The prevalence and the magnitude of folate deficiency across the world are variable, with the condition occurring commonly in countries without folic acid fortification of cereal-grain products and rarely in countries with folic acid fortification. Several national surveys have shown that folate deficiency can be a public health problem in the absence of fortification. The primary age groups affected include pre-school children (33.8% of the folate-deficient population in Venezuela), pregnant women (48.8% in Costa Rica and 25.5% in Venezuela), and older people (15% in the UK). In the US, folate deficiency was present in school-age children (2.3% of the folate-deficient population), adults (24.5%), and older people (10.8%) before folic acid fortification. Mandatory folic acid fortification of enriched cereal-grain products was initiated in the US in 1996 and Canada in 1998. Subsequently, surveys of regional and nationally representative populations have shown that serum and red blood cell folate concentrations have increased in the general population in these countries.
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