Pro Folate Debate

Embed Size (px)

Citation preview

  • 8/10/2019 Pro Folate Debate

    1/19

  • 8/10/2019 Pro Folate Debate

    2/19

    Resources

    1. Brown J. Nutrition in the Lifecycle, 5thed. Stamford, CT: Cengage Learning, 2011:113-17.

    2. Pitkin RM. Folate and neural tube defects. Am J Clin Nutr. 2007;85(1):285S-288S.

    3. Dietary Supplement Fact Sheet: FolateHealth Professional Fact Sheet. National Institute of Health Web site.

    http://ods.od.nih.gov/factsheets/Folate-HealthProfessional/?print=1. Accessed February 12, 2014.

    4. Grosse SD, Waitzman NJ, Romano PS, Mulinare J. Reevaluating the benefits of folic acid fortification in the United States:

    economic analysis, regulation, and public health.American Journal of Public Health. 2005;95(11):1917-22.

    5. Durga J, Van Boxtel MP, Schouten EG, et al. Effect of 3-year folic acid supplementation on cognitive function in older adults in

    the FACIT trial: a randomized, double blind, controlled trial. The Lancet. 2007;369(9557):208-216.

    6. Jacques PF, Selhub J, Bostom, A. G., Wilson, P. W., & Rosenberg, I. H. The effect of folic acid fortification on plasma folate

    and total homocysteine concentrations. New England Journal of Medicine. 1999; 340(19):1449-1454.

    7. Morris MC, Evans DA, Bienias JL, et al. Dietary folate and vitamin B12 intake and cognitive decline among community-

    dwelling older persons.Arch Neruol. 2005;62:641-645.

    8. Chosy J, Clatanoff D, Schilling R. Responses to small doses of folic acid in pernicious anemia. Am J Clin Nutr.1962;10:349-

    50.

    9. Savage DG, Lindenbaum J. Neurological complications of acquired cobalamin deficiency: clinical aspects. Baillieres Clin

    Haematol.1995;8:657-78.

    10. Morris MS, Jacques PF, Rosenberg IH, Selhub J. Folate and vitamin B-12 status in relation to anemia, macrocytosis, and

    cognitive impairment in older Americans in the age of folic acid fortification.Am J Clin Nutr. 2007;85:193-200.

    11. Manshadi SK, Ishiguro L, Sohn K-J, Medline A, et al. Folic acid supplementation promotes mammary tumor progression in

    rat model. PLOS ONE. 2014;9(1).

    12. Troen AM, Mitchell B, Sorensen B, et al. Unmetabolized folic acid in plasma is associated with reduced natural killer cell

    cytotoxicity among postmenopausal women. J Nutr. 2006;136:189-94.

  • 8/10/2019 Pro Folate Debate

    3/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;

    !"# % '() *)(+ ,#"-(,()*-(#. #, -/0 12 ,##+ 3455'6 /*3 700. 70.0,()(*' *.+ 3/#4'+ 70

    (85'080.-0+ 9'#7*''6

    78"*.( $.?"8-0/$".

    !"#0/, $@ 0 5 A$/0-$. /90/ $@ ,@@,./$0# ?"8 BC' 8,+#$%0/$". 0.( 0@ 0 %"-+".,./ "?

    ,.D:-0/$% 8,0%/$".@ $.A"#A,( $. 0-$." 0%$( @:./9,@$@ 0.( A$/0-$. -,/06"#$@-=

  • 8/10/2019 Pro Folate Debate

    4/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;

  • 8/10/2019 Pro Folate Debate

    5/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;

    2$/ !"#0/, 0.( .,*80# /*6, (,?,%/@> !"# %'()*+ ,-.'+*/ -0 1/(+()*/ 2.3'(3(-+>

    ABBCDEFGHIJAEF)KAEE)>

    L9$@ 08/$%#, $@ 0 @*--08: "? /9, -"8, $-+"8/0./ @/*($,@ /90/ 90M, #,( /" /9, %*88,./ 8,%"--,.(0/$".

    /90/ 0## N"-,. %0+06#, "? 6,%"-$.7 +8,7.0./ @9"*#( $./0 L9, (,?$.$/$M,

    %"./8"##,( /8$0# 9, (,@%8$6,( N0@ /9, -*#/$K$.@/$/*/$".0# @/*(: @+".@"8,( 6: /9, =,($%0# 3,@,08%9

    T"*.%$# G=3TD U.$/,( V$.7("-I> L9$@ N0@ 0 -0@ L9, /8$0# 6,70. 0/

    #,0@/ "., -"./9 6,?"8, %".%,+/$". 0.( %"./$.*,( /98"*79 /9, ?$8@/ /8$-,@/,8> L9,8, N,8, Z OLP %0@,@

    0-".7 F[; @*++#,-,./,( N"-,.Q %"-+08,( N$/9 AH %0@,@ 0-".7 Z[A +#0%,6" %"./8"# N"-,.Q N9$%9

    N0@ 0 8$@< 8,(*%/$". "? CAS> )"". 0?/,8 /9, +*6#$%0/$". "? /9, =3T @/*(: $. H[[HQ /9, TPT 0(M$@,(

    N"-,. /90/ 90( 0 +8,M$"*@ OLP +8,7.0.%: /" $.7,@/ X -7 "? ?"#$% 0%$( (0$#: /" +8,M,./ 0."/9,8 OLP

    6$8/9> \. H[[AQ /9, TPT %0-, "*/ N$/9 0 8,+"8/ /90/ 0## N"-,. "? 8,+8"(*%/$M, 07, @9"*#( %".@*-, B>X-7 "? ?"#$% 0%$( $. 0(($/$". /" 0 ?"#0/,K8$%9 ($,/> L9, +8"+"8/$". "? OLP@ /90/ %0. 6, +8,M,./,( N$/9

    +,8$%".%,+/*0# ?"#$% 0%$( @*++#,-,./0/$". "? B>X -7Y( $@ 0@@*-,( /" 6, 0++8"R$-0/,#: FBKZBS>

    2$/ L9$@ 8,@,08%9 %"*#(

    $-+8"M, 8,@*#/@ N$/9 ?"#$% 0%$( @*++#,-,./0/$".> L9, .,R/ $@ /" (,/,8-$., /9, 8,#0/$M, ,??,%/$M,.,@@

    6,/N,,. ($,/08: ?"#0/,Q ?"#$% 0%$( ?""( ?"8/$?$%0/$". 0.( ?"#$% 0%$( @*++#,-,./0/$". 0#".,> L9, -"@/

    ,??,%/$M, ("@, "? ?"#$% 0%$( @*++#,-,./0/$". 0#@" .,,(@ /" 6, 8,,R0-$.,(> )$.%, X-7 $@ ?"*8 /$-,@

    9$79,8 /90. /9, U] $/ $@ $-+"8/0./ /"

  • 8/10/2019 Pro Folate Debate

    6/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;

    2? @0$8"* !? A0. '##,. BC? ,/ 0#D 3,(*%/$". $. .,*80# /*6, (,E,%/> 0E/,8 E"#$% 0%$( E"8/$E$%0/$". $.

    F0.0(0D !"# %&'()&* +,-.&)( ,/ 0"*121&"3GHHIJKLIMGNOPKLQ;GD

    C. R"S,-6,8 PTTU? /9, E"8/$E$%0/$". "E 0## /:+,> "E V9$/, E#"*8? ,.8$%9,( +0>/0 0.( %"8.-,0# 6,%0-,

    -0.(0/"8: $. F0.0(0? V$/9 0 7"0# "E $.%8,0>$.7 0S,807, E"#$% 0%$( $./0W, 0-".7 V"-,. "E %9$#(6,08$.7

    07, 6: KHQIHXD @9, 0$- "E /9$> >/*(: V0> /" 0>>,>> /9, %90.7,> $. +8,S0#,.%, "E R@ 0E/,8 E""(E"8/$E$%0/$". $. F0.0(0D @9, +"+*#0/$". "E /9, >/*(: V0> 0## #$S, 6$8/9>? >/$##6$8/9> 0.( +8,7.0.%:

    /,8-$.0/$".> $. F0.0($0. +8"S$.%,> MI "*/ "E PHN E8"- PTTK /" GHHPD C. ,0%9 +8"S$.%,? /9, 0*/9"8>

    $(,./$E$,( /9, 0-"*./ "E >*6Y,%/> V$/9 R@ *>$.7 0.0#:>$> "E -,($%0# (0/060>,> 0.( -,($%0# 8,%"8(>D

    @9,: E"*.( /90/ /9, "S,80## +8,S0#,.%, "E R@ 0/ 6$8/9 (,%8,0>,( 6: ;ZX 0E/,8 E"8/$E$%0/$".D @9,$8

    8,>*#/> >9"V,( 0. "%%*88,.%, +0//,8. /90/ V0> >/06#, E8"- PTTK /" PTTI? /9,. 0 (,%8,0>, E8"- PTTU /"

    GHHH? 0.( >/06$#$[0/$". 0E/,8 /90/D \S,. /9"*79 ],0#/9 F0.0(0 6,70. 8,%"--,.($.7 (0$#: E"#$% 0%$(

    >*++#,-,./0/$". E"8 +8,7.0./ V"-,. $. PTTKQPTTI? /9,8, V,8, ." "6>,8S,( %90.7,> $. +8,S0#,.%, "E

    R@ (*8$.7 /9$> /$-, +,8$"(D @9, 78,0/,>/ 8$>W 8,(*%/$". 0++,08,( /" 6, $. 08,0> V9,8, /9, 80/,> "E

    R@ V,8, /9, 9$79,>/ 6,E"8, /9, E"8/$E$%0/$". +8"780- 6,70.D @9, 0*/9"8> %".%#*(,( /90/ >$7.$E$%0./

    8,(*%/$".> $. R@ "%%*88,( $. F0.0(0 0E/,8 E""( E"8/$E$%0/$". V0> $-+#,-,./,(D @9, #,S,# "E E""(

    E"8/$E$%0/$". .,,(> /" %".>$(,8 6"/9 /9, >0E,/: "E $/? +08/$%*#08#: E"8 /9">, V9" -0: 90S, *.8,%"7.$[,(5PG (,E$%$,.%:? 0.( /9, 7"0# "E -0^$-$[$.7 R@< 8,(*%/$".D

    @9, 8,>*#/> "E /9$> >/*(: 9,#+ /" >*++"8/ /9, +">$/$". /90/ E"8/$E$%0/$". "E /9, E""( >*++#: V$/9 E"#$% 0%$(

    90> 6,,. 6,.,E$%$0# $. 8,708(> /" #"V,8$.7 R@ $. "/9,8 %"*./8$,> 0> V,## 0> /9, _.$/,( )/0/,>D

  • 8/10/2019 Pro Folate Debate

    7/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;

    08( ?= ?%.*#/: @= ,/ 0#A ' ("B,CD$.($.7 /8$0# "D /9, ,DD,%/ "D #".7C/,8- D"#$% 0%$( $./,8E,./$".F

    $-+#$%0/$".B D"8 D""( D"8/$D$%0/$". +"#$%:A !"# %'()*+ ,-.'+*/ -0 1/(+()*/ 2.3'(3(-+A GHIIJKLMINFIICOA

    )$.%, /9,8, 90E, 6,,. %".%,8.B 06"*/ /9, +"/,./$0# 0(E,8B, ,DD,%/B "D "E,8,P+"B*8, /" D"#$% 0%$(= B*%9

    0B %0.%,8 0.( -0BQ$.7 0 5IG (,D$%$,.%:= $/ $B $-+"8/0./ D"8 D""( D"8/$D$%0/$". +"#$%: /" (,/,8-$., R90/ $B

    /9, #"R,B/ ("B, 8,S*$8,( /" 6, ,DD,%/$E, $. #"R,8$.7 9"-"%:B/,$., #,E,#BA

  • 8/10/2019 Pro Folate Debate

    8/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;

    3"@, AB> A$##,8 CB> V*.,($.> D,H Z,0#0.(E [Y%#*@$". %8$/,8$0 $.%#*(,( 6,$.7 +8,7.0./ "8 #0%/0/$.7>

    +#0..$.7 0 +8,7.0.%: $. /9, .,Y/ NL -"./9@> 8,7*#08#: *@$.7 G"#$% 0%$(F%"./0$.$.7 @*++#,-,./@> "8 @,#GF

    8,+"8/,( 9$@/"8: "G %08($"K0@%*#08> 70@/8"$./,@/$.0#> 9,+0/$%> 8,.0# "8 9,-0/"#"7$% ($@,0@,E 4., 9*.(8,(

    0.( G"8/:F.$., H"-,. H,8, 8,%8*$/,( /"/0#> QP 8,%,$K,( /9, NQM -$%8"780- G"#$% 0%$(\( +$##> QX 8,%,$K,(/9, QMM -$%8"780-\( +$## 0.( /9, 8,@/ 8,%,$K,( /9, +#0%,6"E 4K,80##> /9, -,0. +$## %"-+#$0.%, "G /9,

    78"*+ H0@ XX]E U" (0/,> /9$@ H0@ /9, #".7,@/ /8$0# %".(*%/,( -,0@*8$.7 /9, G"#0/, #,K,# 0.( 80/, "G

    @0/*80/$". $. 35B@E 6*/ /9,8, H0@ ." $.($%0/$". /90/ /9, G"#0/, %".%,./80/$".@ $.

    35B@ +#0/,0*,( $. ,$/9,8 78"*+E !8"- /9,$8 8,@*#/@> /9, 0*/9"8@ %0#%*#0/,( /90/ $/ H"*#( /0I, 06"*/ ^Q

    H,,I@ 0/ NQM -$%8"780-\( 0.( X; H,,I@ 0/ QMM -$%8"780-\( /" 8,0%9 0++8"Y$-0/,#: PM] "G /9,

    0K,807, @/,0(: @/0/,E !8"- 0.0#:@$@ "G /9,$8 -"(,#> /9,: @9"H,( /90/ 9:+"/9,/$%0##: H$/9 @*GG$%$,./ /$-,

    /" 8,0%9 0 @/,0(: @/0/,> 0. ,Y/80 NQM -$%8"780-\( R/9, /:+$%0# 0-"*./ (,#$K,8,( 6: G""( G"8/$G$%0/$".S>

    %"*#( 6, 0@ +8"/,%/$K, 070$.@/ DUV@ 0@ QMM -$%8"780-\( R/9, %*88,./ +,8$%".%,+/*0# 8,%"--,.(,(

    ("@,SE

    U9, 0*/9"8@ ($( 90K, #$-$/0/$".@ H9,. 0.0#:_$.7 /9,$8 8,@*#/@E )$.%, /9,: $.%#*(,( (0/0 G8"-

    +08/$%$+0./@ /90/ 90( `Pa] %"-+#$0.%,> $/ %"*#( 90K, $./8"(*%,( 0 +"/,./$0# @"*8%, "G ,88"8 $. /9,

    0.0#:@$@ "G /9, ("@, "G G"#0/, /90/ 90( 0. ,GG,%/ ". 35B@E '#@"> H9"#,F6"(: G"#0/, /*8."K,8 $@ 9$79#:

    K08$06#,> /9,8,G"8, /9,: H,8, ."/ 06#, /" (,/,8-$., 0. ,Y0%/ +#0/,0* "8 0-"*./ "G /$-, 8,b*$8,( /"

    8,0%9 0 @/,0(: @/0/,E

  • 8/10/2019 Pro Folate Debate

    9/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;

    ?$(,.%, @"8 "*8 +"A$/$".

    )$.%, /9, $-+#,-,./0/$". "@ @"#$% 0%$( @"8/$@$%0/$". $. BCCDE /9,8, 90A 6,,. 0 A$7.$@$%0./ (,%8,0A, $.

    FGHA $. /9, I)= 4?,8 JK %"*./8$,A 90?, 0#A" %9"A,. /" @"8/$@: L$/9 @"#$% 0%$( 0.( 08, A,,$.7 A*6A/0./$0#

    (,%#$.,A 0A L,##=

  • 8/10/2019 Pro Folate Debate

    10/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;

    9,=, $.($H$(*0#= S,8,=,#,%/,( 6,%0*=, /9,: 8,=+".(,( /" 0 W*,=/$"..0$8, */$#$X,( $. /9, YRDG''32 Z$,/ 0.( D,0#/9 )/*(:F

    ' C""( C8,W*,.%: W*,=/$"..0$8, S0= *=,( /" %0#%*#0/, ($,/08:@ =*++#,-,./0# 0.( /"/0# C"#0/, $./0E,

    C"8 6"/9 +8, 0.( +"=/ C"8/$C$%0/$". +,8$"(=F 'C/,8 0++8"T$-0/,#: QFL :,08=@ +08/$%$+0./= S,8,

    8,,H0#*0/,( 0.( VJLJ $.%$(,./ %"#"8,%/0# %0.%,8 %0=,= S,8, $(,./$C$,( *=$.7 =/0/, 0.( -,/8"+"#$/0.

    08,0 %0.%,8 8,7$=/8$,=F >9,=, %0=,= S,8, (,C$.,( 0= /9"=, S$/9 0 C$8=/ /$-,@ +8$-08:@ $.H0=$H, %"#"8,%/0#

    %0.%,8 ($07."=$=F

    Z0/0 C8"- /9, =0-, +08/$%$+0./= S0= %"-+08,( +8$"8 /" 0.( +"=/ C"#$% 0%$( C"8/$C$%0/$". $. "8(,8 /"

    0==,== %"#"8,%/0# %0.%,8 $.%$(,.%,F

    R. /9, +"=/C"8/$C$%0/$". 0.0#:=$=@ 9$79,8 /"/0# C"#0/, $./0E, S0= 0=="%$0/,( S$/9 0 (,%8,0=,( %"#"8,%/0#%0.%,8 8$=EF >9, 9$79,=/ $./0E,= =+,%$C$%0##: C8"- =*++#,-,./= "8 C8"- ($,/ 0++,08,( /" $. C0%/ 6,

    +8"/,%/$H, 070$.=/ %"#"8,%/0# %0.%,8F D"S,H,8@ %".=$(,8$.7 /90/ 0(,."-0 %08%$."-0 -0: /0E, "H,8 LK

    :,08= /" (,H,#"+@ -"8, C"##"S *+ $= .,,(,(F

  • 8/10/2019 Pro Folate Debate

    11/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;

    ?= @0. 5"A/,#= B? 2?= )%9"*/,.= C? D?= E"F= !? >?= >"##,G= >?= E0/0.= B? 5?= H @,89",I= 2? CII,%/ "I JK

    :,08 I"#$% 0%$( G*++#,-,./0/$". ". %"7.$/$L, I*.%/$". $. "#(,8 0(*#/G $. /9, !'MNO /8$0#P 0 80.("-$Q,(=

    ("*6#, 6#$.(= %"./8"##,( /8$0#? !"# %&'(#)? RSSTU*+,V;WWTXPRSYKRZ[?

    O" (,/,8-$., /9, 8"#, "I I"#$% 0%$( G*++#,-,./0/$". ". %"7.$/$L, +,8I"8-0.%,= -,. 0.( +"G/K

    -,."+0*G0# \"-,. 07,( WSKTS :,08G I8"- /9, ],/9,8#0.(G \9" \,8, "8$7$.0##: +08/ "I /9, !"#$% '%$(0.( M08"/$( N./$-0K-,($0 O9$%F.,GG V!'MNOX /8$0# \,8, 8,%8*$/,(? !8"- /9,8,= +0/$,./G \$/9 9$79

    9"-"%:G/,$., #,L,#G \,8, %9"G,.? O9"G, /90/ 0++,08,( /" 90L, 9$79 9"-"%:G/,$., #,L,#G (*, /" "/9,8

    I0%/"8G 6,G$(,G 0 G*6"+/$-0# I"#0/, %".%,./80/$". \,8, ,#$-$.0/,(?

    20/$,./G \,8, 7$L,. ,$/9,8 0 +#0%,6" "8 YSS+,8 (0: "I I"#$% 0%$(? M"7.$/$L, I*.%/$". \0G 0GG,GG,(

    *G$.7 W G,+080/, /,G/G (,G$7.,( /" -,0G*8, -,-"8:= G,.G"8$-"/"8 G+,,(= %"-+#,A G+,,(= $.I"8-0/$".

    +8"%,GG$.7 G+,,(= 0.( \"8( I#*,.%:? 208/$%$+0./G *.(,8\,./ /,G/$.7 0I/,8 0. "L,8.$79/ I0G/= \9,8, 0I/,8

    -,0G*8,-,./G I"8 G,8*- I"#0/,= G,8*- L$/0-$. 5ZR= +#0G-0 /"/0# 9"-"%:G/,$., 0.( "/9,8 -08F,8G

    \,8, -,0G*8,(? O\" 8,G,08%9 0GG$G/0./G 70L, +0/$,./G /9, /,G/ $. /9, G0-, 8""-= \$/9 /9, G0-, +8"+G?

    O9, +#0%,6" 78"*+ 0.( /9, G*++#,-,./ 78"*+ \,8, %"-+08,( 0/ /9, G/08/ "I /9$G G/*(:= 0G \,## 0G 0I/,8

    0 JK:,08 +#0%,6" "8 I"#$% 0%$( G*++#,-,./0/$". +,8$"(? N.$/$0##:= 6"/9 78"*+G (,-".G/80/,( G$-$#08

    60G,#$., G%"8,G ". /9, %"7.$/$L, /,G/G?

    'I/,8 /9, JK:,08 +,8$"(= +08/$%$+0./G /0F$.7 /9, I"#$% 0%$( G*++#,-,./ G9"\,( 0 WT[^ $.%8,0G, $. G,8*-

    I"#0/, %".%,./80/$". 0.( 0 R[^ (,%8,0G, $. +#0G-0 /"/0# 9"-"%:G/,$., %".%,./80/$".G? 4L,80##= $.

    %"-+08$G". \$/9 /9, +#0%,6" 78"*+= /9"G, /0F$.7 /9, I"#$% 0%$( G*++#,-,./ G9"\,( 78,0/,8

    $-+8"L,-,./ $. /9, ("-0$.G "I -,-"8:= $.I"8-0/$". +8"%,GG$.7 G+,,( 0.( G,.G"8$-"/"8 G+,,(?

  • 8/10/2019 Pro Folate Debate

    12/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;= 5"?/"- '@= A$#?". 2A= B 3"?,.6,87 CDE F9, ,GG,%/ "G G"#$% 0%$( G"8/$G$%0/$". ". +#0?-0

    G"#0/, 0.( /"/0# 9"-"%:?/,$., %".%,./80/$".?E !"# %&'()&* +,-.&)( ,/ 0"*121&"E ;HHHIJK

  • 8/10/2019 Pro Folate Debate

    13/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;;

  • 8/10/2019 Pro Folate Debate

    14/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ; ?@$(,.%, 070$.A/ "*8 +"A$/$".>

    B9, +8$-08: 087*-,./A 070$.A/ "*8 +"A$/$". $.%#*(, C"#0/,DA 8"#, $. %"7.$/$@,

    $-+0$8-,./E /*-"8 +8"78,AA$".E 0.( $-+0$8,( $--*.$/:> B9,A, %0A,A +8"@$(, (0/0 0.( %0*A,

    C"8 %".%,8. 070$.A/ C"#$% 0%$( C"8/$C$%0/$". "C /9, F>)> C""( A*++#:E 0.( "CC,8 8,A*#/A /90/%"./80($%/ /9"A, +8,A,./,( 6: /9, 234 A$(,> B9, 8,A*#/A (,-".A/80/, A$7.$C$%0./ (,/8$-,./A /"

    /9, 9,0#/9 "C 0 A+,%$C$% +"+*#0/$".GG$.($@$(*0#A "@,8 /9, 07, "C HIE J9" 90@, 0. $.%8,0A,( 8$AK

    "C @$/0-$. 5;< (,C$%$,.%: 0.( %"#"8,%/0# %0.%,8E 0AA"%$0/,( J$/9 07$.7 0.( #$C,A/:#, C0%/"8A>

    ?@$(,.%, +8,A,./,( $. A/*($,A A*%9 0A /9,A, 90@, C"8-,( /9, 60A$A C"8 /9, %"./8"@,8A:

    8,708($.7 C"#$% 0%$( C"8/$C$%0/$". 0.( 90@, #,( A"-, +8"C,AA$".0#A /" L*,A/$". /9, @0#$($/: "C /9,

    C"#$% 0%$( 8,%"--,.(0/$". 0.( C"8/$C$%0/$". ("A07,> B9,A, A/*($,A 0#A" %"./8$6*/, ,@$(,.%, /"

    /9, C0%/ /90/ -*%9 "C /9, 8,A,08%9 8,708($.7 C"#0/, A/0/*A 0.( $/A $-+#$%0/$". ". 9,0#/9"*/%"-,A $A @08$,( 0.( %".C#$%/$.7>

  • 8/10/2019 Pro Folate Debate

    15/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;90($ )?@ A>9$7*8" B@ )"9. CD@ =,(#$., '@ 3,.#*.( 3@ ,/ 0#E FGH;IJ !"#$% 0%$(

    >*++#,-,./0/$". +8"-"/,> -0--08: /*-"8 +8"78,>>$". $. 0 80/ -"(,#E 2B") 4KL MF;JN

    ,OIP>$". "U >,./$.,#

    -0--08: /*-"8>@ =0.>90($@ ,/ 0#E %".(*%/,( 0 %9,-$%0# %08%$."7,. 8"(,./ -"(,# %#$.$%0#/8$0#@ *>$.7 ;GH +0/9"7,.VU8,,@ W,8, U,( 0 %"./8"# ($,/ 0.( W,8, 0(-$.$>/,8,( 0 >$.7#, (">, "U Q -7 "U R@;GV

    ($-,/9:#6,.Y0Z![0./980%,., F?=5'J /" $.(*%, -0--08: /*-"8 +8"(*%/$". 0/ R W,,X> "#(E

    4.%, /9, /*-"8 8,0%9,( $/> +8,(,/,8-$.,( >$Y,@ /9, 80/> W,8, 80.("-#: ($\$(,( /" 8,%,$\,

    ($,/> %"./0$.$.7 G-7 F%"./8"#J@ Q -7@ O -7@ 0.( ;H -7 U"#$% 0%$(SX7 U"8 *+ /" ;G W,,X>E ]9,

    %"./8"# 78"*+ 8,%,$\,( 0 (">, "U U"#$% 0%$( /90/ -$-$%> /9, 3?' 8,^*$8,-,./ U"8 9*-0.>@ 0.( $>

    /9, >/0.(08( 60>0# ($,/08: 8,^*$8,-,./ U"8 80/>E ]9, Q -7 78"*+ 8,+8,>,./> /9, 0\,807, $./0X,

    "U K"8/9 '-,8$%0. +"+*#0/$".> 0U/,8 /9,

    U"8/$U$%0/$". -0.(0/,@ 0.( 0++8"_$-0/,#:

    -0/%9,> /9, 8,%"--,.(,( 0-"*./ U"8U,-0#,> "U %9$#(6,08$.7 :,08>E ]9, O 0.( ;H

    -7SX7 >*++#,-,./ 78"*+> 8,U#,%/ 0\,807,

    $./0X, "U +0/$,./> 8,%,$\$.7 >*++#,-,./0/$".

    U"8 *.(,8 -,($%0# >*+,8\$>$".E

    ]*-"8 78"W/9 W0> -".$/"8,( W,,X#: 0.(

    *+". .,%8"+>:@ /9, /*-"8> W,8, W,$79,( 0.( 0.0#:Y,( /" 0>>,>> U"#$% 0%$(`> 8"#, $. +8"/,$.

    ,_+8,>>$". 0.( /$>>*, 78"W/9E

    3,>*#/> $.($%0/, /90/ U"#$% 0%$( >*++#,-,./0/$". >$7.$U$%0./#: 0(\0.%,( /9, +8"78,>>$". "U

    %0.%,8@ 0> -,0>*8,( 6: >,./$.,# /*-"8 W,$79/@ \"#*-,@ 0.( >*8U0%, 08,0E ]9, -">/0%%,#,80/,( 78"W/9 "%%*88,( $. /9, 78"*+ >*++#,-,./,( W$/9 Q -7 "U U"#$% 0%$(@ /9, (">07,

    8,+8,>,./$.7 /9, 0\,807, $./0X, U8"- U"8/$U$,( U""(> 0.( -*#/$V\$/0-$. >*++#,-,./>E !"#$% 0%$(

    >*++#,-,./0/$". $. /9, 80/> W0> 0#>" >$7.$U$%0./#: 0>>"%$0/,( W$/9 /9, ,_+8,>>$". "U 2'32 F+"#:

    Z'?2V8$6">,[ +"#:-,80>,J 0.( aL3G F9*-0. ,+$(,8-0# 78"W/9 U0%/"8 8,%,+/"8 GJ@ $.($%0/$.7 0

    8"#, $. %,## 0+"+/">$> 0.( /*-"8$7,.,>$>E

    !"#$%& () *++&,- .+ +./", 0,"1 2$33/&4&5-0-".5 .5 -6& 3%.#%&22".5 .+ 2&5-"5&/ 40440%7 -$4.%2E !"#$% 0%$( >*++#,-,./0/$". 0/ Q

    -7SX7 ($,/ >$7.$U$%0./#: 0%%,#,80/,( /9, +8"78,>>$". "U >,./$.,# -0--08: /*-"8 "\,8 /$-, %"-+08,( W$/9 /9, %"./8"# ($,/ 0.( /W"

    9$79,8 >*++#,-,./0# #,\,#> "U U"#$% 0%$( 0U/,8 %"88,%/$.7 U"8 07, 0/ 80.("-$Y0/$". 0.( (0:> ". ($,/ F+bHEHH;JE

  • 8/10/2019 Pro Folate Debate

    16/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;".>F!"#$ &'(")*F HLLMNOHPO/*(: $.B,>/$70/,( /9, ,GG,%/ "G B$/0-$. 5;H0.( G"#0/, $./0I, ". /9, 80/, "G %"7.$/$B,

    (,%#$., $. 0. ,#(,8#: +"+*#0/$".F R@S;T 8,>$(,./> "G 0 >+,%$G$% 6$80%$0# %"--*.$/:@ 07,( OM

    :,08> 0.( "#(,8 0.( +08/$%$+0./> "G /9, ?9$%07" U,0#/9 0.( '7$.7 28"V,%/ /""I +08/ $. /9$>%"9"8/ >/*(: 6,/K,,. /9, :,08> ;WWR 0.( HLLHF

    Q9, >*6V,%/> %"-+#,/,( 0 %"7.$/$B, 0>>,>>-,./ 0/ 60>,#$.,@ G"##"K,( 6: 0 G""( G8,X*,.%:

    X*,>/$"..0$8, Y!!Z[ 0 -,($0. "G ;FH :,08> #0/,8F TO\ "G /9, !!Z> K,8, %"-+#,/,( 6,G"8, /9,

    ;WWT ].$/,( )/0/,> G"#0/, G"8/$G$%0/$".F Q9, >*6V,%/> +08/$%$+0/,( $. "., /" /K" %"7.$/$B,

    0>>,>>-,./> 0/ RJ 0.( OJ:,08 G"##"K *+ (0/,>@ K$/9 W;\ 90B$.7 0/ #,0>/ "., G"##"KJ*+

    0>>,>>-,./ "%%*88$.7 +">/JG"8/$G$%0/$".F

    Q9, +08/$%$+0./> K,8, ($B$(,( $./" G$B, X*$./$#,>@ 60>,( ". #,B,# "G /"/0# G"#0/, $./0I, 8,+"8/,(

    $. /9, !!ZP

    Z;P ;TO -%7^(

    ZHP HM; -%7^(

    ZRP R;; -%7^(

    Z

    *-,( 0 -*#/$B$/0-$. ".

    0 8,7*#08 60>$>@ >*++#:$.7 WW\ 0.( WS\ "G /9, >*++#,-,./,( G"#$% 0%$( 0.( B$/0-$. 5;HF 4.#: ;L

    >*6V,%/> 8,+"8/,( *>, "G 0. $.($B$(*0# G"#$% 0%$( B$/0-$.F 8,+"8/,( %".>*-$.7 0.

    $.($B$(*0# 5;HB$/0-$. >*++#,-,./F 208/$%$+0./> K$/9 0 78,0/,8 /"/0# G"#0/, $./0I,@ G8"- 6"/9

    G""( 0.( >*++#,-,./>@ /,.(,( /" 6, -"8, ,(*%0/,(@ 90B, 9$79,8 60>,#$., %"7.$/$". >%"8,>@

    78,0/,8 %".>*-+/$". "G 0./$"_$(0./>@ 0.( #,>> ($>,0>, 9$>/"8:F U"K,B,8@ /9,>, >*6V,%/> 0#>"(,-".>/80/,( 0 G0>/,8 80/, "G %"7.$/$B, (,%#$.,@ %"-+08,( /" /9,$8 #"K,8 G"#0/,J%".>*-$.7

    %"*./,8+08/>F Q9, 80/, ($GG,8,.%, $. %"7.$/$B, (,%#$., K0> >$7.$G$%0./#: ($GG,8,./ 6,/K,,. Z;

    0.( ZMF !*8/9,8-"8,@ >*6V,%/> K9" %".>*-,( -"8, /90. *++#,-,./>

    ,_+,8$,.%,( 0 >$7.$G$%0./#: G0>/,8 80/, "G (,%#$., /90. .".J>*++#,-,./ *>,8>F `$/0-$. 5;H$./0I,

    ".#: +8"(*%,( >$7.$G$%0./ (,#0:> $. %"7.$/$B, G*.%/$". 0-".7 /9, "#(,>/ -,-6,8> "G /9,

    +"+*#0/$".F

  • 8/10/2019 Pro Folate Debate

    17/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;? @*#/($. A? A"90.BB". C? ,/ 0#D C"E F"#0/, #,G,#B -0: +8"/,%/ 070$.B/ %"#"8,%/0#

    %0.%,8D!" $"% & '( )*+%,'-"-%-,'.'/0 *"1 2-3*%'.'/0D HIIJK0B/,86"//,. ]./,8G,./$". 28"[,%/ L>]2M? 0.( /9, #"%0# S0--"780+9:

    )%8,,.$.7 28"[,%/ LS)2MD 4F /9,B, B*6[,%/B? HHJ %0B,B 0.( N^T -0/%9,( 8,F,8,./B L%"./8"#BM

    E,8, ,.8"##,(D '## R3R %0B,B E,8, ($07."B,( 6,/E,,. ;VW< 0.( HIIH 0.( %".F$8-,( 0/ /9,

    B/08/ "F /9, B/*(:D 3,F,8,./B E,8, %0.%,8OF8,, *+". +0$8$.7 /" /9,$8 -0/%9,( %0B, 0.( 0##B*6[,%/B E,8, F8,, F8"- +8,G$"*B %"#"8,%/0# %0.%,8 ($07."B,BD

    208/$%$+0./B %"-+#,/,( ,_/,.B$G, F""( F8,`*,.%: 0.( #$F,B/:#, *,B/$"..0$8,B 0.( (".0/,(

    F0B/$.7 6#""( B0-+#,B 0/ /9, B/08/ "F /9, ,_+,8$-,./D !"##"EO*+ B0-+#,B E,8, %"##,%/,(

    6,/E,,. HDN 0.( JDT L-,($0. "F NDHM :,08B #0/,8D

    3,B*#/B $.($%0/,( /90/ +#0B-0 F"#0/, %".%,./80/$".B E,8, B$7.$F$%0./#: 8,#0/,( /" /9, 8$BX "F R3R

    $. 0 6,##OB90+,(? 80/9,8 /90. #$.,08? -0..,8D P9, "((B 80/$" L43M F"8 /9, -$((#, G,8B*B #"E,B/

    `*$./$#, "F +#0B-0 F"#0/, %".%,./80/$". E0B HDHJ LV

  • 8/10/2019 Pro Folate Debate

    18/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;,.6,87 BC? ),#9*6 @D !"#0/, 0.( E$/0-$. 5F;G >/0/*> $. 8,#0/$". /"

    0.,-$0? -0%8"%:/">$>? 0.( %"7.$/$E, $-+0$8-,./ $. "#(,8 '-,8$%0.> $. /9, 07, "H H"#$% 0%$(

    H"8/$H$%0/$".D!" $ %&'( )*+,D GIIJKLMN;OPFGIID

    ),.$"8> 07,( >,>> 0.,-$0? -0%8"%:/">$>? 0.( %"7.$/$E, $-+0$8-,./ 8,#0/,( /" H"#0/, 0.( E$/0-$. 5F;G

    >/0/*>D

    Z80$.,( $./,8E$,U,8> %".(*%/,( 0>>,>>-,./> 6"/9 $. /9, +08/$%$+0./>[ 9"-,> 0.( 070$. 0/

    -"6$#, ,Y0-$.0/$". %,./,8>? U9,8, #06 /,>/> 0.( +9:>$%0# ,Y0-> U,8, 0#>" +,8H"8-,(D 5#""(

    /,>/> U,8, 0.0#:\,( H"8 +8,E0#,.%, "H 0.,-$0 QU"-,. C76 ];G7S(^K -,. ];P 7S(^T 0.(

    -0%8"%:/">$> Q=_` aOO H^TD _"7.$/$E, H*.%/$". U0> 0>>,>>,( *>$.7 /9, b$7$/ ):-6"#F_"($.7

    >*6/,>/ "H /9, c,%9>#,8 '(*#/ B./,##$7,.%, )%0#, BBBD

    ),8*- #,E,#> "H H"#0/, 0.( E$/0-$. 5F;G U,8, -,0>*8,( 0.( %#0>>$H$,( 0> #"U Q];dL +-"#S^T "8

    ,#,E0/,( Qa ,Y+,8$-,./? H"#0/, U0> %#0>>$H$,( 0> 0

    %"./$.*"*> E08$06#,D

    '.,-$0 U0> $(,./$H$,( $. dDMe "H /9, >,.$"8>? U$/9 GMe "H 0.,-$% >*6f,%/> 0#>" ,Y+8,>>$.7 #"U

    E$/0-$. 5F;G >/0/*> Q];dL +-"#S^ "8 >,8*- ==' aG;I .-"#S^TD ),.$"8> U$/9 %"-6$.,( #"U

    E$/0-$. 5F;G >/0/*> 0.( 9$79 >,8*- H"#0/, %".%,./80/$".> 0%%"*./,( H"8 06"*/ de "H /9, /"/0#

    >/*(: +"+*#0/$".D Z9, 8,>,08%9,8> "6>,8E,( 0 >$7.$H$%0./ 0>>"%$0/$". 6,/U,,. >,8*- E$/0-$. 5F

    ;G 0.( >,8*- H"#0/,? 8,708(#,>> "H >*++#,-,./0/$".D 4E,80## 8,>*#/> $.($%0/, /90/ #"U 5F;G

    >/0/*> -0: 6, $.($%0/$E, "H %"7.$/$E, $-+0$8-,./ Q43N GDMT? -0%8"%:/">$> Q43N ;DLT? 0.( 0.,-$0

    Q43N GDJTD ^"U 5F;G >/0/*> 0.( 9$79 >,8*- H"#0/, QaMO .-"#S^T >/0/*> U0> 0>>"%$0/,( U$/9

    0.,-$0 0.( %"7.$/$E, $-+0$8-,./D B. >*6f,%/> U$/9 ."8-0# 5F;G >/0/*>? 9$79 H"#0/, >/0/*> U0>

    +8"/,%/$E, 070$.>/ %"7.$/$E, $-+0$8-,./? %"-+08,( /" ."8-0# H"#0/, #,E,#>D

  • 8/10/2019 Pro Folate Debate

    19/19

    !"#$% '%$( )*++#,-,./0/$".1234 '.."/0/,( 5$6#$"780+9:

    ;B? C"9.@/". '? ,/ 0#D E.-,/06"#$F,( G"#$% 0%$( $.

    +#0@-0 $@ 0@@"%$0/,( H$/9 8,(*%,( .0/*80# I$##,8 %,## %:/"/"J$%$/: 0-".7 +"@/-,."+0*@0#

    H"-,.D! #$%&'KLLMN;OMP;QRS;RTD

    ;LU 9,0#/9: +"@/-,."+0*@0# H"-,. G8"- /9, 78,0/,8 ),0//#, 08,0 H,8, 8,%8*$/,( G8"- /9,

    :,08@ ;RRQSKLLL /" +08/$%$+0/, $. /9$@ @/*(: 8,#0/$.7 G"#$% 0%$( /" .0/*80# I$## VWXY %,##%:/"/"J$%$/:D =9, H"-,. H,8, 6,/H,,. /9, 07,@ ULSZ 6,/H,,. KU 0.( TL

    I7[-K? 0.( 90( ." @$7.$G$%0./ -,($%0# 9$@/"8:D

    !"#0/, $./0I, G8"- G""( @"*8%,@ H0@ 0@@,@@,( 0/ /9, @/08/ "G /9, @/*(:? *@$.7 0 ;KLS$/,- !!\D

    )*++#,-,./0# $./0I, H0@ 8,%"8(,( /98"*79 $./,8]$,H@ $. H9$%9 @*6^,%/@ 68"*79/ /9,$8

    @*++#,-,./ 0.( ]$/0-$. %"./0$.,8@ /" /9, -,,/$.7 H9,8, #06,#@ H,8, +9"/"%"+$,( 0.(

    G8,_*,.%: "G $./0I, H0@ 8,%"8(,(D !0@/,( 6#""( (80H@ H,8, %"##,%/,( 0.( 0.0#:F,( 0/ /9,

    E.$],8@$/: "G A0@9$.7/". /" 0@@,@@ WX %,## %:/"/"J$%$/:D !"##"HS*+ 6#""( @0-+#,@ H,8, %"##,%/,(

    0.( +#0@-0 %".%,./80/$".@ "G US-,/9:#S/,/809:(8"G"#0/, V=B!Y? *.-,/06"#$F,( G"#$% 0%$(? 0.(

    /"/0# +#0@-0 G"#0/, %".%,./80/$".@ H,8, -,0@*8,( D

    )*6^,%/@ H,8, %#0@@$G$,( T 78"*+@P

    `"H G"#0/, @/0/*@ VaKOO -%7[(Y? H$/9 @*++#,-,./0/$". bTLL -%7[(

    `"H G"#0/, @/0/*@ VaKOO -%7[(Y? H$/9"*/ @*++#,-,./0/$".

    B$79 G"#0/, @/0/*@ VbKOO -%7[(Y? H$/9 @*++#,-,./0/$". bTLL -%7[(

    B$79 G"#0/, @/0/*@ VbKOO -%7[(Y? H$/9"*/ @*++#,-,./0/$".

    '@@"%$0/$". 6,/H,,. !' @*++#,-,./0/$". 0.( WX %,## /"J$%$/: H0@ "6@,8],( $. 0. $.],8@, ES

    @90+,? $.($%0/$.7 /90/ -"(,80/, @*++#,-,./0/$". -0: $.%8,0@, WX %:/"/"J$%$/: $. /9, @,//$.7 "G

    #"H ($,/08: G"#0/, $./0I,D cJ/8,-, 9$79 0.( #"H G"#0/, @/0/*@ -0: @*++8,@@ WX %:/"/"J$%$/:D'(($/$".0##:? WX %:/"/"J$%$/: H0@ @$7.$G$%0./#: #"H,8 $. H"-,. H$/9 *.-,/06"#$F,( %$8%*#0/$.7

    !'D =9, G$.($.7@ @*77,@/ /90/ $--*., G*.%/$". -0: 6, -"8, ,0@$#: -"($G$,( 0-".7 "#(,8

    +"+*#0/$".@ 0.( /90/ -"8, 8,@,08%9 $@ .,,(,( /" 70$. 0 6,//,8 *.(,8@/0.($.7 "G /9,

    8,#0/$".@9$+ 6,/H,,. G"#0/, @/0/*@ 0.( WX %,## %:/"/"J$%$/:D