Addressing the safety of high folate levels in the older population and implications for fortification in Ireland

Date:
June 15, 2020
Source:
Trinity College Dublin
Summary:
A new study challenges claims from some international scientific
circles, that having high blood levels of folate (folic acid)
increases the risk of poor cognition in older adults, especially
in those with low levels of vitamin B12. On the contrary the study
found that having higher folate seemed to be associated with better
cognitive function in these older adults.



FULL STORY ==========================================================================
A new study led by researchers from The Irish Longitudinal Study on
Ageing (TILDA) at Trinity College Dublin challenges claims from some international scientific circles, that having high blood levels of folate (folic acid) increases the risk of poor cognition in older adults,
especially in those with low levels of vitamin B12.


==========================================================================
The study published today (Monday, 15th June 2020) in the British Journal
of Nutrition, forms part of the largest representative study of its kind conducted among older persons.

Both vitamin B12 and folate are essential vitamins for the nervous system
and healthy blood cells. Deficiency of folate in early pregnancy can lead
to neural tube defects (NTDs) in new-born babies. This is the reason
for mandatory fortification of the food supply with folic acid in the
US and other countries (but not Ireland or Europe). While fortification
is proven to reduce NTDs, several influential publications in the US
suggest that very high folate levels in older persons, if coupled with
low vitamin B12, leads to poorer brain function and a faster rate of
cognitive decline. Largely because of such fears, no country in Europe
has implemented mandatory folic acid fortification, although the NTD
rates have not declined in two decades and may be rising in Ireland,
according to recent data.

What has the new research unveiled? Using blood samples from over 3,700
Irish older adults aged 50 and over, the study compared cognitive health
in individuals grouped by their combinations of vitamin B12 and folate
blood levels. It found no evidence that having high blood levels of
folate affected the risk of cognitive decline in those with low levels
of vitamin B12. Moreover, having higher folate seemed to be associated
with better cognitive function in these older adults.

Key findings:
* Cognitive performance was not worse in older people with low
vitamin B12
combined with high folate (representing 1.5% of older adults
in Ireland)
* Those with normal vitamin B12 levels and high folate levels (7.6% of
older adults) performed better cognitively than the others
* The use of folic acid -- containing supplements was uncommon,
with higher
rates among women than men but less than 4% overall taking
supplements
Why do the findings matter?


========================================================================== Older adults at significant risk of deficiency TILDA has previously
reported high rates of deficiency: 1 in 8 older adults are deficient
in vitamin B12, while 1 in 7 are deficient in folate. Vitamin B12
deficiency is associated with cognitive impairment and nerve damage. Older adults can have difficulty in absorbing vitamin B12 due to diminished
digestive function or medications. Folate deficiency causes anaemia and
is associated with heart disease, stroke, and possibly certain cancers.

New-born babies at significant risk Folate is critical to the healthy development of the brain and spinal cord in the growing foetus, and
deficiency can cause NTDs, such as spina bifida.

Consequently, public health authorities world-wide recommend that women
of childbearing age consume folic acid from fortified foods and/or
supplements.

Voluntary food fortification is permitted in Ireland but is not effective
in this regard. Ireland has one the highest rates of NTDs in Europe
but does not have mandatory fortification largely because of concerns
detailed above.

Lead author Deirdre O'Connor, Registered Nutritionist and TILDA researcher said, "Concerns surrounding associations between high intakes of folic
acid and cognitive decline in older adults with low vitamin B12 have
impeded mandatory folic acid fortification in Ireland. Our study shows
that a small percentage of older people in the community have this
potentially adverse combination, but they are not at increased risk
of poorer cognition. In fact, older adults with normal vitamin B12
and high folate levels performed better in cognitive tests than their counterparts with normal folate. This implies that elevated folate may
benefit cognitive health in older persons in Ireland."


========================================================================== Professor Anne Molloy, senior author of the study said: "Ireland does
not have mandatory food fortification with folic acid. We know that
folic acid fortification is an effective population strategy if it is
carefully established, controlled and monitored. We can learn from up to
two decades of experience in North and South America and Australia. It
reduces NTD prevalence and eliminates folate deficiency -- a much bigger
health problem.

Our study on this important Irish cohort of almost 4,000 older individuals indicates that improving folate levels in the population would have
positive health consequences for both young and old." Professor Rose Anne Kenny, Principal Investigator of TILDA, said: "This is the largest study
of the interaction between vitamin B12 and folate and cognitive function world-wide. The high rates of vitamin B12 and folate deficiency in the
older adult population are of concern and, given that this can be easily treated with fortification, this has significant policy implications
for Government and health services. TILDA has consistently assisted
policy makers by providing strong evidence-based data on which to make recommendations and this study provides such data to energize policy
decisions on this important topic for all ages and reopen the public
discourse regarding the proposition of mandatory fortification."

========================================================================== Story Source: Materials provided by Trinity_College_Dublin. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Deirdre M. A. O'Connor, Eamon J. Laird, Daniel Carey, Aisling M.

O'Halloran, Robert Clarke, R. A. Kenny, Anne M. Molloy. Plasma
concentrations of vitamin B12 and folate and global cognitive
function in an older population: cross-sectional findings from
The Irish Longitudinal Study on Ageing (TILDA). British Journal
of Nutrition, 2020; 1 DOI: 10.1017/S0007114520001427 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/06/200615140836.htm

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