Reduced plasma homocysteine levels in elderly Australians following mandatory folic acid fortification – A comparison of two cross-sectional cohorts
Objective: In 2009, Australia implemented mandatory folic acid fortification in wheat flour for bread-making. The primary aim was to improve folate status in reproductive-aged women to reduce neural tube defect incidence. However, folic acid consumption has consequently increased in all demographics...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2017-06-01
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| Series: | Journal of Nutrition & Intermediary Metabolism |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352385917300038 |
| _version_ | 1818364370169626624 |
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| author | Emma Louise Beckett Charlotte Martin Lyndell Boyd Teagan Porter Katrina King Suzanne Niblett Zoe Yates Martin Veysey Mark Lucock |
| author_facet | Emma Louise Beckett Charlotte Martin Lyndell Boyd Teagan Porter Katrina King Suzanne Niblett Zoe Yates Martin Veysey Mark Lucock |
| author_sort | Emma Louise Beckett |
| collection | DOAJ |
| description | Objective: In 2009, Australia implemented mandatory folic acid fortification in wheat flour for bread-making. The primary aim was to improve folate status in reproductive-aged women to reduce neural tube defect incidence. However, folic acid consumption has consequently increased in all demographics. Blood folate is inversely associated with homocysteine levels, a risk factor for multiple diseases. Therefore, we assessed the impact of mandatory folic acid fortification on homocysteine levels in elderly Australians.
Methods: Homocysteine and blood folate levels were compared between two elderly cross-sectional cohorts (pre-versus post-mandatory folic acid fortification). Importantly, dietary habits were assessed to evaluate the confounding influence of altered dietary patterns not related to fortification.
Results: Post-fortification, plasma homocysteine levels (10.6 vs. 14.5 μmol/L) and hyperhomocysteinemia incidence (27.2% vs 56.3%) were significantly reduced, relative to the pre-fortification subjects. This was associated with increased blood folate (red cell: 1243 vs 1066 nmol/L, serum 28.0 vs 23.9 nmol/L), and increased intake of synthetic folic acid (366.8 vs 231.0 DFE/day) but not natural folate (332.7 vs 323.6 DFE/day). Limited other differences were detected in dietary intake patterns between groups. The positive relationship between homocysteine levels and age was abrogated post-fortification (p = 0.3 vs p = 0.0003).
Conclusions: A potential off-target benefit of mandatory folic acid fortification in Australia was demonstrated. With many countries still considering the merits and consequences of mandatory fortification policies, it is important to unravel the off-target effects including dietary context. |
| first_indexed | 2024-12-13T22:03:17Z |
| format | Article |
| id | doaj.art-754be5a054054eeb880e690816e695fc |
| institution | Directory Open Access Journal |
| issn | 2352-3859 |
| language | English |
| last_indexed | 2024-12-13T22:03:17Z |
| publishDate | 2017-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Nutrition & Intermediary Metabolism |
| spelling | doaj.art-754be5a054054eeb880e690816e695fc2022-12-21T23:29:56ZengElsevierJournal of Nutrition & Intermediary Metabolism2352-38592017-06-018C142010.1016/j.jnim.2017.04.001Reduced plasma homocysteine levels in elderly Australians following mandatory folic acid fortification – A comparison of two cross-sectional cohortsEmma Louise Beckett0Charlotte Martin1Lyndell Boyd2Teagan Porter3Katrina King4Suzanne Niblett5Zoe Yates6Martin Veysey7Mark Lucock8School of Environmental and Life Sciences, The University of Newcastle, NSW 2258, AustraliaSchool of Environmental and Life Sciences, The University of Newcastle, NSW 2258, AustraliaSchool of Environmental and Life Sciences, The University of Newcastle, NSW 2258, AustraliaSchool of Environmental and Life Sciences, The University of Newcastle, NSW 2258, AustraliaSchool of Medicine & Public Health, University of Newcastle, NSW, AustraliaSchool of Medicine & Public Health, University of Newcastle, NSW, AustraliaSchool of Biomedical Sciences and Pharmacy, The University of Newcastle, Ourimbah, NSW 2258, AustraliaSchool of Medicine & Public Health, University of Newcastle, NSW, AustraliaSchool of Environmental and Life Sciences, The University of Newcastle, NSW 2258, AustraliaObjective: In 2009, Australia implemented mandatory folic acid fortification in wheat flour for bread-making. The primary aim was to improve folate status in reproductive-aged women to reduce neural tube defect incidence. However, folic acid consumption has consequently increased in all demographics. Blood folate is inversely associated with homocysteine levels, a risk factor for multiple diseases. Therefore, we assessed the impact of mandatory folic acid fortification on homocysteine levels in elderly Australians. Methods: Homocysteine and blood folate levels were compared between two elderly cross-sectional cohorts (pre-versus post-mandatory folic acid fortification). Importantly, dietary habits were assessed to evaluate the confounding influence of altered dietary patterns not related to fortification. Results: Post-fortification, plasma homocysteine levels (10.6 vs. 14.5 μmol/L) and hyperhomocysteinemia incidence (27.2% vs 56.3%) were significantly reduced, relative to the pre-fortification subjects. This was associated with increased blood folate (red cell: 1243 vs 1066 nmol/L, serum 28.0 vs 23.9 nmol/L), and increased intake of synthetic folic acid (366.8 vs 231.0 DFE/day) but not natural folate (332.7 vs 323.6 DFE/day). Limited other differences were detected in dietary intake patterns between groups. The positive relationship between homocysteine levels and age was abrogated post-fortification (p = 0.3 vs p = 0.0003). Conclusions: A potential off-target benefit of mandatory folic acid fortification in Australia was demonstrated. With many countries still considering the merits and consequences of mandatory fortification policies, it is important to unravel the off-target effects including dietary context.http://www.sciencedirect.com/science/article/pii/S2352385917300038FolateFolic acidHomocysteineMandatory fortificationElderly |
| spellingShingle | Emma Louise Beckett Charlotte Martin Lyndell Boyd Teagan Porter Katrina King Suzanne Niblett Zoe Yates Martin Veysey Mark Lucock Reduced plasma homocysteine levels in elderly Australians following mandatory folic acid fortification – A comparison of two cross-sectional cohorts Journal of Nutrition & Intermediary Metabolism Folate Folic acid Homocysteine Mandatory fortification Elderly |
| title | Reduced plasma homocysteine levels in elderly Australians following mandatory folic acid fortification – A comparison of two cross-sectional cohorts |
| title_full | Reduced plasma homocysteine levels in elderly Australians following mandatory folic acid fortification – A comparison of two cross-sectional cohorts |
| title_fullStr | Reduced plasma homocysteine levels in elderly Australians following mandatory folic acid fortification – A comparison of two cross-sectional cohorts |
| title_full_unstemmed | Reduced plasma homocysteine levels in elderly Australians following mandatory folic acid fortification – A comparison of two cross-sectional cohorts |
| title_short | Reduced plasma homocysteine levels in elderly Australians following mandatory folic acid fortification – A comparison of two cross-sectional cohorts |
| title_sort | reduced plasma homocysteine levels in elderly australians following mandatory folic acid fortification a comparison of two cross sectional cohorts |
| topic | Folate Folic acid Homocysteine Mandatory fortification Elderly |
| url | http://www.sciencedirect.com/science/article/pii/S2352385917300038 |
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