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Folic Acid --- Folic Acid Deficiency

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Folic acid supplements have been considered as safe. A combined analysis from 2009 of two Norwegian randomized controlled clinical trials, with extended post-trial follow-up, demonstrated however, an increased incidence of cancer among patients taking folic acid for homocysteine reduction as secondary prevention of cardiovascular events. In Norway folic acid is among the 10 most sold non-prescription drugs with 17.5 defined daily doses per 1000 inhabitants/day. Norwegian guidelines have since 1998 recommended supplements of folic acid 0.4 mg daily to women periconceptionally in order to reduce the risk of neural tube defects. The present systematic review explores whether there is an increased cancer risk associated with folic acid supplements given orally. This is done in a systematic review and meta-analysis including controlled studies (randomised and observational) of folic acid supplementation. Key messages1. Meta-analysis of ten RCTs with mainly elderly men with cardiovascular disease showed a borderline significant increase in incidence of cancer in the folic acid group compared to controls. Overall cancer incidence was not studied in the seven observational studies.When analysing site-specific cancers, prostate cancer was the only cancer type where increased risk was shown for folic acid supplements. No increased incidence of cancer was found in the seven observational studies.2. This review found insufficient documentation to conclude about cancer risk for fertile women that are recommended folic acid periconceptionally in order to reduce the risk of neural tube defects.

Neoplasms. --- Folic acid. --- Cancer.

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Pteridines. --- Folic acid. --- Folic Acid --- Pteridines --- physiology. --- Physiology.

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Folic Acid --- Neural Tube Defects

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This guideline provides global, evidence-informed recommendations on blood folate concentrations in women of reproductive age for the prevention of neural tube defects in populations. It aims to help Member States and their partners in their efforts to make informed decisions on the appropriate nutrition actions to take to achieve the Millennium Development Goals (MDGs), in particular reduction of child mortality (MDG 4) and improvement of maternal health (MDG 5), through the establishment of appropriate threshold values for red blood cell folate concentrations at the population level. These values may be used to determine the need for, and guide monitoring and evaluation of the impact of, nutrition interventions aimed at improving folate status and preventing congenital anomalies. In order to establish the utility of serum and red blood cell folate as biomarkers of the risk of having a pregnancy affected by neural tube defects, at population level, this guideline examined 4 critical questions: 1. In the absence of an intervention, what are the key genetic, biological and sociodemographic determinants of folate status (serum, plasma or red blood cell folate) in women of reproductive age? 2. What is the threshold concentration of blood folate associated with the lowest probability/risk (depending on the statistical method) of having a pregnancy affected by neural tube defects? 3. Do blood folate concentrations respond to interventions to improve folate status in women? 4. Does the performance of the laboratory assays used to measure folate concentrations affect serum and red blood cell folate readings?This document presents the key recommendations and a summary of the supporting evidence.

Folic acid in human nutrition.