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• W2098453804 abstract "Background Folic acid is known to prevent neural-tube defects (NTDs) but the size of the effect for a given dose is unclear. We aimed to quantify such an effect. Methods We used published data from 13 studies of folic acid supplementation on serum folate concentrations and results from a large cohort study of the risk of NTDs according to serum folate, to measure the preventive effect of specified increases in intake of folic acid. Findings Serum folate concentrations increase by 0·94 ng/mL (95% Cl 0·77–1·10) for every 0·1 mg/day increase in folic acid intake in women aged 20–35 years, and about double that in people aged 40–65. Every doubling of serum folate concentration roughly halves the risk of an NTD. These two effects can be combined to predict the reduction in risk according to intake of extra folic acid and background serum folate concentration. Such results predict that the preventive effect is greater in women with low serum folate than in those with higher concentrations. The results have also been used to predict direct observations from large randomised trials and the effect of food fortification. From a typical western background serum folate of 5 ng/mL, about 0·2 mg/day (the US level of folic acid fortification) would be expected to reduce NTDs by about 20%; a similar effect can be expected from the current British recommendation (0·24 mg/day). An increase of 0·4 mg/day would reduce risk by about 36%, of 1 mg/day by 57%, and taking a 5-mg tablet daily would reduce risk by about 85%. Interpretation Folic acid fortification levels should be increased. Additionally women planning a pregnancy should take 5 mg folic acid tablets daily, instead of the 0·4 mg dose presently recommended. Folic acid is known to prevent neural-tube defects (NTDs) but the size of the effect for a given dose is unclear. We aimed to quantify such an effect. We used published data from 13 studies of folic acid supplementation on serum folate concentrations and results from a large cohort study of the risk of NTDs according to serum folate, to measure the preventive effect of specified increases in intake of folic acid. Serum folate concentrations increase by 0·94 ng/mL (95% Cl 0·77–1·10) for every 0·1 mg/day increase in folic acid intake in women aged 20–35 years, and about double that in people aged 40–65. Every doubling of serum folate concentration roughly halves the risk of an NTD. These two effects can be combined to predict the reduction in risk according to intake of extra folic acid and background serum folate concentration. Such results predict that the preventive effect is greater in women with low serum folate than in those with higher concentrations. The results have also been used to predict direct observations from large randomised trials and the effect of food fortification. From a typical western background serum folate of 5 ng/mL, about 0·2 mg/day (the US level of folic acid fortification) would be expected to reduce NTDs by about 20%; a similar effect can be expected from the current British recommendation (0·24 mg/day). An increase of 0·4 mg/day would reduce risk by about 36%, of 1 mg/day by 57%, and taking a 5-mg tablet daily would reduce risk by about 85%. Folic acid fortification levels should be increased. Additionally women planning a pregnancy should take 5 mg folic acid tablets daily, instead of the 0·4 mg dose presently recommended. DEPARTMENT OF ERRORQuantifying the effect of folic acid—In this public health article by N Wald and colleagues (Dec 15, p 2069) there were several errors in table 1. The study done by Cuskelly et al (1999) was not placebo-controlled and the mean age should have been 23; in the study by Dierkes (1998), the number of participants should have been 72; in the trial by Malinow (1998), the number of female participants should have been 16 (21%); in the study by Coppen (2000), the number of patients should have been 95, and the number of female participants should have been 61 (64%). Full-Text PDF" @default.
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• W2098453804 date "2001-12-01" @default.
• W2098453804 modified "2023-10-03" @default.
• W2098453804 title "Quantifying the effect of folic acid" @default.
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• W2098453804 doi "https://doi.org/10.1016/s0140-6736(01)07104-5" @default.
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