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Systematic Review and Bayesian Meta-analysis of the Dose-response Relationship between Folic Acid Intake and Changes
Krista S Crider1, Owen Devine2,3,4, Yan Ping Qi5
1Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Congenital and Developmental Disorders, Atlanta, GA 30341, USA. kcrider@cdc.gov.
Nutrients
|January 6, 2019
Summary
Folic acid fortification increases red blood cell (RBC) folate levels, crucial for preventing neural tube defects. This study quantifies the dose-response relationship, informing public health strategies for optimal folic acid intake.
Area of Science:
- Nutritional Science
- Public Health
- Pharmacokinetics
Background:
- Optimal red blood cell (RBC) folate concentration for preventing neural tube defects is estimated at 906 nmol/L in women of reproductive age.
- The precise dose-response relationship between folic acid intake and blood folate levels remains uncharacterized, hindering effective food fortification program design.
Purpose of the Study:
- To estimate the increase in blood folate concentrations in response to specific folic acid dosages under steady-state conditions.
- To inform the planning and monitoring of folic acid fortification programs for public health benefits.
Main Methods:
- Systematic review and meta-analysis of 108 articles, analyzing 14,002 identified records.
- Estimation of steady-state serum/plasma and RBC folate concentrations using Bayesian meta-analytic and physiologically-based pharmacokinetic models.
Main Results:
- RBC folate concentrations increased 1.78-fold at a daily intake of 375–570 µg of folic acid.
- Achieving steady-state RBC folate concentrations required a median of 36 weeks of folic acid intake.
- Serum/plasma folate concentrations increased by an estimated 11.6% for every 100 µg/day of folic acid intake.
Conclusions:
- Provides quantitative data on folic acid intake and blood folate levels, essential for optimizing fortification strategies.
- Supports evidence-based recommendations for folic acid fortification to improve population-level folate status and prevent neural tube defects.
Keywords:
folic acidfortificationplasma folatepublic healthred blood cell folateserum folatesupplementationMore Related Videos
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