Validation of a questionnaire for folate dietary intake assessment and analysis of knowledge, attitudes and practice of pharmacy team members with regards to counseling women of reproductive age on adequate folate intake

Nutritivne deficijencije prepoznate su kao jedan od glavnih preventabilnih faktora rizika za nastanak kongenitalnih anomalija i drugih neželjenih ishoda trudnoće. Naučni napredak u oblasti etiopatogeneze kongenitalnih anomalija doveo je do zaključka da je optimalno izbalansirana ishrana majki uz adekvatan unos makro i mikronutrijenata izuzetno važna za obezbeđivanje normalnog embrionalnog razvoja. Zaštitni efekat perikoncepcijske primene suplemenata folne kiseline u redukciji rizika od nastanka i rekurence defekata nervne cevi naučno je potvrđen mnogim obzervacionim i interventnim studijama. Folati učestvuju kao koenzimi u transferu monougljeničnih grupa u reakcijama metabolizma aminokiselina i sintezi i reparaciji nukleinskih kiselina, pa je uloga ovog hidrosolubilnog B9 vitamina posebno značajna za uspešno odvijanje intenzivne ćelijske deobe i proliferacije tokom embriogeneze. Ipak, uprkos postignutom naučnom konsenzusu o koristima folne kiseline u obezbeđivanju zdravog potomstva i činjenici da su mnoga regulatorna tela u oblasti zdravlja izdala preporuke o primeni folne kiseline u periodu planiranja začeća i ranim fazama trudnoće, studije ukazuju da je među ženama reproduktivne dobi unos ovog esencijalnog nutrijenta i dalje suboptimalan. Na varijabilnost situacije u različitim zemljama utiče niz faktora kao što su: stepen obaveštenosti žena o merama prevencije defekata nervne cevi, postojanje, primena i obuhvat strategija za unapređenje unosa i statusa folata u ciljnoj populacionoj grupi, dostupnost i priuštivost suplemenata folne kiseline i konačno, izloženost stanovništva namirnicama koje su fortifikovane ovim vitaminom. Procena nutritivnog statusa danas je prepoznata kao važan deo zdravstvene nege na individualnom i populacionom nivou. Prvi korak u suočavanju sa izazovom ostvarivanja adekvatnog unosa folata kao esencijalnih nutrijenata je pouzdana i objektivna procena nutritivnog statusa zasnovana na primeni standardizovanih, validiranih instrumenata, koji su prilagođeni specifičnim karakteristikama populacije od interesa. Iz toga je proistekao prvi cilj ove doktorske disertacije – razvoj i evaluacija validnosti Upitnika o učestalosti konzumiranja namirnica za procenu dijetarnog unosa folata kod žena reproduktivne dobi u Republici Srbiji (F-FFQ). U razvoju upitnika primenjena je kombinacija validiranog upitnika za procenu unosa folata iz Republike Hrvatske i NCI/ Block Health Habits and History Questionnaire uz dodatnu adaptaciju odnosno dopunu lokalno dostupnim namirnicama i tradicionalnim jelima iz Srbije. Analizu pregledne (eng. face validity) i sadržajne validnosti (eng. content validity) upitnika sprovela je grupa eksperata iz Centra izuzetne vrednosti u oblasti istraživanja ishrane i metabolzma Instituta za medicinska istraživanja, Univerziteta u Beogradu...Nutritive deficiencies are well-recognized preventable risk factors for the development of congenital anomalies and other adverse pregnancy outcomes. Scientific progress in the comprehension of congenital anomalies has led to the conclusion that optimally balanced maternal diet with adequate intake of macro- and micronutrients can contribute to reducing the incidence of these disorders. Protective effect of the periconceptional folic acid supplementation in reducing the risk for both occurrence and recurrence of neural tube defects (NTDs) is scientifically confirmed through many observational and interventional studies. Folate derivatives are involved as coenzymes in the single-carbon units’ transfer in metabolism of amino acids and synthesis and reparation of nucleic acids. Accordingly, the role of this water-soluble B9 vitamin is of special importance for intense cell maturation, division and proliferation during embryogenesis. However, regardless the unequivocal epidemiological evidence, achieved scientific consensus on the folic acid benefits in ensuring healthy offspring, and the fact that many health authorities officially recommended the use of folic acid prior to conception and during early phases of pregnancy, numerous studies revealed suboptimal intake of this essential nutrient among women of reproductive age. The variability of the situation in different countries is affected by a number of factors such as: the awareness of women of prevention measures for NTDs; the existence, application and coverage of strategies for improving folate intake and status in the targeted population group; the availability and affordability of folic acid supplements; and finally, the population exposure to folic acid- fortified foods. Nutritional status assessment is nowadays recognized as an important part of medical care at individual and population level. In facing the challenge of achieving folate adequacy, the first step is reliable and objective nutritional assessment performed with standardized and validated instruments adapted to specific characteristics of the population of interest. Therefore, the aim of the first study in the present doctoral dissertation was to develop and validate the Food Frequency Questionnaire for the assessment of folate intake (F-FFQ) among women of reproductive age in Serbia. The FFQ for folate (F-FFQ) was developed by combining a validated FFQ for folate in Croatia region with the NCI/Block Health Habits and History Questionnaire with further adaptation based on inclusion of folate-rich traditional foods consumed in Serbia. The F-FFQ was designed to capture habitual intake over the previous three months and was self-administered in the presence of trained dietitians..