Folic acid fortification, maternal obesity and neural tube defects: Policy implications

In 1996, the Food and Drug Administration (FDA) mandated that beginning in January 1998, flour and other enriched grain products be fortified with 140 μg of folic acid per 100 g of grain to prevent neural tube defects (NTDs) that occur in approximately 1 in 1,000 pregnancies in the United States (U.S.). Although this program has demonstrated important public health effects, it is argued that current fortification levels may not be enough to prevent all folic acid-preventable NTD cases. This study reviews published literature, on folic acid fortification in the U.S. and countries with mandatory folic acid fortification programs reported after 1992 and through January 2008. Published studies are evaluated to determine if the current level of folic acid fortification in the U.S. is adequate to prevent the most common forms of NTDs (spina bifida and anencephaly), particularly among overweight and obese women. ^ Although consistent improvement in blood folate levels of child bearing age women is reported in almost all studies, the RBC folate concentration has not reached the level associated with the most significant reduction of risk for NTDs (906 nmol/L); approximately half of the potentially preventable NTDs are prevented by fortification at the current U.S. level. Furthermore, the blood folate status of women in higher BMI categories (obese or overweight) has not improved as much as among women in lower BMI categories. Therefore, women classified as overweight or obese have not benefited from the preventive effects of folic acid fortification as much as normal or underweight women. ^ To reduce risk of folate preventable NTDs, especially in overweight and obese women, it may be necessary to increase the current level of folic acid fortification. However, further research is required to determine the optimal levels of fortification to achieve this goal without causing adverse health effects in the general population. ^

Fortification and Frontier: The Project Drawn up by Juan Martín Zermeño for Puebla de Sanabria in 1766

Following the death of engineer General Jorge Próspero de Verboom in 1744 and after a few years of transition in the management of Spanish fortifications, Juan Martín Zermeño took on the role, initially with a temporary mandate, but then definitively during a second period that ran from 1766 until his death in 1772. He began this second period with a certain amount of concern because of what had taken place during the last period of conflict. The Seven Years War (1756–1763) which had brought Spain into conflict with Portugal and England in the Caribbean had also lead to conflict episodes along the Spanish–Portuguese border. Zermeño’s efforts as a planner and general engineer gave priority to the northern part of the Spanish–Portuguese border. After studying the territory and the existing fortifications on both sides of the border, Zermeño drew up three important projects in 1766. The outposts that needed to be reinforced were located, from north to south, at Puebla de Sanabria, Zamora and Ciudad Rodrigo, which is where he is believed to have come from. This latter township already had a modern installation built immediately after the war of the Spanish Succession and reinforced with the Fort of La Concepción. However, Zamora and Puebla de Sanabria had some obsolete fortifications that needed modernising. Since the middle of the 15th century Puebla de Sanabria had had a modern castle with rounded turrets, that of the counts of benavente. During the 16th and 17th centuries it had also been equipped with a walled enclosure with small bastions. During the war of the Spanish Succession the Portuguese had enlarged the enclosure and had erected a tentative offshoot to the west. In order to draw up the ambitious Puebla de Sanabria project Zermeño had the aid of some previous reports and projects, such as those by the count of robelin in 1722, the one by Antonio de Gaver in 1752, and Pedro Moreau’s report dated June 1755. This study includes a technical analysis of Zermeño’s project and its strategic position within the system of fortifications along the Spanish–Portuguese border.

Boston, Massachusetts and vicinity, showing Revolutionary War fortification sites, 1788 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Boston with its environs, [by] T. Conder, sculpt. The map was originally published in: William Gordon's The history of the rise, progress, and establishment, of the independence of the United States of America, 1788. Scale [ca. 1:53,360]. The image inside the map neatline is georeferenced to the surface of the earth and fit to the Massachusetts State Plane Coordinate System, Mainland Zone (in Feet) (Fipszone 2001). All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, or other information associated with the principal map. This map shows Revolutionary War features such as positions of troops, redoubts, batteries, and forts, etc. It also shows features such as roads, drainage, selected public buildings and residences, and more. Relief is shown by hachures. This layer is part of a selection of digitally scanned and georeferenced historic maps of Massachusetts from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of regions, originators, ground condition dates (1755-1922), scales, and purposes. The digitized selection includes maps of: the state, Massachusetts counties, town surveys, coastal features, real property, parks, cemeteries, railroads, roads, public works projects, etc.

Essai général de fortification et d'attaque et défense des places, dans lequel ces deux sciences sont expliquées et mises l'une par l'autre à la portée de tout le monde ...

Mode of access: Internet.

Remarques sur un nouveau systême de fortification proposé par M. le comte de Saxe, dans ses mémoires sur l'art de la guerre.

Title vignette; head- and tail-pieces.

La nouvelle fortification, de Nicolas Goldman

Mode of access: Internet.

Traité sur la constitution des troupes légères, et sur leur emploi à la guerre : auquel on a joint un supplément contenant la fortification de campagne ; Avec un grand nombre de figures.

Mode of access: Internet.

Le parfait ingenieur françois, ou la fortification offensive et défensive : contenant la construction, l'attaque et la défense des Places régulieres & irrégulieres, selon les méthodes de Monsieur De Vauban ... /

Mode of access: Internet.

The new method of fortification, as practised by Monsieur de Vavban ... : with an explication of all terms appertaining to that art ...

Mode of access: Internet.

Der wahre Vauban, oder, Der von den Deutschen und Holländern verbesserte französische Ingenieur : worinnen die Arithmetik, die Geometrie, die offensiv- und defensiv-Kriegsbaukunst, nach den Grundsätzen des berühmten Herrn von Vauban deutlich erkläret werden : nebst einer ganz neuen Methode zur irregulären Fortification /

Signatures: pi² )(² A-X⁴. Leaves )(1-2 signed )(2-3.

Engineer field manual : Parts I-VII. I. Reconnaissance. II. Bridges. III. Roads. IV. Railroads. V. Field fortification. VI. Animal transportation. VII. Tables, weights, measures and specific gravities. Prepared under the direction of the chief of engineers, U.S. Army.

War dept. doc. no. 355.

Notes on field fortification.

"1st ed., 1912 ... 3d ed., rev., and problems added, 1916."

The elements of navigation; containing the theory and practice. With the necessary tables, and compendiums for finding the latitude and longitude at sea. To which is added, a treatise of marine fortification. Composed for the use of the Royal Mathematical School at Christ's Hospital, the Royal Academy at Portsmouth, and the gentlemen of the Navy ...

"A dissertation on the rise and progress of the modern art of navigation," by James Wilson: v. 1, p. [i]-xxx.

A treatise containing the elementary part of fortification, regular and irregular ...

Mode of access: Internet.

The new method of fortification, as practiced by Monsieur de Vauban, engineer-general of France. Together with A new treatise of Geometry ...

Translated by A. Swall.