27 September 2004
CANADA: MORE EVIDENCE IN SUPPORT OF FOLATE FORTIFICATION
27/09/2004 - A recent study in Canada has given weight to the
assumption that adding folic acid to food can dramatically reduce the
incidence of birth defects - suggesting that Europe should follow the
example set by North America and start to fortify its flour.
The study, published in BMC Pregnancy and Childbirth, showed that
the proportion of babies born with neural tube defects in the province of
Newfoundland and Labrador, Canada, dropped by 78 per cent after the
Canadian government ruled that folic acid must be added to flour, cornmeal
and pasta.
The researchers - led by Dr Catherine McCourt, from the population
and public health branch of Health Canada - found that women of
childbearing age who ate the fortified food increased their dietary intake
of folic acid by an average of 70 micrograms a day. Their blood folate
levels also increased significantly.
Since fortification in 1998, the incidence of neural tube defects in
this province has reduced from an average of 4.36 defects per 1000 births
to an average of 0.96 defects per 1000 births.
Moreover, during this period, the number of women aged between 19 and
44 who took folic acid supplements rose significantly from 17 per cent to
28 per cent.
However, the researchers were not able in this study to determine the
separate contributions of food fortification and supplement use in the
decline of neural tube defects.
The authors therefore concluded that: "public education re garding
folic acid supplement use by women of childbearing age should continue."
Furthermore, they noted that they found no evidence during this study
of a deterioration in vitamin B12 status in this age group and no evidence
that improved levels of blood folate masked this vitamin deficiency, as
some research has suggested.
Folic acid fortification has proven its value in reducing birth
defects in the US too, but in Europe governments have been reluctant to
implement similar initiatives. The UK's Food Standards Agency last year
decided against fortification on the grounds that not enough was known
about the potential adverse effects on older people. Campaigners in
Switzerland have also met with resistance.
However, attitudes in the food industry seem to be changing. A
meeting organised by the Flour Fortification Initiative (FFI) in London in
June raised support for flour fortification among industry members.
"Since talking to the millers seriously about this issue, they seem
very motivated and really want to contribute," said the head of the FFI,
Professor Glen Maberly based at Emory University in the US.
Nontheless, cost and technical issues still present concerns for the
industry. Flour fortification means buying nutrients, new equipment,
further testing and quality control, and marketing spend. With little
government support, both the private sector and consumers must bear some
of these additional costs.
But better dissemination of technical expertise across borders and
increased knowledge about fortification could help to reduce some of these
costs and make the process more efficient.
Note
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