Researchers: Flour Should Be Fortified with Folic Acid
According to a recent study published by Public Health Reviews in the UK, the correct public health policy message is a simple one: flour should be fortified with folic acid.
The discussion regarding fortifying flour with folic acid is not new, but new evidence now shows that the neural tube defects (NTD) anencephaly and spina bifida are two of the most common serious congenital malformations.
On average, folic acid intake should be increased by at least 0.2 mg a day and preferably by about 0.4 mg, as was done in Chile, resulting in an approximate halving in the pregnancy prevalence of NTDs. The use of an upper intake level (the highest level of intake that is likely to pose no risk of adverse health effects for almost all individuals in the general population) for folate should be abandoned, according to “Public health failure in the prevention of neutral tube defects: time to abandon the tolerable upper intake level of folate” study, Nicholas J. Wald, Joan K. Morris and Colin Blakemore.
About 1–2 in every 1,000 pregnancies are affected and are either terminated following prenatal screening and diagnosis, or result in births with fatal or severely disabling malformations. While NTDs can be prevented by increasing the consumption of folic acid in the population, this is not being achieved in practice in many parts of the world.
While folic acid is added to flour in more than 80 countries worldwide, the UK and other countries from the Western and Central Europe have previously held off.
Pregnant women are advised to take folic acid tablets, but many don’t.
The researchers say this view has driven a preference for the use of pre-pregnancy folic acid supplements instead of folic acid fortification, when they are, in fact, complementary interventions: neither is a complete substitute for the other. “Fortification alone does not achieve full protection, but it provides a population safety net that contributes to the overall preventive effect, particularly important for the large number of women who have not taken supplements before becoming pregnant,” according to the study.
The study also mentions that the Institute of Medicine (IOM) of the National Academies (formerly National Academy of Sciences) in the USA found no evidence of harm from folic acid or food folate in respect of toxicology, reproductive, and developmental health or cancer.