Fortification of Foods with Folic Acid

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Abstract
In his Sounding Board article (May 11 issue),1 Mills points out that some have called for an increase in the level of fortification of foods with folic acid,2 even though the effect of the current level of fortification of 140 μg of folic acid per 100 g of grain products is still unknown. Our data from Kaiser Permanente members showed an increase in median serum folate levels, from 12.6 ng per milliliter in 1994 to 18.7 ng per milliliter in 1998.3 It is of interest to know whether serum folate levels stabilized beginning in 1998 or whether they continued to rise. As Table 1 shows, the median serum folate level rose from 18.7 ng per milliliter in 1998 to more than 20.0 ng per milliliter in 1999 while the prevalence of folate deficiency (defined as a level of less than 2.7 ng per milliliter) declined. The median serum folate value could not be assessed in 1999, since it exceeded the maximal value (20.0 ng per milliliter) of the method used to measure serum folate in our laboratory (Advia Centaur immunoassay system, Bayer Diagnostics). The median serum folate value for women 18 to 45 years of age increased from 10.8 ng per milliliter in 1994 to 17.3 ng per milliliter in 1998 and to 19.0 ng per milliliter in 1999.