Fortification is the process of increasing the level of nutrients which are normally present within a food vehicle (e.g. grain flour, enriched cereal grain products, rice, salt, milk, and margarine). In 1998, the U.S. was the first country to mandate fortification of all cereal grain products with FA (fortification level of wheat flour = 140 µg/100 g) (1). Up to date, more than 52 countries are applying mandatory flour fortification programs – but no European country. FA fortification policies resulted in a reduction of prevalence rate of NTDs, an improvement of the folate status in blood, and a reduction of tHcy concentrations. For example in the U.S. the National Health and Nutrition Examination Survey (NHANES) study mean serum folate concentration increased from 11.4 nmol/L before (NHANES III, n = 9,430) to 26.9 nmol/L after FA fortification (NHANES 1999 – 2000, n = 1,978), in adult non-supplement users. An increase in mean RBC folate has been also observed (from 375 nmol/L before to 590 nmol/L after fortification) (2).
1. Food and Drug Administration. Food Standards: Amendment of Standards of Identity For Enriched Grain Products to Require Addition of Folic Acid. Federal Register Vol. 61, No. 44, 21 CFR Parts 136, 137, and 139, 8781-8807. 1996.
2. Dietrich M, Brown CJ, Block G. The effect of folate fortification of cereal-grain products on blood folate status, dietary folate intake, and dietary folate sources among adult non-supplement users in the United States. J Am Coll Nutr 2005;24:266-74.