Fortification folate

Folate is the generic name used to refer to a family of vitamers with related biological activity. Instead, folic acid (pteroylglutamin acid, PGA) (Fignre 19.16) refers to the most oxidized, stable, and easily adsorbable synthetic form (monoglutamate). It is commonly nsed in food supplements and in food fortification because of its stability and becomes biologically active after redaction. 

EA Yetley, JI Rader. Folate fortification of cereal-grain products FDA policies and actions. Cereal Foods World 40 67-70, 72, 1995. 

Several studies have demonstrated an association between plasma tHcy levels and extent of CAD in populations not exposed to fortification of flour products with folic acid, even after controlling for conventional risk factors (26,27). In contrast, Brilakis et al. (28) found no association between plasma tHcy and angiographic CAD in a North American population consuming cereal grain flour fortified with folic acid. Silberberg et al. (29) found an association between plasma folate and CAD independent of tHcy. 

Gregory, J.F., Quinlivan, E.P., and Davis, S.R. (2005). Integrated the issues of folate bioavailability, intake and metabolism in the era of fortification. Trends FoodSci Tech.l6,229-240. 

Jacques PF, Selhub J, Bostom AG, Wilson PW, Rosenberg IH. The effect of folic acid fortification on plasma folate and total homocysteine concentrations. N Engl J Med 1999 340(19) 1449-54. 

Based on folate concentrations in liver biopsy samples, and assuming that the liver contains about half of ail body stores, total body stores of folate are estimated to be between 12 and 28 Kinetic studies that show both fast-turnover and very-slow-turnover folate pools indicate that about 0.5% to 1% of body stores are catabolized or excreted daily,suggesting a minimum daily requirement of between 60 and 280)Llg to replace losses. In calculating nutritional requirement, the concept of dietary folate equivalents (DFE) has been used to adjust for the nearly 50% lower bioavailabihty of food folate compared with supplemental folic acid, such that 1 p.g DFE = 0.6 Llg of folic acid from fortified food = 1 j,g of food folate 0.5 p.g foUc acid supplement taken on an empty stomach. Before the fortification program of cereal grains with folic acid conducted between 1988 and 1994, the median intake of folate from food in the United States was approximately 250p.g/day this figure is expected to increase by about 100 Llg/day after fortification. Recommendations... 

One often-overlooked major factor that may contribute to anemia in the older population is nutritional status. Cross-sectional studies demonstrate a higher prevalence of anemia in low socioeconomic populations, as well as a high prevalence of other nutritional deficiencies. Thus nutritional deficiencies not usually severe enough to affect the hematopoietic system in the younger population may account for anemia in the aged. Edentulous or infirm elderly who may be too ill to prepare their meals are at risk for nutritional folate deficiency. However, unlike cobalamin levels, it has been demonstrated that folate levels increase rather than decline with age. This may be due to the dramatic increase in folate supplements used by the elderly, especially in white women, as well as the fortification of the American diet with folic acid. ... 

CIO. Colman, N., Larsen, J. V., Barker, M., Barker, E. A., Green, R., and Metz, J., Prevention of folate deficiency by food fortification. V. A pilot field trial of folic acid-fortified maize meal. S. Afr. Med. J. 48, 1763-1766 (1974). 

Folate is involved in one-carbon unit transfer reactions during DNA synthesis, DNA methylation, and amino acid metabolism. Evidence to date shows that maternal dietary intake of folic acid is inversely associated with the risk of neural tube defect-affeeted pregnancies [9,10]. Neural tube defects (a term which includes spina bifida) are anatomieal birth anomalies affecting the brain and the spinal cord. As a result of these landmark findings, the first folic acid fortification program was introduced in the United States during 1998, in an attempt to reduce the prevalence... 

Vitamins and Folate Fortification in the Context of Cardiovascular Disease Prevention... 

Nevertheless, despite the decline of cardiovascular risk in North America after the introduction of folate food fortification (Yang et al. 2006), large clinical trials in patients with coronary heart disease (CHD) failed to demonstrate any benefit from B vitamins administration (Clarke et al. 2010). Despite... 

Cardiovascular Effects of Folic Acid, 65 and B12 Any Need for Folate Fortification ... 

However, the maximum beneficial vascular effect of folic acid was observed even with 0.4mg/day, while the higher dose failed to induce any further benefit. Despite the fact that plasma 5-MTHF increases in accordance with the dose of folic acid, vascular intracellular 5-MTHF levels do not exhibit any further increase with high doses compared with low doses of folic acid (Shirodaria et al. 2007). This is possibly explained by the saturation of human vascular wall with 5-MTHF after low-dose treatment (equivalent to the amount received by folate fortification of grain in North America) and the inability of any further increase of circulating folate levels to result into respective elevation of vascular 5-MTHF. 

Folate and B Vitamins in Cardiovascular Disease Insights from Clinical Trials and Folate Fortification Programme... 

However large RCTs, such as VISP (Toole et al. 2004) or VITATOPS (Anonymous 2010) have failed to document any significant effects of B vitamins on stroke prevention. Post hoc analyses, such as that of HOPE-2 (Saposnik et al. 2009) have suggested that folate, Bg and B12 could reduce stroke risk in patients with known CVD, mainly if patients were younger than 70 years, recruited from regions without folic acid food fortification, with higher baseline cholesterol and Hey levels, and not under antiplatelet or lipid-lowering... 

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