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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)

1
Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA 30341, USA
2
Oak Ridge Institute for Science and Education, Oak Ridge, TN 37831, USA
3
Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, GA 30341, USA
*
Author to whom correspondence should be addressed.
Academic Editor: James H. Swain
Nutrients 2021, 13(4), 1325; https://doi.org/10.3390/nu13041325
Received: 18 March 2021 / Revised: 13 April 2021 / Accepted: 13 April 2021 / Published: 16 April 2021
(This article belongs to the Section Nutritional Epidemiology)
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. View Full-Text
Keywords: corn masa; food fortification; NTDs; folic acid corn masa; food fortification; NTDs; folic acid
MDPI and ACS Style

Wang, A.; Rose, C.E.; Qi, Y.P.; Williams, J.L.; Pfeiffer, C.M.; Crider, K.S. Impact of Voluntary Folic Acid Fortification of Corn Masa Flour on RBC Folate Concentrations in the U.S. (NHANES 2011–2018). Nutrients 2021, 13, 1325. https://doi.org/10.3390/nu13041325

AMA Style

Wang A, Rose CE, Qi YP, Williams JL, Pfeiffer CM, Crider KS. 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):1325. https://doi.org/10.3390/nu13041325

Chicago/Turabian Style

Wang, Arick, Charles E. Rose, Yan P. Qi, Jennifer L. Williams, Christine M. Pfeiffer, and Krista S. Crider 2021. "Impact of Voluntary Folic Acid Fortification of Corn Masa Flour on RBC Folate Concentrations in the U.S. (NHANES 2011–2018)" Nutrients 13, no. 4: 1325. https://doi.org/10.3390/nu13041325

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