Folic acid fortification

1 June 2016

Many of you will know that for the past 15 years NZORD has supported the fortification of a staple food (such as bread) with folic acid. Folic acid fortification occurs in over 70 countries (including Australia) and it has proven to be a safe means of improving maternal health and substantially reducing Neural Tube Defects (NTDs).

NTDs are serious birth defects. About 30 pregnancies a year in New Zealand are terminated because of early diagnosis of an NTD, and about 6 births (this includes live births and still births) in every 10,000 births are affected in New Zealand (based on data from the New Zealand Birth Defects Registry from 1996-2013). There is no known cure or standard treatment for anencephaly, with most babies not surviving to birth and almost all live babies dying shortly after birth. Spina bifida outcomes are better, but it is a serious condition (for example, the hospital care costs alone are over $1,000,000 per spina bifida patient in their first 20 years).

At one point a change to the New Zealand Food Standards was planned to make folic acid fortification mandatory. However, in 2012 the Government did a big u-turn and instead a voluntary fortification regime was announced. At that time, the New Zealand Association of Bakers agreed to a Code of Practice under which they would voluntarily achieve 25% fortification of packaged sliced bread by the end of 2014 (which they did just achieve) and they would aspire to achieve 50% over time.

Each year the Baking Industry reports on its progress under the Code of Practice. On 25 May 2016 the Baking Industry Research Trust released its latest report which is available here [link no longer active]. The report shows that in 2015 the Baking Industry increased the amount of bread fortified with folic acid. There were 62 varieties of folic acid fortified packaged sliced bread on the market in New Zealand, which was a 7% increase compared to 2014. 32.2% by production volume of packaged sliced bread was fortified with folic acid. The report notes that there were global folic acid shortages in 2015 following the closure of some folic acid factories in China, and this slowed the bread industry’s progress somewhat.

While 32.2% is a long way short of the mandatory (100%) position promoted by NZORD, it is a significant improvement on where things were a few years ago! Further, the bread industry is continuing to work towards their aspirational goal of 50% fortified packaged bread. While it’s great to see progress, NZORD is hungry for more, as there are many children being afflicted by serious and preventable birth defects.

On the day the report was published Lucy Elwood (Chair of NZORD), met with representatives of the Baking Industry Research Trust, the New Zealand Association of Bakers, the Ministry for Primary Industries, the Ministry of Health and other public health organisations (including Professor Barry Borman from the Centre for Public Health Research, and Dr Andrew Marshall from the Paediatric Society of New Zealand). At this meeting the progress of the baking industry was discussed, as well as the health and policy implications of folic acid fortification.

At the meeting, NZORD reiterated its view that mandatory folic acid fortification should be adopted and presented some recent scientific research on the benefits of folic acid fortification. This research included some recent publications from the UK showing that the voluntary approach is not achieving the desired reductions in NTDs in the UK.

Unfortunately, it doesn’t look likely that mandatory fortification is on the cards any time soon. But NZORD will continue to advocate for change in this space. In addition:

  • The Ministry of Primary Industries retains an interest in this area, monitoring research and bread industry outcomes. They are looking at ways to encourage a further uplift in the amount of voluntary fortification. They are also looking at doing a survey on the amount of voluntary fortification that is occurring in other food groups (e.g. cereals).
  • The Ministry of Health is doing some research which includes identifying the baseline levels of folate in the population.
  • Professor Barry Borman presented some data from the New Zealand Birth Defects Registry which shows that the number of neural tube defects in livebirths, stillbirths and terminations has reduced in the past 20 years. This is encouraging. But, of course, the number would be even lower with mandatory fortification.