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

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.

scholarly journals Folate status in the US population 20 y after the introduction of folic acid fortification

2019 ◽  
Vol 110 (5) ◽  
pp. 1088-1097 ◽  
Author(s):  
Christine M Pfeiffer ◽  
Maya R Sternberg ◽  
Mindy Zhang ◽  
Zia Fazili ◽  
Renee J Storandt ◽  
...  
Keyword(s):  
Folic Acid ◽  
White Women ◽  
Geometric Mean ◽  
Age Groups ◽  
The United States ◽  
Reproductive Age ◽  
Serum Folate ◽  
Folate Status ◽  
Cereal Grain ◽  
The Us

ABSTRACT Background Enriched cereal-grain products have been fortified in the United States for >20 y to improve folate status in women of reproductive age and reduce the risk of folic acid–responsive neural tube birth defects (NTDs). Objectives Our objectives were to assess postfortification changes in folate status in the overall US population and in women aged 12–49 y and to characterize recent folate status by demographic group and use of folic acid–containing supplements. Methods We examined cross-sectional serum and RBC folate data from the NHANES 1999–2016. Results Serum folate geometric means increased from 2007–2010 to 2011–2016 in persons aged ≥1 y (38.7 compared with 40.6 nmol/L) and in women (35.3 compared with 37.0 nmol/L), whereas RBC folate showed no significant change. Younger age groups, men, and Hispanic persons showed increased serum and RBC folate concentrations, whereas non-Hispanic black persons and supplement nonusers showed increased serum folate concentrations. The folate insufficiency prevalence (RBC folate <748 nmol/L; NTD risk) in women decreased from 2007–2010 (23.2%) to 2011–2016 (18.6%) overall and in some subgroups (e.g., women aged 20–39 y, Hispanic and non-Hispanic black women, and supplement nonusers). After covariate adjustment, RBC folate was significantly lower in all age groups (by ∼10–20%) compared with persons aged ≥60 y and in Hispanic (by 8.2%), non-Hispanic Asian (by 12.1%), and non-Hispanic black (by 20.5%) compared with non-Hispanic white women (2011–2016). The 90th percentile for serum (∼70 nmol/L) and RBC (∼1800 nmol/L) folate in supplement nonusers aged ≥60 y was similar to the geometric mean in users (2011–2014). Conclusions Blood folate concentrations in the US population overall and in women have not decreased recently, and folate insufficiency rates are ∼20%. Continued monitoring of all age groups is advisable given the high folate status particularly in older supplement users.

scholarly journals Folate and Synthetic Folic Acid Content in Canadian Fortified Foods 20 Years Post Mandatory Fortification (P24-029-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Siya Khanna ◽  
Susanne Aufreiter ◽  
Deborah O'Connor
Keyword(s):  
Folic Acid ◽  
Preliminary Data ◽  
Acid Content ◽  
Fortified Foods ◽  
Folic Acid Fortification ◽  
Engineering Research ◽  
Funding Sources ◽  
White Flour ◽  
Grain Products ◽  
Health Canada

Abstract Objectives In 1998, Health Canada mandated folic acid fortification of white flour and enriched grain products to reduce the prevalence of neural tube defects. In 2009, we reported that the analyzed folate content of 95 of the mostly commonly purchased folic acid fortified foods in Canada was on average 151 ± 16% of that reported in the Canadian Nutrient File (CNF). The aim of this study was to assess whether 20 years after mandatory fortification, the CNF values for folate and folic acid accurately reflect amounts determined by direct assessment. Methods Using the 2007 ACNielsen Company data 15 of the most commonly purchased folic acid-fortified foods from each of the following categories were selected: “breads”, “rolls and buns”, “cookies” and “crackers”. Folate concentrations in foods were determined using the tri-enzyme digestion method followed by a microbiological assay. Synthetic folic acid concentrations were determined using stable-isotope liquid chromatography-mass spectrometry. Analyzed values were compared to the 2015 Canadian Nutrient File; unbranded foods. Results Our preliminary data show the total folate content analyzed in foods (n = 24 to date) was significantly higher than the CNF values across all categories (P < 0.01) and on average, 187% ± 15 of the CNF values. Similarly, the synthetic folic acid content in foods was significantly higher than CNF values for “rolls and buns” and “cookies” (P < 0.05, P < 0.01 respectively) and on average 163% ± 25 of the CNF values. Conclusions These preliminary data suggest, 20 years after mandatory fortification of the food supply, CNF values which include unbranded foods do not accurately represent the amounts of total folate and synthetic folic acid in foods. Hence dietary estimates established using the CNF many significantly underestimate actual intakes due to continued overages in folic acid fortification. Funding Sources Natural Sciences and Engineering Research Council of Canada.

scholarly journals Folic Acid Fortification and Neural Tube Defect Risk: Analysis of the Food Fortification Initiative Dataset

Nutrients ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 247 ◽  
Author(s):  
Michaela E. Murphy ◽  
Cara J. Westmark
Keyword(s):  
Folic Acid ◽  
Neural Tube ◽  
National Level ◽  
Population Level ◽  
The United States ◽  
Cereal Grains ◽  
Food Fortification ◽  
Folic Acid Fortification ◽  
Vitamin B9 ◽  
Cereal Grain

The United States implemented mandatory fortification of cereal grains with folic acid in 1998 to prevent neural tube defects (NTDs) during pregnancy. The health benefits of folate (vitamin B9) are well documented; however, there are potential risks of exceeding the upper tolerable limit, particularly in vulnerable populations. We conducted a population-based analysis of the Food Fortification Initiative dataset to determine the strength of the evidence regarding reports of decreased NTDs at the national level in response to mandatory folic acid fortification of cereal grains. We found a very weak correlation between NTD prevalence and the level of folic acid fortification, irrespective of the cereal grain fortified (wheat, maize or rice). Stratification of the data based on socioeconomic status (SES) indicated a strong linear relationship between reduced NTDs and better SES. We conclude that national fortification with folic acid is not associated with a significant decrease in the prevalence of NTDs at the population level.

scholarly journals Folate status and health: challenges and opportunities

2016 ◽  
Vol 44 (3) ◽  
Author(s):  
Rima Obeid ◽  
Konrad Oexle ◽  
Anke Rißmann ◽  
Klaus Pietrzik ◽  
Berthold Koletzko
Keyword(s):  
Folic Acid ◽  
Spina Bifida ◽  
Child Mortality ◽  
Heart Diseases ◽  
Health Problems ◽  
Reproductive Age ◽  
Mortality And Morbidity ◽  
Folic Acid Fortification ◽  
Dietary Folate ◽  
Folate Status

AbstractEach year approximately 2400 pregnancies develop folic acid-preventable spina bifida and anencephaly in Europe. Currently, 70% of all affected pregnancies are terminated after prenatal diagnosis. The prevalence of neural tube defects (NTDs) has been significantly lowered in more than 70 countries worldwide by applying fortification with folic acid. Periconceptional supplementation of folic acid also reduces the risk of congenital heart diseases, preterm birth, low birth weight, and health problems associated with child mortality and morbidity. All European governments failed to issue folic acid fortification of centrally processed and widely eaten foods in order to prevent NTDs and other unwanted birth outcomes. The estimated average dietary intake of folate in Germany is 200 μg dietary folate equivalents (DFE)/day. More than half of German women of reproductive age do not consume sufficient dietary folate to achieve optimal serum or red blood cell folate concentrations (>18 or 1000 nmol/L, respectively) necessary to prevent spina bifida and anencephaly. To date, targeted supplementation is recommended in Europe, but this approach failed to reduce the rate of NTDs during the last 10 years. Public health centers for prenatal care and fortification with folic acid in Europe are urgently needed. Only such an action will sufficiently improve folate status, prevent at least 50% of the NTD cases, reduce child mortality and morbidity, and alleviate other health problems associated with low folate such as anemia.

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

Nutrients ◽  
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.

Folate Status of Young Canadian Women after Folic Acid Fortification of Grain Products

2008 ◽  
Vol 108 (12) ◽  
pp. 2090-2094 ◽  
Author(s):  
Aysheh M. Shuaibi ◽  
James D. House ◽  
Gustaaf P. Sevenhuysen
Keyword(s):  
Folic Acid ◽  
Folic Acid Fortification ◽  
Folate Status ◽  
Grain Products

scholarly journals Exploring Attitudes About the Legality of Self-Managed Abortion in the US: Results from a Nationally Representative Survey

2021 ◽  
Author(s):  
Sarah Raifman ◽  
M. Antonia Biggs ◽  
Lauren Ralph ◽  
Katherine Ehrenreich ◽  
Daniel Grossman
Keyword(s):  
Multinomial Logistic Regression ◽  
Public Attitudes ◽  
The United States ◽  
Public Affairs ◽  
Policy Implications ◽  
Reproductive Age ◽  
Factors Associated ◽  
The Us ◽  
The Law ◽  
Nationally Representative

Abstract Introduction Twenty-four states have at least one law in place that could be used to prosecute people for self-managed abortion (SMA), or the termination of a pregnancy outside of the formal healthcare system. We investigated factors associated with public attitudes about SMA legality and legal access to abortion more generally. Methods In August 2017, we surveyed a nationally representative sample of English- and Spanish-speaking women ages 18–49 years in the United States (US) using Ipsos Public Affairs’ KnowledgePanel. Unadjusted and adjusted multinomial logistic regression estimates identify characteristics associated with believing that SMA should not be against the law, compared to should be against the law, with weighting to account for sampling into the panel. Results Overall, 76% (95% CI: 74.3%-77.1%) and 59% (95% CI: 57.3%-60.4%) of participants (n = 7,022, completion rate 50%) reported that abortion and SMA, respectively, should not be against the law; 1% and 19% were unsure. Among those living in a state with at least one law that could be used to prosecute an individual for SMA, the majority (55%, 95% CI: 52.7%-57.9%) believed SMA should not be against the law. Factors associated with believing SMA should not be against the law, compared to should be against the law, included prior abortion experience and higher levels of education and income. Conclusion Most reproductive age women in the US believe that SMA should not be criminalized. There is more uncertainty about SMA legality than about the legality of abortion more generally. Policy Implications US laws that criminalize SMA are not supported by the majority of the people living in their jurisdictions.

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