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

Area of Science:

• Nutritional Science
• Public Health Nutrition
• Dietary Assessment

Background:

• Folate fortification of foods is a public health strategy to increase folate intake and prevent neural tube defects.
• Understanding the impact of different fortification models on specific populations, like older adults, is crucial for optimizing public health initiatives.
• Australia has a voluntary food fortification program for folic acid.

Purpose of the Study:

• To evaluate the potential effects of various folate fortification strategies on the folate consumption of Australians aged 49 years and older.
• To assess the likelihood of exceeding the upper safety limit for synthetic folic acid (SFA) intake under different fortification scenarios.

Main Methods:

• Dietary intake data were collected from 2895 adults over 49 years old in two postcode areas west of Sydney, Australia, using a food frequency questionnaire.
• Folate intake was estimated using four models: pre-fortification, current voluntary fortification, and two universal fortification scenarios (25% and 50% RDI per serve).
• The increased bioavailability of synthetic folic acid (SFA) was accounted for in the intake estimations.

Main Results:

• Under current voluntary fortification, 65% of older adults consumed ≥320 µg DFE/day, with 0.4% exceeding the 1000 µg SFA upper safety level.
• Universal fortification at 50% RDI per serve would likely result in over 95% of this population consuming ≥320 µg DFE/day.
• With 50% RDI universal fortification, an estimated 0.5% of the older population might exceed the 1000 µg SFA upper safety level.

Conclusions:

• Universal folate fortification is unlikely to cause a substantial rise in older adults exceeding the upper safety intake level.
• The majority of individuals currently consuming or predicted to consume over 1000 µg SFA obtain it from folic acid supplements.
• Co-administration of vitamin B12 with folate in supplements is strongly advised for individuals at risk of high synthetic folic acid intake.