Nutr Res Pract.  2013 Aug;7(4):315-325.

Determinants of neural tube defect (NTD)-protective circulating concentrations of folate in women of child-bearing age in the US post-folic acid fortification era

Affiliations
  • 1Department of Nutrition Sciences, University of Alabama at Birmingham, 1675 University Blvd, Birmingham, AL 35294, USA. piyathic@uab.edu
  • 2Department of Preventive Medicine and Medical Research Institute, Chungbuk National University, Cheongju 361-763, Korea.
  • 3Department of Food and Nutrition, Chungbuk National University, Cheongju 361-763, Korea.
  • 4Department of Veterinary Sciences, University of Texas MD Anderson Cancer Center, Bastrop, TX 78602, USA.

Abstract

We evaluated folate status of child-bearing age women diagnosed with abnormal pap smear in the US post-folic acid (FA) fortification era and assessed the determinants of NTD-protective and supra-physiologic (SP) concentrations of folate. The distribution of 843 women according to NTD-protective concentrations of RBC folate, plasma folate and SP concentrations of plasma folate were tested in relation to demographic and life-style factors. Logistic regression models specified NTD-protective concentrations of RBC and plasma folate or SP concentrations of plasma folate as dependent variables and demographic and life-style factors as independent predictors of interest. More than 82% reached NTD-protective concentrations of RBC and plasma folate and ~30% reached SP concentrations of plasma folate. FA supplement use was associated with having SP concentrations of plasma folate rather than NTD-protective concentrations of folate. African American (AA) women and smokers were significantly less likely to achieve NTD-protective concentrations of RBC and plasma folate. A large majority of women reached NTD-protective concentrations of folate with the current level of FA fortification without using supplementary FA. Therefore, the remaining disparities in AA women and in smokers should be addressed by targeted individual improvements in folate intake.

Keyword

Folate; neural tube defect; child-bearing age

MeSH Terms

Female
Folic Acid
Humans
Logistic Models
Neural Tube
Neural Tube Defects
Plasma
Folic Acid

Reference

1. Werler MM, Shapiro S, Mitchell AA. Periconceptional folic acid exposure and risk of occurrent neural tube defects. JAMA. 1993; 269:1257–1261.
Article
2. Pitkin RM. Folate and neural tube defects. Am J Clin Nutr. 2007; 85:285S–288S.
Article
3. Centers for Disease Control and Prevention (CDC). Knowledge and use of folic acid by women of childbearing age-United States, 1995 and 1998. MMWR. 1999; 48:325–327.
4. Food and Drug Administration. Food standards: amendment of standards of identity for enriched grain products to require addition of folic acid. Final rule. 21 CFR parts 136, 137, and 139. Fed Regist. 1996; 61:8781–8807.
5. Daly LE, Kirke PN, Molloy A, Weir DG, Scott JM. Folate levels and neural tube defects. Implications for prevention. JAMA. 1995; 274:1698–1702.
Article
6. Dietrich M, Brown CJ, Block G. The effect of folate fortification of cereal-grain products on blood folate status, dietary folate intake, and dietary folate sources among adult non-supplement users in the United States. J Am Coll Nutr. 2005; 24:266–274.
Article
7. Caudill MA, Le T, Moonie SA, Esfahani ST, Cogger EA. Folate status in women of childbearing age residing in Southern California after folic acid fortification. J Am Coll Nutr. 2001; 20:129–134.
Article
8. Brown RD, Langshaw MR, Uhr EJ, Gibson JN, Joshua DE. The impact of mandatory fortification of flour with folic acid on the blood folate levels of an Australian population. Med J Aust. 2011; 194:65–67.
Article
9. Colapinto CK, O'Connor DL, Tremblay MS. Folate status of the population in the Canadian Health Measures Survey. CMAJ. 2011; 183:E100–E106.
Article
10. Dowd JB, Aiello AE. Did national folic acid fortification reduce socioeconomic and racial disparities in folate status in the US? Int J Epidemiol. 2008; 37:1059–1066.
Article
11. Bentley TG, Willett WC, Weinstein MC, Kuntz KM. Population-level changes in folate intake by age, gender, and race/ethnicity after folic acid fortification. Am J Public Health. 2006; 96:2040–2047.
Article
12. Yang Q, Carter HK, Mulinare J, Berry RJ, Friedman JM, Erickson JD. Race-ethnicity differences in folic acid intake in women of childbearing age in the United States after folic acid fortification: findings from the National Health and Nutrition Examination Survey, 2001-2002. Am J Clin Nutr. 2007; 85:1409–1416.
Article
13. Imhoff-Kunsch B, Flores R, Dary O, Martorell R. Wheat flour fortification is unlikely to benefit the neediest in Guatemala. J Nutr. 2007; 137:1017–1022.
Article
14. Pfeiffer CM, Caudill SP, Gunter EW, Osterloh J, Sampson EJ. Biochemical indicators of B vitamin status in the US population after folic acid fortification: results from the National Health and Nutrition Examination Survey 1999-2000. Am J Clin Nutr. 2005; 82:442–450.
Article
15. Smith AD, Kim YI, Refsum H. Is folic acid good for everyone? Am J Clin Nutr. 2008; 87:517–533.
Article
16. Ulrich CM, Potter JD. Folate supplementation: too much of a good thing? Cancer Epidemiol Biomarkers Prev. 2006; 15:189–193.
Article
17. Morris MS, Jacques PF, Rosenberg IH, Selhub J. Folate and vitamin B12 status in relation to anemia, macrocyosis and cognitive impairment among older Americans in the age of folic acid fortification. Am J Clin Nutr. 2007; 85:193–200.
Article
18. Yajnik CS, Deshpande SS, Jackson AA, Refsum H, Rao S, Fisher DJ, Bhat DS, Naik SS, Coyaji KJ, Joglekar CV, Joshi N, Lubree HG, Deshpande VU, Rege SS, Fall CH. Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: the Pune Maternal Nutrition Study. Diabetologia. 2008; 51:29–38.
Article
19. Kim YI. Will mandatory folic acid fortification prevent or promote cancer? Am J Clin Nutr. 2004; 80:1123–1128.
Article
20. Mojtabai R. Body mass index and serum folate in childbearing age women. Eur J Epidemiol. 2004; 19:1029–1036.
Article
21. Kimmons JE, Blanck HM, Tohill BC, Zhang J, Khan LK. Associations between body mass index and the prevalence of low micronutrient levels among US adults. MedGenMed. 2006; 8:59.
22. Ray JG, Wyatt PR, Vermeulen MJ, Meier C, Cole DE. Greater maternal weight and the ongoing risk of neural tube defects after folic acid flour fortification. Obstet Gynecol. 2005; 105:261–265.
Article
23. Scott JM, Ghanta V, Herbert V. Trouble-free microbiologic serum and red cell folate assays. Am J Med Technol. 1974; 40:125–134.
24. Piyathilake CJ. Folate and vitamin B-12 status and chromosomal damage in the buccal mucosa of smokers and non-smokers [Ph.D. dissertation]. Birmingham (AL): University of Alabama;1993.
25. Piyathilake CJ, Macaluso M, Hine RJ, Richards EW, Krumdieck CL. Local and systemic effects of cigarette smoking on folate and vitamin B-12. Am J Clin Nutr. 1994; 60:559–566.
Article
26. Wald NJ, Law MR, Morris JK, Wald DS. Quantifying the effect of folic acid. Lancet. 2001; 358:2069–2073.
Article
27. Honein MA, Paulozzi LJ, Mathews TJ, Erickson JD, Wong LY. Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects. JAMA. 2001; 285:2981–2986.
Article
28. Williams LJ, Rasmussen SA, Flores A, Kirby RS, Edmonds LD. Decline in the prevalence of spina bifida and anencephaly by race/ethnicity: 1995-2002. Pediatrics. 2005; 116:580–586.
Article
29. Ray JG, Wyatt PR, Thompson MD, Vermeulen MJ, Meier C, Wong PY, Farrell SA, Cole DE. Vitamin B12 and the risk of neural tube defects in a folic-acid-fortified population. Epidemiology. 2007; 18:362–366.
Article
30. Heseker HB, Mason JB, Selhub J, Rosenberg IH, Jacques PF. Not all cases of neural-tube defect can be prevented by increasing the intake of folic acid. Br J Nutr. 2009; 102:173–180.
Article
31. Fazili Z, Pfeiffer CM, Zhang M, Jain RB, Koontz D. Influence of 5,10-methylenetetrahydrofolate reductase polymorphism on whole-blood folate concentrations measured by LC-MS/MS, microbiologic assay, and bio-rad radioassay. Clin Chem. 2008; 54:197–201.
Article
32. Mc Nulty H, Scott JM. Intake and status of folate and related B-vitamins: considerations and challenges in achieving optimal status. Br J Nutr. 2008; 99:Suppl 3. S48–S54.
Article
33. Tinker SC, Hamner HC, Berry RJ, Bailey LB, Pfeiffer CM. Does obesity modify the association of supplemental folic acid with folate status among nonpregnant women of childbearing age in the United States? Birth Defects Res A Clin Mol Teratol. 2012; 94:749–755.
Article
34. Bentley TG, Willett WC, Weinstein MC, Kuntz KM. Population-level changes in folate intake by age, gender, and race/ethnicity after folic acid fortification. Am J Public Health. 2006; 96:2040–2047.
Article
35. Dowd JB, Aiello AE. Did national folic acid fortification reduce socioeconomic and racial disparities in folate status in the US? Int J Epidemiol. 2008; 37:1059–1066.
Article
36. Choumenkovitch SF, Selhub J, Wilson PW, Rader JI, Rosenberg IH, Jacques PF. Folic acid intake from fortification in United States exceeds predictions. J Nutr. 2002; 132:2792–2798.
Article
37. Brown JE, Jacobs DR Jr, Hartman TJ, Barosso GM, Stang JS, Gross MD, Zeuske MA. Predictors of red cell folate level in women attempting pregnancy. JAMA. 1997; 277:548–552.
Article
38. Piyathilake CJ, Macaluso M, Alvarez RD, Bell WC, Heimburger DC, Partridge EE. Lower risk of cervical intraepithelial neoplasia in women with high plasma folate and sufficient vitamin B12 in the post-folic acid fortification era. Cancer Prev Res (Phila Pa). 2009; 2:658–664.
Article
39. Clarke R, Halsey J, Lewington S, Lonn E, Armitage J, Manson JE, Bønaa KH, Spence JD, Nygård O, Jamison R, Gaziano JM, Guarino P, Bennett D, Mir F, Peto R, Collins R. B-Vitamin Treatment Trialists' Collaboration. Effects of lowering homocysteine levels with B vitamins on cardiovascular disease, cancer, and cause-specific mortality: meta-analysis of 8 randomized trials involving 37 485 individuals. Arch Intern Med. 2010; 170:1622–1631.
Article
40. Wilson SM, Bivins BN, Russell KA, Bailey LB. Oral contraceptive use: impact on folate, vitamin B6, and vitamin B12 status. Nutr Rev. 2011; 69:572–583.
Article
41. Gerstman BB, Gross TP, Kennedy DL, Bennett RC, Tomita DK, Stadel BV. Trends in the content and use of oral contraceptives in the United States, 1964-88. Am J Public Health. 1991; 81:90–96.
Article
42. Streiff RR. Folate deficiency and oral contraceptives. JAMA. 1970; 214:105–108.
Article
43. Holzgreve W, Pietrzik K, Koletzko B, Eckmann-Scholz C. Adding folate to the contraceptive pill: a new concept for the prevention of neural tube defects. J Matern Fetal Neonatal Med. 2012; 25:1529–1536.
Article
44. Bart S Sr, Marr J, Diefenbach K, Trummer D, Sampson-Landers C. Folate status and homocysteine levels during a 24-week oral administration of a folate-containing oral contraceptive: a randomized, double-blind, active-controlled, parallel-group, US-based multicenter study. Contraception. 2012; 85:42–50.
Article
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