Institute of Nutrition and Food Technology (INTA), University of Chile, and Genetic Unit, Hospital Clínico Universidad de Chile, Genetics Center, Clínica Las Condes, Chile.
Am J Med Genet A. 2012 Aug;158A(8):1885-90. doi: 10.1002/ajmg.a.35430. Epub 2012 Jun 18.
In January 2000, Chilean Ministry of Health mandated the addition of folic acid (FA) to wheat flour in order to reduce the risk of neural tube defects (NTDs). This policy resulted in significant increases in serum and red cell folate in women of fertile age 1 year after fortification. To evaluate the effect of wheat flour fortification on the prevalence of NTDs in Chile we designed a prospective hospital-based surveillance program to monitor the frequency of NTDs in all births (live and stillbirths) with birth weight≥500 g at the nine public maternity hospitals of Santiago, Chile from 1999 to 2009. During the pre-fortification period (1999-2000) the NTD rate was 17.1/10,000 births in a total of 120,566 newborns. During the post-fortification period (2001-2009) the NTD rate decreased to 8.6/10,000 births in a total of 489,915 newborns, which translates into a rate reduction of 50% (RR: 0.5; 95% CI: 0.42-0.59) for all NTDs. The rate reduction by type of NTD studied was: 50% in anencephaly (RR: 0.5; 95% CI: 0.38-0.67), 42% in cephalocele (RR: 0.58; 95% CI: 0.37-0.89), and 52% in spina bifida (RR: 0.48; 95% CI: 0.38-0.6). Rates showed significant reduction both in stillbirths and live births: 510.3 to 183.6/10,000 (RR=0.36; 95% CI: 0.25-0.53) and 13.3 to 7.5/10,000 (RR=0.56; 95% CI: 0.47-0.68), respectively. In Chile, fortification of wheat flour with FA has proven to be an effective strategy for the primary prevention of NTDs.
2000 年 1 月，智利卫生部规定在小麦粉中添加叶酸（FA），以降低神经管缺陷（NTD）的风险。这一政策导致在强化后 1 年内，育龄妇女的血清和红细胞叶酸显著增加。为了评估小麦粉强化对智利 NTD 患病率的影响，我们设计了一项前瞻性医院监测计划，以监测智利九个公立妇产医院所有出生体重≥500 克的活产和死产（活产和死产）中 NTD 的频率，时间范围为 1999 年至 2009 年。在强化前（1999-2000）期间，在总共 120566 名新生儿中，NTD 发生率为 17.1/10000 活产。在强化后（2001-2009）期间，NTD 发生率下降至 8.6/10000 活产，在总共 489915 名新生儿中，这意味着所有 NTD 的发生率降低了 50%（RR：0.5；95%CI：0.42-0.59）。按研究 NTD 类型的发生率降低情况为：无脑畸形降低 50%（RR：0.5；95%CI：0.38-0.67），脑脊膜膨出降低 42%（RR：0.58；95%CI：0.37-0.89），脊柱裂降低 52%（RR：0.48；95%CI：0.38-0.6）。死产和活产的发生率均显著下降：510.3 降至 183.6/10000（RR=0.36；95%CI：0.25-0.53）和 13.3 降至 7.5/10000（RR=0.56；95%CI：0.47-0.68）。在智利，用 FA 强化小麦粉已被证明是预防 NTD 的有效策略。
