Sekedar Informasi TTg Folic ACid
Semoga bermanfaat
Salam
LeaIbuNyaPatria&Aldi
www.babiesonline.com/babies/p/patrialdi
Overview
Folic Acid is a B vitamin which is found naturally in leafy vegetables, citrus
fruits, beans, and whole grains. Folate and folic acid are interchangeable
terms; folic acid is the synthetic form of folate.
Scientists are in general agreement that folic acid reduces the risk of neural
tube defects, which are serious birth defects, including spina bifida and
anencephaly. In 1992, the Food and Drug Administration (FDA) recommended
fortifying the nation’s food supply with folic acid, a strategy that has worked
well in the past with other beneficial substances including iodine (in salt),
vitamin D (in milk), and thiamin (in flour and bread). Folic acid began being
added to breads and other grain products in January of 1998.
The neural tube defects that folic acid can prevent, including spina bifida and
anencephaly, are among the most serious and frequently occurring birth defects.
Spina bifida occurs when the fetus’ spinal column does not close to protect the
spinal cord; this closure should happen within the first few weeks of the
pregnancy. Spina bifida causes neurological problems and sometimes, varying
levels of mental retardation. Anencephaly is a condition in which the baby’s
brain does not develop properly and most or all of the brain tissue is absent.
Anencephaly results in either stillbirth or death soon after delivery.
Scientists representing many public and private agencies and organizations,
including the Food and Drug Administration, the Public Health Service, the
Teratology Society, and the Spina Bifida Association of America recommend that
women of childbearing age (15–45 years old) take folic acid as a part of their
daily diet, not when they become pregnant which is often too late to prevent
these birth defects.
A recent report by the National Center for Health Statistics examines the US
incidences of spina bifida and anencepahlus over an 11-year period from
1991-2001 and shows significant decreases in the 2001 incidences of these birth
defects as compared to the 1997 rates.
What is Folic Acid/Folate?
Folic acid is a chemical that is essential to sustain human life and must be
provided in adequate amounts through food or other dietary supplements. Folic
acid is a B vitamin which scientists agree reduces the risk of neural tube
defects, including spina bifida and anencephaly, by up to 70% when taken
regularly by women of child bearing age. In order to be effective, folic acid
must be taken during the first weeks of pregnancy when these neural tube
defects occur.
Folate and folic acid are interchangeable terms. Folic acid is the synthetic
form of folate, which is found naturally in some foods, including leafy
vegetables, beans (legumes), citrus fruits, and whole grains.
Neural Tube Defects
According to the FDA (FDA February 29, 1996):
Neural tube defects (NTD), including spina bifida and anencephaly, are the most
common disabling birth defects.
Approximately 2,500 infants are born each year in the U.S. with an NTD. About
half of these cases are thought to be related to inadequate folate intake by
the mother. Other NTDs have different causes that are not well understood.
Spina bifida is a condition in which the spinal cord is exposed. A majority of
babies born with spina bifida grow to adulthood with varying degrees of
disability, ranging to problems with bowel and bladder control, and paralysis.
Many may require a series of operations and other treatments.
In anencephaly, infants die shortly after birth because most or all of the
brain is absent.
Since NTDs develop very early in pregnancy (18-30 days after conception), often
before a woman knows she is pregnant, it is essential that adequate intake of
folic acid be maintained throughout the childbearing years.
Women who have had a prior NTD-affected pregnancy are at high risk of having a
subsequent affected pregnancy. When these women are planning to become
pregnant, they should consult their physicians for advice.
Spina Bifida
The FDA (FDA Consumer, May 1994) has stated:
Spina bifida is a defect of the spinal column. If the vertebrae (bones of the
spinal column) surrounding the spinal cord do not close properly during the
first 28 days after fertilization, the cord or spinal fluid bulge through,
usually in the lower back.
While once all these children died, with proper medical treatment, about 85 to
90 percent of them now live to adulthood, according to the Spina Bifida
Association of America. Depending on the severity of the condition, they have
varying degrees of paralysis and incontinence.
There are two major forms of the condition. The mild form, spina bifida occulta
("hidden") is only a small gap in the spine, with a dimple in the skin covering
it. There are usually no symptoms. Some Americans have spina bifida occulta and
don't even know they have it, according to the National Information Center for
Children and Youth with Disabilities.
The more disabling form is spina bifida aperta, which produces an noticeable
sac on the infant's back. A small sac, called a meningocele, produces little or
no muscle paralysis or incontinence once it is repaired.
But in 90 percent of all spina bifida cases, a portion of the undeveloped
spinal cord itself protrudes through the spine and forms a sac protruding on
the baby's back. Any portion of the spinal cord outside the vertebrae is
undeveloped or damaged, causing paralysis and incontinence. This is called a
myelocele (or meningomyelocele), and it is what most people refer to as spina
bifida.
The location of the sac determines how severely disabled the child will be. In
general, the higher it is on the spinal column, the more paralysis there is.
Doctors must repair the opening of the spine shortly after birth or the child
will die. Other major surgeries often follow in the child's first years. About
85 percent of children with spina bifida develop hydrocephalus, an accumulation
of cerebrospinal fluid surrounding the brain. This fluid must be drained to the
abdomen or bloodstream with a surgically implanted tube.
Some children with spina bifida develop foot and knee deformities caused by an
interruption of spinal nerve circuits. Many patients require leg braces,
crutches, and other devices to help them walk. They may have learning
disabilities, and about 30 percent of children have slight to severe mental
retardation, especially if they have chronic hydrocephalus. Chronic bladder
infections and kidney problems require lifelong medical attention.
Despite their need for medical attention, children with spina bifida can learn
to care for many of their own needs. They often learn to catheterize
themselves, for instance, so they can attend regular schools. With proper
medical care, a person with spina bifida can live a long and productive life.
Testing for Neural Tube Defects
According to the FDA (FDA Consumer, May 1994):
A number of tests are available to diagnose neural tube defects before a baby
is born.
One such test, the maternal serum alpha-fetoprotein (AFP) test, is a blood test
for the mother at 16 to 18 weeks into the pregnancy. It was approved by FDA in
the early 1980s as a prenatal test for neural tube defects (a second approved
use is as an aid for a certain kind of testicular cancer).
The test measures alpha-fetoprotein, a substance produced by the fetus and
secreted into the amniotic fluid, eventually entering the mother's blood. As it
grows, the baby produces increased amounts of AFP. The level of AFP in mother's
blood peaks at about 30 to 32 weeks.
Abnormally high amounts of AFP may indicate a baby has a neural tube defect.
But the test is not perfect.
Up to 20 percent of spina bifida cases do not produce high levels of AFP, so
the test does not detect them. And when the test does indicate a high level of
AFP, a neural tube defect is present only 10 percent of the time. Most
commonly, the AFP level is high because the pregnancy is just further along
than was thought.
If a woman has an elevated AFP test, her doctor will usually give her a second
AFP test, followed by ultrasound. If still no explanation for a high AFP value
can be found, the physician may perform amniocentesis. In this test, the doctor
takes a sample of the amniotic fluid and measures it for AFP levels. The
results of these tests together will identify a high percentage of spina bifida
cases.
History
The FDA (FDA Consumer 1996, 1999 update) has stated:
Scientists first suggested a link between neural tube birth defects and diet in
the 1950s. The incidence of these conditions has always been higher in low
socioeconomic groups in which women may have poorer diets. Also, babies
conceived in the winter and early spring are more likely to be born with spina
bifida, perhaps because the mother's diet lacks fresh fruits and
vegetables--which are good sources of folate--during the early weeks of
pregnancy.
In 1991, British researchers found that 72 percent of women who had one
pregnancy with a neural tube birth defect had a lower risk of having another
child with this birth defect when they took prescription doses of folic acid
before and during early pregnancy.
Another study looked at folic acid intake in Hungarian women. The evidence
indicated that mothers who had never given birth to babies with neural tube
defects and who took a multivitamin and mineral supplement with folic acid had
less risk in subsequent pregnancies for having babies with neural tube defects
than women given a placebo.
The FDA (FDA February 29, 1996) also stated:
The U.S. Public Health Service (PHS) recommended in September 1992 that all
women of childbearing age consume 400 micrograms (ug) of folic acid daily to
reduce their risk of having a pregnancy affected with spina bifida or other
neural tube defects.
In keeping with the recommendations of PHS and the FDA Food Advisory Committee
called to study these issues, the Food and Drug Administration is requiring
that folic acid be added to specific flour, breads and other grains. These
foods were chosen for fortification with folate because they are staple
products for most of the U.S. population, and because they have a long history
of being successful vehicles for improving nutrition to reduce the risk of
classic nutrient deficiency diseases.
These fortified foods include most enriched breads, flours, corn meals, rice,
noodles, macaroni and other grain products.
Food fortification has been introduced effectively in the past. According to
the FDA (FDA February 29, 1996), "Addition of iodine to salt was one of the
earliest successful fortification programs. Iodine fortification was initiated
in the U.S. in 1924 to prevent goiter, cretinism and other symptoms of severe
iodine deficiency. In the early 1930s, vitamin D was first added to cow's milk
to aid in absorption of calcium and phosphorus, preventing development of
rickets".
One concern in fortifying foods with folic acid is that among the elderly, high
levels of folic acid can complicate the prompt diagnosis of vitamin B12
deficiency (FDA February 29, 1996). In addition, there may be other adverse
effects from high folic acid intakes and therefore, care should be taken to
keep total folate consumption under 1 mg per day, except under the supervision
of a physician. Along with this fortification, the PHS suggests two other ways
to ensure the proper level of folic acid: improved dietary habits and daily use
of folic acid supplements by women throughout their childbearing years (FDA
February 29, 1996). The FDA rule is designed to keep total folic acid intake
under the 1 mg level.
FDA Regulation
Studies have shown that folic acid, when consumed daily before pregnancy and
during the early months of pregnancy, can prevent up to 70 percent of disabling
or fatal birth defects of the brain and spine known as neural tube defects.
Therefore, the FDA now requires that Folic Acid be added to specific grain
products.
Under the terms of the new FDA rule (FDA February 29, 1996):
Fortification levels will range from 0.43 milligrams to 1.4 mg per pound of
product.
Fortification of grain products at these levels will allow the daily intake
from all sources to remain below the recommended upper limit of 1 mg per day.
The amount of folic acid that will be consumed through foods fortified at these
levels is considered safe for all population (age/gender) groups.
Manufacturers will be allowed to make claims on the labels that the fortified
products contain folic acid and that adequate intake of the nutrient may reduce
the risk of neural tube defects.
Evidence that these public health actions have been effective is presented in
the 1999 National Health and Nutrition Examination Survey which reports a
significant increase in serum folic acid concentrations in women of
reproductive age as compared with survey values obtained for 1988-1994.
Who Should Take Folic Acid?
According to the March of Dimes (MOD, 2002), folic acid should be taken by all
women of reproductive age (from about 15-45 years old), who are capable of
becoming pregnant, who are planning pregnancy, or are in early pregnancy.
Richard B. Johnston, Jr., M.D., medical director of the March of Dimes (MOD,
2002) has stated "In order to be effective in preventing birth defects, folic
acid must be consumed before conception and during the first four weeks of
pregnancy. Since nearly half of all pregnancies in this country are unplanned,
all women capable of having a baby should be consuming folic acid every day."
The Teratology Society (Teratology Society 1997) recommends that "1) women in
the childbearing age group take a daily vitamin supplement containing 0.4 mg of
folic acid; 2) fortification of enriched cereal grain products be carried out
to a level that will provide 0.4 mg of folic acid each day to at least 95% of
women in the reproductive age group; and 3) research designed to understand the
mechanism by which folic acid or metabolically related chemicals reduce the
risk of birth defects be strongly encouraged".
Naturally Occurring Sources of Folate
The March of Dimes Birth Defects Foundation warns women not to rely on these
foods for enough folic acid to prevent serious birth defects in their future
babies (March of Dimes 1997).
The following are natural sources for varying amounts of folate which were
obtained from the FDA (FDA Consumer, May 1994):
FOOD SOURCES OF FOLATE
Food Type
Micrograms
(per 100 grams of food, or 3.5 oz)
dark-green leafy vegetables 120-160
other vegetables 40-100
fruits (particularly citrus) 50-100
beans (legumes) 50-300
whole grains 60-120
breakfast cereals 100 or 400
The following FDA table (FDA Consumer 1996, updated 1999) lists folic acid
levels of specific foods:
AMOUNT OF FOLATE IN DIFFERENT FOODS
Food Serving Size Amount (Micrograms) %Daily Value*
Chicken liver 3 1/2 oz 770 193
Breakfast cereals 1/2 to 1 1/2 cup 100 to 400 25 to 100
Braised beef liver 3 1/2 oz 217 54
Lentils cooked 1/2 cup 180 45
Chickpeas 1/2 cup 141 35
Asparagus 1/2 cup 132 33
Spinach cooked 1/2 cup 131 33
Black beans 1/2 cup 128 32
Burrito with beans 2 118 30
Kidney beans 1/2 cup 115 29
Baked beans with pork 1 cup 92 23
Lima beans 1/2 cup 78 20
Tomato juice 1 cup 48 12
Brussels sprouts 1/2 cup 47 12
Orange 1 medium 47 12
Broccoli, cooked 1/2 cup 39 10
Fast-food French fries large order 38 10
Wheat germ 2 tbsp 38 10
Fortified white bread 1 slice 38 10
* based on Daily Value for folate of 400 micrograms
More Information
For further information on folic acid and neural tube defects see:
http://www.aap.org/policy/re9834.htm
AYO GALANG SOLIDARITAS UNTUK MEMBANTU KORBAN MUSIBAH DI ACEH & DAN SUMATERA
UTARA !!!
================
Kirim bunga, http://www.indokado.com
Info balita: http://www.balita-anda.com
Stop berlangganan/unsubscribe dari milis ini, e-mail ke: [EMAIL PROTECTED]
Peraturan milis, email ke: [EMAIL PROTECTED]
