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Vladutiu CJ, Kandasamy V, Ahrens KA. Folate Levels by Time Since Last Live Birth Among U.S. Women, 2007-2016. J Womens Health (Larchmt) 2020; 30:1204-1212. [PMID: 33236942 DOI: 10.1089/jwh.2020.8428] [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] [Indexed: 01/18/2023] Open
Abstract
Background: Folate depletion in the postpartum period may increase the risk of adverse pregnancy outcomes for women with a short interpregnancy interval following a live birth. We sought to examine folate levels by time since last live birth among U.S. women. Materials and Methods: Data were from 4,809 U.S. women, 20-44 years of age, participating in the National Health and Nutrition Examination Survey, 2007-2016. Red blood cell (RBC) folate was measured using microbiological assay on whole blood samples. Dietary folate intake and folic acid supplementation were measured during a 24-hour dietary recall. Prevalence of supplementation by time since last live birth was estimated from logistic regression models; mean levels of RBC folate and mean intake of dietary folate equivalent were estimated from linear regression models. Models were adjusted for maternal sociodemographic characteristics. Results: In adjusted models, supplementation (±standard error) was highest among women in the first year postpartum (31.7% ± 3.2) compared with nulliparous women (23.7% ± 1.9) and those 2-3 years (15.6% ± 1.9) and ≥3 years (18.4% ± 1.6) after last live birth. Mean RBC folate was highest among women in the first year postpartum, regardless of supplementation, with overall mean levels of 606 ± 15 ng/mL, compared with 484 ± 9, 477 ± 11, and 474 ± 7 among women in the aforementioned groups, respectively. Mean dietary folate intake was also highest among postpartum women: 542 ± 23 mcg/day, compared with 474 ± 12, 486 ± 21, and 467 ± 12. Conclusions: Folate levels are highest in the first year postpartum compared with other time periods within a woman's reproductive lifespan. These findings do not support the idea that postpartum U.S. women are depleted in folate, on average.
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Affiliation(s)
- Catherine J Vladutiu
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Veni Kandasamy
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
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Zou R, El Marroun H, Cecil C, Jaddoe VWV, Hillegers M, Tiemeier H, White T. Maternal folate levels during pregnancy and offspring brain development in late childhood. Clin Nutr 2020; 40:3391-3400. [PMID: 33279309 DOI: 10.1016/j.clnu.2020.11.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cumulative evidence shows that low maternal folate levels during pregnancy are associated with offspring neuropsychiatric disorders even in the absence of neural tube defects. However, the relationship between prenatal exposure to folate and brain development in late childhood has been rarely investigated. METHODS In 2095 children from a prospective population-based cohort in Rotterdam, the Netherlands, we examined the association of maternal folate levels during pregnancy with downstream brain development in offspring. Maternal folate concentrations were measured from venous blood in early gestation. Child structural neuroimaging data were measured at age 9-11 years. In addition, measures of child head circumference using fetal ultrasound in the third trimester and total brain volume using magnetic resonance imaging at age 6-8 years were used for analyses with repeated assessments of brain development. RESULTS Maternal folate deficiency (i.e., <7 nmol/L) during pregnancy was associated with smaller total brain volume (B = -18.7 cm3, 95% CI -37.2 to -0.2) and smaller cerebral white matter (B = -7.2 cm3, 95% CI -11.8 to -2.6) in children aged 9-11 years. No differences in cortical thickness or surface area were observed. Analysis of the repeated brain assessments showed that children exposed to deficient folate concentrations in utero had persistently smaller brains compared to controls from the third trimester to childhood (β = -0.4, 95% CI -0.6 to -0.1). CONCLUSIONS Low maternal folate levels during pregnancy are associated with altered offspring brain development in childhood, suggesting the importance of essential folate concentrations in early pregnancy.
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Affiliation(s)
- Runyu Zou
- Department of Child and Adolescent Psychiatry, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; The Generation R Study Group, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Charlotte Cecil
- Department of Child and Adolescent Psychiatry, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands; Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZC, Leiden, the Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Social and Behavioral Sciences, T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Tonya White
- Department of Child and Adolescent Psychiatry, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
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3
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van Gool JD, Hirche H, Lax H, Schaepdrijver LD. Fallacies of clinical studies on folic acid hazards in subjects with a low vitamin B 12 status. Crit Rev Toxicol 2020; 50:177-187. [PMID: 32228273 DOI: 10.1080/10408444.2020.1727842] [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] [Indexed: 10/24/2022]
Abstract
A 2016 plea for revision of the 1 mg/day upper level of folic acid intake prompted us to comprehensively review the 1945-2017 literature on folic acid hazards in subjects with low cyanocobalamin. The concept of folic acid treatment 'masking' the anemia in undiagnosed cyanocobalamin deficiency, thereby delaying the diagnosis of neuropathy, does not account for the dissociation between the deficiency's hematologic and neurologic manifestations. Possible risks of this concept were addressed by 1963-1971 FDA rulings, classifying all folic acid preparations as prescription-only drugs, delivering ≤1 mg daily. The neuropathy in folic acid trials for 'pernicious anemia' is due to the singular use of folic acid-neuropathy improved or disappeared with replacement of folic acid by liver extract or cyanocobalamin. The hypothesis that cognitive impairment in 'subclinical' cyanocobalamin deficiency is folate-mediated is untenable. Of 6 papers specifically investigating this, none could prove that increased cognitive impairment was related to high folate intake. This review fully supports the safety of the 1 mg/day upper level for folic acid intake.
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Affiliation(s)
- Jan D van Gool
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen-Duisburg University, Essen, Germany
| | - Herbert Hirche
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen-Duisburg University, Essen, Germany
| | - Hildegard Lax
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen-Duisburg University, Essen, Germany
| | - Luc De Schaepdrijver
- Department of Nonclinical Safety, Janssen Research and Development, Beerse, Belgium
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4
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Li W, Xu B, Cao Y, Shao Y, Wu W, Zhou J, Tan X, Wu X, Kong J, Hu C, Xie K, Wu J. Association of maternal folate intake during pregnancy with infant asthma risk. Sci Rep 2019; 9:8347. [PMID: 31171831 PMCID: PMC6554315 DOI: 10.1038/s41598-019-44794-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 05/24/2019] [Indexed: 12/21/2022] Open
Abstract
Several studies assessed the association of maternal folate intake with infant asthma risk, but the findings are controversial. We performed a meta-analysis to clarify the association between maternal folate intake and infant asthma risk. PubMed and SCOPUS databases were searched for related studies published until August 2018. Fixed-effects models were applied to pool relative risks (RRs) and their corresponding 95% confidence intervals (CIs) due to the low heterogeneity. We also adopted generalized least-squares trend (GLST) estimation for the dose-response analysis. In our study, a total of 10 studies with maternal folate intake and 5 studies with blood folate concentration were included. We found that maternal folate intake during pregnancy was significantly related to the risk of infant asthma (RR = 1.11; 95% CI = 1.06-1.17). Similar results were found for geographic region from Europe (RR = 1.08; 95% CI = 1.01-1.16) and North America (RR = 1.20; 95% CI = 1.11-1.30) in subgroup analyses. Meanwhile, the dose-response analysis showed a linear relationship between maternal folic acid intake during pregnancy and infant asthma risk. This meta-analysis indicates that maternal folate intake during pregnancy could increase infant asthma risk. Therefore, the adverse effect of folic acid on infant asthma should not be ignored when it is supplemented during pregnancy to prevent birth defects.
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Affiliation(s)
- Weijian Li
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
- Department of Urology, Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Bo Xu
- State Key Laboratory of Reproductive Medicine, Institute of Toxicology, Nanjing Medical University, Nanjing, 211166, China
| | - Yuepeng Cao
- Department of Urology, Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Yang Shao
- The First People's Hospital of Zhangjiagang city, The Zhangjiagang Affiliated Hospital of Soochow University, Suzhou, 215600, China
| | - Wanke Wu
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Jun Zhou
- Department of Urology, Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Xiaofang Tan
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Xiaoli Wu
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Jing Kong
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Chen Hu
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Kaipeng Xie
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China.
| | - Jiangping Wu
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China.
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5
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Sharman Moser S, Rabinovitch M, Rotem R, Koren G, Shalev V, Chodick G. Parity and the use of folic acid supplementation during pregnancy. BMJ Nutr Prev Health 2019; 2:30-34. [PMID: 33235954 PMCID: PMC7664500 DOI: 10.1136/bmjnph-2019-000024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/25/2019] [Accepted: 04/13/2019] [Indexed: 11/25/2022] Open
Abstract
Objective Folic acid (FA) supplementation has long been recommended before and during pregnancy to reduce the risk of neural tube defects. Factors influencing adherence to FA supplementation have been extensively evaluated, but little is known on the effect of parity. This study comes to examine the association between parity and maternal use of FA prior to and during pregnancy. Methods In this retrospective population-based study, we identified mothers (N=228 555) of all children (N=578 204) born between the years 2000 and 2016 among members of a large health provider in Israel. Data on FA supplementation purchases were obtained from centralised medical databases. Results The median (IQR) total dose of FA purchased 12 months prior to child birth among previously nulliparous women (120 mg, 48–240) was significantly (p<0.001) higher than the dose purchased by women with one (90 mg (39–202)) and two prior births (84 mg (36–182)). The dose was even lower in women for three or more prior births (75 mg (36–165)). Despite the overall increasing secular trend in FA purchases during the study period, the negative relationship with parity remained. Conclusions Adherence to FA supplementation is negatively associated with parity. Women with increasing parity may be at higher risk for pregnancy complications associated with low FA levels. The results of this study may inform the design of interventions to specifically increase adherence to FA supplementations among multiparous women.
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Affiliation(s)
- Sarah Sharman Moser
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Ran Rotem
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Gideon Koren
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Varda Shalev
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Chodick
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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6
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Mills JL, Dimopoulos A, Bailey RL. What is standing in the way of complete prevention of folate preventable neural tube defects? ACTA ACUST UNITED AC 2018; 106:517-9. [PMID: 27418028 DOI: 10.1002/bdra.23518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/07/2016] [Indexed: 01/21/2023]
Affiliation(s)
- James L Mills
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Aggeliki Dimopoulos
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
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7
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van Gool JD, Hirche H, Lax H, De Schaepdrijver L. Folic acid and primary prevention of neural tube defects: A review. Reprod Toxicol 2018; 80:73-84. [DOI: 10.1016/j.reprotox.2018.05.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/03/2018] [Accepted: 05/14/2018] [Indexed: 12/31/2022]
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8
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Blumberg JB, Cena H, Barr SI, Biesalski HK, Dagach RU, Delaney B, Frei B, Moreno González MI, Hwalla N, Lategan-Potgieter R, McNulty H, van der Pols JC, Winichagoon P, Li D. The Use of Multivitamin/Multimineral Supplements: A Modified Delphi Consensus Panel Report. Clin Ther 2018; 40:640-657. [DOI: 10.1016/j.clinthera.2018.02.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/19/2018] [Accepted: 02/23/2018] [Indexed: 12/13/2022]
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9
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Fischer M, Stronati M, Lanari M. Mediterranean diet, folic acid, and neural tube defects. Ital J Pediatr 2017; 43:74. [PMID: 28818086 PMCID: PMC5561554 DOI: 10.1186/s13052-017-0391-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/03/2017] [Indexed: 01/21/2023] Open
Abstract
The Mediterranean diet has been for a very long time the basis of food habits all over the countries of the Mediterranean basin, originally founded on rural models and low consumption of meat products and high-fat/high-processed foods. However, in the modern era, the traditional Mediterranean diet pattern is now progressively eroding due to the widespread dissemination of the Western-type economy, life-style, technology-driven culture, as well as the globalisation of food production, availability and consumption, with consequent homogenisation of food culture and behaviours. This transition process may affect many situations, including pregnancy and offspring's health. The problem of the diet during pregnancy and the proper intake of nutrients are nowadays a very current topic, arousing much debate. The Mediterranean dietary pattern, in particular, has been associated with the highest risk reduction of major congenital anomalies, like the heterogeneous class of neural tube defects (NTDs). NTDs constitute a major health burden (0.5-2/1000 pregnancies worldwide) and still remain a preventable cause of still birth, neonatal and infant death, or significant lifelong disabilities. Many studies support the finding that appropriate folate levels during pregnancy may confer protection against these diseases. In 1991 one randomised controlled trial (RCT) demonstrated for the first time that periconceptional supplementation of folic acid is able to prevent the recurrence of NTDs, finding confirmed by many other subsequent studies. Anyway, the high rate of unplanned/unintended pregnancies and births and other issues hindering the achievement of adequate folate levels in women in childbearing age, induced the US government and many other countries to institute mandatory food fortification with folic acid. The actual strategy adopted by European Countries (including Italy) suggests that women take 0,4 mg folic acid/die before conception. The main question is which intervention, between folic acid supplementation, foods fortification or both, linked to a healthy life-style and diet pattern may represent the best method in preventing NTDs. The aim of this review is to describe the actual situation in NTDs prevention, with a special attention to the Italiancontext concerning this delicate and controversial subject.
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Affiliation(s)
- Maximilian Fischer
- Department of Pediatric Emergency, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mauro Stronati
- Neonatal Intensive Care Unit, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Marcello Lanari
- Department of Pediatric Emergency, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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10
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Parr CL, Magnus MC, Karlstad Ø, Haugen M, Refsum H, Ueland PM, McCann A, Nafstad P, Håberg SE, Nystad W, London SJ. Maternal Folate Intake during Pregnancy and Childhood Asthma in a Population-based Cohort. Am J Respir Crit Care Med 2017; 195:221-228. [PMID: 27518161 DOI: 10.1164/rccm.201604-0788oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE A potential adverse effect of high folate intake during pregnancy on children's asthma development remains controversial. OBJECTIVES To prospectively investigate folate intake from both food and supplements during pregnancy and asthma at age 7 years when the diagnosis is more reliable than at preschool age. METHODS This study included eligible children born 2002-2006 from the Norwegian Mother and Child Cohort Study, a population-based pregnancy cohort, linked to the Norwegian Prescription Database. Current asthma at age 7 was defined by asthma medications dispensed at least twice in the year (1,901 cases; n = 39,846) or by maternal questionnaire report (1,624 cases; n = 28,872). Maternal folate intake was assessed with a food frequency questionnaire validated against plasma folate. We used log-binomial and multinomial regression to calculate adjusted relative risks with 95% confidence intervals. MEASUREMENTS AND MAIN RESULTS Risk of asthma was increased in the highest versus lowest quintile of total folate intake with an adjusted relative risk of 1.23 (95% confidence interval, 1.06-1.44) that was similar for maternally reported asthma. Mothers in the highest quintile had a relatively high intake of food folate (median, 308; interquartile range, 241-366 μg/d) and nearly all took at least 400 μg/d of supplemental folic acid (median, 500; interquartile range, 400-600 μg/d). CONCLUSIONS In this large prospective population-based cohort with essentially complete follow-up, pregnant women taking supplemental folic acid at or above the recommended dose, combined with a diet rich in folate, reach a total folate intake level associated with a slightly increased risk of asthma in children.
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Affiliation(s)
- Christine L Parr
- 1 Department of Mental and Physical Health and.,2 Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
| | - Maria C Magnus
- 1 Department of Mental and Physical Health and.,3 Medical Research Council Integrative Epidemiology Unit and.,4 School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | | | - Margaretha Haugen
- 5 Department of Exposure and Risk Assessment, Norwegian Institute of Public Health, Oslo, Norway
| | - Helga Refsum
- 6 Institute of Basic Medical Sciences, Department of Nutrition, and
| | - Per M Ueland
- 7 Department of Clinical Science, University of Bergen, Bergen, Norway.,8 Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway; and
| | | | - Per Nafstad
- 1 Department of Mental and Physical Health and.,10 Department of Community Medicine, University of Oslo, Oslo, Norway
| | | | | | - Stephanie J London
- 2 Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
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11
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Khoshnood B, Lelong N. Trends in the Prevalence of Neural Tube Defects: A Tale of Two Policies. Paediatr Perinat Epidemiol 2017; 31:301-303. [PMID: 28617970 DOI: 10.1111/ppe.12367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Babak Khoshnood
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Nathalie Lelong
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
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12
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Samaniego-Vaesken ML, Alonso-Aperte E, Varela-Moreiras G. Voluntary Folic Acid Fortification Levels and Nutrient Composition of Food Products from the Spanish Market: A 2011-2015 Update. Nutrients 2017; 9:E234. [PMID: 28273872 PMCID: PMC5372897 DOI: 10.3390/nu9030234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/22/2017] [Accepted: 03/02/2017] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Folic acid (FA) is a synthetic compound commonly added for voluntary fortification of food products in many European countries. In our country, food composition databases (FCDB) lack comprehensive data on FA fortification practices and this is considered a priority research need when undergoing nutritional assessment of the population. METHODS A product inventory was collected and updated by visiting retail stores in Madrid Region, conducting online supermarket searches, and by the provision of food label information by manufacturers. Euro-FIR FCDB guidelines for data compilation and harmonization were used. RESULTS The FCDB, compiled between 2011 and 2015, includes FA as well as macro and micronutrient data from 338 fortified foodstuffs. As compared to previous FCDB updates (May 2010), 37 products have ceased to declare added FA in their labels, mainly yogurt and fermented milk products. The main food subgroup is 'breakfast cereals' (n = 95, 34% of total). However, the highest average FA fortification levels per recommended serving were observed in the 'milk, milk products, and milk substitutes' group at ≥35% FA Nutrient Reference Values (NRV, 200 µg, EU Regulation 1169 of 2011) (60-76.3 µg FA per 200 mL). Average contribution to the FA NRV per food group and serving ranged between 16%-35%. CONCLUSION Our data show a minor decrease in the number of FA fortified products, but vitamin levels added by manufacturers are stable in most food groups and subgroups. This representative product inventory comprises the main FA food source from voluntary fortification in our country. It is therefore a unique compilation tool with valuable data for the assessment of dietary intakes for the vitamin.
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Affiliation(s)
| | - Elena Alonso-Aperte
- Department of Pharmaceutical and Health Sciences, Faculty of Pharmacy, CEU San Pablo University, Madrid 28668, Spain.
| | - Gregorio Varela-Moreiras
- Department of Pharmaceutical and Health Sciences, Faculty of Pharmacy, CEU San Pablo University, Madrid 28668, Spain.
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Affiliation(s)
- James L Mills
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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14
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Affiliation(s)
- James L Mills
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Aggeliki Dimopoulos
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
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