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Public Health Nutr. 2019 Mar;22(4):738-749. doi: 10.1017/S1368980018003026. Epub 2018 Dec 6.

Effects of folic acid food fortification scenarios on the folate intake of a multi-ethnic pregnant population.

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1Department of Nutrition, School of Public Health,University of São Paulo,São Paulo,Brazil.
2The Centre for Longitudinal Research - He Ara ki Mua, School of Population Health (building 730, level 3), Tamaki Campus,University of Auckland,261 Morrin Road, St Johns, Auckland 1072,New Zealand.



To simulate effects of different scenarios of folic acid fortification of food on dietary folate equivalents (DFE) intake in an ethnically diverse sample of pregnant women.


A forty-four-item FFQ was used to evaluate dietary intake of the population. DFE intakes were estimated for different scenarios of food fortification with folic acid: (i) voluntary fortification; (ii) increased voluntary fortification; (iii) simulated bread mandatory fortification; and (iv) simulated grains-and-rice mandatory fortification.


Ethnically and socio-economically diverse cohort of pregnant women in New Zealand.ParticipantsPregnant women (n 5664) whose children were born in 2009-2010.


Participants identified their ethnicity as European (56·0 %), Asian (14·2 %), Māori (13·2 %), Pacific (12·8 %) or Others (3·8 %). Bread, breakfast cereals and yeast spread were main food sources of DFE in the two voluntary fortification scenarios. However, for Asian women, green leafy vegetables, bread and breakfast cereals were main contributors of DFE in these scenarios. In descending order, proportions of different ethnic groups in the lowest tertile of DFE intake for the four fortification scenarios were: Asian (39-60 %), Others (41-44 %), European (31-37 %), Pacific (23-26 %) and Māori (23-27 %). In comparisons within each ethnic group across scenarios of food fortification with folic acid, differences were observed only with DFE intake higher in the simulated grains-and-rice mandatory fortification v. other scenarios.


If grain and rice fortification with folic acid was mandatory in New Zealand, DFE intakes would be more evenly distributed among pregnant women of different ethnicities, potentially reducing ethnic group differences in risk of lower folate intakes.


Folate; Food fortification; Growing Up in New Zealand; Maternal and child health; Maternal nutrition


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