Contributions of enriched cereal-grain products, ready-to-eat cereals, and supplements to folic acid and vitamin B-12 usual intake and folate and vitamin B-12 status in US children: National Health and Nutrition Examination Survey (NHANES), 2003-2006

Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 11/2010; 93(1):172-85. DOI: 10.3945/ajcn.2010.30127
Source: PubMed


US children consume folic acid from multiple sources. These sources may contribute differently to usual intakes above the age-specific tolerable upper intake level (UL) for folic acid and to folate and vitamin B-12 status.
We estimated usual daily folic acid intakes above the UL and adjusted serum and red blood cell folate, serum vitamin B-12, homocysteine, and methylmalonic acid (MMA) concentrations in US children by age group and by the following 3 major folic acid intake sources: enriched cereal-grain products (ECGP), ready-to-eat cereals (RTE), and supplements containing folic acid (SUP).
We analyzed data in 4 groups of children aged 1-3, 4-8, 9-13, and 14-18 y from the National Health and Nutrition Examination Survey (NHANES), 2003-2006 (n = 7161).
A total of 19-48% of children consumed folic acid from ECGP only. Intakes above the UL varied from 0-0.1% of children who consumed ECGP only to 15-78% of children who consumed ECGP+RTE+SUP. In children aged 1-8 y, 99-100% of those who consumed ≥ 200 μg folic acid/d from supplements exceeded their UL. Although < 0.5% of children had folate deficiency or low vitamin B-12 status, the consumption of RTE or SUP with folic acid was associated with higher mean folate and vitamin B-12 concentrations and, in some older children, with lower homocysteine and MMA concentrations.
Our data suggest that the majority of US children consume more than one source of folic acid. Postfortification, the consumption of RTE or SUP increases usual daily intakes and blood concentrations of folate and vitamin B-12.

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Available from: Alicia Carriquiry, Aug 13, 2015
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    • "In both Canada and the United States, mandatory food fortification has long been employed as a tool to address public health need [1] [2] [3] [4] [5]. For example, although regulatory frameworks differ, in both Canada and the United States white flour is enriched with niacin, thiamine, riboflavin and iron to replace losses during processing [6] [7], and enriched cereal grains are fortified with folic acid to reduce the risk of neural tube defects [8] [9] [10] [11]. The two countries differ markedly, however, in their policies and practices with respect to voluntary fortification. "
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    ABSTRACT: As the availability of fortified foods expands, it is increasingly important to monitor risk of excessive nutrient intake. However, neither Canadian nor US nutrient composition databases systematically differentiate between naturally occurring nutrients and those added to foods at manufacturers’ discretion, and the consumption of fortified foods is not comprehensively assessed during dietary data collection.Objective To describe limitations in the estimation of nutrient intakes from voluntarily fortified foods from the Canadian Community Health Survey (CCHS 2004) and National Health and Nutrition Examination Survey (NHANES 2007-08) for the purposes of evaluating fortification policies and practices.DescriptionWorking with the US Food and Nutrient Database for Dietary Studies, we identified voluntarily fortified foods by food code descriptions containing certain key words and the presence of nutrients for which additions were tracked in the database. This strategy is likely to have resulted in an underestimation of voluntarily fortified food consumption and thus an underestimation of the probability of excessive intakes in the US population. Our efforts to model proposed policy changes to food fortification in Canada were similarly limited by our inability to differentiate added sources of niacin and retinol in the CCHS. This thwarted assessment of risks associated with fortification because the Tolerable Upper Intake Levels only apply to retinol and added niacin.Conclusion It is important that food composition databases and 24hr dietary recall collection methods evolve to facilitate monitoring and evaluating health benefits and risks associated with growing voluntary food fortification practices.
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    ABSTRACT: Periconceptional intake of folic acid is known to reduce a woman's risk of having an infant affected by a neural tube birth defect (NTD). National programs to mandate fortification of food with folic acid have reduced the prevalence of NTDs worldwide. Uncertainty surrounding possible unintended consequences has led to concerns about higher folic acid intake and food fortification programs. This uncertainty emphasizes the need to continually monitor fortification programs for accurate measures of their effect and the ability to address concerns as they arise. This review highlights the history, effect, concerns, and future directions of folic acid food fortification programs.
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