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Many pregnant women in developing countries do not attend antenatal clinics to receive folate supplements. This motivated a controlled trial, which tested the efficacy of fortification of a staple food as a means of administering these supplements. Two hundred and sixty-eight blood specimens were taken from 38 women during the final month of pregnancy and were assayed for serum and red cell folate. Fortified maize meal porridge was given to 20 of these women in daily helpings, each of which contained 1 ,000 �zg crystalline folic acid before cooking. Patients receiving the porridge showed significant rises in both indices of folate nutrition. In unsupplemented patients, red cell folate concentration showed a mean weekly fall of 7 ng/ml. When viewed in the light of recommendations made by the Joint FAO/WHO Expert Committee on Nutrition, the findings of this study suggest that food fortification with folic acid is feasible, and should be instituted in areas where there is a high incidence of folate deficiency. Am. J. Clin. Nutr. 27: 339-344, 1974. Despite the effectiveness of simple replace

A discussion of milk fortification calls for consideration of the interests of both consumers and the dairy industry. The consumer is vitally interested in having an adequate supply of milk at a reasonable cost. He also is interested in any measures proposed for its modification. The dairy, industry is primarily concerned with obtaining the largest possible market for its products and therefore is interested in how any proposal for fortification may affect this market. Thus, the nutritional need for fortification becomes a basic question. I t is agreed by most nutrition scientists that certain steps which have been taken in the field of fortification, such as the enrichment of flour and bread, the iodization of salt, and the addition of vitamin D to milk, have proven advantageous for better nutrition and health. At the same time, it is recognized that the unlimited fortification of our food supply with specific nutrients is undesirable. The issues here involved caused the Council on Foods of the American Medical Association in 1939 and the Food and Nutrition Board of the National Research Council in 1941 to adopt certain policies regarding food fortification. In 1953 these bodies jointly l~considered, in the light of experience and uew developments, the policies which they had established over the intervening years. On December 18, 1953, they issued a "Joint Statement of General Policy in Regard to the Addition of Specific Nutrients to Foods," which has since been published? I t seems worth while to consider this policy statement in connection with the questions under consideration. The statement endorses "with carefully defined limitations" the principle of the addition of specific nutrients to certain staple foods for the purpose of maintaining good nutrition, as well as for correcting deficiencies in the diet of the genera] population or of significant segments of the population. The requirements for endorsement of a specific fortification are stated to be (a) clear indication of a probable advantage of an increased consumption of the nutrient in question, (b) assurance that the food

Spina bifida is one of the commonest neural tube defects. Though food fortification with folic acid has been reported to reduce spina bifida, the incidence of spina bifida and the benefits of taking folic acid have not been documented in many developing countries including Uganda. This study set out to determine the incidence of spina bifida and related skeletal neural tube defects in the skeletons currently housed in the Galloway skeletal collection at Makererere University College of Health Sciences, Anatomy department with the aim of using the data to extrapolate on the usefulness of food fortification with folic acid. This was a descriptive cross sectional study on 226 skeletons in the Galloway osteological collection examined by an experienced anatomist for features of neural tube defects that ranged from non-fusion of the spinal arches to total absence of vertebral structures. Of the skeletons examined 43/226 (19%) had spina bifida. Of these 38/43 (88%) were male, suggesting a higher incidence of spina bifida in males than in the females. Overall 55.2% of the skeletons were within the age range of 20-55 years. This historical study highlights possible differences in the maternal micro nutrient status in the early months of pregnancy for various African populations as shown by the differences in the prevalence rates of minor spina bifida defects in the Galloway osteological collection. There is need for baseline studies on folic acid levels during pregnancy and the various local dietary sources of folic acid for Africans.Key words: Neural tube defects, osteology

A variety of viewpoints in establishing a fortification rationale for specific foods is presented. The stability and technology of adding vitamins, minerals, and amino acids to foods is reviewed based on published and unpublished material.

Summary The decline in the nutritive quality of U. S. diets, 1955-1965, was largely a voluntary phenomenon reflecting a combination of socio-economic and cultural factors associated with increasing urban- ization, mobility, and changes in life styles accompanying the diffusion of affluence and diminishing poverty. The decline of nutritional content of diets was not overall but was limited to two nutrients, vitamins A and C. The decline in these two particular nutrients reflects a change from wide-variety to limited-variety food habits, together with the exercise of strong consumer preference for “fast” foods, low in vitamins A and C, and the neglect of fresh fruits and vegetables, rich in vitamins A and C. In view of the nature of decline in nutrient value of the nation's diets, 1955–1965, there are serious doubts that a major impact can be achieved in raising diet quality by the distribution of food stamps or selected commodities to a small and diminishing percent of the U.S. population classified as still below the poverty threshold (39). Rather, the evidence indicates only a massive pro- gram of nutrition education and perhaps food fortification and enrichment for the entire population can hope to have any overall effect in raising the quality of diets and restoring the former nutrient balance (40). If this is not done, it is a reasonable expectation that the quality of U. S. diets may continue to decline as discretionary per capita real income continues to rise.

Oral administration of the lipid-soluble allithiamins, thiamin propyl disulfide and thiamin tetrahydrofurfuryl disulfide, caused a significant increase in thiamin activity in whole blood, red blood cells, and cerebrospinal fluid equivalent to that produced by parenteral, water-soluble thiamin hydrochloride and thiamin pyrophosphate. In contrast, oral administra- tion of the water-soluble thiamins did not significantly elevate thiamin activity in biological fluids: this was probably due to their rate-limited intestinal transport. The odor of thiamin propyl disulfide limits its usefulness in multivitamins and food fortification. Thiamin tetrahydrofurfuryl disulfide is odorless and is therefore more useful for such purposes. Orally administered allithiamin vitamers are recommended for prophylaxis and treatment of thiamin deficits because they have the same biological properties as parenterally administered water-soluble thiamins. Am. J. C'lin. Nutr. 27: 676-680, 1974.