Folic Acid Working G. Fortification of flour with folic acid

Centers for Disease Control and Prevention, Mail stop E-86, 1600 Clifton Rd, NE, Atlanta, GA 30333, USA.
Food and nutrition bulletin (Impact Factor: 1.15). 03/2010; 31(1 Suppl):S22-35. DOI: 10.1177/15648265100311S103
Source: PubMed


After randomized, controlled trials established that consumption of folic acid before pregnancy and during the early weeks of gestation reduces the risk of a neural tube defect (NTD)-affected pregnancy, the United States Public Health Service recommended in 1992 that all women capable of becoming pregnant consume 400 microg folic acid daily. In 1998, folic acid fortification of all enriched cereal grain product flour was fully implemented in the United States and Canada.
To provide guidance on national fortification of wheat and maize flours to prevent 50 to 70% of the estimated 300,000 NTD-affected pregnancies worldwide.
An expert workgroup reviewed the latest evidence of effectiveness of folic acid flour fortification and the safety of folic acid.
Recent estimates show that in the United States and Canada, the additional intake of about 100 to 150 microg/day of folic acid through food fortification has been effective in reducing the prevalence of NTDs at birth and increasing blood folate concentrations in both countries. Most potential adverse effects associated with folic acid are associated with extra supplement use not mandatory fortification. Fortification of wheat flour has a proven record of prevention in other developed countries. In 2009, 51 countries had regulations written for mandatory wheat flour fortification programs that included folic acid.
NTDs remain an important cause of perinatal mortality and infantile paralysis worldwide. Mandatory fortification of flour with folic acid has proved to be one of the most successful public health interventions in reducing the prevalence of NTD-affected pregnancies. Most developing countries have few, if any, common sources of folic acid, unlike many developed countries, which have folic acid available from ready-to-eat cereals and supplements. Expanding the number of developed and developing countries with folic acid flour fortification has tremendous potential to safely eliminate most folic acid-preventable NTDs.

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Available from: Robert J Berry, Nov 20, 2014
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    • "Epidemiological studies, both observational and interventional, have all been consistent with a 50 to 70% protective effect of adequate consumption of folates on NTDs [67]. Since strategies to modify women's dietary habits and vitamin use have achieved little progress [68] and since about half of all the pregnancies are unplanned, maternal supplementation alone cannot be an effective approach. Only maintenance of optimal nutritional status throughout the reproductive years will help ensure normal fetal development [16]. "
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    ABSTRACT: Nutritional deficiencies are preventable etiological and epigenetic factors causing congenital abnormalities, first cause of infant mortality. Folate deficiency has a well-established teratogenic effect, leading to an increasing risk of neural tube defects. This paper highlights the most recent medical literature about folate deficiency, be it maternal or paternal. It then focuses on associated deficiencies as nutritional deficiencies are multiple and interrelated. Observational and interventional studies have all been consistent with a 50-70% protective effect of adequate women consumption of folates on neural tube defects. Since strategies to modify women's dietary habits and vitamin use have achieved little progress, scientific as well as political effort is mandatory in order to implement global preventive public health strategies aimed at improving the alimentation of women in reproductive age, especially folic acid supplementation. Even with the recent breakthrough of fetal surgery for myelomeningocele, the emphasis should still be on prevention as the best practice rather than treatment of neural tube defects.
    Journal of pregnancy 08/2012; 2012:295083. DOI:10.1155/2012/295083
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