Board recommends mandatory fortification

Thursday 17 May 2007

The FSA's Board has today agreed unanimously that a form of mandatory fortification of a food with folic acid should be recommended to UK health ministers as part of a package of measures to help prevent neural tube defects, which can result in miscarriage, neonatal death or lifelong disability.

At its open meeting in Nottingham, the Board asked for further work to consider whether folic acid should be added to either bread or flour and agreed that controls on voluntary fortification were an essential part of its recommendation.

The Board sent a strong message to Health Departments that they need to carry out further work on this issue to educate the public and, in particular, potentially at-risk groups.

During its discussions, the Board debated a range of options to increase folate intakes of young women in order to prevent pregnancies affected by NTDs such as spina bifida. Currently, there are 700-900 such pregnancies each year.

The Board's decision to recommend adding folic acid to either bread or flour will also improve the diets of 13 million people who currently don’t eat enough folate.

The Board wants controls on voluntary addition of folic acid to products such as breakfast cereals and spreads. It also wants clearer public advice on the taking of supplements to prevent over-consumption by some groups.

The Board’s decision was made during its open Board meeting, which was webcast live, and forms part of an extensive and scientifically robust process, including:

• analysis and advice from the independent government Scientific Advisory Committee on Nutrition (SACN) chaired by Professor Alan Jackson
• risks and benefits to both specific groups and the whole population
• public consultation on a range of options
• consumer research on the options
• consideration of the ethics of adding folic acid to a food
• monitoring the impact of mandatory fortification in other countries

Countries including the US, Chile and Canada have already fortified flour with folic acid. Since the US introduced the measure about ten years ago, it has seen a drop of more than a quarter in such birth defects.

FSA Chair Deirdre Hutton said: ‘The Food Standards Agency is committed to policy-making that benefits people's health. After a detailed discussion about this issue, there was unanimous and strong support for recommending to health ministers that there be mandatory fortification of a food. The Board also agreed that further exploration is needed on whether it should be flour or bread that is fortified.

‘The Board recognises that this move, as part of a package of measures, will help prevent birth defects in pregnancy and have wider health benefits for the rest of the population. The Board was also reassured by the significant science that the benefits outweigh potential risks.

‘I’d like also to pay tribute to SACN’s in-depth and robust work on this difficult issue. And also the commitment demonstrated by Agency colleagues to produce the thorough and quality material that enabled the Board to properly assess the weight of evidence and come to a sensible and proportionate decision.’

SACN Chair Professor Alan Jackson commented: ‘I am delighted that the FSA Board has accepted SACN’s recommendation around mandatory fortification. This will undoubtedly bring real benefits to the population and is an important step forward for public health in the UK. Translating the complexity of the evidence base into a practical recommendation has been a challenge for SACN as experts and I was glad to contribute to a full debate by the FSA Board.’

The issue of whether folic acid should be added to bread or flour, and consideration of appropriate labelling, will be discussed at the next open Board meeting in June. Then the FSA will make its final recommendation to UK health ministers.