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1. Everyone in the world is folate deficient unless they are consuming synthetic folic acid as a supplement or getting enough folic acid from fortified foods. As you probably eat enriched bread in the US, your folate has increased and you are ok. But not the Dutch, the New Zealanders, nor the British or Irish nor Framingham orginial or offspring cohort before fortication.

2. There are major consequences; birth defects, heart attacks and stroke, colon cancer, folate deficiency anemia and perhaps a contribution to Alzheimer's.

3. Folic acid fortificaiton is cheap, safe, sustainable and it works. The United States and Canada fortified at 140 mcg/100 g while Chile fortified at 220 mcg/100g. This resulted in about 4 times as much folic acid as in the U.S. because Chile consumes more flour than the U.S. Great data to come from Chile. In the Unites States, post fortification median plasma folates are higher than pre fortification by 90%. It works. Foltate deficiency anemia is gone from the United States and Canada and probably Chile--gone, removed from the possible causes for anemia in these countries. After fortification, NTDs, homocysteine, heart attacks and strokes are all down.

4. 500,000 cases of spina bifida and anencephaly occur annually around the world. About 375,000 of them are folic acid preventable.

5. We should have as a goal the total prevention of all folic acid preventable birth defects (and other diseases) by some quick date like in 5 years or by 2010.

6. Ideal place for donor money that can show immediate blood level changes, elimination of folate deficiency anemia, prevention of birth defects, reduction of homocysteine and decreases in heart attakcs and strokes and probably colon cancer.

7. Getting folic acid fortification of flour going can be a good way to start in countries that are not doing any fortification. Getting iron in would be good, but iron alone or iron with folic acid may not be as saleable
where no fortification is going on. As folic acid alone, I think that would be ok way to start. Would do great good. Would get the fortification mechanics up to speed. Adding iron or other nutrients to premix would be a simple technical change when the policy stars all line up and everyone agrees. We think in Ukraine the best bet to get fortification done is to lead with folic acid. We may learn differently over the next two weeks.

 

Iron Deficiency Project Advisory Service International Nutrition Foundation Web site: http://www.micronutrient.org/IDPAS Email: idpas@inffoundation.org Phone (1-617) 636-3770 Fax: (1-617) 636-3781 Project Office: 150 Harrison Street, Boston, MA, 02111 Gerald J. & Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University