Fortification with low amounts of folic acid makes a significant difference in folate status in young women: implications for the prevention of neural tube defects

Open Access
Publisher Website
Google Scholar
Abstract
Background: Mandatory fortification of grain products with folic acid was introduced recently in the United States, a policy expected to result in a mean additional intake of 100 μg/d. One way of predicting the effectiveness of this measure is to determine the effect of removing a similar amount of folic acid as fortified food from the diets of young women who had been electively exposed to chronic fortification. Objective: The objective was to examine the effect on folate status of foods fortified with low amounts of folic acid. Design: We investigated the changes in dietary intakes and in red blood cell and serum concentrations of folate in response to removing folic acid–fortified foods for 12 wk from the diets of women who reportedly consumed such foods at least once weekly (consumers). Results: Consumers (n = 21) had higher total folate intakes (P = 0.002) and red blood cell folate concentrations (P = 0.023) than nonconsumers (women who consumed folic acid–fortified foods less than once weekly; n = 30). Of greater interest, a 12-wk intervention involving the exclusion of these foods resulted in a decrease in folate intake of 78 ± 56 μg/d (P < 0.001), which was reflected in a significant reduction in red blood cell folate concentrations (P < 0.05). Conclusions: Cessation of eating folic acid–fortified foods resulted in removing 78 μg folic acid/d from the diet. Over 12 wk this resulted in a lowering of red blood cell folate concentrations by 111 nmol/L (49 μg/L). This magnitude of change in folate status in women can be anticipated as a result of the new US fortification legislation and is predicted to have a significant, although not optimal, effect in preventing neural tube defects.