Nutrition Department, Ministry of Health and Medical Education, Tehran University of Medical Science, Iran.
Ann Nutr Metab. 2011;58(3):188-96. doi: 10.1159/000329726. Epub 2011 Jul 9.
Flour fortification with folic acid is one of the main strategies for improving folate status in women of childbearing age. No interventional trial on the efficacy of folic acid fortification has been conducted so far in Iran.
To study the effects of flour fortification with folic acid on any reduction in neural tube defects (NTDs) and folate status of women of childbearing age.
In a longitudinal hospital-based study, 13,361 postpartum women were studied after admission for childbirth before and after fortification. In addition, two cross-sectional surveys were conducted before (2006) and after flour fortification (2008). The cluster sampling method was used and 580 women, 15-49 years old, were studied as a representative sample of Golestan province in the north of Iran. Fasting blood samples were collected to measure serum vitamin B(12), folate and plasma homocysteine. Sociodemographic data, health characteristics and dietary intake were determined.
The mean daily intakes of folate from natural food before and after flour fortification were 198.3 and 200.8 μg/day, respectively. The total folate intake increased significantly from 198.3 to 413.7 μg/day after fortification (p < 0.001). Folate intake increased by an average of 226 μg/day from fortified bread. The mean serum folate level increased from 13.6 to 18.1 nmol/l; folate deficiency decreased from 14.3 to 2.3% (p < 0.001). The incidence rate of NTDs declined by 31% (p < 0.01) in the post-fortification period (2.19 per 1,000 births; December 2007 to December 2008) compared to the pre-fortification period (3.16 per 1,000 births; September 2006 to July 2007).
Implementation of mandatory flour fortification with folic acid can lead to a significant increase in serum folate and a significant decrease in NTDs.
在育龄妇女中，叶酸强化面粉是改善叶酸状况的主要策略之一。迄今为止，伊朗尚未进行任何关于叶酸强化效果的干预试验。
研究叶酸强化面粉对降低神经管缺陷（NTDs）和育龄妇女叶酸状况的影响。
在一项基于医院的纵向研究中，在强化前后，对 13361 名产后住院的妇女进行了研究。此外，在强化前（2006 年）和强化后（2008 年）进行了两次横断面调查。采用聚类抽样法，选择伊朗北部戈勒斯坦省的 580 名 15-49 岁的妇女作为代表性样本。采集空腹血样，测量血清维生素 B（12）、叶酸和血浆同型半胱氨酸。确定社会人口统计学数据、健康特征和饮食摄入。
强化前后，从天然食物中摄入叶酸的平均日摄入量分别为 198.3 和 200.8μg/天。强化后总叶酸摄入量从 198.3μg/天显著增加至 413.7μg/天（p<0.001）。从强化面包中摄入的叶酸平均增加了 226μg/天。血清叶酸水平从 13.6 增加到 18.1nmol/L；叶酸缺乏症从 14.3%降至 2.3%（p<0.001）。强化后神经管缺陷的发生率下降了 31%（p<0.01）（2.19/1000 例活产；2007 年 12 月至 2008 年 12 月）与强化前（3.16/1000 例活产；2006 年 9 月至 2007 年 7 月）相比。
实施强制叶酸强化面粉可以显著增加血清叶酸水平，并显著降低神经管缺陷的发生率。
