Minutes of the meeting of the National Committee on Folic Acid Food Fortification
Thursday, 23 June 2005

Minutes of the meeting of the National Committee on Folic Acid Food Fortification at the Food Safety Authority of Ireland held on Thursday 23 June 2005 at 11:00 , in the FSAI offices, Abbey Court , Lower Abbey Street , Dublin.

PRESENT:
Ms Maureen Lynott (Chair) [ML]
Dr Louise Sullivan [LS]
Prof. Albert Flynn [AF]
Dr Catherine Hayes [CH]
Ms Joanna Gibson [JG]
Mr Nick Killian [NK]
Dr Mary Flynn [MF]
Dr Sean Daly [SD]
Dr John Devlin [JD]
Dr Harry Comber [HC]
Dr Cliodhna Foley Nolan [CFN]
Dr Ailis ni Riain [AnR]
Prof. Joe McMenamin [JMc]
Dr Kevin O'Donnell [KO'D]
Ms Margot Brennan [MB]
Mr Alan Reilly [AR]

IN ATTENDANCE:
Ms Eileen Lippert [EL]

APOLOGIES:
Prof. John Scott
Mr Eamon Corcoran [EC]
Dr Davida de la Harpe [DdlH]
Dr Orla Healy [OH]
Dr Fenton Howell [FH]

1. Agree Minutes of the Last Meeting

Agreed: The minutes of the meeting of 14 April 2005 were agreed without amendment.

2. Matters Arising, Including New Members

Noted: There were no matters arising that were not agenda items.

3. Declarations of Interest / Conflict of Interest

Noted: There were no declarations of interest.

4.  Update on Consultation

Noted: A preliminary report on the outcome of the national consultation was provided by the FSAI. Also a brief outline of the Omnibus Survey was circulated. A full report on the outcome of the national consultation will be circulated to members in due course.

5. Sub-committee on Consultation Document and Technical Issues

Noted: This Subcommittee has completed its work on the Consultation documents. However, if a decision to fortify bread/ bread flour with folic acid is taken the technical implications have to be considered to enable the formulation of practical and feasible recommendations. The Sub-committee will resume activity on technical issues once clear decisions have been made.

Noted: Industry's cost concerns were also raised and discussed.

6. Sub-committee on Risk, Adverse Effects and Benefits of Folic Acid Fortification

Noted: The Chair of this Sub-committee gave a presentation on the work of this Sub-committee to date. The main areas touched upon in the presentation included:

•  Proposed fortification options;

•  Benefits of fortification;

•  Possible risks of fortification;

•  Some risks of excess folic acid intake;

•  Modelling of folic acid food fortification;

•  Risk/benefit of folic acid fortification of bread;

•  Other fortified foods;

Noted : A copy of the presentation and a chapter outline for this specific section in the report were circulated to members for information. Several questions followed the presentation and these were addressed. There was much discussion about the effects of folic acid on cardiovascular disease and cancer. The need for a full discussion on risks and benefits was acknowledged.

Noted: Would there be an option for consumers to purchase unfortified bread if mandatory fortification was the agreed approach This is particularly relevant if flour/ bread fortification was extended to cover wholemeal bread/ bread making flour. It was also questioned if submissions against fortification provided any alternatives to fortification of food.

Noted: Vitamin B 12 deficiency was discussed. This is not an issue in the USA and Canada where flour has been fortified for close to 8 years.

Agreed: A draft chapter to be available for the next meeting of NCFAFF and it was noted that a response needed to be prepared on issues raised in submissions during the public consultation process.

7. Sub-committee for Register of Congenital Birth Defects

Noted: A presentation outlining the progress of this Sub-committee was given by one of its members and it was circulated to the members for information. Additional information about ante-natal diagnosis was shared and led to several questions from the members about testing methods for NTDs.

Noted: The need for 100% coverage of national data was stressed as only 60% is available at the moment. There was a discussion about who should maintain the database and the HSE as well as HIQA was proposed.

Agreed: There was urgency around setting up a database as quickly as possible as it was acknowledged that data could not be assessed retrospectively – the need to compare like with like was imperative in order to have a robust assessment of true change in prevalence of pregnancies affected by NTDs.

8. Population Monitoring Update

Noted: SD gave a progress update on this matter. He confirmed that he has had discussions with several people who are willing to carry out some of the aspects involved in the project. He has agreed to analyse figures and statistics and revert to the members at the next meeting. Questions were welcomed and suggestions and recommendation were sought by email.

Agreed: DoHC will look into the funding issue and it was suggested a steering committee be set up to get the population monitoring project up and running. It was agreed by all that this project should be progressed further. This will be done by the FSAI.

Noted: The issue of cohorts vs random sampling was discussed and other methods of collection data were raised.

9. Outstanding Areas in final Report

Ethical aspects

Agreed: DoHC will revert to the Committee with an update on this issue. The members were in favour of the issue being addressed and included in the report.

Noted: Members requested more information in relation to what was going on at regulatory level in the EU. It is unlikely that current draft regulations on food fortification would impact negatively on mandatory fortification of flour with folic acid.

Noted: The issue of imported flour was raised as was the issue of what stage the folic acid would be added to flour and several stumbling blocks were highlighted. Costing was also an area which required investigation. The homogenousness of folic acid need to be brought up with bread makers and the need for definitions for brown and wholemeal bread was flagged.

Noted: The issue of false sense of achievement could be possible problem as many women might believe they are taking in adequate folic acid and hence may not bother with supplements. It was acknowledged the effect methods of communication to health professionals need to be looked at.

Agreed: An outline report will be circulated to the members for consultation and comment and following that, the FSAI with the assistance of committee members will draft the report. It was agreed that the members were in favour of mandatory fortification, but need to decide what needs to be fortified, by how much, etc. Concern was expressed that fortifying white bread could encourage unhealthy eating habits and mean women had to make a choice – eat healthily for the sake of their future offspring (fortified white and brown bread) or eat healthily for their own health (fibre-rich wholemeal bread).

Noted: Some members felt that the consultation did not reach the entire population – only interested parties and the need for another omnibus survey was raised. This was dismissed however as the public consultation was provided for all who wanted to comment and this was widely communicated through diverse channels, including an active media campaign.

Agreed: A master list of the various breads needs to be drawn up to ensure NCFAFF recommendations include the majority of breads available.

Agreed: Food should be fortified with folic acid but there was much debate about the level of fortification, with some members wanted to err on the low side to eradicate folate deficiency while others wanted to achieve the greatest effects possible. What constitutes an acceptable level of achievement led to much debate.

10. Review of Work Plan

Agreed: There were no amendments to the work plan.

11. AOB

Noted: There was no other business.

12. Date of Next Meeting

Agreed: The next meeting of the NCFAFF will take place on 15 September 2005 at 11:00 in the FSAI.