Does a ‘Low Carb’ Diet Increase Risk of Neural Tube Defects?
BACKGROUND AND PURPOSE:
FDA mandated that all cereals and grains be enriched with 140 µg of folic acid per 100g of product by 1998 to reduce NTDs
There has been concern that low carb and gluten free diets may limit exposure to this fortification program
Desrosiers et al. (Birth Defects Research, 2018) examined whether a “low carbohydrate” diet could be correlated with increased risk of neural tube defects due to inadequate dietary intake of folic acid
Case control study
1,740 cases and 9,545 controls were analyzed
Data derived from the National Birth Defects Prevention Study
multicenter case-control study of major structural birth defects
Mothers were sorted into two groups:
Cases: mothers with infants, stillbirths (20 weeks), and prenatally diagnosed terminations with anencephaly or spina bifida
Mothers with infants without a birth defect from the same population as cases in each state
A food frequency questionnaire response was used to measure carbohydrate and folic acid intake prior to conception
Dietary folic acid intake included the estimated measure of synthetic folic acid consumed through fortified foods, regardless of consumption of foods with naturally occurring folate (green vegetables, legumes, etc.)
Restricted carbohydrate intake was defined as ≤5th percentile among controls
Odds ratio (OR) was estimated with logistic regression and adjusted for maternal race/ethnicity, education, alcohol use, folic acid supplement use, study center, and caloric intake
Supplemental folic acid use in the month before conception was the same in both groups (31%), and the association with NTDs was not modified by supplement use
Mean dietary intake of folic acid among women with low carbohydrate diets was less than half of that of other women (p <.01)
Women with restricted carbohydrate diets were more likely to have an infant with an neural tube defect (adjusted OR = 1.30, 95% CI: 1.02, 1.67)
Women who had restricted carbohydrate diets had much lower levels of folic acid during pregnancy and had a slightly higher risk of having offspring with neural tube defects
Supplementation may not compensate for folate deficit in women with carbohydrate restricted diets
May be related to inconsistent use or insufficient dose
Authors also suggest that results may also be related to caloric restriction/weight loss or poor diet quality in general
Data suggests that dieting during first trimester may be associated with NTDs, while dieting 3 months prior to conception is not
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