Researchers call for mandatory EU folic acid flour fortification
The European Union must embrace a mandatory folic acid flour fortification program given the prevalence of neural tube defects (NTDs) in newborns across the region, say researchers.
The calls have been made in a review published in Nutrition Bulletin that said folic acid fortification of wheat flour is a cost-effective, primary prevention public health strategy that Europe should take on.
“NTDs are prevalent in Europe, with certain regions in France, Germany, Switzerland and the UK bearing a significant burden. Because most NTDs detected in pregnancy in the EU are terminated, European countries require proven interventions that reduce the risk of NTD-affected pregnancies,” the researchers wrote.
The review said an estimated 4,500 NTDs occur in the 27 EU countries each year, with 72% resulting in terminations.
“For more than a decade, it has been successfully legislated in countries around the world with remarkable reductions in NTDs and cost savings,” they added.
“…Evidence on the cost-effectiveness of folic acid fortification has been unequivocal across different geographic regions that have successfully implemented the policy, providing encouraging evidence for more countries to follow mandatory fortification.”
Flour fortification ideal for Europeans, the UK should start
The researchers said a flour fortification program across the EU would be successful because of the widespread consumption of wheat flour-based products. They added that the region has a technologically advanced milling industry and experience with mandatory salt fortification which would aid implementation.
The UK sets a precedent in the region given the country has followed a program of adding calcium, thiamine, niacin and iron to white wheat flour for over 50 years, the researchers said.
If millers in the UK started to proceed with mandatory folic acid fortification in their flour, other countries with notable figures of NTDs will likely follow suit, they added.
However, the review said that in early 2013 a final decision on folic acid flour fortification was still pending with the UK Department of Health after lengthy discussions.
‘Commonly voiced concerns not backed by science’
The review said commonly voiced concerns are preventing the adoption of mandatory flour fortification, but many “are not supported by current scientific evidence and medical practice”.
One fear quashed in the review is that excessive folic acid intake can cause harm. “Evidence from the USA shows that fortification alone does not cause adults and children to consume more than the age-specific upper intake level of folic acid,” the researchers said.
Other fears associated with folic acid fortification was that it could cause cancer and mask vitamin B12 deficiency, the review said, but the researchers flagged a host of research that they said proves otherwise.
The review did note that if the EU did take on mandatory fortification, an obstacle to tackle would be the negative association among European consumers on anything ‘artificial’ added to their food. However, researchers argued that there are plenty of additives already used routinely in flour production across the EU.
“The main concerns associated with mandatory folic acid fortification have been addressed through research and country experiences and thus should no longer be cited as reasons not to fortify. Additionally, mandatory flour fortification programs are tailored to the population’s specific nutritional needs, include monitoring measures to ensure quality, and are more likely to equitable reach vulnerable populations,” the researchers said.
Folic acid fortification is mandatory is 75 countries worldwide. To see more on that click here .
Source: Nutrition Bulletin
First published online on 15 May 2013, ahead of print, doi: 10.111/nbu.12023
“Folic acid fortification of wheat flour: A cost-effective public health intervention to prevent birth defects in Europe”
Authors: H. Pachón [Flour Fortification Initiative, Atlanta USA and Department of Global Health, Emory University, Atlanta USA]
V. Kancherla [ Department of Epidemiology, Emory University, Atlanta USA]
B. Handforth [Flour Fortification Initiative, Atlanta USA], V. Tyler [UNICEF, Geneva Switzerland]
L. Bauwens [International Federation for Spina Bifida and Hydrocephalus, Brussels Belgium]
