Medical cost savings in Sakado City and worldwide achieved by preventing disease by folic acid fortification

Abstract

The introduction of mandatory fortification of grains with folate in 1998 in the United States resulted in 767 fewer spina bifida cases annually and a cost saving of $603 million per year. However, far more significant medical cost savings result from preventing common diseases, including myocardial infarction, stroke, dementia and osteoporosis. A cost‐effectiveness analysis showed a gain of 266 649 quality‐adjusted life‐years and $3.6 billion saved annually, mainly due to the reduction of cardiac infarction. The recommended folate intake in Japan is 240 μg/day whereas it is 400 μg/day internationally. Our Sakado Folate Project targeted individuals with genetic polymorphism of methylenetetrahydrofolate reductase or with hyperhomocysteinemia. Using, for example, folate‐fortified rice, resulted in an increase in serum folate and a decrease in serum homocysteine in the participants, and reduced medical costs were achieved by decreasing myocardial infarction, stroke, dementia and fracture. Due to the small population of Sakado City (approximately 101 000) and small number of births (693) in 2015, a decrease in spina bifida could not be confirmed but there was a significant decrease in the number of very low birthweight infants. The genome notification of subjects was effective in motivating intake of folate, but the increase in serum folate (from 17.4 to 22.5 nmol/L, 129%) was less than that observed following compulsory folic acid fortification of cereals in the USA (from 12.1 to 30.2 nmol/L, 149.6%). Mandatory folic acid fortification is cheap in decreasing medical costs and is thus recommended in Japan.

Food Intervention with Folate Reduces TNF-α and Interleukin Levels in Overweight and Obese Women with the MTHFR C677T Polymorphism: A Randomized Trial

“…Many studies have shown that an intervention with enriched folic acid diet resulted in positive health effects in adults with hyperhomocysteinemia and low folic acid levels carrying the MTHFR C677T polymorphism [50][51][52][53][54][55][56][57]. However, to date, no other study has presented significant results from a folate intervention on inflammatory biomarker levels of women carrying the MTHFR C677T polymorphism.…”

“…According to the "Sakado Folate Project" conducted by Kagawa et al [57], the genotype-based personalized diet was better accepted than the general individual diet. The personalized diet was more efficient to motivate change in the participants' lifestyle and improve their nutritional status by elevating green leafy vegetables and folic acid-fortified food intake even one year after the end of the study.…”

The effect of the National Birth Defects Intervention Project on the prevention of congenital disabilities among children in China: a natural experiment

“…Previous studies indicated that preventing diseases by maternal microelement supplementation is both low cost and highly effective (23,24) . Due to the introduction of mandatory fortification of grains with folate in the USA, 266 649 quality-adjusted life years are gained, and $3•6 billion is saved annually (23) .…”

“…Previous studies indicated that preventing diseases by maternal microelement supplementation is both low cost and highly effective (23,24) . Due to the introduction of mandatory fortification of grains with folate in the USA, 266 649 quality-adjusted life years are gained, and $3•6 billion is saved annually (23) . A previous study indicated that the disability-adjusted life years in the group intervened by folic acid-fortified flour were approximately 58•5 % lower than in the control group in a high neural tube defects risk region of China (24) .…”

The Japanese Teratology Society declares “Folic Acid Awareness Day” and “Neural Tube Defect Prevention Month”

“…4 Risk factors of NTDs among Japanese women comprise of not taking folic acid supplements, presence of myelomeningocele in patients within third-degree relatives, use of anti-epileptic drugs without folic acid, and low birth weight in the newborn. 9 We urge those of other academic societies who read or hear of this notice to voice solidarity with our endeavor and co-operate with us by spreading information and educating people regarding the great benefits of folic acid. 6 During the past quarter of century, the prevalence of myelomeningocele has not declined, while that of anencephaly has significantly decreased because the majority of pregnancies involving such fetal defects were terminated.…”