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To investigate the prevalence of folic acid deficiency in Queensland-wide data of routine laboratory measurements, especially in high-risk sub-populations.
Secondary health data analysis.
Analysis of routine folic acid tests conducted by Pathology Queensland (AUSLAB).
Female and male persons aged 0–117 years with routine folic acid testing between 1 January 2004 and 31 December 2015. If repeat tests on the same person were conducted, only the initial test was analysed (n 291 908).
Overall the prevalence of folic acid deficiency declined from 7·5 % before (2004–2008) to 1·1 % after mandatory folic acid fortification (2010–2015; P < 0·001) reflecting a relative reduction of 85 %. Levels of erythrocyte folate increased significantly from a median (interquartile range) of 820 (580–1180) nmol/l in 2008 before fortification to 1020 (780–1350) nmol/l in 2010 (P < 0·001) after fortification. The prevalence of folic acid deficiency in the Indigenous population (14 792 samples) declined by 93 % (17·4 v. 1·3 %; P < 0·001); and by 84 % in non-Indigenous residents (7·0 v. 1·1 %; P < 0·001). In a logistic regression model the observed decrease of folic acid deficiency between 2008 and 2010 was found independent of gender, age and ethnicity (ORcrude = 0·20; 95 % CI 0·18, 0·23; P < 0·001; ORadjusted = 0·21; 95 % CI 0·18, 0·23; P < 0·001).
While voluntary folic acid fortification, introduced in 1995, failed especially in high-risk subgroups, the 2009 mandatory folic acid fortification programme coincided with a substantial decrease of folic acid deficiency in the entire population.
To assess nutritional status using red-cell folate (RCF) and associated health behaviours including fruit and vegetable intake, smoking, drinking and physical activity in two Indigenous populations living in remote northern Australia.
A cross-sectional survey conducted during 1998–2000.
Twenty-six rural communities in north Queensland, Australia.
A total of 2524 Indigenous people aged 15 years and over was included in the study. Self-reported fruit and vegetable intake, tobacco smoking, alcohol intake and physical activity were recorded. RCF was measured using the Bayer Advia Centaur automated immunoassay system. The association between low RCF (RCF<295 nmol/l) and risk factors was analysed using general linear models adjusted for demographic factors and covariates, namely BMI, diabetes and dyslipidaemia.
The prevalence of RCF deficiency was higher in Aboriginal participants compared with Torres Strait Islanders (25·6 % v. 14·8 %, P < 0·001). Young women of childbearing age were more likely to have low RCF. Among Aboriginal adults, smoking was strongly associated with low RCF (risk ratio = 1·9, 95 % CI 1·5, 2·5 in females and risk ratio = 2·9, 95 % CI 1·9, 4·2 in males).
Indigenous Australians, especially women of childbearing age, had high prevalence of low RCF. Smoking was associated with insufficient folate independent of fruit and vegetable intake and alcohol consumption in the Aboriginal population. This population with an already higher risk of obesity and higher rate of tobacco smoking should be targeted to improve nutrition status to prevent ill health such as diabetes and CVD.
To document nutritional status and health behaviours of young indigenous women of childbearing age in rural communities in north Queensland.
Cross-sectional survey of 424 Aboriginal and 232 Torres Strait Islander (TSI) women aged 15–34 years, conducted in twenty-three rural and remote communities of far north Queensland in 1999–2000, with follow-up of a smaller cohort (n 132) in 2006–2007.
Main outcome measures
Weight, waist circumference, intake of fruit and vegetables, smoking, alcohol intake, fasting blood glucose, blood pressure, HDL cholesterol, γ-glutamyltransferase, red cell folate (RCF), interval weight and waist gain and incidence of diabetes.
Forty-one per cent of Aboriginal and 69 % of TSI had central obesity, 62 % were smokers, 71 % drank alcohol regularly and of those, 60 % did so at harmful levels. One third of Aboriginal and 16 % of TSI women had very low RCF levels. In the group followed up, there was a mean annual waist gain of 1·6 cm in Aboriginal women and 1·2 cm in TSI, 0·5 kg/m2 in BMI and 1·5 kg in weight. Incidence of new type 2 diabetes mellitus in this cohort was 29·1 per 1000 person-years (py) (95 % CI 14·0, 52·8) in Aboriginal women and 13·9 per 1000 py (95 % CI 5·6, 28·5) among TSI.
High prevalence and incidence of central obesity and diabetes, poor nutrition, high rates of alcohol use and tobacco smoking together with young maternal age, provide a poor intra-uterine environment for many indigenous Australian babies, and contribute to high perinatal morbidity and future disability. Community level interventions to improve pre-pregnancy nutrition and health behaviours in young women are urgent.
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