Background: There is a critical need to estimate dietary folate intakes for nutrition monitoring and food safety evaluations, but available intake data are seriously limited by several factors. Objective: Our objective was to update 2 national food consumption surveys to reflect folate intakes as a result of the recently initiated food fortification program and to correct folate intakes for the apparently higher bioavailability of synthetic folic acid (SFA; ie, folate added to foods or from dietary supplements) than of naturally occurring folate so as to express intakes as dietary folate equivalents. Design: It was not possible to chemically analyze foods, so adjustments were made to food-composition data by using information about food ingredients and characteristics. Total folate intakes were estimated for several sex and age groups by using the modified data coupled with dietary supplement use. Results: Within the limitations of the data, our findings suggested that 67-95% of the population met or surpassed the new estimated average requirement, depending on the sex and age group and survey. Nonetheless, some subgroups had estimated intakes below these standards. Estimated SFA intakes suggested that Ϸ15-25% of children aged 1-8 y, depending on the survey, had intakes above the newly established tolerable upper intake level. We estimated that 68-87% of females of childbearing age had SFA intakes below the recommended intake of 400 g/d, depending on the age group and survey. Conclusion: There is a need to explore ways to improve folate intakes in targeted subgroups, including females of childbearing age, while not putting other population groups at risk of excessive intakes.

OBJECTIVES. This article uses folic acid as an example to illustrate some of the complex issues and general principles that emerge when evaluating fortification of the food supply as one possible means to address a public health recommendation. METHODS. Distributions of current daily folate intakes from conventional foods and dietary supplements were estimated. Intakes that might result from fortification of cereal-grain products and ready-to-eat cereals at various levels for eight age-gender groups were also estimated by using the US Department of Agriculture's 1987-1988 Nationwide Food Consumption Survey. RESULTS. The results illustrate that fortification of the US food supply tends to increase folate intakes of consumers at the high end of the intake distribution curves in the general population to a greater extent than it affects consumers at the low end of the intake distribution curves in the target population. CONCLUSIONS. The effectiveness of food fortification options for a target population and the safety for the general population impose conflicting challenges that must be considered concurrently when making decisions about fortifying the US food supply.

IntrodwtonThe monitoring of the US population's dietary intake and nutritional status received considerable attention in the last decade.1,2 In the next decade, nutrition monitoring will receive increased attention with the passage of the National Nutrition Monitoring and Related Research Act of 1990.3 The estimation of trends in food and nutrient intake by US population groups, although not a measure of change in US population nutritional status per se, will continue to be a priority for several reasons. These data can be used to help (1) form national nutrition objectives and monitor progress toward their achievement-6; (2) form national nutrition policies and interventions; and (3) form and, to a lesser extent, test hypotheses about the relationship between diet and certain chronic diseases, such as coronary heart disease7-10 and cancer.11-'5 Two types of data may be used to estimate trends over time in food and nutrient intake by the US population: (1) annual estimates of foods and nutrients available for consumption as measured from US food supply data (henceforth referred to as food supply estimates) and (2) periodic estimates offood and nutrient intake by individuals as measured from national food consumption surveys of individuals (henceforth referred to as survey intake estimates). Historically, the more frequent per capita food supply estimates, which are available from the turn of the century, have most often been used for this purpose.7-16The main objective ofthis studywas to examine whether trends in macronutrient levels of the food supply can be used as a

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