1
|
Proesmans VLJ, Matthys C, Vermeir I, Geuens M. Evolution of dietary patterns in Flanders: an ecological trend study on best-selling cookbook recipes (2008-2018) and their correlation with household purchases. Nutr J 2024; 23:99. [PMID: 39182141 PMCID: PMC11344928 DOI: 10.1186/s12937-024-01004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/16/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND With rising obesity rates in Western societies, analyzing changes in dietary patterns is paramount. While nutritional surveys have been informative, traditional cookbooks have historically shed light on national cuisines and its changes. Despite the growing popularity of online platforms for food information, cookbooks might still reflect prevalent dietary trends and the diets people follow. This study examined (1) the changes in nutritional content and food group usage in the best-selling cookbooks from 2008 to 2018, and (2) the correlation between the food groups in these cookbooks and dietary patterns (inferred from household purchases) over the same timeframe. METHODS An exploratory ecological study was conducted on 20 main course recipes of each of the five best-selling cookbooks in Flanders annually between 2008 and 2018. Trends in macronutrients and food group usage in these recipes were analyzed using generalized linear models. Additionally, these trends were compared to household purchase data in Flanders using correlation matrices. RESULTS Our results reveal a rising trend towards the use of plant-based ingredients and meat alternatives in cookbooks over the period 2008-2018. There was an increase in the usage of vegetables, nuts & seeds, and cheese. Conversely, there was a decline in the usage of meat, sugar & sweeteners, alcohol, and dairy (all p-values < 0.05). In terms of macronutrient content, there was an upswing in carbohydrate, fibre, and sugar levels, while the total fat content showed a decrease (all p-values < 0.05). The levels of protein and saturated fat remained consistent over time. Notably, shifts in plant-based and animal-based food group preferences in popular cookbook recipes align with the trends seen in actual household purchases of these food groups (all p-values < 0.05). CONCLUSION These findings indicate that cookbook content evolves over time, potentially reflecting shifts in population dietary patterns. Future research is needed to determine (Buisman ME, Jonkman J. Dietary trends from 1950 to 2010: a Dutch cookbook analysis. J Nutr Sci [Internet]. 2019 ed [cited 2022 Apr 19];8. https://www.cambridge.org/core/journals/journal-of-nutritional-science/article/dietary-trends-from-1950-to-2010-a-dutch-cookbook-analysis/AB281ADE0F09FF8F518B8AC4A2A5BEA8#supplementary-materials ) any causative link between cookbooks and dietary habits, and (Ashwell M, Barlow S, Gibson S, Harris C. National Diet and Nutrition Surveys: the British experience. Public Health Nutr. 2006;9(4):523-30.) the potential for cookbooks to aid in health promotion.
Collapse
Affiliation(s)
- Viktor Lowie Juliaan Proesmans
- BE4LIFE, Department of Marketing Innovation and Organisation, Faculty of Economics and Business Administration, Ghent University, Tweekerkenstraat 2, Ghent, 9000, Belgium.
| | - Christophe Matthys
- Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinology, KU Leuven, Herestraat 49, Leuven, 3000, Belgium
- Department of Endocrinology, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Iris Vermeir
- BE4LIFE, Department of Marketing Innovation and Organisation, Faculty of Economics and Business Administration, Ghent University, Tweekerkenstraat 2, Ghent, 9000, Belgium
| | - Maggie Geuens
- BE4LIFE, Department of Marketing Innovation and Organisation, Faculty of Economics and Business Administration, Ghent University, Tweekerkenstraat 2, Ghent, 9000, Belgium
| |
Collapse
|
2
|
Mirabal-Beltran R, Monogue-Rines K, Riva K, Dube N, Donohue P. Hispanic Women's Perceptions of Neural Tube Defects and Folic Acid Supplementation: A Qualitative Study. Womens Health Issues 2024; 34:172-179. [PMID: 37833104 PMCID: PMC10978298 DOI: 10.1016/j.whi.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION In the United States, the prevalence of neural tube defects (NTDs) is higher among infants born to Hispanic women compared with those born to non-Hispanic women. The purpose of this study is to investigate perceptions of NTDs and the use of folic acid and folate as a preventive measure among Hispanic women. METHODS Purposive sampling was used to recruit Hispanic women from a prenatal clinic in a Northeastern metropolitan city. In-depth interviews were conducted by native Spanish-speaking researchers using a semistructured interview guide. Thematic analysis was used to develop themes related to a priori domains. FINDINGS The study sample consisted of 26 Hispanic women representing nine countries of origin. Four themes were revealed: dietary sources of folic acid, awareness of folic acid supplementation and fortification, preferences for receiving health information, and factors in decision-making concerning an NTD diagnosis. CONCLUSIONS This study highlights the importance of early and targeted educational interventions sensitive to the cultural needs of this population. Results suggest that current NTD health education efforts may not be sufficient to increase our participants' knowledge of NTD. Additionally, the disparity may be multimodal, potentially influenced by insufficient understanding of prenatal folic acid use and the role of religiosity in decision-making during pregnancy. If Hispanic women are more likely to continue pregnancies affected by NTDs, this factor could be a part of NTD disparities. Exploring factors beyond supplementation and fortification that might influence rates of NTDs at birth in the U.S. Hispanic population can help to inform prevention efforts.
Collapse
Affiliation(s)
- Roxanne Mirabal-Beltran
- School of Nursing, Georgetown University, Washington, District of Columbia; Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
| | | | - Kylie Riva
- School of Nursing, Georgetown University, Washington, District of Columbia
| | - Nandi Dube
- School of Nursing, Georgetown University, Washington, District of Columbia
| | - Pamela Donohue
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
3
|
Mustafa HJ, Burns CT, Heydari MH, Javinani A, Bidulescu A, Habli M, Khalil A. Contribution of obesity to racial and ethnic disparities in the risk of fetal myelomeningocele: a population-based study. AJOG GLOBAL REPORTS 2024; 4:100290. [PMID: 38274636 PMCID: PMC10808985 DOI: 10.1016/j.xagr.2023.100290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Prepregnancy obesity and racial-ethnic disparities has been shown to be associated with meningomyelocele. OBJECTIVE This study aimed to investigate the association of maternal periconceptional factors, including race-ethnicity and prepregnancy body mass index, with the prevalence of isolated fetal myelomeningocele. METHODS This was a population-based cross-sectional study using Centers for Disease Control and Prevention birth data from 2016 to 2021. Major structural anomalies or chromosomal abnormalities were excluded. Race-ethnicity was classified as non-Hispanic White (reference population), non-Hispanic Black, non-Hispanic Asian, Hispanic, and others. Maternal prepregnancy body mass index was classified as underweight (<18.5 kg/m2), normal (reference group; 18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and class I (30-34.9 kg/m2), class II (35-39.9 kg/m2), and class III obesity (≥40 kg/m2). A chi-square test of independence was performed to identify factors significantly associated with myelomeningocele. These factors were then stratified into 3 adjusted clusters/levels. The prevalence was calculated per 10,000 live births. The Cochran-Armitage test for trend was used to detect any significant increasing or decreasing trends. RESULTS A total of 22,625,308 pregnancies with live birth, including 2866 pregnancies with isolated fetal myelomeningocele, were included in the analysis. The prevalence of isolated fetal myelomeningocele per 10,000 live births varied among different racial/ethnic groups, with the highest prevalence found among the non-Hispanic White (1.60 [1.52-1.67]) and lowest among the non-Hispanic Asian (0.50 [0.40-0.64]) population. The prevalence significantly increased with body mass index, with the highest prevalence found in the population with class III obesity (1.88 per 10,000 live births). Subgroup analysis of the associations between the significant variables (obesity, diabetes, hypertension, and education) and each ethnicity in cases with myelomeningocele showed significant variations in prevalence of these variables among different racial/ethnic groups. Following the model with the 3 levels of adjustment described in the Methods section, prepregnancy overweight and class I, II, and III obesity remained significantly associated with the odds of isolated fetal myelomeningocele. The adjusted odds ratios were 1.32 (95% confidence interval, 1.19-1.46; P<.001) for overweight, 1.55 (95% confidence interval, 1.38-1.75; P<.001) for class I obesity, 1.68 (95% confidence interval, 1.45-1.94; P<.001) for class II obesity, and 1.73 (95% confidence interval, 1.47-2.04; P<.001) for class III obesity. Similarly, following the 3-level adjustment model, the obesity-mediated effect of maternal race-ethnicity on the odds of myelomeningocele remained significant (non-Hispanic Black: adjusted odds ratio, 1.03; 95% confidence interval, 1.02-1.05; P<.001; non-Hispanic Asian: adjusted odds ratio, 1.02; 95% confidence interval, 1.01-1.03; P<.001; Hispanic: adjusted odds ratio, 1.5; 95% confidence interval, 1.03-1.6; P<.001). The test for trend among different racial/ethnic groups did not show significant results across the past 6 years. However, the test for trend showed a significant increase in the prevalence of isolated myelomeningocele associated with class II and III obesity over the past 6 years. CONCLUSION There has been a rising trend of fetal isolated myelomeningocele in pregnancies with maternal class II and III obesity over the past 6 years after adjusting for other covariates. Prepregnancy obesity, a modifiable risk factor, is a significant driver of racial/ethnic disparities in the overall risk for isolated fetal myelomeningocele.
Collapse
Affiliation(s)
- Hiba J. Mustafa
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN (Dr Mustafa)
- Fetal Center, Riley Children's Health, Indiana University Health, Indianapolis, IN (Dr Mustafa)
| | | | - Mohammad H. Heydari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran (Dr. Heydari)
| | - Ali Javinani
- Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA (Dr Javinani)
| | - Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN (Dr Bidulescu)
| | - Mounira Habli
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Habli)
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom (Dr. Khalil)
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom (Dr. Khalil)
| |
Collapse
|
4
|
Khalid SI, Thomson K, Hunter BM, Garcia RM, Bowman R, Lam S. The impact of voluntary folate fortification of corn masa flour on US pregnancies complicated by neural tube defects. Childs Nerv Syst 2023; 39:1813-1819. [PMID: 37099138 PMCID: PMC10132414 DOI: 10.1007/s00381-023-05945-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/27/2023]
Abstract
INTRODUCTION In 1996, the US Food and Drug Administration (FDA) mandated folic acid fortification for all enriched cereal grains. This resulted in a reduction of neural tube defect (NTD)-affected pregnancies. However, Hispanic women continued to be twice as likely to give birth to a child affected by NTD compared to non-Hispanic White women. Some hypotheses explaining this difference focus on cultural variation in dietary intake of cereal grains. In 2016, the FDA approved voluntary folic acid fortification for corn masa flour products to focus on the Hispanic diet staple. This study investigates rates of NTDs in predominantly Hispanic-populated zip codes before and after the voluntary fortification of corn masa flour with folic acid. METHODS Normal pregnancies and those complicated by NTDs between 1/1/2016 and 9/30/2020 were identified using ICD-9 and ICD-10 codes in an all-payor claims database. The post-fortification period began 12 months after the fortification recommendation. The US Census data was used to stratify pregnancies in predominantly Hispanic zip codes (≥ 75% of households) vs. non-Hispanic zip codes. The causal impact of the FDA's recommendation was assessed by means of a Bayesian structural time series model. RESULTS A total of 2,584,366 pregnancies were identified among females aged 15-50 years. Of these, 365,983 took place in predominantly Hispanic zip codes. Mean quarterly NTDs per 100,000 pregnancies did not significantly differ between predominantly Hispanic zip codes and predominantly non-Hispanic zip codes pre-FDA recommendation (184.5 vs. 175.6; p = 0.427), nor post-recommendation (188.2 vs. 185.9; p = 0.713). Rates of NTDs predicted to occur if no FDA recommendation had been made were compared to the actual rate post-recommendation: no significant difference was observed in predominantly Hispanic zip codes (p = 0.245) or overall (p = 0.116). CONCLUSIONS Rates of neural tube defects were not significantly reduced in predominantly Hispanic zip codes following the 2016 FDA approval of voluntary folic acid fortification of corn masa flour. Further research and implementation of comprehensive approaches to advocacy, policy, and public health are necessary to decrease preventable congenital disease rates. Mandatory rather than voluntary fortification of corn masa flour products may achieve more substantial prevention of neural tube defects in at-risk US populations.
Collapse
Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Kyle Thomson
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Brittany M Hunter
- Department of Pediatric Hospital Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Roxanna M Garcia
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robin Bowman
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sandi Lam
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| |
Collapse
|
5
|
Teachout E, Rosenthal J, Smith E, Gwao GO, Kawiche P, Assey V, Brooks-Church F, Wanlund A, Moore M, August M, Razzaghi H, Cannon M, Kishimba R, Williams J. Coverage, Apparent Consumption, and Monthly Use of Packaged Maize Flour in Morogoro Region, Tanzania. Food Nutr Bull 2023; 44:126-135. [PMID: 37016819 PMCID: PMC10634350 DOI: 10.1177/03795721231161395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
INTRODUCTION Tanzania aimed to reduce micronutrient deficiencies and neural tube defects by introducing mandatory fortification of large-scale packaged wheat and maize flour but not for small- and medium-scale mills. OBJECTIVES Ascertain the proportion of the population in Morogoro region, Tanzania, that consumes packaged maize flour from small-, medium- and large-mills; and understand the impact of monthly apparent purchase and consumption of packaged flour. METHODS In 2018, a regional, multistage cluster probability study was conducted among residents in Morogoro region living in households that reported consuming maize flour. Interviews collected information on sociodemographic factors and patterns of household flour consumption. Weighted medians estimated daily apparent flour consumption and the estimated average requirement (EAR), according to age. RESULTS Information was collected on 711 households. Packaged maize flour was purchased 10-12 months of the year by 22.9% of households, 6-9 months by 17.6% of households, 1-5 months by 25.1% of households, and 34.4% did not purchased maize flour. Median apparent daily consumption of maize flour was 209.7 g/d/adult male equivalent (AME). Apparent median daily consumption of maize flour was 230.1 g/d/AME in rural areas and 176.2 g/d/AME in urban areas; 228.7 g/d/AME among males and 196.4 g/d/AME among females. If all packaged maize flour were fortified according to standards, those consuming packaged maize flour 10-12 months of the year would apparently consume 199.9 µg folic acid/d representing 49.7% of daily EAR requirements. CONCLUSIONS Fortifying packaged maize flour at small-, medium- and large-mills is a promising strategy for increasing access to micronutrients, including folic acid.
Collapse
Affiliation(s)
- Emily Teachout
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jorge Rosenthal
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erin Smith
- Helen Keller International, Dar es Salaam, Tanzania
| | | | | | - Vincent Assey
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | | | - Anne Wanlund
- SANKU, Project Healthy Children, Dar es Salaam, Tanzania
| | - Meredith Moore
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary August
- Tanzania National Bureau of Statistics, Dodoma, Tanzania
| | - Hilda Razzaghi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Cannon
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jennifer Williams
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
6
|
Fothergill A, Crider KS, Rose CE, Bose B, Guetterman HM, Johnson CB, Jabbar S, Zhang M, Pfeiffer CM, Qi YP, Williams JL, Kuriyan R, Bonam W, Finkelstein JL. Estimating the serum folate concentration that corresponds to the red blood cell folate concentration threshold associated with optimal neural tube defects prevention: A population-based biomarker survey in Southern India. Am J Clin Nutr 2023; 117:985-997. [PMID: 37137617 PMCID: PMC10356561 DOI: 10.1016/j.ajcnut.2023.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/07/2023] [Accepted: 01/19/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND RBC folate concentrations are monitored at the population level, with a recommended threshold for optimal neural tube defect (NTD) prevention. A corresponding threshold for serum folate has not been established. OBJECTIVES This study aimed to estimate the serum folate insufficiency threshold corresponding to the RBC folate threshold for NTD prevention and examine how this threshold is modified by vitamin B12 status. METHODS Participants were women (15-40 y; not pregnant or lactating; n = 977) from a population-based biomarker survey in Southern India. RBC folate and serum folate were measured via microbiologic assay. RBC folate deficiency (<305 nmol/L) and insufficiency (<748 nmol/L), serum vitamin B12 deficiency (<148 pmol/L) and vitamin B12 insufficiency (<221 pmol/L), elevated plasma MMA (>0.26 μmol/L), elevated plasma homocysteine (>10.0 μmol/L), and elevated HbA1c (≥6.5%) were evaluated. Bayesian linear models were used to estimate unadjusted and adjusted thresholds. RESULTS Compared with adequate vitamin B12 status, the estimated serum folate threshold was higher in participants with serum vitamin B12 deficiency (72.5 vs. 28.1 nmol/L) or vitamin B12 insufficiency (48.7 vs. 24.3 nmol/L) and elevated MMA (55.6 vs. 25.9 nmol/L). The threshold was lower in participants with elevated HbA1c (HbA1c ≥6.5% vs. <6.5%; 21.0 vs. 40.5 nmol/L). CONCLUSIONS The estimated serum folate threshold for optimal NTD prevention was similar to previous reports (24.3 vs. 25.6 nmol/L) among participants with sufficient vitamin B12 status. However, this threshold was more than 2-fold higher in participants with vitamin B12 deficiency and substantially higher across all indicators of insufficient vitamin B12 status (<221 pmol/L, elevated MMA, combined B12, impaired vitamin B12 status), and lower in participants with elevated HbA1c. Findings suggest a serum folate threshold for NTD prevention may be possible in some settings; however, it may not be appropriate in populations with high prevalence of vitamin B12 insufficiency. Am J Clin Nutr 2023;xx:xx-xx. This trial was registered at https://clinicaltrials.gov as NCT04048330.
Collapse
Affiliation(s)
- Amy Fothergill
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA; National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Krista S Crider
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Charles E Rose
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Beena Bose
- Division of Nutrition, St. John's Research Institute, Bangalore, Karnataka, India
| | | | | | - Shameem Jabbar
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mindy Zhang
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine M Pfeiffer
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yan Ping Qi
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer L Williams
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca Kuriyan
- Division of Nutrition, St. John's Research Institute, Bangalore, Karnataka, India
| | - Wesley Bonam
- Arogyavaram Medical Centre, Andhra Pradesh, India
| | - Julia L Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA; Division of Nutrition, St. John's Research Institute, Bangalore, Karnataka, India; Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
| |
Collapse
|
7
|
Ismail S, Eljazzar S, Ganji V. Intended and Unintended Benefits of Folic Acid Fortification-A Narrative Review. Foods 2023; 12:foods12081612. [PMID: 37107407 PMCID: PMC10137700 DOI: 10.3390/foods12081612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
Inadequate folate intake during pregnancy is the leading cause of the development of neural tube defects (NTDs) in newborns. For this reason, mandatory fortification of folic acid, a synthetic, easily bioavailable form, in processed cereals and cereal products has been implemented in the US since 1 January 1998 to reduce the risk of NTD in newborn children. This report aimed to review the literature related to the impact of mandated folic acid fortification on the intended and unintended benefits to health. Potential adverse effects were also discussed. We searched Pubmed, Google Scholar, Embase, SCOPUS, and Cochrane databases for reports. About 60 reports published between January 1998 and December 2022 were reviewed, summarized, and served as background for this review. The intended benefit was decreased prevalence of NTDs, while unintended benefits were reduction in anemia, blood serum homocysteine, and the risk of developing cardiovascular diseases. Potential issues with folic acid fortification are the presence of unmetabolized folic acid in circulation, increased risk of cancer, and the masking of vitamin B-12 deficiency. From a health perspective, it is important to monitor the impact of folic acid fortification periodically.
Collapse
Affiliation(s)
- Shrooq Ismail
- Human Nutrition Department, College of Health Science, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Sereen Eljazzar
- Human Nutrition Department, College of Health Science, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Vijay Ganji
- Human Nutrition Department, College of Health Science, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| |
Collapse
|
8
|
Finkelstein JL, Guetterman HM, Fothergill A, Johnson CB, Qi YP, Jabbar S, Zhang M, Pfeiffer CM, Rose CE, Yeung LF, Williams JL, Krisher JT, Ruth C, Roy Choudhury D, Venkatramanan S, Haas JD, Kuriyan R, Mehta S, Bonam W, Crider KS. A Randomized Trial of Quadruple-Fortified Salt for Anemia and Birth Defects Prevention in Southern India: Protocol Design and Methods. Curr Dev Nutr 2023; 7:100052. [PMID: 37181934 PMCID: PMC10111605 DOI: 10.1016/j.cdnut.2023.100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/20/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
Background Women of reproductive age are at an increased risk of anemia and micronutrient deficiencies. Evidence supports the role of periconceptional nutrition in the development of neural tube defects (NTDs) and other pregnancy complications. Vitamin B12 deficiency is a risk factor for NTDs and may modify folate biomarkers that predict NTD risk at the population level. There is an interest in mandatory fortification with vitamin B12 and folic acid for anemia and birth defect prevention. However, there are limited population-representative data needed to inform policy and guidelines. Objectives This randomized trial will be conducted to evaluate the efficacy of quadruple-fortified salt (QFS; iron, iodine, folic acid, vitamin B12) in 1,000 households in Southern India. Methods Women 18 to 49 y who are not pregnant or lactating and reside within the catchment area of our community-based research site in Southern India will be screened and invited to participate in the trial. After informed consent, women and their households will be randomized to receive one of the following 4 interventions: 1) double-fortified salt (DFS; iron, iodine), 2) DFS + folic acid (iron, iodine, folic acid), 3) DFS + vitamin B12 (iron, iodine, vitamin B12), or 4) DFS + folic acid and vitamin B12 (QFS; iron, iodine, folic acid, vitamin B12) for 12 mo. Structured interviews will be conducted by trained nurse enumerators to collect sociodemographic, anthropometric, dietary, health, and reproductive history data. Biological samples will be collected at baseline, midpoint, and endpoint. Whole blood will be analyzed for hemoglobin using Coulter Counter. Total vitamin B12 will be measured by chemiluminescence; red blood cell folate and serum folate will be evaluated using the World Health Organization-recommended microbiologic assay. Conclusions The results of this randomized trial will help to evaluate the efficacy of QFS to prevent anemia and micronutrient deficiencies. Clinical trial registration numbers: NCT03853304 and Clinical Trial Registry of India REF/2019/03/024479. Registration number NCT03853304 and REF/2019/03/024479.
Collapse
Affiliation(s)
- Julia L. Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
- Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- St. John’s Research Institute, Bangalore, Karnataka, India
| | | | - Amy Fothergill
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
- The National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Yan Ping Qi
- The National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Shameem Jabbar
- The National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mindy Zhang
- The National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine M. Pfeiffer
- The National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Charles E. Rose
- The National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lorraine F. Yeung
- The National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jennifer L. Williams
- The National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jesse T. Krisher
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Caleb Ruth
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Dripta Roy Choudhury
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
- St. John’s Research Institute, Bangalore, Karnataka, India
| | | | - Jere D. Haas
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | | | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
- Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- St. John’s Research Institute, Bangalore, Karnataka, India
| | - Wesley Bonam
- Arogyavaram Medical Centre, Andhra Pradesh, India
| | - Krista S. Crider
- The National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| |
Collapse
|
9
|
Rodrigues VB, da Silva EN, dos Santos AM, Santos LMP. Prevented cases of neural tube defects and cost savings after folic acid fortification of flour in Brazil. PLoS One 2023; 18:e0281077. [PMID: 36812183 PMCID: PMC9946232 DOI: 10.1371/journal.pone.0281077] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/13/2023] [Indexed: 02/24/2023] Open
Abstract
Anencephaly, encephalocele, and spina bifida are congenital neural tube defects and are the main causes of neonatal morbidity and mortality and impose a heavy economic burden on health systems. This study to estimates the direct costs of neural tube defects from the perspective of the Brazilian Ministry of Health, and the prevented cases and cost savings during the period in which mandatory folic acid fortification was in effect in the country (2010-2019). It is a top-down cost-of-illness oriented study based on the prevalence of the disorders in Brazil. Data were collected from the Brazilian Ministry of Health's outpatient and hospital information system databases. The direct cost was estimated from the total patient-years, allocated by age and type of disorder. Prevented cases and cost savings were determined by the difference in the prevalence of the disorders in the pre- and post-fortification periods based on the total number of births and the sum of outpatient and hospital costs during the period. The total cost of outpatient and hospital services for these disorders totaled R$ 92,530,810.63 (Int$ 40,565,896.81) in 10 years; spina bifida accounted for 84.92% of the total cost. Hospital costs were expressive of all three disorders in the first year of the patient's life. Between 2010 and 2019, mandatory folic acid fortification prevented 3,499 live births with neural tube defects and resulted in R$ 20,381,586.40 (Int$ 8,935,373.25) in hospital and outpatient cost savings. Flour fortification has proved to be a valuable strategy in preventing pregnancies with neural tube defects. Since its implementation, there has been a 30% decrease in the prevalence of neural tube defects and a 22.81% decrease associated in hospital and outpatient costs.
Collapse
Affiliation(s)
- Viviane Belini Rodrigues
- Graduate Program in Collective Health, University of Brasília, Brasília, Federal District, Brazil
- * E-mail:
| | | | | | | |
Collapse
|
10
|
Caiaffa CD, Fonteles CSR, Yunping L, Finnell RH. Gene-environment interactions underlying the etiology of neural tube defects. Curr Top Dev Biol 2022; 152:193-220. [PMID: 36707212 DOI: 10.1016/bs.ctdb.2022.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Neural tube defects (NTDs) consist of severe structural malformations of the brain and spinal cord and are the second most common structural birth defect in humans, accounting for approximately 2700 affected pregnancies every year in the United States. These numbers are highly significant, considering that birth defects remain a leading cause of infant mortality in the United States, affecting approximately 120,000 babies born annually. Survivors of these congenital malformations face long-term disability and lifelong challenges imposed by severe physical burdens compromising the afflicted individual's overall quality of life. Clearly, birth defects, and especially NTDs remain a global public health challenge, and the source of significant financial repercussions for healthcare systems worldwide. In order to better understand the role gene-environment interactions play in the etiology of NTDs, this chapter provides an overview of NTD phenotypes and their embryonic origins, discusses the genetic landscape of NTDs as it is currently understood, with a focus on experimental models that best illustrate how environmental factors modulate individual susceptibility to these birth defects. As folic acid interventions have proven to be effective in reducing the prevalence of NTDs, the chapter ends with a discussion on the impact that maternal dietary status has on NTD prevalence from a population perspective.
Collapse
Affiliation(s)
- Carlo Donato Caiaffa
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
| | - Cristiane Sá Roriz Fonteles
- Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceara, Fortaleza, Brazil
| | - Lei Yunping
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
| | - Richard H Finnell
- Center for Precision Environmental Health, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States; Departments of Molecular and Cellular Biology, Molecular and Human Genetics, and Medicine, Baylor College of Medicine, Houston, TX, United States.
| |
Collapse
|
11
|
Antony AC, Vora RM, Karmarkar SJ. The silent tragic reality of Hidden Hunger, anaemia, and neural-tube defects (NTDs) in India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 6:100071. [PMID: 37383344 PMCID: PMC10305893 DOI: 10.1016/j.lansea.2022.100071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Hidden Hunger arising from nutritional iron-, folate-, and vitamin-B12-deficiencies is exceedingly common in India and has profound negative impacts on anaemia, on pregnancy, and on embryonic-foetal neurodevelopment in utero, which predisposes to NTDs and psychological-psychiatric manifestations in childhood. Whereas younger-to-middle-aged Indians fail to perform at maximum potential, the elderly are at risk for calamitous neurologic events. However, these micronutrient-deficiencies are eminently correctable through food-fortification. Therefore, the Indian Government can no longer afford the luxury of inaction by either denying or downplaying the gravity of this problem. What is critically needed from India's leaders is an urgent, clear-eyed reappraisal and act of anagnorisis-(an often startling self-recognition and discovery of a profoundly serious error and tragic flaw)-in failing to confront this problem for decades. Only when closely followed by a metanoia-(a transformative change of heart that triggers remedial action)-can they help India avoid a catastrophic tryst with destiny.
Collapse
Affiliation(s)
- Aśok C. Antony
- Division of Hematology-Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ravindra M. Vora
- Department of Paediatric Surgery, Paediatric Surgery Centre & Post-Graduate Institute, Implementing The Lancet Commission on Global Surgery in India, Sangli, Maharashtra, India
| | - Santosh J. Karmarkar
- Department of Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| |
Collapse
|
12
|
Martínez Traverso IM, Steimle JD, Zhao X, Wang J, Martin JF. LATS1/2 control TGFB-directed epithelial-to-mesenchymal transition in the murine dorsal cranial neuroepithelium through YAP regulation. Development 2022; 149:dev200860. [PMID: 36125128 PMCID: PMC9587805 DOI: 10.1242/dev.200860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/12/2022] [Indexed: 11/20/2022]
Abstract
Hippo signaling, an evolutionarily conserved kinase cascade involved in organ size control, plays key roles in various tissue developmental processes, but its role in craniofacial development remains poorly understood. Using the transgenic Wnt1-Cre2 driver, we inactivated the Hippo signaling components Lats1 and Lats2 in the cranial neuroepithelium of mouse embryos and found that the double conditional knockout (DCKO) of Lats1/2 resulted in neural tube and craniofacial defects. Lats1/2 DCKO mutant embryos had microcephaly with delayed and defective neural tube closure. Furthermore, neuroepithelial cell shape and architecture were disrupted within the cranial neural tube in Lats1/2 DCKO mutants. RNA sequencing of embryonic neural tubes revealed increased TGFB signaling in Lats1/2 DCKO mutants. Moreover, markers of epithelial-to-mesenchymal transition (EMT) were upregulated in the cranial neural tube. Inactivation of Hippo signaling downstream effectors, Yap and Taz, suppressed neuroepithelial defects, aberrant EMT and TGFB upregulation in Lats1/2 DCKO embryos, indicating that LATS1/2 function via YAP and TAZ. Our findings reveal important roles for Hippo signaling in modulating TGFB signaling during neural crest EMT.
Collapse
Affiliation(s)
- Idaliz M. Martínez Traverso
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, USA
- Interdepartmental Graduate Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jeffrey D. Steimle
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Xiaolei Zhao
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Jun Wang
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center and The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - James F. Martin
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, USA
- Interdepartmental Graduate Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Cardiomyocyte Renewal Laboratory, Texas Heart Institute, Houston, TX 77030, USA
- Center for Organ Repair and Renewal, Baylor College of Medicine, Houston, TX 77030 , USA
| |
Collapse
|
13
|
Engelhardt DM, Martyr CA, Niswander L. Pathogenesis of neural tube defects: The regulation and disruption of cellular processes underlying neural tube closure. WIREs Mech Dis 2022; 14:e1559. [PMID: 35504597 PMCID: PMC9605354 DOI: 10.1002/wsbm.1559] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/08/2022]
Abstract
Neural tube closure (NTC) is crucial for proper development of the brain and spinal cord and requires precise morphogenesis from a sheet of cells to an intact three-dimensional structure. NTC is dependent on successful regulation of hundreds of genes, a myriad of signaling pathways, concentration gradients, and is influenced by epigenetic and environmental cues. Failure of NTC is termed a neural tube defect (NTD) and is a leading class of congenital defects in the United States and worldwide. Though NTDs are all defined as incomplete closure of the neural tube, the pathogenesis of an NTD determines the type, severity, positioning, and accompanying phenotypes. In this review, we survey pathogenesis of NTDs relating to disruption of cellular processes arising from genetic mutations, altered epigenetic regulation, and environmental influences by micronutrients and maternal condition. This article is categorized under: Congenital Diseases > Genetics/Genomics/Epigenetics Neurological Diseases > Genetics/Genomics/Epigenetics Neurological Diseases > Stem Cells and Development.
Collapse
Affiliation(s)
- David M Engelhardt
- Molecular Cellular Developmental Biology, University of Colorado, Boulder, Colorado, USA
| | - Cara A Martyr
- Molecular Cellular Developmental Biology, University of Colorado, Boulder, Colorado, USA
| | - Lee Niswander
- Molecular Cellular Developmental Biology, University of Colorado, Boulder, Colorado, USA
| |
Collapse
|
14
|
Crider KS, Qi YP, Yeung LF, Mai CT, Head Zauche L, Wang A, Daniels K, Williams JL. Folic Acid and the Prevention of Birth Defects: 30 Years of Opportunity and Controversies. Annu Rev Nutr 2022; 42:423-452. [PMID: 35995050 PMCID: PMC9875360 DOI: 10.1146/annurev-nutr-043020-091647] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
For three decades, the US Public Health Service has recommended that all persons capable of becoming pregnant consume 400 μg/day of folic acid (FA) to prevent neural tube defects (NTDs). The neural tube forms by 28 days after conception. Fortification can be an effective NTD prevention strategy in populations with limited access to folic acid foods and/or supplements. This review describes the status of mandatory FA fortification among countries that fortify (n = 71) and the research describing the impact of those programs on NTD rates (up to 78% reduction), blood folate concentrations [red blood cell folate concentrations increased ∼1.47-fold (95% CI, 1.27, 1.70) following fortification], and other health outcomes. Across settings, high-quality studies such as those with randomized exposures (e.g., randomized controlled trials, Mendelian randomization studies) are needed to elucidate interactions of FA with vitamin B12 as well as expanded biomarker testing.
Collapse
Affiliation(s)
- Krista S Crider
- Neural Tube Defects Surveillance and Prevention Team, Infant Outcomes Monitoring, Research, and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;
| | - Yan Ping Qi
- Neural Tube Defects Surveillance and Prevention Team, Infant Outcomes Monitoring, Research, and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;
| | - Lorraine F Yeung
- Neural Tube Defects Surveillance and Prevention Team, Infant Outcomes Monitoring, Research, and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;
| | - Cara T Mai
- Neural Tube Defects Surveillance and Prevention Team, Infant Outcomes Monitoring, Research, and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;
| | - Lauren Head Zauche
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Arick Wang
- Neural Tube Defects Surveillance and Prevention Team, Infant Outcomes Monitoring, Research, and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;
| | | | - Jennifer L Williams
- Neural Tube Defects Surveillance and Prevention Team, Infant Outcomes Monitoring, Research, and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;
| |
Collapse
|
15
|
Aksenov LI, Fairchild RJ, Hobbs KT, Tejwani R, Wiener JS, Routh JC. Financial toxicity among individuals with spina bifida and their families: A qualitative study and conceptual model. J Pediatr Urol 2022; 18:290.e1-290.e8. [PMID: 35410804 DOI: 10.1016/j.jpurol.2022.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Spina bifida is the most common permanently disabling birth defect in the United States and requires lifelong, multi-specialty care. The cost of such care has the potential to result in financial toxicity - the 'objective financial burden' and 'subjective financial distress' which can negatively impact clinical outcomes. While this concept has been extensively studied in other areas of medicine, particularly oncology, financial toxicity has not yet been examined in pediatric urology or in individuals with spina bifida and their families/caregivers. OBJECTIVE To qualitatively explore the presence of financial toxicity in individuals with spina bifida and their caregivers with the objective of identifying themes and creating a conceptual model. MATERIALS AND METHODS We conducted semi-structured interviews with individuals with spina bifida and/or their caregivers with the aim of eliciting information regarding financial distress associated with spina bifida care. Interviews were transcribed and qualitative thematic analysis was performed to identify recurring themes. These insights were used to create a conceptual model of financial toxicity among individuals with spina bifida. RESULTS A total of 14 interviews were conducted (total of 6 patients and 13 parents/caregivers). Average patient age was 17.9 years. Five dominant themes were identified: 1) resources (insurance type, community support, etc.), 2) direct costs (copays, deductibles, travel expenses, etc.), 3) indirect costs (lost work time, hindered career advancement, resource navigation burden, etc.), 4) coping (work adjustments, decreased spending, etc.), and 5) affect (lack of control, uncertainty, worry, etc.). These insights were used to create a conceptual model. DISCUSSION This is the first study to explore financial toxicity in spina bifida and establish a conceptual model. Our findings are corroborated by prior spina bifida literature and are closely mirrored by studies in cancer patients. Given that financial toxicity is associated with negative outcomes in other medical domains, the impact of financial toxicity on health outcomes among individuals with spina bifida warrants further study, particularly in instrument development to better understand and quantify financial toxicity in this group. CONCLUSION Financial toxicity is a concern among individuals with spina bifida and their caregivers. This concept will need to be investigated further in order to develop validated measurement tools, identify solutions, and provide optimal care; our conceptual model will help guide these future investigations.
Collapse
Affiliation(s)
- Leonid I Aksenov
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Rebecca J Fairchild
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Kevin T Hobbs
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Rohit Tejwani
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - John S Wiener
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Jonathan C Routh
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
| |
Collapse
|
16
|
Ssentongo P, Heilbrunn ES, Ssentongo AE, Ssenyonga LVN, Lekoubou A. Birth prevalence of neural tube defects in eastern Africa: a systematic review and meta-analysis. BMC Neurol 2022; 22:202. [PMID: 35650541 PMCID: PMC9158202 DOI: 10.1186/s12883-022-02697-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neural tube defects (NTDs) are associated with high rates of neonatal mortality and morbidity worldwide. The promotion of folic acid fortification and supplementation in pregnant women by the Food and Drug Administration significantly decreased the incidence of NTDs in the United States. This practice is not widely adopted in Eastern Africa countries. We hypothesized that these countries experience a higher burden of NTDs than countries that promote the use of folic acid. We aimed to estimate the birth prevalence of NTDs in the United Nations (UN) Eastern African region. METHODS PubMed (Medline), Embase, and Cochrane Library databases were systematically searched from inception to December 17, 2021. We included randomized controlled trials or observational studies that reported the prevalence estimates of NTDs in Eastern Africa. Random effects model was used to pool the effect estimates. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to assess the certainty of the evidence. Outcome measures were overall and specific (spina bifida, anencephaly, encephalocele) rates of NTDs per 10,000 births, including live and stillborn cases. RESULTS The meta-analysis included 20 studies consisting of 752,936 individuals. The pooled prevalence of all NTDs per 10,000 births in Eastern Africa was 33.30 (95% CI: 21.58 to 51.34). Between-study heterogeneity was high (I2 = 97%, p < 0.0001), The rate was highest in Ethiopia (60 per 10,000). Birth prevalence of spina bifida (20 per 10,000) was higher than anencephaly (9 per 10,000) and encephalocele (2.33 per 10,000). No studies on NTDs were identified in 70% of the UN Eastern Africa region. Birth prevalence increased by 4% per year from 1983 to 2018. The level of evidence as qualified with GRADE was moderate. CONCLUSION The birth prevalence of NTDs in the United Nations region of Eastern Africa is 5 times as high as observed in Western countries with mandatory folic acid supplementation in place. Therefore, mandatory folic acid supplementation of stable foods may decrease the risk of NTDs in Eastern Africa.
Collapse
Affiliation(s)
- Paddy Ssentongo
- Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA.
- Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, State College, PA, USA.
- Department of Medicine, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, USA.
| | - Emily S Heilbrunn
- Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Anna E Ssentongo
- Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Lydia V N Ssenyonga
- Department of Nursing, Faculty of Health Sciences, Busitema University, TORORO, Uganda
| | - Alain Lekoubou
- Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Neurology, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
17
|
Krueger H, Robinson S, Hancock T, Birtwhistle R, Buxton JA, Henry B, Scarr J, Spinelli JJ. Priorities among effective clinical preventive services in British Columbia, Canada. BMC Health Serv Res 2022; 22:564. [PMID: 35473549 PMCID: PMC9044882 DOI: 10.1186/s12913-022-07871-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the long-standing experience of rating the evidence for clinical preventive services, the delivery of effective clinical preventive services in Canada and elsewhere is less than optimal. We outline an approach used in British Columbia to assist in determining which effective clinical preventive services are worth doing. METHODS We calculated the clinically preventable burden and cost-effectiveness for 28 clinical preventive services that received a 'strong or conditional (weak) recommendation for' by the Canadian Task Force on Preventive Health Care or an 'A' or 'B' rating by the United States Preventive Services Task Force. Clinically preventable burden is the total quality adjusted life years that could be gained if the clinical preventive services were delivered at recommended intervals to a British Columbia birth cohort of 40,000 individuals over the years of life that the service is recommended. Cost-effectiveness is the net cost per quality adjusted life year gained. RESULTS Clinical preventive services with the highest population impact and best value for money include services that address tobacco use in adolescents and adults, exclusive breastfeeding, and screening for hypertension and other cardiovascular disease risk factors followed by appropriate pharmaceutical treatment. In addition, alcohol misuse screening and brief counseling, one-time screening for hepatitis C virus infection in British Columbia adults born between 1945 and 1965, and screening for type 2 diabetes approach these high-value clinical preventive services. CONCLUSIONS These results enable policy makers to say with some confidence what preventive manoeuvres are worth doing but further work is required to determine the best way to deliver these services to all those eligible and to establish what supportive services are required. After all, if a clinical preventive service is worth doing, it is worth doing well.
Collapse
Affiliation(s)
- Hans Krueger
- H. Krueger & Associates Inc., Delta, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | | | - Trevor Hancock
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Richard Birtwhistle
- Department of Family Medicine and Public Health Sciences, Queen's University, Kingston, Canada
- Canadian Task Force on Preventive Health Care, Ottawa, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- BC Center for Disease Control, Vancouver, Canada
| | - Bonnie Henry
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- BC Ministry of Health, Victoria, Canada
| | - Jennifer Scarr
- Child Health BC, Provincial Health Services Authority, Vancouver, Canada
| | - John J Spinelli
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| |
Collapse
|
18
|
Pardo R, Vilca M, Villarroel L, Davalji T, Obrycki JF, Mazumdar M, Avila C, Mellado C. Neural tube defect prevalence does not increase after modification of the folic acid fortification program in Chile. Birth Defects Res 2022; 114:259-266. [PMID: 35218603 DOI: 10.1002/bdr2.1994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND In 2000, Chile's Ministry of Health mandated fortification of wheat flour with folic acid at a concentration of 2.2 mg/kg to prevent neural tube defects (NTDs), resulting in a 50% reduction in NTD prevalence. Concerns about possible collateral effects of high folic acid intake led, in 2009, to decrease the folic acid fortification to 1.8 mg/kg of flour. Our study evaluated the impact of this modification on the prevalence of NTDs in Santiago. METHODS This study measured the prevalence of NTDs in live births and stillbirths born in Santiago. We calculated prevalence ratios (PR) and 95% confidence intervals (CI) between pre-folic acid fortification (1999-2000), post-folic acid fortification (2001-2009), and post-modified folic acid fortification (2010-2015) periods for all NTDs and their specific types. We used chi-square tests to analyze proportions, and a Joinpoint regression to visualize prevalence time trends. RESULTS The NTD prevalence for the period 2001-2015 was 8.9 per 10,000 births, which represents a 48% reduction (PR = 0.52; 95% CI = 0.45-0.61; p < .001) from the pre-folic acid fortification period. During 2010-2015, the NTD prevalence was 9.5/10,000 births, which was higher, but not statistically significantly different from 2001 to 2009 prevalence of 8.6/10,000 (PR = 1.11; 95% CI = 0.96-1.30, p = .17). CONCLUSIONS Decreasing the concentration of folic acid fortification was not associated with a statistically significant change in the prevalence of NTDs. Mandatory folic acid fortification continues to be a safe and highly effective policy to prevent NTDs. Future studies should evaluate the prevalence of NTDs across Chile and adherence to folic acid fortification mandates.
Collapse
Affiliation(s)
- Rosa Pardo
- Genetics Unit, Pediatrics Service, Complejo Asistencial Dr. Sótero del Río, Puente Alto, Chile.,Genetics Section, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile.,Neonatology Unit, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Marcela Vilca
- Neonatology Unit, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Luis Villarroel
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tahera Davalji
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - John F Obrycki
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maitreyi Mazumdar
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Claudia Avila
- Neonatology Unit, Complejo Hospitalario San José, Santiago, Chile
| | - Cecilia Mellado
- Genetics Unit, Pediatrics Service, Complejo Asistencial Dr. Sótero del Río, Puente Alto, Chile.,Genetics Unit, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
19
|
Vora R, Antony A. The unresolved tragedy of neural-tube defects in India: The case for folate- and vitamin-B12-Fortified Tea for Prevention. J Indian Assoc Pediatr Surg 2022; 27:1-8. [PMID: 35261507 PMCID: PMC8853602 DOI: 10.4103/jiaps.jiaps_211_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 12/04/2022] Open
|
20
|
Srinivasan B, Finkelstein JL, Erickson D, Mehta S. Point-of-Care Quantification of Serum Alpha-Fetoprotein for Screening Birth Defects in Resource-Limited Settings: Proof-of-Concept Study. JMIR BIOMEDICAL ENGINEERING 2021; 6. [PMID: 34746648 PMCID: PMC8570531 DOI: 10.2196/23527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Maternal serum alpha-fetoprotein (MSAFP) concentration typically increases during pregnancy and is routinely measured during the second trimester as a part of screening for fetal neural tube defects and Down syndrome. However, most pregnancy screening tests are not available in the settings they are needed the most. A mobile device–enabled technology based on MSAFP for screening birth defects could enable the rapid screening and triage of high-risk pregnancies, especially where maternal serum screening and fetal ultrasound scan facilities are not easily accessible. Shifting the approach from clinic- and laboratory-dependent care to a mobile platform based on our point-of-care approach will enable translation to resource-limited settings and the global health care market. Objective: The objective of this study is to develop and perform proof-of-concept testing of a lateral flow immunoassay on a mobile platform for rapid, point-of-care quantification of serum alpha-fetoprotein (AFP) levels, from a drop of human serum, within a few minutes. Methods: The development of the immunoassay involved the selection of commercially available antibodies and optimization of their concentrations by an iterative method to achieve the required detection limits. We compared the performance of our method with that of commercially obtained human serum samples, with known AFP concentrations quantified by the Abbott ARCHITECT chemiluminescent magnetic microparticle immunoassay (CMIA). Results: We tested commercially obtained serum samples (N=20) with concentrations ranging from 2.2 to 446 ng/mL to compare the results of our point-of-care assay with results from the Abbott ARCHITECT CMIA. A correlation of 0.98 (P<.001) was observed on preliminary testing and comparison with the CMIA. The detection range of our point-of-care assay covers the range of maternal serum AFP levels observed during pregnancy. Conclusions: The preliminary test results from the AFP test on the mobile platform performed in this study represent a proof of concept that will pave the way for our future work focused on developing a mobile device–enabled quad-screen point-of-care testing with the potential to enable the screening of high-risk pregnancies in various settings. The AFP test on the mobile platform can be applied to enable screening for high-risk pregnancies, within a few minutes, at the point of care even in remote areas where maternal serum tests and fetal ultrasound scans are not easily accessible; assessment of whether clinical follow-up and diagnostic testing may be needed after a positive initial screening evaluation; and development of surveillance tools for birth defects.
Collapse
Affiliation(s)
- Balaji Srinivasan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Julia L Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - David Erickson
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, United States
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| |
Collapse
|
21
|
Rodrigues VB, da Silva EN, Santos MLP. Cost-effectiveness of mandatory folic acid fortification of flours in prevention of neural tube defects: A systematic review. PLoS One 2021; 16:e0258488. [PMID: 34673787 PMCID: PMC8530293 DOI: 10.1371/journal.pone.0258488] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/28/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Neural tube defects (NTDs) constitute the most frequent group among congenital malformations and are the main cause of neonatal morbimortality. Folic acid (FA) can reduce the risk of pregnancies affected by NTDs. OBJECTIVE We aimed to investigate whether mandatory folic acid (FA) fortification of flours is cost-effective as compared to non-mandatory fortification, and to verify whether FA dosage, cost composition, and the quality of economic studies influence the cost-effectiveness of outcomes. METHODS We conducted a systematic review. The protocol was registered on PROSPERO (CRD 42018115682). A search was conducted using the electronic databases MEDLINE/PubMed, Web of Science, Embase, Scopus, and EBSCO/CINAHL between January 2019 and October 2020 and updated in February 2021. Eligible studies comprised original economic analyses of mandatory FA fortification of wheat and corn flours (maize flours) compared to strategies of non-mandatory fortification in flours and/or use of FA supplements for NTD prevention. The Drummond verification list was used for quality analysis. RESULTS A total of 7,859 studies were identified, of which 13 were selected. Most (77%; n = 10) studies originated from high-income countries, while three (23%) were from upper-middle-income countries. Results of a cost-effectiveness analysis showed that fortification is cost-effective for NTD prevention, except for in one study in New Zealand. The cost-benefit analysis yielded a median ratio of 17.5:1 (0.98:1 to 417.1:1), meaning that for each monetary unit spent in the program, there would be a return of 17.5 monetary units. Even in the most unfavorable case of mandatory fortification, the investment in the program would virtually payoff at a ratio of 1:0.98. All FA dosages were cost-effective and offered positive health gains, except in one study. The outcomes of two studies showed that FA dosages above 300 μg/100 g have a higher CBA ratio. The studies with the inclusion of "loss of consumer choice" in the analysis may alter the fortification cost-efficacy ratio. CONCLUSION We expect the findings to be useful for public agencies in different countries in decision-making on the implementation and/or continuity of FA fortification as a public policy in NTD prevention.
Collapse
Affiliation(s)
| | - Everton Nunes da Silva
- Graduate Program Collective Health, University of Brasilia, Brasilia, District federal, Brazil
| | | |
Collapse
|
22
|
Bae S, Kamynina E, Guetterman HM, Farinola AF, Caudill MA, Berry RJ, Cassano PA, Stover PJ. Provision of folic acid for reducing arsenic toxicity in arsenic-exposed children and adults. Cochrane Database Syst Rev 2021; 10:CD012649. [PMID: 34661903 PMCID: PMC8522704 DOI: 10.1002/14651858.cd012649.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Arsenic is a common environmental toxin. Exposure to arsenic (particularly its inorganic form) through contaminated food and drinking water is an important public health burden worldwide, and is associated with increased risk of neurotoxicity, congenital anomalies, cancer, and adverse neurodevelopment in children. Arsenic is excreted following methylation reactions, which are mediated by folate. Provision of folate through folic acid supplements could facilitate arsenic methylation and excretion, thereby reducing arsenic toxicity. OBJECTIVES To assess the effects of provision of folic acid (through fortified foods or supplements), alone or in combination with other nutrients, in lessening the burden of arsenic-related health outcomes and reducing arsenic toxicity in arsenic-exposed populations. SEARCH METHODS In September 2020, we searched CENTRAL, MEDLINE, Embase, 10 other international databases, nine regional databases, and two trials registers. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs comparing the provision of folic acid (at any dose or duration), alone or in combination with other nutrients or nutrient supplements, with no intervention, placebo, unfortified food, or the same nutrient or supplements without folic acid, in arsenic-exposed populations of all ages and genders. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included two RCTs with 822 adults exposed to arsenic-contaminated drinking water in Bangladesh. The RCTs compared 400 µg/d (FA400) or 800 µg/d (FA800) folic acid supplements, given for 12 or 24 weeks, with placebo. One RCT, a multi-armed trial, compared FA400 plus creatine (3 g/d) to creatine alone. We judged both RCTs at low risk of bias in all domains. Due to differences in co-intervention, arsenic exposure, and participants' nutritional status, we could not conduct meta-analyses, and therefore, provide a narrative description of the data. Neither RCT reported on cancer, all-cause mortality, neurocognitive function, or congenital anomalies. Folic acid supplements alone versus placebo Blood arsenic. In arsenic-exposed individuals, FA likely reduces blood arsenic concentrations compared to placebo (2 studies, 536 participants; moderate-certainty evidence). For folate-deficient and folate-replete participants who received arsenic-removal water filters as a co-intervention, FA800 reduced blood arsenic levels more than placebo (percentage change (%change) in geometric mean (GM) FA800 -17.8%, 95% confidence intervals (CI) -25.0 to -9.8; placebo GM -9.5%, 95% CI -16.5 to -1.8; 1 study, 406 participants). In one study with 130 participants with low baseline plasma folate, FA400 reduced total blood arsenic (%change FA400 mean (M) -13.62%, standard error (SE) ± 2.87; placebo M -2.49%, SE ± 3.25), and monomethylarsonic acid (MMA) concentrations (%change FA400 M -22.24%, SE ± 2.86; placebo M -1.24%, SE ± 3.59) more than placebo. Inorganic arsenic (InAs) concentrations reduced in both groups (%change FA400 M -18.54%, SE ± 3.60; placebo M -10.61%, SE ± 3.38). There was little to no change in dimethylarsinic acid (DMA) in either group. Urinary arsenic. In arsenic-exposed individuals, FA likely reduces the proportion of total urinary arsenic excreted as InAs (%InAs) and MMA (%MMA) and increases the proportion excreted as DMA (%DMA) to a greater extent than placebo (2 studies, 546 participants; moderate-certainty evidence), suggesting that FA enhances arsenic methylation. In a mixed folate-deficient and folate-replete population (1 study, 352 participants) receiving arsenic-removal water filters as a co-intervention, groups receiving FA had a greater decrease in %InAs (within-person change FA400 M -0.09%, 95% CI -0.17 to -0.01; FA800 M -0.14%, 95% CI -0.21 to -0.06; placebo M 0.05%, 95% CI 0.00 to 0.10), a greater decrease in %MMA (within-person change FA400 M -1.80%, 95% CI -2.53 to -1.07; FA800 M -2.60%, 95% CI -3.35 to -1.85; placebo M 0.15%, 95% CI -0.37 to 0.68), and a greater increase in %DMA (within-person change FA400 M 3.25%, 95% CI 1.81 to 4.68; FA800 M 4.57%, 95% CI 3.20 to 5.95; placebo M -1.17%, 95% CI -2.18 to -0.17), compared to placebo. In 194 participants with low baseline plasma folate, FA reduced %InAs (%change FA400 M -0.31%, SE ± 0.04; placebo M -0.13%, SE ± 0.04) and %MMA (%change FA400 M -2.6%, SE ± 0.37; placebo M -0.71%, SE ± 0.43), and increased %DMA (%change FA400 M 5.9%, SE ± 0.82; placebo M 2.14%, SE ± 0.71), more than placebo. Plasma homocysteine: In arsenic-exposed individuals, FA400 likely reduces homocysteine concentrations to a greater extent than placebo (2 studies, 448 participants; moderate-certainty evidence), in the mixed folate-deficient and folate-replete population receiving arsenic-removal water filters as a co-intervention (%change in GM FA400 -23.4%, 95% CI -27.1 to -19.5; placebo -1.3%, 95% CI -5.3 to 3.1; 1 study, 254 participants), and participants with low baseline plasma folate (within-person change FA400 M -3.06 µmol/L, SE ± 3.51; placebo M -0.05 µmol/L, SE ± 4.31; 1 study, 194 participants). FA supplements plus other nutrient supplements versus nutrient supplements alone In arsenic-exposed individuals who received arsenic-removal water filters as a co-intervention, FA400 plus creatine may reduce blood arsenic concentrations more than creatine alone (%change in GM FA400 + creatine -14%, 95% CI -22.2 to -5.0; creatine -7.0%, 95% CI -14.8 to 1.5; 1 study, 204 participants; low-certainty evidence); may not change urinary arsenic methylation indices (FA400 + creatine: %InAs M 13.2%, SE ± 7.0; %MMA M 10.8, SE ± 4.1; %DMA M 76, SE ± 7.8; creatine: %InAs M 14.8, SE ± 5.5; %MMA M 12.8, SE ± 4.0; %DMA M 72.4, SE ±7.6; 1 study, 190 participants; low-certainty evidence); and may reduce homocysteine concentrations to a greater extent (%change in GM FA400 + creatinine -21%, 95% CI -25.2 to -16.4; creatine -4.3%, 95% CI -9.0 to 0.7; 1 study, 204 participants; low-certainty evidence) than creatine alone. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that FA supplements may benefit blood arsenic concentration, urinary arsenic methylation profiles, and plasma homocysteine concentration versus placebo. There is low-certainty evidence that FA supplements plus other nutrients may benefit blood arsenic and plasma homocysteine concentrations versus nutrients alone. No studies reported on cancer, all-cause mortality, neurocognitive function, or congenital anomalies. Given the limited number of RCTs, more studies conducted in diverse settings are needed to assess the effects of FA on arsenic-related health outcomes and arsenic toxicity in arsenic-exposed adults and children.
Collapse
Affiliation(s)
- Sajin Bae
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Elena Kamynina
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | | | - Adetutu F Farinola
- Faculty of Public Health, Department of Human Nutrition and Dietetics, University of Ibadan, Ibadan, Nigeria
| | - Marie A Caudill
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Robert J Berry
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | |
Collapse
|
23
|
Teshome F, Kebede Y, Girma K, Birhanu Z. A survey on women's awareness of iron and folic acid intake during preconception period and its associated factors in Manna District, Oromia region, Southwest Ethiopia. Nurs Open 2021; 9:950-958. [PMID: 34415662 PMCID: PMC8859085 DOI: 10.1002/nop2.1041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/06/2021] [Accepted: 08/04/2021] [Indexed: 11/07/2022] Open
Abstract
Aim This study aimed to assess pregnant women's awareness of iron and folic acid intake during the preconception period and associated factors. Design A cross‐sectional study. Methods This study was conducted on 636 pregnant women in Manna District, Oromia region, Southwest Ethiopia. Women's awareness of iron and folic acid intake during the preconception period was measured using a pre‐tested structured questionnaire. Descriptive, binary and multivariable logistic regression analyses were carried out. Results Of the total of 623 participants, 6.7% of them had an awareness of iron and folic acid intake during preconception period. Women's husband who had formal education, women who had ≥four ANC visits and women who were at distance of <30 min from the nearest health facility were significant predictors of pregnant women's awareness iron and folic acid intake during the preconception period. Conclusions Women's awareness of iron and folic acid intake during the preconception period was very low. Husband educational status, frequency of ANC visits and distance from health facility were predictors of women's awareness of iron and folic acid intake during the preconception period.
Collapse
Affiliation(s)
- Firanbon Teshome
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Yohannes Kebede
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Kasahun Girma
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
24
|
Papadakis JL, Holmbeck GN. Sociodemographic factors and health-related, neuropsychological, and psychosocial functioning in youth with spina bifida. Rehabil Psychol 2021; 66:286-299. [PMID: 34043409 PMCID: PMC8855727 DOI: 10.1037/rep0000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: Past research suggests that certain sociodemographic factors may put youth with spina bifida (SB) at risk for poor outcomes. The aims of this study were to examine (a) associations between ten sociodemographic factors and health-related, neuropsychological, and psychosocial functioning among youth with SB,(b) cumulative sociodemographic risk as a predictor of youth outcomes as moderated by age, and (c) SB-related family stress as a mediator of longitudinal associations between cumulative sociodemographic risk and youth outcomes. Method: Participants were youth with SB (N = 140 at Time 1; Mage at Time 1 = 11.43, 53.6% female) recruited as part of a larger, longitudinal study. The study included questionnaire (parent-, teacher-, and youth-report), neuropsychological testing, and medical chart data across three time points, spaced 2 years apart. Results: A subset of the sociodemographic factors and their cumulative risk were associated with study outcomes. Specifically, youth characterized by sociodemographic risk had greater pain and lower academic achievement, but also fewer urinary tract infections and fewer attention and executive function problems. Age did not moderate the association between cumulative risk and outcomes. Cumulative risk predicted lower SB-related family stress, which, in turn, predicted several outcomes. Conclusions: Examining a range of sociodemographic factors is warranted. Sociodemographic risk is linked to poorer outcomes for some risk indicators but similar or better outcomes for others. Results have implications for delivering evidence-based, diversity-sensitive clinical care to youth with SB. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Jaclyn Lennon Papadakis
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago
| | | |
Collapse
|
25
|
Simkulet W. Mitochondrial Replacement Techniques, the Non-Identity Problem, and Genetic Parenthood. Asian Bioeth Rev 2021; 13:317-334. [PMID: 34295386 DOI: 10.1007/s41649-021-00176-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022] Open
Abstract
Mitochondrial replacement techniques (MRTs) are designed to allow couples to have children without passing on mitochondrial diseases. Recently, Giulia Cavaliere and César Palacios-González argued that prospective parents have the right to use MRTs to pursue genetic relatedness, such that some same-sex couples and/or polygamous triads could use the process to impart genetic relatedness between a child and more of its caregivers. Although MRTs carry medical risks, Cavaliere and Palacios-González contend that because MRTs are identity-affecting, they do not cause harm to an existing human being, and our intuitions otherwise arise from the non-identity problem. Here, I review several attempts to address the non-identity problem, and propose a solution to the problem. Furthermore, I argue that regardless of one's stance on whether MRTs are identity-affecting, the use of MRTs to pursue genetic relatedness alone falls outside the scope of the medical profession, as they involve substantive medical risk for no medical benefit.
Collapse
|
26
|
Sensory and Physicochemical Properties and Stability of Folic Acid in a Pineapple Ready-to-Serve Beverage Fortified with Encapsulated Folic Acid. J FOOD QUALITY 2021. [DOI: 10.1155/2021/9913884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fortification of food and beverages with folic acid is carried out frequently as a remedy to folic acid deficiency which causes serious health issues. This study was carried out to investigate the effect of incorporation of folic acid encapsulated alginate submicron particles in pineapple ready-to-serve (RTS) beverages. The encapsulation efficiency and loading capacity of the particles were 91.54 ± 0.45% and 1.02 ± 0.01%, respectively. The photostability and thermal stability studies of folic acid revealed that encapsulation poses a protective effect on folic acid and that dark and refrigerated conditions contribute to higher stability of folic acid. In this study, sensory evaluation of the RTS beverages was carried out through both ranking tests and acceptance tests using a five-point hedonic scale. The sensory panel showed the highest preference to pineapple RTS with incorporated encapsulated folic acid at a quantity of its recommended daily intake (400 µg/200 mL) before heat treatment. Shelf-life evaluations were carried out through measuring physicochemical properties, and pH, titratable acidity, and total soluble solids showed negligible or acceptable changes over two months. Folic acid degradation occurred due to heat treatment, but encapsulation in alginate submicron particles provided heat stability to folic acid. Thus, microencapsulated folic acid may be a successful carrier of folic acid which can be incorporated in beverages such as fortified pineapple RTS.
Collapse
|
27
|
Grosse SD, Kemper AR, Prosser LA. Data Needs for Economic Evaluations of Screening in Pediatric Primary Care: A Research Framework. Pediatrics 2021; 148:s45-s50. [PMID: 34210848 PMCID: PMC8312553 DOI: 10.1542/peds.2021-050693j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alex R. Kemper
- Division of Primary Care Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Lisa A. Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
28
|
Caceres A, Blount JP, Messing-Jünger M, Chatterjee S, Fieggen G, Salomao JF. The International Society for Pediatric Neurosurgery resolution on mandatory folic acid fortification of staple foods for prevention of spina bifida and anencephaly and associated disability and child mortality. Childs Nerv Syst 2021; 37:1809-1812. [PMID: 33942142 DOI: 10.1007/s00381-021-05191-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Adrian Caceres
- Department of Neurosurgery, Hospital Nacional de Ninos ¨Dr. Carlos Saenz Herrera¨, Paseo Colon y Calle 20 Sur, San Jose, 10103, Costa Rica.
| | - Jeffrey P Blount
- Department of Neurosurgery, Hospital Nacional de Ninos ¨Dr. Carlos Saenz Herrera¨, Paseo Colon y Calle 20 Sur, San Jose, 10103, Costa Rica
| | - Martina Messing-Jünger
- Department of Neurosurgery, Hospital Nacional de Ninos ¨Dr. Carlos Saenz Herrera¨, Paseo Colon y Calle 20 Sur, San Jose, 10103, Costa Rica
| | - Sandip Chatterjee
- Department of Neurosurgery, Hospital Nacional de Ninos ¨Dr. Carlos Saenz Herrera¨, Paseo Colon y Calle 20 Sur, San Jose, 10103, Costa Rica
| | - Graham Fieggen
- Department of Neurosurgery, Hospital Nacional de Ninos ¨Dr. Carlos Saenz Herrera¨, Paseo Colon y Calle 20 Sur, San Jose, 10103, Costa Rica
| | - Jose Francisco Salomao
- Department of Neurosurgery, Hospital Nacional de Ninos ¨Dr. Carlos Saenz Herrera¨, Paseo Colon y Calle 20 Sur, San Jose, 10103, Costa Rica
| |
Collapse
|
29
|
Lapehn S, Piorczynski TB, Hansen JM, Harris C. Spatiotemporal evaluation of the mouse embryonic redox environment and histiotrophic nutrition following treatment with valproic acid and 1,2-dithiole-3-thione during early organogenesis. Reprod Toxicol 2021; 101:81-92. [PMID: 33713778 PMCID: PMC8110175 DOI: 10.1016/j.reprotox.2021.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/27/2022]
Abstract
Redox regulation during metazoan development ensures that coordinated metabolic reprogramming and developmental signaling are orchestrated with high fidelity in the hypoxic embryonic environment. Valproic acid (VPA), an anti-seizure medication, is known to increase markers of oxidation and also increase the risk of neural tube defects (NTDs) when taken during pregnancy. It is unknown, however, whether oxidation plays a direct role in failed neural tube closure (NTC). Spatial and temporal fluctuations in total glutathione (GSH) and total cysteine (Cys) redox steady states were seen during a 24 h period of CD-1 mouse organogenesis in untreated conceptuses and following exposure to VPA and the Nrf2 antioxidant pathway inducer, 1,2-dithiole-3-thione (D3T). Glutathione, glutathione disulfide (GSSG), and Cys, cystine (CySS) concentrations, measured in conceptal tissues (embryo/visceral yolk sac) and fluids (yolk sac fluid/amniotic fluid) showed that VPA did not cause extensive and prolonged oxidation during the period of NTC, but instead produced transient periods of oxidation, as assessed by GSH:GSSG redox potentials, which revealed oxidation in all four conceptal compartments at 4, 10, and 14 h, corresponding to the period of heartbeat activation and NTC. Other changes were tissue and time specific. VPA treatment also reduced total FITC-Ab clearance from the medium over 3 h, indicating potential disruption of nutritive amino acid supply. Overall, these results indicated that VPA's ability to affect cellular redox status may be limited to tissue-specific windows of sensitivity during the period of NTC. The safety evaluation of drugs used during pregnancy should consider time and tissue specific redox factors.
Collapse
Affiliation(s)
- Samantha Lapehn
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, 48109, United States.
| | - Ted B Piorczynski
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, UT, 84602, United States
| | - Jason M Hansen
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, UT, 84602, United States
| | - Craig Harris
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, 48109, United States
| |
Collapse
|
30
|
Shlobin NA, LoPresti MA, Du RY, Lam S. Folate fortification and supplementation in prevention of folate-sensitive neural tube defects: a systematic review of policy. J Neurosurg Pediatr 2021; 27:294-310. [PMID: 33338998 DOI: 10.3171/2020.7.peds20442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neural tube defects (NTDs) are common congenital neurological defects, resulting in mortality, morbidity, and impaired quality of life for patients and caregivers. While public health interventions that increase folate consumption among women who are or plan to become pregnant are shown to reduce folate-sensitive NTDs, public health policy reflecting the scientific evidence lags behind. The authors aimed to identify the types of policies applied, associated outcomes, and impact of folate fortification and supplementation on NTDs worldwide. By identifying effective legislation, the authors aim to focus advocacy efforts to more broadly effect change, reducing the burden of NTDs in neurosurgery. METHODS A systematic review was conducted exploring folate fortification and supplementation policies using the PubMed and Scopus databases. Titles and abstracts from articles identified were read and selected for full-text review. Studies meeting inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes. RESULTS Of 1637 resultant articles, 54 were included. Mandatory folate fortification was effective at reducing folate-sensitive NTDs. Mandatory fortification also decreased hospitalization rates and deaths after discharge and increased 1st-year survival for infants with NTDs. Recommended folate supplementation also resulted in decreased NTDs; however, issues with compliance and adherence were a concern and impacted effectiveness. Folate fortification and/or supplementation resulted in decreased NTD prevalence, although more change was attributed to fortification. Dual policies may hold the most promise. Furthermore, reductions in NTDs were associated with significant cost savings over time. CONCLUSIONS Both mandatory folate fortification and recommended supplementation policies were found to effectively decrease folate-sensitive NTD rates when applied. A comprehensive approach incorporating mandatory folate fortification, appropriate folate supplementation, and improved infrastructure and access to prenatal care may lead to decreased NTDs worldwide. This approach should be context-specific, emphasize education, and account for regional access to healthcare and social determinants of health. With wide implications for NTDs, associated health outcomes, quality of life of patients and caregivers, and economic impacts, policy changes can drastically improve global NTD outcomes. As caretakers of children with NTDs, the authors as neurosurgeons advocate for a comprehensive policy, the engagement of stakeholders, and a broader global impact.
Collapse
Affiliation(s)
- Nathan A Shlobin
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; and
| | | | - Rebecca Y Du
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; and
| | - Sandi Lam
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; and
| |
Collapse
|
31
|
Kancherla V, Wagh K, Pachón H, Oakley GP. A 2019 global update on folic acid-preventable spina bifida and anencephaly. Birth Defects Res 2020; 113:77-89. [PMID: 33124747 DOI: 10.1002/bdr2.1835] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Mandatory folic acid fortification of staples is a proven intervention to prevent spina bifida and anencephaly, two life-threatening and disabling neural tube defects. We estimated the global proportion of folic acid-preventable spina bifida and anencephaly (FAP SBA) prevented through mandatory folic acid fortification of wheat and/or maize flour in 2019. METHODS Using data from the Global Fortification Data Exchange, we identified countries with mandatory fortification policies that required at least 1.0 ppm folic acid be added to wheat and/or maize flour and had information on percentage of industrially milled flour that is fortified. We built FAP SBA prevention models assuming mandatory folic acid fortification at 200 μg/day of folic acid fully protects against FAP SBA and would lower the prevalence neural tube defects to 0.5 per 1,000 live births. RESULTS In 2019, 56 countries met our criteria for mandatory folic acid fortification of wheat (n = 56 countries) and/or maize (n = 15 countries) flour and with complete data for our modeling. Overall, our prevention model estimated that 65,380 FAP SBA cases were prevented in 2019 through folic acid fortification of wheat and/or maize flour. We estimated the current global prevention proportion of all preventable FAP SBA cases worldwide to be at 23% of total possible prevention. CONCLUSION Global prevention efforts for FAP SBA are slow and have stalled. Mandatory fortification should be urgently implemented in all countries to prevent epidemics of FAP SBA, and to achieve health-related Sustainable Development Goals for year 2030 by reducing child mortality due to preventable FAP SBA.
Collapse
Affiliation(s)
- Vijaya Kancherla
- Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA
| | - Kaustubh Wagh
- Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA
| | - Helena Pachón
- Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA.,Food Fortification Initiative, Atlanta, Georgia, USA
| | - Godfrey P Oakley
- Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA
| |
Collapse
|
32
|
Prevention of Neural Tube Defects by Folic Acid Supplementation: A National Population-Based Study. Nutrients 2020; 12:nu12103170. [PMID: 33081287 PMCID: PMC7603060 DOI: 10.3390/nu12103170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022] Open
Abstract
Folic acid supplementation is recommended for neural tube defect prevention during pregnancy. We conducted an observational, retrospective national registry study to determine the rate of dispensing of periconceptional folic acid after prescription in a sample of French women representative of the general population. Our study population (n = 186,061) was a representative sample of the French population, recorded in the Health Data System database on pharmacy dispensing of medication and mandatory reporting of pregnancy. Between 2006 and 2016, 14.3% of pregnant women had a prescription for folic acid supplementation during the month preceding conception and for the first 12 weeks of pregnancy. Of these prescriptions, 30.9% were issued before the start of pregnancy. This percentage was lower for first pregnancies. The rate of pharmacy dispensing during the preconception period increased progressively from 3.8% to 8.3% between 2006 and 2016. In France, the rate of pharmacy dispensing of periconceptional folic acid after medical prescription is very low and does not follow international recommendations. It seems essential to implement awareness-raising policies targeting the general population and physicians regarding effective periconceptional supplementation, particularly starting in the preconception period. Clarification of international recommendations and fortification of flour could improve the efficacy of folate supplementation at population level.
Collapse
|
33
|
Kancherla V, Tsang B, Wagh K, Dixon M, Oakley GP. Modeling shows high potential of folic acid-fortified salt to accelerate global prevention of major neural tube defects. Birth Defects Res 2020; 112:1461-1474. [PMID: 32738033 DOI: 10.1002/bdr2.1769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/27/2020] [Accepted: 06/30/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND We estimated the global proportion of folic acid-preventable spina bifida and anencephaly (FAP SBA) potentially prevented through mandatory double fortification of iodized salt with folic acid. METHODS Using United Nations Children's Fund (UNICEF) and Global Fortification Data Exchange (GFDx) data sets, we modeled country-specific number of FAP SBA cases prevented annually using (a) current coverage of the salt in households worldwide and (b) expected daily amount of folic acid intake from folic acid-fortified iodized salt. Our evidence-based modeling strategy assumed mandatory folic acid fortification of salt at 20 ppm, and that at 200 μg/day intake of folic acid through fortified salt, should achieve 100% prevention of all FAP SBA in countries. RESULTS One hundred countries that have data on percent of households consuming iodized salt globally were examined; 55 of them have ≥80% households consuming iodized salt. Our model estimated approximately 180,000 cases of FAP SBA could be prevented in these 100 countries through folic acid-fortified iodized salt, and 150,000 of them would be in countries where ≥80% households consuming iodized salt that can be potentially fortified with folic acid. Salt fortification with folic acid could contribute to the prevention of about 65% global FAP SBA cases annually. CONCLUSIONS Our evidence-based model shows that there is high potential to prevent FAP SBA using folic acid-fortified iodized salt. Prevention will reach countries where there is a limited reach of centrally processed folic acid-fortified wheat or maize flour. If this intervention is made feasible by the salt industry, it can accelerate the prevention of FAP SBA significantly.
Collapse
Affiliation(s)
- Vijaya Kancherla
- Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Becky Tsang
- Food Fortification Initiative, Atlanta, Georgia, USA
| | - Kaustubh Wagh
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Meredith Dixon
- Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Godfrey P Oakley
- Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| |
Collapse
|
34
|
Wei X, Ma W, Gu H, Liu D, Luo W, Bai Y, Wang W, Lui VCH, Yang P, Yuan Z. Transamniotic mesenchymal stem cell therapy for neural tube defects preserves neural function through lesion-specific engraftment and regeneration. Cell Death Dis 2020; 11:523. [PMID: 32655141 PMCID: PMC7354991 DOI: 10.1038/s41419-020-2734-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022]
Abstract
Neural tube defects (NTDs) lead to prenatal mortality and lifelong morbidity. Currently, surgical closure of NTD lesions results in limited functional recovery. We previously suggested that nerve regeneration was critical for NTD therapy. Here, we report that transamniotic bone marrow-derived mesenchymal stem cell (BMSC) therapy for NTDs during early development may achieve beneficial functional recovery. In our ex vivo rat embryonic NTD model, BMSCs injected into the amniotic cavity spontaneously migrated into the defective neural tissue. Hepatocyte growth factor and its receptor c-MET were found to play critical roles in this NTD lesion-specific migration. Using the in vivo rat fetal NTD model, we further discovered that the engrafted BMSCs specifically differentiated into the cell types of the defective tissue, including skin and different types of neurons in situ. BMSC treatment triggered skin repair in fetuses, leading to a 29.9 ± 5.6% reduction in the skin lesion area. The electrophysiological functional recovery assay revealed a decreased latency and increased motor-evoked potential amplitude in the BMSC-treated fetuses. Based on these positive outcomes, ease of operation, and reduced trauma to the mother and fetus, we propose that transamniotic BMSC administration could be a new effective therapy for NTDs.
Collapse
Affiliation(s)
- Xiaowei Wei
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Wei Ma
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Hui Gu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Dan Liu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Wenting Luo
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yuzuo Bai
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, PR China
| | - Weilin Wang
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, PR China
| | - Vincent Chi Hang Lui
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Peixin Yang
- Departments of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Zhengwei Yuan
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China.
| |
Collapse
|
35
|
Vitamin B12 and folic acid alleviate symptoms of nutritional deficiency by antagonizing aryl hydrocarbon receptor. Proc Natl Acad Sci U S A 2020; 117:15837-15845. [PMID: 32571957 DOI: 10.1073/pnas.2006949117] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Despite broad appreciation of their clinical utility, it has been unclear how vitamin B12 and folic acid (FA) function at the molecular level to directly prevent their hallmark symptoms of deficiency like anemia or birth defects. To this point, B12 and FA have largely been studied as cofactors for enzymes in the one-carbon (1C) cycle in facilitating the de novo generation of nucleotides and methylation of DNA and protein. Here, we report that B12 and FA function as natural antagonists of aryl hydrocarbon receptor (AhR). Our studies indicate that B12 and FA bind AhR directly as competitive antagonists, blocking AhR nuclear localization, XRE binding, and target gene induction mediated by AhR agonists like 2,3,7,8-tetrachlorodibenzodioxin (TCDD) and 6-formylindolo[3,2-b]carbazole (FICZ). In mice, TCDD treatment replicated many of the hallmark symptoms of B12/FA deficiency and cotreatment with aryl hydrocarbon portions of B12/FA rescued mice from these toxic effects. Moreover, we found that B12/FA deficiency in mice induces AhR transcriptional activity and accumulation of erythroid progenitors and that it may do so in an AhR-dependent fashion. Consistent with these results, we observed that human cancer samples with deficient B12/FA uptake demonstrated higher transcription of AhR target genes and lower transcription of pathways implicated in birth defects. In contrast, there was no significant difference observed between samples with mutated and intact 1C cycle proteins. Thus, we propose a model in which B12 and FA blunt the effect of natural AhR agonists at baseline to prevent the symptoms that arise with AhR overactivation.
Collapse
|
36
|
Wegner C, Kancherla V, Lux A, Köhn A, Bretschneider D, Freese K, Heiduk M, Redlich A, Schleef D, Jorch G, Rissmann A. Periconceptional folic acid supplement use among women of reproductive age and its determinants in central rural Germany: Results from a cross sectional study. Birth Defects Res 2020; 112:1057-1066. [PMID: 32445297 DOI: 10.1002/bdr2.1714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Prevalence of neural tube defects (NTD) has not decreased in Germany despite longstanding recommendations for folic acid supplementation. To examine the prevalence of periconceptional folic acid supplement use and associated factors among German women of reproductive age. METHODS Cross-sectional survey was conducted in hospital-based maternity units in rural Germany. A sample of 1,004 women of reproductive age, either pregnant or in their early postpartum period, took interviewer/self-administered paper-based survey questionnaire. Prevalence of periconceptional folic acid supplement use was assessed, where periconception was defined as 1 month prior to and 3 months post-conception. Prevalence odds ratios (POR) and 95% confidence intervals (CI) using crude and adjusted logistic regression analysis were estimated to examine determinants of folic acid supplement use. RESULTS Prevalence of folic acid supplement use was 41.5% (95% CI: 37.7%, 45.7%). Multivariable analysis showed lack of educational qualifications, unplanned pregnancy, later diagnosis of pregnancy, increased parity, and not having an awareness of importance of folic acid for optimal pregnancy outcomes were associated with not taking periconceptional folic acid supplements. Books, doctors, friends, media, were sources of information. CONCLUSION Periconceptional folic acid is sub-optimal in rural Germany and thus failing to prevent NTDs. Targeted promotion of folic acid supplement use should be conducted periodically by gynecologists and primary care physicians during annual medical screenings. Mandatory folic acid fortification of staple foods is a complementary approach to overcome limitations of individual behaviors of folic acid supplement intake, and should be considered as it has been proven effective in multiple countries.
Collapse
Affiliation(s)
- Clara Wegner
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Anke Lux
- Institute for Biometrics and Medical Informatics, University Magdeburg, Magdeburg, Germany
| | - Andrea Köhn
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Dirk Bretschneider
- Department of Pediatrics, Hospital Marienstift Magdeburg, Magdeburg, Germany
| | - Kristina Freese
- Department of Obstetrics and Gynecology, Hospital Marienstift Magdeburg, Magdeburg, Germany
| | - Mathias Heiduk
- Department of Pediatrics, Hospital Magdeburg gGmbH, Magdeburg, Germany
| | - Anke Redlich
- Department of Obstetrics and Gynaecology, University Hospital Magdeburg, Magdeburg, Germany
| | - Daniela Schleef
- Department of Obstetrics and Gynecology, Hospital Magdeburg GmbH, Magdeburg, Germany
| | - Gerhard Jorch
- Department of Paediatrics, University Hospital Magdeburg, Magdeburg, Germany
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| |
Collapse
|
37
|
Tanacan A, Ozgen B, Fadiloglu E, Unal C, Oguz KK, Beksac MS. Prenatal diagnosis of central nervous system abnormalities: Neurosonography versus fetal magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol 2020; 250:195-202. [PMID: 32460228 DOI: 10.1016/j.ejogrb.2020.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/30/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To share our experience in diagnosis of congenital central nervous system (CNS) abnormalities by fetal magnetic resonance imaging (MRI). STUDY DESIGN This study consisted of 110 pregnancies. Neurosonography (NS) findings were compared with MRI results. Anomalies were categorized into 10 groups: 1) Corpus callosum (CC) and cavum septum pellucidum (CSP) anomalies, 2) Neural tube defects (NTD), 3) Posterior fossa anomalies (PFA), 4) Primary ventriculomegaly (PVM), 5) Microcephaly, 6) Macrocephaly, 7) Periventricular leukomalacia (PVL), 8) Craniosynostosis, 9) Intracranial hemorrhage (ICH) and 10) Lumbosacral teratoma. Demographic features, clinical characteristics and perinatal outcomes of the study subjects were evaluated. RESULTS Gestational weeks for NS and for MRI were 25.5 and 26.5 weeks, respectively. Fourteen (12.7%) pregnancies were terminated. PVM (n = 36, 32.7%), CC and CSP anomalies (n = 29, 26.3%), PFA (n = 11, 10%) and NTD (n = 11, 10%) were the most common fetal MRI indications. There were no statistically significant differences between the accuracy of fetal NS and fetal MRI for CC and CSP anomalies, NTDs, PFA and PVM (p = 0.09, 0.43, 0.45 and 0.23, respectively). However, fetal MRI was more accurate for the detection of normal anatomic findings in cases with suspected microcephaly, macrocephaly and craniosynostosis in NS when pooled together (p = 0.007). Furthermore, MRI also seemed to be advantageous in CC & CSP anomalies though it was not validated by statistical measures. No statistically significant difference was found for diagnostic performance of NS and MRI according to gestational week (p = 0.27). CONCLUSION Fetal MRI in addition to NS may improve diagnostic accuracy in pregnancies with congenital CNS abnormalities.
Collapse
Affiliation(s)
- Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey.
| | - Burce Ozgen
- Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | | | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| |
Collapse
|
38
|
Abstract
Spinal dysraphism is an umbrella term that encompasses a number of congenital malformations that affect the central nervous system. The etiology of these conditions can be traced back to a specific defect in embryological development, with the more disabling malformations occurring at an earlier gestational age. A thorough understanding of the relevant neuroembryology is imperative for clinicians to select the correct treatment and prevent complications associated with spinal dysraphism. This paper will review the neuroembryology associated with the various forms of spinal dysraphism and provide a clinical-pathological correlation for these congenital malformations.
Collapse
|
39
|
Wei X, Cao S, Ma W, Zhang C, Gu H, Liu D, Luo W, Bai Y, Wang W, Yuan Z. Intra-Amniotic Delivery of CRMP4 siRNA Improves Mesenchymal Stem Cell Therapy in a Rat Spina Bifida Model. MOLECULAR THERAPY. NUCLEIC ACIDS 2020; 20:502-517. [PMID: 32330869 PMCID: PMC7177192 DOI: 10.1016/j.omtn.2020.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/13/2020] [Indexed: 11/16/2022]
Abstract
Neural tube defects (NTDs) result in prenatal mortality and lifelong morbidity, and available treatments have limited efficacy. We previously suggested that prenatal bone marrow-derived mesenchymal stem cell (BMSC) transplantation could treat neuron deficiency in NTD rats; however, BMSC-based therapy is limited by the low survival rate of BMSCs when used to treat severe NTDs. Herein, a new therapy using combined BMSC transplantation and small interfering RNA of collapsin response mediator protein 4 (CRMP4 siRNA), which was identified as a novel potential target for the NTD treatment, is proposed. The intra-amniotic CRMP4 siRNA, BMSC, and CRMP4 siRNA + BMSC injections repaired skin lesions, improved motor neural function, reduced neuronal apoptosis, and promoted expression of neural differentiation-related molecules and neurotrophic factors in the spinal cord of spina bifida rat fetuses. Therapeutic effects in the CRMP4 siRNA + BMSC injection group were superior to those of the CRMP4 siRNA only or BMSC only injection groups. CRMP4 siRNA + BMSC injection resulted in a 45.38% reduction in the skin lesion area and significantly shorter latency and higher amplitude of motor-evoked potentials (MEPs) in spina bifida fetuses. Our results suggest that intrauterine Ad-CRMP4 siRNA delivery with BMSCs is an innovative platform for developing fetal therapeutics to safely and efficaciously treat NTDs.
Collapse
Affiliation(s)
- Xiaowei Wei
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang 110004, P.R. China
| | - Songying Cao
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang 110004, P.R. China.
| | - Wei Ma
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang 110004, P.R. China
| | - Chaonan Zhang
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang 110004, P.R. China
| | - Hui Gu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang 110004, P.R. China
| | - Dan Liu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang 110004, P.R. China
| | - Wenting Luo
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang 110004, P.R. China
| | - Yuzuo Bai
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, P.R. China
| | - Weilin Wang
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, P.R. China
| | - Zhengwei Yuan
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang 110004, P.R. China.
| |
Collapse
|
40
|
Maternal Folic Acid Supplementation Mediates Offspring Health via DNA Methylation. Reprod Sci 2020; 27:963-976. [PMID: 32124397 DOI: 10.1007/s43032-020-00161-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 10/24/2022]
Abstract
The clinical significance of periconceptional folic acid supplementation (FAS) in the prevention of neonatal neural tube defects (NTDs) has been recognized for decades. Epidemiological data and experimental findings have consistently been indicating an association between folate deficiency in the first trimester of pregnancy and poor fetal development as well as offspring health (i.e., NTDs, isolated orofacial clefts, neurodevelopmental disorders). Moreover, compelling evidence has suggested adverse effects of folate overload during perinatal period on offspring health (i.e., immune diseases, autism, lipid disorders). In addition to several single-nucleotide polymorphisms (SNPs) in genes related to folate one-carbon metabolism (FOCM), folate concentrations in maternal serum/plasma/red blood cells must be considered when counseling FAS. Epigenetic information encoded by 5-methylcytosines (5mC) plays a critical role in fetal development and offspring health. S-adenosylmethionine (SAM), a methyl donor for 5mC, could be derived from FOCM. As such, folic acid plays a double-edged sword role in offspring health via mediating DNA methylation. However, the underlying epigenetic mechanism is still largely unclear. In this review, we summarized the link across DNA methylation, maternal FAS, and offspring health to provide more evidence for clinical guidance in terms of precise FAS dosage and time point. Future studies are, therefore, required to set up the reference intervals of folate concentrations at different trimesters of pregnancy for different populations and to clarify the epigenetic mechanism for specific offspring diseases.
Collapse
|
41
|
Louden AR, Suhl J, Kancherla V, Caspers Conway KM, Makelarski J, Howley MM, Hoyt AT, Olney RS, Olshan AF, Romitti PA. Association between maternal periconceptional alcohol consumption and neural tube defects: Findings from the National Birth Defects Prevention Study, 1997-2011. Birth Defects Res 2020; 112:427-439. [PMID: 32104984 DOI: 10.1002/bdr2.1656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/03/2020] [Accepted: 01/26/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neural tube defects (NTD)s are common birth defects with a multifactorial etiology. Findings from human studies examining environmental (non-inherited) exposures tend to be inconclusive. In particular, although animal studies of alcohol exposure and NTDs support its teratogenic potential, human studies are equivocal. Using data from the National Birth Defects Prevention Study (NBDPS), associations between maternal periconceptional (1 month before through 1 month after conception) alcohol consumption and NTDs in offspring were examined. METHODS NTD cases and unaffected live born singleton controls with expected dates of delivery from October 1997-December 2011 were enrolled in the NBDPS. Interview reports of alcohol consumption (quantity, frequency, variability, type) from 1,922 case and 11,251 control mothers were analyzed. Crude and adjusted odds ratios (aOR)s and 95% confidence intervals (CI)s for alcohol consumption and all NTDs combined and selected subtypes (spina bifida, anencephaly, encephalocele) were estimated using unconditional logistic regression analysis. RESULTS Among mothers in the NBDPS, 28% of NTD case and 35% of control mothers reported any periconceptional alcohol consumption. For each measure of alcohol consumption, inverse associations were observed for all NTDs combined (aORs = 0.6-1.0). Results for NTD subtypes tended to be similar, but CIs for spina bifida and encephalocele were more likely to include the null. CONCLUSIONS These findings suggest a lack of positive associations between maternal periconceptional alcohol consumption and NTDs. Future studies should continue to evaluate the association between maternal alcohol consumption and NTDs in offspring accounting for methodological limitations such as potential misclassification from self-reported alcohol consumption.
Collapse
Affiliation(s)
- Adia R Louden
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jonathan Suhl
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Vijaya Kancherla
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Jennifer Makelarski
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Meredith M Howley
- Congenital Malformations Registry, New York State Department of Health, Albany, New York
| | - Adrienne T Hoyt
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | - Richard S Olney
- Genetic Disease Screening Program, California Department of Public Health, Richmond, California
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | | |
Collapse
|
42
|
Chen Z, Zhou L, Jiang S, Haddix A. Identifying Options of Best Value: Use of Economic Evaluation in Public Health. China CDC Wkly 2020; 2:75-78. [PMID: 34594811 PMCID: PMC8393107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/15/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, USA,School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham, Ningbo, Zhejiang, China,Zhuo Chen,
| | - Lei Zhou
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shan Jiang
- School of Population and Public Health, University of British Columbia, Vancouver, V6T1Z3, BC, Canada
| | | |
Collapse
|
43
|
Association between Ready-to-Eat Cereal Consumption and Nutrient Intake, Nutritional Adequacy, and Diet Quality in Adults in the National Health and Nutrition Examination Survey 2015-2016. Nutrients 2019; 11:nu11122952. [PMID: 31817088 PMCID: PMC6950451 DOI: 10.3390/nu11122952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/28/2019] [Accepted: 12/01/2019] [Indexed: 11/30/2022] Open
Abstract
This study examined differences in dietary intake between ready-to-eat cereal eaters and non-eaters in adults from the United States. Participants (n = 5163) from the National Health and Nutrition Examination Survey 2015–2016 were included. One-day dietary recall was used to define ready-to-eat cereal consumption status and estimate dietary intake in eaters and non-eaters. Data from Food Patterns Equivalent Database 2015–2016 were used to compare intakes of food groups by consumption status. Diet quality was assessed by Healthy Eating Index 2015. Nineteen percent of US adults were ready-to-eat cereal eaters; they had a similar level of energy intake as non-eaters, but they had significantly higher intake of dietary fiber, and several vitamins and minerals, such as calcium, iron, magnesium, potassium, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, and vitamin D. They were also more likely to meet nutrient recommendations. Compared to non-eaters, ready-to-eat cereal eaters had the same level of added sugar intake but they had significantly higher intake of whole grains, total fruits, and dairy products. The diet quality of ready-to-eat cereal eaters was significantly higher than that of non-eaters. The study supports that ready-to-eat cereal eaters have better dietary intake with a healthier dietary pattern than non-eaters in the United States.
Collapse
|
44
|
Mowla S, Gissler M, Räisänen S, Kancherla V. Association between maternal pregestational diabetes mellitus and spina bifida: A population-based case-control study, Finland, 2000-2014. Birth Defects Res 2019; 112:186-195. [PMID: 31774241 DOI: 10.1002/bdr2.1624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Maternal pregestational diabetes mellitus (PGDM) is a known risk factor for neural tube defects. We examined the association between maternal PGDM and spina bifida in the offspring using PGDM status from medical records in Finland. METHODS We conducted a nationally representative, multiregistry, population-based case-control study in Finland. Cases were included if they were live or stillborn infants and diagnosed with spina bifida and delivered between years 2000 and 2014 in Finland. Controls were Finnish infants without spina bifida or other major structural birth defects and delivered during the same time period as cases. Clinical and demographic data were obtained by linking multiple national health registers and census. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CI) for PGDM were estimated using logistic regression analysis. Interaction by maternal obesity was examined. RESULTS Our study included 181 spina bifida cases (61% isolated) and 876,672 controls. Overall, 2.2% percent of all case, and 0.5% of control mothers, had PGDM during pregnancy. Maternal PGDM was significantly associated with an increased odds of spina bifida (adjusted OR 4.35; 95% CI 1.37, 13.82). A similar association was found in our subanalysis on isolated spina bifida cases (adjusted OR 4.41; 95% CI 1.07, 18.24). There was no significant interaction by maternal obesity. CONCLUSIONS Maternal PGDM was positively associated with spina bifida in Finland, and maternal obesity did not modify this effect. We lacked information on maternal PGDM for electively terminated and spontaneously aborted cases; results should be interpreted with caution.
Collapse
Affiliation(s)
- Sanjida Mowla
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mika Gissler
- Information Services Department, Helsinki, Finland, THL Finnish Institute for Health and Welfare and Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Sari Räisänen
- School of Health Care and Social Services, Tampere University of Applied Sciences, Tampere, Finland
| | - Vijaya Kancherla
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| |
Collapse
|
45
|
Temkin A, Evans S, Manidis T, Campbell C, Naidenko OV. Exposure-based assessment and economic valuation of adverse birth outcomes and cancer risk due to nitrate in United States drinking water. ENVIRONMENTAL RESEARCH 2019; 176:108442. [PMID: 31196558 DOI: 10.1016/j.envres.2019.04.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Nitrate ingestion from drinking water has been associated with an increased risk of adverse birth outcomes as well as elevated risk of colorectal cancer and several other cancers. Yet, to date, no studies have attempted to quantify the health and economic impacts due to nitrate in drinking water in the United States. METHODS This study presents a first-of-its-kind comprehensive assessment of nitrate exposure from drinking water for the entire United States population. This exposure assessment serves as the basis for our analysis of the annual nitrate-attributable disease cases in the United States and the associated economic losses due to medical costs and lost productivity. Additionally, through a meta-analysis of studies on drinking water nitrate and colorectal cancer, we examine the exposure-response relationship for nitrate and cancer risk. RESULTS On the basis of national nitrate occurrence data and relative risk ratios reported in the epidemiology literature, we calculated that annually, 2939 cases of very low birth weight, 1725 cases of very preterm birth, and 41 cases of neural tube defects could be related to nitrate exposure from drinking water. For cancer risk, combining nitrate-specific risk estimates for colorectal, ovarian, thyroid, kidney, and bladder cancers results in a range of 2300 to 12,594 annual nitrate-attributable cancer cases (mean: 6537 estimated cases). For medical expenditures alone, this burden of cancer corresponds to an annual economic cost of 250 million to 1.5 billion U.S. dollars, together with a potential 1.3 to 6.5 billion dollar impact due to lost productivity. With the meta-analysis of eight studies of drinking water nitrate and colorectal cancer, we observed a statistically significant positive association for nitrate exposure and colorectal cancer risk and calculated a one-in-one million cancer risk level of 0.14 mg/L nitrate in drinking water. CONCLUSION Health and economic analyses presented here suggest that lowering exposure to nitrate in drinking water could bring economic benefits by alleviating the impacts of nitrate-associated diseases.
Collapse
Affiliation(s)
- Alexis Temkin
- Environmental Working Group, 1436 U Street NW Suite 100, Washington, DC, 20009, USA.
| | - Sydney Evans
- Environmental Working Group, 1436 U Street NW Suite 100, Washington, DC, 20009, USA
| | - Tatiana Manidis
- Duke University, Nicholas School of the Environment, 9 Circuit Dr, Durham, NC, 27710, USA
| | - Chris Campbell
- Environmental Working Group, 1436 U Street NW Suite 100, Washington, DC, 20009, USA
| | - Olga V Naidenko
- Environmental Working Group, 1436 U Street NW Suite 100, Washington, DC, 20009, USA
| |
Collapse
|
46
|
Aguiar M, Andronis L, Pallan M, Högler W, Frew E. The economic case for prevention of population vitamin D deficiency: a modelling study using data from England and Wales. Eur J Clin Nutr 2019; 74:825-833. [PMID: 31427760 DOI: 10.1038/s41430-019-0486-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/01/2019] [Accepted: 07/15/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Vitamin D deficiency (VDD) affects the health and wellbeing of millions worldwide. In high latitude countries such as the United Kingdom (UK), severe complications disproportionally affect ethnic minority groups. OBJECTIVE To develop a decision-analytic model to estimate the cost effectiveness of population strategies to prevent VDD. METHODS An individual-level simulation model was used to compare: (I) wheat flour fortification; (II) supplementation of at-risk groups; and (III) combined flour fortification and supplementation; with (IV) a 'no additional intervention' scenario, reflecting the current Vitamin D policy in the UK. We simulated the whole population over 90 years. Data from national nutrition surveys were used to estimate the risk of deficiency under the alternative scenarios. Costs incurred by the health care sector, the government, local authorities, and the general public were considered. Results were expressed as total cost and effect of each strategy, and as the cost per 'prevented case of VDD' and the 'cost per Quality Adjusted Life Year (QALY)'. RESULTS Wheat flour fortification was cost saving as its costs were more than offset by the cost savings from preventing VDD. The combination of supplementation and fortification was cost effective (£9.5 per QALY gained). The model estimated that wheat flour fortification alone would result in 25% fewer cases of VDD, while the combined strategy would reduce the number of cases by a further 8%. CONCLUSION There is a strong economic case for fortifying wheat flour with Vitamin D, alone or in combination with targeted vitamin D3 supplementation.
Collapse
Affiliation(s)
- M Aguiar
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - L Andronis
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,Population, Evidence and Technologies, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - M Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - W Högler
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Johannes Kepler University, Linz, A-4040, Austria.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - E Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| |
Collapse
|
47
|
Dixon M, Kancherla V, Magana T, Mulugeta A, Oakley GP. High potential for reducing folic acid-preventable spina bifida and anencephaly, and related stillbirth and child mortality, in Ethiopia. Birth Defects Res 2019; 111:1513-1519. [PMID: 31424635 DOI: 10.1002/bdr2.1584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/15/2019] [Accepted: 08/09/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recent surveillance studies in Ethiopia show an epidemic of spina bifida and anencephaly, two major neural tube birth defects that are severe and life-threatening. Our objective was to estimate proportional reductions in current stillbirth and child mortality rates in Ethiopia through folic acid-based interventions to prevent spina bifida and anencephaly. METHODS Using secondary data from multiple sources, we estimated percent reductions in stillbirth, neonatal, infant, and under-five child mortality rates that would have occurred in Ethiopia in the year 2016 had all folic acid-preventable spina bifida and anencephaly been prevented; and the contributions of these reductions toward Ethiopia's Year 2030 Every Newborn Action Plan (ENAP) goal on stillbirth, and sustainable development goal (SDG) on child mortality rates. The 2016 prevalence of spina bifida and anencephaly in Ethiopia was assumed as 13 per 1,000 total births, with the prevention goal reaching 0.5 per 1,000 total births. RESULTS Folic acid interventions in Ethiopia would have prevented about 41,610 cases of folic acid-preventable spina bifida and anencephaly-affected pregnancies during the year 2016. We estimate that this prevention is associated with reduction of 31,830 stillbirths and 7,335 under-five child deaths annually. The proportional contribution of this prevention toward achieving Ethiopia's ENAP goal is 54% for stillbirth, and toward SDG is 4.5% for neonatal- and 6.8% for under-five mortality. CONCLUSIONS Spina bifida and anencephaly contribute to substantial stillbirths and child death in Ethiopia. Large-scale fortification of foods like wheat flour and salt can help achieve Ethiopia's ENAP and SDG targets addressing preventable stillbirth, neonatal, and under-five mortality.
Collapse
Affiliation(s)
- Meredith Dixon
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Tony Magana
- Department of Neurosurgery, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Afework Mulugeta
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Godfrey P Oakley
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia
| |
Collapse
|
48
|
Kancherla V, Redpath B, Oakley GP. Reductions in child mortality by preventing spina bifida and anencephaly: Implications in achieving Target 3.2 of the Sustainable Development Goals in developing countries. Birth Defects Res 2019; 111:958-966. [PMID: 30070775 DOI: 10.1002/bdr2.1362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/18/2018] [Accepted: 06/01/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is an opportunity to reduce child mortality by preventing folic acid-preventable spina bifida and anencephaly (FAP SBA) in developing countries. We estimated reductions in FAP SBA-associated child mortality in 69 countries with an immediate potential for mandatory fortification of wheat flour. METHODS Using data from multiple sources, we estimated the percent reductions in neonatal, infant, and under-five mortality that would have occurred by preventing FAP SBA; and the contributions of these reductions toward each country's Sustainable Development Goals (SDG) for child mortality reduction. We used the combined prevalence of spina bifida and anencephaly in selected countries before fortification, and estimated preventable child mortality associated with FAP SBA, assuming 0.5 per 1,000 live births as minimum achievable prevalence from mandatory fortification. RESULTS Annually, 56,785 live births with FAP SBA occurred in the 69 countries examined. Of these, about 49,680 (87%) would have resulted in deaths under age 5 years, and are preventable through mandatory folic acid fortification. On average, compared to current rates, prevention of FAP SBA would have reduced the neonatal, infant, and under-five mortality by 19% (95% uncertainty interval [UI]: 16-24%), 15% (UI: 13-17%), and 14%, (95% UI: 13-17%), respectively. Prevention of FAP SBA seemed to contribute toward achieving SDG on neonatal and under-five mortality in developing countries. CONCLUSIONS Prevention of FAP SBA will lead to notable and immediate reductions in child mortality. Many countries have an opportunity to effectively move toward child mortality-related SDG targets with existing milling infrastructure for food fortification.
Collapse
Affiliation(s)
- Vijaya Kancherla
- Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ben Redpath
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Godfrey P Oakley
- Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| |
Collapse
|
49
|
Ross MM, Piorczynski TB, Harvey J, Burnham TS, Francis M, Larsen MW, Roe K, Hansen JM, Stark MR. Ceramide: a novel inducer for neural tube defects. Dev Dyn 2019; 248:979-996. [PMID: 31390103 DOI: 10.1002/dvdy.93] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/02/2019] [Accepted: 07/21/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Circulating plasma ceramides, a class of bioactive sphingolipids, are elevated in metabolic disorders, including obesity. Infants of women with these disorders are at 2- to 3-fold greater risk for developing a neural tube defect (NTD). This study aimed to test the effects of embryonic exposure to C2-ceramides (C2) during neural tube closure. Preliminary data shows an increase in NTDs in chick embryos after C2 exposure, and addresses potential mechanisms. RESULTS Cell and embryo models were used to examine redox shifts after ceramide exposure. While undifferentiated P19 cells were resistant to ceramide exposure, neuronally differentiated P19 cells exhibited an oxidizing shift. Consistent with these observations, GSH E h curves revealed a shift to a more oxidized state in C2 treated embryos without increasing apoptosis or changing Pax3 expression, however cell proliferation was lower. Neural tube defects were observed in 45% of chick embryos exposed to C2, compared to 12% in control embryos. CONCLUSIONS C2 exposure during critical developmental stages increased the frequency of NTDs in the avian model. Increased ROS generation in cell culture, along with the more oxidative GSH E h profiles of C2 exposed cells and embryos, support a model wherein ceramide affects neural tube closure via altered tissue redox environments.
Collapse
Affiliation(s)
- Micah M Ross
- Department of Physiology and Developmental Biology, College of Life Sciences, Brigham Young University, Provo, Utah
| | - Ted B Piorczynski
- Department of Physiology and Developmental Biology, College of Life Sciences, Brigham Young University, Provo, Utah
| | - Jamison Harvey
- Department of Physiology and Developmental Biology, College of Life Sciences, Brigham Young University, Provo, Utah
| | - Tyson S Burnham
- Department of Physiology and Developmental Biology, College of Life Sciences, Brigham Young University, Provo, Utah
| | - Morgan Francis
- Department of Physiology and Developmental Biology, College of Life Sciences, Brigham Young University, Provo, Utah
| | - Madison W Larsen
- Department of Physiology and Developmental Biology, College of Life Sciences, Brigham Young University, Provo, Utah
| | - Kyle Roe
- Department of Physiology and Developmental Biology, College of Life Sciences, Brigham Young University, Provo, Utah
| | - Jason M Hansen
- Department of Physiology and Developmental Biology, College of Life Sciences, Brigham Young University, Provo, Utah
| | - Michael R Stark
- Department of Physiology and Developmental Biology, College of Life Sciences, Brigham Young University, Provo, Utah
| |
Collapse
|
50
|
Kancherla V, Black RE. Historical perspective on folic acid and challenges in estimating global prevalence of neural tube defects. Ann N Y Acad Sci 2019. [PMID: 29532513 DOI: 10.1111/nyas.13601] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Neural tube defects (NTD) are major congenital malformations affecting births worldwide. NTD are associated with life-long disability, significant medical care costs, and child mortality. Their prevalence varies worldwide. We conducted a review of published literature and surveillance systems to examine challenges in estimating an overall global prevalence estimate for NTD. Our review showed that most low- and middle-income countries do not track NTD and indicate a high prevalence of these malformations where data are available. Challenges in global NTD prevalence estimation include (1) quality of surveillance methods, (2) existing risk factors (including geographic or socioeconomic factors, availability and use of folic acid, and racial-ethnic and genetic factors), and (3) limitations in education and access to care. We recommend population-based surveillance systems tracking all pregnancy outcomes and major risk factors. Countries should invest in sustainable, multisource surveillance systems, in parallel to folic acid interventions, for gaining a more accurate knowledge of global prevalence of NTD than we currently have. Such efforts will assist in both global prevention of NTD and periodic evaluation of folic acid interventions for NTD reduction. Global NTD prevalence data can drive political will and accelerate the implementation and evaluation of NTD prevention programs.
Collapse
Affiliation(s)
- Vijaya Kancherla
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Robert E Black
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|