FSAI Advises Against Any Further Folic Acid Food Fortification

Monday, 9 September 2013

Food Safety Authority of Ireland Expert States   

Currently, there would be no additional benefits for mandatory folic acid fortification of bread in Ireland, an International Conference on Homocysteine at Trinity College Dublin (TCD) heard today. The FSAI who co-hosted with TCD, a special session on the issues and controversies involved in Folic Acid Food Fortification stated its blood monitoring of the Irish population indicates that folic acid intake from fortified foods and supplements remains high.  However, there has been no change over the past five years. In collaboration with TCD, FSAI measured folic acid in blood samples collected from women of all ages, men and children in two time periods - 2005–2007 and from 2010-12. These findings continue to show evidence of high intakes of folic acid in Ireland mainly due to voluntary food fortification by industry.  Therefore, the FSAI states that at this time, there would be no benefit to be gained from further addition of folic acid to food through the mandatory fortification of bread and it will continue to monitor the situation.

Since 2004, the FSAI, in collaboration with the Public Analyst Laboratory in Galway, have been monitoring the food supply in Ireland regarding the amount of folic acid being provided to the population. This work particularly focuses on women of childbearing age who have a special requirement of this essential nutrient to protect against birth defects (Neural Tube Defects – NTDs) developing in early pregnancy.  The FSAI monitoring includes analysis of the amounts of folic acid in foods fortified voluntarily by industry as well as using IUNA national nutrition survey data to determine how much is being consumed by women of all ages, men and children.  In addition, the FSAI, in collaboration with TCD, have assessed blood samples of individuals to more accurately estimate the exposure of different population age and gender groups to folic acid from fortified food on the Irish market. These blood samples were collected from women of all ages, men and children at two time-points – the first during 2005 – 2007 and the second from 2010-12. 

A complete count of the numbers of pregnancies affected by NTDs was conducted with Dr Sean Daly of the Coombe Hospital, Dublin at around the same time as the first blood sampling survey.  This found a reduction in the incidence of neural tube defects (NTDs) to 0.93 per 1,000 births had occurred. Although there is no direct estimation of the number of pregnancies currently affected by NTDs, the findings of the recent second blood sampling survey indicates that the level is likely to remain at less than 1.0 per 1,000 births. As this level is close to the lowest that can be achieved through folic acid fortification of food, the FSAI maintains no further addition of folic acid would be of benefit especially given that some individuals may have high intakes.

Professor Mary Flynn, Chief Specialist in Public Health Nutrition, FSAI who chaired the special session on food fortification at today’s international conference told delegates that there is no doubt that food products voluntarily fortification by the food industry has contributed to the reduction in the numbers of pregnancies affected by NTDs in Ireland. However, there are some disadvantages as compared with a government controlled mandatory food fortification program – whilst mandatory fortification reaches almost everyone in the population, voluntary fortification can be ‘hit and miss’ in that it only reaches those who consume fortified products.

“The advice we gave in 2008 still stands - voluntary addition of folic acid to food products should not increase further. Dietary intake studies and blood monitoring work show that the Irish population, including women of childbearing age (the target group) continue to receive more folic acid in their diet due to voluntary fortification across the food sector as compared to previous decades, such as in the 90s. This is preventing NTDs, but the impact of higher levels of folic acid being consumed by other population groups – particularly those with high intakes of fortified foods has to be an important consideration for any public health policy in this area,” Prof Flynn stated.

“Folic acid food fortification is complex because to be successful it needs to provide effective amounts of folic acid to women of childbearing age without providing too much to others in the population.”  

The FSAI states that in Ireland voluntary folic acid fortification has been in place for years and any decision to introduce a mandatory folic acid fortification program has to take account of this. However, the variable amount of folic acid provided in the wide range of food products voluntarily fortified by industry can cause some issues.  While mandatory fortification provides for a very specific amount of folic acid in one food category, the level provided in foods voluntarily fortified, varies greatly. The amounts of folic acid can vary even within similar foods in the same categories and brands. These differences make it difficult for women to choose the right food products and calculate what foods will give them the optimal amount of folic acid every day.

In addition, Prof Flynn stated that the ad hoc nature of voluntary food fortification means the industry may decide at any time to stop fortification or to change the amount added. 

“Continuous monitoring is required to establish the levels of folic acid intake in the population, but the widespread variability in voluntary fortification makes this difficult.  For example keeping track of the wide range of food products that are fortified with different levels of folic acid is demanding of itself - but then we have the task of determining who in the population consumes these particular products and to what level.  This is much more challenging compared with the monitoring required for mandatory fortification which involves a specific amount of folic acid added to just one type of food.”

The many issues and controversies involved in the provision of folic acid through food fortification were discussed and debated at today’s special session by internationally renowned experts on the effects folic acid has on all aspects of health. This includes the latest research findings on the impact of folic acid food fortification on major chronic diseases such as cardiovascular disease and cancer.

“There is a need for more EU wide regulation of this area. Now that EU food legislation allows food businesses to voluntarily fortify their food products there is a real need to set maximum limits for the addition of vitamins, such as folic acid to food. We anticipate that folic acid food fortification will continue to increase due to health claims being recently authorised for food. These are likely to prompt more food businesses to fortify their products so they can make a claim. This makes the on-going work at EU level to set maximum limits vitally important,” Prof Flynn concluded.

The special session on Food Fortification at today’s conference is a memorial to the late Professor John Scott of Trinity College, Dublin, who contributed greatly throughout his distinguished career towards identification of the dietary causes of birth defects (Neural Tube Defects - such as Spina Bifida, and orofacial clefts). Professor Scott was a key member of the FSAI National Committee that advised the Irish government on folic acid food fortification in 2006 and 2008. Up until his death earlier this year, he continued to work with FSAI in monitoring the Irish situation regarding folic acid nutrition and population health.