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ORIGINAL RESEARCH COMMUNICATION |
1 From the National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
Background: Mandatory folic acid fortification of cereal-grain products was introduced in the United States in 1998 to decrease the risk that women will have children with neural tube defects.
Objective: The objective was to determine the effect of folic acid fortification on concentrations of serum and red blood cell (RBC) folate, serum vitamin B-12, and plasma total homocysteine (tHcy) and methylmalonic acid (MMA) in the US population.
Design: Blood was collected from a nationally representative sample of 
7300 participants aged 
3 y in the National Health and Nutrition Examination Survey (NHANES) during 1999–2000 and was analyzed for these B vitamin–status indicators. The results were compared with findings from the prefortification survey NHANES III (1988–1994).
Results: The reference ranges (5th–95th percentiles) were 13.1–74.3 nmol/L for serum folate, 347–1167 nmol/L for RBC folate, and 179–738 pmol/L for serum vitamin B-12. For plasma tHcy and MMA, the reference ranges for serum vitamin B-12–replete participants with normal serum creatinine concentrations were 3.2–10.7 µmol/L and 60–210 nmol/L, respectively. The prevalence of low serum folate concentrations (<6.8 nmol/L) decreased from 16% before to 0.5% after fortification. In elderly persons, the prevalence of high serum folate concentrations (>45.3 nmol/L) increased from 7% before to 38% after fortification; 3% had marginally low serum vitamin B-12 concentrations (<148 pmol/L) and 7% had elevated plasma MMA concentrations (>370 nmol/L). Seventy-eight percent of the US population had plasma tHcy concentrations <9 µmol/L.
Conclusions: Every segment of the US population appears to benefit from folic acid fortification. Continued monitoring of B vitamin concentrations in the US population is warranted.
Key Words: Nutrition survey • age • sex • race • ethnic groups • National Health and Nutrition Examination Survey • NHANES
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