title: Modelling fortification of corn masa flour with folic acid and the potential impact on Mexican-American women with lower acculturation.
abstract: OBJECTIVE
  Hispanics with lower acculturation may be at higher risk for neural tube defects compared with those with higher acculturation due to lower total folic acid intake or other undetermined factors. Modelling has indicated that fortification of corn masa flour with folic acid could selectively target Mexican Americans more than other race/ethnicities. We assessed whether fortification of corn masa flour with folic acid could selectively increase folic acid intake among Mexican-American women with lower acculturation, as indicated by specific factors (language preference, country of origin, time living in the USA).
  
  
  METHODS
  We used dietary intake and dietary supplement data from the National Health and Nutrition Examination Survey 2001-2008, to estimate the amount of additional total folic acid that could be consumed if products considered to contain corn masa flour were fortified at 140 μg of folic acid per 100 g of corn masa flour.
  
  
  METHODS
  USA.
  
  
  METHODS
  Non-pregnant women aged 15-44 years (n 5369).
  
  
  RESULTS
  Mexican-American women who reported speaking Spanish had a relative percentage change in usual daily total folic acid intake of 30·5 (95 % CI 27·8, 33·4) %, compared with 8·3 (95 % CI 7·3, 9·4) % for Mexican-American women who reported speaking English. We observed similar results for other acculturation factors. An increase of 6·0 percentage points in the number of Mexican-American women who would achieve the recommended intake of ≥400 μg folic acid/d occurred with fortification of corn masa flour; compared with increases of 1·1 percentage points for non-Hispanic whites and 1·3 percentage points for non-Hispanic blacks. An even greater percentage point increase was observed among Mexican-American women who reported speaking Spanish (8·2).
  
  
  CONCLUSIONS
  Fortification of corn masa flour could selectively increase total folic acid intake among Mexican-American women, especially targeting Mexican-American women with lower acculturation, and result in a decrease in the number of pregnancies affected by neural tube defects.
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30033, USA. hfc2@cdc.gov
authors.forename: Heather C
authors.initials: HC
authors.lastname: Hamner
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Tinker
authors.forename: Alina L
authors.initials: AL
authors.lastname: Flores
authors.forename: Joe
authors.initials: J
authors.lastname: Mulinare
authors.forename: Aliki P
authors.initials: AP
authors.lastname: Weakland
authors.forename: Nicole F
authors.initials: NF
authors.lastname: Dowling
mesh_terms: D000069:Acculturation; D000293:Adolescent; D000328:Adult; D019587:Dietary Supplements; D005260:Female; D005433:Flour / Q000032:analysis*; D005492:Folic Acid / Q000008:administration & dosage*; D005527:Food, Fortified; D006801:Humans; D017058:Mexican Americans / Q000706:statistics & numerical data*; D009436:Neural Tube Defects / Q000453:epidemiology / Q000517:prevention & control; D018673:Nutrition Policy; D009749:Nutrition Surveys; D009751:Nutritional Requirements; D015995:Prevalence; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult; D003313:Zea mays
chemical_list: D005492:Folic Acid