Folate Status and Neural Tube Defects in Aboriginal Australians: The Success of Mandatory Fortification in Reducing a Health Disparity

Citation:
D'Antoine H, Bower C. Folate Status and Neural Tube Defects in Aboriginal Australians: The Success of Mandatory Fortification in Reducing a Health Disparity. Current Developments in Nutrition. 2019;3(8):nzz071

Keywords:
Aboriginal; closing the gap; folic acid; fortification; health promotion; neural tube defects; surveillance

Abstract:
Historically, neural tube defects (NTD) in Australia affected around 1 in every 1000 births; 42% higher for Aboriginal births. Following firm evidence of the protective effect of periconceptional folate, health promotion activities encouraged increased folate intake through diet and supplements and limited voluntary food fortification. A 30% reduction in NTD was observed in non-Aboriginal but not Aboriginal infants, widening the disparity between Aboriginal and non-Aboriginal rates. Mandatory flour fortification with folic acid in 2009, led to further reductions in overall NTD, and greater reduction among Aboriginal infants, such that rates in Aboriginal and non-Aboriginalinfants were similar by 2010-2014. Elimination of this disparity will make a small but important contribution to the Australian government's Closing the Gap initiative to reduce disadvantage among Aboriginal people. Long-term, complete, high-quality surveillance data on NTD have been of great value in monitoring trends in and evaluation of public health interventions for NTD in Australia.