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Articles & Key Findings

Key Findings: Fortification of Corn Masa Flour With Folic Acid in the United States

The journal Annals of the New York Academy of Sciences has published a new article about the fortification of corn masa flour with folic acid in the United States and how it can improve health outcomes for Hispanics. Fortification means adding vitamins or minerals to certain foods. This article might be useful for public health professionals and policymakers interested in addressing gaps within the current folic acid fortification policy. You can read the article here.

What are neural tube defects?

  • Neural tube defects are serious birth defects of the brain and spine.
  • The two most common neural tube defects are spina bifida (affects the spine) and anencephaly (affects the brain).
  • Neural tube defects happen during the first month of pregnancy.

What is folic acid?

  • Folic acid is a B vitamin.
  • If a woman has enough folic acid in her body before and during early pregnancy, it can help prevent neural tube defects.
  • Women of a reproductive age need 400 micrograms (mcg) of folic acid every day.
  • It is important that women consume folic acid by taking a daily vitamin with 400 mcg of folic acid in it, and by eating food that is fortified with folic acid (such as some breakfast cereals and other cereal grain products), in addition to eating a diet rich in natural folate.

About This Article

This article summarizes the current U.S. folic acid fortification policy, and looks at the effects of folic acid fortification of corn masa flour, a staple of the Hispanic diet, could have on this population.

In the United States, folic acid fortification has:

  • Decreased the number of neural tube defects by 36%;
  • Increased folic acid intake among women of childbearing age by 117 micrograms (mcg); and
  • Increased measures of the amount of folate found in the blood, known as serum and red blood cell folate concentrations [from 14.0 nanomoles per liter (nmol/L) and 686 nmol/L, respectively, to 37.6 nmol/L and 1,060 nmol/L, respectively].

Main Findings From This Article

Mexican-American women1 tend to have lower total folic acid intake and are less likely to take folic acid supplements (vitamins containing folic acid) than non-Hispanic White women. Also, Hispanic women tend to be at higher risk for having a baby affected by a neural tube defect than non-Hispanic White women. This article summarizes results from many studies on the effects that folic acid fortification of corn masa flour could have in the United States. These results suggest that folic acid fortification of corn masa flour could increase folic acid intake and reduce the number of neural tube defects among Hispanics.

  • If corn masa flour were fortified, folic acid intake could increase by:
    • 3.9% for all non-Hispanic White women;
    • 21.0% for all Mexican-American women; and
    • 42.9% for Mexican-American women who speak primarily Spanish and report getting folic acid exclusively from eating cereal grain products that have been enriched, such as bread, pasta and corn grits (in other words, no consumption of folic acid-containing supplements or ready-to-eat breakfast cereals).
  • If corn masa flour were fortified, about 40 cases of neural tube defects per year could be prevented among Hispanic women.

Paper Reference

Hamner HC, Tinker SC. Fortification of corn masa flour with folic acid in the United States: an overview of the evidence. Ann N Y Acad Sci. 2014 [epub ahead of print].

Neural Tube Defects: Centers for Disease Control and Prevention (CDC) Activities

CDC’s National Center on Birth Defects and Developmental Disabilities is working with the World Health Organization and other partners on a global initiative, Birth Defects COUNT (Countries and Organizations United for Neural Tube Defects Prevention), to reduce death and lifelong disability due to neural tube defects. The three focus areas of Birth Defects COUNT are science, partnerships, and public health policy.

  1. Science. Develop and strengthen regional and in-country abilities to monitor birth defects, as well as develop and strengthen laboratory capacity to measure the amount of folic acid present in the blood (or blood folate levels).
  2. Partnership. Engage a global network of partners who are experts in conducting birth defects prevention programs, tracking birth defects rates and monitoring blood folate levels, and developing interventions to increase the amount of folic acid consumed by women of childbearing age.
  3. Policy. Educate and inform decision makers on the benefits of fortification policies for preventing neural tube defects.

CDC’s activities support United Nations Millennium Development Goal 4 to reduce the mortality rate of children under-five and improve global efforts to prevent neural tube defects.

Reference

Ennis SR, Rios-Vargas M, Albert NG. 2010. The Hispanic Population: 2010. 2010 Census Briefs.

Glossary

Mexican American: The term “Hispanic” is used for rates of neural tube defects based on the data collected, but folic acid intake data are available only for Mexican Americans. However, Mexican Americans make up approximately 63% of the Hispanic population in the United States (Ennis et al., 2010).

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