Evidence map›Paper›PMID 34280291›Full record

ArticleAdvances in nutrition (Bethesda, Md.)2021

Review of Existing Models to Predict Reductions in Neural Tube Defects Due to Folic Acid Fortification and Model Results Using Data from Cameroon.

Hanqi Luo, Kenneth H Brown, Christine P Stewart, Laurel A Beckett, Adrienne Clermont, Stephen A Vosti, Jules M Guintang Assiene, Reina Engle-Stone

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In one paragraph

Article in Advances in nutrition (Bethesda, Md.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.7field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 7 citations in OpenAlex.

  1. Article
  2. Review
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 2 countries.

Hanqi LuoDepartment of Nutrition, University of California, Davis, CA, USA.ORCID 0000-0001-6253-5818
Kenneth H BrownDepartment of Nutrition, University of California, Davis, CA, USA.
Christine P StewartDepartment of Nutrition, University of California, Davis, CA, USA.
Laurel A BeckettDepartment of Public Health Sciences, University of California, Davis, CA, USA.
Adrienne ClermontDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Stephen A VostiDepartment of Agricultural and Resource Economics, University of California, Davis, CA, USA.
Jules M Guintang AssieneHellen Keller International, Yaoundé, Cameroon.
Reina Engle-StoneDepartment of Nutrition, University of California, Davis, CA, USA.ORCID 0000-0003-2446-6166
University of California, Davis · USEmory University · USHelen Keller International · CMJohns Hopkins University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Several models have been developed to predict the effects of folic acid fortification programs on prevention of neural tube defects (NTDs), but each relies on different assumptions and data inputs. We identified and reviewed 7 models that predict the effects of folic acid intake or status on NTD risk. We applied 4 of these models [the original and a modified version of the Lives Saved Tool (LiST) and models developed by Arth et al. and Wald et al.] to predict the effect of folic acid fortification of wheat flour on reduction of NTDs using national survey data from Cameroon. The estimated percentage of NTDs averted due to fortified wheat flour (5.0 μg folic acid/g flour) varied by predictive model, with a 21-31% reduction in LiST to 83% in Arth's model, and 15% in Wald's model. As the simulated fortification level was increased from 1.0 to 7.0 μg folic acid/g flour, the pattern of change in estimated numbers of NTDs averted differed due to different model assumptions: the number of NTDs averted increased and then reached a plateau in the modified LiST model (as would be expected in real-world conditions), increased sharply in Arth's model, and increased continuously in Wald's model. This wide variation in predicted effects, and implausible results in some cases, undermines the models' utility for users of model outputs. Concurrent collection of dietary and biomarker data, including plasma and RBC folate concentrations, and NTD outcomes, is necessary to validate these models and monitor change in folic acid intake, folate-related biomarkers, and reduced NTD risk due to fortification. In the meantime, models based on erythrocyte folate concentration are recommended, based on biological plausibility and consistency with empirical evidence. Where erythrocyte folate data are unavailable, sensitivity analyses (using several models) could be conducted to examine the range of possible outcomes.

Indexed as

Folic AcidNeural Tube DefectsCameroonFlourFood, FortifiedHumansTriticumFolic AcidCameroonfolic acidfortificationneural tube defectsnutritional models

Identifiers

PMID34280291
PMCPMC8634386
OpenAlexW3186210824

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.