title: Effectiveness of Folic Acid Fortified Flour for Prevention of Neural Tube Defects in a High Risk Region.
abstract: Despite efforts to tackle folate deficiency and Neural Tube Defects (NTDs) through folic acid fortification, its implementation is still lacking where it is needed most, highlighting the need for studies that evaluate the effectiveness of folic acid fortified wheat flour in a poor, rural, high-risk, NTD region of China. One of the most affected regions, Shanxi Province, was selected as a case study. A community intervention was carried out in which 16,648 women of child-bearing age received fortified flour (eight villages) and a control group received ordinary flour (three villages). NTD birth prevalence and biological indicators were measured two years after program initiation at endline only. The effect on the NTD burden was calculated using the disability-adjusted life years (DALYs) method. In the intervention group, serum folate level was higher than in the control group. NTDs in the intervention group were 68.2% lower than in the control group (OR = 0.313, 95% CI = 0.207-0473, p < 0.001). In terms of DALYs, burden in intervention group was approximately 58.5% lower than in the control group. Flour fortification was associated with lower birth prevalence and burden of NTDs in economically developing regions with a high risk of NTDs. The positive findings confirm the potential of fortification when selecting an appropriate food vehicle and target region. As such, this study provides support for decision makers aiming for the implementation of (mandatory) folic acid fortification in China.
authors.affiliation: Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing 100871, China. woody_37@126.com.
authors.forename: Haochen
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Agricultural Economics, Faculty of Bio-Science engineering, Ghent University. Ghent 9000, Belgium. Hans.DeSteur@UGent.be.
authors.forename: Hans
authors.initials: H
authors.lastname: De Steur
authors.affiliation: Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing 100871, China. chengong@pku.edu.cn.
authors.forename: Gong
authors.initials: G
authors.lastname: Chen
authors.affiliation: Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing 100871, China. windson_zxt@126.com.
authors.forename: Xiaotian
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing 100871, China. peilj@pku.edu.cn.
authors.forename: Lijun
authors.initials: L
authors.lastname: Pei
authors.affiliation: Department of Agricultural Economics, Faculty of Bio-Science engineering, Ghent University. Ghent 9000, Belgium. Xavier.Gellynck@UGent.be.
authors.forename: Xavier
authors.initials: X
authors.lastname: Gellynck
authors.affiliation: Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing 100871, China. xzheng@pku.edu.cn.
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Zheng
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D015930:Diet Records; D005260:Female; D005433:Flour; D005492:Folic Acid / Q000008:administration & dosage* / Q000097:blood; D005494:Folic Acid Deficiency / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D005527:Food, Fortified; D006801:Humans; D039382:Maternal Nutritional Physiological Phenomena; D009436:Neural Tube Defects / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D015596:Nutrition Assessment; D009752:Nutritional Status; D016017:Odds Ratio; D011247:Pregnancy; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012423:Rural Health; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005492:Folic Acid
keywords: China; DALY; community intervention; folic acid fortified flour; neural tube defects