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Predicted contribution of folic acid fortification of corn masa flour to the usual folic acid intake for the US population: National Health and Nutritional Examination Survey 2001–2004^1,2,3

¹ From the Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (HCH, JM, ALF, MEC, CAB, CEP, and OD); the Division of Health and Nutrition Examination Surveys, Planning Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD (C-YW); and the Department of Statistics, Iowa State University, Ames, IA (ALC).

² The findings and conclusions in this report are those of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

³ Reprints not available. Address correspondence to HC Hamner, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Mail-Stop E-86, Atlanta, GA 30333. E-mail: hhamner{at}uga.edu, hfc2{at}cdc.gov.

ABSTRACT

Background: Folic acid can prevent up to 70% of neural tube defects (NTDs) if taken before pregnancy. Compared with other race-ethnicities, Hispanic women have higher rates of NTDs, lower rates of folic acid supplement use, and lower total folic acid intakes.

Objective: The objective was to assess potential effects of fortifying corn masa flour with folic acid on Mexican American women and other segments of the US population.

Design: A model was developed by using data from the National Health and Nutritional Examination Survey 2001–2004 to estimate the folic acid content in foods containing corn masa flour if fortified at a level of 140 µg folic acid/100 g corn masa flour.

Results: Had corn masa flour fortification occurred, we estimated that Mexican American women aged 15–44 y could have increased their total usual daily folic acid intake by 19.9% and non-Hispanic white women by 4.2%. Among the US population, estimated relative percentage increases in total usual daily folic acid intake with corn masa flour fortification were greatest among Mexican Americans (16.8%) and lowest among children aged 1–3 y (2%) and adults aged >51 y (0–0.5%).

Conclusion: Analyses suggest that corn masa flour fortification would have effectively targeted Mexican Americans, specifically, Mexican American women, without substantially increasing folic acid intake among other segments of the population. Such increases could reduce the disparity in total folic acid intake between Mexican American and non-Hispanic white women of childbearing age and implies that an additional NTD preventive benefit would be observed for Mexican American women.

Received for publication April 28, 2008. Accepted for publication September 15, 2008.