Folic acid belongs to the group of water-soluble B vitamins and naturally exists in multiple forms in a wide variety of foods such as legumes, vegetables, liver, and milk (Iyer and Tomar, 2009; Lyon et al., 2020). It is involved in many biochemical reactions critical for cell division, such as purine and pyrimidine biosynthesis, DNA/RNA biosynthesis, and amino acid metabolism (Iyer and Tomar, 2009). Mammals cannot synthesize folic acid and thus they must acquire it from food. Although folic acid is ubiquitous in foods, folic acid deficiency still often occurs due to various causes such as unhealthy diet (Hildebrand et al., 2021; Iimura et al., 2022), disease-related malabsorption (Arcot and Shrestha, 2005), medication-related depletion (Arcot and Shrestha, 2005), or vitamin B12 deficiency (Fishman et al., 2000). Folic acid deficiency has been associated with several health problems, such as anemia (Carmel, 2005; Bailey and Caudill, 2012), cancer (Duthie, 1999), cardiovascular diseases (Wald et al., 2002), neural tube defects in newborns (van der Put et al., 2001), neuropsychiatric dysfunction (Shea et al., 2002), depression (Falade et al., 2021), inflammatory diseases (Suzuki and Kunisawa, 2015; Jones et al., 2019), and eye diseases (Sijilmassi, 2019). To prevent folic acid deficiency, its daily intake (400 μg/d) has been recommended for adults in the European Union, and its increased intake (600 μg/d) is advised for women before and during pregnancy (FAO/WHO, 2002; IOM, 2004). The New Zealand government mandated the fortification of non-organic wheat flour with folic acid in July 2021, and the UK government mandated the fortification of non-wholemeal wheat flour with folic acid in September 2021 (Haggarty, 2021).
Adult ; Animals ; Female ; Flour ; Folic Acid/metabolism* ; Folic Acid Deficiency/prevention & control* ; Food, Fortified ; Humans ; Infant, Newborn ; Mammals/metabolism* ; Pregnancy ; Triticum/metabolism*

BACKGROUND: Before iodination of Swedish table salt in 1936, iodine deficiency resulting in goitre and hypothyroidism was common. Sweden has become iodine sufficient, as shown in a national survey in 2007, proving its iodination fortification programme effective for the general population. The objective of this study was to collect drinking water from water treatment plants nationally and test if water iodine concentration (WIC) correlated to urinary iodine concentration (UIC) of school-aged children in a national survey 2007 to former goitre frequency in 1929 and to thyroid volume data in 2007. METHODS: In 2012, 166 treatment plants, located in 57% (166 of 290) of all Swedish municipalities, were asked to collect drinking water samples of approximately 10 ml. In 2007, tap water samples of the same volume were collected from 30 randomly selected schools for the national survey. Analysis of WIC was done in both treatment plants in 2012 (n = 166) and tap water in 2007 (n = 30). The correlation of WIC to the children's UIC and thyroid volume after iodination was tested based on data from the national survey in 2007. The association of WIC to former goitre frequency was tested based on pre-iodination data, derived from a map of goitre frequency drawn in 1929. RESULTS: The median WIC from water treatment plants was 4.0 μg/L (range 0-27 μg/L). WIC was similar in coastal and inland areas, for both ground and surface water. WIC correlated with historical goitre areas and was lower in the goitre areas than in non-goitre areas (p < 0.001). WIC in the same municipalities as the schools correlated with the UIC of children (p < 0.01), but not with their thyroid volume. CONCLUSIONS WIC still contributes to iodine nutrition in Sweden, but iodination overrides the goitre effect.
Adolescent ; Child ; Drinking Water ; chemistry ; Female ; Food, Fortified ; analysis ; Goiter ; epidemiology ; history ; History, 20th Century ; History, 21st Century ; Humans ; Iodine ; analysis ; urine ; Male ; Sodium Chloride, Dietary ; analysis ; Sweden ; epidemiology ; Thyroid Gland ; anatomy & histology

BACKGROUND/OBJECTIVES: The 6–23 months for infants is the longest period in the “first 1,000 days” of life. This period is very important for child development, so complementary feeding (CF) practices should be optimized to maximize children's potential for growth and development. The aim of this study was to analyze the CF practices and nutritional status of children aged 6–23 months. SUBJECTS/METHODS: For this cross-sectional study, 392 children aged 6–23 months were selected using stratified random sampling. Socio-demographic data were collected through interviews. CF practices, collected by interviews and repeated 24-hour food recall method, were the timely introduction of CF, minimum meal frequency, dietary diversity and minimum acceptable diet, consumption food rich in proteins and vitamin A. Nutritional status was assessed using the indicators of underweight, wasting and stunting. To analyze the association between socio-demographic indicators and CF with nutritional status, the chi-square test with a confidence interval of 95% was used. RESULTS: Results showed that 39% were exclusively breastfed, only 61% received prolonged breastfeeding and 50% received timely introduction of CF. Minimum meal frequency was met by 74% of subjects, but dietary diversity and minimum acceptable diet were only realized in 50% and 40% of the children, respectively. The prevalence of underweight, wasting, and stunting were 26%, 23%, and 28%, respectively. Age of the child, birth order, birth weight, parents' education level, family size and incidence of fever and diarrhea during the previous two weeks were associated with underweight, while child's birth order, fathers' education level, mother's age, family size, completion of the age-appropriate vaccination and fish consumption frequency were associated with wasting. Age of the child, incidence of fever and acute respiratory infection, and fortified food consumption were associated with stunting. CONCLUSIONS: Suboptimal CF practices and high prevalence of underweight, wasting and stunting were found among children aged 6–23 months old in Aceh. These results highlight the need to improve CF and nutritional status.
Birth Order ; Birth Weight ; Breast Feeding ; Child Development ; Child* ; Cross-Sectional Studies ; Diarrhea ; Diet ; Education ; Family Characteristics ; Fever ; Food, Fortified ; Growth and Development ; Growth Disorders ; Humans ; Incidence ; Indonesia* ; Infant ; Infant Nutritional Physiological Phenomena* ; Meals ; Methods ; Nutritional Status* ; Prevalence ; Thinness ; Vaccination ; Vitamin A

BACKGROUND AND PURPOSE: Additional folic acid (FA) treatment appears to have a neutral effect on reducing vascular risk in countries that mandate FA fortification of food (e.g., USA and Canada). However, it is uncertain whether FA therapy reduces stroke risk in countries without FA food fortification. The purpose of this study was to comprehensively evaluate the efficacy of FA therapy on stroke prevention in countries without FA food fortification. METHODS: PubMed, EMBASE, and clinicaltrials.gov from January 1966 to August 2016 were searched to identify relevant studies. Relative risk (RR) with 95% confidence interval (CI) was used as a measure of the association between FA supplementation and risk of stroke, after pooling data across trials in a random-effects model. RESULTS: The search identified 13 randomized controlled trials (RCTs) involving treatment with FA that had enrolled 65,812 participants, all of which stroke was reported as an outcome measure. After all 13 RCTs were pooled, FA therapy versus control was associated with a lower risk of any future stroke (RR, 0.85; 95% CI, 0.77 to 0.95). FA alone or combination of FA and minimal cyanocobalamin (≤0.05 mg/day) was associated with a lower risk of future stroke (RR, 0.75; 95% CI, 0.66 to 0.86) whereas combination of FA and cyanocobalamin (≥0.4 mg/day) was not associated with a lower risk of future stroke (RR, 0.95; 95% CI, 0.86 to 1.05). CONCLUSIONS: FA supplement reduced stroke in countries without mandatory FA food fortification. The benefit was found mostly in patients receiving FA alone or combination of FA and minimal cyanocobalamin.
Folic Acid ; Food, Fortified ; Humans ; Outcome Assessment (Health Care) ; Stroke ; Vitamin B 12

In the Chinese national nutrition surveys, fortified foods were not investigated separately from the base diet, and the contribution of fortified foods to micronutrients intake is not very clear. This study investigated the diet, including fortified foods and food supplements, of urban pregnant women and analyzed the intake of calcium, iron, and zinc to assess the corresponding contributions of fortified foods, food supplements, and the base diet. The results demonstrated that the base diet was the major source of calcium, iron, and zinc, and was recommended to be the first choice for micronutrients intake. Furthermore, consumption of fortified foods and food supplements offered effective approaches to improve the dietary intake of calcium, iron, and zinc in Chinese urban pregnant women.
Adult ; Calcium, Dietary ; analysis ; metabolism ; China ; Cities ; Diet ; Dietary Supplements ; analysis ; Female ; Food, Fortified ; analysis ; Health Knowledge, Attitudes, Practice ; Humans ; Iron, Dietary ; analysis ; metabolism ; Micronutrients ; analysis ; metabolism ; Minerals ; analysis ; Pregnancy ; Socioeconomic Factors ; Urban Health ; statistics & numerical data ; Young Adult ; Zinc ; analysis ; metabolism

Adult ; Anemia, Iron-Deficiency ; epidemiology ; prevention & control ; China ; epidemiology ; Cost-Benefit Analysis ; Female ; Food, Fortified ; Health Education ; methods ; Health Knowledge, Attitudes, Practice ; Health Promotion ; methods ; Humans ; Middle Aged ; Outcome Assessment (Health Care) ; Pilot Projects ; Soy Foods ; Young Adult

PURPOSE: The purpose of this study was to estimate dietary intake of vitamin D and the relationship between serum 25-hydroxyvitamin D (25OHD) concentration and bone mineral density (BMD) in Korean adults using the 2011 data from the Korea National Health and Nutrition Examination Survey. METHODS: Daily intake of vitamin D and ratio of subjects that consumed less vitamin D than adequate intake (AI) were estimated in 4,879 Korean adults. The relationship between daily intake of vitamin D and serum 25OHD and BMD were analyzed. RESULTS: Average daily intakes of vitamin D were 3.84 ± 0.23 µg/day for men and 2.22 ± 0.11 µg/day for women. Approximately 72~97% of men and 80~99% of women consumed less than the AI of vitamin D for Koreans. Serum 25OHD concentration increased with age, and the ratios of serum vitamin D deficiency (< 20 ng/mL) were 47.8~81.1% for men and 59.4~92.8% for women. Average intake of vitamin D was higher in subjects aged < 50 yr than in those ≥ 50 yr, but lower in serum 25OHD concentration. In subjects aged < 50 yr, serum 25OHD was higher in subjects that consumed 10 µg/day of vitamin D than in those that consumed less than 5 µg/day. In female subjects aged ≥ 50 yr, average intake of vitamin D was associated with higher bone mineral density. CONCLUSION: It was found that dietary intake of vitamin D could increase serum 25OHD concentration in young adults and bone mineral density in old women. Therefore, nutrition policies for enriched foods with vitamin D and nutrition education to consume more vitamin D-rich foods are needed to ameliorate vitamin D status of the Korean population. Adequate intake for Korean population aged < 50 yr might be adjusted upwardly up to 10 µg/day.
Adult* ; Bone Density* ; Education ; Female ; Food, Fortified ; Humans ; Korea* ; Male ; Nutrition Policy ; Nutrition Surveys* ; Vitamin D Deficiency ; Vitamin D* ; Vitamins* ; Young Adult

Epidemiological surveys show that folic acid can prevent prostate cancer, but fortified folic acid may increase the risk of the malignancy. The physician data queries from the National Cancer Institute of the USA describe folate as protective against prostate cancer, whereas its synthetic analog, folic acid, is considered to increase prostate cancer risk when taken at levels easily achievable by eating fortified food or taking over-the-counter supplements. We review the current literature to examine the effects of folate and folic acid on prostate cancer, help interpret previous epidemiologic data, and provide a clarification regarding the apparently opposing roles of folate for patients with prostate cancer. A literature search was conducted in Medline to identify studies investigating the effect of nutrition and specifically folate and folic acid on prostate carcinogenesis and progression. In addition, the National Health and Nutrition Examination Survey database was analyzed for the trends in serum folate levels before and after mandatory fortification. Folate likely plays a dual role in prostate carcinogenesis. There remains some conflicting epidemiologic evidence regarding folate and prostate cancer risk. However, there is growing experimental evidence that higher circulating folate levels can contribute to prostate cancer progression. Further research is needed to clarify these complex relationships.
Dietary Supplements ; adverse effects ; Disease Progression ; Folic Acid ; analogs & derivatives ; blood ; pharmacology ; Food, Fortified ; Humans ; Male ; Nutrition Surveys ; Nutritional Status ; Prostatic Neoplasms ; blood ; chemically induced

OBJECTIVETo assess the effect of sodium iron ethylenediaminetetraacetate (NaFeEDTA)-fortified soy sauce on anemia prevalence in the Chinese population.

METHODSA systematic review was performed to identify potential studies by searching the electronic databases of PubMed, Cochrane Library, WHO Library, HighWire, CNKI, and other sources. The selection criteria included randomized controlled trials that compared the efficacy of NaFeEDTA-fortified soy sauce with that of non-fortified soy sauce. Anemia rates and hemoglobin levels were the outcomes of interest. Inclusion decisions, quality assessment, and data extraction were performed by two reviewers independently. A total of 16 studies met the inclusion criteria for anemia rate analysis, of which 12 studies met the inclusion criteria for hemoglobin analysis. All included studies assessed the effect of NaFeEDTA-fortified soy sauce on anemia rates and hemoglobin concentrations.

RESULTSAfter the intervention, the hemoglobin concentration increased and anemia rates decreased significantly as compared with the non-fortified soy sauce groups. For anemia rates, data from 16 studies could be pooled, and the pooled estimate odds ratio was 0.25 (95% CI 0.19-0.35). For hemoglobin concentrations, data from 12 studies could be pooled, and the pooled weighted mean difference was 8.81 g/L (95% CI 5.96-11.67).

CONCLUSIONNaFeEDTA-fortified soy sauce has a positive effect on anemia control and prevention in the at-risk population.

Age Factors ; Anemia, Iron-Deficiency ; epidemiology ; prevention & control ; China ; epidemiology ; Edetic Acid ; Ferric Compounds ; Food, Fortified ; Hematocrit ; Humans ; Prevalence ; Randomized Controlled Trials as Topic ; Soy Foods

Dietary supplement use is prevalent and represents an important source of nutrition. This study was conducted in order to assess the dietary maximum exposure of vitamins and minerals from various sources including regular diet, vitamin.mineral supplements for non-prescription drug (VMS-NPD), vitamin.mineral supplements for health functional foods (VMS-HFF), and fortified foods (FF). A total of 1,407 adolescent boys and girls attending middle or high schools were chosen from various cities and rural communities in Korea. Users of vitamin and mineral supplements (n = 60, 15-18 years of age) were chosen from the above 1,407 students. Intake of vitamins and minerals from a regular diet and FF was assessed by both food record method and direct interview for three days of two weekdays and one weekend, and those from VMS-NPD and VMS-HFF were assessed by both questionnaire and direct interview, and compared with the recommended nutrient intake (RNI) and the tolerable upper intake level (UL) for Korean adolescents. Daily average exposure range of vitamins and minerals from a regular diet was 0.3 to 4.4 times of the RNI. Some subjects had an excessive exposure to the UL in the following areas: from regular diets, vitamin A (1.7%) and niacin (5.0%); from only VMS-NPD, vitamin C (9.1%) and iron (5.6%); and from only VMS-HFF, niacin (8.6%) > vitamin B6 (7.5%) > folic acid (2.9%) > vitamin C (2.3%). Nutrients of daily total intake from regular diet, VMS-NPD, VMS-HFF, and FF higher than the UL included nicotinic acid for 33.3% of subjects, and, then, in order, vitamin C (26.6%) > vitamin A (13.3%), iron (13.3%) > zinc (11.7%) > calcium (5.0%) > vitamin E (1.7%), vitamin B6 (1.7%). Thus, findings of this study showed that subjects may potentially be at risk due to overuse of supplements, even though most of them took enough vitamins and minerals from their regular diet. Therefore, we should encourage adolescents to have sound health care habits through systematic and educational aspects.
Adolescent* ; Ascorbic Acid ; Calcium ; Delivery of Health Care ; Diet ; Dietary Supplements ; Folic Acid ; Food, Fortified ; Functional Food ; Humans ; Iron ; Korea ; Minerals* ; Niacin ; Surveys and Questionnaires ; Rural Population ; Vitamin A ; Vitamin B 6 ; Vitamin E ; Vitamins* ; Zinc