Folate is essential for healthy growth and development. Fortification of foods with folic acid can improve folate status and reduce the risk of neural tube defects (NTD). Following concern around folate status in the UK, the UK government announced in 2021 the intention to introduce mandatory folic acid fortification.
The objective was to describe folate status in the UK population prior to the implementation of mandatory folic acid fortification of non-wholemeal wheat flour and to assess trends in folate status, including in females of reproductive age (FRA).
Data were from the UK National Diet and Nutrition Survey Rolling Programme (2008-2019), a cross-sectional, nationally-representative survey of children and adults aged 1.5+ years (n 5,792 with folate result). Serum folate concentration was measured by liquid chromatography tandem mass spectrometry (LC-MS/MS) and red blood cell (RBC) folate concentration by microbiological assay. Concentration data were compared against method-specific cut-offs and thresholds, and relationships explored against demographic and lifestyle characteristics.
RBC and serum folate concentration significantly decreased by ∼3 percentage points per year between 2008 and 2019 in all age/sex groups. Prevalence of deficiency (RBC folate <305 nmol/L) was highest in children aged 11-18 years (17% in 2016-19). The proportion of FRA below the cut-off for increased risk of NTD (RBC folate <748 nmol/L), increased from 69% to 89% between 2008 and 2019. Ethnicity, smoking status and income were significant determinants of RBC and serum folate concentrations.
These data reveal a decline in population folate status in the UK between 2008 and 2019 and, a high prevalence of folate deficiency. A high proportion of FRA had RBC folate concentrations below the cut-off for increased risk of NTD. These data provide information on folate status in a population not currently exposed to mandatory folic acid fortification, and are essential to model and assess its impact.

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