Folic Acid Fortification of Wheat Flour: Chile

Hertrampf, Eva; Cortés, Fanny

doi:10.1301/nr.2004.jun.s44s48

Cited by 48 publications

(74 citation statements)

References 8 publications

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“…Of the twenty-seven studies reported in the present systematic review , there was a drop in the prevalence of NTD in fifteen (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) of them in response to fortification ( Table 2). The largest drops were observed in Costa Rica (58 %) (28) Argentina (49?7 %) (25) and Canada (49 %) (21) .…”

Section: Resultsmentioning

confidence: 82%

“…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%

“…Fortification has particularly benefited mothers with lower incomes and older women with no social security coverage (21,31) . The greatest impact of fortification has been observed in regions or countries with a higher prevalence of NTD prior to intervention (20,39,54) . Williams et al looked at the prevalence of spina bifida and anencephaly in different ethnic groups in the USA.…”

Section: References Identified Medline Viamentioning

confidence: 99%

“…According to data provided by López-Carmelo et al of ECLAMC, Chile would not have had a downward trend in the number of NTD cases prior to the folic acid flour fortification. Therefore, the observed decrease in spina bifida and anencephaly cases in the first post-fortification period (2001)(2002) can be exclusively explained by flour fortification (35) , which caused a significant increase in folate in women of childbearing age (60) . In 1999, another surveillance system for registering NTD was established in nine public hospitals in Santiago, Chile's capital, accounting for 60 % of the city's births and 25 % of the country's (60) .…”

Section: References Identified Medline Viamentioning

confidence: 99%

“…Therefore, the observed decrease in spina bifida and anencephaly cases in the first post-fortification period (2001)(2002) can be exclusively explained by flour fortification (35) , which caused a significant increase in folate in women of childbearing age (60) . In 1999, another surveillance system for registering NTD was established in nine public hospitals in Santiago, Chile's capital, accounting for 60 % of the city's births and 25 % of the country's (60) . In Chile, termination of pregnancies and therapeutic abortions are not permitted and almost all deliveries occur in institutionalised settings.…”

Section: References Identified Medline Viamentioning

confidence: 99%

See 4 more Smart Citations

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

Castillo-Lancellotti

Tur

Uauy

2012

Public Health Nutr.

188

141

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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...

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Section: Resultsmentioning

confidence: 82%

Section: References Identified Medline Viamentioning

confidence: 87%

Section: References Identified Medline Viamentioning

confidence: 99%

Section: References Identified Medline Viamentioning

confidence: 99%

Section: References Identified Medline Viamentioning

confidence: 99%

See 3 more Smart Citations

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

Castillo-Lancellotti

Tur

Uauy

2012

Public Health Nutr.

188

141

View full text Add to dashboard Cite

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Chilean primary health workers' knowledge about folic acid supplementation for the prevention of neural tube defects

Pardo

Lay-Son

Aranda

et al. 2006

American J of Med Genetics Pt A

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Folate concentrations and folic acid supplementation among women in their first trimester of pregnancy in a rural area with a high prevalence of neural tube defects in Shanxi, China

Zhang

Ren

et al. 2006

Birth Defects Research

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Women in rural areas had low plasma and erythrocyte folate levels, and folate deficiency was highly prevalent in the area. Few women followed the recommendations regarding folic acid supplementation, and the information campaign in Shanxi was unsuccessful. These findings suggest the urgent need for combined strategies in rural areas to fortify grain with folic acid and promote folic acid supplements for childbearing-age women.

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Folic Acid Fortification of Wheat Flour: Chile

Cited by 48 publications

References 8 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

Chilean primary health workers' knowledge about folic acid supplementation for the prevention of neural tube defects

Folate concentrations and folic acid supplementation among women in their first trimester of pregnancy in a rural area with a high prevalence of neural tube defects in Shanxi, China

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