By Mike Foster
In 2007, Cynthia Colapinto was working as a public health nutritionist in Sudbury when new guidelines were published suggesting that vulnerable women of child-bearing age take supplements containing more folic acid. She refused to take the recommendations released by the Society of Obstetricians and Gynaecologists of Canada and Motherisk at face value.
“I realized that there was a lack of data – there was no national-level data on the blood-folate status of Canadians,” explains Colapinto.
It was the beginning of a journey that would lead to her winning two prestigious awards last year – the Governor General’s Gold Medal in Medicine Health Sciences and Interdisciplinary Studies and the 2014 Joseph de Koninck Prize, granted to the best doctoral thesis in an inter-disciplinary collaborative program at the University of Ottawa.
But Colapinto says that the best reward of all was finding her mentor and doctoral thesis supervisor Dr. Mark Tremblay, a professor at uOttawa’s Population Health Program and at the Faculty of Medicine’s Department of Pediatrics. It was when she heard him speak about new data that was being gathered under the 2007-2009 Canadian Health Measures Survey(CHMS) that she found her new calling.
At the time, she was chairing a provincial Family Health Nutrition Advisory Group and had been discussing a recommendation to double the levels of folic acid fortification in the food supply with colleagues and nurses at the Sudbury and District Health Unit. These recommendations also suggested that most women who could become pregnant should take supplements containing 5,000 micrograms of folic acid rather than the standard 400 micrograms. Colapinto began to raise questions. What if vulnerable women could not afford the supplements? What did the evidence show? Although the CHMS findings were still two years away from being published, she saw this as an opportunity to inform the recommendations.
A sometimes controversial field
She followed Dr. Tremblay, who is director of the Healthy Active Living and Obesity research group at the Children’s Hospital of Eastern Ontario, to uOttawa’s inter-disciplinary Population Health Program.
“I waded into a complex and sometimes controversial field,” says Colapinto. “There are many different aspects to folic acid: policies related to fortification and supplementation, biochemistry, epidemiology, maternal health and child health.”
Previous data on folic acid dated back to the 1971 Nutrition Canada National Survey, which was conducted before some grain products were fortified with folic acid. Moreover, the1971 data was restricted to serum folate levels, a measure of recent folate intake, whereas the CHMS included directly-measured red blood cell (RBC) folate status, a reflection of long-term folate levels in the Canadian population post-fortification.
Studies have shown that the prevalence of neural tube defects, such as spina bifida in newborns, has been cut in half since 1998, when folic acid fortification of white wheat flour and other grains was introduced in Canada.
“The CHMS was the first of its kind in terms of collecting directly measured bio-markers from Canadians. It includes a wealth of information on many different health topics,” says Colapinto. “I seized on that wealth of information. With the folic acid fortification and supplementation policies that were in place, I wanted to know the folate status of Canadians. Was it high? Was it low? What were the levels among women and the general population?”
The work became her PhD dissertation: Examining the Folate Status of Canadians: An Analysis of the CHMS to Assess and Guide Folic Acid Supplementation and Fortification Policies. It found that folate deficiency is virtually non-existent among Canadians and that around 40 per cent of Canadians have levels that tend to be high. However, although more than three-quarters of Canadian women of child-bearing age have blood-folate levels that lower the risk of neural tube defects, some 22 per cent of Canadian women are not at this optimal threshold, she says.
Colapinto’s dissertation was also the first to compare RBC folate concentrations in Canada and the U.S. on a national scale. To do this, she had to develop a conversion equation to account for the different methods each country uses in analyzing and measuring folates.
“Our study underscored the importance of harmonizing folate laboratory measures prior to between-country comparisons,” she says. “My dissertation provides an extensive evidence base, including an international comparison, which policy makers, researchers and clinicians can use to inform decisions regarding folic acid policy and guidelines.”
She adds: “There is a lot of good news. We need to think about what targeted strategies need to be in place and examine these findings further. I think we also need to look closer at the trend towards elevated folate levels. Do we need to look at what is going on with folic acid supplementation?”
The health implications of higher folic acid intake are being studied in great depth at the moment, with some studies suggesting higher intake may lead to colorectal cancer in people with pre-existing neoplasms, but other studies suggesting this is not the case, says Colapinto.
Thanks to a fellowship from the Canadian Institute for Health Research (CIHR), Colapinto was able to treat her doctoral dissertation as a full-time job. She completed her studies in less than five years, during which she and her husband had two children. Colapinto commends the CIHR for its “unique support of female health researchers” in the form of maternity leave policies that helped her to continue her dissertation while starting a family.
In August 2014, she was hired as a nutrition advisor at Health Canada’s Office of Nutrition Policy and Promotion to examine the evidence that underpins a whole range of dietary guidelines, including the Canada Food Guide and pre-natal nutrition guidelines.
“No policy is set in stone. These public health interventions must be monitored and examined. I am certainly not afraid to ask questions,” says Colapinto.
Colapinto says the experience and mentorship she received at uOttawa’s Population Health Program was invaluable. And she says it was “incredibly humbling” to be selected for two awards from the field of over 230 talented researchers who received PhDs in 2013.
“The work I was able to do combines epidemiology and statistics and biochemistry and population health. It has prepared me exceptionally well for the work I am doing in policy right now. I could be an academic who is conducting and conceptualizing research, or I could be a policy specialist who’s examining available research and identifying knowledge gaps. These types of programs really create opportunities and give you career choices,” says Colapinto.
She adds that the program also helped her build contacts and network with Statistics Canada, Health Canada, CHEO, Sick Kids and others.
“You don’t achieve these things by yourself as a student,” says Colapinto. “You can drive it as much as you want, but if nobody’s helping you steer, you are not going to get anywhere.”
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Cynthia Colapinto (right) on the job as a Health Canada nutrition advisor with Tracey Bushnik, a senior analyst at Statistics Canada’s Health Analysis Division.