Folic acid should be added to UK flour, expert report
to a panel of experts advising the government.
Their report, which points to the proven benefit of folate in protecting babies from birth defects, is still in draft form but it may lead to a change in UK policy.
Some manufacturers already add folic acid to flour but the Scientific Advisory Committee on Nutrition (SACN), a group of independent experts that advises the UK's food authorities and health department, recommends it is made compulsory along with a strategy to manage vitamin B12 deficiencies in the over-65s.
Trials first showed more than a decade ago that folic acid can reduce the occurrence of neural tube defects, such as spina bifida. In recent years the US, Canada, Chile and the Czech Republic, have all introduced mandatory fortification of flour with folic acid to ensure that all pregnant women are receiving adequate amounts of the nutrient.
Yet even though these initiatives have paid off - recent research shows that in both Chile and Canada the prevalence of neural-tube defects among both unborn and newborn children has halved - most European countries have been cautious about taking the same step, despite pressure from medical experts.
Many have argued that there could be possible side-effects from a wide-ranging fortified food initiative. The UK said in May 2002 that an investigation into flour fortification raised concerns that such a move could mask a deficiency of vitamin B12 in elderly people.
Folic acid can remedy anaemia caused by a lack of B12 but this threatens to delay treatment for the underlying B12 deficiency, which can cause neurological damage.
But after further investigation, the SACN said yesterday that "mandatory fortification of flour with folate should be introduced" as long as proper consideration is given to a number of related issues.
These include the level of fortification and the form of folate to be used, as well as consideration of overages in food fortification, and consumption of other foods that have been voluntarily fortified.
According to the report, folic acid intakes appear to have increased in the US population by more than twice that originally intended, presumably due to overages.
Further, "the incidence, prevalence, and management strategy for vitamin B12-deficiency in people aged 65 years and over, should be assessed," it said.
Up to 6,000 people aged 65 and over could be at risk if flour fortification is introduced.
COMA, the Committee on the Medical Aspects of Food Policy, has previously estimated that folic acid fortification of flour at 240mcg per 100g would result in a 41 per cent lower incidence of neural tube defects in births, or 156 babies in 2002, the assessed period.
The report also noted that "there are no data that demonstrate that folic acid, at doses of 1000 mcg per day or less, can mask the diagnosis of vitamin B12 deficiency in the short term. There are no data from countries that have introduced fortification that could help provide clarification".
In those countries that do fortify flour, doses of between 150 - 300 mcg are being used per 100g of flour.
Ireland is currently looking at a mandatory initiative with a lower level -120mcg per 100g flour. New Zealand and Australia are also currently consulting on folic acid fortification.
Although most countries recommend the use of folic acid supplements for women looking to conceive, evidence suggests that this is not enough, as only a certain segment of the population can afford to use supplements. Also, this policy fails to account for the high number of unplanned pregnancies.
The SACN is calling for comments on its report before the final version is agreed, and published in spring 2006. The FSA will then consult on SACN's recommendations before taking a final decision on fortification.
A full copy of the SACN draft report can be found on its website. The deadline for comments is 18 January 2006.