Acid Fortification Of Wheat Flour Research Articles

Folic Acid Fortification and Women’s Folate Levels in Selected Communities in Brazil - A First Look

Several countries have implemented mandatory folic acid fortification of wheat flour and selected grain products to increase the folate intake of reproductive-aged women. Brazil implemented a folic acid fortification program in 2004. No previous studies have examined folate differences among Brazilian women following the mandate. We evaluate differences in serum and red blood cell (RBC) folate concentrations between two samples of women of childbearing age from selective communities in Brazil, one tested before (N = 116) and the other after the mandate (N = 240). We compared the baseline folate levels of women enrolled in a prevention study shortly before the fortification mandate was implemented, to baseline levels of women from the same communities enrolled in the same study shortly after fortification began. The participants were women enrolled in a folate supplementation clinical trial, at a hospital specializing in treating craniofacial anomalies in the city of Bauru from January 29, 2004 to April 27, 2005. We only compared baseline folate levels before the women received oral cleft prevention program (OCPP) folic acid supplements. Women enrolled after the fortification mandate had higher means of serum folate (20.3 versus 11.2 nmol/L; p < 0.001) and RBC folate (368.3 versus 177.6 nmol/L; p < 0.001) than women enrolled before the mandate. Differences in folate levels between the two groups remained after adjusting for several co-variables. The results suggest that serum and RBC folate levels among women of childbearing age increased after implementing the folic acid fortification mandate in Brazil.

Concentrations of blood folate in Brazilian studies prior to and after fortification of wheat and cornmeal (maize flour) with folic acid: a review.

BackgroundIn July 2004, the Brazilian Ministry of Health through the National Health Surveillance Agency made the fortification of wheat flour and cornmeal (maize flour) with iron and folic acid mandatory, with the intention of reducing the rate of diseases such as neural tube defects.ObjectiveThe aim of the study was to investigate the impact of the folic acid fortified wheat flour and cornmeal on serum and red blood cell folate levels and on the reduction of neural tube defects in different Brazilian studies.MethodsIn order to compare folate concentrations in the Brazilian population prior to and following the implementation of mandatory fortification of wheat and cornmeal, studies that involved blood draws between January 1997 and May 2004 (pre-fortification period), and from June 2004 to the present (post-fortification period) were chosen. The data search included PubMed and Scopus databases as well as the Brazilian Digital Library of Theses and Dissertations. The following keywords were employed for the query: folate, folic acid, fortification, Brazil, healthy population, the elderly, children and pregnant women.ResultsA total of 47 Brazilian studies were selected; 26 from the pre-fortification period and 22 after the fortification implementation. The studies were classified according to the cohort investigated (pregnant women, children, adolescents, adults and the elderly). After the implementation of flour fortification with folic acid in Brazil, serum folate concentrations increased in healthy populations (57% in children and adolescents and 174% in adults), and the incidence of neural tube defects dropped.ConclusionFolic acid fortification of wheat flour and cornmeal increased the blood folate concentrations and reduced the incidence of neural tube defects.

Folic acid fortification of wheat flour: A cost‐effective public health intervention to prevent birth defects in Europe

SummaryNeural tube defects (NTDs) annually affect an estimated 320 000 newborns worldwide. Folic acid (FA), provided through supplementation and fortification, is an effective primary‐prevention strategy for NTDs if consumed in the periconceptional period. However, the potential impact of FA supplementation is tempered by low compliance. Countries that mandate FA fortification of wheat flour report an average reduction of 46% in NTD birth prevalence and favourable benefit : cost ratios of 12–48:1. Despite the well‐documented benefits of fortification and the new evidence that provides a better understanding of purported risks associated with FA, European countries have yet to embrace this public health initiative. Viable primary‐prevention strategies are needed given that an estimated 4500 NTDs occur in the 27 countries of the European Union annually, of which 72% end in terminations. Many existing factors will facilitate the success of FA flour fortification programs in the region: widespread consumption of wheat‐based products, a technologically advanced milling industry, experience adhering to and monitoring food safety measures, and familiarity with mandatory food fortification.

Baseline investigations of folate status in Aboriginal and non‐Aboriginal West Australians prior to the introduction of mandatory fortification

In September 2009, Australia implemented mandatory folic acid fortification of wheat flour for bread-making to reduce the incidence of neural tube defects. Our study aimed to establish baseline folate status data in Aboriginal and non-Aboriginal Western Australians. Patients who presented at a health service or collection centre for blood tests were invited to participate. One hundred and ninety-one Aboriginals and 159 non-Aboriginals were recruited between April 2008 and September 2009. Participants completed a five-minute questionnaire and had blood taken for red blood cell (RBC) folate and serum vitamin B12. Data were analysed using SPSS (version 17.0.2, SPSS Inc., Chicago, IL, USA). Ten per cent (95% confidence intervals (CI): 5, 19) of the Aboriginal women participants and 26% (95% CI: 16, 40) of men had RBC folate concentrations below 250 ng/mL, the cut-off associated with folate deficiency. None of the non-Aboriginal women (95% CI: 0, 4) and 4% of the non-Aboriginal men (95% CI: 2, 12) had RBC folate concentrations below 250 ng/mL. All participants were vitamin B12 replete. None of the 96 Aboriginal and 8% of non-Aboriginal women aged 16-44 reported consumption of supplements with a daily intake of >400 μg folic acid during the previous week. This study established a baseline of RBC folate, folate consumption and supplement use in Aboriginal and non-Aboriginal groups. We identified 10% of Aboriginal women and none of non-Aboriginal women participants with low folate concentrations. The higher prevalence of folate deficiency in Aboriginal participants suggests they are more likely to benefit from a universal program of folate fortification.

Appeal to the European Food Safety Authority

About 4500 neural tube defects (NTD) occur every year in the European Union. Children with NTD will suffer from a lifelong disability often with inability to walk, hydrocephalus, learning problems, urinary infections and genital dysfunction. Up to two-thirds of these tragic cases can be prevented by folic acid supplementation. USA and Canada implemented mandatory folic acid fortification of wheat flour and corn in 1998. A number of other countries followed the North American rules including Australia, most states in South America and many countries in the Middle East and Africa. In China and India, it is voluntary. EU is an exception, although the UK is considering fortification. I feel particularly ashamed of my own country Sweden, where food is not even voluntarily fortified with folic acid. Thus, many children could be saved from being severely disabled, and several more foetuses would not be aborted owing to the detection of NTD by ultrasound. The cleft palate could also, to some extent, be prevented. In this issue of the Acta Paediatrica, Margaretha Jägerstad, professor emerita of food sciences, reviews the argument in favour of and against folic acid fortification. She reports that the daily folate intake among women is lower than the recommended levels. By fortification, most women will reach the recommended intake of folate (about 400 μg/day). With these levels there is no increased risk for cancer, which has been the strongest argument against fortification in the EU countries. Actually, it decreases the cancer risk, as the risk for cancer seems to be related in U-shaped fashion to folate concentrations. Only if a man eats more than five loaves of bread made of fortified flour every day, he may reach levels of folic acid that have been demonstrated to increase the risk of cancer in rats. The European Food Safety Authority (EFSA) is still hesitant to recommend fortification with folic acid and requires more investigations. However, neither EFSA nor the global World Cancer review present data on increased cancer risk at physiological folate intake. Therefore, EU should act to implement folic acid fortification as NTD prophylaxis as soon as possible. I am convinced that the EU Commission would act promptly if a preventable error was detected in the Airbus plane or European cars, which would cause thousands of deaths and/or severe handicaps every year.

Estimates of Total Dietary Folic Acid Intake in the Australian Population Following Mandatory Folic Acid Fortification of Bread

Mandatory folic acid fortification of wheat flour for making bread was implemented in Australia in September 2009, to improve the dietary folate status of women of child-bearing age, and help reduce the incidence of neural tube defects in the population. This paper presents estimates of folic acid intake in the target population and other subgroups of the Australian population following implementation of the mandatory folic acid fortification standard. In June/July 2010 one hundred samples from seven bread categories were purchased from around the country and individually analysed for the amount of folic acid they contained. A modification to the triple enzyme microbiological method was used to measure folic acid in the individual bread samples. The folic acid analytical values together with national food consumption data were used to generate estimates of the population's folic acid intake from fortified foods. Food Standards Australia New Zealand's (FSANZ) custom-built dietary modelling program (DIAMOND) was used for the estimates. The mean amount of folic acid found in white bread was 200 μg/100 g which demonstrated that folic-acid-fortified wheat flour was used to bake the bread. The intake estimates indicated an increase in mean folic acid intake of 159 μg per day for the target group. Other sub-groups of the population also showed increases in estimated mean daily intake of folic acid.

Folic Acid and Vitamin B12 Fortification of Flour: A Global Basic Food Security Requirement

Folic acid is an essential water soluble B vitamin which has been used for decades in the prevention of folate deficiency anemia of pregnancy. In 1991, folic acid taken prior to the start of pregnancy was shown unequivocally to prevent spina bifida and anencephaly—two of the most serious and common birth (neural tube) defects. Soon governments recommended that women of reproductive age consume folic acid daily to prevent these birth defects. Because compliance was low and since more than half of pregnancies are unplanned, the United States Food and Drug Administration mandated in 1998 that all enriched flour be fortified with folic acid at a concentration estimated to give the average woman an intake of 100 micrograms of folic acid a day. Canada and Chile followed with similar requirements for folic acid fortification of wheat flour. Now there is mandatory fortification in more than 50 countries globally. Where fortification has been implemented and studied, it has led to dramatic increases in serum folate concentrations, reduction in neural tube defects, folate deficiency anemia, as well as the reduction in homocysteine concentrations and stroke mortality with no known risk. Australia implemented mandatory folic acid fortification in 2009. To date, no country in Europe has implemented mandatory folic acid fortification of flour, although it has been recommended by the UK Food Safety Authority. This review discusses the vital importance of mandatory flour fortification with folic acid and vitamin B12, for public health food security and as a challenge to the New Public Health in Europe and globally.

Impacto de la Fortificación con Ácido Fólico Sobre el Estado Nutricional en Mujeres y la Prevalencia de Defectos del Tubo Neural

ABSTRACT Impact of folic acid fortification on women nutritional status and on the prevalence of neural tube defects Introduction: In 2003 iron and folic acid fortification of wheat flour became mandatory in Argentina. Folate nutritional status was assessed in a national probabilistic sample of women 10-49 years old and pregnant women. Changes in the prevalence of neural tube defects (NTDs) were evaluated before and after fortification. Population and Methods: Data from the National Nutritional and Health Survey done in 2005 were used for folate intakes (24 h dietary recall) and serum levels. Fetal and infant mortality rates for NTDs were assessed in the period 2000-2006 from Vital Statistics Series, based on birth and death certificates. Prevalence of NTDs in hospital discharge statistics were analyzed in the pre and post fortification period. Results: Median folate in-takes were 532 and 821 µg/ day in women 10-49 years-old and pregnant women, respectively. In both groups, folic acid from wheat flour represented 245 and 331 µg/day. Serum folate was assessed in 5,322 women 10-49 years old and in 1,321 pregnant women. Prevalence of serum folate concentration < 3 ng/mL was 0.8% in women of child-bearing age and 2.7% in pregnant women. Mortality rate due to anencephaly in 2000-2003 was 53.1 per 100.000 births and decreased to 23.3 per 100.000 births in 2005-2006. Spina bifida mortality rate decreased 67% in the same period. In a similar way, hospital discharge statistics showed a decrease of 54% for anencephaly, 33% for encephalocele, and 45% for spina bifida between 2000 and 2005. Conclusions: Food fortification with folic acid was associated with adequate intakes and serum folate levels in women. Concur-rently, NTDs prevalence and mortality showed a significant reduction. (Key words: Folic acid, neural tube defects, intake, serum folate, Vitamin B12). Arch Argent Pediatr 2008; 106 (6): 492-498/492RESUMENIntroduccion: Se evaluo el efecto de la fortificacion de la harina de trigo con acido folico (iniciada en 2003) sobre la ingesta de folatos en la poblacion de mujeres en edad reproductiva y en embarazadas y los niveles sericos de folato y vitamina B12 en los mismos grupos. Asimismo, se analizaron los cambios ocurridos en CONO SURRev Chil Pediatr 2010; 81 (1): 78-79SOUTH CONE OF AMERICA

Impact of folic acid fortification on women's nutritional status and on the prevalence of neural tube defects

In 2003 iron and folic acid fortification of wheat flour became mandatory in Argentina. Folate nutritional status was assessed in a national probabilistic sample of women 10-49 years old and pregnant women. Changes in the prevalence of neural tube defects (NTDs) were evaluated before and after fortification. Data from the National Nutritional and Health Survey done in 2005 were used for folate intakes (24 hs dietary recall) and serum levels. Fetal and infant mortality rates for NTDs were assessed in the period 2000-2006 from Vital Statistics Series, based on birth and death certificates. Prevalence of NTDs in hospital discharge statistics were analyzed in the pre and post fortification period. Median folate intakes were 532 and 821 microg/ day in women 10-49 years-old and pregnant women, respectively. In both groups, folic acid from wheat flour represented 245 and 331 microg/day. Serum folate was assessed in 5.322 women 10-49 years old and in 1.321 pregnant women. Prevalence of serum folate concentration <3 ng/mL was 0.8% in women of child-bearing age and 2.7% in pregnant women. Mortality rate due to anencephaly in 2000-2003 was 53.1 per 100.000 births and decreased to 23.3 per 100.000 births in 2005-2006. Spina bifida mortality rate decreased 67% in the same period. In a similar way, hospital discharge statistics showed a decrease of 54% for anencephaly, 33% for encephalocele, and 45% for spina bifida between 2000 and 2005. Food fortification with folic acid was associated with adequate intakes and serum folate levels in women. Concurrently, NTDs prevalence and mortality showed a significant reduction.

Folic Acid Fortification of Wheat Flour: Chile

Folic Acid Fortification of Wheat Flour: Chile

Folic acid fortification of wheat flour: Chile.

Neural tube defects (open spina bifida, anencephaly, and encephalocele) represent the first congenital malformations to be preventable through public health measures such as supplementation and/or food fortification with folic acid. In Chile, starting in January 2000, the Chilean Ministry of Health legislated to add folic acid to wheat flour (2.2 mg/kg) to reduce the risk of NTDs. This policy resulted in an estimated mean additional supply of 427 microg/d in significant increases in serum folate and red cell folate of 3.8 and 2.4-fold, respectively, in women of fertile age, one year after fortification. The impact on the rate of NTDs is presently being studied in all births, both live births and still births, with birth weight >500 g in the city of Santiago. Preliminary results show a reduction of 40% in the rates on NTDs from the pre-fortification period (1999-2000) to post-fortification period (2001-June 2002). Fortification of wheat flour with folic acid in Chile is effective in preventing NTDs in Chile.

Folic Acid Fortification of Wheat Flour: Chile

Folic Acid Fortification of Wheat Flour: Chile

Folic Acid Fortification of Wheat Flour: Chile

Folic Acid Fortification of Wheat Flour: Chile

Frecuencia de los defectos de cierre del tubo neural en las maternidades públicas de Santiago durante el año 1999

Fortification of wheat flour with folic acid in Chile, started in January 2000. This fortification should decrease the incidence of neural tube defects. To study the incidence of neural tube defects among Chilean newborns, during 1999. The records of all newborns and stillbirths with a birth weight over 500 g from 9 public maternity hospitals in Santiago in 1999, were reviewed. All neural tube defects, associated or not to other malformations were taken into account. During the study period, 59.627 newborns and 455 stillbirths were analyzed. The global incidence of neural tube defects was 1.56 per 1.000 born (57% women, 42% men and 1% ambiguous sex). Spina bifida was the most frequent neural tube defect found. These baseline data will be useful to assess the impact of folic acid fortification of wheat flour.