Folic acid fortification

The mandatory fortification of flour with folic acid is currently being considered by UK health ministers, following advice from the four Chief Medical Officers in the UK. If approved, the relevant UK health department will be responsible for producing implementation plans.

Before making a decision, UK Health Ministers have requested that all the evidence that has been considered by Scientific Advisory Committee on Nutrition (SACN) should be put in the public domain.

SACN has recommended mandatory fortification, along with the controls on voluntary fortification and advice on supplements containing folic acid. They have also recommended that people who might be more at risk of developing colorectal adenomas or colorectal cancer (people over 50 and those who have had colorectal cancer before) should not take supplements containing more than 200mg folic acid a day without medical advice.

SACN considered all the available scientific evidence, including research that suggested folic acid may increase the risk of colorectal cancer and the results of a meta-analysis of a number of B vitamin trials that investigated the association between B Vitamins (including folic acid) and cardiovascular disease, and which also collected data on cancer outcomes.

In 2007, the FSA Board confirmed it agreed with SACN’s recommendations. In reaching its decision, as well as considering SACN's report, the Board also considered the risks and benefits to both specific groups of the population as well as the whole population, the public consultation on a range of options, consumer research on the options, the ethnics of adding folic acid to a food, and the impact that mandatory fortification has had in other countries.

The Chief Medical Officers have since considered this evidence and agreed with the recommendations. Following advice from the UK Chief Medical Officers the decision on folic acid fortification is under consideration by UK health ministers.

There is strong evidence that consuming higher folic acid intakes before pregnancy and in the first 12 weeks of pregnancy will reduce the risk of neural tube defects.

Almost half the pregnancies in the UK are unplanned and even though women are advised to take folic acid supplements many do not, or they start taking them too late.

If bread or flour were fortified with folic acid this would increase folic acid intake of women with otherwise low intake who may become pregnant and the most effective way of reaching sections of the population with the lowest folate intakes i.e. younger women from the most socioeconomically deprived areas.

It has been estimated that there are between 700 and 900 pregnancies affected by neural tube defects each year in the UK.