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Massachusetts General Hospital released the following announcement on July 3.
Fortifying cereal-based foods with folic acid – instituted in the United States in the 1990s to prevent neural tube defects in infants – can also reduce the incidence of mental illnesses serious as schizophrenia that initially appears in young adults. In their study comparing brain images of young school-age children born just before the fortification warrant to those born afterwards, a research team from Massachusetts General Hospital (MGH) found that folic acid had increased in utero the exposure was associated with changes in the subsequent development of the brain. These changes in the brain, in turn, predicts a reduced risk of psychotic symptoms.
"Serious mental illnesses such as autism and schizophrenia that plague children and young adults are devastating and chronic and, at present, no known prevention" says Joshua Roffman, MD, MMSc, from the Department of Psychiatry of the MGH, lead author of the report published in JAMA Psychiatry . "It is thought that these diseases start in the womb, so it makes sense to concentrate our efforts there. If even a fraction of these cases could be prevented through a benign and easily available intervention during pregnancy, it could be as transformative for psychiatry as vaccines have been for infectious diseases or fluoridation for dentistry. Our results with folic acid make an important step in this direction.
A 1996 Food and Drug Administration regulation required that grain products such as fortified bread, flour, corn flour, rice and pasta be fortified with folic acid. January 1, 1998. It is known that folic acid reduces the risk of neural tube defects such as spina bifida, in which the spine does not close completely around the spinal cord, which can lead to severe disability. . Although it is recommended to take folic acid supplements in women likely to become pregnant, because neural tube defects may appear before the recognition of pregnancy, folic acid fortification has been designed to largely protect against risks. This measure has led to a rapid doubling of blood levels of folate – nutrient category, including folic acid – in US women and to a reduction in the incidence of spina bifida in the country [19659005]. schizophrenia in offspring, and recent long-term studies in several countries – including the United States – have associated prenatal folic acid use with a reduction of about 50% in the risk of dengue. autism in children. But none of these observations included biological evidence that could support a cause-and-effect relationship between prenatal exposure to folic acid and the development of these psychiatric disorders. In seeking such evidence, researchers took advantage of the "natural experience" provided by the rapid implementation of folic acid fortifiers in the United States for two years, from 1996 to 1998.
The team examined two series adolescents born between 1993 and 2001 were aged 8 to 18 years. One set included normal brain images taken at the MGH as part of the clinical care of 292 patients; another series included images of 861 participants at the Philadelphia Neurodevelopmental Cohort, a study that included the assessment of psychiatric symptoms, including those associated with psychotic disorders. These two groups were divided according to the likely prenatal exposure to folic acid – those born before July 1, 1996 when the fortifications started, those born after July 1, 1998, when the implementation was over, and those born between two group exposure would have been intermediate. A third set of images reflected 217 participants in a multi-site study of National Institutes Health (NIH), all aged 8 to 18 during imaging but born before acid enrichment folic was instituted.
Images from the MGH and Philadelphia cohorts revealed that young born after full implementation of folic acid fortification had different cortical ripening patterns from those born before the program started. These differences were characterized by significantly thicker brain tissue and delayed thinning of the cerebral cortex in areas associated with schizophrenia. The cortical thickness of those born during the deployment period was intermediate between the other two groups. While thinning of the cerebral cortex in school-aged children is a normal part of brain maturation – probably associated with processes like eliminating unnecessary connections between neurons – previous studies have associated with early and accelerated cortical thinning to autism and psychotic symptoms.
Data on psychiatric symptoms available from the Philadelphia cohort revealed that delayed cortical thinning observed in participants fully exposed to folic acid was associated with a significantly reduced risk of psychotic symptoms . Images from the NIH cohort, which was not exposed to folic acid fortification, found no evidence of delayed cortical thinning observed in participants exposed to the other two groups, supporting the association between prenatal exposure to folic acid and delayed cortical thinning Although our findings establish a link between prenatal exposure to fortification In folic acid and changes in cortical development and reduced risk of psychotic symptoms, they can not directly link exposure to folic acid to a reduced risk of schizophrenia. The disorder is in the early 20's. But since such symptoms in young people are on the same continuum as schizophrenia, the results are promising for the prevention of schizophrenia, "says Roffman. "The older participants in our study are now approaching the age of greatest risk for several psychiatric disorders – including bipolar disorder and depression – so it will be very interesting to see if exposure has an effect on the impact of these disorders Future research should also examine how actual levels of maternal folate relate to postnatal brain development and the risk of subsequent mental illness. "
Roffman, Associate Professor of Psychiatry at Harvard Medical School, adds: "While 81 countries are fortifying their food supply with folic acid, more than half of the world's population remains without such exposure." Prove conclusively that prenatal folic acid could have beneficial effects on brain health beyond its well-established effects on the prevention of spinal bifida could tip the scales towards the setting up of fortifications in countries that have not yet adopted it . ] JAMA Psychiatry article is Hamdi Eryilmaz PhD, MGH Psychiatry. Other co-authors are Kevin Dowling, Franklin Huntington, Anais Rodriguez-Thompson, Thomas Soare PhD, and Randy Gollub MD, Ph.D., MGH Psychiatry; Hang Lee PhD, MGH Biostatistics; Lauren Beard, Ph.D. Ruben Gur, Ph.D. Monica E. Calkins, Dr. Raquel Gur, PhD, and Theodore Satterthwaite MD, Perelman School of Medicine, University of Pennsylvania; Jeffrey C. Blossom, Harvard Center for Geographic Analysis; and Ezra Susser MD, DrPH, Columbia University. Support for this study includes a MQ research grant: Transforming Mental Health and an NIH grant R01 MH101425.
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