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Folic Acid: Foods
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Folic acid is a water-soluble, B-complex vitamin that is available orally and parenterally. This vitamin is found in a variety of foods including liver, kidneys, yeast, and leafy, green vegetables. Folic acid is administered orally and parenterally.
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Prevention of Birth Defects—In 1996, the FDA published regulations requiring the addition of folic acid to enriched breads, cereals, flours, and other grain products. This was specifically targeted to reduce the risk of neural tube defects (malformations of the spinal cord) in newborns. The Centers for Disease Control and Prevention reported in 2004 that since the addition of folic acid to grain-based foods, the rate of neural tube defects has dropped by 25% in the United States.
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This population-based study was conducted in Norway, which has one of the highest rates of facial clefts in Europe and does not allow foods to be fortified with folic acid. The investigators contacted all families of newborn infants with clefts (either cleft lip with or without cleft palate (CLP) or cleft palate only (CPO)) born between 1996 and 2001 in Norway. The study included 377 babies with CLP and 196 with CLO; as well as 763 control babies randomly selected from all live births in Norway.
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"The Food & Drug Administration's decision to add folic acid to our nation's fortified grain foods was a victory for mothers and babies," responded Michael Katz, M.D., senior vice president for Research and Global Programs at the March of Dimes. "It is so rare that we get an opportunity to prevent thousands of babies from being born with a disabling or fatal birth defect with such an easy means. There is no real basis to the suggestion made by some commentators today that folic acid fortification should be rolled back."
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In October 1993, in a separate rulemaking, FDA proposed a health claim for folic acid and neural tube defects. Under the proposal, health claims would be permitted on foods containing 40 mcg. or more of folic acid per serving. FDA proposed amending the standards of identity for cereal grains labeled as "enriched" to require mandatory addition of folic acid at 140 mcg/100g. Dietary supplements would retain their levels of 400 mcg. per daily dose.
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In 1996, the United States Food and Drug Administration required enriched grain products be fortified with folic acid to reduce the risk of neural tube defects in newborns. The researchers hypothesized that fortification might offer a secondary benefit of reducing serum homocysteine concentrations in the population as a whole, which might lead to a decline in death rates due to cardiovascular disease and stroke.
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