Fortifying food with folic acid improves folate intake in German infants, children, and adolescents

Folate - a scoping review for Nordic Nutrition Recommendations 2023

Folate is an essential micronutrient for normal development and metabolic function, and folate deficiency is associated with an increased risk of cancer, cardiovascular disease, mental dysfuntion and negative pregnancy outcomes. When estimating folate requirements, one must consider different bioavailability and functionality between synthetic folic acid and dietary folate, together with increased needs of folate in women of fertile age, pregnant and lactating women, preterm and small for gestational age weight infants and individuals who are homozygote for the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene polymorphism. In order to achieve an adequate metabolic status based on the metabolic marker total homocysteine, and not merely the absence of clinical signs of folate deficiency, the recommended intake of folate differs according to age, pregnancy and lactation. According to the World Health Organization, a decision limit for folate deficiency in adults is serum folate level below 10 nmol/L, and in women of fertile age a red blood cell folate level below 906 nmol/L in order to prevent neural tube defects. Qualified systematic reviews along with identified relevant literature have been used for this scoping review prepared for the Nordic Nutrition Recommendations 2023.

Foods contributing to vitamin B6, folate, and vitamin B12 intakes and biomarkers status in European adolescents: The HELENA study

PURPOSE

To examine the association between food groups consumption and vitamin B6, folate and B12 intakes and biomarkers in adolescents.

METHODS

In total 2189 individuals participating in the cross-sectional Healthy Lifestyle in Europe by Nutrition in Adolescence study met the eligibility criteria for analysis of dietary intakes (46 % males) and 632 for biomarker analysis (47 % males). Food intakes were assessed by two non-consecutive 24-h recalls. Biomarkers were measured by chromatography and immunoassay. Food groups which best discriminated participants in the extreme tertiles of the distribution of vitamins were identified by discriminant analyses. Food groups with standardised canonical coefficients higher or equal to 0.3 were selected as valid discriminators of vitamins intake and biomarkers extreme tertiles. Linear mixed model elucidated the association between food groups and vitamins intakes and biomarkers.

RESULTS

Vitamin B6 intakes and biomarkers were best discriminated by meat (males and females), margarine and mixed origin lipids only in males and breakfast cereals (females). Breakfast cereals (males), and fruits, margarine and mixed origin lipids, vegetables excluding potatoes, breakfast cereals, and soups/bouillon (females) determined the most folate intakes and biomarkers. Considering vitamin B12 intakes and biomarkers, meat, and white and butter milk (males and females), snacks (males), and dairy products (females) best discriminated individual in the extremes of the distribution. Fewer associations were obtained with mixed model for biomarkers than for vitamins intakes with food groups.

CONCLUSIONS

Whereas B-vitamin intakes were associated with their food sources, biomarkers did with overall food consumption. Low-nutrient-density foods may compromise adolescents' vitamin status.

Trade, Development, and Regulatory Issues in Food

Trade in food and animal products has increased several-fold in the past decade, and simultaneously regulations governing the movement of such products across national boundaries have also increased. The present study reviews harmonization in food trade regulation by focusing on nutritional aspects to understand its role in enhancing world trade on the one hand and consumer interest and welfare on the other. Harmonization to a large extent brings in more regulation from the developed world acting through their governments, consumer organizations, and multinational companies; it does not seem to address, in general, the concerns of the large segments of the poor population for whom agriculture and food trade are the main sources of livelihood. There is a lack of quantifiable estimates of the loss in well-being of the disadvantaged. However, there is substantial research focused on the potential harm to developed nations as a result of nonadherence to the rules. Clearly, lack of adequate infrastructure, resource constraints, and weak institutions not only result in poor food safety regulation within developing countries but also remain barriers to realizing the greater potential benefits from increased trade. Harmonization of standards would have some losers and some winners, but to make it more inclusive, scientific knowledge alone may not be adequate; social and cultural aspects also need to be considered, since food systems differ among regions, with varying preferences, local resource availability, and levels of economic development. Improvement in governance in many countries not only would ensure better participation in international rule-making and the negotiation process for fairer trade but also would result in effective domestic legislation to ensure safer health for citizens, resulting in higher overall well-being.

Serum homocysteine and folate concentrations among a US cohort of adolescents before and after folic acid fortification

OBJECTIVE

We assessed serum homocysteine (tHcy) and folate concentrations among US adolescents before and after fortification of cereal-grain products with folic acid, and associations with demographic, behavioural and physiological factors.

DESIGN

Observational study conducted among participants of a randomized trial.

SETTING

The Child and Adolescent Trial for Cardiovascular Health (CATCH) study.

SUBJECTS

Adolescents (n 2445) in grades 8 (pre-fortification, mean age 14 years) and 12 (post-fortification, mean age 18 years).

RESULTS

Average serum concentrations of tHcy, folate and vitamin B6 increased by 17 %, 16 % and 14 %, respectively, while serum concentrations of vitamin B12 decreased by 11 % post-fortification. Folic acid fortification provided, on average, an additional intake of 118 μg folate/d. Male sex (P < 0.0001) and white race (P = 0.0008) were associated with significantly greater increases in tHcy concentration, while increases in BMI (P = 0.006) and serum folate concentration (P < 0.0001) were associated with significant decreases in tHcy concentration. Female sex (P < 0.0001), non-smoking (P < 0.0001), use of multivitamins (P < 0.0001) and higher dietary intake of folate (P = 0.001) were associated with significantly greater increases in serum folate concentrations. From grade 8 to grade 12, the upward age trend in serum tHcy concentration was uninterrupted in its course (P > 0.50); whereas serum folic acid concentration showed a downward trend that incurred a discrete jump upward (17 % higher; P < 0.0001) with fortification. These trends differed significantly for males v. females (P < 0.001 for interaction).

CONCLUSIONS

Fortification had a significant impact on improving folate status but not serum tHcy concentrations among US adolescents.

Preconceptional folic acid supplement use in Lebanon

OBJECTIVE

The objective of the present study was to assess the prevalence and determinants of preconceptional folic acid supplement use among pregnant women in Lebanon.

DESIGN/SETTING/SUBJECTS

The study was a descriptive epidemiological study. Analysis was performed on 5280 deliveries admitted to twelve member hospitals of the National Collaborative Perinatal Neonatal Network during the period September 2003-January 2005. Information on folic acid intake and maternal and neonatal characteristics were obtained from obstetric charts along with direct interviews performed by trained personnel. Logistic regression was performed to determine the predictors of preconceptional folic acid use.

RESULTS

The overall use of preconceptional folic acid supplementation was 14.0 % (18.6 % in urban hospitals v. 2.7 % in rural hospitals). Higher socio-economic status, lower parity and having a history of previous spontaneous abortions were significantly associated with preconceptional folic acid use.

CONCLUSION

Our study shows that Lebanon currently has a low rate of preconceptional folic acid supplement use. Intervention through the means of awareness campaigns needs to be implemented on a national level.

Marginal folate inadequacy observed in a group of young children in Kwangju, Korea

Folate is important for multiple metabolic processes such as nucleic acid synthesis and interconversions, and cell division. Folate deficiency may be a risk factor for several pathologies, such as neural tube birth defects, dementia, and cardiovascular diseases. The objectives of this study were to estimate folate intakes and plasma concentrations of young children living in Kwangju, Korea. Three consecutive 24-h food recalls and fasting blood samples were obtained from 24 boys and 30 girls, aged 2-6 y, living in Kwangju, Korea. The daily folate intake (mean ± SD) of the children was 146.7 ± 73.6 µg dietary folate equivalents. No differences in folate intakes were observed by gender (p≥0.05). The mean folate intakes of the 2 and 3 y old groups were significantly lower (p<0.05) than those of 5 and 6 y old groups. Over half of subjects consumed <Korean Estimated Average Requirements for folate. The plasma folate concentration (mean ± SD) of all subjects was 19.2 ± 8.7 nmol/L, and there was no significant difference by age nor gender (p≥0.05). No significant correlation was observed between folate intakes and plasma folate concentrations. One subject (1.9%) in this study had a plasma folate concentration <6.8 nmol/L, which is indicative of folate deficiency. Approximately 24% of subjects had plasma folate concentrations of 6.8-13.4 nmol/L, which is representative of marginal folate status. In conclusion, some young children may have less than adequate folate status in Korea.