• Women's Health Nursing
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• v.29 no.4
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• pp.291-301
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• 2023

Purpose: This study aimed to investigate the current status of effective folic acid intake and the level of folic acid knowledge of Chinese pregnant women and to analyze the relationship between effective folic acid intake and folic acid knowledge. Methods: From November 2021 to May 2022, 140 pregnant women at Yantai Yuhuangding Hospital in the Chinese province of Shandong, answered questions about their general characteristics, folic acid intake, and folic acid knowledge. The data were analyzed using the t-test, chi-square test, and logistic regression analysis, and were presented with frequency with percentage or mean±standard deviation. Results: Only 16.4% of the pregnant women (n=23) took folic acid effectively, using the following four criteria. Of all pregnant women who took folic acid, 72.2% took folic acid starting 1 month before pregnancy, 70.8% took folic acid up to 3 months after pregnancy, 36.8% took 400 ㎍ every time, and 78.6% took folic acid more than 24 days every month. The score for folic acid knowledge was relatively high (5.61±2.18 on a scale of 0-9). A higher folic acid knowledge score correlated with more effective folic acid intake (t=4.10, p<.001). Conclusions: Our study shows that the current recommendations to prevent neural tube defects through effective folic acid intake supplementation are not being fully implemented in China. Furthermore, folic acid knowledge was positively correlated with the effectiveness of its intake. Future education related to effective folic acid intake should emphasize the four methods of effective folic acid intake, especially regarding the recommended dose of 400 ㎍ every time.

• Nutrition Research and Practice
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• v.12 no.1
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• pp.78-84
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• 2018

BACKGROUND/OBJECTIVES: Folic acid supplementation before pregnancy is known to reduce the risk of neural tube defects. The purposes of this study were to investigate the awareness, knowledge, and use of folic acid supplements along with their associated factors among non-pregnant Korean women of childbearing age. SUBJECTS/METHODS: From August 2012 to March 2013, 704 women aged 19-45 years completed a self-administered questionnaire regarding their awareness, knowledge, and use of folic acid as well as questions to identify risk of inadequate folate intake. RESULTS: Approximately 67% of women reported that they had heard of folic acid, and 23.7% had knowledge of both the role of folic acid in preventing birth defects and appropriate time for taking folic acid supplements to prevent birth defects. However, only 9.4% of women took folic acid supplements at the time of the survey. Women aged 19-24 years, unmarried women, and women who had never been pregnant were less likely to be aware and knowledgeable of folic acid or take folic acid supplements. In addition, women at high risk of inadequate folate intake were less likely to take folic acid supplements. In a multivariate analysis, women aged 19-24 years, women with a high school diploma or lower education level, and unmarried women were less likely to be aware and have knowledge of folic acid. The percentage of women taking folic acid supplements was significantly higher among knowledgeable women than among unknowledgeable women. CONCLUSIONS: These results support our hypothesis that women with knowledge of folic acid are more likely to take folic acid supplements. Therefore, educational programs or campaigns to improve knowledge regarding the importance of folic acid and to promote consumption of folic acid supplements as well as folate-rich foods are needed to target young, less educated, and unmarried women.

• Preventive Nutrition and Food Science
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• v.19 no.4
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• pp.247-260
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• 2014

The impact of folate on health and disease, particularly pregnancy complications and congenital malformations, has been extensively studied. Mandatory folic acid fortification therefore has been implemented in multiple countries, resulting in a reduction in the occurrence of neural tube defects. However, emerging evidence suggests increased folate intake may also be associated with unexpected adverse effects. This literature review focuses on contemporary issues of concern, and possible underlying mechanisms as well as giving consideration the future direction of mandatory folic acid fortification. Folate fortification has been associated with the presence of unmetabolized folic acid (PteGlu) in blood, masking of vitamin $B_{12}$ deficiency, increased dosage for anti-cancer medication, photo-catalysis of PteGlu leading to potential genotoxicity, and a role in the pathoaetiology of colorectal cancer. Increased folate intake has also been associated with twin birth and insulin resistance in offspring, and altered epigenetic mechanisms of inheritance. Although limited data exists to elucidate potential mechanisms underlying these issues, elevated blood folate level due to the excess use of PteGlu without consideration of an individual's specific phenotypic traits (e.g. genetic background and undiagnosed disease) may be relevant. Additionally, the accumulation of unmetabolized PteGlu may lead to inhibition of dihydrofolate reductase and other enzymes. Concerns notwithstanding, folic acid fortification has achieved enormous advances in public health. It therefore seems prudent to target and carefully monitor high risk groups, and to conduct well focused further research to better understand and to minimize any risk of mandatory folic acid fortification.

• The Journal of the Convergence on Culture Technology
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• v.5 no.1
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• pp.327-332
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• 2019

The purpose of this study was to investigate the effect of 4 week folic acid and vitamin B12 intake on hematological, immune and aerobic anaerobic exercise performance in female basketball players. The subjects were divided into nine groups: ingestion and control group. The results were as follows; 4 weeks of folic acid and vitamin B12 before and after ingestion. There was a significant effect on intake of aerobic and anaerobic capacity, and blood factor analysis showed a significant effect on intake of RBC and Hct. In conclusion, considering the results of the above study, it is expected that folic acid and vitamin B12 intake for improvement of anaerobic and anaerobic exercise ability of female basketball player can improve the performance.

• Nutrition Research and Practice
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• v.1 no.3
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• pp.163-174
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• 2007

Folate has received international attention regarding its role in the risk-reduction of birth defects, specifically neural tube defects (NTDs). In 1998 health officials in Canada, like the United States, mandated the addition of folic acid to white flour and select grain product's to increase the folate intake of reproductive-aged women. Subsequent to this initiative there has been an increase in blood folate concentrations in Canada and a 50% reduction in NTDs. Many countries, including Korea, have not mandated folic acid fortification of their food supply. Reasons vary but often include concern over the masking of vitamin $B_{12}$ deficiency, a belief that folate intakes among womenare adequate, low priority relative to other domestic issues, and the philosophy that individuals have the right not to consume supplemental folic acid if they so choose. Prior to folic acid fortification of the food supply in Canada, the folate intakes of women were low, and their blood folate concentrations while not sufficiently low to produce overt signs of folate deficiency (eg. anemia) were inconsistent with a level known to reduce the risk of an NTD-affected pregnancy. The purpose of this article is to describe the role of folate during the periconceptional period, pregnancy, and during lactation. The rationale for, and history of recommending folic acid-containing supplements during the periconceptional period and pregnancy is described as is folic acid fortification of the food supply. The impact of folic acid fortification in Canada is discussed, and unresolved issues associated with this policy described. While the incidence of NTDs in Canada pre-folic acid fortification were seemingly higherthan that of Korea today, blood folate levels of Korean women are strikingly similar. We will briefly explore these parallels in an attempt to understand whether folic acid fortification of the food supply in Korean might be worth consideration.

• Korean Journal of Community Nutrition
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• v.15 no.4
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• pp.460-474
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• 2010

This study was performed to assess the physical activity, food habit and nutrient intakes by gender and age groups in 193 adults aged 20-59 years (84 men and 109 women) in Pusan. Data for physical activity and dietary survey was assessed by a questionnaire and 24hr recall method. The mean BMIs of men and women were 24.0 and 22.2 respectively and BMI of women in the 20-29 years group (20.9) was significantly lower than that of women in the 30-49 and 50-59 years group (22.7, 23.2) (p < 0.01). 56.0% for men and 44.0% for women exercised regularly. The mean exercise duration per once of men (69.7 minutes) was significantly higher than that of women (52.4minutes) (p < 0.01). The mean exercise duration per day was 36.0 minutes for men and 29.9 minutes for women. 67.9% for men and 78.0% for women often skipped meals and 68.4% for men and 69.4% for women skipped breakfast in the main. The mean energy intake of men was 2067.2 kcal and that of women was 1783.1 kcal comprised of 87.2% and 92.1% of the Estimated Energy Requirements (EER). The mineral intakes of men and women were over Recommended Intake (RI) and Adequate Intake (AI) except calcium and potassium. The mean calcium intake was 88.3% for men and 84.0% for women of RI. The mean potassium intake was 63.3% for men and 59.2% for women of AI. The mean vitamin intakes of men and women were over RI and AI except vitamin C and folic acid. The mean vitamin C intake was 92.5% for men and 85.6% for women of RI. The mean folic acid intake was 76.6% for men and 70.0% for women of RI. The mean energy, protein, sodium and zinc intakes of men were significantly higher than those of women (p < 0.01, p < 0.05, p < 0.05, p < 0.05). The mean vitamin $B_6$, vitamin C and folic acid intakes of men in the 20-29 years group were significantly lower than those of men in the 30-49 and 50-59 years group (p < 0.01, p < 0.05, p < 0.05). For energy, proportions of subjects with intake levels less than 90% EER were 64.3% for men and 56.0% for women. For calcium, proportions of subjects with intake levels less than Estimated Average Requirement (EAR) were 52.4% for men and 59.6% for women. For folic acid, proportions of subjects with intake levels less than EAR were 78.6% for men and 83.5% for women. For iron and phosphorus, proportions of women (36.7%, 14.7%)with intake levels less than EAR were significantly higher than those of men (6.0%, 1.2%) (p < 0.01, p < 0.001). For men, age was positively correlated with intakes of potassium, vitamin $B_6$, vitamin C and folic acid (p < 0.05, p < 0.05, p < 0.05, p < 0.01). For men, weight showed significantly negative correlations with intakes of carbohydrate, phosphorus, potassium, zinc, vitamin $B_6$ and folic acid (p < 0.01, p < 0.05, p < 0.05, p < 0.05, p < 0.01) and BMI showed significantly negative correlations with protein, lipid, phosphorus, potassium, zinc, vitamin E and folic acid (p < 0.05, p < 0.05, p < 0.05, p < 0.05, p < 0.05, p < 0.05, p < 0.05) For men, exercise duration per once showed significantly positive correlations with intakes of calcium, phosphorus, potassium, zinc, vitamin $B_1$, vitamin $B_2$, niacin, vitamin C and folic acid (p < 0.01, p < 0.05, p < 0.01, p < 0.05, p < 0.05, p < 0.01, p < 0.01, p < 0.01, p < 0.05). Therefore, nutritional education for adult health management is needed by gender and age groups.

• Journal of Preventive Medicine and Public Health
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• v.52 no.4
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• pp.205-213
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• 2019

Objectives: Maternal folic acid supplementation is considered mandatory in almost every country in the world to prevent congenital malformations. However, little is known about the association of maternal folic acid intake with the occurrence of childhood cancer. Hence, this study aimed to determine the effects of maternal folic acid consumption on the risk of childhood cancer. Methods: A total of 158 related articles were obtained from PubMed, Google Scholar, Scopus, and ProQuest using standardized keywords, of which 17 were included in the final review. Results: Eleven of the 17 articles showed a significant protective association between maternal folic acid supplementation and childhood cancer. Using a random-effects model, pooled odds ratios (ORs) showed a protective association between maternal folic acid supplementation and childhood acute lymphoblastic leukaemia (OR, 0.75; 95% confidence interval [CI], 0.66 to 0.86). However, there was no significant association between maternal folic acid supplementation and acute myeloid leukaemia (OR, 0.70; 95% CI, 0.46 to 1.06) or childhood brain tumours (OR, 1.02; 95% CI, 0.88 to 1.19). Conclusions: Maternal folic acid supplementation was found to have a protective effect against childhood acute lymphoblastic leukaemia. Thus, healthcare professionals are recommended to provide regular health education and health promotion to the community on the benefits of folic acid supplementation during pregnancy.

• Journal of Nutrition and Health
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• v.49 no.2
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• pp.72-79
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• 2016

Purpose: The initiation of mandatory folic acid fortification using pteroylmonoglutamic acid (PteGlu) has reduced the rate of congenital malformations. However, it also appears to be responsible for several adverse effects, including increased cancer incidence. This may be related to physicho-chemical characteristics of PteGlu. This study examines the potential effect of high concentrations of PteGlu on a population subjected to mandatory folic acid fortification using an in vitro model. Methods: Caco-2 (colorectal cancer) and MCF7 (breast cancer) cell lines were cultured at 6 different PteGlu concentrations (0, 0.1, 1, 50, 250, and $500{\mu}g/ml$) for 6 days. Cell growth was determined using thiazolyl blue tetrazolium bromide assay. The genotype of dihydrofolate reductase 19bp deletion/insertion (DHFR 19-del) was also scored in cell lines using a restriction fragment length polymorphism technique to examine whether genetic variations may factor in cell proliferation. Results: PteGlu exhibited differential growth promoting properties between cell lines. Caco-2 cells did not show a significant growth difference at low concentrations compared to control, however, at higher concentrations, the growth showed a contrasting trend in the early experimental period, while MCF7 showed enhanced cell growth at all concentrations. The DHFR 19-del genotype differed in the two cell lines. Conclusions: Altered response to PteGlu by Caco-2 and MCF7 may reflect a tissue specific disease aetiology or genotype specific differential enzyme activity, for example by DHFR, to critical levels of PteGlu. As folic acid fortification is a blanket intervention, and DHFR and other enzyme activities vary between individuals, PteGlu intake may have an as yet undefined effect on health. These findings may be relevant when considering mandatory folic acid fortification for disease prevention.

• Journal of the East Asian Society of Dietary Life
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• v.21 no.2
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• pp.185-193
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• 2011

The purpose of this study was to determine the effects of nutrient intake, screen time (television viewing and computer and/or video games) and physical activity on obesity in preschool children. Recruitment began in January 2008 by distributing letters to mothers who had children aged 6 years enrolled in daycare. Dietary intakes were obtained from the children's mothers, using the 24-hour recall method. The average height and weight of the children were 114.2 cm and 20.3 kg, respectively. Mean age, body weight, height and Kaup index were not significantly different between groups consisting of boys or girls. Assessment by the Kaup index showed that 14.0% of children were underweight, 69.0% were normal weight, 13.0% were overweight, and 4% were obese. The daily intakes of calcium, potassium, fiber, and folic acid in the group of boys were 77.7%, 58.5%, 80.4% and 88.9% respectively. as compared with the DRIs. The daily intakes of calcium, potassium, fiber, and folic acid in the group of girls were 77.7%, 58.5%, 80.4% and 88.9%, respectively. as compared with the DRIs. Intakes of protein, phosphorus, iron, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin C, and vitamin E were higher than the DRIs. There were no difference among 3 groups (underweight, normal, overweight) in energy or nutrient intake. Preschool children with screen time (TV viewing and computer and/or video games use time) of >2 hours per day had significantly higher Kaup index values, and intakes of energy, carbohydrate, folic acid and zinc. In conclusion, preschool children with reported screen time (TV viewing and computer and/or video games use time) of >2 hours per day were fatter. Therefore, we need further investigate the relation between diet and screen time in preschool children to improve future nutrition education programs. Further studies are required to explore the effects of food intake and screen time (TV viewing and computer and/or video games use time) over a longer period of time.

• Journal of the Korean Dietetic Association
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• v.10 no.4
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• pp.417-427
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• 2004

The purpose of this study was to investigate children's nutrient intakes by school lunch. Evaluation of nutrient intakes by school lunch for three days was conducted with 86 children in urban and 64 children in rural of Jeonbuk area. The results of this study were as follows. 1) With respect to amounts of provided nutrients in school lunch, CPF (carbohydrate : protein : fat) energy ratio was 48.6 : 19.7 : 31.6 in urban and was 46.7 : 20.5 : 32.7 in rural. Compared to 1/3 RDA (RDA) of children for 10-12 years, folic acid and zinc were provided below 50 % of RDA. Protein, fat, phosphorus, vitamin $B_1$, vitamin $B_2$, niacin, vitamin C and vitamin E were provided above 125 % of RDA. There were no differences in amounts of provided nutrients-except calcium, vitamin A, vitamin $B_6$, folic acid and zinc-between urban and rural. 2) With respect to amounts of nutrient intakes, CPF energy ratio was 51.1 : 17.4 : 31.5 in urban and 47.5 : 19.7 : 32.7 in rural. Compared to RDA, folic and zinc were below 50 % of RDA. Iron and vitamin $B_6$ were below 75 % of RDA. Protein, fat, phosphorus and vitamin E were above 125 % of RDA. There were significant differences in nutrient intakes between urban and rural. The children in rural showed higher levels of nutrient intakes-energy, carbohydrate, protein, fat, calcium, phosphorus, iron, zinc, vitamins and folic acid-compared to those of children in urban. These results suggest that programs are needed for providing adequate nutrient intakes for children in school lunch and for improving nutrient intakes of children in urban.