Fortifying cereal-based gluten-free products with folic acid: A strategy to achieve the dietary reference values in children and adolescents with celiac disease

• Spanish celiac youth have folate intakes below 80% Dietary Reference Values (DRV). • Under 3% of commercial gluten-free (GF) products include added folic acid. • Fortifying with 60 μg folic acid/100 g GF foods meet DRV without exceeding safe limits. Celiac disease (CD) is an autoimmune enteropathy triggered by dietary gluten, affecting 1% of the global population. The only currently available treatment is the gluten-free (GF) diet, which is often associated with nutritional imbalances and deficiencies in both macronutrients and micronutrients, particularly folate. This study aimed first to assess the folate intake of children and adolescents with CD (n = 68) compared to healthy controls (n = 65) using three 24-hour dietary recalls and a food frequency questionnaire. Secondly, to evaluate the vitamin composition of cereal-based GF products available in the Spanish market, using a previously developed GF food database (GLUTENFREE-2019). And finally, simulate two scenarios of GF product fortification with folic acid (low (60 μg/100 g) and high (280 μg/100 g) as a strategy to prevent folate deficiency in children and adolescents with CD. Dietary assessments showed that folate intake among CD patients was significantly lower than that of controls ( p = 0.006) and fell below 80 % of the Dietary Reference Values (DRV), suggesting a higher risk of folate deficiency within youngsters with CD. The analysis of 629 GF products revealed that only ten were fortified with folic acid. The fortification model at a concentration of 60 μg/100 g proved to be adequate to cover DRV of children and adolescents with CD without exceeding tolerable upper intake levels. In conclusion, possible folate deficiencies in the young population with CD could be reduced by fortification of commercially available GF products.