title: Trends in blood folate and vitamin B-12 concentrations in the United States, 1988 2004.
abstract: BACKGROUND
  Monitoring the folate status of US population groups over time has been a public health priority for the past 2 decades, and the focus has been enhanced since the implementation of a folic acid fortification program in the mid-1990s.
  
  
  OBJECTIVE
  We aimed to determine how population concentrations of serum and red blood cell (RBC) folate and serum vitamin B-12 have changed over the past 2 decades.
  
  
  METHODS
  Measurement of blood indicators of folate and vitamin B-12 status was conducted in approximately 23,000 participants in the prefortification third National Health and Nutrition Examination Survey (NHANES III; 1988-1994) and in approximately 8000 participants in 3 postfortification NHANES periods (together covering 1999-2004).
  
  
  RESULTS
  Serum and RBC folate concentrations increased substantially (by 119-161% and 44-64%, respectively) in each age group in the first postfortification survey period and then declined slightly (by 5-13% and 6-9%, respectively) in most age groups between the first and third postfortification survey periods. Serum vitamin B-12 concentrations did not change appreciably. Prevalence estimates of low serum and RBC folate concentrations declined in women of childbearing age from before to after fortification (from 21% to <1% and from 38% to 5%, respectively) but remained unchanged thereafter. Prevalence estimates of high serum folate concentrations increased in children and older persons from before to after fortification (from 5% to 42% and from 7% to 38%, respectively) but decreased later after fortification.
  
  
  CONCLUSIONS
  The decrease in folate concentrations observed longer after fortification is small compared with the increase soon after the introduction of fortification. The decrease is not at the low end of concentrations and therefore does not raise concerns about inadequate status.
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. cpfeiffer@cdc.gov
authors.forename: Christine M
authors.initials: CM
authors.lastname: Pfeiffer
authors.forename: Clifford L
authors.initials: CL
authors.lastname: Johnson
authors.forename: Ram B
authors.initials: RB
authors.lastname: Jain
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Yetley
authors.forename: Mary Frances
authors.initials: MF
authors.lastname: Picciano
authors.forename: Jeanne I
authors.initials: JI
authors.lastname: Rader
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Fisher
authors.forename: Joseph
authors.initials: J
authors.lastname: Mulinare
authors.forename: John D
authors.initials: JD
authors.lastname: Osterloh
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004912:Erythrocytes / Q000737:chemistry; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage* / Q000097:blood*; D005494:Folic Acid Deficiency / Q000097:blood* / Q000453:epidemiology; D005527:Food, Fortified; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009751:Nutritional Requirements; D015995:Prevalence; D012016:Reference Values; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014805:Vitamin B 12 / Q000097:blood*; D014803:Vitamin B Complex / Q000008:administration & dosage / Q000097:blood*