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Providing perspectives on recent research into vitamins and nutritionals


Fortification Costs are Inconsequential Compared to Alternatives

By Michael McBurney

Craziness. Just craziness. The thought that foods which aren’t processed, by that I mean foods which are not enriched and/or fortified, are better for you. Don’t believe me? Go to the USDA National Nutrient Database for Standard Reference Release 28 and see for yourself. Looking to buy pasta for dinner? You might be enticed by a whole grain pasta (51% whole wheat and unenriched semolina, NDB_No 20136) versus an enriched pasta (NDB_No 20120). If you read the rest of this blog, it should change your mind. The whole grain pasta has 23 µg folate per cup whereas the enriched variety has 216 µg. Almost a 10-fold difference!

In 1998, folic acid fortification of cereal grain products was mandated by US law. The CDC estimates that fortification has helped about 1,300 babies to be born without a neural tube defect (NTD) each year. The prevalence of NTDs has decreased 35% in the US. Beyond the emotional costs of having a baby born with a NTD, there are financial costs.

Grosse and colleagues report that folic acid fortification averts total direct costs of $607 in 2014 dollars each year, or $442 million excluding caregiver time costs. That assumes 767 averted live-born spin bifida cases annually and a constant cost per live-born case.  This is 3 times more than previously estimated. the average direct lifetime cost per infant with spina bifida is $791,900, or $577,000 excluding caregiving costs.

The 2015-2020 Dietary Guidelines for Americans emphasize the importance of eating nutrient-dense foods. Folic acid and iron are especially important for young  women who may become pregnant.  For a list of shortfall nutrients see the 2015-2020 Dietary Guidelines for Americans..

Everybody, and especially women of child-bearing age, choose fortified foods. Enriched/fortified foods contain more vitamins and minerals per serving and per 100 calories (vs unfortified equivalents).  The US Public Health Services and CDC recommend that all women of childbearing age consume 400 µg of folic acid daily. Please make wise choices. It can save everyone millions of dollars. And heartache for thousands.

Main Citation

Grosse SD, Berry RJ, Tilford JM, Kucik JE, Waitzman NJ. Retrospective assessment of cost savings from prevention. 2015 Prev Med doi: 10.1016/j.amepre.2015.10.012

Other Citations

Grosse SD, Waitzman NJ, Romano PS, Mulinare J. Reevaluating the benefits of folic acid fortification in the United States: economic analysis, regulation, and public health. 2005 Am J Publ Health doi: 10.2105/AJPH.2004.05889