Provision of folic acid: review of the safety and toxicology effects in populations

Abstract

Increasing awareness of the significance of public health consequences of insufficient folate intake has led to increased implementation of interventions providing folic acid. This has emphasized the need for an in-depth review of the safety and toxicology of the provision of folic acid through a variety of mechanisms, such as supplementation and fortification, and in a variety of contexts, including areas receiving antifolate medications. Therefore, WHO is currently scoping the work for developing guidance on the provision of folic acid in populations receiving antifolate medications and on the safety/toxicology of the provision of folic acid in populations. The Evidence and Programme Guidance Unit also hosts the Vitamin and Mineral Nutrition Information System (VMNIS), formerly known as the Micronutrient Deficiency Information System (MDIS), which includes the Micronutrients Database (used to monitor micronutrient status around the globe) and the Global laboratory directory for the assessment of micronutrient status. Under the supervision of the responsible officers at WHO, the proposed terms of reference for this project aims to: a) Assist in scoping the work for providing guidance on the safety/toxicology of the provision of folic acid in populations by conducting a search for current literature and defining the key questions that need answering, b) Update the Vitamin and Mineral Nutrition Information System with the extraction of data from at least 10 national or first administrative surveys containing data on micronutrient status from Brazil or other Portuguese-speaking countries, c) Assist in the identification and contact of laboratories for potential inclusion in the Global laboratory directory for the assessment of micronutrient status, d) Other tasks as requested by supervisors. In order to achieve the proposed objectives, a systematic search for literature concerning evidences about the safety and possible toxicology effects of folic acid in the population and the provision of folic acid in specific groups receiving antifolate medications will be perform. After a brief review of this literature, the key questions that need to be most urgently addressed will be identified and outlines in the PICO format (Population, Intervention, Control, Outcomes) within a WHO guideline development scoping document. As the Micronutrients database has recently undergone expansion to include more variables and indicators of micronutrient status, additional data are being added to the newly designed input platform. Using information collected in the Micronutrients Database about laboratories that have assessed micronutrient status in previous national surveys, contacts for these laboratories will be searched for and they will be invited to submit their information into the directory.