Twenty Years After Folic Acid Fortification, FDA Ponders Expansion to Corn Masa Flour

Abstract Objectives Surveillance data have highlighted continued disparities in neural tube defects (NTDs) among infants of Hispanic women of reproductive age (HWRA) in the United States. Starting in 2017, the US Food and Drug Administration implemented voluntary folic acid fortification of corn masa flour to reduce the risk of NTDs. We assessed folate status, using red blood cell (RBC) folate concentrations, in HWRA (aged 12–49 y) before (2011–2016) and after (2017–2018) voluntary fortification of corn masa, stratified by acculturation factors (i.e., primary language spoken at home, length of time residing in the US). Methods Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2011–2018 with available RBC folate concentrations for HWRA were analyzed. Additional analyses were conducted among HWRA whose only folic acid source was fortified foods (enriched cereal grain products (ECGP) only), including usual intake and NTD prevalence estimations based on previously published models. Results Overall, RBC folate concentrations (adjusted geometric means) among HWRA remained similar from 2011–2016 to 2017–2018, though RBC folate significantly increased in 2017–2018 among lesser acculturated HWRA consuming ECGP only. Concentrations for those who were born outside the US and resided in the US < 15 y increased from 894 nmol/L (95% CI: 844–946) in 2011–2016 to 1018 nmol/L (95% CI: 982–1162; p < 0.001) in 2017–2018. Primarily Spanish speaking HWRA who consumed ECGP only increased from 941 nmol/L (95% CI: 895–990) in 2011–2016 to 1034 nmol/L (95% CI: 966–1107; p = 0.03) in 2017–2018. We observed no significant changes in the proportion at risk of NTD (<748 nmol/L) and no changes in Bayesian model-based estimated NTD rates. Conclusions This early analysis following voluntary corn masa fortification found an increase in RBC folate concentrations in lesser acculturated groups relying on fortified foods as their primary folic acid source, though HWRA overall had no significant increase in folate concentrations. These early data suggests that there is remaining risk among Hispanics for folate sensitive NTDs; continued monitoring of folate status with NHANES will help assess the long-term efficacy of voluntary fortification. Funding Sources No funding sources outside of salaries.

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FDA approves folic acid fortification of corn masa flour

Case Medical Research ◽

10.31525/cmr-29dcae8 ◽

2016 ◽

Author(s):

Keyword(s):

Folic Acid ◽

Folic Acid Fortification ◽

Corn Masa

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Impact of Voluntary Folic Acid Fortification of Corn Masa Flour on RBC Folate Concentrations in the U.S. (NHANES 2011–2018)

Nutrients ◽

10.3390/nu13041325 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1325

Author(s):

Arick Wang ◽

Charles E. Rose ◽

Yan Ping Qi ◽

Jennifer L. Williams ◽

Christine M. Pfeiffer ◽

...

Keyword(s):

Folic Acid ◽

Neural Tube ◽

Neural Tube Defects ◽

Hispanic Women ◽

Reproductive Age ◽

Women Of Reproductive Age ◽

Folic Acid Fortification ◽

Folate Concentration ◽

Corn Masa ◽

The U.S

Surveillance data have highlighted continued disparities in neural tube defects (NTDs) by race-ethnicity in the United States. Starting in 2016, the Food and Drug Administration (FDA) authorized voluntary folic acid fortification of corn masa flour to reduce the risk of neural tube defects (NTDs) among infants of Hispanic women of reproductive age. To assess the impact of voluntary corn masa fortification, cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2011–2018 for Hispanic women of reproductive age with available red blood cell (RBC) folate concentrations were analyzed, with additional analyses conducted among Hispanic women whose sole source of folic acid intake was fortified foods (enriched cereal grain products (ECGP) only), excluding ready-to-eat cereals and supplements. RBC folate concentration (adjusted geometric mean) among Hispanic women of reproductive age did not differ between 2011–2016 and 2017–2018, though RBC folate concentration increased significantly among lesser acculturated Hispanic women consuming ECGP only. Concentrations of RBC folate for those born outside the U.S and residing in the U.S <15 years increased from 894 nmol/L (95% CI: 844–946) in 2011–2016 to 1018 nmol/L (95% CI: 982–1162; p < 0.001) in 2017–2018. Primarily Spanish-speaking Hispanic women of reproductive age who only consumed ECGP saw an increase from 941 nmol/L (95% CI: 895–990) in 2011–2016 to 1034 nmol/L (95% CI: 966–1107; p = 0.03) in 2017–2018. By subpopulation, we observed no significant changes in the proportion at risk of NTDs (<748 nmol/L) and no changes in the model-based estimated NTD rates following voluntary corn masa fortification. This analysis suggests that there is a remaining risk among Hispanics for folate sensitive NTDs, though continued monitoring of folate status in future NHANES data cycles will help inform the long-term efficacy of voluntary fortification of corn masa flour.

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A Public Health Success Story: Folic Acid Fortification and Supplementation for Prevention of Neural Tube Defects

PsycEXTRA Dataset ◽

10.1037/e509012013-064 ◽

2004 ◽

Author(s):

Linda Longerich ◽

Roy West ◽

Ed Randell ◽

Marian Crowley ◽

Shiliang Liu ◽

...

Keyword(s):

Public Health ◽

Folic Acid ◽

Neural Tube ◽

Neural Tube Defects ◽

Success Story ◽

Folic Acid Fortification

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Faculty Opinions recommendation of Reduction in neural-tube defects after folic acid fortification in Canada.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1088590.545119 ◽

2007 ◽

Author(s):

Asok Antony

Keyword(s):

Folic Acid ◽

Neural Tube ◽

Neural Tube Defects ◽

Folic Acid Fortification

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Folate Nutritional Status among Psoriasis Patients not Exposed to Antifolate Drug

Current Nutrition & Food Science ◽

10.2174/1573401314666180702100301 ◽

2020 ◽

Vol 16 (4) ◽

pp. 543-553

Author(s):

Luciana Y. Tomita ◽

Andréia C. da Costa ◽

Solange Andreoni ◽

Luiza K.M. Oyafuso ◽

Vânia D’Almeida ◽

...

Keyword(s):

Folic Acid ◽

Linear Regression ◽

Multiple Linear Regression Model ◽

Folate Intake ◽

Serum Folate ◽

Linear Regression Models ◽

Cross Sectional ◽

Folic Acid Fortification ◽

Plasma Folate ◽

Psoriasis Severity

Background: Folic acid fortification program has been established to prevent tube defects. However, concern has been raised among patients using anti-folate drug, i.e. psoriatic patients, a common, chronic, autoimmune inflammatory skin disease associated with obesity and smoking. Objective: To investigate dietary and circulating folate, vitamin B12 (B12) and homocysteine (hcy) in psoriatic subjects exposed to the national mandatory folic acid fortification program. Methods: Cross-sectional study using the Food Frequency Questionnaire, plasma folate, B12, hcy and psoriasis severity using the Psoriasis Area and Severity Index score. Median, interquartile ranges (IQRs) and linear regression models were conducted to investigate factors associated with plasma folate, B12 and hcy. Results: 82 (73%) mild psoriasis, 18 (16%) moderate and 12 (11%) severe psoriasis. 58% female, 61% non-white, 31% former smokers, and 20% current smokers. Median (IQRs) were 51 (40, 60) years. Only 32% reached the Estimated Average Requirement of folate intake. Folate and B12 deficiencies were observed in 9% and 6% of the blood sample respectively, but hyperhomocysteinaemia in 21%. Severity of psoriasis was negatively correlated with folate and B12 concentrations. In a multiple linear regression model, folate intake contributed positively to 14% of serum folate, and negative predictors were psoriasis severity, smoking habits and saturated fatty acid explaining 29% of circulating folate. Conclusion: Only one third reached dietary intake of folate, but deficiencies of folate and B12 were low. Psoriasis severity was negatively correlated with circulating folate and B12. Stopping smoking and a folate rich diet may be important targets for managing psoriasis.

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