Folate and neural tube defects: The role of supplements and food fortification

Question 1

What does folate do?

Answer 1

1. DNA synthesis and repair
2. Cell growth and division
3. DNA methylation (important for epigenomic regulation)
4. Neural tube defects

Question 2

What foods are folate found in?

Answer 2

1. Leafy vegetables
2. Legumes
3. Red meat
4. Offal i.e. liver

Question 3

What percentage of folate is lost during cooking?

Answer 3

70%

Question 4

What is the etiology of NTD?

Answer 4

1. Genetics
2. chromosomal abnormalities
3. Environmental factors esp. folate

Question 5

What foods are fortified with folic acid?

Answer 5

All flour and grain products incld. ready-to-eat cereals and pastas with 150ug folic acid/100g

Question 6

What was the reduction of NTD post folic acid fortification of foods?

Answer 6

Decrease of spina bifida by 50%

All other NTDs by 2/3

Question 7

What are the recommendations regarding oral folic acid supplements?

Answer 7

Folic acid 0.4mg PO daily 2-3m pre-conceptation until 4-6w post partum

Question 8

Which women are considered high risk?

Answer 8

1. Birth of previous child with NTD
2. Family history of NTD
3. Maternal obesity
4. Maternal Hispanic origin
5. Use of some anticonvulsants
6. GDM (low risk)

Question 9

What are the recommendations regarding oral folic acid supplementation in women with a family history of NTD or other health complications?

Answer 9

Folic acid 5mg PO daily for 3m prior to conception and for 10-12 weeks post conception

Question 10

What are some challenges regarding food fortification?

Answer 10

There has been a significant decrease in intake of flour

SOGC recommends folic acid fortification of flour increased to 300ug/100g flour

Question 11

What percentage of N. American women of child-bearing age have suboptimal folic acid levels?

Answer 11

25%

Question 12

What is the connection between folate supplementation and vitamin B12 deficiency and pernicious anemia?

Answer 12

No threat of masking vitamin B12 deficiency

Question 13

What is the association between high folate and cancer?

Answer 13

1. No association with breast cancer
2. Unable to r/o some association with increase prostate cancer risk
3. Protective against pancreatic cancer in women, no effect on men
4. Reduction in risk of lung cancer
5. Reduction in risk of colorectal cancer

Question 14

What are the CPS recommendations re: folate and natural diet?

Answer 14

Eat folate-rich foods such as leafy green vegetables

Question 15

What are the CPS recommendations re: food fortification with folate?

Answer 15

Increase the level of folic acid food fortification

Question 16

What is the CPS recommendation re: oral supplementation with folate?

Answer 16

1. Women of child-bearing age should take a multivitamin containing folate 0.4mg and vitamin B12
2. Higher intake for high risk women
3. Provide free folate supplementation for women of child bearing age