{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:27:38Z","timestamp":1781742458710,"version":"3.54.5"},"reference-count":16,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T00:00:00Z","timestamp":1709856000000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Folic acid is a micronutrient that is effective at preventing neural tube defects (NTDs). In 2016, the FDA authorized the voluntary fortification of corn masa flour (CMF) with folic acid to reduce disparities in NTDs among infants of women who do not regularly consume other fortified cereal grains, in particular Hispanic women of reproductive age (WRA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to March 2020 assessing the impact of voluntary fortification of CMF on the folate status of Hispanic WRA. We analyzed folic acid usual intake and red blood cell (RBC) folate concentrations among non\u2010pregnant, non\u2010lactating Hispanic WRA, comparing pre\u2010fortification (2011\u20132016) to post\u2010fortification (2017\u2013March 2020) data. RBC folate concentrations were used to create model\u2010based estimation of NTD rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The proportion of Hispanic WRA with folic acid usual intakes &lt;400\u2009\u03bcg\/d did not change (2011\u20132016: 86.1% [95% Confidence Interval, CI: 83.7\u201388.5]; 2017\u2013March 2020: 87.8% [95% CI: 84.8\u201390.7]; <jats:italic>p<\/jats:italic>\u2009=\u2009.38) nor did the proportion of Hispanic WRA with RBC folate below optimal concentrations (&lt;748\u2009nmol\/L, 2011\u20132016: 16.0% [95% CI: 13.7\u201318.2]; 2017\u2013March 2020: 18.1% [95% CI: 12.1\u201324.0]; <jats:italic>p<\/jats:italic>\u2009=\u20090.49). Model\u2010based estimates of NTD rates suggest further improvements in the folate status of Hispanic WRA might prevent an additional 157 (95% Uncertainty Interval: 0, 288) NTDs\/year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Voluntary fortification of CMF with folic acid has yet to have a significant impact on the folate status of WRA. Continued monitoring and further research into factors such as fortified product availability, community knowledge, and awareness of folic acid benefits would inform and improve future public health interventions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.2321","type":"journal-article","created":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T16:37:17Z","timestamp":1709915837000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Update on the impact of voluntary folic acid fortification of corn masa flour on red blood cell folate concentrations\u2014National Health and Nutrition Examination Survey, 2011\u2013March 2020"],"prefix":"10.1002","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6768-6153","authenticated-orcid":false,"given":"Arick","family":"Wang","sequence":"first","affiliation":[{"name":"Prevention and Health Disparities Team, Infant Outcomes Monitoring, Research and Prevention Branch, Division of Birth Defects and Infant Disorders National Center on Birth Defects and Developmental Disabilities, CDC  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7976-1096","authenticated-orcid":false,"given":"Amy","family":"Fothergill","sequence":"additional","affiliation":[{"name":"Prevention and Health Disparities Team, Infant Outcomes Monitoring, Research and Prevention Branch, Division of Birth Defects and Infant Disorders National Center on Birth Defects and Developmental Disabilities, CDC  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine F.","family":"Yeung","sequence":"additional","affiliation":[{"name":"Prevention and Health Disparities Team, Infant Outcomes Monitoring, Research and Prevention Branch, Division of Birth Defects and Infant Disorders National Center on Birth Defects and Developmental Disabilities, CDC  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista S.","family":"Crider","sequence":"additional","affiliation":[{"name":"Prevention and Health Disparities Team, Infant Outcomes Monitoring, Research and Prevention Branch, Division of Birth Defects and Infant Disorders National Center on Birth Defects and Developmental Disabilities, CDC  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Williams","sequence":"additional","affiliation":[{"name":"Prevention and Health Disparities Team, Infant Outcomes Monitoring, Research and Prevention Branch, Division of Birth Defects and Infant Disorders National Center on Birth Defects and Developmental Disabilities, CDC  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,8]]},"reference":[{"issue":"15","key":"e_1_2_7_2_1","first-page":"421","article-title":"Optimal serum and red blood cell folate concentrations in women of reproductive age for prevention of neural tube defects: World Health Organization guidelines","volume":"64","author":"Cordero A. M.","year":"2015","journal-title":"MMWR. Morbidity and Mortality Weekly Report"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqy065"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-nutr-043020-091647"},{"key":"e_1_2_7_5_1","first-page":"8781","article-title":"Food standards: Amendment of standards of identity for enriched grain products to require addition of folic acid","volume":"61","author":"Department of Health and Human Services Food and Drug Administration","year":"1996","journal-title":"Federal Register"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2017.11.003"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980012004582"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.1518"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v009.i08"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)90133-A"},{"issue":"1","key":"e_1_2_7_11_1","first-page":"1","article-title":"Births: Final data for 2021","volume":"72","author":"Osterman M. J. K.","year":"2023","journal-title":"National Vital Statistics Reports"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.116.138529"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.11939"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.profoo.2013.04.022"},{"key":"e_1_2_7_15_1","unstructured":"United States Census Bureau. (2021).The Hispanic population in the United States: 2021. Available from:https:\/\/www.census.gov\/data\/tables\/2021\/demo\/hispanic\u2010origin\/2021\u2010cps.html"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13041325"},{"issue":"1","key":"e_1_2_7_17_1","first-page":"1","article-title":"Updated estimates of neural tube defects prevented by mandatory folic acid fortification\u2014United States, 1995\u20102011","volume":"64","author":"Williams J.","year":"2015","journal-title":"MMWR. Morbidity and Mortality Weekly Report"}],"container-title":["Birth Defects Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bdr2.2321","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T13:33:14Z","timestamp":1711546394000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/bdr2.2321"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":16,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1002\/bdr2.2321"],"URL":"https:\/\/doi.org\/10.1002\/bdr2.2321","archive":["Portico"],"relation":{},"ISSN":["2472-1727","2472-1727"],"issn-type":[{"value":"2472-1727","type":"print"},{"value":"2472-1727","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3]]},"assertion":[{"value":"2023-11-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2321"}}