Canada's folic acid success to encourage others?

By Stephen Daniells

- Last updated on GMT

Related tags: Folic acid, Vitamin b12 deficiency

If anyone needed further support for benefits of folic acid
fortification, a new study shows that the incidence of neural tube
defects in Canada has dropped by 46 per cent since the advent of
folic acid addition to flours.

The study, published in the New England Journal of Medicine​, has implications for countries debating the effectiveness of fortification. Currently, only Canada, the United States, and Chile require that folic acid be added to flour. The signs are indicating that it will be introduced in the UK soon. An announcement is expected within the next month or so concerning fortification in Ireland, and similar measure under scrutiny in Australia. "We found that food fortification with folic acid was associated with a significant reduction in neural-tube defects in Canada,"​ wrote lead author Philippe De Wals of Université Laval. "Furthermore, the risk reduction appeared greatest in regions in which the rates were highest before the fortification program was implemented."​ Folate is found in foods such as green leafy vegetables, chick peas and lentils, and an overwhelming body of evidence links has linked folate deficiency in early pregnancy to increased risk of neural tube defects (NTD) - most commonly spina bifida and anencephaly - in infants. This connection led to the 1997 introduction of public health measures in Canada and the US followed suit a year later, where all grain products are fortified with folic acid - the synthetic, bioavailable form of folate. "Canada decided to add folic acid to all flour produced in the country because formation of the neural tube in embryos is particularly intense during the first four weeks of pregnancy, which is before a lot of women even know they're pregnant,"​ stated De Wals. "Since half of Canadian pregnancies are unplanned and the human body can't store folic acid, it is better to integrate folic acid into the food chain than to focus exclusively on taking vitamin supplements."​ De Wals and co-workers used published results of testing of red-cell folate levels, and divided the study period into pre-fortification, partial-fortification, and full-fortification periods. The researchers compared the incidence of neural tube deformations before and after the introduction of folic acid-enriched flours for over 2 million births in Canada. Between 1993 and 1997, the incidence was 1.58 per 1,000 births. Between 2000 and 2002, the rate dropped 46 per cent to 0.86, showing the effectiveness of folic acid fortification. In the case against folic acid fortification, fears have been raised that high levels may mask detection of vitamin B12 deficiency, especially in the elderly. If this deficiency is not identified it can eventually lead to dementia. According to the UK FSA's Scientific Advisory Committee on Nutrition, folic acid intakes of one mg/day would not be expected to mask vitamin B12 deficiency, and most adverse effects in relation to vitamin B12 deficiency have been reported at doses at or above 5mg/day. "Decisions regarding the optimal level of food fortification and the types of foods to be enriched must take into account both safety, especially for seniors who may have unrecognized B12 deficiency, and the goal of maximizing the reduction in neural-tube defects,"​ concluded the researchers. Source: New England Journal of Medicine​ 2007, Volume 357, Pages 135-142 "Reduction in Neural-Tube Defects after Folic Acid Fortification in Canada" ​Authors: P. De Wals, F. Tairou, M.I. Van Allen, S.-H. Uh, R.B. Lowry, B. Sibbald, J.A. Evans, M.C. Van den Hof, P. Zimmer, M. Crowley, B. Fernandez, N.S. Lee, and T. Niyonsenga

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