Fortification folic acid

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. 

Mills JL, Von Kohorn I, Conley MR, Zeller JA, Cox C, Williamson RE, Dufour DR. Low vitamin B-12 concentrations in patients without anemia the effect of folic acid fortification of grain. Am J Clin Nutr 2003 6(77) 1474-7. 

Bailey, L. B., Rampersaud, G. C., Kauwell, G. P. (2003). Folic acid supplements and fortification affect the risk for neural tube defects, vascular disease and cancer evolving science. J. Nutr., 133,1961S-1968S. 

Folacin has recently been implicated in a number of nonvitamin functions, including roles in various types of cancer, coronary heart disease, and the prevention of birth defects, such as neural tube abnormalities (109,121,131-144). Investigations into these functions are ongoing and have generated controversy concerning the exact nature of the nonvitamin functions, human nutritional requirements for folacin, and the wisdom of food fortification or supplementation of selected population groups with pharmacological doses of folic acid (131,132,145-150). 

C Bower, NJ Wald. Vitamin B12 deficiency and the fortification of food with folic acid. Eur J Clin Nutr 49 787-793, 1995. 

C Schorah, D Buss. Should flour fortification with folic acid be mandatory to reduce the incidence of neural Lube defects BNF Nutr Bull 20 292-301, 1995. 

GE Gaull, CA Testa, PR Thomas, DA Weinreich. Fortification of the food supply with folic acid to prevent neural tube defects is not yet warranted. J Nutr 126 773S-780S, 1996. 

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. 

Brilakis ES, et al. Lack of association between plasma homocysteine and angiographic coronary artery disease in the era of fortification of cereal grain flour with folic acid. Atherosclerosis 2002 165(2) 375 381. 

Dietary supplementation with B vitamins is also highly effective in lowering homocysteine in most individuals with mild or moderate hyperhomocysteinemia. A meta-analysis of 12 randomized trials performed prior to folic acid fortification concluded that treatment with folic acid (0.5 to 5 mg daily) decreased homocysteine levels by 25%, and that the addition of... 

For prevention of disease in the elderly, the pregnant, or other susceptible groups, national fortification of food with vitamin B12 appears sensible and inexpensive but at present is not used and, in the absence of population screening s unlikely to be mandated by governmental edict. In general terms, the hematological manifestations of vitamin B12 deficiency are rapidly and fully correctable, although deficiencies of other micronutrients such as iron, folic acid, pyridoxine, copper, or vitamin C may be unmasked in the process and may limit the bone marrow s response until they are also corrected. 

Source Reprinted from Health Canada, Health Protection Branch consultative document on draft proposals-sub-jects (1) fortification of flour and pasta with folic acid, (2) harmonization of flour enrichment with the United States of America, (3) optional enrichment of flour. 

Selhub J, Jacques PF Bostom AG, Wilson PW, and Rosenberg IH (2000) Relationship between plasma homocysteine and vitamin status in the Framingham study population. Impact of folic acid fortification. Public Health Review 28, 117-45. 

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. 

Supplements of folic acid (0.4 mg/day), or possibly less, can reduce the rate of NTDs. To achieve an extra 0.4 mg folic acid per day, using food, one would have to drink eight glasses of orange juice or eat three servings of Brussels sprouts per day (Wald and Bower, 1995). Since it is not likely that any population, as a whole, would be expected to consume folic acid supplements on a consistent, daily basis, food fortification has become an attractive option. Because neural tube formation occurs early in pregnancy, it is probably necessary for folic acid supplements (when taken) to be consumed for 2-3 weeks (every day) prior to the day of conception, and for 2-3 weeks (every day) after conception, in order for the vitamin to produce its apparent effect. 

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... 

Palomaki GE, Williams J, Haddow JE. Comparing the observed and predicted effectiveness of folic acid fortification in preventing neural tube defects. J Med Screen 2003 10 52-3. 

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). 

Folic Acid Fortification. U.S. Food and Drug Administration. http //vm.cfsan.fda.gov/ dms/wh folic.html (accessed on October 10, 2005). 

FoUc acid is found in citrus fruits and leafy green vegetables. The FDA is now requiring that folic acid be added to cereals, breads, and pastas. The American Journal of Public Health says that such grain fortification would prevent 300 to 700 birth defects per year. At the level recommended for addition, approximately 3.25 million adults over 50 would receive too much folic acid. What question would you want answered before you would support such a nationwide program ... 

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... 

Wright, A. J. A., Dainty, J. R., and Finglas, P. M. 2007. Folic acid metabolism in human subjects revisited Potential implications for proposed mandatory folic acid fortification in the UK. Br. J. Nutr. 98 667-675. 

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