High folate levels in Aboriginal children after subsidised fruit and vegetables and mandatory folic acid fortification

Aust N Z J Public Health. 2014 Jun;38(3):241-6. doi: 10.1111/1753-6405.12235.

Abstract

Objective: To evaluate the impact of a fruit and vegetable (F&V) subsidy program for disadvantaged Aboriginal children in Australia, implemented alongside the introduction of mandatory folic acid fortification of bread-making flour.

Methods: A before-and-after evaluation was undertaken of a F&V subsidy program at three Aboriginal community-controlled health services in New South Wales. The program provided a weekly box of subsidised F&V linked to preventive health services and nutrition promotion for families. In this analysis, red blood cell (RBC) folate was assessed together with self-reported dietary intake at baseline and 12 months later in a cohort of 125 children (aged 0-17 years).

Results: No children had low RBC folate at baseline or at follow-up; however, 33 children (26%) exceeded the reference range of RBC folate at baseline and 38 children (30%) exceeded the reference range at follow-up. Mean RBC folate levels increased substantially in children at follow-up (mean RBC folate z-score increased +0.55 (95%CI 0.36-0.74). Change in F&V intake (p=0.196) and mean bread intake (p=0.676) were not statistically significant predictors for change in RBC folate levels.

Conclusions: RBC folate levels increased among these disadvantaged Aboriginal children following mandatory folic acid fortification and participation in a subsidised F&V program. Even before mandatory folic acid fortification, none of these children had low RBC folate.

Implications: The effect on health of mandatory fortification of foods with folate is not clear, hence, ongoing population-based monitoring of folate levels to assess the impact of mandatory folic acid fortification is important.

Keywords: Aboriginal health; biomarkers; nutrition.

MeSH terms

  • Adolescent
  • Australia
  • Child
  • Child, Preschool
  • Dietary Supplements
  • Female
  • Flour
  • Folic Acid / blood*
  • Folic Acid Deficiency / blood
  • Folic Acid Deficiency / diagnosis
  • Folic Acid Deficiency / ethnology*
  • Follow-Up Studies
  • Food Assistance*
  • Food, Fortified*
  • Fruit*
  • Health Services, Indigenous
  • Health Surveys
  • Humans
  • Infant
  • Male
  • Neural Tube Defects / prevention & control
  • New South Wales / epidemiology
  • Nutritional Status
  • Program Evaluation
  • Vegetables*

Substances

  • Folic Acid