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Spina bifida folate fortification in Brazil, update 2022: a cross-sectional study.

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dc.contributor.author Zanon, Nelci
dc.contributor.author Dos Santos Silva, Rhuann Pontes
dc.contributor.author Varjão Vieira, Eduardo
dc.contributor.author Niquen Jimenez, María Milagros
dc.contributor.author Estevão, Iracema
dc.contributor.author da Costa Benalia, Victor Hugo
dc.contributor.author Coelho, Giselle
dc.contributor.author Salomão, Francisco
dc.coverage.spatial Brasil
dc.date.accessioned 2023-02-20T13:28:09Z
dc.date.available 2023-02-20T13:28:09Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/13133
dc.description.abstract INTRODUCTION: Despite improving maternal-child indicators in Brazil, congenital malformations are still the second cause of mortality in the first years of life. This work aims to compare statistical data before and after flour fortification with folic acid (FA) in Brazil.METHODS: A cross-sectional Brazilian-population-based study compares the spina bifida (SB) rates pre- and post-fortification of the flour with folate. Data collected from the public database of the Live Birth Information System (SINASC/SUS) was performed. The period 1999-2004 (pre-fortification) was compared with 2005-2010 (post-maize and wheat fortification with FA), and another analysis comparing 2005-2010 and 2011-2020 (cassava flour fortification) was performed. The estimator was the prevalence ratio (PRR); the confidence interval selected was 95%. We used a random effects analysis model and inverse variance.RESULTS: The review showed a tendency to decrease the PRR after flour fortification; however, there is no statistical significance between studies. DATASUS data analysis comparing 5years before and 5years after mandatory maize and wheat flour fortification demonstrated a rate ratio of 1.05 (95% CI 0.99-1.1; p=0.075). Furthermore, comparing 10years after additional cassava flour folate fortification, the rate ratio increased to 1.4 (95% CI 1.34-1.45; p<0.01).CONCLUSION: This study demonstrated an increase in SB after FA fortification. Possible explanations rely on national registry improvement, not fortified staple food, or further unidentified causes. Moreover, suggestions can be made for creating a mandatory registry for malformations, inspecting the concentrations of FA in the flour, and fortifying all food. en_US
dc.language.iso eng
dc.publisher Springer
dc.relation.ispartofseries Child's Nervous System
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Brazil en_US
dc.subject DATASUS database en_US
dc.subject Folic acid fortification en_US
dc.subject Myelomeningocele en_US
dc.subject Prevention en_US
dc.subject Spina bifida en_US
dc.subject.mesh Brazil
dc.subject.mesh database
dc.subject.mesh Folic Acid
dc.subject.mesh Meningomyelocele
dc.subject.mesh Spinal Dysraphism
dc.title Spina bifida folate fortification in Brazil, update 2022: a cross-sectional study. en_US
dc.type info:eu-repo/semantics/review
dc.identifier.doi https://doi.org/10.1007/s00381-022-05771-6
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.03
dc.relation.issn 1433-0350


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