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Modeling the impact of folic acid fortification and supplementation on red blood cell folate concentrations and predicted neural tube defect risk in the United States: have we reached optimal prevention?
Am J Clin Nutr. 2018 06 01; 107(6):1027-1034.AJ

Abstract

Background

The US CDC and the Institute of Medicine recommend that women capable of becoming pregnant consume ≥400 µg synthetic folic acid/d to prevent neural tube defects (NTDs). The United States has 3 sources of folic acid: fortified enriched cereal grain products (ECGPs), fortified ready-to-eat (RTE) cereals, and dietary supplements.

Objective

Our objectives were as follows: 1) to estimate the usual daily folic acid intake and distributions of red blood cell (RBC) folate concentrations among women consuming folic acid from different sources; 2) to assess the usual daily total folic acid intake associated with optimal RBC folate concentrations for NTD prevention; 3) to predict NTD prevalence; and 4) to estimate the number of preventable folate-sensitive NTDs.

Design

NHANES data (2007-2012) for nonpregnant women of reproductive age (12-49 y) were used to estimate usual daily intakes of synthetic folic acid and natural food folate. We applied existing models of the relation between RBC folate concentrations and NTD risk to predict NTD prevalence.

Results

Based on the distribution of overall RBC folate concentrations (4783 women), the predicted NTD prevalence was 7.3/10,000 live births [95% uncertainty interval (UI): 5.5-9.4/10,000 live births]. Women consuming folic acid from ECGPs as their only source had lower usual daily total folic acid intakes (median: 115 µg/d; IQR: 79-156 µg/d), lower RBC folate concentrations (median: 881 nmol/L; IQR: 704-1108 nmol/L), and higher predicted NTD prevalence (8.5/10,000 live births; 95% UI: 6.4-10.8/10,000 live births) compared with women consuming additional folic acid from diet or supplements. If women who currently consume folic acid from ECGPs only (48% of women) consumed additional folic acid sources, 345 (95% UI: 0-821) to 701 (95% UI: 242-1189) additional NTDs/y could be prevented.

Conclusions

This analysis supports current recommendations and does not indicate any need for higher intakes of folic acid to achieve optimal NTD prevention. Ensuring 400 µg/d intake of folic acid prior to pregnancy has the potential to increase the number of babies born without an NTD.

Authors+Show Affiliations

Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Congenital and Developmental Disorders, Atlanta, GA.Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Congenital and Developmental Disorders, Atlanta, GA.Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Congenital and Developmental Disorders, Atlanta, GA. Chestatee Solutions, Dahlonega, GA.Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Congenital and Developmental Disorders, Atlanta, GA.Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Congenital and Developmental Disorders, Atlanta, GA. G²S Corporation, San Antonio, TX.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29767673

Citation

Crider, Krista S., et al. "Modeling the Impact of Folic Acid Fortification and Supplementation On Red Blood Cell Folate Concentrations and Predicted Neural Tube Defect Risk in the United States: Have We Reached Optimal Prevention?" The American Journal of Clinical Nutrition, vol. 107, no. 6, 2018, pp. 1027-1034.
Crider KS, Qi YP, Devine O, et al. Modeling the impact of folic acid fortification and supplementation on red blood cell folate concentrations and predicted neural tube defect risk in the United States: have we reached optimal prevention? Am J Clin Nutr. 2018;107(6):1027-1034.
Crider, K. S., Qi, Y. P., Devine, O., Tinker, S. C., & Berry, R. J. (2018). Modeling the impact of folic acid fortification and supplementation on red blood cell folate concentrations and predicted neural tube defect risk in the United States: have we reached optimal prevention? The American Journal of Clinical Nutrition, 107(6), 1027-1034. https://doi.org/10.1093/ajcn/nqy065
Crider KS, et al. Modeling the Impact of Folic Acid Fortification and Supplementation On Red Blood Cell Folate Concentrations and Predicted Neural Tube Defect Risk in the United States: Have We Reached Optimal Prevention. Am J Clin Nutr. 2018 06 1;107(6):1027-1034. PubMed PMID: 29767673.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modeling the impact of folic acid fortification and supplementation on red blood cell folate concentrations and predicted neural tube defect risk in the United States: have we reached optimal prevention? AU - Crider,Krista S, AU - Qi,Yan Ping, AU - Devine,Owen, AU - Tinker,Sarah C, AU - Berry,Robert J, PY - 2017/12/01/received PY - 2018/03/16/accepted PY - 2018/5/17/pubmed PY - 2019/7/12/medline PY - 2018/5/17/entrez SP - 1027 EP - 1034 JF - The American journal of clinical nutrition JO - Am J Clin Nutr VL - 107 IS - 6 N2 - Background: The US CDC and the Institute of Medicine recommend that women capable of becoming pregnant consume ≥400 µg synthetic folic acid/d to prevent neural tube defects (NTDs). The United States has 3 sources of folic acid: fortified enriched cereal grain products (ECGPs), fortified ready-to-eat (RTE) cereals, and dietary supplements. Objective: Our objectives were as follows: 1) to estimate the usual daily folic acid intake and distributions of red blood cell (RBC) folate concentrations among women consuming folic acid from different sources; 2) to assess the usual daily total folic acid intake associated with optimal RBC folate concentrations for NTD prevention; 3) to predict NTD prevalence; and 4) to estimate the number of preventable folate-sensitive NTDs. Design: NHANES data (2007-2012) for nonpregnant women of reproductive age (12-49 y) were used to estimate usual daily intakes of synthetic folic acid and natural food folate. We applied existing models of the relation between RBC folate concentrations and NTD risk to predict NTD prevalence. Results: Based on the distribution of overall RBC folate concentrations (4783 women), the predicted NTD prevalence was 7.3/10,000 live births [95% uncertainty interval (UI): 5.5-9.4/10,000 live births]. Women consuming folic acid from ECGPs as their only source had lower usual daily total folic acid intakes (median: 115 µg/d; IQR: 79-156 µg/d), lower RBC folate concentrations (median: 881 nmol/L; IQR: 704-1108 nmol/L), and higher predicted NTD prevalence (8.5/10,000 live births; 95% UI: 6.4-10.8/10,000 live births) compared with women consuming additional folic acid from diet or supplements. If women who currently consume folic acid from ECGPs only (48% of women) consumed additional folic acid sources, 345 (95% UI: 0-821) to 701 (95% UI: 242-1189) additional NTDs/y could be prevented. Conclusions: This analysis supports current recommendations and does not indicate any need for higher intakes of folic acid to achieve optimal NTD prevention. Ensuring 400 µg/d intake of folic acid prior to pregnancy has the potential to increase the number of babies born without an NTD. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/29767673/Modeling_the_impact_of_folic_acid_fortification_and_supplementation_on_red_blood_cell_folate_concentrations_and_predicted_neural_tube_defect_risk_in_the_United_States:_have_we_reached_optimal_prevention L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.1093/ajcn/nqy065 DB - PRIME DP - Unbound Medicine ER -