Fortification of flour with folic acid can contribute to eliminating deficiency

September 9, 2013

According to a new US study mandatory folic acid fortification of select cereal grains has led to a near eradication of folate deficiency and related anemia in the elderly.

The observational study assessed the prevalence of folate deficiency and folate-deficiency anemia among 1,546 participants aged around 50 years (1). The study results showed that only two of the participants were folate deficient (blood folate levels less than 6.6 nmol/L resp. 3.0 ng/mL), while only one of these people was also considered anemic (hemoglobin levels less than 13 g/dL in men and less than 12 g/dL in women who are not pregnant).

The researchers commented that although other factors such as increased supplement use and improved nutrition may have contributed to a decline in folate-deficiency anemia, reductions in both the prevalence of folate deficiency and folate-deficiency anemia are an added benefit of mandatory flour fortification, in addi-tion to preventing neural tube defects (NTDs). The introduction of folic acid fortification of flour in the US in 1998, initially aimed at reducing the incidence of serious birth defects in infants, has now shown additional health benefits for other population groups. This is important news for regulators in countries around the world considering folic acid fortification, the researchers said.

More than 70 countries fortify industrially milled wheat flour, maize products and/or rice with folic acid, ac-cording to data from the Flour Fortification Initiative. A meta-analysis showed an overall 46% reduction in NTDs such as spina bifida and anencephaly in countries where wheat flour was fortified with folic acid (2). The US Centers for Disease Control and Prevention has listed the prevention of NTDs through flour forti-fication amongst its list of 10 great health achievements in the US for the last decade.


  1. Odewole O. A. et al. Near-elimination of folate-deficiency anemia by mandatory folic acid fortification in older US adults: Reasons for Geographic and Racial Differences in Stroke study 2003–2007. American Journal of Clinical Nutrition. Published online August 2013.
  2. Blencowe H. et al. Folic acid to reduce neonatal mortality from neural tube disorders. Int J Epidemiol. 2010; 39(Suppl 1):110–121.