Reduction in neural-tube defects after folic acid fortification in Canada
Reduction in neural-tube defects after folic acid fortification in Canada
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DOI：
10.1056/nejmoa067103
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发表时间：
2007-07-12
影响因子：
158.5
通讯作者：
Niyonsenga, Theophile
中科院分区：
文献类型：
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作者：
De Wals, Philippe;Tairou, Fassiatou;Niyonsenga, Theophile
背景：1998 年，加拿大强制要求在多种谷物产品中添加叶酸，该国东部省份的神经管缺陷患病率历来高于西部省份。我们评估了加拿大实施叶酸食品强化前后神经管缺陷患病率的变化。方法：研究人群包括1993年至2002年居住在加拿大七个省的妇女中的活产、死产和因胎儿异常而终止妊娠的妇女。根据已发表的红细胞叶酸水平检测结果，研究期分为预强化期、部分强化期和完全强化期。我们评估了各省神经管缺陷基线率与实施强化后下降幅度之间的关系。结果：190万新生儿中共有2446名神经管缺陷受试者。神经管缺陷的患病率从强化前的每 1000 名新生儿 1.58 例下降到完全强化期间的每 1000 名新生儿 0.86 例，降低了 46%（95% 置信区间，40 至 51）。下降幅度与各省的设防基线率成正比，设防开始后，地域差异几乎消失。观察到的脊柱裂发病率下降幅度更大（下降 53%），而无脑畸形和脑膨出（分别下降 38% 和 31%）则更大。结论：在加拿大，叶酸食品强化与神经管缺陷发生率显着下降相关。在基线率较高的地区，下降幅度最大。
BACKGROUND:In 1998, folic acid fortification of a large variety of cereal products became mandatory in Canada, a country where the prevalence of neural-tube defects was historically higher in the eastern provinces than in the western provinces. We assessed changes in the prevalence of neural-tube defects in Canada before and after food fortification with folic acid was implemented.METHODS:The study population included live births, stillbirths, and terminations of pregnancies because of fetal anomalies among women residing in seven Canadian provinces from 1993 to 2002. On the basis of published results of testing of red-cell folate levels, the study period was divided into prefortification, partial-fortification, and full-fortification periods. We evaluated the relationship between baseline rates of neural-tube defects in each province and the magnitude of the decrease after fortification was implemented.RESULTS:A total of 2446 subjects with neural-tube defects were recorded among 1.9 million births. The prevalence of neural-tube defects decreased from 1.58 per 1000 births before fortification to 0.86 per 1000 births during the full-fortification period, a 46% reduction (95% confidence interval, 40 to 51). The magnitude of the decrease was proportional to the prefortification baseline rate in each province, and geographical differences almost disappeared after fortification began. The observed reduction in rate was greater for spina bifida (a decrease of 53%) than for anencephaly and encephalocele (decreases of 38% and 31%, respectively).CONCLUSIONS:Food fortification with folic acid was associated with a significant reduction in the rate of neural-tube defects in Canada. The decrease was greatest in areas in which the baseline rate was high.