Prevalence of inadequate intake of folate after mandatory fortification: results from the first National Dietary Survey in Brazil

  • Cecília Zanin Palchetti
  • Josiane Steluti
  • Eliseu VerlyJr.
  • Rosangela A. Pereira
  • Rosely Sichieri
  • Dirce Maria Lobo MarchioniEmail author
Original Contribution



Our aim was to estimate the prevalence of folate inadequacy (POFI) according to life stage, socio-economic status, and geographical regions after the mandatory fortification of wheat and maize flour in Brazil.


This was a population-based study. Data from two non-consecutive food records from the National Dietary Survey/Household Budget Survey 2008–2009 were used to estimate the usual dietary folate intake in µg dietary folate equivalents (DFEs). The National Cancer Institute method was used to account for within-person variance and the Estimated Average Requirement (EAR) cut-point method was used to calculate the POFI. The survey included 32,749 individuals, 15,700 males and 17,049 females, over 10 years old. Pregnant women, lactating women, and individuals with unreliable energy intake data were excluded.


Overall POFI was 31.5% and mean dietary folate intake was 411.1 µg DFE. The lowest POFI occurred in the youngest age group of 10–13 years in both sexes, while the highest POFI was observed in the group ≥ 71 years. In women of childbearing age, POFI was around 32%. The lowest income strata had the highest POFI. The most developed regions (South and Southeast) had the lowest POFI compared to less developed regions.


Our data show that folate inadequacy is still prevalent in Brazil mainly in low-income groups and less developed regions. Actions need to be taken to ensure that women of childbearing age, who presented a high prevalence of inadequate folate intake, achieve the recommended daily intake of 400 µg DFEs.


Folate Folic acid Mandatory food fortification Survey 


Author contributions

CZP, EVJ, JS drafted the manuscript and analyzed the data. EVJ assisted with statistical analyses, CZP, EVJ, JS, DMM interpreted the data and provided critical feedback. RS, RAP, DMM designed the research and were involved in all aspects of the manuscript from analyses to writing. All authors read and approved the final manuscript.


The study analyzed secondary data from the survey NDS/HSB 2008–2009 (IBGE), which was funded by the Brazilian Ministry of Health. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorBrasil (CAPES)—Finance Code 001. C.Z.P. is supported by a grantship from CAPES.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standards disclosure

This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the ethics committee of the Institute of Social Medicine of State University of Rio de Janeiro (CAAE 0011.0.259.000-11). All data were obtained from secondary sources and available publicly. Written informed consent was obtained from all subjects/patients.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Cecília Zanin Palchetti
    • 1
  • Josiane Steluti
    • 1
  • Eliseu VerlyJr.
    • 2
  • Rosangela A. Pereira
    • 3
  • Rosely Sichieri
    • 2
  • Dirce Maria Lobo Marchioni
    • 1
    Email author
  1. 1.Department of Nutrition, School of Public HealthUniversity of Sao Paulo (USP)Sao PauloBrazil
  2. 2.Institute of Social Medicine, Rio de Janeiro State University (UERJ)Rio De JaneiroBrazil
  3. 3.Department of NutritionFederal University of Rio de Janeiro (UFRJ)Rio De JaneiroBrazil

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