title: High folate levels in Aboriginal children after subsidised fruit and vegetables and mandatory folic acid fortification.
abstract: OBJECTIVE
  To evaluate the impact of a fruit and vegetable (F&V) subsidy program for disadvantaged Aboriginal children in Australia, implemented alongside the introduction of mandatory folic acid fortification of bread-making flour.
  
  
  METHODS
  A before-and-after evaluation was undertaken of a F&V subsidy program at three Aboriginal community-controlled health services in New South Wales. The program provided a weekly box of subsidised F&V linked to preventive health services and nutrition promotion for families. In this analysis, red blood cell (RBC) folate was assessed together with self-reported dietary intake at baseline and 12 months later in a cohort of 125 children (aged 0-17 years).
  
  
  RESULTS
  No children had low RBC folate at baseline or at follow-up; however, 33 children (26%) exceeded the reference range of RBC folate at baseline and 38 children (30%) exceeded the reference range at follow-up. Mean RBC folate levels increased substantially in children at follow-up (mean RBC folate z-score increased +0.55 (95%CI 0.36-0.74). Change in F&V intake (p=0.196) and mean bread intake (p=0.676) were not statistically significant predictors for change in RBC folate levels.
  
  
  CONCLUSIONS
  RBC folate levels increased among these disadvantaged Aboriginal children following mandatory folic acid fortification and participation in a subsidised F&V program. Even before mandatory folic acid fortification, none of these children had low RBC folate.
  
  
  CONCLUSIONS
  The effect on health of mandatory fortification of foods with folate is not clear, hence, ongoing population-based monitoring of folate levels to assess the impact of mandatory folic acid fortification is important.
authors.affiliation: School of Population Health, Division of Health Sciences, University of South Australia; Bulgarr Ngaru Medical Aboriginal Corporation, Grafton, New South Wales.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Black
authors.forename: Hassan
authors.initials: H
authors.lastname: Vally
authors.forename: Peter
authors.initials: P
authors.lastname: Morris
authors.forename: Mark
authors.initials: M
authors.lastname: Daniel
authors.forename: Adrian
authors.initials: A
authors.lastname: Esterman
authors.forename: Fiona
authors.initials: F
authors.lastname: Smith
authors.forename: Kerin
authors.initials: K
authors.lastname: O'Dea
mesh_terms: D000293:Adolescent; D001315:Australia; D002648:Child; D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D005433:Flour; D005492:Folic Acid / Q000097:blood*; D005494:Folic Acid Deficiency / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D005500:Follow-Up Studies; D063105:Food Assistance; D005527:Food, Fortified; D005638:Fruit; D006303:Health Services, Indigenous; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D009436:Neural Tube Defects / Q000517:prevention & control; D009517:New South Wales / Q000453:epidemiology; D009752:Nutritional Status; D015397:Program Evaluation; D014675:Vegetables
chemical_list: D005492:Folic Acid
keywords: Aboriginal health; biomarkers; nutrition