Folic acid fortification

bread rolls
In 2006 and 2009 the Scientific Advisory Committee on Nutrition (SACN) recommended mandatory fortification of flour with folic acid should be introduced alongside restrictions on voluntary fortification of foods with folic acid and guidance on supplement use. In 2016/17 SACN reviewed this evidence following a request from Food Standards Scotland.

SACN's recommendation

On 12 July 2017 the Scientific Advisory Committee on Nutrition (SACN) published a review of the evidence that has emerged on Folic Acid since the previous reports which were published in 2006 and 2009. SACN continue to recommend mandatory fortification of flour with folic acid, along with the controls on voluntary fortification.

The FSA has previously recommended the mandatory fortification of bread or flour with folic acid in order to reduce the risk of neural tube defects in foetuses.  In 2007, the FSA Board confirmed it agreed with SACN's 2006 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.

Dietary modelling of folic acid

In 2016, Food Standards Scotland commissioned an update of previous folic acid modelling using the latest available data and modelling techniques to inform the possibility of introducing mandatory fortification of wheat flour. 
The updated modelling followed a similar strategy as the modelling in the 2006 SACN report and an update to the modelling by FSA in 2007/8 to look at the effect of different fortification scenarios on folate and folic acid intakes and the reduction in risk of neural tube defects for pregnant women. 
The work has been jointly funded by Food Standards Scotland, the FSA in Northern Ireland, the Welsh Government and Scottish Government. The report was published on 16 August 2017:  

Stochastic modelling to estimate the potential impact of fortification of flour with folic acid in the UK

NDNS: blood folate supplementary report

Public Health England published revised blood folate results from the National Diet and Nutrition Survey (NDNS) rolling programme on 28 November 2017. The revised report, originally published in 2015, covers results for the UK as a whole and separately for Scotland, Northern Ireland and Wales, based on analysis of blood samples collected over four years 2008/09-2011/12 (2009/10-2012/13 for Wales).

NDNS: blood folate supplementary report

Rationale for folic acid fortification

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.