Fortified Flours are the Major Food Source of Folate in a Population of Reproductive Age Women: the ProcriAr Cohort Study in Brazil



BACKGROUND. Inadequate nutrition during reproductive years and pregnancy has serious implications on health of children, both in utero and during childhood. OBJECTIVE. To quantify major dietary sources of folate in a cohort of pregnant women from Sao Paulo-Brazil. DESIGN. A total of 454 women in the first trimester of pregnancy (mean age=26, range 14-49years) retrospectively completed a validated 110-item food frequency questionnaire. The USDA food composition table was used to estimate the daily intake of dietary folate equivalents (DFE=natural folate+1.7*folic acid). The folic acid fortification of wheat and corn flours is mandatory in Brazil since 2004. The amount of folic acid was corrected due to differences on levels of flour fortification in Brazil and USA. Folate provided by each food item was divided by total folate to obtain the contribution of each food item to folate intake. RESULTS. The eight food items that together contributed 73% of folate intake were French bread (19.6%), beans (13.2%), fruits (12.0%), snacks and sandwiches (9.5%), vegetables (6.1%), crackers (4.8%), cereal ready-to-eat (4.0%), and pasta (4.0%). Almost 42% of folate comes from the synthetic and 31% comes from the natural form. CONCLUSIONS. Fortification programs have contributed to the dietary intake of folate for women in this population. Health promotion programs should encourage the dietary intake by women of known healthy foods containing natural folate, such as fruits, vegetables and mainly beans, once, in Brazil, it was described a reduction trend in the consumption of this legume, important to health and to Brazilian food culture maintenance. Keywords: Primary health care; Food, nutrition; Maternal health Key Messages 1. Fortification programs have been contributing to the dietary intake of folate for women in Brazil. 2. Beans are good contributors to dietary intake of folate in Brazil. 3. Intake of foods containing natural folate, such as fruits, vegatables and beans, has to be encouraged.


Juliana Teixeira

School of Population Health, University of Sao Paulo