Folic acid on the EU agenda
initiated at EU-level, as various member states mull public health
strategies for reducing pregnancies affected by neural tube
Deficiency of folic acid, a B vitamin that occurs naturally in foods such as grains, lentils, chick peas and green leafy vegetables, in the very early stages of pregnancy can lead to neutral tube defect, such as spina bifida, in the infant.
Mandatory fortification of grain products with folic acid in North America since 1998 has led to a significant reduction in NTD incidence. Although the UK and Ireland have been seriously looking into it, no European country has introduced parallel measures so far.
The UK's FSA launched its final consultation in December, and Ireland's National Committee on Folic Acid Fortification made a positive recommendation last July on fortification of most white, brown and wholemeal breads sold in the country.
However, since different public health policies and risk management strategies are being implemented, the EC Advisory Committee suggested last September that a discussion forum should take place so that member states could share experiences and concerns on the matter.
After a meeting of 31 participants from EU states and Switzerland in Berlin in last month at which a number of key issues were discussed, the matter returns the table today at the European Food Standards Agency's (EFSA) advisory forum in Parma, Italy, to discuss common proposed projects and co-ordinate food safety and nutrition policies across the bloc.
At the Berlin meeting, participants flagged the need for a reliable database of NTD rates across the bloc - which vary from state to state - since the existing EUROCAT register is incomplete and there is no EU-wide way of monitoring the impact of supplementation or fortification measures.
They also drew attention to the fact that there is no common approach to measuring folate status of the European population, and a common reference value for folate intake in Europe does not eixist. This means that a reliable comparison of intakes is not possible.
It was recognized that many member states advise sexually active women to take folic acid supplements. For instance in the UK women of child-bearing age are advised to take 400 micrograms of folic acid a day, and those planning a pregnancy should take it prior to conception and until the 12th week of pregnancy.
But it is thought that only a minority of women follow this advice. Moreover, as many as 50 per cent of pregnancies in some countries (Ireland, for instance) are unplanned, so it is not necessarily the case that women ensure they are consuming beneficial nutrients prior to conception.
In light of this Berlin meeting discussed the benefits and drawbacks of voluntary and mandatory fortification.
It noted that, at present, a wide range of fortified food products are available on European markets, but this can lead to uneven and unpredictable intakes across the population as a whole.
"In order to ensure safe levels of consumption, there is a need to limit the numbers of foods fortified with folic acid and to set an upper limit for voluntary fortification," said a note on the discussions.
This thinking is in line with current debate over the setting of maximum levels of vitamins and minerals under the 2002 supplements directive and the new fortified foods regulation - a touchy topic since different member states would like different approaches to enforcement, in some cases to protect products currently on the market.
In the case of folic acid, there are fears that high levels may mask detection of vitamin B12 deficiency, especially in the elderly. If this deficiency is not identified it can eventually lead to dementia.
According to the UK FSA's Scientific Advisory Committee on Nutrition, folic acid intakes of one mg/day would not be expected to mask vitamin B12 deficiency, and most adverse effects in relation to vitamin B12 deficiency have been reported at doses at or above 5mg/day.
As for mandatory fortification with folic acid, the participants flagged up a need to maintain consumer choice.
"Safety aspects of introducing folic acid into the diet of the whole population were discussed and gaps in our knowledge identified," said the note.