title: Impact of voluntary fortification and supplement use on dietary intakes and biomarker status of folate and vitamin B-12 in Irish adults.
abstract: BACKGROUND
  Ireland has traditionally operated a liberal policy of voluntary fortification, but little is known about how this practice, along with supplement use, affects population intakes and status of folate and vitamin B-12.
  
  
  OBJECTIVE
  The aim was to examine the relative impact of voluntary fortification and supplement use on dietary intakes and biomarker status of folate and vitamin B-12 in Irish adults.
  
  
  METHODS
  Folic acid and vitamin B-12 from fortified foods and supplements were estimated by using brand information for participants from the cross-sectional National Adult Nutrition Survey 2008-2010. Dietary and biomarker values were compared between 6 mutually exclusive consumption groups formed on the basis of folic acid intake.
  
  
  RESULTS
  The consumption of folic acid through fortified foods at low, medium, and high levels of exposure [median (IQR) intakes of 22 (13, 32), 69 (56, 84), and 180 (137, 248) μg/d, respectively]; from supplements [203 (150, 400) μg/d]; or from both sources [287 (220, 438) μg/d] was associated with significantly higher folate intakes and status compared with nonconsumption of folic acid (18% of the population). Median (IQR) red blood cell (RBC) folate increased significantly from 699 (538, 934) nmol/L in nonconsumers to 1040 (83, 1390) nmol/L in consumers with a high intake of fortified foods (P < 0.001), with further nonsignificant increases in supplement users. Supplement use but not fortification was associated with significantly higher serum vitamin B-12 concentrations relative to nonconsumers (P < 0.001). Two-thirds of young women had suboptimal RBC folate for protection against neural tube defects (NTDs); among nonconsumers of folic acid, only 16% attained optimal RBC folate.
  
  
  CONCLUSIONS
  The consumption of voluntarily fortified foods and/or supplement use was associated with significantly higher dietary intakes and biomarker status of folate in Irish adults. Of concern, the majority of young women remain suboptimally protected against NTDs.
authors: From the Institute of Food and Health, University College Dublin, Belfield Dublin, Republic of Ireland (SMH, MJG, APN, and BAM); the Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland (HM, JJS, and MW); the School of Clinical Medicine, Trinity College, Dublin, Republic of Ireland (AMM and JMS); and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (AF and JW).
authors: Sinéad M
authors: SM
authors: Hopkins
authors: From the Institute of Food and Health, University College Dublin, Belfield Dublin, Republic of Ireland (SMH, MJG, APN, and BAM); the Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland (HM, JJS, and MW); the School of Clinical Medicine, Trinity College, Dublin, Republic of Ireland (AMM and JMS); and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (AF and JW). gibney.mike@gmail.com.
authors: Michael J
authors: MJ
authors: Gibney
authors: From the Institute of Food and Health, University College Dublin, Belfield Dublin, Republic of Ireland (SMH, MJG, APN, and BAM); the Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland (HM, JJS, and MW); the School of Clinical Medicine, Trinity College, Dublin, Republic of Ireland (AMM and JMS); and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (AF and JW).
authors: Anne P
authors: AP
authors: Nugent
authors: From the Institute of Food and Health, University College Dublin, Belfield Dublin, Republic of Ireland (SMH, MJG, APN, and BAM); the Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland (HM, JJS, and MW); the School of Clinical Medicine, Trinity College, Dublin, Republic of Ireland (AMM and JMS); and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (AF and JW).
authors: Helene
authors: H
authors: McNulty
authors: From the Institute of Food and Health, University College Dublin, Belfield Dublin, Republic of Ireland (SMH, MJG, APN, and BAM); the Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland (HM, JJS, and MW); the School of Clinical Medicine, Trinity College, Dublin, Republic of Ireland (AMM and JMS); and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (AF and JW).
authors: Anne M
authors: AM
authors: Molloy
authors: From the Institute of Food and Health, University College Dublin, Belfield Dublin, Republic of Ireland (SMH, MJG, APN, and BAM); the Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland (HM, JJS, and MW); the School of Clinical Medicine, Trinity College, Dublin, Republic of Ireland (AMM and JMS); and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (AF and JW).
authors: John M
authors: JM
authors: Scott
authors: From the Institute of Food and Health, University College Dublin, Belfield Dublin, Republic of Ireland (SMH, MJG, APN, and BAM); the Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland (HM, JJS, and MW); the School of Clinical Medicine, Trinity College, Dublin, Republic of Ireland (AMM and JMS); and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (AF and JW).
authors: Albert
authors: A
authors: Flynn
authors: From the Institute of Food and Health, University College Dublin, Belfield Dublin, Republic of Ireland (SMH, MJG, APN, and BAM); the Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland (HM, JJS, and MW); the School of Clinical Medicine, Trinity College, Dublin, Republic of Ireland (AMM and JMS); and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (AF and JW).
authors: J J
authors: JJ
authors: Strain
authors: From the Institute of Food and Health, University College Dublin, Belfield Dublin, Republic of Ireland (SMH, MJG, APN, and BAM); the Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland (HM, JJS, and MW); the School of Clinical Medicine, Trinity College, Dublin, Republic of Ireland (AMM and JMS); and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (AF and JW).
authors: Mary
authors: M
authors: Ward
authors: From the Institute of Food and Health, University College Dublin, Belfield Dublin, Republic of Ireland (SMH, MJG, APN, and BAM); the Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland (HM, JJS, and MW); the School of Clinical Medicine, Trinity College, Dublin, Republic of Ireland (AMM and JMS); and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (AF and JW).
authors: Janette
authors: J
authors: Walton
authors: From the Institute of Food and Health, University College Dublin, Belfield Dublin, Republic of Ireland (SMH, MJG, APN, and BAM); the Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland (HM, JJS, and MW); the School of Clinical Medicine, Trinity College, Dublin, Republic of Ireland (AMM and JMS); and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (AF and JW).
authors: Breige A
authors: BA
authors: McNulty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D004912:Erythrocytes / Q000187:drug effects / Q000378:metabolism; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000097:blood*; D005527:Food, Fortified; D006801:Humans; D007494:Ireland; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics / Q000378:metabolism; D008875:Middle Aged; D009436:Neural Tube Defects / Q000517:prevention & control; D015596:Nutrition Assessment; D009749:Nutrition Surveys; D009752:Nutritional Status; D014805:Vitamin B 12 / Q000008:administration & dosage / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005492:Folic Acid; C573423:MTHFR protein, human; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D014805:Vitamin B 12
keywords: B vitamin biomarkers; folate intakes; supplements; vitamin B-12 intakes; voluntary fortification