Lecture 13: Folate Supplementation & Fortification

Question 1

What are two neural tube defect (consequences of the neural tube not closing properly)

Answer 1

1. Spina bifida = defect involving spinal structures, can be survived with proper care
2. Anencephaly = defect involving cranial structures, brain not properly developed (fatal)

Question 2

What were the results of two studies investigating the link between folic acid and NTDs?

Answer 2

• Folic acid supplementation reduced NTD
• No demonstrable harm from folic acid supplementation
• Supplementation was particularly effective fr people who had low folic acid to begin with, not so much for people whose levels were already higher

Question 3

What are two strategies to increase folate through public health officials?

Answer 3

1. Target high risk individuals:
   - small effect on population prevalence
   - substantially change individual risk
2. Target population:
   - small change in individual risk
   - large effect on population prevalence

Question 4

What are possible harms of folic acid?

Answer 4

1. High dose of folic acid can mask vit B12 deficiency
   - B12 deficiency causes irreversible neurological damage
   - folic acid can correct anaemia but not the underlying B12 deficiency
2. Folic acid and cancer
   - anti folate drugs are used for the treatment of some cancers
   - concern about possible risks of cancer associated with folic acid supplements and fortification
   - concern about possible risks of cancer associated with folic

Question 5

What are 3 ways to increase folate intake to prevent NTDs?

Answer 5

1. Naturally folate-rich diet (most of folate comes from vegetables)
2. Mandatory fortification
3. Supplements

Question 6

What are pro’s and con’s of folate supplementation and fortification?

Answer 6

Supplements
Pro:
- correct dose at correct time
- no risk to non-target population
Con:
- conscious choice
- education/awareness needed
- cost barrier

Fortification
Pro:
- reaches most women
- less discrimination
Con:
- only use low level of fortification to prevent risks to old and young so few would receive 400ug/day

Question 7

What was the effect of folate fortification in Canada?

Answer 7

Richer areas (where people were probably eating better and had higher folate) were not much impacted, but poorer areas were

Question 8

What are the recommendations for pregnant women in NZ

Answer 8

• 800ug tablet of folic acid daily prior to conception and for 12 weeks after conceiving to reduce NTD risk
• Folic acid tables can be obtained on prescription or purchased from a pharmacy

Question 9

Is there mandatory fortification of folate in NZ?

Answer 9

Yes, there is mandatory fortification for:
- bread
- bread-making wheat flour
- all wheat flour (only a few mills in NZ, so much easier to check this than checking every bakery in NZ)
—> folic acid must be added to the product ingredient list

Question 10

What happened in Australia after mandatory folate fortification of bread?

Answer 10

The NTD rates for Aboriginal or Torres Strait Islanders dropped significantly, the rate for non-indigenous people stayed the same