Should Europe fortify a staple food with folic acid?
2007; Elsevier BV; Volume: 369; Issue: 9562 Linguagem: Inglês
10.1016/s0140-6736(07)60309-2
ISSN1474-547X
Autores Tópico(s)Congenital Anomalies and Fetal Surgery
ResumoThere is a large body of evidence that periconceptional folic acid protects against the occurrence of lethal anencephaly and disabling spina bifida,1MRC Vitamin Study Research GroupPrevention of neural tube defects: results of the Medical Research Council Vitamin Study.Lancet. 1991; 338: 131-137Summary PubMed Scopus (3510) Google Scholar which are collectively known as neural tube defects (NTDs) and which affect more than 4000 fetuses or babies in Europe each year. In most countries in Europe, women planning a pregnancy are advised to take 0·4 mg folic acid daily starting before conception and throughout the first trimester of pregnancy.2EUROCAT Folic Acid Working GroupPrevention of neural tube defects by periconceptional folic acid supplementation in Europe. 2nd edn. EUROCAT Central Registry, Newtownabbey2005http://www.eurocat.ulster.ac.uk/pubdata/folic%20acid.htmlGoogle Scholar However, most do not take folic acid supplementation before conception, and the hoped-for dramatic decline in NTD rates has failed to materialise.3Busby A Abramsky L Dolk H Armstrong B the EUROCAT Working Group on Periconceptional Folic AcidPreventing neural tube defects in Europe: population based study.BMJ. 2005; 330: 574-578Crossref PubMed Scopus (112) Google Scholar Many countries, particularly those of North and South America, have introduced mandatory fortification of flour with folic acid, and have enjoyed a reduction in NTD rates.4Lopez-Camelo JS Orioli IM da Graca Dutra M et al.Reduction of birth prevalence rates of neural tube defects after folic acid fortification in Chile.Am J Med Genet A. 2005; 135A: 120-125Crossref Scopus (144) Google ScholarThere have been moves towards fortification of flour in several European countries, but to date this has not been implemented. The main obstacle has been the concern that the known benefit of folic acid fortification to the few (women who become pregnant) and the potential benefits to the many (for example, the possible prevention of cardiovascular disease5Yang Q Botto LD Erickson JD et al.Improvement in stroke mortality in Canada and the United States, 1990 to 2002.Circulation. 2006; 113: 1335-1343Crossref PubMed Scopus (290) Google Scholar) might be outweighed by some as-yet-unknown risk for the general population. The general public and all stakeholders should be involved in determining this balance. Patients' or parents' organisations, who represent those most knowledgeable about the effect of NTDs on individuals and families, are key stakeholders.At the beginning of 2006, the EUROCAT (organisation for European Surveillance of Congenital Anomalies) Folic Acid Working Group sent out a brief questionnaire to representatives of NTD support groups in 25 countries across Europe. We asked what their position was regarding mandatory fortification of a staple food with folic acid and what they were doing about it. We received (after one reminder) replies from groups in 12 countries: Austria, Belgium, Croatia, Denmark, France, Ireland, Italy, the Netherlands, Portugal, Slovakia, Turkey, and the UK. It is plausible that the groups who did not reply were less interested in the issue of fortification, but this is not possible to verify.10 of the 12 groups were in favour of mandatory fortification of a staple food (usually flour) with folic acid. The other two, in the Netherlands and Italy, preferred voluntary fortification. Half of the ten groups in favour of mandatory fortification said that they were actively campaigning for it and half said they were not actively campaigning: three due to lack of resources, one because they were too busy with other problems, and one because they were still in the process of planning a campaign.We found that NTD support groups in Europe are generally in favour of mandatory fortification of flour with folic acid.We wish to thank the members of the NTD support groups who replied to our questionnaire and also colleagues who helped with translations where necessary. EUROCAT is supported by the Public Health Programme of the European Commission. We declare that we have no conflict of interest. There is a large body of evidence that periconceptional folic acid protects against the occurrence of lethal anencephaly and disabling spina bifida,1MRC Vitamin Study Research GroupPrevention of neural tube defects: results of the Medical Research Council Vitamin Study.Lancet. 1991; 338: 131-137Summary PubMed Scopus (3510) Google Scholar which are collectively known as neural tube defects (NTDs) and which affect more than 4000 fetuses or babies in Europe each year. In most countries in Europe, women planning a pregnancy are advised to take 0·4 mg folic acid daily starting before conception and throughout the first trimester of pregnancy.2EUROCAT Folic Acid Working GroupPrevention of neural tube defects by periconceptional folic acid supplementation in Europe. 2nd edn. EUROCAT Central Registry, Newtownabbey2005http://www.eurocat.ulster.ac.uk/pubdata/folic%20acid.htmlGoogle Scholar However, most do not take folic acid supplementation before conception, and the hoped-for dramatic decline in NTD rates has failed to materialise.3Busby A Abramsky L Dolk H Armstrong B the EUROCAT Working Group on Periconceptional Folic AcidPreventing neural tube defects in Europe: population based study.BMJ. 2005; 330: 574-578Crossref PubMed Scopus (112) Google Scholar Many countries, particularly those of North and South America, have introduced mandatory fortification of flour with folic acid, and have enjoyed a reduction in NTD rates.4Lopez-Camelo JS Orioli IM da Graca Dutra M et al.Reduction of birth prevalence rates of neural tube defects after folic acid fortification in Chile.Am J Med Genet A. 2005; 135A: 120-125Crossref Scopus (144) Google Scholar There have been moves towards fortification of flour in several European countries, but to date this has not been implemented. The main obstacle has been the concern that the known benefit of folic acid fortification to the few (women who become pregnant) and the potential benefits to the many (for example, the possible prevention of cardiovascular disease5Yang Q Botto LD Erickson JD et al.Improvement in stroke mortality in Canada and the United States, 1990 to 2002.Circulation. 2006; 113: 1335-1343Crossref PubMed Scopus (290) Google Scholar) might be outweighed by some as-yet-unknown risk for the general population. The general public and all stakeholders should be involved in determining this balance. Patients' or parents' organisations, who represent those most knowledgeable about the effect of NTDs on individuals and families, are key stakeholders. At the beginning of 2006, the EUROCAT (organisation for European Surveillance of Congenital Anomalies) Folic Acid Working Group sent out a brief questionnaire to representatives of NTD support groups in 25 countries across Europe. We asked what their position was regarding mandatory fortification of a staple food with folic acid and what they were doing about it. We received (after one reminder) replies from groups in 12 countries: Austria, Belgium, Croatia, Denmark, France, Ireland, Italy, the Netherlands, Portugal, Slovakia, Turkey, and the UK. It is plausible that the groups who did not reply were less interested in the issue of fortification, but this is not possible to verify. 10 of the 12 groups were in favour of mandatory fortification of a staple food (usually flour) with folic acid. The other two, in the Netherlands and Italy, preferred voluntary fortification. Half of the ten groups in favour of mandatory fortification said that they were actively campaigning for it and half said they were not actively campaigning: three due to lack of resources, one because they were too busy with other problems, and one because they were still in the process of planning a campaign. We found that NTD support groups in Europe are generally in favour of mandatory fortification of flour with folic acid. We wish to thank the members of the NTD support groups who replied to our questionnaire and also colleagues who helped with translations where necessary. EUROCAT is supported by the Public Health Programme of the European Commission. We declare that we have no conflict of interest.
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