Near elimination of folate deficiency anemia by mandatory folic acid fortification in older US asults: REasons for Geographic and Racial Differences in Stroke study (REGARDS) 2004-2007 公开

Abstract

ABSTRACT
Prevalence of Folate deficiency and Folate Deficiency Anemia in the REasons for Geographic and Racial Differences in Stroke study (REGARDS)
By: Oluwaseun A. Odewole

BACKGROUND: The US implemented mandatory folic acid fortification in 1998. While several studies have documented the resulting decrease in anemia and folate deficiency, none has determined the prevalence of folate deficiency anemia post-fortification.

OBJECTIVE: We aim to determine the prevalence of folate deficiency and folate deficiency anemia within a sample of the REGARDS cohort.

METHODS: REGARDS is a prospective cohort (collected from January 2003 to October 2007) comprised of 42% black and 58%white participants. We measured mean serum folate concentrations on a sample of 1,547 REGARDS participants who were 45 years and older and had baseline hemoglobin and red cell mean corpuscular volume (MCV) measurements. Folate deficiency was defined as serum folate concentrations <3.0 ng/mL and anemia was defined using both the WHO definition and age, sex, race specific criteria. Folate deficiency anemia was defined as the presence of both folate deficiency and anemia.

RESULTS: Mean hemoglobin level was 13.6g/dL and the prevalence of anemia by WHO definition in the sample was 15.9%. Mean serum folate was 14.6 ng/mL and two (0.13%) participants were found to be folate deficient. Both participants are African American females with markedly elevated C reactive protein levels and macrocytosis but had normal serum B12 levels. Of these two participants, only one had folate deficiency with anemia. Overall, the prevalence of folate deficiency anemia in the sample was 0.06%.

CONCLUSION: There is almost no folate deficiency anemia in our sample of REGARSDS participants from the post-fortification era. Thus, in addition to being instrumental in the decline of neural tube defects, our data suggests that folic acid fortification has also resulted in nearly eliminating the prevalence of folate deficiency anemia in the US in particular among those over age 50.

Table of Contents

Table of Contents
BACKGROUND...1
MANUSCRIPT...4

Student contribution...5
Abstract...6
Introduction...8
Methods...9
Results...11
Discussion...13
References...16
Tables...20

Table 1: Characteristics of study participants, REGARDS 2003-2007...20
Table 2: Hematologic Parameters of study participants, REGARDS 2003-2007...21
Table 3: Characteristics of folate deficient participants, REGARDS 2003-2007...22

PUBLIC HEALTH IMPLICATIONS AND RECOMENDATIONS...23
REFERENCES...25

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
关键词	REGARDS Mandatory fortification Folic acid Anemia
Committee Chair / Thesis Advisor	Oakley Jr, Godfrey, Emory University
Committee Members	Girard, Amy Webb, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs University, college or educational institution (other than Emory) CDC

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