Mandatory Folic Acid Food Fortification to Prevent Neural Tube Defects: The Pro or Con Debate

Evangelia Chrysanthopoulou; Irene Karampela; Chrysi Diakaki; Maria Theodorakopoulou; Apostolos Armaganidis

doi:doi:10.11648/j.ajim.20180604.14

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Mandatory Folic Acid Food Fortification to Prevent Neural Tube Defects: The Pro or Con Debate

Evangelia Chrysanthopoulou, Irene Karampela, Chrysi Diakaki, Maria Theodorakopoulou, Apostolos Armaganidis

Published in American Journal of Internal Medicine (Volume 6, Issue 4)

Received: 15 June 2018 Accepted: 9 July 2018 Published: 4 August 2018

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Abstract

Neural tube defects are the second most common congenital anomaly. Among the known risk factors, low levels of folic acid rank first as responsible for the majority of cases recorded worldwide. In 1986, the mandatory folic acid food fortification in the U.S.A. led to dramatic reduction of disease incidence, while for many people it was considered as one of the most successful interventions in the history of public health promotion. Despite the satisfactory results from all countries that adopted similar policies, a significant number of countries, including the EU, preferred alternative ways to address it, considering the very limited safety data for such an intervention. Today, after 20 years of mandatory fortification from a sufficiently representative sample (1/3 of the planet), the necessity to apply this at global level should probably be reviewed, since until now no correlation with unfavourable impacts has been demonstrated. Objective of the present review was to assess the necessity of mandatory folic acid food fortification in the context of congenital neural tube defects (NTDs) prevention. Material – Method: an extensive search in the electronic database PubMed was performed. Animal or in vivo studies and articles were excluded, due to the inability to draw conclusions that is frequently observed, as well as the strong suspicion of failure to respond to clinical data. Furthermore, part of the studies was derived from searches to the References of the articles of the aforementioned database. Conclusions: the decision of mandatory folic acid food fortification should be determined by specific factors as: disease prevalence, rates of planned pregnancies, efficiency of existing measures to decrease significantly the overall disease’s incidence and the folate level in the general population.

Published in	American Journal of Internal Medicine (Volume 6, Issue 4)
DOI	10.11648/j.ajim.20180604.14
Page(s)	66-72
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Neural Tube Defects, Spina Bifida, Anencephaly, Folic Acid Food Fortification, Folic Acid and Carcinogenicity

References

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APA Style

Evangelia Chrysanthopoulou, Irene Karampela, Chrysi Diakaki, Maria Theodorakopoulou, Apostolos Armaganidis. (2018). Mandatory Folic Acid Food Fortification to Prevent Neural Tube Defects: The Pro or Con Debate. American Journal of Internal Medicine, 6(4), 66-72. https://doi.org/10.11648/j.ajim.20180604.14

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ACS Style

Evangelia Chrysanthopoulou; Irene Karampela; Chrysi Diakaki; Maria Theodorakopoulou; Apostolos Armaganidis. Mandatory Folic Acid Food Fortification to Prevent Neural Tube Defects: The Pro or Con Debate. Am. J. Intern. Med. 2018, 6(4), 66-72. doi: 10.11648/j.ajim.20180604.14

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AMA Style

Evangelia Chrysanthopoulou, Irene Karampela, Chrysi Diakaki, Maria Theodorakopoulou, Apostolos Armaganidis. Mandatory Folic Acid Food Fortification to Prevent Neural Tube Defects: The Pro or Con Debate. Am J Intern Med. 2018;6(4):66-72. doi: 10.11648/j.ajim.20180604.14

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@article{10.11648/j.ajim.20180604.14,
  author = {Evangelia Chrysanthopoulou and Irene Karampela and Chrysi Diakaki and Maria Theodorakopoulou and Apostolos Armaganidis},
  title = {Mandatory Folic Acid Food Fortification to Prevent Neural Tube Defects: The Pro or Con Debate},
  journal = {American Journal of Internal Medicine},
  volume = {6},
  number = {4},
  pages = {66-72},
  doi = {10.11648/j.ajim.20180604.14},
  url = {https://doi.org/10.11648/j.ajim.20180604.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20180604.14},
  abstract = {Neural tube defects are the second most common congenital anomaly. Among the known risk factors, low levels of folic acid rank first as responsible for the majority of cases recorded worldwide. In 1986, the mandatory folic acid food fortification in the U.S.A. led to dramatic reduction of disease incidence, while for many people it was considered as one of the most successful interventions in the history of public health promotion. Despite the satisfactory results from all countries that adopted similar policies, a significant number of countries, including the EU, preferred alternative ways to address it, considering the very limited safety data for such an intervention. Today, after 20 years of mandatory fortification from a sufficiently representative sample (1/3 of the planet), the necessity to apply this at global level should probably be reviewed, since until now no correlation with unfavourable impacts has been demonstrated. Objective of the present review was to assess the necessity of mandatory folic acid food fortification in the context of congenital neural tube defects (NTDs) prevention. Material – Method: an extensive search in the electronic database PubMed was performed. Animal or in vivo studies and articles were excluded, due to the inability to draw conclusions that is frequently observed, as well as the strong suspicion of failure to respond to clinical data. Furthermore, part of the studies was derived from searches to the References of the articles of the aforementioned database. Conclusions: the decision of mandatory folic acid food fortification should be determined by specific factors as: disease prevalence, rates of planned pregnancies, efficiency of existing measures to decrease significantly the overall disease’s incidence and the folate level in the general population.},
 year = {2018}
}

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TY  - JOUR
T1  - Mandatory Folic Acid Food Fortification to Prevent Neural Tube Defects: The Pro or Con Debate
AU  - Evangelia Chrysanthopoulou
AU  - Irene Karampela
AU  - Chrysi Diakaki
AU  - Maria Theodorakopoulou
AU  - Apostolos Armaganidis
Y1  - 2018/08/04
PY  - 2018
N1  - https://doi.org/10.11648/j.ajim.20180604.14
DO  - 10.11648/j.ajim.20180604.14
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 66
EP  - 72
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20180604.14
AB  - Neural tube defects are the second most common congenital anomaly. Among the known risk factors, low levels of folic acid rank first as responsible for the majority of cases recorded worldwide. In 1986, the mandatory folic acid food fortification in the U.S.A. led to dramatic reduction of disease incidence, while for many people it was considered as one of the most successful interventions in the history of public health promotion. Despite the satisfactory results from all countries that adopted similar policies, a significant number of countries, including the EU, preferred alternative ways to address it, considering the very limited safety data for such an intervention. Today, after 20 years of mandatory fortification from a sufficiently representative sample (1/3 of the planet), the necessity to apply this at global level should probably be reviewed, since until now no correlation with unfavourable impacts has been demonstrated. Objective of the present review was to assess the necessity of mandatory folic acid food fortification in the context of congenital neural tube defects (NTDs) prevention. Material – Method: an extensive search in the electronic database PubMed was performed. Animal or in vivo studies and articles were excluded, due to the inability to draw conclusions that is frequently observed, as well as the strong suspicion of failure to respond to clinical data. Furthermore, part of the studies was derived from searches to the References of the articles of the aforementioned database. Conclusions: the decision of mandatory folic acid food fortification should be determined by specific factors as: disease prevalence, rates of planned pregnancies, efficiency of existing measures to decrease significantly the overall disease’s incidence and the folate level in the general population.
VL  - 6
IS  - 4
ER  -

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Author Information

Evangelia Chrysanthopoulou

Department of Intensive Care Unit, Attiko University Hospital, Haidari, Greece
Irene Karampela

Department of Intensive Care Unit, Attiko University Hospital, Haidari, Greece
Chrysi Diakaki

Department of Intensive Care Unit, Attiko University Hospital, Haidari, Greece
Maria Theodorakopoulou

Department of Intensive Care Unit, Attiko University Hospital, Haidari, Greece
Apostolos Armaganidis

Department of Intensive Care Unit, Attiko University Hospital, Haidari, Greece

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APA Style

Evangelia Chrysanthopoulou, Irene Karampela, Chrysi Diakaki, Maria Theodorakopoulou, Apostolos Armaganidis. (2018). Mandatory Folic Acid Food Fortification to Prevent Neural Tube Defects: The Pro or Con Debate. American Journal of Internal Medicine, 6(4), 66-72. https://doi.org/10.11648/j.ajim.20180604.14

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ACS Style

Evangelia Chrysanthopoulou; Irene Karampela; Chrysi Diakaki; Maria Theodorakopoulou; Apostolos Armaganidis. Mandatory Folic Acid Food Fortification to Prevent Neural Tube Defects: The Pro or Con Debate. Am. J. Intern. Med. 2018, 6(4), 66-72. doi: 10.11648/j.ajim.20180604.14

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AMA Style

Evangelia Chrysanthopoulou, Irene Karampela, Chrysi Diakaki, Maria Theodorakopoulou, Apostolos Armaganidis. Mandatory Folic Acid Food Fortification to Prevent Neural Tube Defects: The Pro or Con Debate. Am J Intern Med. 2018;6(4):66-72. doi: 10.11648/j.ajim.20180604.14

Copy | Download

@article{10.11648/j.ajim.20180604.14,
  author = {Evangelia Chrysanthopoulou and Irene Karampela and Chrysi Diakaki and Maria Theodorakopoulou and Apostolos Armaganidis},
  title = {Mandatory Folic Acid Food Fortification to Prevent Neural Tube Defects: The Pro or Con Debate},
  journal = {American Journal of Internal Medicine},
  volume = {6},
  number = {4},
  pages = {66-72},
  doi = {10.11648/j.ajim.20180604.14},
  url = {https://doi.org/10.11648/j.ajim.20180604.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20180604.14},
  abstract = {Neural tube defects are the second most common congenital anomaly. Among the known risk factors, low levels of folic acid rank first as responsible for the majority of cases recorded worldwide. In 1986, the mandatory folic acid food fortification in the U.S.A. led to dramatic reduction of disease incidence, while for many people it was considered as one of the most successful interventions in the history of public health promotion. Despite the satisfactory results from all countries that adopted similar policies, a significant number of countries, including the EU, preferred alternative ways to address it, considering the very limited safety data for such an intervention. Today, after 20 years of mandatory fortification from a sufficiently representative sample (1/3 of the planet), the necessity to apply this at global level should probably be reviewed, since until now no correlation with unfavourable impacts has been demonstrated. Objective of the present review was to assess the necessity of mandatory folic acid food fortification in the context of congenital neural tube defects (NTDs) prevention. Material – Method: an extensive search in the electronic database PubMed was performed. Animal or in vivo studies and articles were excluded, due to the inability to draw conclusions that is frequently observed, as well as the strong suspicion of failure to respond to clinical data. Furthermore, part of the studies was derived from searches to the References of the articles of the aforementioned database. Conclusions: the decision of mandatory folic acid food fortification should be determined by specific factors as: disease prevalence, rates of planned pregnancies, efficiency of existing measures to decrease significantly the overall disease’s incidence and the folate level in the general population.},
 year = {2018}
}

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TY  - JOUR
T1  - Mandatory Folic Acid Food Fortification to Prevent Neural Tube Defects: The Pro or Con Debate
AU  - Evangelia Chrysanthopoulou
AU  - Irene Karampela
AU  - Chrysi Diakaki
AU  - Maria Theodorakopoulou
AU  - Apostolos Armaganidis
Y1  - 2018/08/04
PY  - 2018
N1  - https://doi.org/10.11648/j.ajim.20180604.14
DO  - 10.11648/j.ajim.20180604.14
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 66
EP  - 72
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20180604.14
AB  - Neural tube defects are the second most common congenital anomaly. Among the known risk factors, low levels of folic acid rank first as responsible for the majority of cases recorded worldwide. In 1986, the mandatory folic acid food fortification in the U.S.A. led to dramatic reduction of disease incidence, while for many people it was considered as one of the most successful interventions in the history of public health promotion. Despite the satisfactory results from all countries that adopted similar policies, a significant number of countries, including the EU, preferred alternative ways to address it, considering the very limited safety data for such an intervention. Today, after 20 years of mandatory fortification from a sufficiently representative sample (1/3 of the planet), the necessity to apply this at global level should probably be reviewed, since until now no correlation with unfavourable impacts has been demonstrated. Objective of the present review was to assess the necessity of mandatory folic acid food fortification in the context of congenital neural tube defects (NTDs) prevention. Material – Method: an extensive search in the electronic database PubMed was performed. Animal or in vivo studies and articles were excluded, due to the inability to draw conclusions that is frequently observed, as well as the strong suspicion of failure to respond to clinical data. Furthermore, part of the studies was derived from searches to the References of the articles of the aforementioned database. Conclusions: the decision of mandatory folic acid food fortification should be determined by specific factors as: disease prevalence, rates of planned pregnancies, efficiency of existing measures to decrease significantly the overall disease’s incidence and the folate level in the general population.
VL  - 6
IS  - 4
ER  -

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