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Impact of Voluntary Folic Acid Fortification of Corn Masa Flour on RBC Folate Concentrations in the U.S. (NHANES 2011-2018).
Nutrients. 2021 Apr 16; 13(4)N

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.

Authors+Show Affiliations

Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA 30341, USA. Oak Ridge Institute for Science and Education, Oak Ridge, TN 37831, USA.Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA 30341, USA.Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA 30341, USA.Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA 30341, USA.Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, GA 30341, USA.Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA 30341, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33923768

Citation

Wang, Arick, et al. "Impact of Voluntary Folic Acid Fortification of Corn Masa Flour On RBC Folate Concentrations in the U.S. (NHANES 2011-2018)." Nutrients, vol. 13, no. 4, 2021.
Wang A, Rose CE, Qi YP, et al. Impact of Voluntary Folic Acid Fortification of Corn Masa Flour on RBC Folate Concentrations in the U.S. (NHANES 2011-2018). Nutrients. 2021;13(4).
Wang, A., Rose, C. E., Qi, Y. P., Williams, J. L., Pfeiffer, C. M., & Crider, K. S. (2021). Impact of Voluntary Folic Acid Fortification of Corn Masa Flour on RBC Folate Concentrations in the U.S. (NHANES 2011-2018). Nutrients, 13(4). https://doi.org/10.3390/nu13041325
Wang A, et al. Impact of Voluntary Folic Acid Fortification of Corn Masa Flour On RBC Folate Concentrations in the U.S. (NHANES 2011-2018). Nutrients. 2021 Apr 16;13(4) PubMed PMID: 33923768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Voluntary Folic Acid Fortification of Corn Masa Flour on RBC Folate Concentrations in the U.S. (NHANES 2011-2018). AU - Wang,Arick, AU - Rose,Charles E, AU - Qi,Yan Ping, AU - Williams,Jennifer L, AU - Pfeiffer,Christine M, AU - Crider,Krista S, Y1 - 2021/04/16/ PY - 2021/03/18/received PY - 2021/04/13/revised PY - 2021/04/13/accepted PY - 2021/4/30/entrez PY - 2021/5/1/pubmed PY - 2021/5/27/medline KW - NTDs KW - corn masa KW - folic acid KW - food fortification JF - Nutrients JO - Nutrients VL - 13 IS - 4 N2 - 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. SN - 2072-6643 UR - https://www.unboundmedicine.com/medline/citation/33923768/Impact_of_Voluntary_Folic_Acid_Fortification_of_Corn_Masa_Flour_on_RBC_Folate_Concentrations_in_the_U_S___NHANES_2011_2018__ L2 - https://www.mdpi.com/resolver?pii=nu13041325 DB - PRIME DP - Unbound Medicine ER -