Prevalence of inadequate intake of folate after mandatory fortification: results from the first National Dietary Survey in Brazil

Prevalence of inadequate intake of folate in the post-fortification era: data from the Brazilian National Dietary Surveys 2008-2009 and 2017-2018

The objectives were to compare the evolution of dietary folate intake, to estimate the prevalence of folate inadequacy (POFI) and the contribution of food groups to folate intake (dietary folate plus folic acid from fortified foods) in two post-fortification periods in the Brazilian population, according to life stages, geographic regions and per capita income. Population-based study including representative data from the National Dietary Survey - Brazilian Household Budget Surveys (NDS-HBS) 2008-2009 and 2017-2018, with a total of 32 749 (2008-2009) and 44 744 (2017-2018) individuals aged ≥ 10 years old, excluding pregnant and lactating women. The National Cancer Institute method was used to estimate the distributions of usual dietary folate intake. POFI was estimated according to estimated average requirement cut-off point method. After 10 years of the first NDS-HBS, POFI has increased in all sex-age groups, except for 10-13 years. POFI among women of reproductive age was around 30 and 40 % in 2008-2009 and 2017-2018. Higher POFI was observed in the North region. The top five food groups contributors to folate intake in Brazil were beans, breads, pasta and pizza, cakes and cookies and non-alcoholic beverages groups in both periods, differing in the rank order of the last two groups. Although being a country that has adopted mandatory folic acid flour fortification for almost two decades, increased POFI was observed in 2017-2018. This study brings significant scientific information, which can help understand folate dietary data in different contexts and consequently guide the approach for public health fortification strategies.

Comparative Transcriptome Analysis Reveals Mechanisms of Folate Accumulation in Maize Grains

Previously, the complexity of folate accumulation in the early stages of maize kernel development has been reported, but the mechanisms of folate accumulation are unclear. Two maize inbred lines, DAN3130 and JI63, with different patterns of folate accumulation and different total folate contents in mature kernels were used to investigate the transcriptional regulation of folate metabolism during late stages of kernel formation by comparative transcriptome analysis. The folate accumulation during DAP 24 to mature kernels could be controlled by circumjacent pathways of folate biosynthesis, such as pyruvate metabolism, glutamate metabolism, and serine/glycine metabolism. In addition, the folate variation between these two inbred lines was related to those genes among folate metabolism, such as genes in the pteridine branch, para-aminobenzoate branch, serine/tetrahydrofolate (THF)/5-methyltetrahydrofolate cycle, and the conversion of THF monoglutamate to THF polyglutamate. The findings provided insight into folate accumulation mechanisms during maize kernel formation to promote folate biofortification.

Diet and supplement assessment in a Brazilian urban population

OBJECTIVE:

To assess total usual nutrient intakes from foods and dietary supplements by age, sex, physical activity, and nutritional status, and to compare usual nutrient intakes to the Dietary Reference Intakes among non-users and users of dietary supplements in an urban population.

METHODS:

Cross-sectional population-based survey with 506 adults conducted in the city of Brasília, Brazil, using 24h food recalls. The 24-HR was collected on two nonconsecutive days, for which individuals reported all food, supplements, and beverages consumed in the previous 24 hours. The estimates of mean and the distribution percentiles were adjusted to reflect usual nutrient intake using the Iowa State University method. The prevalence of inadequate micronutrient intake was estimated according to sex using the Estimated Average Requirement (EAR), and values above the Tolerable Upper Intake Level (UL) were also considered. Also, a comparison was made of the total mean usual intake between supplement users and non-users according to BMI and physical activity.

RESULTS:

The total mean usual dietary intake was significantly higher among users than non-users of dietary supplements (p ≤ 0.02). Dietary supplement use increased intakes of nutrients and decreased prevalence of inadequacy according to sex, with only small (typically < 13%) increases in the population exceeding the Tolerable Upper Intake Level. There was a significant interaction between physical activity and BMI categories with supplement use.

CONCLUSIONS:

The population that consumes food supplements comprises individuals with more advanced age, female, normal BMI, and physically active. Our findings show that the use of supplements appears beneficial to attain nutrient adequacy. Careful monitoring of intake from food and supplements is recommended, and the statistical methods must be powerful enough to achieve relevant information.

Opportunities for diet quality improvement: the potential role of staple grain foods

OBJECTIVE

Given the high disease burden associated with the low intake of whole grains, modelling studies that estimate the impact of dietary strategies to increase more healthful grain foods consumption are essential to inform evidence-based and culturally specific policies. The current study investigated the potential nutritional impact of replacing staple grain foods with more healthful options.

DESIGN

Based on the 2015 Health Survey of São Paulo, a cross-sectional, population-based study, we modelled the substitution of white rice and white bread with brown rice and whole-wheat bread. Outcomes included changes in more healthful grain foods, energy and nutrient intakes.

SETTING

Urban area of São Paulo, Brazil.

PARTICIPANTS

Participants aged over 12 years who completed a semi-structured questionnaire and one 24-h recall (n 1741).

RESULTS

The substitution of all white rice and white bread with brown rice and whole-wheat bread, respectively, would result in more than 5 % increases in Zn (+9·1 %), Ca (+9·3 %), vitamin E (+18·8 %), dietary fibre (+27·0 %) and Mg (+52·9 %) intake, while more than a 5 % decrease would be seen for total carbohydrate (-6·1 %), folate (-6·6 %), available carbohydrate (-8·5 %), Fe (-8·6 %), vitamin B6 (-12·5 %), vitamin B2 (-17·4 %), and vitamin B1 (-20·7 %). A substantial increase in the amount of more healthful grain foods consumed would be seen (10 g/d to 220 g/d, or from 4 % to 69 % of total grain intake).

CONCLUSIONS

Replacing white rice and white bread with their whole-grain versions has the potential to improve diet quality, suggesting they are prime targets for policy actions aiming at increasing intake of more healthful grain foods.