As reported by The Guardian, ministers were “considering expert advice and will respond in due course,” as the newspaper expected policy to be introduced in a matter of weeks.
The UK had previously resisted calls for mandatory folic acid fortification, going against the approach adopted by other European countries such as Switzerland, in which voluntarily fortification with folic acid is applied to approximately 250 food products.
At one point Ireland’s voluntary fortification of foods with folic acid was widespread but the number of fortified foods is declining along with the increasing incidences of birth defects of the brain and spine.
The UK is thought to have the highest rate of Neural Tube Defects (NTD) recorded in Europe with one study noting its prevalence from 1991 to 2012 to be 1.28 (95% CI 1.24 to 1.31) per 1000 total births (19% live births, 81% terminations and 0.5% stillbirths and foetal deaths less than 20 weeks’ gestation).
The same study concluded that an estimated 2000 pregnancies associated with a neural tube defect would have been prevented if the UK had adopted the same fortification regimen adopted in the USA from 1998.
Strong evidence based & informed public health policy making - Folic acid to be added to UK flour in effort to reduce birth defects https://t.co/UoJqhW67VT— Jeremy Farrar (@JeremyFarrar) October 14, 2018
Public and political pressure
The Government’s U-turn comes after calls from a number of MPs, government, NHS and advisory bodies, who had all urged the authorities to back food fortification.
“This is fantastic news, very pleased that government has finally accepted the strong evidence for this policy,” tweeted the British Dietetic Association (BDA), the nation's largest organisation & trade union for UK dietitians.
“Tremendous news for @SHINEUKCharity and all those who have campaigned for many years for mandatory fortification of flour with folic acid in UK,” added Kate Steele, CEO of the charity Shine, a UK-based organisation providing help and support for those living with spina bifida and/or hydrocephalus.
Nicholas Wald, professor of environmental and preventative medicine at Queen Mary University of London, spoke of his delight at hearing the news reported in the Guardian.
"If this is officially confirmed, the UK would be taking an important step in preventive medicine, and helping to avoid disability or termination of pregnancy," he said.
"There will undoubtedly now be discussion over the level of fortification, which should be high enough to prevent an estimated half of cases of spina bifida and anencephaly.
"Fortification of flour with folic acid provides a safety net; it does not mean that women no longer need to take a folic acid supplement and this should be 5 milligrams (mg) a day, to obtain the full level of protection.”
The European Food and Safety Authority (EFSA) currently advises a daily supplement of 600 micrograms per day (µg/day) for pregnant women.
For lactating women, an additional intake of 130 µg/day is considered to cover folate losses via breast milk.
The UK’s department of Health recommends 400 micrograms (µg) of folic acid each day – ideally taken from before pregnancy up until the 12th week of pregnancy.
Some of the facts about the benefits of fortification of flour with folic acid: pic.twitter.com/nLrnMRb009— Owen Smith (@OwenSmith_MP) October 15, 2018
Poor compliance suggested
Despite the advice, many women, particularly those from poorer homes, do not take enough with a UK government survey finding over 90% of women of childbearing age to be folate deficient.
The survey found the compliance rate to be relatively low or that they had begun supplementing too late into the pregnancy term.
The Food Standards Agency (FSA) said that 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.
This approach could also be most effective way of reaching sections of the population with the lowest folate intakes i.e. younger women from the most socioeconomically deprived areas.