LATEBREAKER
COVID-19 Pandemic
Folic Acid Fortification and COVID-19 Incidence and Mortality: An International Study Lydia Famuyide* Lydia Famuyide Ruofei Du Namvar Zohoori Benjamin Amick III Wendy N. Nembhard
It is hypothesized that SARS-CoV-2 utilizes folate for replication in humans. Prior studies demonstrated that folic acid supplementation protects against SARS-CoV-2 infection but may increase the risk of post-infection mortality in humans. Our study evaluated these findings in an ecologic study by assessing the association between country-specific folic acid intake levels and COVID-19 incidence and mortality rates.
We obtained folic acid fortification legislation status (mandatory, voluntary or none), fortification levels of grain flours, and potential folic intake (mg/day) for each country (n=196) as of December 2019 from the Global Fortification Data Exchange. COVID-19 incidence and mortality data, December 2019–April 2023, for countries were obtained from the World Health Organization (WHO). Countries were categorized into six WHO-regions and four income groups using World Bank categories. Rate ratios and 95% CI were estimated from negative binomial regression analyses to estimate the association between folic acid fortification/potential intake (mg/day) and COVID-19 incidence and mortality rates per 100,000 population stratified by WHO region and World Bank income categories.
For middle- income countries, those that had mandatory folic acid fortification policies had a 30% lower COVID-19 incidence than those that did not fortify with folic acid (unadjusted RR=0.7; 95% CI: 0.5, 1.1). There was a significant association between mandatory folic acid fortification policies and COVID-19 incidence among countries in Africa and Europe. We found no significant association between mandatory folic acid fortification policies or potential intake and COVID-19 mortality in countries by income category or WHO region.
Folic acid fortification is associated with lower incidence of COVID-19 even after adjusting for income and region but does not appear to be associated with mortality. Additional studies are warranted to further investigate this possible association.