Key Findings: Assessing the Association between Natural Food Folate Intake and Blood Folate Concentrations


The journal Nutrients has published a new study that assessed the relationship between the amount of natural food folate consumed by women and their blood folate concentrations. Blood folate concentrations refer to the amount of folate found in the blood, and include folate concentrations in serum/plasma (the liquid part of blood) or red blood cells (the cells in blood that carry oxygen to the body). Red blood cell folate concentrations in women have previously been shown to predict the risk in populations of having pregnancies affected by neural tube defects.

In this study, CDC researchers conducted a systematic review and meta-analysis and found that

  • Consuming natural food folate affects blood folate concentrations, and
  • Adequate food folate consumption by women could help them achieve red blood cell folate concentrations that reduce their risk of having a pregnancy affected by a neural tube defect.

However, it is difficult for a woman to eat enough natural food folate to prevent neural tube defects.

These findings will be useful for public health professionals and policymakers interested in preventing neural tube defects through a variety of interventions including folic acid fortification, supplementation, as well as through diet. You can read the article’s abstract hereExternal.

About This Study

We already know that…

  • Consuming folic acid increases blood folate concentrations;
  • The lowest risk for neural tube defects occurs when red blood cell folate concentration is approximately 1,000 nmol/L or higher; this is also known as the “optimal” blood folate concentration; and
  • Folic acid fortification of staple foods and use of folic acid supplements reduces the risk of a pregnancy being affected by a neural tube defect.

Prior to this study, there was limited information on

  • The unique contribution of natural food folate intake to blood folate concentrations, and
  • The potential to achieve “optimal” blood folate concentrations to prevent neural tube defects by consuming just natural food folate.

A better understanding of the relationship between the amount of natural food folate consumed and the effect it has on increasing blood folate concentrations could improve the development, monitoring, and evaluation of neural tube defect prevention programs. This is of particular interest in settings where folic acid supplement use is low or folic acid fortified staple foods are not available.

The objective of this study was to determine the relationship between amount of natural food folate consumed and its effect on blood folate concentrations. This is the first study of its kind.

Main Findings from This Study

This study found that if at least 450 micrograms (mcg) dietary folate equivalents of natural food folate are consumed each day (this is equal to 270 mcg of folic acid) red blood cell folate concentrations increase to the level that provides the lowest risk for pregnancies to be affected by neural tube defects.

In countries where access to folic acid supplements or foods fortified with folic acid is limited, higher intakes of natural food folate may be necessary to optimally prevent neural tube defects. However, many populations have difficulties achieving sufficient intake of natural food folate, usually due to barriers to accessing these foods or difficulty in changing eating habits. Therefore, it’s important to identify populations at risk for pregnancies affected by neural tube defects and deliver public health interventions to best reach them, such as folic acid fortification of staple food products and/or use of supplements containing folic acid.

What are neural tube defects?

  • Neural tube defects are serious birth defects of the brain and spine.
  • The two most common neural tube defects are spina bifida (affects the spine) and anencephaly (affects the brain).
  • Neural tube defects happen during the first month of pregnancy.

What is folate?

  • Folate is a B vitamin that is present naturally in foods. Folic acid is a synthetic form of folate that is added to vitamins and some foods.
  • Many, but not all, neural tube defects can be prevented by consuming enough folic acid daily. These birth defects are called folate-sensitive neural tube defects.
  • It is important that women of reproductive age consume 400 mcg of folic acid daily by taking a daily vitamin with folic acid in it, by eating food that is fortified with folic acid (such as some breakfast cereals and other cereal grain products), or both, in addition to eating a diet rich in natural folate.
  • If a woman has enough folate in her blood before and during early pregnancy, from synthetic and natural sources, it can help prevent neural tube defects.

Paper Reference

Marchetta CM, Devine OJ, Crider KS, Tsang BL, Cordero AM, Qi YP, Guo J, Berry RJ, Rosenthal J, Mulinare J, Mersereau P, Hamner HC. Assessing the Association between Natural Food Folate Intake and Blood Folate Concentrations: A Systematic Review and Bayesian Meta-Analysis of Trials and Observational Studies. Nutrients: 2015.

Neural Tube Defects: Centers for Disease Control and Prevention (CDC) Activities

CDC’s National Center on Birth Defects and Developmental Disabilities is working with the World Health Organization and other partners on a global initiative, Birth Defects COUNT (Countries and Organizations United for Neural Tube Defects Prevention), to reduce death and lifelong disability due to neural tube defects. The three focus areas of Birth Defects COUNT are science, partnerships, and public health policy.

  1. Science. Develop and strengthen regional and in-country abilities to monitor birth defects, as well as develop and strengthen laboratory capacity to measure the amount of folate present in the blood (or blood folate concentration).
  2. Partnership. Engage a global network of partners who are experts in conducting birth defects prevention programs, tracking birth defects rates, monitoring blood folate concentrations, and developing interventions to increase the amount of folic acid consumed by women of childbearing age.
  3. Policy. Educate and inform decision makers on the benefits of fortification policies for preventing neural tube defects.

CDC’s activities support United Nations Millennium Development Goal 4, to reduce the mortality rate of children under-five, and improve global efforts to prevent neural tube defects.