Folate intakes and awareness of folate to prevent neural tube defects: A survey of women living in Vancouver, Canada☆

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Abstract

Objective To estimate folate intake and knowledge in women of childbearing age, in relation to risk of neural tube defects. Subjects/setting One hundred forty-eight women (aged 18 to 45 years) in the Vancouver area of British Columbia, Canada. Design Using an interviewer-administered survey, we examined women for folate knowledge and the relation of folate knowledge to intake in a random sample. Contribution of folate from food, fortified grain products, and supplements was assessed by validated semiquantitative food frequency questionnaire. Statistical analyses performed Descriptive statistics, t tests, χ2, Pearson correlation analysis. Results Mean daily folate intake from food, fortified foods, and supplementation was 812±710 Dietary Folate Equivalents (DFE)/day. Fortification of bread and grain products contributed 104±68 μg synthetic folic acid (SFA)/day (equal to 174±114 DFE), and supplements contributed 205±388 μg SFA/day. Although 86% of women met the Estimated Average Requirement (320 DFE/day) for folate, only 26% met the recommendation (400 μg SFA/day) for women capable of becoming pregnant. Most (95%) of the women had heard of folate, but only 25% knew that it could prevent birth defects. One-fourth of the women had good or very good knowledge of folate-rich foods. However, folate knowledge was not related to its intake. The most common sources of folate information were magazines/newspapers, doctors, and television/radio. Lack of awareness of the importance of folate was the most common reason given for choosing not to use folic acid supplements before pregnancy. However, 78% of the women indicated that, with knowledge of the benefits of folate, they would use supplemental folic acid daily to reduce the risk of birth defects. Applications/conclusions Educational strategies are required to increase folate awareness among women and to promote the benefits of periconceptional folic acid supplementation. Targeting physicians to educate women on the importance of folate could be a potentially successful route. J Am Diet Assoc. 2003;103:181-185.

Section snippets

Methods

This cross-sectional study was approved by the Behavioral Research Ethics Review Committee, University of British Columbia. A survey and a validated semiquantitative food frequency questionnaire (FFQ) were verbally administered by a trained dietitian interviewer in the participants' homes.

Results

One thousand seven hundred sixteen letters were mailed to households in the Vancouver area of British Columbia, of which 1,058 were ineligible, and 243 households were not successfully contacted. One hundred forty-eight women with a mean age of 35.5±7.4 years participated in the study, representing 35.7% of contacted households. Demographic characteristics of study participants are shown in Table 1.Fifty-two percent of eligible nonresponders reported their age, number of children, and whether

Discussion

The study findings confirmed that most women do not meet the special recommendation to decrease NTD risk despite current efforts to increase folic acid intake of women of childbearing potential. In the current study, fortification findings supported the hypothesis that fortification would result in an increase of approximately 100 μg of folic acid daily in the diets of adult women ((13)) and are similar to results of other recent studies [17], [18]. The additional folic acid provided by

Applications

Similarities between the dietary intakes, knowledge, and supplement use of women in the current study and women participating in other studies suggest that the data collected may have broader applications despite the relative homogeneity of the sample population. The findings from this study provide important information that will be valuable in the development of folic acid educational tools aimed at women who are capable of becoming pregnant. To further decrease NTD risk, educational

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    Source of financial support: British Columbia Health Research Foundation.

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    Copyright © 2003 American Dietetic Association. Published by Elsevier Inc. All rights reserved.