Fortification of corn masa flour products could increase folic acid intake among Mexican-Americans

Fortification of corn masa flour products could increase folic acid intake by nearly 20 percent for Mexican-Americans, who are at a 30-40 percent higher risk for a number of severe brain and spinal birth defects, according to a study by the Centers for Disease Control and Prevention (CDC).

The study is published in the January issue of the American Journal of Clinical Nutrition.

Corn masa flour is used to make most corn tortillas and corn chips. The study indicates that if the flour was fortified with folic acid, the intake of folic acid for Mexican-American women could increase. Folic acid can prevent up to 70 percent of neural tube defects (NTDs), such as anencephaly (a brain defect) and spina bifida (a defect in the development of the spinal cord).

"The increased consumption of folic acid through corn masa flour fortification could provide an added level of protection for Mexican-American women," said Alina Flores, health education specialist at the CDC's National Center on Birth Defects and Developmental Disabilities. "But we still need more research to understand why Hispanics have higher prevalence rates of NTDs."

In 1992, the U.S. Public Health Service recommended that all women capable of becoming pregnant consume 400 micrograms of folic acid every day to reduce their risk of having a child born with a NTD. However, a recent CDC study reported that only 21 percent of Hispanic women are consuming the recommended amount of folic acid, compared with over 40 percent of white women. This is even more crucial because Hispanic women in the United States have the highest rates of babies born with NTDs. CDC recommends that all women, especially Hispanic women, make folic acid intake part of a daily routine.

Overall, the prevalence rates of NTDs declined by 27 percent in the United States since the U.S. Food and Drug Administration's mandatory addition of folic acid to cereal, pasta, rice, bread and flour in 1998. These products were considered a staple for most of the United States population.

The mandate did not apply to corn masa flour, whole grain breads and corn meal products manufactured in other countries. Before fortification, about 4,130 babies had such neural tube defects each year in the United States, and nearly 1,200 died. After fortification, the yearly number dropped to about 3,000, with 840 deaths. However, Hispanics have continued having a higher rate of these birth defects.

The study, "Predicted contribution of folic acid fortification of corn masa flour to the usual folic acid intake for the U.S. population, NHANES 2001-2004," examined data from 2,862 women aged 15-44 years collected through the National Health and Nutritional Examination Survey (NHANES). To look at potential impact of corn masa flour fortification with folic acid on Mexican-American women compared to other segments of the U.S. population, the researchers developed a model. This model included identifying food that contained corn masa flour, measuring how much corn masa flour is in each food item, determining how much folic acid to add to the food products and creating sample food items to estimate impact of folic acid corn masa flour fortification on folic acid intake.

The primary goal of the study was to determine if fortification of a food product that could specifically target Hispanic women might increase their overall average intake of folic acid and thus, improve their chances of reducing their risk of having babies affected by NTDs. It focused on Mexican-American women instead of Hispanic women in general because this group had the largest representation among the NHANES participants.