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However, far more significant medical cost savings result from preventing common diseases, including myocardial infarction, stroke, dementia and osteoporosis. A cost\u2010effectiveness analysis showed a gain of 266\u00a0649 quality\u2010adjusted life\u2010years and $3.6 billion saved annually, mainly due to the reduction of cardiac infarction. The recommended folate intake in Japan is 240\u00a0\u03bcg\/day whereas it is 400\u00a0\u03bcg\/day internationally. Our Sakado Folate Project targeted individuals with genetic polymorphism of methylenetetrahydrofolate reductase or with hyperhomocysteinemia. Using, for example, folate\u2010fortified rice, resulted in an increase in serum folate and a decrease in serum homocysteine in the participants, and reduced medical costs were achieved by decreasing myocardial infarction, stroke, dementia and fracture. Due to the small population of Sakado City (approximately 101\u00a0000) and small number of births (693) in 2015, a decrease in spina bifida could not be confirmed but there was a significant decrease in the number of very low birthweight infants. The genome notification of subjects was effective in motivating intake of folate, but the increase in serum folate (from 17.4 to 22.5\u00a0nmol\/L, 129%) was less than that observed following compulsory folic acid fortification of cereals in the USA (from 12.1 to 30.2\u00a0nmol\/L, 149.6%). Mandatory folic acid fortification is cheap in decreasing medical costs and is thus recommended in Japan.<\/jats:p>","DOI":"10.1111\/cga.12215","type":"journal-article","created":{"date-parts":[[2017,2,10]],"date-time":"2017-02-10T01:36:42Z","timestamp":1486690602000},"page":"157-165","source":"Crossref","is-referenced-by-count":16,"title":["Medical cost savings in Sakado City and worldwide achieved by preventing disease by folic acid fortification"],"prefix":"10.1111","volume":"57","author":[{"given":"Yasuo","family":"Kagawa","sequence":"first","affiliation":[{"name":"Department of Medical Chemistry Kagawa Nutrition University  Sakado City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mami","family":"Hiraoka","sequence":"additional","affiliation":[{"name":"Shukutoku University College of Nursing and Nutrition, School of Nutrition  Chiba City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuyo","family":"Kageyama","sequence":"additional","affiliation":[{"name":"Yamanashi Gakuin University Faculty of Health and Nutrition  Kofu City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiko","family":"Kontai","sequence":"additional","affiliation":[{"name":"University of Niigata Prefecture Faculty of Human Life Studies Department of Health and Nutrition  Niigata City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayumi","family":"Yurimoto","sequence":"additional","affiliation":[{"name":"Yakult Honsha Co., Ltd.  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