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.

Academic Article


  • BACKGROUND: The United States implemented mandatory folic acid fortification of enriched cereal grains in 1998. Although several studies have documented the resulting decrease in anemia and folate deficiency, to our knowledge, no one has determined the prevalence of folate-deficiency anemia after fortification. OBJECTIVE: We determined the prevalence of folate deficiency and folate-deficiency anemia within a sample of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. DESIGN: The REGARDS cohort is a prospective cohort of 30,239 black and white participants living in the contiguous United States. We measured serum folate concentrations in a random sample of 1546 REGARDS participants aged ≥50 y with baseline hemoglobin and red blood cell mean corpuscular volume measurements. Folate deficiency was defined as a serum folate concentration <6.6 nmol/L (<3.0 ng/mL), and anemia was defined as a hemoglobin concentration <13 g/dL in men and <12 g/dL in nonpregnant women (WHO criteria). Folate-deficiency anemia was defined as the presence of both folate deficiency and anemia. RESULTS: The mean hemoglobin concentration was 13.6 g/dL, and 15.9% of subjects had anemia. The median serum folate concentration was 34.2 nmol/L (15.1 ng/mL), and only 2 of 1546 participants 0.1%) were folate deficient. Both subjects were African American women with markedly elevated C-reactive protein concentrations, macrocytosis, and normal serum cobalamin concentrations; only one subject was anemic. Overall, the prevalence of folate-deficiency anemia was <0.1% (1 of 1546 subjects). CONCLUSION: Our data suggest that, after mandatory folic acid fortification, the prevalence of folate-deficiency anemia is nearly nonexistent in a community-dwelling population in the United States.
  • Authors


  • African Continental Ancestry Group, Aged, Anemia, Cohort Studies, Continental Population Groups, Edible Grain, Erythrocyte Indices, European Continental Ancestry Group, Female, Folic Acid, Folic Acid Deficiency, Food, Fortified, Hemoglobins, Humans, Male, Middle Aged, Prospective Studies, Sex Factors, United States, United States Food and Drug Administration
  • Digital Object Identifier (doi)

    Pubmed Id

  • 4905365
  • Author List

  • Odewole OA; Williamson RS; Zakai NA; Berry RJ; Judd SE; Qi YP; Adedinsewo DA; Oakley GP
  • Start Page

  • 1042
  • End Page

  • 1047
  • Volume

  • 98
  • Issue

  • 4