementia was examined using linear mixed effect model during 27 years from 1990 to 2017 in 151countries with populations of 1 million or greater. The effects of folic acid, year and interaction of folic acid and year were estimated controlling for covariates including socio-economic variables and life-style variables. Results Fixed effects of folic acid was highly significant (mean and SE; -33.1±7.1, p < 0.001) and interaction of folic acid and survey year was also significant (0.90±0.13, p < 0.001). Slope of folic acid for dementia prevalence was significant in 1990 and the slope has decreased with the year and has become not significant after 2011. Conclusions Folic acid was associated with the prevalence of dementia, but weakened over the years. Key messages Although folic acid intake has been associated with the of dementia, the risk of dementia may be increasingly related to factors other than nutrition.

Misoprostol Induced Expulsion of Fetus Following Diagnosis of Anencephaly on Ultrasound: A Case Report

Anencephaly is a condition in which there is an absence of skull and brain tissues. Absence of cranial vault mainly results because of defective neurulation. Absence of cerebral tissues may cause diminished heart size, due to decreased heart load causing various cardiac abnormalities. Here, we report a case of a primigravida lady at 17 weeks of gestation with misoprostol induced expulsion of fetus after ultrasonography revealed absence of brain tissue and calvarium above the orbits suggesting anencephaly. A 300g fetus was delivered which confirmed the ultrasound findings. The patient was discharged with advice for intake of folic acid beginning from 3 months before conception in future pregnancies. Neural tube defects can manifest within approximately 28 days of gestation which highlights the importance of oral folic acid intake before pregnancy.

Effect of Folic Acid Intake on Infant and Child Allergic Diseases: Systematic Review and Meta-Analysis

Objective: This study aimed to analyze the effect of folic acid supplements on infant and child allergic diseases through systematic review and meta-analysis.Design: PubMed, The Cochrane Library and references of related articles published before January 1, 2020 were searched.Setting: Meta-analysis was used to explore the influence of folic acid on skin allergies (eczema, and atopic dermatitis) and respiratory allergies (asthma, wheezing, and allergic rhinitis).Participants: Data were collected from 15 studies with 244,018 individual participants from five different countries for meta-analysis.Results: Folic acid was confirmed as a risk factor for allergic diseases in infant and child. The risk of allergic diseases dramatically increased when maternal folic acid intake <400 μg/day (RR = 1.050; 95% CI = 1.027–1.073) during pregnancy. Stratified analyses revealed that the association was significant only for respiratory allergy (RR = 1.067; 95% CI = 1.028–1.108) and pregnant women who only used folic acid supplements (RR = 1.070; 95% CI = 1.030–1.112) and that countries without folic acid fortification (RR = 1.046; 95% CI = 1.026–1.067).Conclusions: This study suggested that folic acid intake can be a risk factor for allergic diseases, especially respiratory tract allergies among infants and young children. Furthermore, pregnant women should pay attention to supplementation of folic acid from both folic acid supplements and fortified foods with folic acid during pregnancy.