Fortified wheat flour and cleft lip and palate in Chile
What it found
Hospital discharge rates for cleft lip and palate in Chilean infants fell by 9% after wheat flour was fortified with folic acid.
This was a population study, not a study in individual people.
What they found
Studies in people
Hospital discharge rates fell
The hospital discharge rate for cleft lip and palate in infants fell from 1.88 per 1,000 live births in 1986-1996 to 1.68 per 1,000 live births in 2001-2012. The authors call this a 9% decrease.
Fortification linked to decrease
After adjusting for other factors, the authors found that the timing of folic acid fortification was the variable that explained the decrease in hospital discharge rates. The other variables they looked at did not show a significant link.
Different cleft types changed
Between 2004 and 2011, hospital discharge rates for cleft lip decreased, but rates for cleft lip and palate increased by 50%. Rates for cleft palate alone stayed about the same.
Other findings
Possible record issues
The authors note that hospital discharge records may not capture all cases, and that a 2008 rise may be due to a health programme change rather than a real increase in cases.
What the authors conclude
“The 9% decrease in hospital discharge rates for CLP is concomitant with wheat folic acid fortification.”
Also in their conclusions
- They conclude that the 9% decrease in hospital discharge rates for cleft lip and palate happened at the same time as wheat flour fortification with folic acid.
- They say that although a causal link cannot be stated definitively, the results are a valuable contribution about possible population effects of folic acid.
- They highlight the need for a National Registry of Congenital Malformations.
How it was done
The authors say the effect of food fortification with folic acid on the incidence of cleft lip and palate is under discussion. They wanted to see whether hospital discharge rates for this condition changed after Chile started fortifying wheat flour with folic acid in 2000.
They analysed hospital discharge databases from the Chilean Ministry of Health for children under one year old, from 1986 to 2012. They compared the rate of discharges for cleft lip and palate before fortification (1986-1999) and after (2000-2010), and adjusted for rubella, poverty, obesity in pregnant women, and smoking and alcohol use in women.
What it can’t tell you
- This was a population study, so it can show a link between fortification and cleft rates but cannot prove that folic acid fortification caused the decrease.
- Hospital discharge records may miss some cases, such as stillbirths or cases diagnosed later, so the rates may not reflect all cleft lip and palate cases.
- The study could not rule out that the decrease was due to changes in how cases were recorded.
The paper
- Title
- [Cleft lip/palate and flour fortification with folic acid in Chile]
- Type
- Study
- Evidence
- Studies in people
- Summarised from
- Full text
- Cite
- Paulos A, Pino P, Cavada G, Lagos C, Broussain V, Hasbún A (2016). [Cleft lip/palate and flour fortification with folic acid in Chile]. Revista medica de Chile. doi:10.4067/S0034-98872016000800008Free full textPubMed 27905647DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error