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Is Folic Acid safe for malnourished children?

This question was posted the Micronutrients forum area and has 1 replies.

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Mathias Grossiord


Normal user

12 Feb 2013, 05:22

Dear All, In the light of the short video listed below and the scientific article cited in the same page, Can we still consider that the amount of Folic acid given to malnourished children is safe? Should we consider Folate to be safer? Thanks for your replies Mathias

Andy Seal

Associate Prof. International Nutrition

Technical expert

26 Feb 2013, 10:16

Thanks for posting this very interesting question. My initial thoughts follow below. The term 'folate' is usually used to refer to both the natural and synthetic forms of the vitamin. Folic acid is a synthetic form of the vitamin that is very widely used in food fortification and nutritional supplementation. Folic acid fortification was introduced in a number of countries from the 1990s onwards to reduce the incidence of Neural Tube Defects, and this has been very successful. However, due to concerns about a possible link to cancer, the safety of folic acid has been attracting a lot of attention from the nutrition science community. A review was published last month as an e-pub by the Lancet: "Effects of folic acid supplementation on overall and site-specific cancer incidence during the randomised trials: meta-analyses of data on 50?000 individuals." They concluded that "Folic acid supplementation does not substantially increase or decrease incidence of site-specific cancer during the first 5 years of treatment. Fortification of flour and other cereal products involves doses of folic acid that are, on average, an order of magnitude smaller than the doses used in these trials." An associated commentary in the Lancet provides useful context and analysis. (subscription required) However, your questions are of course a bit different: "Can we still consider that the amount of Folic acid given to malnourished children is safe?" "Should we consider Folate to be safer?" Given the lack of data on human subjects these questions are hard to answer definitively. However, I am not aware of any data that suggests any increased risk or vulnerability in malnourished children to any adverse affects of folic acid. Putting things in another way, if my children were malnourished would I want folic acid to be included in their nutrition therapy? Yes I would. And, should we consider folate to be safer than folic acid? For me, there is not the evidence base to answer this one way or the other. But, in general, I would certainly prefer to eat a well balanced diet rather than using micronutrient supplements. For the treatment of malnourished children the use of folate in therapeutic foods is not really an option at the moment. As a final thought, the folic acid debate illustrates to me again the importance of balancing risks and benefits in deciding on appropriate nutrition interventions. To ensure the best possible risk:benefit balance it would seem sensible to use the minimum dose of any micronutrient that will achieve the desired physiological effect. This approach is important to optimise the risk:benefit ratio for both healthy individuals and patients. More is often not better.

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