In the past, food fortification along with nutritional education and the decrease in food costs relative to income have proven successful in eliminating common
nutritional deficiencies. These deficiencies such as
goiter,
rickets,
beriberi, and
pellagra have been replaced with an entirely new set of "emergent deficiencies" that were not previously considered a problem [e.g.,
folate and
neural tube defects (NTDs)]. In addition, the different nutrition surveys in so-called affluent countries have identified "shortfalls" of nutrients specific to various age groups and/or physiological status. Complex, multiple-etiology diseases, such as
atherosclerosis, diabetes,
cancer, and
obesity have emerged. Food fortification has proven an effective tool for tackling
nutritional deficiencies in populations; but today a more reasonable approach is to use food fortification as a means to support but not replace dietary improvement strategies (i. e. nutritional education campaigns).
Folic acid (FA) is a potential relevant factor in the prevention of a number of pathologies. The evidence linking FA to NTD prevention led to the introduction of public health strategies to increase
folate intakes: pharmacological supplementation, mandatory or voluntary fortification of staple foods with FA, and the advice to increase the intake of
folate-rich foods. It is quite contradictory to observe that, regardless of these findings, there is only limited information on food
folate and FA content. Data in Food Composition Tables and Databases are scarce or incomplete. Fortification of staple foods with FA has added difficulty to this task. Globally, the decision to fortify products is left up to individual food manufacturers. Voluntary fortification is a common practice in many countries. Therefore, the "worldwide map of
vitamin fortification" may be analyzed. It is important to examine if fortification today really answers to
vitamin requirements at different ages and/or physiological states. The real impact of
vitamin fortification on some key
biomarkers is also discussed. An important question also to be addressed: how much is too much? It is becoming more evident that chronic excessive intakes may be harmful and a wide margin of safety seems to be a mandatory practice in dietary recommendations. Finally, the "risk/benefit" dilemma is also considered in the "new" FA-fortified world.