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Folic acid fortification: The key to supporting pre-natal nutrition?

11 February 20227 min reading

“Adequate consumption of folic acid, which occurs naturally as folate or vitamin B9, is essential for consumers of all ages across the globe. It is vital that millers, brand owners, private sector partners, governments, donors and NGOs work together to find and implement long-term solutions to combat folate deficiency and subsequently improve pre-natal health – allowing even the most vulnerable across the globe access to a brighter future.”

Global Director Nutrition
Improvement
DSM 


Pre-natal nutrition plays a critical role in supporting healthier futures for babies and children across the globe. While many of the most widely consumed foods – such as flour, rice, and oil – support an adequate calorie intake, they lose vital vitamins and minerals during processing. The consequence of this is that millions of people around the world who rely on staple foods lack access to the micronutrients – like folic acid – needed to support optimal levels of health and development. The effects are particularly prominent in newborn babies, who are at increased risk of life-threatening birth defects if the folate status of the mother is low during pregnancy. Indeed, undernutrition and folate deficiency are global issues – poor folate status is commonly observed both in low- and middle-income countries, but also in some of the world’s wealthiest nations. So, how can fortification help to reduce the risk of folate deficiency and ensure babies are born healthy? 

Folic acid: a vital building block in pre-natal nutrition

Adequate consumption of folic acid, which occurs naturally as folate or vitamin B9, is essential for consumers of all ages across the globe. In women who are pregnant or trying to conceive, it is especially important as the nutrient plays a critical role in preventing babies from developing neural tube defects (NTDs). NTDs can lead to conditions such as spina bifida, where spinal tissue herniates outside the body, and anencephaly, where there is an absence of brain in the top part of the skull. These conditions occur in roughly 1 in 1,000 pregnancies per year in the UK alone.1  Both can greatly decrease the quality and length of life, with many babies who are diagnosed with anencephaly either being delivered stillborn or dying shortly after birth. 

While a balanced diet of leafy greens and pulses is usually sufficient to maintain healthy folate levels, a higher intake is typically required during pregnancy.2  However, in the UK a recent National Diet and Nutrition Survey (NDNS) found that 90% of women of childbearing age have a poor folate status, meaning that if they fell pregnant their baby would be at an increased risk of developing NTDs.3  In the UK, women are advised to consume 400mg of folic acid per day for a month before conception and during the first 12 weeks of pregnancy via the ingestion of folate supplements.4  However, with unplanned pregnancies accounting for 50% of all pregnancies in the UK per year and awareness of the importance of folic acid remaining low, there is a likelihood that voluntary supplementation is not the most effective tool in preventing folate deficiency in expectant mothers.5  The universal fortification of a staple food product – like wheat flour – with folic acid can therefore help to plug the gap and reduce the number of unborn babies at risk of developing life-threatening conditions.

Fortification and the global stage

Historically, the results of mandatory fortification initiatives have been extremely positive. Since the addition of folic acid to flour became US policy in 1998, there has been a 28% decrease in the prevalence of NTDs in babies.6  New Zealand has also recently announced that, by 2023, millers must incorporate between 2 and 3mg/kg of folic acid into their flour.7 This follows on from a 2014 Code of Practise where the New Zealand Association of Bakers agreed to fortify 25-50% of bread with folic acid.9 In 2021, the UK became the most recent country to introduce a mandate that requires folic acid fortification in all non-wholemeal flour.10 This aims to reduce the number of babies born with NTDs by around 200 each year – around 20% of the UK annual total.11  

Flour has been fortified in the UK for over 80 years with the addition of calcium, niacin, iron and thiamin – nutrients typically lost during the milling process.12  This means that the addition of folic acid is neither a logistical nor a financial challenge. Beyond an initial investment, the cost of incorporating folic acid is far outweighed by the total healthcare costs that are saved by doing so, with the benefit to cost ratios typically sitting at 12-48:1.13

Seeing the opportunity to provide better futures for all

Similar steps are being taken in lower-income countries, with major flour and milling companies in India agreeing in 2017 to introduce fortified flour into their flagship brands. Around 50% of the Indian population lives with some form of health deficiency due to malnutrition.14 Even more crucially, between 4-8 in 1000 babies here are born with spina bifida – four times the global average.15 By taking these steps to fortify a staple food like flour, the numbers of infants with this potentially life-threatening condition can begin to be reduced.

It is vital that millers, brand owners, private sector partners, governments, donors and NGOs work together to find and implement long-term solutions to combat folate deficiency and subsequently improve pre-natal health – allowing even the most vulnerable across the globe access to a brighter future.

As the leading expert in flour fortification, DSM’s knowledge and experience ensures the correct concentration, distribution, and stability of micronutrients to meet specific regulatory requirements and quality standards. With a complete portfolio of high-quality ingredients, alongside specialized fortification technologies and customized solutions including micronutrient blends, DSM is the ideal end-to-end partner – bringing expertise and passion at every stage of the development process. DSM has also set ambitious environmental, social, and governance (ESG) targets. This mission is reflected in measurable and transparent Food System Commitments, designed to deliver Health for People, Health for Planet, and Health for Livelihoods. By 2030, DSM aims to have played a tangible role in helping to close the micronutrient gap for 800 million people, and through our partnerships in both the public and private sectors we are constantly innovating for affordable, accessible, and aspirational solutions to keep the world’s growing population healthy. 

For more information about how partnering with DSM can help you to innovate in the fortification market, visit www.nutritionimprovement.com.

References

1 Morris JK et al, Prevention of neural tube defects in the UK: a missed opportunity, Archives of Disease in Childhood, 2016.
2 University of Maryland Medical Centre. “Vitamin B9 (Folic acid)” 5 August 2015.
3 NDNS Supplementary Folate Report – a summary of findings, British Nutrition Foundation.
4 UK National Health Service, Vitamins, supplements and nutrition in pregnancy, last reviewed 14 February 2020.
5 Public Health England, Health Matters: Reproductive health and pregnancy planning, 2018.
6 UK Government, Department for Health and Social Care, Folic acid added to flour to prevent spinal conditions in babies, 20 September 2021.
8 Government of New Zealand, Fortification of flour with the B vitamin folic acid, 8 July 2021
9 Government of New Zealand, Fortification of flour with the B vitamin folic acid, 8 July 2021.
10 Ibid., Folic acid added to flour to prevent spinal conditions in babies.
11 Ibid., Folic acid added to flour to prevent spinal conditions in babies.
12 Ibid., Folic acid added to flour to prevent spinal conditions in babies.
13 H. Pachon et al., Folic acid fortification in wheat flour: A cost-effective public health intervention to prevent birth defects in Europe, 2015.
14 Global Fortified Flour Market Analysis – Forecast to 2026.
15 ‘Doctors call for more awareness of spina bifida.



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