Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA 30341, USA.
Oak Ridge Institute for Science and Education, Oak Ridge, TN 37831, USA.
Nutrients. 2021 Apr 16;13(4):1325. doi: 10.3390/nu13041325.
Surveillance data have highlighted continued disparities in neural tube defects (NTDs) by race-ethnicity in the United States. Starting in 2016, the Food and Drug Administration (FDA) authorized voluntary folic acid fortification of corn masa flour to reduce the risk of neural tube defects (NTDs) among infants of Hispanic women of reproductive age. To assess the impact of voluntary corn masa fortification, cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 for Hispanic women of reproductive age with available red blood cell (RBC) folate concentrations were analyzed, with additional analyses conducted among Hispanic women whose sole source of folic acid intake was fortified foods (enriched cereal grain products (ECGP) only), excluding ready-to-eat cereals and supplements. RBC folate concentration (adjusted geometric mean) among Hispanic women of reproductive age did not differ between 2011-2016 and 2017-2018, though RBC folate concentration increased significantly among lesser acculturated Hispanic women consuming ECGP only. Concentrations of RBC folate for those born outside the U.S and residing in the U.S <15 years increased from 894 nmol/L (95% CI: 844-946) in 2011-2016 to 1018 nmol/L (95% CI: 982-1162; < 0.001) in 2017-2018. Primarily Spanish-speaking Hispanic women of reproductive age who only consumed ECGP saw an increase from 941 nmol/L (95% CI: 895-990) in 2011-2016 to 1034 nmol/L (95% CI: 966-1107; = 0.03) in 2017-2018. By subpopulation, we observed no significant changes in the proportion at risk of NTDs (<748 nmol/L) and no changes in the model-based estimated NTD rates following voluntary corn masa fortification. This analysis suggests that there is a remaining risk among Hispanics for folate sensitive NTDs, though continued monitoring of folate status in future NHANES data cycles will help inform the long-term efficacy of voluntary fortification of corn masa flour.
监测数据突显了美国神经管缺陷（NTDs）在种族和族裔方面的持续差异。自 2016 年起，美国食品和药物管理局（FDA）授权对玉米粉进行自愿叶酸强化，以降低育龄西班牙裔妇女所生婴儿患神经管缺陷（NTDs）的风险。为了评估自愿玉米粉强化的效果，分析了 2011-2018 年国家健康和营养检查调查（NHANES）中育龄西班牙裔妇女的红细胞（RBC）叶酸浓度的横截面数据，并在仅从强化食品（仅强化谷物产品（ECGP））中摄入叶酸的西班牙裔妇女中进行了补充分析，不包括即食谷物和补充剂。育龄西班牙裔妇女的 RBC 叶酸浓度（调整后的几何平均值）在 2011-2016 年和 2017-2018 年之间没有差异，尽管仅食用 ECGP 的较少同化西班牙裔妇女的 RBC 叶酸浓度显著增加。出生于美国以外且在美国居住时间不到 15 年的人的 RBC 叶酸浓度从 2011-2016 年的 894nmol/L（95%CI：844-946）增加到 2017-2018 年的 1018nmol/L（95%CI：982-1162；<0.001）。仅食用 ECGP 的主要讲西班牙语的育龄西班牙裔妇女的 RBC 叶酸水平从 2011-2016 年的 941nmol/L（95%CI：895-990）增加到 2017-2018 年的 1034nmol/L（95%CI：966-1107；=0.03）。按亚群分析，我们观察到神经管缺陷风险人群（<748nmol/L）的比例没有显著变化，自愿玉米粉强化后，基于模型的神经管缺陷估计率也没有变化。这项分析表明，西班牙裔人群仍然存在叶酸敏感神经管缺陷的风险，尽管未来 NHANES 数据周期中对叶酸状况的持续监测将有助于了解玉米粉自愿强化的长期效果。
