Consumption of folic acid fortified foods among Hispanic women of reproductive age in the US: a systematic review

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#humans #food-fortified #folic-acid #female #hispanic-or-latino

Consumption of folic acid fortified foods among Hispanic women of reproductive age in the US: a systematic review

Villalba et al., 2025 | BMC Public Health | Systematic Review

Citation

Villalba Nicole, Byrne Kayla, ... Garcia Roxanna M. Consumption of folic acid fortified foods among Hispanic women of reproductive age in the US: a systematic review. BMC Public Health. 2025-Apr-09;25(1):1334. doi:10.1186/s12889-025-22407-x

Abstract

BACKGROUND: In 1998, the United States (US) implemented mandatory folic acid fortification of enriched cereal grain products (ECGP) to prevent neural tube defects (NTD) in newborns. NTD rates remained highest among Hispanic births. Voluntary fortification of corn masa flour was approved in 2016, without improvement in NTD rates. This review aims to understand folic acid consumption among Hispanic women in the US before and after voluntary fortification. METHODS: A systematic search was conducted in PubMed, Embase, and Scopus from inception to September 2024 using the keywords folic acid, Hispanic Americans, and fortification. Study designs included descriptive, cross-sectional, and observational cohort. Studies in any language reporting the consumption of folic acid fortified foods among Hispanic women of reproductive age in the US were eligible. Study variables were compared to non-Hispanic White (NHW) women when available. Findings were summarized descriptively. RESULTS: Of 446 publications, eight studies (n = 20,123) met inclusion criteria. All studies reported on folic acid fortified foods, four characterized folic acid intake and acculturation factors, three quantified red blood cell (RBC) folate concentrations, and two described NTD rates. Hispanic women consumed grains, cereals, bread, flour, pasta, and corn masa flour. Most Hispanic women obtained folic acid from ECGP only. Hispanic women consumed more dietary folic acid than NHW women pre-voluntary fortification (406-456 µg (mcg) versus 349 mcg daily, p < 0.001) but less total folic acid when supplements were included (244 mcg versus 332 mcg daily, p < 0.05). Monolingual Spanish-speakers had the lowest total intake (224 mcg daily, p < 0.05). RBC folate concentrations were lower among Hispanic women compared to NHW women pre-voluntary fortification (963 nmol per liter (nmol/L) versus 1043 nmol/L) but showed no improvement post-fortification. Voluntary fortification did not significantly increase folic acid intake or reduce the proportion with inadequate intake; however, monolingual Spanish-speakers demonstrated higher intake and RBC folate concentrations. NTD rates remained similar between Hispanic (7.5/10,000 live births) and NHW women (7.1/10,000 live births) post-fortification. The certainty of evidence, assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework, ranged from low to very low across outcomes. CONCLUSIONS: There is a paucity of literature to describe the rate, influencing factors, and prevalence disparities in NTD among Hispanic women living in the US despite its public health importance. This review provides a current summary on the disparities in folic acid intake and NTD rates between Hispanic and NHW women, and the effectiveness of voluntary fortification targeting populations at higher risk. Research initiatives investigating the factors influencing these disparities and future targeted interventions are necessary.

Key Findings

Of 446 publications, eight studies (n = 20,123) met inclusion criteria. All studies reported on folic acid fortified foods, four characterized folic acid intake and acculturation factors, three quantified red blood cell (RBC) folate concentrations, and two described NTD rates. Hispanic women consumed grains, cereals, bread, flour, pasta, and corn masa flour. Most Hispanic women obtained folic acid from ECGP only. Hispanic women consumed more dietary folic acid than NHW women pre-voluntary fortif

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 20123
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Food, Fortified
  • Folic Acid
  • Female
  • Hispanic or Latino
  • United States
  • Neural Tube Defects
  • Adult
  • Cross-Sectional Studies
  • White

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Systematic Review
  • Vertical: folate

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09