Global folic acid fortification

by Jeff Gelski
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Global government actions and scientific studies recently have centered on enriching bread and other products with folic acid.

According to the Flour Fortification Initiative, about 50 countries, including the United States, require folic acid fortification of flour while at least 35 other countries have voluntary fortification. Australia joined the list of countries requiring fortification in September. Food Standards Australia New Zealand ruled bread-making flour in Australia must have folic acid added to it to reduce the risk of babies being born with birth defects.

Mandatory fortification in Europe may be further away. A Scientific Cooperation Working Group within the European Food Safety Authority in November ruled current data are insufficient to allow a full quantitative risk assessment of risks linked to folic acid.

Europe generally takes a conservative approach, said Julie Miller Jones, a professor of food and nutrition at the College of St. Catherine in St. Paul, Minn., and a member of the Grain Foods Foundation’s scientific advisory panel.

She said the big question in Europe is whether mandatory folic acid fortification might create problems for the older population marginal in vitamin B12 intake. Blood tests may show whether elderly people have a B12 deficiency, she said, but high amounts of folic acid may mask the B12 deficiency in the blood tests.

Also, according to a study appearing in the Nov. 18 issue of the Journal of The American Medical Association, treatment with folic acid plus vitamin B12 was associated with increased cancer outcomes and all-cause mortality in patients with ischemic heart disease in Norway, where there is no mandatory folic acid fortification of foods. The study involved two randomized, double-blind, placebo-controlled clinical trials and 6,837 patients with ischemic heart disease who were treated with B vitamins or placebo between 1998 and 2005. They were followed through Dec. 31, 2007.

Overall, 2.7% of adults consumed more than the upper level of folic acid, according to the results of a study that appeared Oct. 14 in the American

Journal of Clinical Nutrition. Researchers used data from the National Health and Nutrition Examination Survey (NHANES) from 2003-06.

Dr. Jones said the studies

examining the danger of too much folic acid intake are using high levels of folic acid intake.

“The levels are those which you would achieve through supplements and never through food,” she said.

The U.S. Food and Drug Administration in 1998 mandated folic acid fortification of enriched flour. Neural tube defects, including spina bifida, have declined by more than 25% since then.

Increased folate intake is needed in some subgroups in the United States, according to a study appearing in the Nov. 18 issue of the American Journal of Clinical Nutrition. The study used statistics from the NHANES from 2003-06. The researchers concluded improved total folate intake is warranted in subgroups, including women of childbearing age and non-Hispanic black women. They also concluded total folate and folic acid intakes are highest for people age 50 and over with 5% exceeding the tolerable upper intake level.

Consumers in certain geographic areas might be coming up short.

“It is my understanding that there is more folic acid deficiency

in the South because of a higher consumption of grits (not folic enriched) and corn tortillas (not folic enriched),” said Lee Sanders, vice-president of regulatory and technical services for the American Bakers Association, Washington.

According to the 2005 Dietary Guidelines for Americans, women of childbearing age who may become pregnant and those in the first trimester of pregnancy should consume adequate synthetic folic acid daily from fortified foods or supplements in addition to food forms of folate. A dietary guidelines advisory committee will recommend changes for the entire 2010 Dietary Guidelines for Americans.

“I think it is unlikely that there will be a change in policy regarding folic acid enrichment since the neural tube defect incidence has dropped significantly since its implementation,” Ms. Sanders said. “I think we will continue to see a balance of recommendations for enriched and whole grains in a healthy diet.

“With the Dietary Guidelines and MyPyramid review, as well as legislation on child nutrition reauthorization, I would think that the nutrition policy and guidance on folic acid enrichment will be a consideration for overall human health and disease prevention.”

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