Ministers have ‘moral duty’ to act in folic acid fortification, say experts
Writing in the Archives of Disease in Childhood, the three experts stress that action would prevent spina bifida, a cause of lifelong disability, and anencephaly, a birth defect where most of the brain is missing.
The team say that thousands of pregnancies have been terminated or resulted in the birth of children with these Neural Tube Defects (NTD) that could be prevented if folic acid fortification had been implemented universally.
One of the experts, professor sir Colin Blakemore, former chief executive of the Medical Research Council, says, “I hope this time the Government introduces folic acid fortification, which would save the lives of hundreds of babies a year. It would be shocking if it did not.”
Professor Sir Nicholas Wald, author of the article from St George’s, University of London and University College London, adds, “Britain’s past failure to fortify flour and grains with folic acid is a missed public health opportunity. It is like having a vaccine for polio and not using it.”
“It is more than a disappointment that UK funded research published nearly 30 years ago has not been fully used in the UK to improve the health and wellbeing of its citizens who paid for the research.”
The article attempts to answer a number of questions posed in the Government’s public consultation on whether the UK should introduce mandatory folic acid fortification.
Over 80 countries have already done so, including the USA, where it’s estimated that fortification has saved 1,300 children each year from death or a lifetime of disability.
The scientists are calling for fortification of cereal grains such as rice as well as flour to ensure the benefits reach all sections of the population, regardless of their personal or cultural preferences for cereal products.
They also believe there should be no limits set on fortification level, as there is no limit above which folic acid consumption is unsafe.
Professors Blakemore, Wald and medical statistician Joan Morris, also from St George’s, University of London are calling for fortification levels of 0.4 milligrams (mg) of folic acid consumption daily.
The three believe this amount would save more than 400 UK babies’ lives a year and prevent another 100 suffering spina bifida.
This amount mirrors that of current fortification efforts in Chile, in which women consuming fortified flour and grain with a 0.4 mg/day increase in folic acid along with 0.4 mg supplements, could expect about a 60% reduction in NTD risk.
“The research has been done, the health effects evaluated, and there now needs to be the political will to introduce folic acid fortification to prevent one of the most serious birth defects,” says professor Morris.
Folic acid supplements
Currently in the UK, women are advised to take folic acid supplements before pregnancy and in early pregnancy.
However, data from the National Diet and Nutrition Survey show that despite widespread promotion of the policy of voluntary supplementation, folate intakes of women who could become pregnant have declined and periconceptional folic acid supplement use has also declined.
“The economic arguments for preventing such disorders are obvious, but the humanitarian arguments are paramount,” says the article.
“Fortification will prevent both affected live births and medically induced abortions and stillbirths. It will prevent the tragedy of lost babies and the impact of infant mortality and lifetime handicap on children, their families and society as a whole.
“In the absence of evidence for any harm to the rest of the population, the moral arguments for the public health intervention of fortification are undeniable.”
Source: Archives of Disease in Childhood
Published online: doi: 10.1136/archdischild-2019-318534
“Urgent need for folic acid fortification of flour and grains: response to the 2019 UK Government’s public consultation.”
Authors: Nicholas Wald, Joan Morris, Colin Blakemore