Folic Acid Food Fortification—Its History, Effect, Concerns, and Future Directions

2011
Krista S. Crider, Lynn B. Bailey, and Robert J. Berry 

Abstract

Periconceptional intake of folic acid is known to reduce a woman’s risk of having an infant affected by a neural tube birth defect (NTD). National programs to mandate fortification of food with folic acid have reduced the prevalence of NTDs worldwide. Uncertainty surrounding possible unintended consequences has led to concerns about higher folic acid intake and food fortification programs.

This uncertainty emphasizes the need to continually monitor fortification programs for accurate measures of their effect
and the ability to address concerns as they arise. This review highlights the history, effect, concerns, and future directions of folic acid food fortification programs.

Keywords: folic acid; flour fortification; neural tube defects; cancer; epigenetics

Future

Existing folic acid food fortification programs have reduced significantly the number of pregnancies affected by NTDs and the associated morbidity and mortality. In the future, new hypotheses will be generated that will need exploration and testing, such as concerns over the possibility of epigenetic changes.

Careful monitoring of existing and proposed programs will enable the scientific community to evaluate blood folate concentrations needed for NTD prevention, evaluate and respond appropriately to concerns as they arise, and document the benefit of these public health programs. As with any public health program, it is important to revisit recommendations regularly as additional information becomes available.

A significant portion of the estimated 300,000 NTDs worldwide that occur yearly are preventable by the consumption of folic acid and continue to be a great public health burden globally.