Contemporary Issues Surrounding Folic Acid Fortification Initiatives

Jeong-Hwa Choi; Zoe Yates; Martin Veysey; Young-Ran Heo; Mark Lucock

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한국식품영양과학회
Preventive Nutrition and Food Science 학술저널
Preventive Nutrition and Food Science Vol.19 No.4
2014.12 247 - 260 (14page)

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Jeong-Hwa Choi (University of Newcastle)
Zoe Yates (University of Newcastle)
Martin Veysey (Central Coast Local Health District)
Young-Ran Heo (Chonnam National University)
Mark Lucock (University of Newcastle)

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The impact of folate on health and disease, particularly pregnancy complications and congenital malformations, has been extensively studied. Mandatory folic acid fortification therefore has been implemented in multiple countries, resulting in a reduction in the occurrence of neural tube defects. However, emerging evidence suggests increased folate intake may also be associated with unexpected adverse effects. This literature review focuses on contemporary issues of concern, and possible underlying mechanisms as well as giving consideration the future direction of mandatory folic acid fortification. Folate fortification has been associated with the presence of unmetabolized folic acid (PteGlu) in blood, masking of vitamin B<SUB>12</SUB> deficiency, increased dosage for anti-cancer medication, photo-catalysis of PteGlu leading to potential genotoxicity, and a role in the pathoaetiology of colorectal cancer. Increased folate intake has also been associated with twin birth and insulin resistance in offspring, and altered epigenetic mechanisms of inheritance. Although limited data exists to elucidate potential mechanisms underlying these issues, elevated blood folate level due to the excess use of PteGlu without consideration of an individual"s specific phenotypic traits (e.g. genetic background and undiagnosed disease) may be relevant. Additionally, the accumulation of unmetabolized PteGlu may lead to inhibition of dihydrofolate reductase and other enzymes. Concerns notwithstanding, folic acid fortification has achieved enormous advances in public health. It therefore seems prudent to target and carefully monitor high risk groups, and to conduct well focused further research to better understand and to minimize any risk of mandatory folic acid fortification.

#mandatory folic acid fortification #synthetic folic acid #adverse effects #public health

ABSTRACT
INTRODUCTION
FOLIC ACID ABSORPTION AND DIHYDROFOLATE REDUCTASE
BACKGROUND TO THE IMPLEMENTATION OF MANDATORY FOLIC ACID FORTIFICATION
MANDATORY FOLIC ACID FORTIFICATION POLICIES IN SELECTED COUNTRIES
IMPROVED BLOOD FOLATE LEVEL AND DECREASED OCCURRENCE OF NEURAL TUBE DEFECTS
THE CONTROVERSY OF POTENTIAL ADVERSE EFFECTS OF EXCESS FOLIC ACID
CONCLUSION
REFERENCES