Pre-fortification Period Research Articles

Changes in Spina Bifida Lesion Level After Folic Acid Fortification in the US

Changes in Spina Bifida Lesion Level After Folic Acid Fortification in the US

Handmade Pottery from the Excavations at Bilsk Hill-fort Rampart Sector

The Bilsk archaeological expedition of the Institute of Archaeology of the National Academy of Sciences of Ukraine explored a part of a rampart of the Great Bilsk hill-fort on the territory of the settlement in the Tsaryna Mohyla tract in 2016—2017. The building was found in the investigated area under the embankment of the rampart. It functioned before the construction of the defensive structures of the Great Bilsk hill-fort and was used as a place for the formation of the ash hill after destruction as a result of a fire. The embankment of the rampart was covered by the layers of the settlement from the inside, which continued to function after its construction. The archaeological layers were quite clearly separated, so during the excavations it was possible to get materials from individual stratigraphic horizons. Most of the finds are represented by local handmade pottery. An analysis of the complex of handmade pottery from individual horizons made it possible to give some conclusions about changes of the inhabitants’ pottery of the settlement in a short period of time (the end of the 7th — the first third of the 5th centuries BC). In general, horizons I—IV are characterized by minimal changes in the local ceramic complex. Materials from the cultural deposits of the pre-fortification period and the time of the creation of the fortifications indicate that the pottery traditions of the local population were transformed slowly and the main form of the complex remained stable. It is indicated by the use of slightly profiled pots as cookingware and most of them had an ornament in the shape of a molded roller on the rim or neck, sometimes on the body. Tableware (bowls, ladles) and containers (very large pots) have polished surface and archaic morphological features. There are no forms (jugs, mugs and vessels of small sizes) which are more typical for the Middle Scythian time. Only after the building of fortifications, at the end of the 6th — the first third of the 5th centuries BC (horizon V) more noticeable changes can be traced in the pottery of the population of the Bilsk hill-fort: appearance of cookingware with expressed body profile, disappearance of the ornamentation with molded rollers tradition, the fading of the tradition of polished tableware and containers, disappearance of some groups and the spread of new forms (jugs, mugs and small vessels). Thus, the study of the part of the rampart at the territory of the settlement in the Tsaryna Mohyla tract at the Bilsk hill-fort made it possible to consider a collection of handmade pottery dated from the end of the 7th — the first third of the 5th centuries BC. It was possible to divide these materials into close chronological groups with clear stratigraphy and trace certain changes in the material complex of the end of the Early Scythian / the beginning of the Middle Scythian periods. These results clarify ideas about the development of pottery traditions of the population in the forest-steppe zone between the Dnipro and Siverskyi Donets Rivers at the Scythian time.

Changes in Spina Bifida Lesion Level after Folic Acid Fortification in the US

To assess whether the severity of cases of spina bifida changed after the institution of mandatory folic acid fortification in the US. Six active population-based birth defects programs provided data on cases of spina bifida for 1992-1996 (prefortification period) and 1999-2016 (postfortification period). The programs contributed varying years of data. Case information included both a medical record verbatim text description of the spina bifida diagnosis and spina bifida codes (International Classification of Diseases, Clinical Modification, or a modified birth defects surveillance coding system). Comparing the prefortification and postfortification periods, aORs for case severity (upper-level lesions [cervical, thoracic] vs lower-level lesions [lumbar, sacral]) and prevalence ratios (PRs) were estimated. A total of 2593 cases of spina bifida (out of 7 816 062 live births) met the inclusion criteria, including 573 cases from the prefortification period and 2020 cases from the postfortification period. Case severity decreased by 70% (aOR, 0.30; 95% CI, 0.26-0.35) between the fortification periods. The decrease was most pronounced for non-Hispanic White mothers. Overall spina bifida prevalence declined by 23% (PR, 0.77; 95% CI, 0.71-0.85), with similar reductions seen across the early, mid, and recent postfortification periods. A statistically significant decrease in upper-level lesions occurred in the postfortification period compared with the prefortification period (PR, 0.28; 95% CI, 0.22-0.34), whereas the prevalence of lower-level lesions remained relatively similar (PR, 0.94; 95% CI, 0.84-1.05). The severity of spina bifida cases decreased after mandatory folic acid fortification in the US. Further examination is warranted to better understand the potential effect of folic acid on spina bifida severity.

Temporal Relation between Double Fortification of Wheat Flour with Iron and Folic Acid, and Markers and Prevalence of Anemia in Children.

Fortification of wheat flour with iron and folic acid became mandatory in Ivory Coast in 2007. The purpose of this study was to determine the time trend relation between mandatory double fortification of wheat flour with iron and folic acid and markers and prevalence of anemia by comparing the data between pre- and post-fortification periods in Ivory Coast children. Data were derived from the pediatric unit of the University Hospital of Treichville, Abidjan, Ivory Coast. Medical records of 467 children from 5 to 14 years old were analyzed from the years 2004 through 2010. Periods from 1 January 2004 to 31 December 2006 and 1 January 2008 to 31 December 2010 were considered as pre- and post-fortification periods, respectively. Data on hemoglobin, hematocrit, red blood cell count (RBC), mean corpuscular volume (MCV), and anemia between pre- and post-fortification periods were compared. There were no significant differences in hemoglobin, hematocrit, RBC, and prevalence of anemia between pre- and post-fortification periods. However, MCV in post-fortification period was significantly higher compared to pre-fortification period in all subjects (77.6 fL vs. 76.8 fL; p = 0.02) and in young girls (79.1 fL vs. 75.2 fL; p = 0.01). Lack of significant differences in anemia and in markers of anemia between pre- and post-fortification periods need further investigation in children of Ivory Coast.

EFFECT OF FOLIC ACID FORTIFICATION ON THE PREVALENCE OF NEURAL TUBE CLOSING DEFECTS IN GOIÁS

Introduction: Neural Tube Closure Defects classify the most common congenital anomalies of the central nervous system and constitute the main preventable congenital malformation through nutritional strategies. Although its mechanism of action is little known, it is known that folic acid is an important cofactor in the synthesis of amino acids and nucleic acids, therefore, the lack of this nutrient can prevent the correct cellular mitosis interfering already in the early stages of development embryonic. Objective: To evaluate the effect of dietary fortification of wheat and corn flour with folic acid on the prevalence of Neural Tube Closure Defects in Goias. Methods: A cross-sectional study was designed to compare the prevalence of neural tube closure defects at two stages: before (2000 to 2004) and after (2005 to 2013) the introduction of mandatory supplementation of folic acid wheat and maize flour. (June 2004). Secondary data provided by the Live Birth Information System (SINASC) and Mortality Information System (SIM) for mothers living in the state of Goias were used. Results: In the period studied (2000 to 2013), there were a total of 1,269,393 live births and 11,350 dead births, with a total of 519 cases of Neural Tube Closure Defects, resulting in a prevalence of 0.41 / 1000 births. The evaluation of the evolution of the time series of the Neural Tube Closing Defects in Goias over the study period allows us to conclude that there was a trend of increasing prevalence in the pre-fortification period (2000 to 2004), followed by a downward trend in the period post-fortification period (2005-2013) for live births, stillbirths and all births. From 2000 to 2004, the period prior to folic acid food fortification, the total prevalence of Neural Tube Closing Defects (considering all births) was 0.42 / 1000 births, while in the period after food fortification, 2005 to 2013, the prevalence dropped to 0.40 / 1000 live births. The results show a general trend of increasing prevalence of Neural Tube Closing Defects in the pre-fortification period (2000-2004) and reduction of prevalence in the post-fortification period (2005-2013), both when considering born alive, born dead and all births. Regarding the assessment of the effect of fortification on the prevalence of Neural Tube Closing Defects, a significant reduction of 42.6% in dead born (from 14 to 8/1000) was found, this may indicate a beneficial effect of fortification from Wheat and corn flour with folic acid in Goias. Conclusion: The results obtained in this study provided important information about the temporal evolution of the Neural Tube Closing Defects in Goias using the records available in DATASUS.

Using behavioral data to ‘do good’

To evaluate the influence of alcohol consumption on the risk of colorectal cancer according to folic acid fortification period in the United States.We evaluated the association between alcohol consumption and colorectal cancer by fortification period (before 1998 vs. after 1998) in 2 prospective cohort studies, the Nurses’ Health Study (NHS) of women and the Health Professionals Follow-up Study (HPFS) of men, in which 2793 cases of invasive colorectal cancer were documented.Alcohol consumption was associated with an increased risk of colorectal cancer. Among nonusers of multivitamins and/or folic acid supplements, the pooled multivariate relative risk for ≥30 g/d drinkers versus nondrinkers was 1.36 (95% confidence interval [95% CI], 1.09–1.70; P for trend, 0.02). The effect of alcohol consumption was slightly stronger in the prefolic acid fortification period (1980 NHS/1986 HPFS-1998) than in the postfortification period (1998–2008); the pooled multivariate relative risks for ≥30 g/d drinkers versus nondrinkers were 1.31 (95% CI, 1.00–1.71; P for trend, 0.10) in the prefortification period and 1.07 (95% CI, 0.69–1.65; P for trend, 0.67) in the postfortification period.Folic acid fortification may attenuate the adverse effect of high alcohol consumption on the risk of colorectal cancer.

Comparison of breast-milk iodine concentration of lactating women in Australia pre and post mandatory iodine fortification.

To compare the breast-milk iodine concentrations (BMIC) of lactating women before and after the mandatory iodine fortification of bread in Australia in 2009. Cross-sectional study. Breast milk samples were collected from two cohorts of women in South Australia within 7 d of delivery to determine BMIC. The percentage of samples with iodine concentration below 100 µg/l, a level considered adequate for breast-fed infants, was calculated. Sociodemographic information and intake of dietary supplements were obtained from all women. The breast milk samples were collected between 2006 and 2007 in the pre-fortification cohort and between 2012 and 2013 in the post-fortification cohort. The median (interquartile range) BMIC was higher in the post-fortification samples compared with samples collected in the pre-fortification period (187 (130-276) v. 103 (73-156) µg/l; P<0·05). Overall, the percentage of women with BMIC <100 µg/l was lower in the post-fortification cohort than in the pre-fortification cohort (13 v. 49 %; P<0·01). The percentage of women with BMIC <100 µg/l in the post-fortification cohort was lower among women who took iodine supplements in pregnancy (12 v. 29 %; P<0·01). Mandatory iodine fortification of bread has resulted in an increase in the iodine content of breast milk in Australian women. However, iodine supplementation may still be required in some women post-iodine fortification to reach the level of BMIC that is considered adequate to meet the iodine requirement of full-term infants.

Folic acid fortification and prevalences of neural tube defects, orofacial clefts, and gastroschisis in California, 1989 to 2010.

We examined whether prevalences of neural tube defects (NTDs), orofacial clefts, and gastroschisis changed more rapidly after than before folic acid fortification in California. This population-based study used vital statistics and birth defects registry data. The study population included all live births and stillbirths delivered in central California counties from 1989 to 2010. Cases included deliveries with NTDs, orofacial clefts, and gastroschisis. Weighted least squares regression was used to estimate slopes during prefortification (before 1997) and postfortification (after 1998), respectively. The difference of the two slopes with the 95% confidence interval (CI) was calculated. For all NTDs combined, slopes indicated that NTD prevalence was decreasing by 8.7 (slope: -8.7; 95% CI, -13.5--3.9) cases per 100,000 deliveries per year before fortification and by 1.7 (slope: -1.7; 95% CI, -3.7-0.3) after fortification; thus the decline had slowed by 7.0 (95% CI, 2.7-11.3) cases per 100,000 deliveries per year. For orofacial clefts, slopes for cleft lip with/without palate as well as for cleft palate alone indicated that the postfortification slope was lower than the prefortification slope suggesting a more accelerated decrease in the postfortification time period. For gastroschisis, the slope after fortification was lower compared with prefortification, indicating a less accelerated prevalence increase in the postfortification time period. Stratification by race/ethnicity did not substantially alter results. We observed a slower decline in prevalence of NTDs, an emergence of a decline in orofacial clefts, and a slower increase in gastroschisis, during the postfortification period in central California, relative to the prefortification period. Birth Defects Research (Part A), 2016. © 2016 Wiley Periodicals, Inc. Birth Defects Research (Part A) 106:1032-1041, 2016. © 2016 Wiley Periodicals, Inc.

Prevalencia de defectos del tubo neural y estimación de casos evitados posfortificación en Argentina

Periconceptional intake of folic acid has demonstrated to be effective to reduce the frequency of neural tube defects, and food fortification has been one of the strategies implemented to increase it. An update is herein presented on the reduced prevalence of neural tube defect cases in the post-fortification period in Argentina and an estimation of cases averted in the 2005-2013 period as a result of this intervention. When comparing the prevalence observed in the post-fortification period to that reported in the pre-fortification period, anencephaly and encephalocele decreased by 66%, and spina bifida, by 47%, which were significant reductions. The estimated number of cases averted was higher for anencephaly, followed by spina bifida; encephalocele showed the lowest number of cases averted given that the prevalence of this defect was smaller. The decrease observed in the prevalence supports findings from previous studies on the impact of fortification.

Unmetabolized Folic Acid in Prediagnostic Plasma and the Risk of Colorectal Cancer.

Higher folate has been associated with a reduced colorectal cancer (CRC) risk, but excessive folate may promote tumor progression. The role of unmetabolized folic acid (UFA) from high folic acid consumption in carcinogenesis is largely unexplored. We evaluated prediagnostic plasma levels of UFA in relation to CRC risk in nested case-control studies (618 CRC case patients and 1207 matched control) with blood samples collected prior to folic acid fortification. UFA was detected in 21.4% of control UFA levels were not associated with CRC risk. Compared with undetectable levels, the multivariable relative risks (RRs) of CRC were 1.03 (95% confidence interval [CI] = 0.73 to 1.46) for less than 0.5 nmol/L and 1.12 (95% CI = 0.81 to 1.55) for 0.5 nmol/L or more (Ptrend = .32). A positive association between UFA levels and CRC risk was observed among men (RR = 1.57, 95% CI = 0.99 to 2.49 for ≥0.5 nmol/L vs undetectable, Pinteraction = .04), and a positive association was also observed among those with the methylene-tetrahydrofolate reductase (MTHFR) CT/TT genotype (RR = 2.20, 95% CI = 1.22 to 3.94 for ≥0.5 nmol/L vs undetectable, Pinteraction=0.02). In conclusion, prediagnostic plasma levels of UFA from the prefortification period were not associated with risk of CRC.

Analysis of the Family Life Surveys in Indonesia: The Contribution of Wheat Flour Fortification to Reducing Anemia

Mandatory fortification of wheat flour with electrolytic iron, zinc, thiamine, riboflavin, and folic acid became effective in Indonesia in 2002. There have been no longitudinal evaluations of the effectiveness of wheat flour fortification on reducing anemia. This study estimated the contribution of wheat flour fortification to the change in anemia prevalence from the period before to after the introduction of mandatory fortification. The Indonesia Family Life Survey is a longitudinal study that followed over 30,000 Indonesians from 1993 to 2008. Data from 5,828 non‐pregnant women of child‐bearing age with hemoglobin measurements in 1997, 2000, and 2007 were analyzed. Anemia prevalence was calculated, adjusting for smoking status and altitude. Logistic regression was used to predict the effect of confounders on anemia status. Anemia prevalence significantly decreased (p&lt;0.0001) from the pre‐fortification period during 1997‐2000 (34.0%) to the post‐fortification period in 2007 (25.2%). The main variable of interest, whether a household purchased flour‐containing foods, was not significantly associated with anemia status. Wheat flour fortification does not appear to have significantly contributed to the reduction in anemia prevalence among women of child‐bearing age in Indonesia. It is recommended that the fortification iron source be changed from electrolytic iron to a more bioavailable form and that fortification iron, zinc and folic acid levels be increased. Funding: FFI, MI, Emory, SEAMEO‐RECFON.

Neural tube defects in Costa Rica, 1987-2012: origins and development of birth defect surveillance and folic acid fortification.

Our aim was to provide a descriptive overview of how the birth defects surveillance and folic acid fortification programs were implemented in Costa Rica-through the establishment of the Registry Center for Congenital Anomalies (Centro de Registro de Enfermedades Congénitas-CREC), and fortification legislation mandates. We estimated the overall prevalence of neural tube defects (i.e., spina bifida, anencephaly and encephalocele) before and after fortification captured by CREC. Prevalence was calculated by dividing the total number of infants born with neural tube defects by the total number of live births in the country (1987-2012).A total of 1,170 newborns with neural tube defects were identified from 1987 to 2012 (1992-1995 data excluded); 628 were identified during the baseline pre-fortification period (1987-1991; 1996-1998); 191 during the fortification period (1999-2002); and 351 during the post-fortification time period (2003-2012). The overall prevalence of neural tube defects decreased from 9.8 per 10,000 live-births (95 % CI 9.1-10.5) for the pre-fortification period to 4.8 per 10,000 live births (95 % CI 4.3-5.3) for the post-fortification period. Results indicate a statistically significant (P < 0.05) decrease of 51 % in the prevalence of neural tube defects from the pre-fortification period to the post-fortification period. Folic acid fortification via several basic food sources has shown to be a successful public health intervention for Costa Rica. Costa Rica's experience can serve as an example for other countries seeking to develop and strengthen both their birth defects surveillance and fortification programs.

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.

Pre‐diagnostic plasma unmetabolized folic acid and the risk of colorectal cancer (136.5)

Objective: To investigate the association between pre‐diagnostic plasma unmetabolized folic acid levels and risk of colorectal cancer (CRC).Methods: We evaluated pre‐diagnostic plasma levels of unmetabolized folic acid in relation to the risk of CRC in nested case‐control studies within two prospective cohort studies, Nurses’ Health Study (NHS) and Health Professionals Follow‐up Study (HPFS). Blood samples were collected prior to folic acid fortification (in 1989‐1990 in NHS and 1993‐1995 in HPFS). A total of 618 cases of CRC up to 2010 follow‐up and 1215 matched controls (344/680 women and 274/532 men) were included in the analysis.Results: Unmetabolized folic acid was detected in 22 % of the controls and 21% of the CRC cases. Among those detected, the median value of unmetabolized folic acid was 0.61 nmol/L in both controls and cases. Overall, pre‐diagnostic plasma levels of unmetabolized folic acid were not associated with CRC risk. Compared to those undetected, the multivariate relative risks (RRs) of CRC were 1.14 (95% confidence interval (CI), 0.79‐1.65) for &lt;0.5 nmol/L and 1.13 (95% CI, 0.79‐1.60; P for trend, 0.30) for 蠅0.5 nmol/L. When we stratified the association by sex, there was a positive association between unmetabolized folic acid levels and CRC risk among men (RR=1.58 [95% CI 1.01‐2.49] for 蠅0.5 nmol/L vs. undetected) but not among women (RR=0.64 [95% CI 0.39‐ 1.05] for the same comparison; P for interaction=0.05). The association was also positive among those with methylene‐tetrahydrofolate reductase (MTHFR) CT/TT genotype (RR=2.20 [95% CI 1.24‐3.90] for 蠅0.5 nmol/L vs. undetected) but not among those with CC genotype (RR=0.49 [95% CI 0.22‐1.08] for the same comparison; P for interaction=0.03) Conclusions: Pre‐diagnostic plasma levels of unmetabolized folic acid from pre‐fortification period were not associated with the risk of CRC. The positive association in some subgroups of the population needs to be further explored.Grant Funding Source: Supported by CA136950, CA87969, and CA55075

Impact of folic acid fortification on global DNA methylation and one-carbon biomarkers in the Women's Health Initiative Observational Study cohort

DNA methylation is an epigenetic mechanism that regulates gene expression and can be modified by one-carbon nutrients. The objective of this study was to investigate the impact of folic acid (FA) fortification of the US food supply on leukocyte global DNA methylation and the relationship between DNA methylation, red blood cell (RBC) folate, and other one-carbon biomarkers among postmenopausal women enrolled in the Women's Health Initiative Observational Study. We selected 408 women from the highest and lowest tertiles of RBC folate distribution matching on age and timing of the baseline blood draw, which spanned the pre- (1994–1995), peri- (1996–1997), or post-fortification (1998) periods. Global DNA methylation was assessed by liquid chromatography-tandem mass spectrometry and expressed as a percentage of total cytosine. We observed an interaction (P = 0.02) between fortification period and RBC folate in relation to DNA methylation. Women with higher (vs. lower) RBC folate had higher mean DNA methylation (5.12 vs. 4.99%; P = 0.05) in the pre-fortification period, but lower (4.95 vs. 5.16%; P = 0.03) DNA methylation in the post-fortification period. We also observed significant correlations between one-carbon biomarkers and DNA methylation in the pre-fortification period, but not in the peri- or post-fortification period. The correlation between plasma homocysteine and DNA methylation was reversed from an inverse relationship during the pre-fortification period to a positive relationship during the post-fortification period. Our data suggest that (1) during FA fortification, higher RBC folate status is associated with a reduction in leukocyte global DNA methylation among postmenopausal women and; (2) the relationship between one-carbon biomarkers and global DNA methylation is dependent on folate availability.

Gene-Environment Interactions and the Risk of Childhood Acute Lymphoblastic Leukemia: Exploring the Role of Maternal Folate Genes and Folic Acid Fortification

Few studies have evaluated the interaction of folic acid fortification and folate metabolic genes on the risk of childhood acute lymphoblastic leukemia (ALL). Because folate status is influenced by both intake and genetic variation, the objective of this study was to explore maternal folate metabolic gene-folic acid fortification interactions and the risk of childhood ALL. The study population consisted of 120 ALL case-parent triads recruited from Texas Children's Cancer Center between 2003 and 2010. For this analysis, we focused on 13 maternal single nucleotide polymorphisms (SNPs) in 5-methyltetrahydrofolate-homocysteine methyltransferase (MTR). Prefortification was defined as delivery before January 1997 and postfortification as delivery in or after January 1997. We used a two-step approach to evaluate gene-environment interactions. First, a case-only approach was used, as this design provides greater power in the assessment of gene-environment interactions compared to other approaches. Second, we confirmed all statistically significant interactions using a log-linear approach among case-parent triads. Only one of 13 interactions evaluated was confirmed in step 2. Specifically, mothers with the minor allele of MTR rs1804742 and who delivered during the prefortification period were at a greater risk of having a child with ALL (OR = 1.54, 95% CI: 0.82–2.88), compared to those mothers who delivered during the postfortification period (OR = 0.81, 95% CI: 0.22–2.99, P for interaction = .03). In one of the few studies to evaluate maternal folate metabolic genotype-folic acid interactions, we found limited evidence that the maternal MTR rs1804742 appeared to interact with higher folic acid levels to influence childhood ALL risk.

Resultados del Programa de Prevención de Defectos de Tubo Neural en Chile mediante la fortificación de la harina con ácido fólico: Período 2001-2010

Congenital malformations (CMF) have an important role in infant mortality. Neural tube defects (NTD) have great relevance from both social and public health points of view. The ECLAMC (Collaborative Latin American Study of Congenital Malformations) maintains in Chile an epidemiological surveillance of CMF prevalence rate at birth since 1969. To assess the effect of wheat flour folic acid fortification on the prevalence of NTD. Only Anencephaly, Spina bifida and Cephalocele were considered as NTD. All children born in the maternities incorporated to ECLAMC between 1969 and 1999 were considered as belonging to the pre folic acid fortification period and those who were born from 2001 to 2010 were considered as belonging to the post fortification period. The NTD prevalence rate at birth in the pre fortification period was 17.03/10,000. In the second period, there were 291,996 births and among them, 280 newborns were affected by a form of NTD (9.59 in 10,000 births). This represents a 44% decrease (p < 0.01). Anencephaly rate fell from 7.16/10,000 to 3.67/10,000, representing a 49% lower rate (p < 0.01). Spina bifida rate decreased from 8.61/10,000 to 4.49/10,000, representing a 48% lower rate (p < 0.01). Cephalocele had a 20% non-significant reduction. Wheat flour fortification with folic acid reduced by 44% the prevalence rate of NTD at birth. This means that NTDs were prevented in 185 Chilean newborns each year.

Prospective study of alcohol consumption and the risk of colorectal cancer before and after folic acid fortification in the United States

PurposeTo evaluate the influence of alcohol consumption on the risk of colorectal cancer according to folic acid fortification period in the United States. MethodsWe evaluated the association between alcohol consumption and colorectal cancer by fortification period (before 1998 vs. after 1998) in 2 prospective cohort studies, the Nurses’ Health Study (NHS) of women and the Health Professionals Follow-up Study (HPFS) of men, in which 2793 cases of invasive colorectal cancer were documented. ResultsAlcohol consumption was associated with an increased risk of colorectal cancer. Among nonusers of multivitamins and/or folic acid supplements, the pooled multivariate relative risk for ≥30 g/d drinkers versus nondrinkers was 1.36 (95% confidence interval [95% CI], 1.09–1.70; P for trend, 0.02). The effect of alcohol consumption was slightly stronger in the prefolic acid fortification period (1980 NHS/1986 HPFS-1998) than in the postfortification period (1998–2008); the pooled multivariate relative risks for ≥30 g/d drinkers versus nondrinkers were 1.31 (95% CI, 1.00–1.71; P for trend, 0.10) in the prefortification period and 1.07 (95% CI, 0.69–1.65; P for trend, 0.67) in the postfortification period. ConclusionsFolic acid fortification may attenuate the adverse effect of high alcohol consumption on the risk of colorectal cancer.

Improved iodine status in Tasmanian schoolchildren after fortification of bread: a recipe for national success

To examine population iodine status in Tasmania after mandatory iodine fortification of bread and assess the magnitude of difference compared with results from a period of voluntary iodine fortification. A cross-sectional urinary iodine survey of schoolchildren from classes that included fourth-grade students was conducted in Tasmania in 2011. Results were compared with surveys conducted before fortification and during a period of voluntary fortification. Three hundred and twenty students aged 8-13 2013s from 37 participating school classes. Median urinary iodine concentration (UIC) and proportion of UIC results < 50 µg/L. Median UIC in 2011 was 129 µg/L, and 3.4% of samples had a UIC under 50µg/L. This was significantly higher than during the period of voluntary fortification (129 µg/L v 108 µg/L) (P> < 0.001), which was significantly higher than before fortification (108 µg/L v 73 µg/L) (P < 0.001). There was a reduction in the proportion of samples with UIC under 50 µg/L after mandatory fortification (3.4%) compared with results from the period of voluntary fortification (9.6%) (P = 0.01), which was a further reduction compared with results from the prefortification period (17.7%) (P < 0.001). Iodine status in Tasmania can now be considered optimal. Mandatory iodine fortification has achieved significantly greater improvements in population iodine status compared with voluntary fortification. However, surveys of schoolchildren cannot be generalised to pregnant and breastfeeding women, who have higher iodine requirements. Measurement of iodine status in population surveys is warranted for ongoing monitoring and to justify the appropriate level of fortification of the food supply into the future.

Peru's national folic acid fortification program and its effect on neural tube defects in Lima

OBJECTIVE: To evaluate the impact of Peru's national folic acid fortification program on folic acid content in wheat flour, and the effect on birth prevalence of neural tube defects (NTDs) in Lima, and to compare the program's legislative requirements with international standards. METHODS: Bread was sampled from six sites across Peru and tested for folic acid. Data were obtained from the largest obstetric hospital in Lima on the prevalence of births (live and still) with NTDs during both the pre-fortification period (2004-2005) and post-fortification years (2007-2008). RESULTS: Folic acid content in the sampled bread met national legislative requirements but was less than one-half of the level recommended for Peru by the World Health Organization (WHO) (2.6 mg/kg wheat flour). Birth prevalence of NTDs was 18.4/10 000 in the pre-fortification period and 20.0/10 000 during post-fortification years. Relative risk for NTDs after fortification was 1.02 (95% confidence interval 0.77-1.35, P = 0.90). CONCLUSIONS: Peruvian legislative requirements for folic acid fortification are below international (WHO) recommendations; birth prevalence of NTDs in Lima is higher than international benchmarks; and no decrease in NTDs following fortification of flour with folic acid (according to Peruvian national standards) was observed. As increasing the level of folic acid in flour remains the most sustainable way of preventing NTDs, it is recommended that Peru increase its folic acid fortification requirements to meet those recommended by WHO (2.6 mg/kg).