U.S. not meeting folate targets

By Will Boggs, MD

NEW YORK (Reuters Health) - Folate intake in the U.S. is well below targets established by the Food and Drug Administration when it mandated folic acid fortification of enriched grain products in 1998, according to a report in the American Journal of Public Health.

Folate is a B vitamin that is found in food, and folic acid is the synthetic form of folate contained in dietary supplements and added to fortified foods.

"The folic acid fortification program was successful in that it increased the amount of folic acid consumed by women of childbearing age, and neural tube (birth) defects decreased 20 to 32 percent following the policy," Dr. Karen M. Kuntz from Harvard School of Public Health, Boston, told Reuters Health.

"However," she said, "the success of the program falls short of the Food and Drug Administration's goal to increase the percent of women of childbearing age consuming a total of at least 400 micrograms per day of folic acid to 50 percent."

Dr. Kuntz and colleagues used data from the National Health and Nutrition Examination Surveys (NHANES III) to estimate folate consumption levels by age, gender, and racial/ethnic subgroups.

Average folate intake increased after fortification for all population subgroups, the authors report, with higher average increases for whites than for blacks and Mexican Americans.

In all subgroups, women of reproductive age increased their intake by at least 100 micrograms per day, the results indicate, but persons aged 65 years or older increased their intake by less than 100 micrograms per day.

Only 39 percent of white women, 26 percent of black women, and 28 percent of Mexican American women have reached the 400 microgram per day target for folate intake, the researchers note, despite substantial gains since fortification.

Surprisingly, the investigators say, more than half the subgroups had decreases in folic acid supplementation after the fortification program began.

"Talking to patients of all ages (particularly women of childbearing age) about taking a daily multivitamin will move us closer the FDA's goal," Dr. Kuntz said.

SOURCE: American Journal of Public Health, October 2006.