Fortification of wheat and maize flour with folic acid for population health outcomes

Tablante, Elizabeth Centeno; Pachón, Helena; Guetterman, Heather; Finkelstein, Julia L.

doi:10.1002/14651858.cd012150.pub2

Cited by 58 publications

(44 citation statements)

References 157 publications

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“…In this study, FA was detected in the serum of Japanese pregnant women, and was considered to be unmetabolized FA, but no causal relationship between blood FA levels and negative fetal outcomes has been demonstrated. On the other hand, the benefits of FA in preventing NTD appear incontrovertible [53,54]. Further research is needed to establish optimal blood levels thresholds to balance NTD prevention with excess disease.…”

Section: Discussionmentioning

confidence: 99%

Distribution of 5-Methyltetrahydrofolate and Folic Acid Levels in Maternal and Cord Blood Serum: Longitudinal Evaluation of Japanese Pregnant Women

et al. 2020

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“Total” folate in blood has usually been measured to evaluate the folate status of pregnant women. However, folate is composed of many metabolites. The main substrate is 5-methyltetrahydrofolate (5-MTHF), with folic acid (FA) representing a very small component as an unmetabolized species in blood. We longitudinally evaluated 5-MTHF, FA and total homocysteine in maternal and cord blood from Japanese pregnant women. Subjects were 146 pregnant women who participated in the Chiba study of Mother and Child Health (C-MACH) prospective cohort study. Sera were obtained in early and late pregnancy, at delivery, and from cord blood. Species levels were measured by isotope-dilution mass spectrometry. Both 5-MTHF and FA levels were lower than reported levels from pregnant women in populations from countries with mandatory FA fortification. As gestational age progressed, serum 5-MTHF levels decreased, whereas serum FA levels were slightly reduced only at delivery compared to early pregnancy. A significant negative association between serum 5-MTHF and total homocysteine was shown at all examined times, but no associations with FA were evident. At delivery, cord 5-MTHF was significantly higher than maternal levels, while FA again showed no significant correlation. These results suggest that 5-MTHF is actively transported to the fetus through placental transporters and may reflect folate status during pregnancy as a physiologically important species.

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Section: Discussionmentioning

confidence: 99%

Distribution of 5-Methyltetrahydrofolate and Folic Acid Levels in Maternal and Cord Blood Serum: Longitudinal Evaluation of Japanese Pregnant Women

et al. 2020

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“…This means that populations within those countries whose diets consist mostly of other grains, such as corn, maize, or rice, may not receive the full benefit of folic acid fortification. A recent systematic review also found that fortification of wheat or maize flour with folic acid (i.e., alone or in combination with other micronutrients) was associated with increased erythrocyte and serum/plasma folate concentrations (Centeno Tablante, Pachón, Guetterman, & Finkelstein, 2019). In 2016, the U.S. Food and Drug Administration approved folic acid fortification of corn masa flour; modeling studies suggested that such an intervention could reduce the disparity in prevalaence at birth of neural tube defects between Hispanic Americans and other ethnic groups (Tinker et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Folate intake, markers of folate status and oral clefts: An updated set of systematic reviews and meta‐analyses

Zhou

Sinnathamby

et al. 2020

Birth Defects Research

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Background There has been a longstanding debate about the role of folate in the etiology of orofacial clefts (OFCs). Studies of different measures of nutritional intake or folate status have been done to investigate the possible role of folate in the prevention of OFC. Only one knowledge synthesis has attempted to bring together different types of evidence. The aim of the present work was to update it. Methods Evidence for associations between OFC and dietary folate, supplement use, folic acid fortification, biomarkers of folate status, and variants of MTHFR (C677T and A1298C) were included. Potentially eligible articles were systematically identified from PubMed, Medline, Embase, and Web of Science (2007–2020) and combined using random‐effects meta‐analysis when appropriate. Quality assessments were conducted using the Newcastle‐Ottawa scale and Cochrane's risk of bias tool. Results Sixty‐four studies published since the previous knowledge synthesis were identified, with eight of these identified through a supplementary search from October, 2018 to August, 2020. There was an inverse association between folic acid‐containing supplement use before or during pregnancy and cleft lip with or without cleft palate (CL/P) (OR 0.60, 95% CI 0.51–0.69), with considerable between‐study heterogeneity. The prevalence of CL/P showed a small decline post‐folic acid fortification in seven studies (OR 0.94, 95% CI 0.86–1.02). No association was found between OFC and genetic markers of folate status. The coronavirus‐19 pandemic has threatened food availability globally and therefore there is a need to maintain and even enhance surveillance concerning maternal intake of folate and related vitamins. Conclusions The risk of non‐syndromic OFC was reduced among pregnant women with folic acid‐containing supplements during the etiologically relevant period. However, high heterogeneity between included studies, incomplete reporting of population characteristics and variation in timing of exposure and supplement types mean that conclusions should be drawn with caution.

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“…A Cochrane systematic review assessed the efficacy of folic acid fortification of wheat and maize flour on health outcomes in the overall population [27]. The review included 10 studies (five randomized control clinical trials (RCTs), three non-RCTs, and two interrupted time series (ITS) studies) conducted in upper-middle-income countries (China, Mexico, South Africa), a lower-middle-income country (Bangladesh), and a high-income country (Canada).…”

Section: Discussionmentioning

confidence: 99%

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

Murphy

Westmark

2020

Nutrients

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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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Fortification of wheat and maize flour with folic acid for population health outcomes

Cited by 58 publications

References 157 publications

Distribution of 5-Methyltetrahydrofolate and Folic Acid Levels in Maternal and Cord Blood Serum: Longitudinal Evaluation of Japanese Pregnant Women

Distribution of 5-Methyltetrahydrofolate and Folic Acid Levels in Maternal and Cord Blood Serum: Longitudinal Evaluation of Japanese Pregnant Women

Folate intake, markers of folate status and oral clefts: An updated set of systematic reviews and meta‐analyses

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

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