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Folate status in Aboriginal people before and after mandatory fortification of flour for bread-making in Australia

Bower, Carol, Maxwell, Susannah, Hickling, Siobhan, D'Antoine, Heather and O'Leary, Peter (2015). Folate status in Aboriginal people before and after mandatory fortification of flour for bread-making in Australia. Australian and New Zealand Journal of Obstetrics and Gynaecology,56(3):233-237.

Document type: Journal Article
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IRMA ID 81144320xPUB168
Title Folate status in Aboriginal people before and after mandatory fortification of flour for bread-making in Australia
Author Bower, Carol
Maxwell, Susannah
Hickling, Siobhan
D'Antoine, Heather
O'Leary, Peter
Journal Name Australian and New Zealand Journal of Obstetrics and Gynaecology
Publication Date 2015
Volume Number 56
Issue Number 3
ISSN 1479-828X   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84949974401
Start Page 233
End Page 237
Total Pages 5
Place of Publication Australia
Publisher Wiley-Blackwell Publishing Asia
Field of Research 1111 - Nutrition and Dietetics
HERDC Category C1 - Journal Article (DIISR)
Abstract Background: Mandatory fortification of wheat flour for bread-making was introduced in Australia in September 2009, to
assist in the prevention of neural tube defects (NTD). NTD are twice as common in Aboriginal compared with non-
Aboriginal infants, and folate levels are lower in the Aboriginal population.
Aims: This study was undertaken to compare folate status and NTD in the Aboriginal population before and after
fortification.

Methods
: Postfortification, 95 Aboriginal men and nonpregnant women aged 16–44 years in metropolitan and regional
Western Australia (WA) completed a rapid dietary assessment tool and had blood taken to measure red cell folate.
Measures were compared with prefortification values obtained in an earlier study using the same methods. Data on NTD
in Aboriginal infants were obtained from the WA Register of Developmental Anomalies.

Results:
No participant was folate de ficient. The mean red cell folate increased after fortification to 443 ng/mL for males
and 567 ng/mL for females. The mean difference between red cell folate after fortification compared with before was
129 ng/mL for males (95% CI 81–177); t = 5.4; P < 0.0001) and 186 ng/mL for females (95% CI 139–233); t = 7.9;
P < 0.0001). Most participants ate forti fied shop-bought bread at least weekly, resulting in an estimated additional folate
intake per day of 178 (males) and 145 (females) dietary folate equivalents. NTD prevalence fell by 68% following
fortification (prevalence ratio 0.32 (CI 0.15–0.69)).

Conclusions:
The population health intervention of mandatory fortification of wheat flour for bread-making has had the
desired effect of increasing folate status and reducing NTD in the Australian Aboriginal population.
Keywords Australian Aboriginal population
flour fortification
folic acid
neural tube defects
prevention
DOI http://dx.doi.org/10.1111/ajo.12425   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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