title: Medical cost savings in Sakado City and worldwide achieved by preventing disease by folic acid fortification.
abstract: The introduction of mandatory fortification of grains with folate in 1998 in the United States resulted in 767 fewer spina bifida cases annually and a cost saving of $603 million per year. However, far more significant medical cost savings result from preventing common diseases, including myocardial infarction, stroke, dementia and osteoporosis. A cost-effectiveness analysis showed a gain of 266 649 quality-adjusted life-years and $3.6 billion saved annually, mainly due to the reduction of cardiac infarction. The recommended folate intake in Japan is 240 μg/day whereas it is 400 μg/day internationally. Our Sakado Folate Project targeted individuals with genetic polymorphism of methylenetetrahydrofolate reductase or with hyperhomocysteinemia. Using, for example, folate-fortified rice, resulted in an increase in serum folate and a decrease in serum homocysteine in the participants, and reduced medical costs were achieved by decreasing myocardial infarction, stroke, dementia and fracture. Due to the small population of Sakado City (approximately 101 000) and small number of births (693) in 2015, a decrease in spina bifida could not be confirmed but there was a significant decrease in the number of very low birthweight infants. The genome notification of subjects was effective in motivating intake of folate, but the increase in serum folate (from 17.4 to 22.5 nmol/L, 129%) was less than that observed following compulsory folic acid fortification of cereals in the USA (from 12.1 to 30.2 nmol/L, 149.6%). Mandatory folic acid fortification is cheap in decreasing medical costs and is thus recommended in Japan.
authors.affiliation: Department of Medical Chemistry, Kagawa Nutrition University, Sakado City, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kagawa
authors.affiliation: Shukutoku University, College of Nursing and Nutrition, School of Nutrition, Chiba City, Japan.
authors.forename: Mami
authors.initials: M
authors.lastname: Hiraoka
authors.affiliation: Yamanashi Gakuin University Faculty of Health and Nutrition, Kofu City, Japan.
authors.forename: Mitsuyo
authors.initials: M
authors.lastname: Kageyama
authors.affiliation: University of Niigata Prefecture Faculty of Human Life Studies Department of Health and Nutrition, Niigata City, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Kontai
authors.affiliation: Yakult Honsha Co., Ltd., Tokyo, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Yurimoto
authors.affiliation: Department of Medical Chemistry, Kagawa Nutrition University, Sakado City, Japan.
authors.forename: Chiharu
authors.initials: C
authors.lastname: Nishijima
authors.affiliation: Department of Medical Chemistry, Kagawa Nutrition University, Sakado City, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Sakamoto
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000378:metabolism*; D005494:Folic Acid Deficiency / Q000191:economics* / Q000453:epidemiology / Q000378:metabolism / Q000517:prevention & control; D005527:Food, Fortified / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics / Q000378:metabolism; D009203:Myocardial Infarction / Q000191:economics* / Q000453:epidemiology / Q000378:metabolism / Q000517:prevention & control; D011110:Polymorphism, Genetic; D011247:Pregnancy; D015995:Prevalence; D064167:Recommended Dietary Allowances; D016135:Spinal Dysraphism / Q000191:economics* / Q000453:epidemiology / Q000378:metabolism / Q000517:prevention & control
chemical_list: D005492:Folic Acid; C573423:MTHFR protein, human; D042965:Methylenetetrahydrofolate Reductase (NADPH2)
keywords: folate; fortification; genetic polymorphism; medical cost