EVIDENCE BASED PUBLIC HEALTH POLICY AND PRACTICE

Impact of voluntary folate fortification on plasma homocysteine and serum folate in Australia from 1995 to 2001: a population based cohort study

Siobhan Hickling¹, Joseph Hung², Matthew Knuiman¹, Konrad Jamrozik¹, Brendan McQuillan², John Beilby³ and Peter Thompson²

¹ School of Population Health, University of Western Australia, Australia
² Department of Cardiology, Sir Charles Gairdner Hospital, and School of Medicine and Pharmacology, University of Western Australia
³ PathCentre, QEII Medical Centre, Nedlands, Australia and School of Surgery and Pathology, University of Western Australia

Correspondence to:
Correspondence to:
Mrs S Hickling
School of Population Health, University of Western Australia, Crawley WA 6009, Australia; siobhan{at}cyllene.uwa.edu.au

Study objective: To investigate the effect of the voluntary folate fortification policy in Australia on serum folate and total plasma homocysteine (tHcy) concentrations.

Design: Population based cohort study.

Setting: Perth, Western Australia.

Participants: Men and women aged 27 to 77 years (n = 468), who were originally randomly selected from the Perth electoral roll. The cohort was surveyed in 1995/96 before widespread introduction of folate fortification of a variety of foods, and followed up on two occasions, firstly in 1998/99 and again in 2001, when a moderate number of folate fortified foods were available. Subjects with abnormal serum creatinine concentrations at baseline were excluded from this analysis.

Main results: Repeated measures analysis of variance was used to determine changes in serum folate and tHcy over the three surveys and to assess whether time trends were related to age, sex, MTHFR C677T genotype, or consumption of folate fortified foods. An increase (38%) in mean serum folate (p<0.0005) and a decrease (21%) in mean tHcy (p<0.0005) were seen after introduction of the voluntary folate fortification policy in Australia. Serum folate was consistently higher (p = 0.032) and tHcy was consistently lower (p = 0.001) in subjects who consumed at least one folate fortified food compared with subjects who did not consume any folate fortified foods in the previous week. The time related changes in serum folate and tHcy were affected only by intake of folate fortified foods (p<0.0005) and not by any other measured variables including age, sex, or MTHFR genotype.

Conclusion: Voluntary fortification of foods with folate in Australia has been followed by a substantial increase in serum folate and decrease in tHcy in the general population.

Abbreviations: NTD, neural tube defect; tHcy, total plasma homocysteine

Keywords: folate; fortified food; homocysteine

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