Comments on "Low carbohydrate diets may increase risk of neural tube defects".

Abstract

The title “Low carbohydrate diets may increase risk of neural tube defects” from the article published by your Journal on January 25th, 2018 (Desrosiers, Siega-Riz, Mosley, Meyer, & National Birth Defects Prevention Study, 2018), may be misleading. The article discusses the association between folic acid and neural tube defects (NTD's) during pregnancy, and the further association between folic acid intake and fortified foods, which happen to be mostly foods composed of carbohydrates (CHO). Therefore, the article actually revisits the well-known association of NTD's and folic acid intake. The article even makes this statement in the introduction “The practice of restricting carbohydrates entails abstaining from the very foods that are fortified with folic acid, such as cereal, pasta, and bread. Indeed, adherence to low-carbohydrate diets is associated with lower than recommended intake of several micronutrients including folic acid (Freedman, King, & Kennedy, 2001).” This article (Desrosiers et al., 2018) does not include any analysis that compares the association of NTD's with CHO intake fortified with folic acid and CHO intake without fortification. There is no data or information in the paper that allows to suggest a general association between low carbohydrate diets and NTD's, independently from its folic acid content (either fortified or not). However, the title suggests otherwise. Hence, the title should be adjusted to what is actually discussed within the paper. Maintaining the title as it is can give the impression that consumption of CHO in general must be encouraged in order to avoid NTD's, or even that a high CHO intake could be protective. Leaving space to this kind of misinterpretations caused by a misleading title, could be absolutely detrimental to population's health, given the association between high CHO intake and obesity (Park, Ahn, Kim, & Lee, 2017; Spadaro, Naug, Du Toit, Donner, & Colson, 2015), and maternal obesity and NTD's (Rasmussen, Chu, Kim, Schmid, & Lau, 2008). I would kindly ask you to consider a modification of the title so it can accurately describe the actual discussion and findings of the referred article.