Summary

Fortification of grain products with folic acid began in Canada over ten years ago. An analysis of births in Quebec reveals that the move has had a positive impact.

For the rate of congenital heart disease has dropped by 6% per year since fortification, although other factors might be expected to lead to an increase.

Introduction

Fortification of food and water means adding some nutrient that a population may otherwise lack. It has been done in some countries with fluoridation of water supplies to strengthen children’s teeth. In Canada grain products, such as bread and pasta, have been fortified with folic acid since 1998. Folic acid supplements are recommended to pregnant women in order to protect their babies from neural tube defects and there is also some evidence that folic acid prevents congenital heart defects as well. Researchers set out to discover whether Canada’s folic acid fortification policy has had any impact upon rates of congenital heart disease.

What was done

Researchers at McGill University and at the University of Alberta identified all births occurring in Quebec between 1990 and 2005 and noted those babies born with severe heart defects. They worked out rates of heart defects before and after fortification.

What was found

Out of 1.3 million births, there were 2,083 infants born with severe heart defects. In the nine years before fortification the annual rate of heart defects remained constant, but in the seven years after it went down by 6% per year. The change in trend did not occur by chance, the researchers say, but supports the theory that adequate folic acid intake, via fortification of grain, reduces the rate of severe congenital heart defects.

What this study means

Factors such as obesity and diabetes among women tend to increase the risk of their babies being born with heart defects. Therefore, fortification is helping to reverse a worrying trend. Treating congenital heart defects is complex and mortality is high. Therefore, fortification has a profound impact on child health. However, fortification policies may have some drawbacks and some way to go. Some people object to the government ‘tampering’ with their food and it’s possible fortification could be harmful to some. We also don’t know what the optimum level of fortification is to get the maximum health benefits. And there are other ways of reducing the risk of congenital heart defects, such as trying to improve maternal health by reducing factors like obesity and diabetes.

Source

Ionescu-Ittu R, Marelli AJ et al Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada BMJ online BMJ 2009;338:b1673