Folic Acid Supplements and Fortification Affect the Risk for Neural Tube Defects, Vascular Disease and Cancer: Evolving Science

Bailey, Lynn B.; Rampersaud, Gail C.; Kauwell, Gail P. A.

doi:10.1093/jn/133.6.1961s

Cited by 155 publications

(96 citation statements)

References 55 publications

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“…There are possible benefits of increased folate to other groups in the population, in particular for those at risk of vascular disease or some cancers, but these studies provide inconsistent or conditional results. 38 There is uncertainty about possible risks of folate; for instance, in twin genesis 5 (although disputed 39,40 ), in cancer promotion but not genesis 41 and in masking vitamin B12 deficiency 42 (although disputed 29 ). Mandatory fortification does have the advantage of providing a higher intake for women who are unaware of folate or who have an unplanned pregnancy.…”

Section: Food Folate and Physical Activitymentioning

confidence: 99%

Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia

Watson

Brown

Davey

2006

Australian and New Zealand Journal of Public Health

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In both surveys younger women, women with less education, less income, of nonEnglish speaking background and women who were not married were less likely to take folate supplements in the recommended period. In Victoria, multiparous women were significantly less likely to take supplements. In NSW, women with an unplanned pregnancy and those living in rural areas were significantly less likely to take periconceptional folate supplements. Fifty-three per cent of women cited a general practitioner or obstetrician as a source of folate information and 45% cited family or friends; both of these sources were significantly associated with periconceptional folate supplementation. Conclusions: Less than 50% of women took periconceptional folate supplements.Among socially disadvantaged groups, the proportion was significantly lower. Implications: Since women are unlikely to achieve adequate folate intake periconceptionally without deliberate action, there remains the need for a multifaceted approach to providing women with information about folate. Future surveys are needed to monitor usage and knowledge. (Aust N Z J Public Health 2006; 30: 42-9) N eural tube defects (NTDs) are a group of serious congenital structural abnormalities of the brain, skull, and spinal cord that are able to be detected antenatally by the use of ultrasound and maternal serum screening in the second trimester. 1 Since the routine introduction of these tests in Victoria, the birth prevalence of NTDs has reduced because pregnancies found to be affected are usually terminated. 2,3 There are also indications that since 1997, when folate awareness programs were introduced and after voluntary fortification of folate to staple foods was recommended, 4 the incidence of NTDs including pregnancies terminated after prenatal diagnosis has decreased in Victoria. 2 These data are not available for New South Wales (NSW).There is strong evidence that an adequate intake of folate periconceptionally reduces the risk of NTDs by about two-thirds, 5 and that folate (or folic acid) is only effective in reducing the risk of NTDs when recommended maternal folate levels are achieved before the critical time that neural tube closure occurs, around week four after conception. The National Health and Medical Research Council 6 has recommended that "women planning a pregnancy or likely to become pregnant should be encouraged to increase their dietary intake of folate-rich foods, particularly in the month before and in the first three months of the pregnancy. Low risk women . . . should be offered periconceptional folic acid supplementation (0.5 mg daily)." NHMRC draft documentation has this amount as 400 µg/ day, in line with overseas recommendations. The current habitual dietary intake of folate for most Australian women is well below that recommended for risk reduction of NTDs. 8,9 Primary prevention strategies to reduce the risk of NTDs include: periconceptional intake of folic acid supplements, increased consumption of foods naturally high in folate, and fortification ...

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Section: Food Folate and Physical Activitymentioning

confidence: 99%

Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia

Watson

Brown

Davey

2006

Australian and New Zealand Journal of Public Health

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“…The high tHcy serum levels are relatively easy to correct by the use of folic acid at low doses, such as 0.5 mg/day (Oakley et al, 1996), which has been proven cost effective. There is an epidemiological evidence that folic acid supplementation and fortification might protect against the increased risk of neural tube defects, vascular disease and some types of cancer (Bailey et al, 2003;Johnson, 2004;Green and Miller, 2005). Moreover, Verhoef and de Groot (2005) showed that folic acid could be more effective than dietary folate in lowering tHcy concentration.…”

Section: Folate Vitamin B12 and Thcy In Brazilian Newbornmentioning

confidence: 99%

Folate, vitamin B12 and total homocysteine levels in neonates from Brazil

Couto

Moreira²,

Santos

et al. 2006

Eur J Clin Nutr

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Objective: To determine folates, vitamin B12 and total homocysteine levels among neonates from mothers of low or high socioeconomic status. Design: We carried out a cross-sectional transversal study comprising 143 neonates from two maternity hospitals in the city of Salvador, Northeast of Brazil. Cord blood samples were obtained at the time of delivery from newborns from low (group 1, n ¼ 77) or high (group 2, n ¼ 66) socioeconomic status. The vitamin B12 and folates were analyzed by electrochemiluminescence immunoassay and by a competitive test using a natural folate-binding protein (FBP), respectively. Total homocyteine levels were measured by fluorescence polarization immunoassay. Maternal environmental risk factors for pregnancy complications were obtained from all mothers. Results: Only 2% of women from group 1 received prenatal care/vitamin supplementation, whereas almost all mothers from group 2 (96%) were properly followed. Anemia and/or infections pre-or during pregnancy was more prevalent among mothers of babies from group 1. Folate levels among newborns from group 1 and 2 were 7.3872.71 and 8.8374.06 ng/ml, respectively. No difference in the vitamin B12 levels was determined between groups. In addition, tHcy serum levels were higher among newborns from group 1 compared to those from group 2 (8.5474.06 vs 6.3571.33 mmol/l, respectively; P ¼ 0.005).Conclusion: These results demonstrate that unprivileged young woman has limited accesses to prenatal care, present high-risk factors that hamper both maternal and newborn health. Maternal and newborn health status could be improved by simply reinforcing the use of folate-enriched diet. The work presented illustrates the challenges that developing countries have to face in order to provide preventive adequate health care to the population at large.

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“…This is particularly evident in humans, where the availability of folate for one-carbon metabolism is known to be essential for normal embryonic development, as well having impacts on neural function, cardiovascular disease, alcoholic liver disease, and carcinogenesis (51)(52)(53). It is possible that factors influencing one-carbon activation of H 4 folate, as opposed to H 4 folate availability, may also have clinical relevance.…”

mentioning

confidence: 99%

Identification of a Novel One-carbon Metabolism Regulon in Saccharomyces cerevisiae

Gelling

Piper²,

Hong³

et al. 2004

Journal of Biological Chemistry

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Glycine specifically induces genes encoding subunits of the glycine decarboxylase complex (GCV1, GCV2, and GCV3), and this is mediated by a fall in cytoplasmic levels of 5,10-methylenetetrahydrofolate caused by inhibition of cytoplasmic serine hydroxymethyltransferase. Here it is shown that this control system extends to genes for other enzymes of one-carbon metabolism and de novo purine biosynthesis. Northern analysis of the response to glycine demonstrated that the induction of the GCV genes and the induction of other amino acid metabolism genes are temporally distinct. The genomewide response to glycine revealed that several other genes are rapidly co-induced with the GCV genes, including SHM2, which encodes cytoplasmic serine hydroxymethyltransferase. These results were refined by examining transcript levels in an shm2⌬ strain (in which cytoplasmic 5,10-methylenetetrahydrofolate levels are reduced) and a met13⌬ strain, which lacks the main methylenetetrahydrofolate reductase activity of yeast and is effectively blocked at consumption of 5,10-methylene tetrahydrofolate for methionine synthesis. Glycine addition also caused a substantial transient disturbance to metabolism, including a sequence of changes in induction of amino acid biosynthesis and respiratory chain genes. Analysis of the glycine response in the shm2⌬ strain demonstrated that apart from the one-carbon regulon, most of these transient responses were not contingent on a disturbance to onecarbon metabolism. The one-carbon response is distinct from the Bas1p purine biosynthesis regulon and thus represents the first example of transcriptional regulation in response to activated one-carbon status.

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Folic Acid Supplements and Fortification Affect the Risk for Neural Tube Defects, Vascular Disease and Cancer: Evolving Science

Cited by 155 publications

References 55 publications

Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia

Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia

Folate, vitamin B12 and total homocysteine levels in neonates from Brazil

Identification of a Novel One-carbon Metabolism Regulon in Saccharomyces cerevisiae

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