Effect of a voluntary food fortification policy on folate, related B vitamin status, and homocysteine in healthy adults 2

Leane Hoey, Nadina Askin, Adrian Dunne, Mary Ward, Kristina Pentieva, J. J. Strain, Anne M. Molloy, Cliona A. Flynn, John M. Scott

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93 Citations (Scopus)


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. Design: 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 μg/d) between the fortified food categories. Red blood cell folate concentrations were 387 nmol/L higher and plasma total homocysteine concentrations were 2 μmol/L lower in the group with the highest fortified food intake (median intake: 208 μg/d folic acid) than in the nonconsumers of fortified foods (0 μg/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.

Original languageEnglish
Pages (from-to)1405-1413
Number of pages9
JournalAmerican Journal of Clinical Nutrition
Issue number5
Publication statusPublished (in print/issue) - 1 Nov 2007


  • Adults
  • B vitamins
  • Biomarkers
  • Dietary folate equivalents
  • Folate
  • Folic acid
  • Food fortification
  • Intakes
  • Plasma homocysteine


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