Evaluation of dietary folate in children assisted in Family Health Strategy units: A cross-sectional study

Abstract

Background and aims: Folate is an indispensable nutrient in human food and its deficiency may affect growth and development, and influence the risk of infant morbidity and mortality. The objective was to analyze the consumption of folic acid and its association with socioeconomic, environmental, maternal and anthropometric data of children aged 12-14 months assisted in Family Health Strategy units in a Brazilian capital.

Methods: This is a cross-sectional study included in a pragmatic clinical trial conducted with 101 children. Food intake was analyzed by means of a 24-h recall, a simple and multiple linear regression analysis was performed in a hierarchical model, and the outcome variable Dietary Folate Equivalents (DFE) was calculated. A hierarchical model was used at three levels (distal: sociodemographic; medial processes: maternal characteristics; proximal: individual processes of the child) in the adjustment of the model, in which the variables presenting p < 0.20 in the crude analysis were inserted in the adjusted analysis, from distal to proximal block, in the increasing order of magnitude of association with the outcome.

Results: Regarding folic acid consumption, 10.9% (n = 11) of children presented deficiency according to the calculated DFE considering the evaluation by Estimated Average Requirement (EAR), and 42.6% (n = 43) had excessive intake according to the calculated DFE considering the evaluation by the Tolerable Upper Intake Levels (UL). After multiple linear regression analysis flour intake was associated with an increase in DFE intake by 2.05 μg (95% CI: 1.72-2.45) and the presence of at least one more child under 5 years of age with an increase in DFE intake by 0.77 μg (95% CI: 0.67-0.89), while receiving the Bolsa Família Program is associated with an increase in DFE intake by 1.39 μg (95% CI: 1.07-1.65) in the model adjusted for birthweight and maternal age, regardless of the child's age.

Conclusion: Data from this study showed low prevalence of deficient consumption and high percentage of excessive consumption of folic acid in the children. In addition, receiving the Bolsa Família Program, consuming flour and the number of children under 5 years of age were positively associated with the calculated DFE.

Keywords: Children; Folate; Folic acid; Food intake; Infant.