title: Effect of a voluntary food fortification policy on folate, related B vitamin status, and homocysteine in healthy adults.
abstract: BACKGROUND
  Mandatory folic acid fortification of food is effective in reducing neural tube defects and may even reduce stroke-related mortality, but it remains controversial because of concerns about potential adverse effects. Thus, it is virtually nonexistent in Europe, albeit many countries allow food fortification on a voluntary basis.
  
  
  OBJECTIVE
  The objective of the study was to examine the effect of a voluntary but liberal food fortification policy on dietary intake and biomarker status of folate and other homocysteine-related B vitamins in a healthy population.
  
  
  METHODS
  The study was a cross-sectional study. From a convenience sample of 662 adults in Northern Ireland, those who provided a fasting blood sample and dietary intake data were examined (n = 441, aged 18-92 y). Intakes of both natural food folate and folic acid from fortified foods were estimated; we used the latter to categorize participants by fortified food intake.
  
  
  RESULTS
  Fortified foods were associated with significantly higher dietary intakes and biomarker status of folate, vitamin B-12, vitamin B-6, and riboflavin than were unfortified foods. There was no difference in natural food folate intake (range: 179-197 microg/d) between the fortified food categories. Red blood cell folate concentrations were 387 nmol/L higher and plasma total homocysteine concentrations were 2 micromol/L lower in the group with the highest fortified food intake (median intake: 208 microg/d folic acid) than in the nonconsumers of fortified foods (0 microg/d folic acid).
  
  
  CONCLUSIONS
  These results show that voluntary food fortification is associated with a substantial increase in dietary intake and biomarker status of folate and metabolically related B vitamins with potential beneficial effects on health. However, those who do not consume fortified foods regularly may have insufficient B vitamin status to achieve the known and potential health benefits.
authors.affiliation: Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, United Kingdom. l.hoey@ulster.ac.uk
authors.forename: Leane
authors.initials: L
authors.lastname: Hoey
authors.forename: Helene
authors.initials: H
authors.lastname: McNulty
authors.forename: Nadina
authors.initials: N
authors.lastname: Askin
authors.forename: Adrian
authors.initials: A
authors.lastname: Dunne
authors.forename: Mary
authors.initials: M
authors.lastname: Ward
authors.forename: Kristina
authors.initials: K
authors.lastname: Pentieva
authors.forename: Jj
authors.initials: J
authors.lastname: Strain
authors.forename: Anne M
authors.initials: AM
authors.lastname: Molloy
authors.forename: Cliona A
authors.initials: CA
authors.lastname: Flynn
authors.forename: John M
authors.initials: JM
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000517:prevention & control; D004912:Erythrocytes / Q000737:chemistry; D005260:Female; D005492:Folic Acid / Q000097:blood*; D005527:Food, Fortified; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009436:Neural Tube Defects / Q000517:prevention & control; D018673:Nutrition Policy; D009752:Nutritional Status; D014805:Vitamin B 12 / Q000097:blood*; D025101:Vitamin B 6 / Q000097:blood*
chemical_list: D006710:Homocysteine; D025101:Vitamin B 6; D005492:Folic Acid; D014805:Vitamin B 12