Food Sources

Good dietary sources are fresh green leafy vegetables, such as cabbage and spinach, asparagus, broccoli, sprouts, mushrooms, legumes, nuts and fortified cereals, and organ meats.

Food preparation and processing can destroy up to 100% of the naturally occurring folate, as it is sensitive to light and air but especially heat; therefore, raw foods, as well as fortified foods, are considered superior sources, which in Australia provide 10O/jg per serve (Gropper et al 2005, Hickling et al 2005). Folate 467

Clinical note — Food fortification with folate: still not enough for pregnant women?

In 1995, legislation allowing voluntary fortification of Australian foods with folate was introduced with the goal of improving the population's folate status, especially that of pregnant women without putting certain groups at risk of masked pernicious anaemia. In the years following the introduction of fortification, a study evaluating mean serum levels of folate in over 20,000 Australian women aged 14-45 years found that although a mean increase in serum concentrations of 19% was evident, the prevalence of poor folate status in this age group was only reduced from 8.5% to 4.1% (Metz et al 2002). More recently, a smaller study conducted in Perth found a 38% increase in mean serum folate in subjects post-fortification, which correlates with a 30% reduction in the incidence of neural tube defect in Western Australia (Hickling et al 2005).

Although food fortification provides some measure of protection for women of reproductive age, it is still insufficient and personal supplementation is required. Unfortunately, widespread public health campaigns have had limited success and many women remain unaware of the need to take folic acid supplements prior to pregnancy or are aware but still fail to use supplements (Metz et al 2002). In a systematic review of 52 studies, in approximately 20 (mainly Western) countries between 1992 and 2001, the reported periconceptional supplement use ranged from 0.5% to 52% (Ray et al 2004). The situation is similar in Australia, with research demonstrating that only 36% and 46% of new mothers in Victoria and New South Wales, respectively, took folate supplements, with even lower rates reported for women of low socioeconomic or non-English speaking backgrounds (Watson et al 2006)._

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