Department of Pediatric Emergency, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Neonatal Intensive Care Unit, IRCCS Foundation Policlinico San Matteo, Pavia, Italy.
Ital J Pediatr. 2017 Aug 17;43(1):74. doi: 10.1186/s13052-017-0391-7.
The Mediterranean diet has been for a very long time the basis of food habits all over the countries of the Mediterranean basin, originally founded on rural models and low consumption of meat products and high-fat/high-processed foods. However, in the modern era, the traditional Mediterranean diet pattern is now progressively eroding due to the widespread dissemination of the Western-type economy, life-style, technology-driven culture, as well as the globalisation of food production, availability and consumption, with consequent homogenisation of food culture and behaviours. This transition process may affect many situations, including pregnancy and offspring's health. The problem of the diet during pregnancy and the proper intake of nutrients are nowadays a very current topic, arousing much debate. The Mediterranean dietary pattern, in particular, has been associated with the highest risk reduction of major congenital anomalies, like the heterogeneous class of neural tube defects (NTDs). NTDs constitute a major health burden (0.5-2/1000 pregnancies worldwide) and still remain a preventable cause of still birth, neonatal and infant death, or significant lifelong disabilities. Many studies support the finding that appropriate folate levels during pregnancy may confer protection against these diseases. In 1991 one randomised controlled trial (RCT) demonstrated for the first time that periconceptional supplementation of folic acid is able to prevent the recurrence of NTDs, finding confirmed by many other subsequent studies. Anyway, the high rate of unplanned/unintended pregnancies and births and other issues hindering the achievement of adequate folate levels in women in childbearing age, induced the US government and many other countries to institute mandatory food fortification with folic acid. The actual strategy adopted by European Countries (including Italy) suggests that women take 0,4 mg folic acid/die before conception. The main question is which intervention, between folic acid supplementation, foods fortification or both, linked to a healthy life-style and diet pattern may represent the best method in preventing NTDs. The aim of this review is to describe the actual situation in NTDs prevention, with a special attention to the Italiancontext concerning this delicate and controversial subject.
地中海饮食长期以来一直是地中海盆地各国饮食习惯的基础，最初以农村模式为基础，肉类产品和高脂肪/高加工食品的消费较低。然而，在现代，由于西方经济、生活方式、以技术为驱动的文化以及食品生产、供应和消费的全球化的广泛传播，传统的地中海饮食模式正在逐渐被侵蚀，导致食品文化和行为的同质化。这一转变过程可能会影响许多情况，包括怀孕和后代的健康。如今，饮食在怀孕期间的问题以及营养物质的适当摄入是一个非常热门的话题，引起了广泛的争论。特别是地中海饮食模式与降低主要先天畸形（如神经管缺陷（NTD）这一异质类别的风险有关。NTD 构成了重大的健康负担（全球范围内 0.5-2/1000 例妊娠），仍然是死产、新生儿和婴儿死亡或严重终身残疾的可预防原因。许多研究支持这样的发现，即怀孕期间适当的叶酸水平可能提供对这些疾病的保护。1991 年，一项随机对照试验（RCT）首次证明，在受孕前补充叶酸能够预防 NTD 的复发，随后的许多其他研究也证实了这一发现。然而，由于计划外/非意愿妊娠和分娩的高发生率以及其他阻碍生育年龄妇女获得足够叶酸水平的问题，美国政府和许多其他国家开始强制在食品中添加叶酸。欧洲国家（包括意大利）采用的实际策略建议妇女在受孕前每天服用 0.4 毫克叶酸。主要问题是，在预防 NTD 方面，叶酸补充剂、食品强化剂或两者结合，再加上健康的生活方式和饮食模式，哪种干预措施可能是最好的方法。本综述旨在描述 NTD 预防的现状，特别关注意大利在这个敏感和有争议的问题上的情况。
