Folic acid fortification more important than ever

by Dr. Lutz Popper and Martina Schneider
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Enrichment of wheat flour with folic acid began 20 years ago. Today, the addition of Vitamin B9 is mandated in around 80 countries. But the number of birth defects that are prevented by folic acid fortified staple foods is still less than ten percent of the total. Further efforts are urgently needed.

Folic acid insufficiency during pregnancy can cause severe deformities of the neural tube in the brain and along the spine (spina bifida or “open spine”). Women planning to have children are therefore advised to get enough folic acid early on, and no later than six to eight weeks before conception. Enriching basic foodstuffs with folic acid is an effective way to make up for folic acid deficits without a change in diet.

Since 2006, the Center for Spina Bifida Research, Prevention and Policy at Emory University in Atlanta, Georgia, U.S., has gathered extensive statistics on the struggle against spina bifida. The recently published results show there is room for improvement. The number of cases prevented by food enrichment rose steadily in the first years, and the highest success rate was in 2013, when an estimated 38,147 children worldwide were protected because their mothers ate folic acid-enriched food. But scientists now see a reverse trend. In part this is based on more precise data on fortification, but in part it is also because some countries have stopped their efforts in micronutrient fortification due to political unrest.

The Food Fortification Initiative (FFI), an international network that promotes the appropriate enrichment of foods with vitamins and minerals, also views the latest figures with concern.

“In 2015, only about 25,000 babies were protected from spina bifida,” said Sarah Zimmerman, FFI communications coordinator. “That is still an important success. But it is a mere 9.6% of all of the birth defects that could have been prevented through folic-acid fortification. This percentage needs to be raised urgently.”

Many other staples like sugar, salt and cooking oil are now enriched with micronutrients, but grain continues to play the most important role in the fight against malnutrition. Currently folic acid enrichment of industrially-produced wheat flour, maize flour and/or rice is legally mandated in 80 countries. But the FFI’s message to the mills is that enriched flour should be standard even where not required by law.

“There are no technical problems with doing it, and it has no negative effects on product quality,” Zimmerman said. “So the flour mills can make a big difference in the prevention of neural tube defects.”

In an article on the status of flour enrichment in Germany that appeared in several countries, Dr. Lutz Popper, director of R&D at Mühlenchemie, criticized the inaction of German and European officials concerning the fortification of staple foods, which has a demonstrated ability to prevent much suffering as well as economic losses.

“Each NTD case costs the European economy an average quarter million euros,” Popper said. “Opponents argue that fortification would encroach on the fundamental right of self-determination. This argument seems rather cynical, since the unborn are not asked whether they would like to be born without a brain or to cope with lifelong severe disabilities. Is the right to physical integrity so much less important? This is a question we must all ask ourselves.”

As a world-renowned flour fortification specialist, Mühlenchemie helps manufacturers through advice, technical equipment and custom nutrient premixes individually tailored to regional factors and national regulations. All of the company’s vitamin and mineral mixes meet the strict requirements of the World Health Organisation (WHO), and are made under the highest product protection measures in Mühlenchemie’s own compounding plant. 

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