Near-elimination of folate-deficiency anemia by mandatory folic acid fortification in older US adults: Reasons for Geographic and Racial Differences in Stroke study 2003-2007.
BACKGROUND
The United States implemented mandatory folic acid fortification of enriched cereal grains in 1998. Although several studies have documented the resulting decrease in anemia and folate deficiency, to our knowledge, no one has determined the prevalence of folate-deficiency anemia after fortification.


OBJECTIVE
We determined the prevalence of folate deficiency and folate-deficiency anemia within a sample of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort.


METHODS
The REGARDS cohort is a prospective cohort of 30,239 black and white participants living in the contiguous United States. We measured serum folate concentrations in a random sample of 1546 REGARDS participants aged ≥50 y with baseline hemoglobin and red blood cell mean corpuscular volume measurements. Folate deficiency was defined as a serum folate concentration <6.6 nmol/L (<3.0 ng/mL), and anemia was defined as a hemoglobin concentration <13 g/dL in men and <12 g/dL in nonpregnant women (WHO criteria). Folate-deficiency anemia was defined as the presence of both folate deficiency and anemia.


RESULTS
The mean hemoglobin concentration was 13.6 g/dL, and 15.9% of subjects had anemia. The median serum folate concentration was 34.2 nmol/L (15.1 ng/mL), and only 2 of 1546 participants 0.1%) were folate deficient. Both subjects were African American women with markedly elevated C-reactive protein concentrations, macrocytosis, and normal serum cobalamin concentrations; only one subject was anemic. Overall, the prevalence of folate-deficiency anemia was <0.1% (1 of 1546 subjects).


CONCLUSIONS
Our data suggest that, after mandatory folic acid fortification, the prevalence of folate-deficiency anemia is nearly nonexistent in a community-dwelling population in the United States.
Department of Epidemiology and Center for Spina Bifida Research, Prevention and Policy, Rollins School of Public Health, Emory University, Atlanta, GA.
Oluwaseun A
OA
Odewole
Rebecca S
RS
Williamson
Neil A
NA
Zakai
Robert J
RJ
Berry
Suzanne E
SE
Judd
Yan Ping
YP
Qi
Demilade A
DA
Adedinsewo
Godfrey P
GP
Oakley
D000368:Aged; D000740:Anemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D044383:Black People; D015331:Cohort Studies; D002523:Edible Grain; D004909:Erythrocyte Indices; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage* / Q000097:blood; D005494:Folic Acid Deficiency / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control*; D005527:Food, Fortified; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D044469:Racial Groups; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration; D044465:White People; D001741:Black or African American
D006454:Hemoglobins; D005492:Folic Acid