With an official notification (2017, No. 8) issued on 20 October 2017 by the National Health and Family Planning Commission of the PRC (former Ministry of Health of the People’s Republic of China), Quatrefolic has been publicly authorised as a Food Nutritional Fortification Substance with a specific monograph that describes its quality (physical, chemical and microbiological) requirements
After the first positive assessment made by the China National Center for Food Safety Risk assessment (CFSA) in 2016, the use of Quatrefolic as a Food Nutritional Fortification Substance now enters into force in China.
The published monograph defines dosage and intended use of Quatrefolic, the 5-MTHF glucosamine salt, as a new active ingredient, introducing this innovative folate instead of the already known folic acid.
Quatrefolic is a metabolically active folate, which is not affected by the common impairments of folate metabolism, because it does not require the complex absorption, metabolic and enzymatic steps that are required by folic acid.
Contrary to folic acid, Quatrefolic — the metabolically active form of folate — is not influenced by the polymorphism of the MTHFR (methyltetrahydrofolate reductase) enzyme, a genetic defect with a high incidence in the Chinese population.
In the Chinese population folic acid is often not effectively converted to the biologically active form 5-MTHF (methylfolate) due to the reduced enzymatic activity.
Therefore, the beneficial effect of folic acid supplementation is not guaranteed in the folate deficiency related status of Chinese people.1
In the recent years, a wide number of clinical studies have investigated the incidence of this polymorphism in China. Of particular relevance, was a recent meta-analysis published in 2016 by Wang et al. where sixty-six studies were identified with a total of 92277 study participants, in 23 provinces in Mainland China.2
The meta-analysis revealed that the frequencies of the MTHFR C677T allele and the 677TT genotype increased from lower values (5% and 17%, respectively) in Guangxi, to intermediate values (12% and 32%, respectively) in Anhui, to higher values (39% and 62%, respectively) in Shandong.
The frequency of the 1298C allele was found to be the lowest in northern China 18%, intermediate in central China 18% and highest in southern China 28%. The mean frequency of the 1298C allele was 20%.