Fortification successful for ‘near-elimination’ of folic acid anemia

More than 70 countries fortify industrially milled wheat flour, maize products and/or rice with folic acid

Mandatory fortification of select cereal grains with folic acid has led to the ‘near eradication’ of folate-deficiency anemia, says a new study.

Nutritional anemia is reported to account for about 33% of all anemia in the elderly US population, with folate deficiency alone accounting for 6.4% of anemia, with a further 5% linked to folate in combination with another nutrient deficiency.

The introduction of folic acid fortification of flour in the US in 1998 aimed at reducing the incidence of neural tube defects in infants has also been successful in practically eradicating this folate deficiency anemia, according to results published in the American Journal of Clinical Nutrition.

Wide-ranging benefits

More than 70 countries fortify industrially milled wheat flour, maize products and/or rice with folic acid, according to data from the Flour Fortification Initiative (FFI). A meta-analysis published in 2010 showed an overall 46% reduction in neural tube defects such as spina bifida and anencephaly in countries where wheat flour was fortified with this B vitamin.

The US Centers for Disease Control and Prevention (CDC) has listed the prevention of neural tube defects through flour fortification amongst its list of 10 great health achievements in the US for the last decade.

Commenting independently on the new study, Scott J. Montgomery, Director of the Flour Fortification Initiative (FFI), said: “While we know that fortifying cereal grains with folic acid is an effective strategy for reducing the prevalence of these serious birth defects, this study confirms that fortification is also good for other population groups.”

Study details

Scientists from Emory University, University of Vermont, the CDC, and the University of Alabama at Birmingham assessed the prevalence of folate deficiency and folate-deficiency anemia using data from 1,546 people participating in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort.

The data showed that only two of the participants were folate deficient, defined as blood folate levels less than 6.6 nmol/L (3.0 ng/mL). while only one of these people was also considered anemic, defined as a hemoglobin levels less than 13 g/dL in men and less than 12 g/dL in non-pregnant women. This was equivalent to folate-deficiency anemia prevalence of less than 0.1%.

“Although other factors such as increased supplement use and perhaps improved nutrition may have contributed to a decline in folate-deficiency anemia, reductions in both the prevalence of folate deficiency and folate-deficiency anemia are an added benefit of mandatory flour fortification,” wrote the researchers.

“In addition to preventing spina bifida and anencephaly, mandatory folic acid fortification has contributed to the near elimination of folate deficiency and folate-deficiency anemia in individuals aged around 50 years.

“Thus, regulators in countries around the world considering folic acid fortification need to take into account the benefits of mandatory folic acid fortification on both newborns in preventing NTDs and in older adults in preventing folate-deficiency anemia.”

Source: American Journal of Clinical Nutrition
Published online ahead of print, doi: 10.3945/ajcn.113.059683
“Near-elimination of folate-deficiency anemia by mandatory folic acid fortification in older US adults: Reasons for Geographic and Racial Differences in Stroke study 2003–2007”
Authors: O.A. Odewole, R.S. Williamson, N.A. Zakai, R.J. Berry, S.E. Judd, Y.P. Qi, D.A. Adedinsewo, G.P. Oakley Jr

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