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

Arick Wang,Yan Ping Qi,Charles E Rose,Jennifer L Williams,Krista S Crider,Christine M Pfeiffer

doi:10.3390/nu13041325

Abstract

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.

Highlights

Folic acid consumed prior to and during the first months of pregnancy has been shown to reduce the risk of serious birth defects of the brain and spinal cord, collectively referred to as neural tube defects (NTDs) [1,2]
2017–2018) voluntary fortification periods in the U.S we looked at differences among Hispanic women of reproductive age whose sole folic acid source was fortified foods, the target subpopulation for the intervention, to determine if voluntary fortification of corn masa flour significantly impacted red blood cell (RBC) folate concentrations and NTD risk
The groups across the two periods were comparable by age, body mass index (BMI), smoking, folic acid supplement use, and primary language spoken at home

Summary

Introduction

Folic acid consumed prior to and during the first months of pregnancy has been shown to reduce the risk of serious birth defects of the brain and spinal cord, collectively referred to as neural tube defects (NTDs) [1,2]. In 1996, the Food and Drug Administration (FDA) authorized the mandatory folic acid fortification of grain products labeled as enriched, requiring 140 μg folic acids/100 g of product [4]. Fortification of this staple food was implemented in the U.S. because about 45% of pregnancies in the U.S are unplanned, and the neural tube closes within the first month of pregnancy before many women know they are pregnant [5,6]. Data from birth defects surveillance systems have shown that, since the implementation of mandatory fortification of enriched grain products, spina bifida and anencephaly prevalence has decreased from 10.7 to 5/10,000 live births, averting >1300 cases/year and saving an estimated >$600 million/year [7,8,9]

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