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Systematic Review and Bayesian Meta-analysis of the Dose-response Relationship between Folic Acid Intake and Changes in Blood Folate Concentrations

1
Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Congenital and Developmental Disorders, Atlanta, GA 30341, USA
2
Karna, LLC, Atlanta, GA 30329, USA
3
G²S Corporation, San Antonio, TX 78216, USA
4
Oak Ridge Institute for Science and Education, Oak Ridge, TN 37831, USA
5
Doctoral Program in Nutrition Health Sciences, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
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Department of Epidemiology, Gilling’s School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
*
Author to whom correspondence should be addressed.
Nutrients 2019, 11(1), 71; https://doi.org/10.3390/nu11010071
Received: 5 November 2018 / Revised: 22 December 2018 / Accepted: 28 December 2018 / Published: 2 January 2019
The threshold for population-level optimal red blood cell (RBC) folate concentration among women of reproductive age for the prevention of neural tube defects has been estimated at 906 nmol/L; however, the dose-response relationship between folic acid intake and blood folate concentrations is uncharacterized. To estimate the magnitude of blood folate concentration increase in response to specific dosages of folic acid under steady-state conditions (as could be achieved with food fortification), a systematic review of the literature and meta-analysis was conducted. Of the 14,002 records we identified, 533 were selected for full-text review, and data were extracted from 108 articles. The steady-state concentrations (homeostasis) of both serum/plasma and RBC folate concentrations were estimated using a Bayesian meta-analytic approach and one-compartment physiologically-based pharmacokinetic models. RBC folate concentrations increased 1.78 fold (95% credible interval (CI): 1.66, 1.93) from baseline to steady-state at 375–570 µg folic acid/day, and it took a median of 36 weeks of folic acid intake (95% CI: 27, 52) to achieve steady-state RBC folate concentrations. Based on regression analysis, we estimate that serum/plasma folate concentrations increased 11.6% (95% CI: 8.4, 14.9) for every 100 µg/day folic acid intake. These results will help programs plan and monitor folic acid fortification programs. View Full-Text
Keywords: folic acid; red blood cell folate; serum folate; plasma folate; fortification; supplementation; public health folic acid; red blood cell folate; serum folate; plasma folate; fortification; supplementation; public health
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MDPI and ACS Style

Crider, K.S.; Devine, O.; Qi, Y.P.; Yeung, L.F.; Sekkarie, A.; Zaganjor, I.; Wong, E.; Rose, C.E.; Berry, R.J. Systematic Review and Bayesian Meta-analysis of the Dose-response Relationship between Folic Acid Intake and Changes in Blood Folate Concentrations. Nutrients 2019, 11, 71. https://doi.org/10.3390/nu11010071

AMA Style

Crider KS, Devine O, Qi YP, Yeung LF, Sekkarie A, Zaganjor I, Wong E, Rose CE, Berry RJ. Systematic Review and Bayesian Meta-analysis of the Dose-response Relationship between Folic Acid Intake and Changes in Blood Folate Concentrations. Nutrients. 2019; 11(1):71. https://doi.org/10.3390/nu11010071

Chicago/Turabian Style

Crider, Krista S.; Devine, Owen; Qi, Yan P.; Yeung, Lorraine F.; Sekkarie, Ahlia; Zaganjor, Ibrahim; Wong, Eugene; Rose, Charles E.; Berry, Robert J. 2019. "Systematic Review and Bayesian Meta-analysis of the Dose-response Relationship between Folic Acid Intake and Changes in Blood Folate Concentrations" Nutrients 11, no. 1: 71. https://doi.org/10.3390/nu11010071

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