Availability of Corn Masa Flour and Tortillas Fortified With Folic Acid in Atlanta After National Regulations Allowing Voluntary Fortification

ABSTRACT Background In Mexico, wheat and corn flour fortification with folic acid (FA) was implemented in 2001 and mandated in 2008, but without direct enforcement. Current Mexican nutrient-content tables do not account for FA contained in bakery bread and corn masa–based foods, which are dietary staples in Mexico. Objective The objective of this study was to examine the impact of FA fortification of dietary staples on the proportion of the population consuming below the Estimated Average Requirement (EAR) for folate or above the Tolerable Upper Intake Level (UL) for FA. Methods We measured FA and folate content in dietary staples (bakery bread and tortillas) using microbial assays and MS, and we recalculated FA intake from 24-h recall dietary intake data collected in the 2012 Mexican National Health and Nutrition Survey (Encuesta Nacional de Salud y Nutrición) utilizing estimates from our food measurements, using nutrient concentrations from tortillas to approximate nutrient content of other corn masa–derived foods. The revised FA intake estimates were used to examine population-level intake of FA and dietary folate equivalent (DFE) accounting for geographic differences in FA content with statistical models. Results FA content in dietary staples was variable, whereas use of FA-fortified flour in corn masa tortillas increased with population size in place of residence. Accounting for dietary staples’ FA fortification increased population estimates for FA and DFE intake, resulting in a lower proportion with intake below the EAR and a higher proportion with intake above the UL. Despite accounting for FA-fortified staple foods, 9–33% of women of childbearing age still have intake below the EAR, whereas up to 12% of younger children have intake above the UL. Conclusions Unregulated FA fortification of dietary staples leads to unpredictable total folate intake without adequately impacting the intended target. Our findings suggest that monitoring, evaluation, and enforcement of mandatory fortification policies are needed. Without these, alternate strategies may be needed in order to reach women of childbearing age while avoiding overexposing children.

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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)

Current Developments in Nutrition ◽

10.1093/cdn/nzab046_124 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 827-827

Author(s):

Arick Wang ◽

Charles Rose ◽

Yan Ping Qi ◽

Jennifer Williams ◽

Christine Pfeiffer ◽

...

Keyword(s):

Folic Acid ◽

The United States ◽

Reproductive Age ◽

Fortified Foods ◽

Folic Acid Fortification ◽

Folate Status ◽

Funding Sources ◽

Cereal Grain ◽

The Us ◽

Corn Masa

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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Stability of Native Folate and Added Folic Acid in Micronutrient-Fortified Corn Masa and Tortillas

Cereal Chemistry ◽

10.1094/cchem-12-09-0164 ◽

2010 ◽

Vol 87 (5) ◽

pp. 434-438 ◽

Cited By ~ 8

Author(s):

J. S. Chapman ◽

F. M. Steele ◽

D. L. Eggett ◽

N. P. Johnston ◽

M. L. Dunn

Keyword(s):

Folic Acid ◽

Corn Masa

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