Press Releases

Mandatory Folic Acid Fortification of Bread Recommended

18 July 2006

Mandatory fortification with folic acid of most white, brown and wholemeal breads on sale in Ireland is the policy recommendation contained in a report presented to An Tánaiste and Minister for Health and Children, Mary Harney T.D., today by the National Committee on Folic Acid Food Fortification. Some minor bread products and retail flour will not be fortified to allow for consumer choice. The Committee says the aim of its recommendation is to reduce the number of babies born with neural tube defects (NTDs) in Ireland every year. Folic acid is a B vitamin, which, if taken for at least eight weeks prior to, and 12 weeks, after conception, is known to reduce by up to 70% the risk of NTDs, a group of severe birth defects such as spina bifida that can develop in babies during the first weeks of pregnancy.

Ireland currently has one of the highest incidences of NTDs in Europe, with approximately 1-1.5 per 1,000 births nationally, equating to between 49 and 93 babies, affected by NTDs each year. The National Committee on Folic Acid Food Fortification, established by the Minister for Health and Children, under the secretariat of the Food Safety Authority of Ireland (FSAI), was tasked with establishing the most effective public health strategy to increase the intake of folic acid among Irish women of childbearing age, to reduce the nation's high incidence of NTDs. Its report, launched today, outlines a number of key recommendations, following extensive research, and a public consultation to seek the views of the public and interested parties, on folic acid food fortification.

The Committee is proposing mandatory fortification at a level of 120µg of folic acid per 100g of bread, which will require legislative change and minor modifications to the bread-making process. On average, up to a quarter of pregnancies affected by NTDs will be prevented by the level of folic acid bread fortification recommended. However, the folic acid fortification programme will also eliminate deficiency of this B vitamin and it is expected that this will result in a much higher degree of pregnancy protection against NTDs for women who have poor body stores of this vitamin. The recommended daily intake of folic acid for women of childbearing age is 400µg, however mandatory fortification of 120µg per 100g of bread is being recommended, because this ensures a good safety margin for people who consume large amounts of bread.

Commenting on the report, An Tánaiste and Minister for Health and Children, Mary Harney, T.D., states, “We need to redouble our efforts to increase folic acid intake in women of childbearing age in Ireland. We need an effective public health measure to introduce the required levels of folic acid into women's daily diets. This has been achieved in the USA and Canada since 1996, when those countries introduced mandatory fortification of all flour with folic acid. The National Committee on Folic Acid Food Fortification has spent just over a year conducting its research, and I am pleased to express my support for the recommendations contained in its report. The next step will be to establish an implementation group to develop a detailed implementation process for the mandatory fortification of bread.”

According to Ms Maureen Lynott, Chair of the National Committee on Folic Acid Food Fortification, national health policies since 1993 have urged women who may become pregnant to take a folic acid supplement and to eat foods that contain high levels of natural folate. However, research shows that 50% of pregnancies in Ireland are unplanned and it is too late for folic acid to be protective by the time these women realise they are pregnant. Overall, only one in five pregnant women take a folic acid supplement and dietary surveys indicate that up to one third of women consume no folic acid at all. She states that based on knowledge gained from international experience, a policy of mandatory fortification of bread with folic acid is the most effective and safe national strategy going forward.

“Since the early 1990s it has been accepted that up to 70% of NTDs can be prevented by the consumption of folic acid, with the remaining 30% related to unknown causes not prevented by taking folic acid. The two key policies currently in place to increase folic acid intake in Irish women - consumption of folic acid supplements, and voluntary fortification of selected foods with folic acid - have only been marginally successful in reducing NTDs, and it had become apparent that a more effective policy is needed. A staple food such as bread is the ideal food to fortify, because it meets all the necessary criteria of being consumed regularly and in sufficient quantities, encouraged as part of a healthy diet, technically amenable to fortification, and can offer consumer choice by omitting some varieties from the fortification programme,” Ms Lynott states.

Other key recommendations contained in the Committee's report include:

• Mandatory fortification of bread with folic acid must form part of a dual approach which also sees women being continually advised to take folic acid supplements. The recommended level of folic acid fortification of bread will not provide women with the full amount of folic acid they should consume for protection of their pregnancies.

• A national integrated health promotion programme, involving all stakeholders, should be developed to maintain awareness of the need for women of childbearing age to take folic acid supplements.

• An implementation group should be established to oversee the operational issues associated with the recommendations and to advise the Minister for Health and Children on progress.

• The Department of Health and Children should make new regulations that will introduce mandatory fortification of all bread marketed in Ireland (with the exception of minor bread products) and provide for labelling and health claims for breads fortified with folic acid.

• An assessment of all pregnancies affected by NTDs, including those that do not reach term, should be undertaken immediately to establish a baseline for monitoring progress. 

• A national congenital birth defects register that records all pregnancies affected by birth defects, including those that do not reach term, should be established for ongoing surveillance purposes.

• To assess the impact of the fortification programme on the population in Ireland, the measurement of blood parameters relevant to folate status of all age/sex groups should be undertaken immediately to establish a baseline for monitoring future progress.

• Monitoring of dietary intakes among all population subgroups to assess the total amount of folic acid consumed from both mandatory and voluntary food fortification.

Ms Lynott describes the public consultation process undertaken by the Committee last year as a key element to defining future national policy on folic acid food fortification: “The support during the consultation for the option of mandatory food fortification received from the public, key stakeholder groups, and the food industry was a vital element in the work the Committee undertook to reach the policy recommendation proposed. Having reviewed all scientific data available, the Committee is confident that the strategy of mandatory fortification of bread will make substantial strides in reducing the unnecessarily high level of NTDs currently recorded each year in Ireland,” she concludes. 

Click here for a copy of ‘Report of the National Committee for Folic Acid Food Fortification' PDF 808kb