FSA board prepares to issue folic acid advice

Maternal consumption of folate, or its synthetic form folic acid, is strongly associated with a reduced risk of neural tube defect (NTD) in the early states of pregnancy. Fortification of certain food groups with folic acid has been mandatory in North America since 1998, and the number of pregnancies affected by NTDs is reported to have fallen by 26 per cent. The FSA launched its final consultation on mandatory fortification of flour in December, at the same time as the SACN recommended pressing ahead with the measure. At the open board meeting to be held on Thursday, the board will be asked to agree on advice for health ministers. It will consider a large bundle of evidence, including four possible options set out in the consultation package - as well as around 200 responses to the consultation received in the last five months. If the UK adopts mandatory fortification it will be the first European country to do so, although the wheels are in motion in Ireland. Australia and New Zealand have also been mulling over the matter, although the bakery industry there has been vociferous in its opposition. Consumer groups, including the UK's Consumers for Health Choice, have also flagged a need to maintain consumer choice. The four possible options relating to folic acid fortification and communication measures set out by the FSA are: To continue with the current policy of advising all women planning to get pregnant to take a 400 microgram supplement before conception and until the 12th week of pregnancy; to increase efforts to encourage women to take supplements or eat more folate-rich foods (natural sources include grains, lentils, chick peas and green leafy vegetables); to encourage the food industry to fortify more foods on a voluntary basis; or to recommend mandatory fortification of bread or four with folic acid. The consultation package included a detailed analysis of the costs of supporting each individual NTD sufferer throughout their lifetime. The monetised benefit reflecting value of averted pain, grief, and suffering, alongside a productivity component, is said to be around £487,000 per individual. "Already at this stage, we start to see that the benefits to fortification will significantly outweigh the costs,"​ said the paper. Folic acid fortification has been on the table in the UK since 2000, following a report by SACN's predecessor COMA, which concluded that universal fortification of flour with folic acid would significantly reduce the number of conceptions and births complicated by NTDs. But after consultation with stakeholders the decision was taken not to make fortification mandatory at that time due to concern that it may mask vitamin B12 deficiency in some sectors of the population and because it would impinge on consumer choice. In fact, a decision from the FSA board was expected at an open board meeting last April, but at the last minute the SACN requested more time to look at additional evidence on risks and benefits - particularly relating to high level folate consumption (over 1mg per day). The SACN finally published its recommendations in mid December. "Following a detailed assessment of the evidence, SACN is recommending mandatory fortification of flour with folic acid as the most effective way to increase folate intakes of women most at risk of NTD-affected pregnancies, provided voluntary fortification is controlled and advice is given about supplement use,"​ said SACN chair Professor Alan Jackson. SACN said that, even with mandatory fortification, women should still continue to take a daily supplement of 400 micrograms of folic acid prior to conception and until the 12th week of pregnancy.