Folate fortification: potential impact on folate intake in an older population

Abstract

Objective: To examine the potential impact of different models of folate fortification of Australian foods on the folate intakes of older Australians. Design: Dietary data were collected using a food frequency questionnaire from people attending a populationbased health study. Setting: Two postcode areas west of Sydney, Australia. Subjects: A total of 2895 people aged over 49 y, obtained from a door knock census (79% of 3654 subjects examined). Main outcome measures: The folate intake in this population was estimated using four different models: (1) prefortification folate values; (2) current voluntary folate fortification in Australia; (3) universal fortification of all foods permitted to add folate, at 25% recommended dietary intake (RDI) per reference serve; and (4) universal fortification of all foods permitted to add folate, at 50% RDI per reference serve. The increased bioavailability of synthetic folic acid (SFA) was included in the analysis. Results: At current voluntary folate fortification, approximately 65% of this population consume 320 mg dietary folate equivalents (DFE) or more per day from diet and supplements, and 0.4% (n ¼ 10) consume greater than the recommended upper safety level of 1000 mg from SFA. More than 95% of this older population would be expected to consume more than 320 mg DFE from diet and supplements with universal fortification at 50% of the RDI, and 0.5% (n ¼ 14) may consume greater than 1000 mg=day of SFA. Conclusions: There is unlikely to be a large increase in the proportion of older persons who are likely to consume more than the upper safety level of intake with universal folate fortification. As most of those who currently or are predicted to consume over 1000 mg SFA take supplements containing folic acid, it is highly recommended that vitamin B 12 be included in any vitamin supplements containing folate.

Food and nutrient consumption trends in older Australians: a 10-year cohort study

“…Folate intake also increased substantially and significantly over the 10-year period largely due to an increase in folate from fortified foods, mainly in breakfast cereals and yeast extracts, which commenced in Australia in 1997 (around the start of the second data collection period) (Abraham and Food consumption trends in older Australians VM Flood et al Flood et al, 2001). Some authors (Hickling et al, 2005) had predicted that voluntary folate fortification may not be able to achieve any significant changes to folate intake, but these data provide evidence that significant changes have been achieved with voluntary fortification, in at least this subpopulation.…”

Prevalence of low serum folate and vitamin B12 in an older Australian population

“…Some researchers have suggested that vitamin B12 should be added to any folate-fortified foods. 22,23 Because our earlier research showed that most older people who would be likely to consume high levels of folate are those who take supplements containing folic acid, 8 it is recommended that vitamin B12 be included in any vitamin supplements containing folate.…”

“…3 In Australia, folate fortification of food is voluntary, and breakfast cereals are the main products fortified. In previous research, 8 we examined the potential impact on folate intake in older people if folate fortification became mandatory in Australia. Under this scenario, our results showed that only 0.5% of the study population would be likely to consume levels greater than 1000 µg per day from synthetic folic acid, the intake considered by the Institute of Medicine (IOM) as the tolerable upper intake level.…”

“…7 However, to determine the public health impact of folate fortification on middle aged and older people, reliable prevalence estimates for both vitamin B12 and folate deficiency are required. 8 Recent studies have been reported from United Kingdom, the Netherlands, United States of America and New Zealand, 1,6,9,10 with prevalence estimates for vitamin B12 deficiency ranging from 10-40%, depending on the method and cut-points used to determine deficiency. No population-based studies of blood levels for folate, vitamin B12 and homocysteine have been conducted in Australia.…”

Wonder vitamin or mass medication? Media and academic representation of folate fortification as a policy problem in Australia and New Zealand

“…A strong discourse was introduced into the news reporting from August 2004 and continues into the second last month of analysis, just before the mandatory decision is announced. This discourse raises serious concerns about the risks of fortification of bread with headlines such as Cereals raise concern (The Christchurch Press, 18 The occasional journal article in the time period acknowledged potential iatrogenic risks of fortification [29][30][31] but also referred to range of wider risks, such as Australia's lack of national nutrition monitoring and surveillance system to use as basis for policy decisions. 32 These other concerns are not as clearly articulated in media representation.…”