Folic acid supplementation

Irmgard Schiller-Frühwirth
Project co-operation: Tim Johansson, Manuela Göbl, Sonja Reiselhuber
Duration: September 2008 - December 2008

Third-party funds project - Austrian Health Ministry
Publication: https://eprints.aihta.at/847

Background:
Folic acid, as a water-soluble B-vitamin, is very important for women of childbearing age because of its key-role in many metabolic processes, particularly in cell growth and cell regeneration. A folic acid deficiency in the early stages of pregnancy could lead to defects of the spinal column, so-called neural tube defects. In contrast to adolescents and adults, who normally need about 400 microgram folate equivalents a day, pregnant and breastfeeding women are in need of 600 microgram. German-speaking countries document about 1 neural tube defect per 1000 births. In the case of recurrence, the risk is about 3% and after a second occurrence about 10%. On average, between 300.000 and 400.000 children are affected by these defects world-wide. In Austria the frequency ranges from 70 to 80 cases per year. Recent studies have shown that the prevalence of neural tube defects can be reduced by the administration of folic acid before conception. The natural source of folic acid is food (folate). Artificially produced folic acid is contained in dietary supplements and in enriched foods. Hence the possibilities of an obligatory folic acid fortification of staple foods (such as flour), the selective intake of foods which are rich in folic acid, as well as folic acid tablets have been discussed world-wide, and are currently being discussed in Austria.

Aims and research objectives:
This review was requested by the Austrian Ministry of Health in order to provide a scientific basis for a decision for or against an obligatory folic acid enrichment of flour in Austria. The aim of the project is to describe the recent evidence on benefits and risks, as well as efficacy and safety of potential flour enrichment with folic acid. Efficacy was analysed with regard to the decrease of neural tube defects and other birth deformities, the risk of aborts and twin births, the prevalence of cardiovascular diseases, breast cancer, colorectal carcinoma, and also the safety regarding masking of a vitamin B 12-deficiency and anti-epileptic drug therapy. Further questions were: Which potential long-term effects of folic acid oversupply are predicted? Which ethical and social aspects have to be taken into consideration in case of a nationwide intervention such as the obligatory fortification of foods?

Method:
Systematic research in relevant databases such as Ovid Medline, Embase, DARE ,NHS, EED, HTA, Cochrane, World of knowledge (Wok); period 1993 – 2008; systematic review.

Publication:
Responsibility of the Austrian Health Ministry (BMGFJ)