Folate status in Aboriginal people before and after mandatory fortification of flour for bread-making in Australia

Carol Bower, Susannah Maxwell, Siobhan Hickling, Heather D'Antoine, Peter O'Leary

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Mandatory fortification of wheat flour for bread-making was introduced in Australia in September 2009, to assist in the prevention of neural tube defects (NTD). NTD are twice as common in Aboriginal compared with non-Aboriginal infants, and folate levels are lower in the Aboriginal population. 

    Aims: This study was undertaken to compare folate status and NTD in the Aboriginal population before and after fortification. 

    Methods: Postfortification, 95 Aboriginal men and nonpregnant women aged 16-44 years in metropolitan and regional Western Australia (WA) completed a rapid dietary assessment tool and had blood taken to measure red cell folate. Measures were compared with prefortification values obtained in an earlier study using the same methods. Data on NTD in Aboriginal infants were obtained from the WA Register of Developmental Anomalies. 

    Results: No participant was folate deficient. The mean red cell folate increased after fortification to 443 ng/mL for males and 567 ng/mL for females. The mean difference between red cell folate after fortification compared with before was 129 ng/mL for males (95% CI 81-177); t = 5.4; P < 0.0001) and 186 ng/mL for females (95% CI 139-233); t = 7.9; P < 0.0001). Most participants ate fortified shop-bought bread at least weekly, resulting in an estimated additional folate intake per day of 178 (males) and 145 (females) dietary folate equivalents. NTD prevalence fell by 68% following fortification (prevalence ratio 0.32 (CI 0.15-0.69)). 

    Conclusions: The population health intervention of mandatory fortification of wheat flour for bread-making has had the desired effect of increasing folate status and reducing NTD in the Australian Aboriginal population.

    Original languageEnglish
    Pages (from-to)233-237
    Number of pages5
    JournalAustralian and New Zealand Journal of Obstetrics and Gynaecology
    Volume56
    Issue number3
    DOIs
    Publication statusPublished - Jun 2016

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    Bread
    Flour
    Folic Acid
    Neural Tube Defects
    Western Australia
    Population
    Triticum
    Health

    Cite this

    Bower, Carol ; Maxwell, Susannah ; Hickling, Siobhan ; D'Antoine, Heather ; O'Leary, Peter. / Folate status in Aboriginal people before and after mandatory fortification of flour for bread-making in Australia. In: Australian and New Zealand Journal of Obstetrics and Gynaecology. 2016 ; Vol. 56, No. 3. pp. 233-237.
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    abstract = "Background: Mandatory fortification of wheat flour for bread-making was introduced in Australia in September 2009, to assist in the prevention of neural tube defects (NTD). NTD are twice as common in Aboriginal compared with non-Aboriginal infants, and folate levels are lower in the Aboriginal population. Aims: This study was undertaken to compare folate status and NTD in the Aboriginal population before and after fortification. Methods: Postfortification, 95 Aboriginal men and nonpregnant women aged 16-44 years in metropolitan and regional Western Australia (WA) completed a rapid dietary assessment tool and had blood taken to measure red cell folate. Measures were compared with prefortification values obtained in an earlier study using the same methods. Data on NTD in Aboriginal infants were obtained from the WA Register of Developmental Anomalies. Results: No participant was folate deficient. The mean red cell folate increased after fortification to 443 ng/mL for males and 567 ng/mL for females. The mean difference between red cell folate after fortification compared with before was 129 ng/mL for males (95{\%} CI 81-177); t = 5.4; P < 0.0001) and 186 ng/mL for females (95{\%} CI 139-233); t = 7.9; P < 0.0001). Most participants ate fortified shop-bought bread at least weekly, resulting in an estimated additional folate intake per day of 178 (males) and 145 (females) dietary folate equivalents. NTD prevalence fell by 68{\%} following fortification (prevalence ratio 0.32 (CI 0.15-0.69)). Conclusions: The population health intervention of mandatory fortification of wheat flour for bread-making has had the desired effect of increasing folate status and reducing NTD in the Australian Aboriginal population.",
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    Folate status in Aboriginal people before and after mandatory fortification of flour for bread-making in Australia. / Bower, Carol; Maxwell, Susannah; Hickling, Siobhan; D'Antoine, Heather; O'Leary, Peter.

    In: Australian and New Zealand Journal of Obstetrics and Gynaecology, Vol. 56, No. 3, 06.2016, p. 233-237.

    Research output: Contribution to journalArticleResearchpeer-review

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    AU - Maxwell, Susannah

    AU - Hickling, Siobhan

    AU - D'Antoine, Heather

    AU - O'Leary, Peter

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    N2 - Background: Mandatory fortification of wheat flour for bread-making was introduced in Australia in September 2009, to assist in the prevention of neural tube defects (NTD). NTD are twice as common in Aboriginal compared with non-Aboriginal infants, and folate levels are lower in the Aboriginal population. Aims: This study was undertaken to compare folate status and NTD in the Aboriginal population before and after fortification. Methods: Postfortification, 95 Aboriginal men and nonpregnant women aged 16-44 years in metropolitan and regional Western Australia (WA) completed a rapid dietary assessment tool and had blood taken to measure red cell folate. Measures were compared with prefortification values obtained in an earlier study using the same methods. Data on NTD in Aboriginal infants were obtained from the WA Register of Developmental Anomalies. Results: No participant was folate deficient. The mean red cell folate increased after fortification to 443 ng/mL for males and 567 ng/mL for females. The mean difference between red cell folate after fortification compared with before was 129 ng/mL for males (95% CI 81-177); t = 5.4; P < 0.0001) and 186 ng/mL for females (95% CI 139-233); t = 7.9; P < 0.0001). Most participants ate fortified shop-bought bread at least weekly, resulting in an estimated additional folate intake per day of 178 (males) and 145 (females) dietary folate equivalents. NTD prevalence fell by 68% following fortification (prevalence ratio 0.32 (CI 0.15-0.69)). Conclusions: The population health intervention of mandatory fortification of wheat flour for bread-making has had the desired effect of increasing folate status and reducing NTD in the Australian Aboriginal population.

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