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Public health failure in the prevention of neural tube defects: time to abandon the tolerable upper intake level of folate.

Wald, NJ; Morris, JK; Blakemore, C (2018) Public health failure in the prevention of neural tube defects: time to abandon the tolerable upper intake level of folate. Public Health Rev, 39. p. 2. ISSN 0301-0422 https://doi.org/10.1186/s40985-018-0079-6
SGUL Authors: Morris, Joan Katherine

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Abstract

The neural tube defects anencephaly and spina bifida are two of the most common serious congenital malformations. Most cases can be prevented by consuming sufficient folic acid immediately before pregnancy and in early pregnancy. Fortification of flour with folic acid to prevent these defects has been implemented in 81 countries without public objection or indication of harm. An obstacle to the wider adoption of fortification arises from the creation of a "tolerable upper intake level" for folate (which includes natural food folate as well as synthetic folic acid), and which has been set at 1 mg/day, thereby proscribing higher folate intakes. Increasing the intake of folic acid in a population will necessarily increase the number of people with a folate intake greater than 1 mg per day, and this concern is obstructing folic acid fortification. This paper shows that the scientific basis for setting any upper limit, let alone one at 1 mg/day, is flawed. An upper intake level is therefore unnecessary and should be removed, thus allaying unjustified concerns about folic acid fortification. As a result, the full global opportunity to prevent two serious fatal or disabling disorders can and should be realized.

Item Type: Article
Additional Information: © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Anencephaly, Folate, Folic acid, Neural tube defects, Spina bifida, Tolerable upper intake level, General & Internal Medicine
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: Public Health Rev
ISSN: 0301-0422
Language: eng
Dates:
DateEvent
31 January 2018Published
8 January 2018Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 29450103
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110348
Publisher's version: https://doi.org/10.1186/s40985-018-0079-6

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