Health impact assessment of folate biofortified rice in China

Introduction : As folate deficiency is mainly caused by the dependency on folate-poor staple crops, such as rice, the implementation of rice with a high level of natural folate could be a successful pro-rural and pro-poor intervention strategy to reduce folate deficiencies in China, where about 260 million people are considered to be folate deficient. Consuming folate biofortified rice instead of conventional rice could prevent someone from negative health outcomes of folate deficiency, such as megaloblastic aneamia and neural-tube defects. Especially for poor Chinese women of childbearing age, folate biofortification could be important to prevent them from having a baby with a neural-tube defect, the main adverse health outcome. As Northern and Southern China differ significantly in terms of rice consumption and production, and folate intake, a regional comparison of the potential health benefits of folate biofortified rice could further underpin the introduction of this strategy in China. Objective : The aim is to measure the potential regional health impact of folate biofortified rice (12 μg per 1 gram of rice) in China. Method : Based on the Disability-Adjusted Life Years (DALY) approach, the health impact of folate enriched rice in China is evaluated as the numbers of DALYs lost that can be reduced. As there is only data available on contribution of folate deficiency to its main adverse health outcome of folate deficiency, i.e. neural-tube defects, the health impact refers to the neural-tube defects that are caused by folate deficiency. Furthermore, two coverage rate of the introduction of folate enriched rice are included based on previous research. Results : Based on the efficacy of folate biofortified rice, the total daily folate intake for Chinese women of childbearing age after biofortification amounts to 1 120 μg, which is significantly higher than the required folate intake. The application of the DALY method shows that the implementation of folate biofortified rice could save 116 090 DALYs (low impact scenario) and 257 345 DALYs (high impact scenario) per year. Although rice consumption is significantly lower in Northern China, the folate intake after biofortication is still high enough to alleviate the burden of neural-tube defects caused by folate deficiency. Furthermore, a rough estimation of the costs of folate biofortification indicates that this policy intervention could be a cost-effective method as well. Conclusions : Although these results underpin folate biofortification of rice as a valuable policy intervention to tackle folate deficiency in different regions of China, further research is required to compare the benefits and costs with other interventions or folate biofortified products.