Subject: Folic Acid Fortification
Of Corn Flour
Posted by: Ellen
Finegan R.N. B.S.N. on 10/06/05
How can the public health professionals partner with other organizations to work toward the fortification of corn flour with folic acid ? Cindy Brownstein mentioned her work with the C.D.C. and the Spina Bifida Association to encourage the company that makes MASECA corn flour to consider voluntary fortification.
Subject: Re: Folic Acid Fortification Of Corn Flour Hello Ellen,
The National Council on Folic Acid (NCFA) is leading efforts to approach
GRUMA, a major cornmeal manufacturer, about the possibilities of folic
acid fortification of its products at the recommended levels. Organizations
can participate by signing letters going out to GRUMA or can write
letters to GRUMA themselves. It would be best for interested organizations
to contact NCFA for more information. The website is http://www.folicacidinfo.org and
the contact email is info@folicacidinfo.org Thank you for your interest
in this important issue!
Thank you all so much for your participation in this important broadcast!
If you have questions or comments, please post them here before 10/07/05.
After 10/07/05, you may email a question or comment to the Birth Defects
Prevention Research Team at CDC at flo@cdc.gov.
You can find more information about folic acid and birth defects prevention
online at: www.cdc.gov/folicacid
You can order free folic acid educational materials online at: http://www2.cdc.gov/ncbddd/faorder
Thank you!
Katie Kilker
Birth Defects Prevention Research Team
CDC/NCBDDD
does alcohol deplete folic acid in the body (if one is taking a supplement)?
if so, is there a dose dependent effect? for example, if one drinks
1 glass of red wine per day (no effect) vs. 3 glasses per day (measured
depletion)?
I understand that 400 mcg is the recommended dose, however what is the
min dose that shows reduction...for example 200 mcg shows 20% incidence
reduction?
Andrea,
Alcohol can decrease folic acid absorption. Folic acid is a water-soluable
vitamin, which means that what the body doesn't use it excretes, so
folic acid needs to be replenished every day. If a woman drinks alcohol,
her body may not be absorbing all of the folic acid she consumes each
day. We are not aware of any data about the relationship between alcohol
dosage and absorption.
However, another thing to think about is that if a woman is planning
to become pregnant or could possibly become pregnant, she should avoid
alcohol consumption altogether. Drinking any amount or kind of alcoholic
beverage during pregnancy-including during the first few weeks, before
she knows she is pregnant- can put a baby at risk for a lifetime of problems
associated with a fetal alcohol spectrum disorder.
About your next question...
CDC and the US Public Health Service recommends a daily dose of 400 mcg
of folic acid daily for all women of childbearing age. This dose, 400
mcg, was the smallest dose that the US Public Health Service could recommend
for the prevention of neural tube defects. Smaller daily doses of folic
acid may have protective benefits of a lesser degree but it is not proven.
We have seen a partial decline in affected pregnancies as a result of
fortification of flour with folic acid. This may suggest that lower dosages
of folic acid could prevent some cases. At this point in time, the recommendation
reamins at 400 mcg daily.
If you have additional questions about neural tube defects or folic acid,
please email the team at flo@cdc.gov.
The comment was made regarding the increased risk of NTD's among Hispanic
women, with one explanation being inadequate dietary intake of fortified
grains/cereals. The graph showing pre and post fortification rates
of NTD's by race/ethnicity seemed to show that the most dramatic decrease
in pre- and post- rates was in fact among Hispanics, eventhough their
rates over all were higher for pre and post-. This seems contradicatory
and if in fact they do not have adequate intake of fortified grains,
then I would not have expected such a steep drop relative to other
ethnicities/race?
Hi Wes. Thank you for your question, it's a good one. Inadequate dietary
intake of fortified foods really can't be looked at in isolation as
a cause of higher NTD rates among Hispanic women. There are several
factors, including inadequate dietary intake of fortified foods along
with lower levels of multivitamin and synthetic folic acid consumption,
that really need to be looked at in combination. We understand that
there are probably other factors that have not yet been well documented
that may also play a role into why we saw such a steep drop in rates
among Hispanic women. We certainly would hope that intensive education
efforts put forth by several states have helped to increase fortified
food intake and multivitamin consumption among Hispanic women.
Interesting rounds but I wonder about a few things. First, quite a bit
of research I have read notes the high incidence of spina bifda and NTDs
amongs persons of Irish descent, which was not mentioned today. Second,if
folic acids works about half the time (50%-70% effective) to reduce NTDs,
what, then, might be causing the other half of the NTDs?
Hi Byron. Good question. The latest research has shown that rates of
NTDs are highest among Hispanic women. This is a change from the trend
seen years earlier, that pointed to women of Irish descent as those having
the higher rates. Spina bifida was indeed once considered a " blue eye,
blond hair" condition, owing to the higer rates among women of Irish
descent. However, research now shows that these rates have shifted with
Hispanic women having the higher rates.
You are correct. Up to 70% of NTDs are considered folic acid preventable.
The remaining percentage may be due to a combination of genetic and environmental
factors. More research into this area is needed.
Welcome to the discussion forum for the grand rounds session Birth
Defects Prevention: Realizing the Full Potential of Folic Acid! The forum
will be available until October 7th, 2005. I invite you to submit your
ideas, questions, and comments and encourage ongoing discussion of the
important issues related to folic acid and birth defects prevention.
Please visit the Florida Folic Acid Coalition website at www.folicacidnow.net.
In addtion, through the March of Dimes Florida Chapter Vita Grant, the
Florida Depeartment of Health is providing free multivitamins to under
served women of child bearing age. The Vita Grant will provide free multivitmaims
through 2007.
The University of South Florida through March of Dimes funding has developed
a series of materials targeted at Hispanic women. The materials include
a low-literacy brochure, a photo novella (The Story of Three Sisters),
and a video novella based on the photo novella.
The University of Florida, also with March of Dimes funding, developed
the " Folic Acid Every Day" tool-kit. Another of UF's folic acid products
includes a program targeted at youth and distributed through the 4-H
program in Florida.
Please feel free to contact me or other members of the Florida Folic
Acid Coaltion regarding our programs and materials. Our contact information
is on our website.
Kim