Effects of folic acid on preschool children's appetite: randomized triple-blind clinical trial

Background: In recent years some Iranian pediatricians have used folic acid empirically as an appetite-enhancing drug in poor-appetite, low-weight children. Many parents have expressed their satisfaction with this treatment but until now no study has been done to confirm or exclude folic acid as an appetite enhancer. Methods: In order to determine if complementary folic acid has any effect on preschool children’s appetite, 61 3–5-year-old children (27 girls and 34 boys) whose weight/age and weight/height ratios were below the 25 centile and whose parents regarded them as having poor appetite were randomly assigned to receive either folic acid (1 mg/day) or placebo for 20 days. The primary outcome measures were any appetite changes during and 1 month after the end of the intervention, measured by means of a questionnaire completed by parents on the 20th and 60th days. Secondary measures were mean weight gain on the 30th and 60th days. Results: Children who received folic supplement had a significantly better appetite on the 20th day than those who received placebo (mean difference of appetite score: 1.7; 95% confidence interval: 0.1–3.4; P = 0.04) and significantly more children receiving folic acid were reported to have increased appetite than the placebo group (P = 0.03). But 40 days after the end of the intervention there was no difference between the two groups. Weight gain did not significantly differ between groups. Conclusions: Although folic acid appears to improve preschool children’s appetite, further study is necessary to determine whether it has any effect on growth as an adjunctive to management protocols of low appetite for undernourished children.