FSA recommends mandatory folic acid fortification for bread
acid fortification of bread in the UK, in an effort to reduce the
incidence of pregnancies affected by neural tube defects (NTDs).
At its open board meeting in London, the agency will ask its board to consider the latest research for and against fortification, and present the opinion of the Scientific Advisory Committee on Nutrition (SACN) that neither continuing voluntary fortification nor raising more awareness of folate amongst women of childbearing age will alone have an effect on NTD incidence.
Spina bifida and anencephaly are the most common NTDs. Both conditions occur in the very early stages of pregnancy, often before women are aware that they are expecting.
It is estimated that between 700 and 900 pregnancies are affected by NTDs in the UK each year - including terminations as a result of detection but not including miscarriages.
Dietary folate is known to reduce the risk of these conditions. It occurs naturally in foods such as grains, lentils, chick peas and green leafy vegetables. Folic acid is a synthetic form of the nutrient which, according to the National Council on Folic Acid in the US, is actually better absorbed by the human body.
Mandatory fortification of flour with folic acid is already in place in several countries, including the US, Canada, and Chile. A 30 to 50 percent reduction in NTDs has been seen in these countries since fortification began.
For the UK, the FSA said in a document published in advance of the meeting that: "Bread would be an appropriate vehicle because it has a relatively uniform consumption across subgroups of the population."
This would mean that folate consumption would increase in a predictable way across the population.
Consultations with the bakery industry has indicated that the preferred point of fortification would be at the milling stage (with the exception of wholemeal flour), rather than at the bread-making stage.
This is because there is already a requirement in place to fortify milled flour with iron, calcium, thiamine and niacine, so the new requirement would build on existing technology and regulation.
It would also mean that wholemeal bread would be excluded from the requirement, providing an alternative to those who would prefer not to have increased levels of folic acid in their diet.
The Federation of Bakers indicated today that it would fully support mandatroy fortification. Director Gordon Polson said: "Any decision to mass medicate the population must be made by government not by industry and only then after the fullest possible consultation with consumers and other interested parties."We would support any decision to fortify flour should the government decide it appropriate. In the meantime Federation members will continue to fortify certain products with folic acid, on a voluntary basis."Wholemeal bread naturally contains 40 micrograms of folate per 100g, compared to 25 micrograms for white bread.
The level of the proposed fortification has not yet been determined, but would likely be between 100 and 450 microgrames per 100g.
In the US, the level is 140 micrograms of folic acid per 100 grams of grain (across all grain products, including bread, pasta, cereal, rice and flour). But some campaigners have recently been calling for an increase in levels to 280 or even 350 micrograms per 100 grams.
The cost of mandatory folic acid at the milling stage is estimated by industry to be in the region of £700,000 per year, although this will depend on the precise requirements.
Following discussions with the industry, the FSA said that there is unlikely to be opposition from that quarter, "subject to labelling and trade concerns being addressed".
The current advice is that all adults consume 200 micrograms of folate per day, and that women consume an additional 400 micrograms prior to conception and during the first 12 weeks of pregnancy.
However surveys have shown that only a quarter of women actually follow this advice.
What is more, half of all UK pregnancies are unplanned, and by the time a woman realises she is pregnant the damage may already have been done.
UK women of childbearing age typically consume between 66g and 68g of flour per day.
According to the document, mandatory fortification would not replace the advice that women supplement their diet with folic acid, but rather complement this advice.
This is not the first time that the FSA has considered mandatory fortification. In 2002 SACN opted not to adopt it because of concerns that folate consumption in excess of 1000 micrograms per day could delay the detection of vitamin B12 deficiency in older people, which can have severe neurological consequences.
However the latest research indicates that B12 deficiency would be masked only with folate consumption of more than 5000 micrograms per day.
The document also said that some lobbyists have opposed mandatory fortification in the past, on the grounds of consumer choice.
Sue Croft of Consumers for Health Choice told NutraIngredients.com that her organisation is very much opposed to mandatory fortification.
"We feel what is needed is better education of women of childbearing age about the consequences of not consuming enough folate. We should still have the choice if we are not in that group."
She expressed concern that the B12 deficiency issue in older people has still not been fully addressed.
"The elderly eat a lot of bread because it is cheap and it is filling," she said.
