Advisor(s)
Andrzej Kulczycki
Committee Member(s)
David Becker
InmacUlada Aban
Jeffrey Blount
Lyn Steffen
Vijaya Kancherla
School
School of Public Health
Document Type
Dissertation
Department (new version)
Public Health
Date of Award
9-9-2024
Abstract
The overarching goal of the three-paper dissertation is to address the gaps in the literature on the clinical care burden of preventable spina bifida on the global neurosurgical community and the need for a universal food vehicle for fortification with folic acid as a novel prevention strategy. It is known that sufficient intake of folic acid is imperative to prevent neural tube defects (spina bifida) in the developing fetus in the first month post-conception. It is also known that fortifying staple foods is the most cost-saving and effective prevention method. However, very few countries have mandatory fortification policies. Therefore, the overall goals of this dissertation work are to address the following topics: 1) assess the impact of spina bifida on the neurosurgical workforce globally; 2) show the effectiveness of the 1998 United States mandatory folic acid food fortification policy of enriched cereal grain products on increasing serum folate concentrations in Coronary Artery Risk Development in Young Adults (CARDIA) participants in pairwise comparison at two-time points (pre-and post-fortification); 3) evaluate the feasibility of salt as a new food vehicle for fortification with folic acid. The first paper is a descriptive survey-based study that quantifies neural tube defects prevalence globally, clinical time neurosurgeons spend taking care of spina bifida patients, and prevention strategies implemented currently with a comparison between high and low-income regions of the world. The second paper is a secondary analysis of change in serum folate concentrations in a stable cohort of participants between 1992-1993 (pre-fortification) and 2000-2001 (post-fortification) utilizing general linear model regression. It also examines improvement in the folate insufficiency status in women of reproductive age and compare to those who did not improve their insufficient status using logistic regression analysis. The third paper is a nonrandomized intervention trial of the feasibility of iodized salt fortified with folic acid to increase serum folate concentrations after voluntary one-month use of a saltshaker with folic acid in a country with a mandatory fortification policy. Future steps should include a large sample size effectiveness study of fortified iodized salt with folic acid in a country without mandatory fortification and advocacy on a country level to promote mandatory fortification based on cultural food preferences.
ProQuest ID
Recommended Citation
Smith, Anastasia Arynchyna, "Prevention Of Spina Bifida Through Fortification Of Iodized Salt With Folic Acid" (2024). All ETDs from UAB. 7633.
https://digitalcommons.library.uab.edu/etd-collection/7633
