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Updated: Jul 9, 2026
03:19
Modifying Levels of Maternal Dietary Folic Acid or Choline to Study the Impact of Deficiencies on Offspring Health Outcomes
Published on: June 28, 2024
Integrated risk-benefit analyses: method development with folic acid as example
Jeljer Hoekstra1, Janneke Verkaik-Kloosterman, Cathy Rompelberg
1National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Jeljer.Hoekstra@rivm.nl
Summary
A new quantitative risk-benefit model for foods integrates hazards and benefits using DALYs. Folic acid fortification in bread shows potential public health benefits, but results depend on assumptions about cancer risks.
Area of Science:
- Food safety and nutrition science
- Quantitative risk assessment
- Public health policy
Background:
- Increasing introduction of novel and functional foods necessitates integrated quantitative risk-benefit assessments.
- A consensus exists for a quantitative risk-benefit assessment approach mirroring established risk assessment methodologies.
- Existing frameworks often lack a unified approach to evaluating both risks and benefits of food interventions.
Purpose of the Study:
- To propose and validate a quantitative risk-benefit model for assessing food interventions.
- To apply the model to a case study of folic acid fortification in bread in the Netherlands.
- To illustrate the practical application and challenges of such a model in policy-making.
Main Methods:
- Development of a four-step risk-benefit model: hazard/benefit identification, characterization (dose-response), exposure assessment, and integration.
- Utilizing the Disability-Adjusted Life Year (DALY) as a common health measure combining morbidity and mortality.
- Simulation of the health impact of folic acid-fortified bread, including sensitivity analysis.
Main Results:
- The model successfully simulated the health impact of folic acid fortification, aiding policy decisions.
- Modest fortification (140 µg/100 g bread) appears beneficial for public health, primarily by preventing neural tube defects.
- Results are sensitive to assumptions regarding the association between high folate intake and colorectal cancer risk.
Conclusions:
- The proposed risk-benefit model can assist policymakers in decisions regarding food fortification programs.
- Uncertainties and data demands are significant challenges in implementing quantitative risk-benefit assessments.
- While folic acid fortification offers potential health gains, a cautious approach is warranted due to uncertainties in risk-benefit calculations.
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