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

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

Research output: Contribution to journalArticlepeer-review

80 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 - 1 Nov 2007


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


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