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101.79 Health claims: Folate and neural tube defects.

Home > Regulations > Food labeling > 101.79 Health claims: Folate and neural tube defects.



[Code of Federal Regulations]
[Title 21, Volume 2]
[Revised as of April 1, 2006]
From the U.S. Government Printing Office via GPO Access
[CITE: 21CFR101.79]

[Page 135-138]
 
                        TITLE 21--FOOD AND DRUGS
 
CHAPTER I--FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN 
                          SERVICES (CONTINUED)
 
PART 101_FOOD LABELING--Table of Contents
 
            Subpart E_Specific Requirements for Health Claims
 
Sec.  101.79  Health claims: Folate and neural tube defects.

    (a) Relationship between folate and neural tube defects--(1) 
Definition. Neural tube defects are serious birth defects of the brain 
or spinal cord that can result in infant mortality or serious 
disability. The birth defects anencephaly and spina bifida are the most 
common forms of neural tube defects and account for about 90 percent of 
these defects. These defects result from failure of closure of the 
covering of the brain or spinal cord during early embryonic development. 
Because the neural tube forms and closes during early pregnancy, the 
defect may occur before a woman realizes that she is pregnant.
    (2) Relationship. The available data show that diets adequate in 
folate may reduce the risk of neural tube defects. The strongest 
evidence for this relationship comes from an intervention study by the 
Medical Research Council of the United Kingdom that showed that women at 
risk of recurrence of a neural tube defect pregnancy who consumed a 
supplement containing 4 milligrams (mg)(4,000 micrograms (mcg)) folic 
acid daily before conception and continuing into early pregnancy had a 
reduced risk of having a child with a neural tube defect. (Products 
containing this level of folic acid are drugs). In addition, based on 
its review of a Hungarian intervention trial that reported 
periconceptional use of a multivitamin and multimineral preparation 
containing 800 mcg (0.8 mg) of folic acid, and its review of the 
observational studies that reported periconceptional use of 
multivitamins containing 0 to 1,000 mcg of folic acid, the Food and Drug 
Administration concluded that most of these studies had results 
consistent with the conclusion that folate, at levels attainable in 
usual diets, may reduce the risk of neural tube defects.
    (b) Significance of folate--(1) Public health concern. Neural tube 
defects occur in approximately 0.6 of 1,000 live births in the United 
States (i.e., approximately 6 of 10,000 live births; about 2,500 cases 
among 4 million live births annually). Neural tube defects are believed 
to be caused by many factors. The single greatest risk factor for a 
neural tube defect-affected pregnancy is a personal or family history of 
a pregnancy affected with a such a defect. However, about 90 percent of 
infants with a neural tube defect are born to women who do not have a 
family history of these defects. The available evidence shows that diets 
adequate in folate may reduce the risk of neural tube defects but not of 
other birth defects.
    (2) Populations at risk. Prevalence rates for neural tube defects 
have been reported to vary with a wide range of factors including 
genetics, geography, socioeconomic status, maternal birth cohort, month 
of conception, race, nutrition, and maternal health, including maternal 
age and reproductive history. Women with a close relative (i.e., 
sibling, niece, nephew) with a neural tube defect, those with insulin-
dependent diabetes mellitus, and women with seizure disorders who are 
being treated with valproic acid or carbamazepine are at significantly 
increased risk compared with women without these characteristics. Rates 
for neural tube defects vary within the United States, with lower rates 
observed on the west coast than on the east coast.
    (3) Those who may benefit. Based on a synthesis of information from 
several studies, including those which used multivitamins containing 
folic acid at a daily dose level of =400 mcg (=0.4 
mg), the Public Health Service has inferred that folate alone at levels 
of 400 mcg (0.4 mg) per day may reduce the risk of neural tube defects. 
The protective effect found in studies of lower dose

[[Page 136]]

folate measured by the reduction in neural tube defect incidence, ranges 
from none to substantial; a reasonable estimate of the expected 
reduction in the United States is 50 percent. It is expected that 
consumption of adequate folate will avert some, but not all, neural tube 
defects. The underlying causes of neural tube defects are not known. 
Thus, it is not known what proportion of neural tube defects will be 
averted by adequate folate consumption. From the available evidence, the 
Public Health Service estimates that there is the potential for averting 
50 percent of cases that now occur (i.e., about 1,250 cases annually). 
However, until further research is done, no firm estimate of this 
proportion will be available.
    (c) Requirements. The label or labeling of food may contain a 
folate/neural tube defect health claim provided that:
    (1) General requirements. The health claim for a food meets all of 
the general requirements of Sec.  101.14 for health claims, except that 
a food may qualify to bear the health claim if it meets the definition 
of the term ``good source.''
    (2) Specific requirements--(i) Nature of the claim--(A) 
Relationship. A health claim that women who are capable of becoming 
pregnant and who consume adequate amounts of folate daily during their 
childbearing years may reduce their risk of having a pregnancy affected 
by spina bifida or other neural tube defects may be made on the label or 
labeling of food provided that:
    (B) Specifying the nutrient. In specifying the nutrient, the claim 
shall use the terms ``folate,'' ``folic acid,'' ``folacin,'' ``folate, a 
B vitamin,'' ``folic acid, a B vitamin,'' or ``folacin, a B vitamin.''
    (C) Specifying the condition. In specifying the health- related 
condition, the claim shall identify the birth defects as ``neural tube 
defects,'' ``birth defects spina bifida or anencephaly,'' ``birth 
defects of the brain or spinal cord anencephaly or spina bifida,'' 
``spina bifida and anencephaly, birth defects of the brain or spinal 
cord,'' ``birth defects of the brain or spinal cord;'' or ``brain or 
spinal cord birth defects.''
    (D) Multifactorial nature. The claim shall not imply that folate 
intake is the only recognized risk factor for neural tube defects.
    (E) Reduction in risk. The claim shall not attribute any specific 
degree of reduction in risk of neural tube defects from maintaining an 
adequate folate intake throughout the childbearing years. The claim 
shall state that some women may reduce their risk of a neural tube 
defect pregnancy by maintaining adequate intakes of folate during their 
childbearing years. Optional statements about population-based estimates 
of risk reduction may be made in accordance with paragraph (c)(3)(vi) of 
this section.
    (F) Safe upper limit of daily intake. Claims on foods that contain 
more than 100 percent of the Daily Value (DV) (400 mcg) when labeled for 
use by adults and children 4 or more years of age, or 800 mcg when 
labeled for use by pregnant or lactating women) shall identify the safe 
upper limit of daily intake with respect to the DV. The safe upper limit 
of daily intake value of 1,000 mcg (1 mg) may be included in 
parentheses.
    (G) The claim shall state that folate needs to be consumed as part 
of a healthful diet.
    (ii) Nature of the food--(A) Requirements. The food shall meet or 
exceed the requirements for a ``good source'' of folate as defined in 
Sec.  101.54;
    (B) Dietary supplements. Dietary supplements shall meet the United 
States Pharmacopeia (USP) standards for disintegration and dissolution, 
except that if there are no applicable USP standards, the folate in the 
dietary supplement shall be shown to be bioavailable under the 
conditions of use stated on the product label.
    (iii) Limitation. The claim shall not be made on foods that contain 
more than 100 percent of the RDI for vitamin A as retinol or preformed 
vitamin A or vitamin D per serving or per unit.
    (iv) Nutrition labeling. The nutrition label shall include 
information about the amount of folate in the food. This information 
shall be declared after the declaration for iron if only the levels of 
vitamin A, vitamin C, calcium, and iron are provided, or in accordance 
with Sec.  101.9 (c)(8) and (c)(9) if other optional vitamins or 
minerals are declared.

[[Page 137]]

    (3) Optional information--(i) Risk factors. The claim may 
specifically identify risk factors for neural tube defects. Where such 
information is provided, it may consist of statements from Sec.  
101.79(b)(1) or (b)(2) (e.g., Women at increased risk include those with 
a personal history of a neural tube defect-affected pregnancy, those 
with a close relative (i.e., sibling, niece, nephew) with a neural tube 
defect; those with insulin-dependent diabetes mellitus; those with 
seizure disorders who are being treated with valproic acid or 
carbamazepine) or from other parts of this paragraph (c)(3)(i).
    (ii) Relationship between folate and neural tube defects. The claim 
may include statements from paragraphs (a) and (b) of this section that 
summarize the relationship between folate and neural tube defects and 
the significance of the relationship except for information specifically 
prohibited from the claim.
    (iii) Personal history of a neural tube defect-affected pregnancy. 
The claim may state that women with a history of a neural tube defect 
pregnancy should consult their physicians or health care providers 
before becoming pregnant. If such a statement is provided, the claim 
shall also state that all women should consult a health care provider 
when planning a pregnancy.
    (iv) Daily value. The claim may identify 100 percent of the DV (100% 
DV; 400 mcg) for folate as the target intake goal.
    (v) Prevalence. The claim may provide estimates, expressed on an 
annual basis, of the number of neural tube defect-affected births among 
live births in the United States. Current estimates are provided in 
Sec.  101.79(b)(1), and are approximately 6 of 10,000 live births 
annually (i.e., about 2,500 cases among 4 million live births annually). 
Data provided in Sec.  101.79(b)(1) shall be used, unless more current 
estimates from the U.S. Public Health Service are available, in which 
case the latter may be cited.
    (vi) Reduction in risk. An estimate of the reduction in the number 
of neural tube defect-affected births that might occur in the United 
States if all women consumed adequate folate throughout their 
childbearing years may be included in the claim. Information contained 
in paragraph (b)(3) of this section may be used. If such an estimate 
(i.e., 50 percent) is provided, the estimate shall be accompanied by 
additional information that states that the estimate is population-based 
and that it does not reflect risk reduction that may be experienced by 
individual women.
    (vii) Diets adequate in folate. The claim may identify diets 
adequate in folate by using phrases such as ``Sources of folate include 
fruits, vegetables, whole grain products, fortified cereals, and dietary 
supplements.'' or ``Adequate amounts of folate can be obtained from 
diets rich in fruits, dark green leafy vegetables, legumes, whole grain 
products, fortified cereals, or dietary supplements.'' or ``Adequate 
amounts of folate can be obtained from diets rich in fruits, including 
citrus fruits and juices, vegetables, including dark green leafy 
vegetables, legumes, whole grain products, including breads, rice, and 
pasta, fortified cereals, or a dietary supplement.''
    (d) Model health claims. The following are examples of model health 
claims that may be used in food labeling to describe the relationship 
between folate and neural tube defects:
    (1) Examples 1 and 2. Model health claims appropriate for foods 
containing 100 percent or less of the DV for folate per serving or per 
unit (general population). The examples contain only the required 
elements:
    (i) Healthful diets with adequate folate may reduce a woman's risk 
of having a child with a brain or spinal cord birth defect.
    (ii) Adequate folate in healthful diets may reduce a woman's risk of 
having a child with a brain or spinal cord birth defect.
    (2) Example 3. Model health claim appropriate for foods containing 
100 percent or less of the DV for folate per serving or per unit. The 
example contains all required elements plus optional information: Women 
who consume healthful diets with adequate folate throughout their 
childbearing years may reduce their risk of having a child with a birth 
defect of the brain or spinal cord. Sources of folate include

[[Page 138]]

fruits, vegetables, whole grain products, fortified cereals, and dietary 
supplements.
    (3) Example 4. Model health claim appropriate for foods intended for 
use by the general population and containing more than 100 percent of 
the DV of folate per serving or per unit: Women who consume healthful 
diets with adequate folate may reduce their risk of having a child with 
birth defects of the brain or spinal cord. Folate intake should not 
exceed 250% of the DV (1,000 mcg).

[61 FR 8779, Mar. 5, 1996; 61 FR 48529, Sept. 13, 1996, as amended at 65 
FR 58918, Oct. 3, 2000]





Additives that reference this regulation:


Source: U.S. Code of Federal Regulations - CFR Title 21, Part 101, Section 79


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