Verhoef Hans, Veenemans Jacobien, Mwangi Martin N, Prentice Andrew M
London School of Hygiene and Tropical Medicine, MRC International Nutrition Group, London, UK.
Nutrition Theme, MRC Unit The Gambia, Banjul, Gambia.
Br J Haematol. 2017 Jun;177(6):905-918. doi: 10.1111/bjh.14618. Epub 2017 Mar 29.
For decades, folic acid has routinely been given to prevent or treat anaemia in children, pregnant women and people with sickle cell disease. However, there is no conclusive evidence that folate deficiency anaemia constitutes a public health problem in any of these groups. Industrial flour fortification is recommended and implemented in many countries to combat neural tube defects. Dietary folates or folic acid can antagonise the action of antifolate drugs that play a critical role in the prevention and treatment of malaria. Randomised trials have shown that folic acid supplementation increases the rate of treatment failures with sulfadoxine-pyrimethamine. The efficacy of antifolate drugs against Plasmodium is maximized in the absence of exogenous folic acid, suggesting that there is no safe minimum dose of ingested folic acid. We here review the safety and benefits of interventions to increase folate status in malaria-endemic countries. We conclude that formal cost-benefit analyses are required.
几十年来，叶酸一直被常规用于预防或治疗儿童、孕妇和镰状细胞病患者的贫血。然而，没有确凿证据表明叶酸缺乏性贫血在这些群体中的任何一个构成公共卫生问题。许多国家建议并实施工业面粉强化以对抗神经管缺陷。膳食叶酸或叶酸可拮抗在疟疾预防和治疗中起关键作用的抗叶酸药物的作用。随机试验表明，补充叶酸会增加磺胺多辛-乙胺嘧啶治疗失败的发生率。在没有外源性叶酸的情况下，抗叶酸药物对疟原虫的疗效最大化，这表明不存在安全的最低摄入叶酸剂量。我们在此回顾了疟疾流行国家提高叶酸水平干预措施的安全性和益处。我们得出结论，需要进行正式的成本效益分析。
