Forty years after the discovery of vitamin B_(12), there is still much work left to be done. This connects also with Dr. Troen's remarks on folic acid. The powerful effects of the randomized controlled trial that led to the decision in some countries to fortify flour with folic acid in order to prevent neural tube defects present additional challenges for interpretation. The message of those trials was not just that there needs to be better folic acid status in the preconceptional period in order to limit, even if not to altogether prevent, the incidence of neural tube defects. Another message of those trials is that we need to be much more concerned about the entire nutritional status of women in the periconcep-tional period. This isn't just about folic acid, nor is it even just about those other micronutrients which may be involved in prevention of neural tube defects.
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