1. LETTERS TO THE EDITORS
...............................................................................................................................................
not have as much of aneed for identifica-
tion symbols at work. However, whose in
practice less than 5 years felt that this
was an important part of dress. Individu-
als in health care agencies and higher
education tended Lobe more favorable to
power/authority symbols in dress than
those in consulting and industry areas.
Respondents in higher education tended
to be positive in terms of dress code/
policies for dress in health care than
those in health care agencies, consult-
ing, industry and those unemployed.
In summary, dietitians who have been
in practice over 20 years tended to be
more positive in their views of formal
attire for work. Likewise, those 60 years
of age or older tended to be more positive
toward formal attire. Those dietitians in
the midrange of age and years of practice
01 to 20) were more negative toward
formal attire than those younger with
fewer years in practice. These individu-
als embraced casual dress more than
those older individuals who entered the
profession when more formal attire was
expected or the younger individuals who
are still trying to become secure or striv-
ing to enter the career. Casual dress for
health care professionals has an addi-
tional element not present in other busi-
ness occupations, that of perception of
safety and competence with clients'
physical well-being. This appears to be
recognized by dietitians. The groups in
the study that tended not to favor formal
attire were Lhose in the midrange of age
and career and those employed in higher
education. This seems to suggest that
dietitians who have direct daily contact
with clients recognize and/or accept the
importanc of projecting an image
through their dress of competence and
safety in their knowledge and practice.
DNISPILLMAN, PhD, RD
Department of physical education,
health and sports studies, school of
education and allied professions,
Miami University, Oxford, OH
References
1. BarrettTG,BoothIW.Sartorialeloquence: Does
it exist in the pediatrician-patient relationship?
British Medical Journal International. 1994;
309(6970) 1710-1712.
2. Lehna C, Phoutz S, Peterson TG, Degner K,
Grubaugh K,LorenzL,MastropietroS, Rogers LS,
Schoettle B,Seck LL.Nursingattire: Indicatorsof
professionalism. Journal of Professional NurSing.
1999;15(3):192-199.
346/ March 2002 Volume 102 Number 3
Folie acid fortification: Additional
issues
To the Editors:
As we read the article "Folic acid fortifi-
cation: Informed mothers, healthy ba-
bies" (1) we were impressed with the
facts presented concerning cereal forti-
fication. We agree that food manufactur-
ers ought to be regulated more strictly in
their folic acid fortification and that di-
eLitians should be a leading force in this
effort. We would like to add some addi-
tional information about possible con-
tributing factors to neural tube defects
(NTDs).
First, we wish to comment on the list
of good sources of folate given in the
article. We agree that the listed foods are
good sources of folate, but they may not
be the most practical source for the gen-
eral public, given the eating habits of
typical Americans. Young American
women typically consume only 2 of the
folate-rich foods listed-cold cereal and
orange juice. Per mandates of the Food
and Drug Administration, folic acid forti-
fication has been required in grains since
January 1998 (2) so other important
folate sources include white bread, rolls,
and crackers. Also, these foods are forti-
fied with synthetic folic acid, which is
absorbed much better than food folate is
(3).
Second, genetic defects that produce
altered forms of enzymes like cystathione
~-synthase, methionine synthase, and
especially 5,1 G-methylenetetrahydro-
folate reductase can lead to elevated
levels of total homocysteine (an amino
acid and by-product of methionine me-
tabolism). Elevated homocysteine is in-
dicative of inadequate folate intake or
abnormal folate metabolism (4), and
women withhyperhomocysteinemiamay
have an increased need for dietary or
supplemental folate/folic acid.
Third, Lhe popularity of low-carbohy-
drate diets may play an indirect role in
folic acid consumption and NTDs. If
women following popular fad diets are
avoiding high-carbohydrate foods, they
may, in fact, be avoiding folic acid unwit-
tingly. Also, we must look at that seg-
ment of the population that tends to diet:
women aged 15-35 years; this age group
of dieters happens to overlap with the
prime childbearing age. Because NTDs
arise within the first month of preg-
nancy-often before women recognize
they are pregnant-a low-carbohydrate
diet may deny women the fortified grain
foods they need and will not help to
reduce NTDs.
We appreciaLe this opportunity to ex-
press our interest in this pressing issue.
As future dietitians, we look forward to
the Journal as a leading source of knowl-
edge and we look forward to any further
coverage concerning NTDs.
STEPHANIE MOYA
GENIE MclVER
JENNIFER SEITER
DIANE BAILEY
Of the maternal and child nutrition
class, Arizona State University East
References
1. McCaffreeJ. Folicacid fortification:informed
mothers, healthy babies. J Am Diet Assoc.
2001;101:872.
2. Foodand DrugAdministration.FoodStandards.
Federal Register. 1996;61:8781-8797.
3. BaileyLB.New standard for dietary folate in-
take in pregnant women. Am J Clin Nutr.
2000;71(suppl):1304S-1307S.
4. SchollTO, Johnson WG.Folicacid: influence
on the outcome of pregnancy. Am J Clin Nutr.
2000;71(suppl):1295S-1303S.
ERRATUM
The references to Dr Barbara Dennison's
letter to the editor in the November 2001
Journal (pg. 1312) were inadvertently
omitLed. They are:
1. DennisonBA,ErbTA,Jenkins PL.Predictors of
dietarymilk-fatintakeby preschool children. Prev
Med 2001 (inpress)
2. What a surprise' MilkSpreading Across the
Lips of Celebrities [press release]. New York:
NationalFluidMilkProcessor EducationProgram;
January 11, 1995.
The Journal regrets the error.
LETTERS TO THE EDITORS ARE WELCOME
Letters may have a maximum of 500
words; references should be kept to five
or fewer. Relevant charts or graphs are
acceptable. Letters should be typed
double-spaced with wide margins. Sub-
mission of a letter constitutes permission
for the American Dietetic Association to
use it in the Journal, subject to editing
and abridgment. Financial associations
or other possible cont1icts of interest
should always be disclosed. Letters relat-
ing to articles published in recent Jour-
nal issues have priority. Send four copies
to: The Editor, Elaine R. Monsen, PhD,
RD, Journal of the American Dietetic
Association, University of Washington,
BOX 353410 Seattle, WA 98195-3410.
Letters may also be submitted via e-mail
to:ltejada@u.washington.edu.
![LETTERS TO THE EDITORS
...............................................................................................................................................
not have as much of aneed for identifica-
tion symbols at work. However, whose in
practice less than 5 years felt that this
was an important part of dress. Individu-
als in health care agencies and higher
education tended Lobe more favorable to
power/authority symbols in dress than
those in consulting and industry areas.
Respondents in higher education tended
to be positive in terms of dress code/
policies for dress in health care than
those in health care agencies, consult-
ing, industry and those unemployed.
In summary, dietitians who have been
in practice over 20 years tended to be
more positive in their views of formal
attire for work. Likewise, those 60 years
of age or older tended to be more positive
toward formal attire. Those dietitians in
the midrange of age and years of practice
01 to 20) were more negative toward
formal attire than those younger with
fewer years in practice. These individu-
als embraced casual dress more than
those older individuals who entered the
profession when more formal attire was
expected or the younger individuals who
are still trying to become secure or striv-
ing to enter the career. Casual dress for
health care professionals has an addi-
tional element not present in other busi-
ness occupations, that of perception of
safety and competence with clients'
physical well-being. This appears to be
recognized by dietitians. The groups in
the study that tended not to favor formal
attire were Lhose in the midrange of age
and career and those employed in higher
education. This seems to suggest that
dietitians who have direct daily contact
with clients recognize and/or accept the
importanc of projecting an image
through their dress of competence and
safety in their knowledge and practice.
DNISPILLMAN, PhD, RD
Department of physical education,
health and sports studies, school of
education and allied professions,
Miami University, Oxford, OH
References
1. BarrettTG,BoothIW.Sartorialeloquence: Does
it exist in the pediatrician-patient relationship?
British Medical Journal International. 1994;
309(6970) 1710-1712.
2. Lehna C, Phoutz S, Peterson TG, Degner K,
Grubaugh K,LorenzL,MastropietroS, Rogers LS,
Schoettle B,Seck LL.Nursingattire: Indicatorsof
professionalism. Journal of Professional NurSing.
1999;15(3):192-199.
346/ March 2002 Volume 102 Number 3
Folie acid fortification: Additional
issues
To the Editors:
As we read the article "Folic acid fortifi-
cation: Informed mothers, healthy ba-
bies" (1) we were impressed with the
facts presented concerning cereal forti-
fication. We agree that food manufactur-
ers ought to be regulated more strictly in
their folic acid fortification and that di-
eLitians should be a leading force in this
effort. We would like to add some addi-
tional information about possible con-
tributing factors to neural tube defects
(NTDs).
First, we wish to comment on the list
of good sources of folate given in the
article. We agree that the listed foods are
good sources of folate, but they may not
be the most practical source for the gen-
eral public, given the eating habits of
typical Americans. Young American
women typically consume only 2 of the
folate-rich foods listed-cold cereal and
orange juice. Per mandates of the Food
and Drug Administration, folic acid forti-
fication has been required in grains since
January 1998 (2) so other important
folate sources include white bread, rolls,
and crackers. Also, these foods are forti-
fied with synthetic folic acid, which is
absorbed much better than food folate is
(3).
Second, genetic defects that produce
altered forms of enzymes like cystathione
~-synthase, methionine synthase, and
especially 5,1 G-methylenetetrahydro-
folate reductase can lead to elevated
levels of total homocysteine (an amino
acid and by-product of methionine me-
tabolism). Elevated homocysteine is in-
dicative of inadequate folate intake or
abnormal folate metabolism (4), and
women withhyperhomocysteinemiamay
have an increased need for dietary or
supplemental folate/folic acid.
Third, Lhe popularity of low-carbohy-
drate diets may play an indirect role in
folic acid consumption and NTDs. If
women following popular fad diets are
avoiding high-carbohydrate foods, they
may, in fact, be avoiding folic acid unwit-
tingly. Also, we must look at that seg-
ment of the population that tends to diet:
women aged 15-35 years; this age group
of dieters happens to overlap with the
prime childbearing age. Because NTDs
arise within the first month of preg-
nancy-often before women recognize
they are pregnant-a low-carbohydrate
diet may deny women the fortified grain
foods they need and will not help to
reduce NTDs.
We appreciaLe this opportunity to ex-
press our interest in this pressing issue.
As future dietitians, we look forward to
the Journal as a leading source of knowl-
edge and we look forward to any further
coverage concerning NTDs.
STEPHANIE MOYA
GENIE MclVER
JENNIFER SEITER
DIANE BAILEY
Of the maternal and child nutrition
class, Arizona State University East
References
1. McCaffreeJ. Folicacid fortification:informed
mothers, healthy babies. J Am Diet Assoc.
2001;101:872.
2. Foodand DrugAdministration.FoodStandards.
Federal Register. 1996;61:8781-8797.
3. BaileyLB.New standard for dietary folate in-
take in pregnant women. Am J Clin Nutr.
2000;71(suppl):1304S-1307S.
4. SchollTO, Johnson WG.Folicacid: influence
on the outcome of pregnancy. Am J Clin Nutr.
2000;71(suppl):1295S-1303S.
ERRATUM
The references to Dr Barbara Dennison's
letter to the editor in the November 2001
Journal (pg. 1312) were inadvertently
omitLed. They are:
1. DennisonBA,ErbTA,Jenkins PL.Predictors of
dietarymilk-fatintakeby preschool children. Prev
Med 2001 (inpress)
2. What a surprise' MilkSpreading Across the
Lips of Celebrities [press release]. New York:
NationalFluidMilkProcessor EducationProgram;
January 11, 1995.
The Journal regrets the error.
LETTERS TO THE EDITORS ARE WELCOME
Letters may have a maximum of 500
words; references should be kept to five
or fewer. Relevant charts or graphs are
acceptable. Letters should be typed
double-spaced with wide margins. Sub-
mission of a letter constitutes permission
for the American Dietetic Association to
use it in the Journal, subject to editing
and abridgment. Financial associations
or other possible cont1icts of interest
should always be disclosed. Letters relat-
ing to articles published in recent Jour-
nal issues have priority. Send four copies
to: The Editor, Elaine R. Monsen, PhD,
RD, Journal of the American Dietetic
Association, University of Washington,
BOX 353410 Seattle, WA 98195-3410.
Letters may also be submitted via e-mail
to:ltejada@u.washington.edu.](https://image.slidesharecdn.com/d9df5e53-7c02-492e-a388-9f3b838226b5-160317095709/85/J-Am-Diet-Assoc-Folic-acid-Students-letter-1-320.jpg)
