Persistent circulating unmetabolised folic acid in a setting of liberal voluntary folic acid fortification. Implications for further mandatory fortification?
AuthorsSweeney, Mary R
Bailey, Steven W
Alverson, Patricia B
Ayling, June E
Scott, John M
AffiliationUCD School of Public Health and Population Science, University College Dublin,, and Coombe Women's and Infant's Hospital, Dublin, Ireland., firstname.lastname@example.org
Folic Acid/administration & dosage/*blood
MetadataShow full item record
CitationBMC Public Health. 2009 Aug 18;9:295.
JournalBMC public health
AbstractBACKGROUND: Ireland is an example of a country that has extensive voluntary fortification with folic acid. After a public consultation process, in 2006, the Food Safety Authority in Ireland FSAI 1 recommended mandatory fortification. However due to safety considerations this decision is now on hold. Before mandatory fortification goes ahead, existing levels of unmetabolised folic acid and their anticipated increase after fortification needs investigation because of the potential of folic acid to mask pernicious anaemia and possibly accelerate the growth of existing cancers. The aim of this study was to examine the levels of circulatory unmetabolised folic acid in Irish adults (both fasted and un-fasted) and new-born infants (fasted) before the proposed implementation of mandatory folic acid fortification. A secondary aim was to predict the increase in circulatory unmetabolised folic acid levels after fortification. METHODS: Study 1. Setting: Irish Blood Transfusion Service (IBTS). Whole blood samples were collected from blood donors (n=50) attending for routine blood donation sessions (representing the general population). Subjects were not fasted prior to sampling. Study 2. Setting: Coombe Women's and Infant's University Hospital, Dublin. Whole blood samples were collected by venipuncture from mothers (n=20), and from their infant's umbilical-cords (n=20) immediately after caesarean section. All women had been fasted for at least 8 hours prior to the surgery. A questionnaire on habitual and recent dietary intakes of folic acid was administered by an interviewer to all subjects. The data collection period was February to April 2006. Serum samples were analysed for plasma folate, plasma folic acid and red cell folate. RESULTS: Blood Donor Group: Circulatory unmetabolised folic acid was present in 18 out of 20 mothers (fasted) (CI: 68.3%-99.8%) comprising 1.31% of total plasma folate, 17 out of 20 babies (fasted) (CI: 62.1%-96.8%), and 49 out of 50 blood donors (unfasted) (CI: 88.0%-99.9%), comprising 2.25% of total plasma folate, CONCLUSION: While the levels of circulatory unmetabolised folic acid reported are low, it is persistently present in women immediately after caesarean section who were fasting indicating that there would be a constant/habitual exposure of existing tumours to folic acid, with the potential for accelerated growth. Mandatory fortification might exacerbate this. This has implications for those with responsibility for drafting legislating in this area.
- Unmetabolized folic acid prevalence is widespread in the older Irish population despite the lack of a mandatory fortification program.
- Authors: Boilson A, Staines A, Kelleher CC, Daly L, Shirley I, Shrivastava A, Bailey SW, Alverson PB, Ayling JE, McDermott AP, MacCooey A, Scott JM, Sweeney MR
- Issue date: 2012 Sep
- Synthetic folic acid intakes and status in children living in Ireland exposed to voluntary fortification.
- Authors: Vaish S, White M, Daly L, Molloy AM, Staines A, Sweeney MR
- Issue date: 2016 Feb
- Folic acid fortification and public health: report on threshold doses above which unmetabolised folic acid appear in serum.
- Authors: Sweeney MR, McPartlin J, Scott J
- Issue date: 2007 Mar 22
- Evidence of unmetabolised folic acid in cord blood of newborn and serum of 4-day-old infants.
- Authors: Sweeney MR, McPartlin J, Weir DG, Daly S, Pentieva K, Daly L, Scott JM
- Issue date: 2005 Nov
- Impact of voluntary fortification and supplement use on dietary intakes and biomarker status of folate and vitamin B-12 in Irish adults.
- Authors: Hopkins SM, Gibney MJ, Nugent AP, McNulty H, Molloy AM, Scott JM, Flynn A, Strain JJ, Ward M, Walton J, McNulty BA
- Issue date: 2015 Jun