Improved folate status in children and adolescents during voluntary fortification of food with folate

Abstract

Objective: To assess longitudinal changes in folate status in South Australian children and adolescents during fortification of food with folic acid. Methods: Sixty-nine children and adolescents (age 12.8 ± 2.3 years), 47 with diabetes and 22 healthy controls, had their folate status assessed at the beginning of 1999 and again after a mean 1.1 ± 0.23 years. Intake of folate at baseline was assessed with a quantitative food frequency questionnaire. Results: Baseline red cell folate (mean ± standard deviation (SD)) was 756 ± 294.5 nmol/L and remained constant at follow up at 736 ± 299 nmol/L (P = 0.55) in the whole group. Serum folate increased from 24.4 ± 6.3 nmol/L to 27.2 ± 8.8 nmol/L (P = 0.002). Children with diabetes showed a significant increase in serum folate (from 26.3 ± 5.7−30.1 ± 7.9, P < 0.001) and stable red cell folate (835.8 ± 278.6 and 808.6 ± 296.7, P = 0.51) between baseline and the second samples, while controls showed stable serum (20.4 ± 5.7 and 21.1 ± 7.7, P = 0.7) and red cell folate (586.6 ± 255.9 and 579.8 ± 240.1, P = 0.92). A third sample collected in 17 subjects after a further 9 ± 1.3 months showed a further increase in serum and red cell folate. Mean folate intake at baseline was 301 ± 129 µg/day, below the mean recommended for prevention of neural tube defects. Conclusions: Voluntary fortification of food with folate is associated with improved folate status in South Australian children and adolescents, but may not be sufficient at current levels to provide maximal protection against neural tube defects at a population level.