Background In 1996, the Food and Drug Administration issueda regulation requiring all enriched grain products to be fortifiedwith folic acid to reduce the risk of neural-tube defects innewborns. Fortification (140 µg per 100 g) began in 1996,and the process was essentially complete by mid-1997.
Methods To assess the effect of folic acid fortification onfolate status, we measured plasma folate and total homocysteineconcentrations (a sensitive marker of folate status) using bloodsamples from the fifth examination (January 1991 to December1994) of the Framingham Offspring Study cohort for base-linevalues and the sixth examination (January 1995 to August 1998)for follow-up values. We divided the cohort into two groupson the basis of the date of their follow-up examination: thestudy group consisted of 350 subjects who were seen after fortification(September 1997 to March 1998), and the control group consistedof 756 subjects who were seen before fortification (January1995 to September 1996).
Results Among the subjects in the study group who did not usevitamin supplements, the mean folate concentrations increasedfrom 4.6 to 10.0 ng per milliliter (11 to 23 nmol per liter)(P<0.001) from the base-line visit to the follow-up visit,and the prevalence of low folate concentrations (<3 ng permilliliter [7 nmol per liter]) decreased from 22.0 to 1.7 percent(P< 0.001). The mean total homocysteine concentration decreasedfrom 10.1 to 9.4 µmol per liter during this period (P<0.001),and the prevalence of high homocysteine concentrations (>13µmol per liter) decreased from 18.7 to 9.8 percent (P<0.001).In the control group, there were no statistically significantchanges in concentrations of folate or homocysteine.
Conclusions The fortification of enriched grain products withfolic acid was associated with a substantial improvement infolate status in a population of middle-aged and older adults.
Source Information
From the Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston (P.F.J., J.S., I.H.R.); the Division of General Internal Medicine, Memorial Hospital of Rhode Island, Providence (A.G.B.); and the Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Mass. (P.W.F.W.).
Address reprint requests to Dr. Rosenberg at the Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St., Boston, MA 02111.
Folic Acid Fortification
Oakley G. P., Pfeiffer C. M., Gunter E. W., Miller D. T., Watkins M. L., Erickson J. D., Mulinare J., Jacques P. F., Selhub J., Rosenberg I. H.
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N Engl J Med 1999;
341:922-924, Sep 16, 1999.
Correspondence
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