Revised D-A-CH intake recommendations for folate: how much is needed?

Abstract

The D-A-CH reference value (D-A-CH arises from the initial letters of the common country identification for the countries Germany (D), Austria (A) and Switzerland (CH)) for folate equivalents had been set at 400 μg/d for adults in the year 2000. By that time, the prevention of cardiovascular diseases through reduction of homocysteine was considered an important target of the reference value. Since that time a number of research papers revealed that in spite of an inverse association between folate-rich diet and chronic diseases, a preventive effect of folic acid intake on cardiovascular events was not supported by randomized controlled trials, and the reduction of plasma homocysteine levels to around 10–12 μmol/l did not reduce the risk for thromboembolic and cardiovascular diseases in persons already affected by these diseases. These results together with the observation that folate intakes below 400 μg/d result in a sufficient folate status justified a review of the current literature and—consequently—a reduction of the reference value to 300 μg/d for adults. This reference value is expressed as dietary folate equivalents that take into account the difference in bioavailability between folic acid and all types of folates in food. The recommendation to take a daily supplement of 400 μg of synthetic folic acid for women who intend to get pregnant and until the end of the first trimester of pregnancy is maintained.

Response of Red Blood Cell Folate to Supplementation in Nonpregnant Women is Predictable: A Proposal for Personalized Supplementation

“…Though the average dietary folate intake (≈200 μg d –1 )7 might be sufficient to prevent severe deficiency in the majority of women from this population, it is not sufficient to prevent NTDs.…”

Folate status and health: challenges and opportunities

“…The recommended dietary allowance (RDA) for folate in German population is 300 μg DFE/day [4] (Table 1), whereas the Institute of Medicine (IOM) of the US National Academy of Sciences set the RDA for folate to 400 μg DFE [5]. Different intake data from the national survey on German population (NVSII 2012) showed a mean folate intake of 200 μg DFE/day [6].…”

“…The median intake of dietary folate in young women (19-35 years) is from 170 to 181 μg DFE/day, thus clearly showing that the majority of them are at risk for insufficient intake of folate [6]. To recommend doubling the folate intake from dietary sources [4] (increase by ∼200 μg DFE/day) in the population appears unrealistic. In fact, the German nutrition survey NVSII showed that healthy lifestyle patterns did not predict a difference in dietary folate intake of more than 30 μg DFE/ day [6].…”

Use of folic acid during pregravid preparation and pregnancy

“…Данные рекомендации согласуются с мнением других европейских и американ-ских специалистов. Совместный анализ результатов дота-ции фолиевой кислоты, проведенный немецкими, швей-царскими и австрийскими специалистами, подтвердил, что минимально эффективной дозой является суточная доза 400 мкг [44]. Верхний порог дозы фолиевой кислоты с целью профилактики не должен достигать 1000 мкг/сут.…”

“…До получения дополнительных сведений, применение левомефолата в РОССИЙСКИЙ ВЕСТНИК АКУШЕРА-ГИНЕКОЛОГА 1,2015 составе витаминных комплексов и контрацептивов более обосновано у женщин с подтвержденной недостаточно-стью МТГФР. В настоящее время европейские эксперты рекомендуют на этапе прегравидарной подготовки и во время беременности прием синтетической фолиевой кис-лоты [44], а FDA напоминает, что левомефолат кальция и фолиевая кислота не являются эквивалентными веще-ствами, и обязывает производителей указывать, какой именно фолат содержит биодобавка или лекарственный препарат. В Европе было проведено рандомизированное, двойное слепое плацебо-контролируемое клиническое исследование, в котором сравнили влияние применения метилфолата ([6S]-5-метилтетра гидро фолата) и фолиевой кислоты на концентрацию фолатов в плазме и эритроци-тах в течение 24 недель у женщин детородного возраста (18-49 лет).…”