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KMID : 1160620140190040247
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Preventive Nutrition and Food Science
2014 Volume.19 No. 4 p.247 ~ p.260
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Contemporary Issues Surrounding Folic Acid Fortification Initiatives
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Choi Jeong-Hwa
Yates Zoe
Veysey Martin
Heo Young-Ran
Lucock Mark
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Abstract
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The impact of folate on health and disease, particularly pregnancy complications and congenital malforma-tions, has been extensively studied. Mandatory folic acid fortification therefore has been implemented in multiple coun-tries, resulting in a reduction in the occurrence of neural tube defects. However, emerging evidence suggests increased folate intake may also be associated with unexpected adverse effects. This literature review focuses on contemporary is-sues of concern, and possible underlying mechanisms as well as giving consideration the future direction of mandatory folic acid fortification. Folate fortification has been associated with the presence of unmetabolized folic acid (PteGlu) in blood, masking of vitamin B12 deficiency, increased dosage for anti-cancer medication, photo-catalysis of PteGlu leading to potential genotoxicity, and a role in the pathoaetiology of colorectal cancer. Increased folate intake has also been asso-ciated with twin birth and insulin resistance in offspring, and altered epigenetic mechanisms of inheritance. Although limited data exists to elucidate potential mechanisms underlying these issues, elevated blood folate level due to the ex-cess use of PteGlu without consideration of an individual's specific phenotypic traits (e.g. genetic background and un-diagnosed disease) may be relevant. Additionally, the accumulation of unmetabolized PteGlu may lead to inhibition of di-hydrofolate reductase and other enzymes. Concerns notwithstanding, folic acid fortification has achieved enormous ad-vances in public health. It therefore seems prudent to target and carefully monitor high risk groups, and to conduct well focused further research to better understand and to minimize any risk of mandatory folic acid fortification.
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KEYWORD
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mandatory folic acid fortification, synthetic folic acid, adverse effects, public health
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