Since 1998, the FDA has required the fortification of enriched cereal grain
products with 140 mcg of folic acid per 100 g of cereal grain. The major impetus to this
initiative was to reduce the incidence of neural tube defects (NTDs) by increasing folic
acid intake among women of reproductive age.
The effect of the fortification program has been studied on a number of levels,
from determination of the actual amount of folic acid present in fortified products, to
changes in serum and plasma folate levels, to the effects on NTD incidence. The Center
for Food Safety and Applied Nutrition at FDA has found that fortified cereals may
contain anywhere from 100% to over 300% of the amount of folate noted on their labels.
Several large studies comparing pre- and post-fortification blood levels of folic acid in
various populations demonstrate increases ranging from about 50% to over 100%.
Studies of the incidence of neural tube defects before and after the fortification program
show a decrease in incidence by 19% to 54%, depending on the population studied and
the specific study methodology.
There has been discussion in the literature as to whether the fortification program
is optimal, or whether additional decreases in NTD rates, either nationally or in specific
subpopulations, are possible through provision of additional folic acid to reproductive-
The presentations and discussion will focus on the following issues: