Health Professionals:

Folic Acid and NTDs

The Food and Drug Administration (FDA) requires that food manufacturers fortify all enriched cereal grain products with folic acid effective January 1, 1998. The fortification level is 140 micrograms folic acid per 100 grams of cereal grain food. This regulation affects enriched foods including flour, breads, rolls, pasta, rice, cornmeal, instant oatmeal, crackers, baked goods (e.g., cookies, cakes), and mixed foods containing these foods (e.g., soups with rice or pasta, certain convenience and frozen foods, etc.). Cereal grain foods were chosen for fortification because they are consumed widely by the target age group (women of childbearing age). In 2016 the FDA approved voluntary fortification or corn masa flour, which is used to make tortillas, tortilla chips, tamales, taco shells, and corn chips (FDA, 2016). This effort will help increase folic acid consumption in those who regularly consume this type of flour, including Hispanic women who are at higher risk for neural tube defects.

Folic acid fortification has improved folate status in the United States. Red blood cell folate concentrations in women aged 15-44 years were reported to be 2-3 times higher after fortification compared to pre-fortification (CDC, 2000). NTD rates in the US decreased by 28% for spina bifida and anencephaly since the introduction of food fortification in 1998 (CDC, 2015), which is significant yet far short of the estimated reduction in NTD incidence of 50%-70% based on observational and intervention studies for women taking supplements containing folic acid.