Folate fortification: Potential impact on folate intake in an older population

Objective: To examine the potential impact of different models of folate fortification of Australian foods on the folate intakes of older Australians. Design: Dietary data were collected using a food frequency questionnaire from people attending a population-based health study. Setting: Two postcode areas west of Sydney, Australia. Subjects: A total of 2895 people aged over 49 y, obtained from a door knock census (79% of 3654 subjects examined). Main outcome measures: The folate intake in this population was estimated using four different models: (1) prefortification folate values; (2) current voluntary folate fortification in Australia; (3) universal fortification of all foods permitted to add folate, at 25% recommended dietary intake (RDI) per reference serve; and (4) universal fortification of all foods permitted to add folate, at 50% RDI per reference serve. The increased bioavailability of synthetic folic acid (SFA) was included in the analysis. Results: At current voluntary folate fortification, approximately 65% of this population consume 320 μg dietary folate equivalents (DFE) or more per day from diet and supplements, and 0.4% (n = 10) consume greater than the recommended upper safety level of 1000 μg from SFA. More than 95% of this older population would be expected to consume more than 320 μg DFE from diet and supplements with universal fortification at 50% of the RDI, and 0.5% (n = 14) may consume greater than 1000 μg/day of SFA. Conclusions: There is unlikely to be a large increase in the proportion of older persons who are likely to consume more than the upper safety level of intake with universal folate fortification. As most of those who currently or are predicted to consume over 1000 μg SFA take supplements containing folic acid, it is highly recommended that vitamin B₁₂ be included in any vitamin supplements containing folate.