‘Antiquated’ national flour fortification laws must be updated to meet WHO recommendations: Researcher
This was the message of professor Emeritus Richard Hurrell, member of the WHO Task Force on Food Fortification and Micronutrient Advisory Group and previous head of Micronutrient Research Team for Nestlé.
In a letter to the editor of the British Journal of Nutrition published this week, Hurrell said: “[T]here is an urgent need for many countries (including the UK) to update antiquated national flour fortification legislation to conform to the more recent WHO recommendations on Fe compounds and fortification levels.”
Playing catch up
In 2009 the WHO published a consensus statement on flour fortification. For iron they said only select iron compounds, including NaFeEDTA, ferrous sulphate, ferrous fumarate and electrolytic iron, had been shown to improve iron status in populations. The report, which Hurrell contributed to, said average wheat flour consumption should also be considered in designing fortification programs.
In the UK, under the UK Bread and Flour Regulations 1998, industry is required to add iron, thiamin (vitamin B1), nicotinic acid or nicotinamide and calcium carbonate to all wheat flour except wholemeal flour at the milling stage – but the type of compounds and levels stated differ from that recommended by the WHO.
National wheat flour fortification programmes were introduced in the US and Europe in the post-war 1940s to combat iron and B vitamin deficiencies and to replace what is lost in the milling process. Hurrell said we’ve come a long way since then in our understanding of optimal nutrition and fortification methods.
Despite this clear message from the WHO, a 2010 review of the UK’s programme saw no changes made.
“It seems they’ve just reaffirmed this original regulation without changing it. I think there would be too many problems trying to change them but no problem in just reaffirming them and it’s better to have what we’ve got than nothing at all.”
Hurrell said this was a missed opportunity and if they had upped the levels then maybe Britain wouldn’t have 20% of young girls iron deficient – which can have a big impact if young pregnant women are deficient, he said. Iron deficient foetuses have been shown to have impaired neural development, a process which is irreversible.
Hurrell’s letter came in light of the publication of a review of 32 different countries with data onfortifying wheat flour alone or in combination with maize flour with at least iron, folic acid, vitamin A or vitamin B12. It found that that fortifying flour with micronutrients has been effective in decreasing national prevalence of anaemia, but warned that greater research was needed on the bioavailability of iron compounds used.
A difference of national opinion
“What I really think we need to do is make people aware they’re adding the wrong or too little of the wrong compounds and that legislation needs to be updated. To get legislation updated is really not an easy thing to do, presumably,” Hurrell said.
Asked if this could be on an EU level, he said moving through an institution like the European Food Safety Authority (EFSA) could be one option but this was likely to be very long and drawn out too particularly considering member state differences.
“For Europe there are areas where fortification can be useful but there’s a lot of disagreement in the use of fortification in European countries. Some countries are quite enthusiastic about it, the Scandinavians more so than people in southern Europe. France has always been very anti-fortification.”
Speaking previously with NutraIngredients about its vitamin D programme, Swedish authorities defended its mandatory fortification of foodstuffs like cooking oils and butter as a ‘real world’ strategy to target the foods that people actually eat not what the government would like them to eat.
Meanwhile the UK government has cited uncertainty over what public health message it would send as one of the key reasons why it has not yet introduced mandatory folic acid fortification of flour to tackle neural tube defects.
He added there was a big difference in fortification programmes between regions like the EU and North America and the poorer 80% of the world where deficiency tended to be much more severe.
Voluntary vs mandatory
Hurrell said fortifying“market-driven foods” alone was unlikely to have a big impact.
“Industry is always so interested in adding micronutrients because it’s a marketing thing. I don’t think industry can have a defined role in improving the micronutrient status at a national level other than through mandatory fortification of staple foods.”
Staple foods like cereal flours or condiments like sauces and salt were more appropriate targets, and this would likely come with mandatory fortification.
“There’s a big difference between industry products and government-organised fortification because there’s usually not enough [industry] product consumed to have any big effect at a national level, the exemption being the bouillon [stock] cubes which are consumed quite widely in Africa.”
However is firms were to fortify, they should provide a useful amount – about 15% RDA – that is absorbable.
Source: British Journal of Nutrition
Published online ahead of print, DOI: http://dx.doi.org/10.1017/S0007114515002147
“Flour fortification as a strategy to prevent anaemia”
Author: R. F. Hurrell