Fortification study combines folic acid, vitamin B12

by Jeff Gelski
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WAGENINGEN, THE NETHERLANDS — Bread fortified with folic acid and vitamin B12 improved folate and vitamin B12 status and a considerable proportion of vitamin B12 deficiency in a research study involving men and women ages 50 to 75 in The Netherlands. The study addressed concerns that high intakes of folic acid might mask vitamin B12 deficiency in older persons. Those concerns have delayed the introduction of folic acid fortification in many European countries.

The 12-week, double-blind, placebo-controlled study revealed consumption of fortified bread increased serum folate concentrations by 45% and serum vitamin B12 concentration by 49% relative to the placebo group. Consumption of fortified bread decreased the population of individuals with marginal serum vitamin B12 concentrations to 0% after 12 weeks from 8% at enrollment.

The U.S. Food and Drug Administration introduced mandatory folic acid fortification in 1998. Neural tube defects, including spina bifida, have declined by 26% since then.

Results of the study in The Netherlands appear in the August issue of the American Journal of Clinical Nutrition (Vol. 88, No. 2, 348-355). The study involved researchers from the Top Institute of Food & Nutrition in Wageningen, The Netherlands; Wageningen University in Wageningen; the Institute of Health Sciences at Vrije Universiteit in Amsterdam, The Netherlands; the University of Oxford in Oxford, United Kingdom; and the Unilever Food and Health Research Institute in Vlaardingen, The Netherlands.

An editorial titled "Are we ready for mandatory fortification with vitamin B12?" appears in the same issue of the American Journal of Clinical Nutrition. Helga Refsum, involved in the Oxford Project to Investigate Memory and Aging at the University of Oxford, and A. David Smith, with the Department of Nutrition at the University of Oslo in Oslo, Norway, were the authors.

The editorial cited data from the U.S. National Health and Nutrition Examination Survey (NHANES) that indicate the function of vitamin B12 deteriorates as serum folate status increases in persons who are deficient in vitamin B12. The data also show persons with both low vitamin D12 and high folate concentrations are at a high risk of memory impairment and anemia.

The editorial said no adverse effects have been associated with excess vitamin B12 intake from food or supplements in healthy individuals, which benefits the argument for mandatory vitamin B12 fortification.

"Nevertheless, before this step is taken, it is essential that government authorities ensure that the required investigations are performed and provide the funding for them," the editorial said.

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