Abstract
Despite efforts to tackle folate deficiency and Neural Tube Defects (NTDs) through folic acid fortification, its implementation is still lacking where it is needed most, highlighting the need for studies that evaluate the effectiveness of folic acid fortified wheat flour in a poor, rural, high-risk, NTD region of China. One of the most affected regions, Shanxi Province, was selected as a case study. A community intervention was carried out in which 16,648 women of child-bearing age received fortified flour (eight villages) and a control group received ordinary flour (three villages). NTD birth prevalence and biological indicators were measured two years after program initiation at endline only. The effect on the NTD burden was calculated using the disability-adjusted life years (DALYs) method. In the intervention group, serum folate level was higher than in the control group. NTDs in the intervention group were 68.2% lower than in the control group (OR = 0.313, 95% CI = 0.207–0473, p < 0.001). In terms of DALYs, burden in intervention group was approximately 58.5% lower than in the control group. Flour fortification was associated with lower birth prevalence and burden of NTDs in economically developing regions with a high risk of NTDs. The positive findings confirm the potential of fortification when selecting an appropriate food vehicle and target region. As such, this study provides support for decision makers aiming for the implementation of (mandatory) folic acid fortification in China.
Highlights
Fifty years after the first indications of the potential role of folic acid in pregnancy [1] and nearly 40 years after groundbreaking work on folic acid as a means of preventing neural tube defects (NTDs) [2], the scientific evidence underpinning the effectiveness of this vitamin [3,4] is considered among the strongest in the field of congenital anomalies [5]
Approximately 78.9% of women in the intervention group consumed more than 200 g per day, whereas 38.1% of women consumed more than 300 g per day
By using a community intervention approach and selecting participants from regions, we could reduce the impact of other factors that often appear in before-after studies, as mentioned; for instance, validity of birth defect data from birth certificates or failure to record all NTD-affected spontaneous abortions, in the US study on the folic acid fortification policy [46]
Summary
Fifty years after the first indications of the potential role of folic acid in pregnancy [1] and nearly 40 years after groundbreaking work on folic acid as a means of preventing neural tube defects (NTDs) [2], the scientific evidence underpinning the effectiveness of this vitamin [3,4] is considered among the strongest in the field of congenital anomalies [5]. Folic acid supplementation was demonstrated as effective in the RCTs (Randomized Controlled Trial) that established the preventive role of folic acid in NTDs, due to its undoubted effect on first occurrence [8]. Nutrients 2016, 8, 152 the first mandatory wheat fortification programs were established in 1998 in the United States and Canada—various before-and-after studies have demonstrated a declining trend in NTD prevalence in the post-fortification period [11], resulting in similar risk reductions to those found with folic acid supplementation [12]. Case studies in Chile [13], South Africa [14], the USA [15], Australia and New Zealand [16] proved that adding folic acid to flour is a cost-effective means to alleviate the burden of NTDs
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
