Sources of dietary folate/folic acid in women of different races in the United States between 2009 and 2012: What is the role of fortified and enriched products?
Authors: DeVirgiliis Raymond 
Published: November 2023

BackgroundIn 1998 the United States Food and Drug Administration mandated that enriched grain products be fortified with folic acid in order to decrease the number of pregnancies affected by or at risk of neural tube defects. However, differences in food and nutrient intake differ among sub‐populations and higher rates of a number of birth defects are observed in certain sub‐populations including American Indians/Alaska Natives and non‐Hispanic blacks compared to non‐Hispanic whites. With differences in folic acid intake among non‐Hispanic black and Hispanic women compared to non‐Hispanic white women, there is a need to understand why these differences exist and how the food supply contributes to these differences.ObjectiveThe aim of this project is to show whether or not the sources and the proportion of sources of dietary folate/folic acid consumed by women of childbearing age differ between races from 2009 through 2012. This analysis estimates the mean and source of dietary folate, whether fortified, enriched, or intrinsic, for women of childbearing age in the United States, by race based on NHANES intake data from 2009 through 2012. Sources of total folate consumed will be described as coming from intrinsic sources (folate), fortified sources (folic acid), or enriched (folic acid). The analysis will also allow for the identification of the top food sources of both fortified/enriched folic acid as well as intrinsic folic acid by race.MethodsThis analysis will be performed using NHANES intake data in conjunction with a new, publicly available data set that identifies vitamins and nutrients reported consumed in NHANES 2009–2012 as being intrinsic, fortified or enriched. In order to estimate the sources and means of dietary folate, values from day one of the two 24‐hour dietary recalls collected in the these two cycles of NHANES analysis will be used. This analysis is being performed using SAS and SAS‐Callable SUDAAN. Data from the two data sets will be merged based on the food codes used to identify food reported as consumed in NHANES. Dietary sample weights, which account for the differential probabilities of selection, non‐response, non‐coverage, and day of the week are being used.ResultsCrude and adjusted means for total folate, intrinsic folate, fortified folic acid and enriched folic acid will be presented. Means are adjusted for age, country of birth, and socio‐economic status. Ratios of fortified, enriched and intrinsic sources to total folate will be presented by race. Initial analyses indicate significant differences across race when looking at intake of fortified, enriched, and intrinsic sources of folic acid/folate.Support or Funding InformationTechnical support on data analysis was provided by the George Washington University, Milken Institute School of Public Health, Epidemiology Department and the National Center for Health Statistics of the Centers for Disease Control and Prevention. The new data set was made available by ILSI North America.