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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #165684
Title: FOLIC ACID INTAKE FROM FORTIFICATION IN UNITED STATES EXCEEDS PREDICTIONS

Author
item CHOUMENKOVITCH, SILVINA - TUFTS-HNRCA
item SELHUB, JACOB - TUFTS-HNRCA
item WILSON, PETER - FRAMINGHAMN HEART STUDY
item RADER, JEANNE - OFFICE OF FOOD LBLING,FDA
item ROSENBERG, IRWIN - TUFTS-HNRCA
item JACQUES, PAUL - TUFTS-HNRCA

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/2/2002
Publication Date: 9/1/2002
Citation: Choumenkovitch, S.F., Selhub, J., Wilson, P.W., Rader, J.I., Rosenberg, I.H., Jacques, P.F. 2002. Folic acid intake from fortification in united states exceeds predictions. Journal of Nutrition. 132(9):2792-8.

Interpretive Summary: Folic acid taken during the periconceptional period decreases the risk of pregnancies affected by neural tube defects (NTD). Thus, in 1992, the U.S. Public Health Service issued a recommendation that all women of childbearing age capable of becoming pregnant consume 400 micrograms of folic acid each day. However, as the level of compliance with this recommendation was low, fortification of the food supply with folic acid was considered to be the most effective approach to help women of childbearing age to increase periconceptional folic acid intake. Consequently, the U.S. Food and Drug Administration (FDA) issued a rule effective January 1998, that required all enriched cereal-grain products (flour, rice, breads, rolls and buns, pasta, corn grits, corn meal, farina, macaroni and noodle products) to be fortified with folic acid. The amount of folic acid added to different products was selected based on a target level of 140 micrograms folic acid/100 grams of cereal grain product. The projected average increase of folic acid intake in the general population due to fortification of enriched cereal grain products was estimated to be approximately 100 micrograms/day. The purpose of the current study was to estimate the impact of the FDA mandated folic acid fortification on folic acid and total folate intake. We used data on food and nutrient intake from the Framingham Offspring Study and published data on total folate measured in enriched cereal-grain products after implementation of fortification to correct the folate values for these foods. By these estimations, folic acid fortification resulted in a mean increase in folic acid intake of 190 micrograms/day, which was approximately twice as large as previously projected.

Technical Abstract: In 1996, the U.S. Food and Drug Administration issued a regulation requiring that by January 1998, all enriched cereal grain products be fortified with folic acid. An average increase in folic acid intake of 100 microgram/d was projected as a result of this fortification. The objective of the present study was to estimate the impact of this fortification on the intake of folic acid and total folate, and on the prevalence of individuals with inadequate folate intake and with high folic acid intake. We used data on food and nutrient intake from 1,480 individuals who participated in the 5th and 6th examination of the Framingham Offspring Cohort Study. Fortification was instituted during the 6th examination so that 931 participants were examined before its implementation (nonexposed) and 549 after implementation (exposed). Published data on total folate in enriched cereal-grain products were used to correct folate content in these foods to reflect fortification. Among non-supplement users, folic acid intake increased by a mean of 190 (95% CI: 176, 204) microgram/d (P<0.001) and total folate intake increased by a mean of 323 (95% CI: 296-350) microgram of DFE/d (P<0.001) in the exposed participants. Prevalence of exposed individuals with total folate intake below the Estimated Average Requirement (320 microgram of DFE/d) decreased from 48.9% (95% CI: 44.2-53.1%) before fortification to 7.0% (95% CI: 3.1-10.9%) after fortification in individuals who did not use folic acid supplements. By these estimations, folic acid fortification resulted in a mean increase in folic acid intake that was approximately twice as large as previously projected.