Ineffectiveness of dietary folic acid supplementation on the incidence of lipomyelomeningocele: pathogenetic implications.
OBJECTIVE
Periconceptual folic acid supplementation is effective in myelomeningocele prevention. The relationship between folic acid and lipomyelomeningocele (LMM) and the overall incidence of this occult form of spina bifida has never been studied. The objectives of this study were to determine the impact of dietary folic acid supplementation on the incidence of LMM and to measure its overall incidence.


METHODS
In a retrospective population-based study the authors calculated the incidence of LMM in Nova Scotia between 1985 and 2001. Because of changes in public policy during this period, there are three intervals defined in relation to the treatment of the food supply with folic acid: 1) prior to folic acid fortification (1985-1994); 2) postsupplementation but prefortification (1995-1998); and 3) postfortification. The overall incidence of LMM in Nova Scotia between 1985 and 2001 was 16 per 100,000 live births or one case per 6121 live births. Its incidence between 1985 and 1994 was 15 per 100,000 live births, and between 1995 and 1998 it was 12 per 100.000 live births (relative risk [RR] 0.82, 95% confidence interval [CI] 0.31-2.22; p = 0.7). Between 1999 and 2001, the incidence of LMM was 29 per 100,000 live births, which was not significantly different from that between 1995 and 1998 (RR 2.41. 95% CI 0.79-7.36; p = 0.11) or between 1985 and 1994 (RR 1.98, 95% CI 0.86-4.56; p = 0.1).


CONCLUSIONS
The overall incidence of LMM between 1985 and 2001 in Nova Scotia was 16 per 100,000 live births and has not been reduced by dietary folic acid supplementation. This finding provides epidemiological evidence that the embryogenesis of LMM is fundamentally different from that of myelomeningocele.
McNeely
P Daniel
PD
Department of Neurosurgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Howes
William J
WJ
D002420:Cauda Equina / Q000002:abnormalities*; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D005527:Food, Fortified; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008067:Lipoma / Q000151:congenital* / Q000453:epidemiology / Q000517:prevention & control; D008161:Lumbosacral Region; D008297:Male; D008432:Mathematical Computing; D008591:Meningomyelocele / Q000453:epidemiology / Q000517:prevention & control*; D009674:Nova Scotia / Q000453:epidemiology; D010524:Peripheral Nervous System Neoplasms / Q000151:congenital* / Q000453:epidemiology / Q000517:prevention & control; D016742:Preconception Care; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000151:congenital* / Q000453:epidemiology / Q000517:prevention & control
D005492:Folic Acid