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Effectiveness of Folic Acid Fortified Flour for Prevention of Neural Tube Defects in a High Risk Region.
Nutrients. 2016 Mar 09; 8(3):152.N

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.

Authors+Show Affiliations

Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing 100871, China. woody_37@126.com.Department of Agricultural Economics, Faculty of Bio-Science engineering, Ghent University. Ghent 9000, Belgium. Hans.DeSteur@UGent.be.Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing 100871, China. chengong@pku.edu.cn.Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing 100871, China. windson_zxt@126.com.Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing 100871, China. peilj@pku.edu.cn.Department of Agricultural Economics, Faculty of Bio-Science engineering, Ghent University. Ghent 9000, Belgium. Xavier.Gellynck@UGent.be.Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing 100871, China. xzheng@pku.edu.cn.

Pub Type(s)

Controlled Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27005659

Citation

Wang, Haochen, et al. "Effectiveness of Folic Acid Fortified Flour for Prevention of Neural Tube Defects in a High Risk Region." Nutrients, vol. 8, no. 3, 2016, p. 152.
Wang H, De Steur H, Chen G, et al. Effectiveness of Folic Acid Fortified Flour for Prevention of Neural Tube Defects in a High Risk Region. Nutrients. 2016;8(3):152.
Wang, H., De Steur, H., Chen, G., Zhang, X., Pei, L., Gellynck, X., & Zheng, X. (2016). Effectiveness of Folic Acid Fortified Flour for Prevention of Neural Tube Defects in a High Risk Region. Nutrients, 8(3), 152. https://doi.org/10.3390/nu8030152
Wang H, et al. Effectiveness of Folic Acid Fortified Flour for Prevention of Neural Tube Defects in a High Risk Region. Nutrients. 2016 Mar 9;8(3):152. PubMed PMID: 27005659.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of Folic Acid Fortified Flour for Prevention of Neural Tube Defects in a High Risk Region. AU - Wang,Haochen, AU - De Steur,Hans, AU - Chen,Gong, AU - Zhang,Xiaotian, AU - Pei,Lijun, AU - Gellynck,Xavier, AU - Zheng,Xiaoying, Y1 - 2016/03/09/ PY - 2015/11/22/received PY - 2016/02/21/revised PY - 2016/02/25/accepted PY - 2016/3/24/entrez PY - 2016/3/24/pubmed PY - 2016/12/15/medline KW - China KW - DALY KW - community intervention KW - folic acid fortified flour KW - neural tube defects SP - 152 EP - 152 JF - Nutrients JO - Nutrients VL - 8 IS - 3 N2 - 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. SN - 2072-6643 UR - https://www.unboundmedicine.com/medline/citation/27005659/Effectiveness_of_Folic_Acid_Fortified_Flour_for_Prevention_of_Neural_Tube_Defects_in_a_High_Risk_Region_ L2 - https://www.mdpi.com/resolver?pii=nu8030152 DB - PRIME DP - Unbound Medicine ER -