Voluntary fortification is ineffective to maintain the vitamin B12 and folate status of older Irish adults: evidence from the Irish Longitudinal Study on Ageing (TILDA)

Mandatory fortification of staple grains with folic acid and/or vitamin B-12 (B-12) is under debate in many countries including Ireland, which has a liberal, but voluntary, fortification policy. Older adults can be at risk of both deficiency and high folate status, although little is known on the actual prevalence and the major predictors. Population prevalence estimates from older adults (n 5290 50 years) from the Irish Longitudinal Study on Ageing (TILDA) (Wave 1) are presented here. Measures included plasma total vitamin B-12 and folate, whereas predictors included detailed demographic, socio-economic, geographic, seasonal and health/lifestyle data. The prevalence of deficient or low B-12 status (<185 pmol/l) was 12 %, whereas the prevalence of deficient/low folate status was 15 %. High folate status (>45 nmol/l) was observed in 8.9 %, whereas high B-12 status was observed in 3.1 % (>601 pmol/l). The largest positive predictor of B-12 concentration was self-reported B-12 injection and/or supplement use (coefficient 51.5 pmol/; 95 % CI 9.4, 93.6; P=0.016) followed by sex and geographic location. The largest negative predictor was metformin use (-33.6; 95 % CI -51.9, -15.4; P<0.0001). The largest positive predictor of folate concentration was folic acid supplement use (6.0; 95 % CI 3.0, 9.0 nmol/l; P<0.001) followed by being female and statin medications. The largest negative predictor was geographic location (-5.7; 95 % CI -6.7, -4.6; P<0.0001) followed by seasonality and smoking. B-vitamin status in older adults is affected by health and lifestyle, medication, sampling period and geographic location. We observed a high prevalence of low B-12 and folate status, indicating that the current policy of voluntary fortification is ineffective for older adults.