RESUMO
OBJECTIVE: Hispanics with lower acculturation may be at higher risk for neural tube defects compared with those with higher acculturation due to lower total folic acid intake or other undetermined factors. Modelling has indicated that fortification of corn masa flour with folic acid could selectively target Mexican Americans more than other race/ethnicities. We assessed whether fortification of corn masa flour with folic acid could selectively increase folic acid intake among Mexican-American women with lower acculturation, as indicated by specific factors (language preference, country of origin, time living in the USA). DESIGN: We used dietary intake and dietary supplement data from the National Health and Nutrition Examination Survey 2001-2008, to estimate the amount of additional total folic acid that could be consumed if products considered to contain corn masa flour were fortified at 140 µg of folic acid per 100 g of corn masa flour. SETTING: USA. SUBJECTS: Non-pregnant women aged 15-44 years (n 5369). RESULTS: Mexican-American women who reported speaking Spanish had a relative percentage change in usual daily total folic acid intake of 30·5 (95 % CI 27·8, 33·4) %, compared with 8·3 (95 % CI 7·3, 9·4) % for Mexican-American women who reported speaking English. We observed similar results for other acculturation factors. An increase of 6·0 percentage points in the number of Mexican-American women who would achieve the recommended intake of ≥400 µg folic acid/d occurred with fortification of corn masa flour; compared with increases of 1·1 percentage points for non-Hispanic whites and 1·3 percentage points for non-Hispanic blacks. An even greater percentage point increase was observed among Mexican-American women who reported speaking Spanish (8·2). CONCLUSIONS: Fortification of corn masa flour could selectively increase total folic acid intake among Mexican-American women, especially targeting Mexican-American women with lower acculturation, and result in a decrease in the number of pregnancies affected by neural tube defects.
Assuntos
Aculturação , Farinha/análise , Ácido Fólico/administração & dosagem , Alimentos Fortificados , Americanos Mexicanos/estatística & dados numéricos , Zea mays , Adolescente , Adulto , Suplementos Nutricionais , Feminino , Humanos , Defeitos do Tubo Neural/epidemiologia , Defeitos do Tubo Neural/prevenção & controle , Política Nutricional , Inquéritos Nutricionais , Necessidades Nutricionais , Prevalência , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
Folic acid can prevent neural tube defects (NTD). Hispanic women have a higher prevalence of NTD than non-Hispanic white (NHW) women and consume less folic acid. Among Hispanics, acculturation has been associated with lower intakes of natural folate. It is unknown if this same relationship is seen for fortified foods. This article describes the associations of acculturation factors with usual folate intakes from foods and supplements and compares the proportion that meets recommended intakes of folic acid of US Mexican American (MA) women with those of NHW women. For US NHW and MA women aged 15-44 y (n = 3167), usual folate intakes (i.e., natural food folate, folic acid from food, total folic acid [fortified foods plus supplements], and total folate) were estimated using measurement error models from NHANES 2001-2008. Compared with NHW women, MA women did not differ in their intake of natural food folate or folic acid from food. Similarly, compared with NHW women (332 ± 17.3 µg/d), the mean total usual folic acid intakes were lower among MA women who reported speaking Spanish (224 ± 24.9 µg/d) but not for MA women who reported speaking English (283 ± 36.2 µg/d). MA women were more likely than NHW women to consume a total folic acid intake <400 µg/d. MA women with lower acculturation factors were the most likely to have an intake <400 µg/d compared to NHW women. Public health efforts should focus on increasing total folic acid intake among MA women, emphasizing those with lower acculturation factors (e.g., MA women who report speaking Spanish).
Assuntos
Aculturação , Dieta/etnologia , Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Americanos Mexicanos , Adolescente , Adulto , Estudos Transversais , Dieta/efeitos adversos , Dieta/tendências , Suplementos Nutricionais/análise , Feminino , Deficiência de Ácido Fólico/prevenção & controle , Alimentos Fortificados/análise , Promoção da Saúde , Humanos , Defeitos do Tubo Neural/epidemiologia , Defeitos do Tubo Neural/prevenção & controle , Política Nutricional , Inquéritos Nutricionais , Necessidades Nutricionais , Valor Nutritivo , Cooperação do Paciente/etnologia , Risco , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Previous studies have shown that acculturation factors are associated with dietary patterns of older Mexican Americans (MAs), but the association of these factors with post-fortification folate intake is unknown. We estimated usual folate intakes for U.S. MAs aged ≥60 years (N = 712) by acculturation factors using data from the National Health and Nutrition Examination Survey 2001-2006. Mean total folic acid and total folate, but not natural folate intakes, were lower for MAs with lower acculturation factors, and 16% of MAs had total folate intakes less than the estimated average requirement (EAR) of 320 µg/day. Most older U.S. MAs did not meet requirements from natural food folate intake alone, regardless of acculturation status, but their intakes were adequate when fortified foods and supplement sources were taken into account. Logistic regression models including age, sex, education, poverty, and acculturation factors indicated that low income, not acculturation, was significantly associated with intake below the EAR. Thus our findings indicate that the association of low acculturation with folate intake below the EAR is not independent of poverty. [Supplementary materials are available for this article. Go to the publisher's online edition of the Journal of Nutrition in Gerontology and Geriatrics for the following free supplemental resource: a table of the distribution of usual folate intake among Mexican Americans aged ≥60 years by sex, age, education level, poverty income ratio, and acculturation factors, from the National Health and Nutrition Examination Survey 2001-2006.].
Assuntos
Aculturação , Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Alimentos Fortificados , Americanos Mexicanos/estatística & dados numéricos , Inquéritos Nutricionais , Idoso , Grão Comestível , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores SocioeconômicosRESUMO
Acculturation factors have been found to affect dietary intakes of folate among older Mexican Americans (MAs) (≥60 years). The association of acculturation with folate biomarkers is unknown. We determined whether acculturation factors were associated with folate biomarkers (e.g., serum folate, red blood cell [RBC] folate, and total homocysteine concentrations) and whether this association could be explained by dietary folate. Using data from the National Health and Nutrition Examination Survey (NHANES) 2001-2006, we estimated that 42.8% and 40.1% of older MAs reported speaking Spanish all or most of the time or being born in Mexico, respectively (lower acculturation factors). Lower acculturation factors were not associated with total homocysteine concentrations but were, in general, associated with lower serum folate and RBC folate concentrations, but these associations were not always independent of factors such as sex, education, and poverty, and possibly were mediated by dietary and supplemental folate. Thus, the lower folate status observed among older MA with lower acculturation factors may be modifiable by changes in the intake of folic acid. [Supplementary materials are available for this article. Go to the publisher's online edition of the Journal of Nutrition in Gerontology and Geriatrics for the following free supplemental resource: a table of the predictors of serum folate or red blood cell folate concentrations among Mexican Americans 60 years of age or older using country of origin or language preference, respectively, as acculturation factors, from the National Health and Nutrition Examination Survey 2001-2006.].
Assuntos
Aculturação , Suplementos Nutricionais , Ácido Fólico/sangue , Alimentos Fortificados , Americanos Mexicanos/estatística & dados numéricos , Inquéritos Nutricionais , Idoso , Dieta , Eritrócitos , Feminino , Ácido Fólico/administração & dosagem , Humanos , Modelos Lineares , Masculino , México , Pessoa de Meia-Idade , Estado Nutricional , Fatores SocioeconômicosRESUMO
Neural tube defects (NTDs) are serious birth defects of the brain and spine that affect approximately 3,000 pregnancies in the United States each year and affected 404 pregnancies in Puerto Rico from 1996 to 2002. Consuming the B vitamin folic acid can reduce the incidence of NTDs 50%-70%, and recent efforts to reduce NTD rates have focused on increasing the number of childbearing-aged women who take a vitamin containing folic acid every day. As the first stage of formative research in campaign planning, two exploratory, qualitative studies were conducted in order to (a) understand the complexity of vitamin use among women in the United States and Puerto Rico and (b) serve as a foundation on which to develop national communication and education interventions. Also, this information shed light on theories that might be used to guide campaign development. Results indicated that campaign messages designed to increase folic acid use through multivitamin supplementation in the United States must address women's barriers to vitamin use (e.g., cost, time), increase women's perceived need for multivitamins (e.g., identify immediate, tangible results from taking a daily multivitamin), and address the relationship between daily food choices and the need for supplementation. Future campaign messages in Puerto Rico must focus on many of these same issues, in addition to increasing women's knowledge about when folic acid should be taken in relation to pregnancy and addressing women's perceptions that vitamins cause weight gain (an undesirable outcome for most participants). The practical and theoretical implications of these results are discussed in terms of their contribution to the development of a creative new approach to increase multivitamin consumption among women of childbearing age in the United States and Puerto Rico.