Folic Acid Food Fortification

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Folic Acid Food Fortification

• Elizabeth A. Yetley, Ph.D.
• Center for Food Safety Applied Nutrition
• Food and Drug Administration

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U.S. Folic Acid Fortification

• ? folate-responsive NTDs by ? folate intakes of
  women of child-bearing age
• Mandated folic acid addition to enriched cereal
  grain products
• Allowed fortification of breakfast cereals up to
  100 DV (400 µg/serving)
• No limits on dietary supplements
• Effective 1996

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Fortification Characteristics

• Ubiquitous in food supply
• Passive for consumer
• Exposures lifetime cumulative
• Balance
• Safe intake for all consumers
• Improve intakes of target consumers
• Uncertainty surrounded every decision

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Ubiquitous in Food Supply

• Orange juice
• McDonalds hamburger
• Pastas
• Breakfast cereals bars
• Cookies, cakes

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Daily Folate Intakes
Folate (mcg/day) Food, Supplements,
Fortified Food
19-50 M
51 M
11-18 F
1-3 MF
4-10 MF
11-18 M
19-50 F
51 F
Age in Years
6
Total Folate Intake
Percent
Females 19 Yrs
Total Folate (mcg DFEs)
7

Nutrient Function/Risk
8

Nutrient Function/Risk
1000 - ????? Mcg???
400 800 mcg???
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Post-fortification Monitoring?

• Assume underestimate intakes therefore
  underestimate effectiveness and safety
• Biomarkers of folate status
• Changing incidence of NTDs

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Dietary Intakes

• Unreliable predictors of clinical status
• Underestimate calorie intakes
• Underestimate food content
• Analytical methods
• Labeling practices
• Overestimate requirements
• Consumer responsiveness varies

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Intakes as predictors of status?
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Changes in Folate Status
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Bottom Line

• Advantages of national fortification
• Passive exposure
• Disadvantages of national fortification
• Passive exposure
• Balancing act competing issues of safety and
  effectiveness

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Summary

• Uncertainties
• Effective intakes
• Safety
• Ubiquitous in food supply
• Significant increases in folate status