British Journal of Nutrition

Dietary Surveys and Nutritional Epidemiology

Comparison of standardised dietary folate intake across ten countries participating in the European Prospective Investigation into Cancer and Nutrition

Jin Young Parka1 c1, Genevieve Nicolasa1, Heinz Freislinga1, Carine Biessya1, Augustin Scalberta1, Isabelle Romieua1, Véronique Chajèsa1, Shu-Chun Chuanga2, Ulrika Ericsona3, Peter Wallströma4, Martine M. Rosa5a6, Petra H. M. Peetersa7, Amalia Mattielloa8, Domenico Pallia9, José María Huertaa10a11, Pilar Amianoa11a12, Jytte Halkjæra13, Christina C. Dahma14a15, Antonia Trichopouloua16a17, Philippos Orfanosa16, Birgit Teuchera18, Silke Fellera19, Guri Skeiea20, Dagrun Engeseta20, Marie-Christine Boutron-Ruaulta21, Françoise Clavel-Chapelona21, Francesca Crowea22, Kay-Tee Khawa23, Paolo Vineisa2 and Nadia Slimania1

a1 Section of Nutrition and Metabolism, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon Cedex 08, France

a2 School of Public Health, Imperial College London, London, UK

a3 Diabetes and Cardiovascular Disease, Genetic Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden

a4 Nutrition Epidemiology Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden

a5 National Institute for Public Health and the Environment, Bilthoven, The Netherlands

a6 Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

a7 Julius Centre, University Medical Centre Utrecht, Utrecht, The Netherlands

a8 Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy

a9 Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, Florence, Italy

a10 Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain

a11 CIBER Epidemiología y Salud Pública, Spain

a12 Public Health Division of Gipuzkoa, Institute Investigation IIS BioDonostia, Basque Country Region, Spain

a13 Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark

a14 Department of Cardiology, Aalborg Hospital, Aarhus University Hospital, Aarhus, Denmark

a15 Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark

a16 WHO Collaborating Centre for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece

a17 Hellenic Health Foundation, Athens, Greece

a18 German Cancer Research Centre, Heidelberg, Germany

a19 Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany

a20 Department of Community Medicine, University of Tromsø, Tromsø, Norway

a21 Inserm, ERI 20, Institut Gustave Roussy, Villejuif, France

a22 Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK

a23 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK


Folate plays an important role in the synthesis and methylation of DNA as a cofactor in one-carbon metabolism. Inadequate folate intake has been linked to adverse health events. However, comparable information on dietary folate intake across European countries has never been reported. The objective of the present study was to describe the dietary folate intake and its food sources in ten countries in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. A cross-sectional analysis was conducted in 36 034 participants (aged 35–74 years) who completed a single 24 h dietary recall using a computerised interview software program, EPIC-Soft® (International Agency for Research on Cancer, Lyon). Dietary folate intake was estimated using the standardised EPIC Nutrient DataBase, adjusted for age, energy intake, weight and height and weighted by season and day of recall. Adjusted mean dietary folate intake in most centres ranged from 250 to 350 μg/d in men and 200 to 300 μg/d in women. Folate intake tended to be lower among current smokers and heavier alcohol drinkers and to increase with educational level, especially in women. Supplement users (any types) were likely to report higher dietary folate intake in most centres. Vegetables, cereals and fruits, nuts and seeds were the main contributors to folate intake. Nonetheless, the type and pattern of consumption of these main food items varied across the centres. These first comparisons of standardised dietary folate intakes across different European populations show moderate regional differences (except the UK health conscious group), and variation by sex, educational level, smoking and alcohol-drinking status, and supplement use.

(Received May 24 2011)

(Revised August 22 2011)

(Accepted September 20 2011)

(Online publication November 01 2011)


c1 Corresponding author: J. Y. Park, fax +33 4 72 73 83 61, email


Abbreviations: 24-HDR, 24 h dietary recall; ENDB, European Prospective Investigation into Cancer Nutrient DataBase; EPIC, European Prospective Investigation into Cancer and Nutrition