Consumption of Folic Acid–Fortified Bread Improves Folate Status in Women of Reproductive Age in Chile

Abstract

Since January 2000 the Chilean Ministry of Health has required the fortification of wheat flour with folic acid (FA) at a concentration of 2.2 mg FA/kg in order to reduce the risk of neural tube defects (NTD) in newborns. This policy was expected to result in a mean additional intake of approximately 400 microg FA/d. We assessed the effectiveness of the FA flour fortification program on bread folate content and on blood folate concentration in women of childbearing age in Santiago, Chile. The prefortification folate status of 751 healthy women of reproductive age was assessed. The folate content of 100 bread samples bought at retail bakeries was measured, average wheat flour consumption was estimated and postfortification FA dietary intake was calculated. The effect of flour fortification on blood folate concentration in this group of women (n = 605) was evaluated in a follow-up study. Blood folate concentrations of the 605 women in the follow-up group increased (P < 0.0001) following fortification. Before fortification the mean serum and red blood cell folate concentrations were 9.7 +/- 4.3 and 290 +/- 102 nmol/L, respectively, compared with 37.2 +/- 9.5 and 707 +/- 179 nmol/L postfortification, respectively. The mean FA content of bread was 2020 +/- 940 micro g/kg. The median FA intake of the group evaluated postfortification was 427 microg/d (95% CI 409-445) based on an estimated intake of 219 g/d (95% CI 201-229) of wheat flour, mainly as bread. Fortification of wheat flour substantially improved folate status in a population of women of reproductive age in Chile. The effect of the FA fortification program on the occurrence of NTD is currently being assessed.

Effects of a dairy product fortified with multiple micronutrients and omega-3 fatty acids on birth weight and gestation duration in pregnant Chilean women

“…There is evidence suggesting that maternal body water near term is an important variable influencing birth weight 34 . Changes in gestation duration were not observed in any of the above-mentioned trials that used a combination of micronutrients in mostly healthy women [8][9][10]28 . Omega-3 fatty acids in this trial may account for the observed statistically significant longer gestation duration.…”

High prevalence of folic acid and vitamin B12 deficiencies in infants, children, adolescents and pregnant women in Venezuela

“…However, a recent study in Mexico in 117 women of reproductive age reported a deficiency of erythrocyte folate and vitamin B 12 of 28 and 20%, respectively (Casanueva et al, 2000). Chile deserves special mention with a successful wheat flour fortification program that has been evaluated recently and resulted in an important decrease of folic acid deficiency (Bunout et al, 1998;Hertrampf et al, 2003). Other countries such as Spain, Cuba and Poland, with important socioeconomic differences, are affected by a high prevalence of folic acid and vitamin B 12 deficiencies (OPS, 1999;Wartanowicz et al, 2001;Planeéis et al, 2003).…”

Primary Prevention of Neural Tube Defects

“…In Canada, a study conducted on 38,000 women in Ontario showed an increase in red blood cell folate from 527nmol/l to 741 nmole/l after food fortification (p<0.001) (Ray et al, 2002). In Chile, the mean serum concentrations and red blood cell folate increased respectively from 9.7 and 290nmol/l to 37.2 and 707nmol/l (p<0.0001) after mandatory fortification (Hertrampf et al, 2003).…”