Transcript File

FOLATE/ FOLIC ACID AND SPINA
BIFIDA PREVENTION IN INFANTS
BY BRANDON L. LEE
PREGNANCY AND HEALTH
• Nutrition, exercise, general health, environment, genetics, stress, sleeping
patterns and knowledge of all these aspects of health all affect a women
during pregnancy.
• Nutrients of concern during pregnancy include calcium, iron, choline, iodine
and folate (Brown, 2014).
• Folate deficiencies in recent times have decreased due to fortifications and
awareness.
SPINA BIFIDA
• Spina bifida is the result of a fusion failure of the caudal neural tube during
the sequence of events known as neurulation. Spina bifida is neural tube
defect (NTD).
• Spina bifida is one of the most common malformations of the human body
structure (Mitchell, 2004).
• The malformation affects the spinal cord, vertebrae and skin.
• Every year 1,500 babies are born with spina bifida (Data, 2014).
SPINA BIFIDA EXAMPLES
SPINA BIFIDA CAUSES/RISK FACTORS
•
Causes of spina bfida are believed to be chromosome abnormalities, single gene
disorders, teratogenic exposures, disturbances in cell adhesion, alterations in the
neural plate forming, and bending that will stop apposition of the neural folds
(Mitchell, 2004).
•
Risk factors include family factors, maternal diabetes, maternal valproic acid
exposure, maternal carbamazepine exposure, maternal obesity, hyperinsulinaemia,
chlorination disinfection by-products in drinking water, electromagnetic fields,
hazardous waste sites and pesticides (Hendricks, 2001; Klotz, 1999; Dodds, 2001;
Blaasaas, 2002; Orr, 2002; Dolk, 1998).
FOLATE (VITAMIN B9)
• The roles of folate include making new cells and tissues (e.g. intestines, skin,
embryonic and fetal tissues), and synthesizing DNA and keep normal
metabolism of many amino acids (Sizer, 2012).
• In addition, folate works with vitamin B12 to produce red blood cells and
keep homocysteine levels low (Grosvenor, 2012).
• The other form of folate is folic acid which is the form not found in food but in
a synthetic form.
FOLATE/ FOLIC ACID RECOMMENDATIONS
• The current recommendations for a pregnant woman or women trying to
become pregnant is 400 micrograms from folate and another 400 micrograms
from a synthetic source per day (i.e. folic acid) (Grosvenor, 2012).
• Toxicity levels stand at 1,000 micrograms per day. Exceeding this limit will
lead to suppression of immune system, increase cancer risks and masks vitamin
B12 deficiency symptoms (Sizer, 2012).
FOLATE SOURCES
• Folate is found in foods such as asparagus, beef liver, oranges, lentils,
legumes, pinto beans, yeast, spinach (raw), eggs and beets (Grosvenor,
2012).
FOLATE AND OTHER NUTRIENTS/ DEFICIENCY
•
Folate and Vitamin B12 work together to create red blood cells and with the help of
vitamin B6 all three of them keep homocysteine levels from going to high.
•
Moreover, deficiency of vitamin B12 prevents folate from being converted into an
active form that the body can use (Grosvenor, 2012).
•
Deficiency of folate in the mother’s diet can result in anemia, smooth, red tongue;
depression, weakness, fatigue, headache mental confusion, poor growth, nerve
development and function issues and diarrhea (Sizer, 2012).
FOLATE/ FOLIC ACID AND PREVENTION OF SPINA
BIFIDA
• Up to 70% of spina bifida cases can be prevented by proactive intake of
folate/folic foods or supplements (Mitchell, 2004).
• In a study that was conducted by the UK Medical Research Council, mothers
supplemented with only 4 mg of folic acid per day showed a three-fold
reduction in NTD recurrence risk (Mitchell, 2004).
FOLATE/ FOLIC ACID AND PREVENTION OF SPINA
BIFIDA (CONT.)
•
In 2013, a study was done using a food frequency questionnaire (FFQ) to determine
the folate/folic acid intake of women who recently gave birth.
•
Results sated the following, “The joint effect of low folic acid intake and preexisting
diabetes mellitus resulting 4-fold increased risk for spina bifida… relative to mothers
without diabetes mellitus and with higher daily folic acid intake, which was greater
than expected given the individual additive effects of low folic acid intake and preexisting diabetes mellitus.” (Parker, 2013).
•
Folate/ folic acid intake has a significant relationship to infants born with spin bifida.
SPINA BIFIDA AND OBESITY
• Another study had showed that prepregnancy weight and neural tube defects
observed that folic acid supplementation offered only some protection for
women weighing less than 70kg (154 lbs.) but none for women any heavier
(Werler, 1996).
• Obese women who take the recommended amount of folate/folic acid daily
are at just as much risk for the their baby being born with spina bifida as if
they didn’t take it at all due to their obesity (Parker, 2013).
FOLATE/ FOLIC ACID FORTIFICATION
• In 1998 the fortification of folate become mandatory in the United States.
• There has since been a decrease in NTDs by 19% (Honein, 2001).
• More specifically this translates to a decrease of 31% of spina bifida cases
(Williams, 2002; Canfield, 2005).
• Food items that have been fortified since 1998 include but are not limited to
flour, breads, rice, noodles, cereals and corn meals.
FOLATE/ FOLIC ACID FORTIFIED FOODS
SPINA BIFIDA PREVENTION
•
•
Intake of folic acid supplements, folate rich foods, folic acid fortified foods.
•
Referrals from Obstetrics and gynecology (OB/GYN) doctors to Registered
Dietitians.
•
Through maternal, periconceptional folic acid supplementation alone 70% of spina
bifida cases can be eliminated (Mitchell, 2004).
Women, Infants and Children also known as WIC helps women, infants and children
(up to age five) of low income by providing nutrition education, supplementation and
health care referrals.
KEY POINTS
• 1 in 1,000 births result in spina bifida (Blom, 2006).
• Infants with spina bifida have been shown to have folate deficiencies
compared to infants without spina bifida.
• It is recommended that women who are trying to become pregnant or are
pregnant take in 400 micrograms of folate and 400 micrograms folic acid
per day.
KEY POINTS (CONT.)
•
Spina bifida is a posterior NTD that is caused by the failure of the neural
tube to come together at the caudal end (Blom, 2006).
• Spina bifida can prevented through supplementation, consumption of fortified
foods, education and use of government resources (e.g. WIC, USDA, AND).
REFERENCES
• Blaasaas, K. G., Tynes, T., Irgens, Å., & Lie, R. T. (2002). Risk of Birth Defects by Parental Occupational Exposure to 50 Hz Electromagnetic Fields:
A Population Based Study. Occupational and Environmental Medicine, (2). 92.
• Blom, H. J., Shaw, G. M., den Heijer, M., & Finnell, R. H. (2006). Neural tube defects and folate: case far from closed. Nature Reviews
Neuroscience, 7(9), 724-731. doi:10.1038/nrn1986
• Brown, J. (2014). Nutrition through the life cycle (5th ed.). Belmont, CA: Wadsworth, CENGAGE Learning.
• Canfield, M. A. et al. (2005). Changes in the birth prevalence of selected birth defects after grain fortification with folic acid in the United
States: findings from a multi-state population-based study. Birth Defects Res. Clin. Mol. Teratol. 73, 679-689.
• Data and Statistics. (2014, August 5). Retrieved November 12, 2014, from http://www.cdc.gov/ncbddd/spinabifida/data.html
• Dodds, L., & King, W. D. (2001). Relation between Trihalomethane Compounds and Birth Defects. Occupational and Environmental Medicine, (7).
443.
• Dolk, H., Vrijheid, M., Armstrong, B., Abramsky, L., Bianchi, F., Garne, E., & ... Tenconi, R. (1998). Risk of congenital anomalies near hazardouswaste landfill sites in Europe: The EUROHAZCON study. Lancet, 352(9126), 423.
REFERENCES (CONT.)
• Dolk, H., Vrijheid, M., Armstrong, B., Abramsky, L., Bianchi, F., Garne, E., & ... Tenconi, R. (1998). Risk of congenital anomalies
near hazardous-waste landfill sites in Europe: The EUROHAZCON study. Lancet, 352(9126), 423.
• Grosvenor, M., & Smolin, L. (2012). Visualizing nutrition: Everyday choices (2nd ed.). Hoboken, NJ: Wiley ;.
• Hendricks, K. A., Nuno, O. M., Suarez, L., & Larsen, R. (2001). Effects of Hyperinsulinemia and Obesity on Risk of Neural Tube
Defects among Mexican Americans. Epidemiology, (6). 630.
• Honein, M., Paulozzi, L., Mathews, T., Erickson, J., & Wong, L. (2001). Impact of folic acid fortification of the US food supply
on the occurrence of neural tube defects. JAMA: Journal Of The American Medical Association, 285(23), 2981.
• Klotz, J. B., & Pyrch, L. A. (1999). Neural Tube Defects and Drinking Water Disinfection By-Products. Epidemiology, (4). 383.
• Mitchell, L., Adzick, N., Melchionne, J., Pasquariello, P., Sutton, L., & Whitehead, A. (2004). Spina bifida. Lancet, 364(9448),
1885-1895.
REFERENCES (CONT.)
• Orr, M., Bove, F., Kaye, W., & Stone, M. (2002). Elevated birth defects in racial or ethnic minority children of women living
near hazardous waste sites. International Journal Of Hygiene And Environmental Health, 205(1-2), 19-27.
• Parker, S., Yazdy, M., Tinker, S., Mitchell, A., & Werler, M. (2013). The impact of folic acid intake on the association among
diabetes mellitus, obesity, and spina bifida. American Journal Of Obstetrics & Gynecology, 209(3), 239.e1-8.
doi:10.1016/j.ajog.2013.05.047
• Sizer, F., & Whitney, E. (2012). Nutrition, concepts and controversies (12th ed.). Belmont, CA: Wadsworth, CENGAGE
Learning.
• Werler, M., Louik, C., Shapiro, S., & Mitchell, A. (1996). Prepregnant weight in relation to risk of neural tube defects. JAMA:
Journal Of The American Medical Association, 275(14), 1089-1092
• Williams, L. J. (2002). Prevalence of spina bifida and anencephaly during the transition to mandatory folic acid fortification
in the United States. JAMA, The Journal Of The American Medical Association, (14), 1694.