Minutes of the meeting of the National Committee on Folic Acid Food Fortification
Friday, 11th February 2005

Minutes of the meeting of the National Committee on Folic Acid Food Fortification at the Food Safety Authority of Ireland held on Friday, 11th February 2005 at 11:00, in the FSAI offices, Abbey Court, Lower Abbey Street, Dublin.

PRESENT:
Ms Maureen Lynott (Chair) [ML]
Dr Cliodhna Foley Nolan [CFN]
Dr Louise Sullivan [LS]
Prof. John Scott [JS]
Prof. Joe McMenamin [JMc]
Dr Kevin O'Donnell [KO'D]
Prof. Albert Flynn [AF]
Mr Eamon Corcoran [EC]
Dr Annette Kelly [AK]
Dr Ailis ni Riain [AnR]
Dr Catherine Hayes [CH]
Ms Joanna Gibson [JG]
Mr Nick Killian [NK]
Dr Mary Flynn [MF]
Dr Sean Daly [SD]
Dr Orla Healy [OH]

IN ATTENDANCE:
Mr Alan Reilly [AR]
Ms Eileen Lippert [EL]
Ms Jane Ryder [JR]

APOLOGIES:
Dr John Devlin [JD]
Dr Harry Comber [HC]

1 Welcome

Noted: The Chair introduced herself and welcomed all the members to the meeting.

2. Introductions

Noted: Upon the request of the Chair, the members introduced themselves.

•  Terms of Reference

Noted: The terms of reference were circulated to the members and the Chair clarified that the Committee will recommend to the Minister for Health & Children if fortification should be carried out.

Noted: The issue of conflict of interest was raised at this point.

Agreed: The FSAI will prepare a declaration of interest form for the members and ‘declaration of interests' can become a standing agenda item. It was agreed that due to the wide range of expertise required within the membership, there would be some element of conflict of interest on some issues. It was decided that if and when these arose those members could abstain from this section of the meeting.

4  Background

Overview of Issues – Presentation from Dr Mary Flynn, FSAI

Noted: A copy of the presentation was circulated to the members. The main points of this presentation included:

• Explaining what Neural Tube Defects (NTDs) are and the situation in Ireland ;
• References to papers advocating B vitamins to prevent NTDs ;
• Recommendations for women living in Ireland ;
• Incidence and trends of NTDs in Ireland ;
• Genetic disposition of the Irish;
• Approaches to the prevention of NTDs;
• The American experience with mandatory food fortification;
• Effectiveness of folic acid fortification in the US – some unresolved issues;
• Effectiveness of folic acid fortification in some Canadian provinces;
• Changing prevalence of NTDs in the British Isles ;
• Data from Newfoundland from 1991 to 2001, showing effectiveness of mandatory fortification and the ineffectiveness of advising women to take supplements (current policy in Ireland );
• Risks and benefits of a fortification policy.

Prevalence of NTDs in Ireland – Presentation from Dr Orla Healy, Dept of Health and Children

Noted: A copy of this presentation was made available to the members. The main points of the presentation included:

• European surveillance of congenital anomalies (Eurocat) and the lack of a National register for Ireland ;
• Surveillance systems;
• Declining rates of NTDs in Ireland 1980-2000;
• National data collection - what is required to establish a national register in Ireland .

Risk / Benefit Analysis – Presentation from Prof. Albert Flynn, UCC

Noted: A copy of this presentation will be made available to the members. Meanwhile, the main points of the talk included:

• Modelling of folic acid fortification of foods carried out by UCC and FSAI;
• Benefit of folic acid fortification;
• Relationship of folate status and NTDs;
• Relationship of folic acid intake and NTDs;
• Effect of folic acid fortification of bread on NTDs;
• Risks associated with excess folic acid intake;
• Tolerable Upper Intake Level (UL) for folic acid;
• Risk of exceeding UL for folic acid at various levels of fortification;
• Risk of exceeding UL vs. benefit in reduction of NTDs at two levels of folic acid fortification of bread using Irish food intake data;

Noted: The speakers were thanked for their presentations and there were very few additional questions. However, the issue of representation from HSE was raised with respect to the lack of a national register to capture the true prevalence of NTDs in Ireland .

Agreed: It was agreed by the members that the HSE should have a representative. DoHC and FSAI will progress this issue.

5a Revision of Draft Outline of Consultation Document and Questions Inviting Submissions on Folic Acid Food Fortification

Noted: Prior to the discussing this agenda item, the Chair stressed the fact that all documents should be read by all member so that they would be in a position to better participate in meetings of the committee.

Noted: The first draft outline of the consultation document was circulated to the members at the meeting and MF outlined its main points and also the various options available with regards to folic acid fortification.

Agreed: It was agreed a Subcommittee should be formed to fast-track the progress of the report and the Subcommittee members are:

•  Dr Mary Flynn

•  Prof. Albert Flynn

•  Prof. John Scott

•  Dr Cliodhna Foley Nolan

Noted: Members were requested to send their comments on the documents to Elippert@fsai.ie

Noted: The members were in agreement that there should be a version of the consultation document for the general public only and a more scientific version for industry and the medical sector. It was agreed that a summary of the main document would be available in non-scientific language and that the main document would be kept as simple as possible. It was agreed also, that the help of Irish society for Spina Bifida and Hydrocephalus would be availed of to ensure both versions of the Consultation Document and Summary document would deal with NTDs in a sensitive and appropriate manner..

Agreed: The consultation document should be finished within two weeks.

5b List of Key Informants / Groups from Whom Submissions will be Invited

Noted: An incomplete list of key informants was circulated to members. They were invited to add to the list by sending their suggestions to elippert@fsai.ie

5c Methods for Consultation Process

Noted: JR spoke about the options available for the consultation process and also elaborated on the radio campaign being planned to publicise the process. The FSAI has also developed a website for the Committee and its outline was unveiled to the members. Several ideas were put forward with regards to the format of the Consultation Document and these included:

• i. Have a journalist look at and amend the document as necessary

• ii. Follow the format of the national broadcasting standards children's report

• iii. Some members' organisations have guidelines for the readability of their documents – members were requested to forward these to FSAI for guidance

Agreed: Much discussion ensued regarding the options for fortification contained in the report and it was eventually agreed that the options should be as broad as possible and should include the current policy (status quo). The Consultation Document Working Group to research and finalise the options that are feasible in Ireland .

6 Proposed Work Plan

Noted: An updated version of the draft work plan was circulated to the members and members were asked to express their opinions on it. Several members felt the time frames were too tight – particularly for the Consultation. An extra month was added for this and all the members were satisfied with this amendment.

Agreed: In order to fully progress the work plan in the allotted time frame it was necessary to appoint various Sub-committees. These are:

Subcommittee for Register of Congenital Birth Defects

•  Dr Orla Healy

•  Dr Fenton Howell

•  Dr Catherine Hayes

•  Dr Sean Daly

•  Dr Mary Flynn

•  Mr Nick Killian

Subcommittee on technical matters/issues

•  Dr Mary Flynn

•  Dr Louise Sullivan

•  Mr Alan Reilly

Subcommittee on the Risk, adverse effects and benefits of folic acid fortification

•  Prof John Scott

•  Prof Albert Flynn

•  Dr Cliodhna Foley Nolan

•  Dr Mary Flynn

•  Dr Catherine Hayes

•  Dr Kevin O'Donnell

Agreed: All the Subcommittees will report to the main Committee at its meeting on 14 April 2004

•  Meeting Dates

Agreed: The National Committee will meet on the following dates at 11:00 to 13:00 in the FSAI offices on the following dates:

14 April 2005

23 June 2005

15 September 2005

13 October 2005

17 November 2005

•  AOB and Next Steps

Noted: Nothing had to be discussed under this agenda item.