The United Kingdom’s Food Standards Agency is to consult consumers on mandatory food fortification with folic acid to help prevent neural tube defects. A 12 week consultation will start in May 2006, in which the agency will seek the views of consumers, industry, and other stakeholders.
In addition, the agency’s board has requested clarification on the subject from the independent scientific advisory committee on nutrition, which advises the government. The agency will then make a recommendation to UK health ministers in September.
The committee estimates, in its draft report on folate and disease prevention, that 700-900 pregnancies are affected by neural tube defects in the UK each year. An unknown number of miscarriages also result.
Countries that have introduced mandatory fortification—Chile, Canada, and the United States—have reduced the risk of affected pregnancies by 30-50%.
Masking of the symptoms due to vitamin B12 deficiency in elderly people has been a theoretical concern of food fortification. But the advisory committee states that evidence now shows that even 1000 micrograms a day of folic acid—far in excess of what fortification of flour produces by itself—would not cause delays in the diagnosis of vitamin B-12 deficiency in older people. This is consistent with expert opinions from the UK, US, and European Union.
The draft proposal put to the food agency’s board on 6 April by the agency’s executive members clearly favoured fortification of bread or flour, in line with the advice of the advisory committee. The key original option was to agree that mandatory fortification be presented as the preferred option, subject to the findings of the consultation. But the board decided to remain neutral on its preferences. The options now under consideration are:
Maintain the status quo and do nothing at this stage
Encourage young women to take supplements and change their diet to include folate rich foods
Further encourage voluntary fortification of foods
Implement mandatory fortification of the most appropriate food.
Deirdre Hutton, the agency’s chairwoman, said that the board had requested key information in the areas of trade issues (control over imported food); acceptability to the public of mandatory fortification of food; scientific issues; and other routes of fortification.
The chief executive of the Association for Spina Bifida and Hydrocephalus, Andrew Russell, expressed disappointment that the preferred option that had been drafted had been revised: “I hope that eventually the [Food Standards Agency] will come out with a recommendation based on the science on what [the scientific advisory committee on nutrition] have put to them.”