Effect of a 12-Week Dietary Intervention with Folic Acid or Folate-Enhanced Foods on Folate Status in Healthy Egyptian Women

Mohammed E Hefni,Ahmad M Elwa,Rasha A Mohamed,Cornelia M Witthöft,Mohamed T Shalaby

doi:10.4236/fns.2016.714122

Mohammed E Hefni, Ahmad M Elwa + Show 3 more

Open Access

https://doi.org/10.4236/fns.2016.714122

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Abstract

The Egyptian government introduced wheat-flour fortification with iron and folic acid to reduce the incidence of neural tube defects, but suspended it for technical reasons. We previously developed novel legume foods with enhanced folate content. In this study, we investigated the efficacy of 12-week intervention with folate-enhanced foods versus folic acid supplement in improving folate status in Egyptian women. A randomized, parallel intervention trial with two active groups (n = 19, n = 18) and one blinded control group (n = 20) was executed over 12 weeks. Volunteers received either germinated legume foods and orange juice (≈250 μg/d folate) or folic acid supplement (500 μg/d) or apple juice (0 μg/d folate). Folate status was assessed by erythrocyte and plasma folate and total homocysteine (tHcy) at day 0, and after 8 and 12 weeks of intervention. After 12 weeks, mean plasma folate increased by 14 (P < 0.0001) and 12 (P < 0.0001) nmoL in the folic acid and food group, respectively. Erythrocyte folate concentration increased in the folic acid group from 614 to 912 (P < 0.0001) and in the food group from 631 to 914 nmoL (P < 0.0001). After 12 weeks, 90% of subjects in the folic acid group and 70% in the food group had erythrocyte folate concentrations exceeding 906 nmol/L. tHcy concentration was decreased by 20% (P = 0.007) and 18% (P = 0.006) in the folic acid and food group, respectively, but remained unchanged in the control group during intervention. Folate-enhanced foods effectively improve folate status in women of reproductive age. These foods could be used as a complement to folic acid fortification.

Highlights

Dietary folate is of interest due to its protective role against fetal abnormalities such as neural tube defects (NTD) [1]
The Egyptian government introduced wheat-flour fortification with iron and folic acid to reduce the incidence of neural tube defects, but suspended it for technical reasons
We investigated the efficacy of 12-week intervention with folate-enhanced foods versus folic acid supplement in improving folate status in Egyptian women

Summary

Introduction

Dietary folate is of interest due to its protective role against fetal abnormalities such as neural tube defects (NTD) [1]. Mandatory folic acid fortification of cereal grain foods has been implemented in several countries, e.g. US [2], Canada [3] and Chile [4], to cover the daily recommended folate intake. Folic acid fortification effectively improves folate status [4] [5] [6] and reduces the prevalence of neural tube defects [1] [7]. The Egyptian public health authorities previously introduced mandatory folic acid and iron fortification of the subsidized wheat flour used for making baladi bread (type of pita bread) [11], with the aim of reducing the incidence of NTD (currently estimated at 4.5/1000 pregnancies; [12]) and the prevalence of anemia (estimated to affect 30% 50% of women of reproductive age; [13]). The Egyptian folic acid fortification program was repeatedly interrupted for technical reasons and additional strategies for improving folate intake in the Egyptian population are required

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