Ministry Supports Voluntary Fortification Ministry

20 April 2000

Ministry Supports Voluntary Fortification of Selected Foods with Folic Acid

POLICY is being developed to set guidelines for voluntary fortification of selected cereals and flours with folic acid in an attempt to reduce the incidence of birth defects, Ministry of Health Chief Advisor Child Health Dr Pat Tuohy said today.

Folic acid is a synthetic form of folate, a water soluable B group vitamin. Folic acid is easier for the body to absorb than folate.

Evidence suggests taking folic acid as a supplement can reduce the incidence of neural tube defects (NTDs) which include spina bifida and anencephalus. Birth defects, of which NTDs are a category, are the second leading cause of infant mortality and the third leading cause of late foetal death in New Zealand.

Neural tube damage affects the development of the spine or skull which may involve damage to the brain or spinal cord. In 1997/98, there were 33 cases of spina bifida.

Dr Tuohy said the Ministry already has policies inplace for decreasing the incidence of NTDs, including recommending supplementation, consumption of folate rich foods and undertaking the folate health claims pilot project.

This project will allow folate health claims on certain foods, which meet particular criteria, that link a decreased risk of NTDs with an increased intake of folic acid in women of child-bearing age.

Since 1993, the Ministry has recommended that women considering becoming pregnant should take a supplement of 0.8mg of folic acid from four weeks before conception till the end of the 12th week of pregnancy. Women with a family history of NTDs should take 5mg of folic acid per day.

Dr Tuohy said while it was very important for women considering pregnancy to ensure they had adequate levels of folate, it was important to look at all the startegies available and assess the effect of such strategies as fortification and supplementation on the whole population.

"We believe that the existing policies, combined with the implementation of voluntary fortifcation of selected cereals and flours can have an even greater impact in reducing the number of children born with NTD's."

For more information contact: Selina Gentry, Media Advisor, ph: 04-496-2483 or 025-277-5411 Internet address: http://www.moh.govt.nz/media.html

Questions and Answers About Folate

What is folic acid? Folic acid is a synthetic form of folate - a water soluble B group vitamin. Folic acid can be taken in the form of a supplement, ie in tablet form, and can be added to foods. Folate is found naturally in certain food. Folic acid is more bio-available than folate, which means it is easier for the body to absorb.

Why are women of child bearing age advised to take folic acid? The main body of evidence suggests taking folic acid as a supplement can reduce the incidence of neural tube defects (NTDs). It is recommended that women take 0.8mg of folic acid per day during the period one month before and three months after conception. High risk women (eg those with a family history or a previous neural tube defect baby) should take 5mg per day.

What is a neural tube defect? A neural tube defect is a birth defect in the development of the spine or skull which may involve damage to the brain or spinal cord. Spina bifida is an example of a NTD in which part of the spinal column or backbone remains open. The outcome can range from a minor to a major disability.

How many children are born with spina bifida each year? In 1997-1998 there were 33 cases of spina bifida. The numbers of cases appears reasonably static - though it has decreased steadily from the 1970s and 80s. One possible explanation of this decrease in incidence of NTDs is the pre-natal diagnosis and subsequent termination of pregnancy. Women have been advised to take folic acid supplementation as outlined above, since 1993. This, of course, is not always possible as approximately half of all pregnancies are unplanned.

What is the Minstry's policy on folate supplements? The Ministry of Health has policies in place for decreasing the incidence of NTDs - this includes recommending supplementation, encouraging consumption of folate rich foods and undertaking the folate health claims pilot project. Since 1993 the Ministry has recommended women considering becoming pregnant should take folic acid supplements from four weeks before conception until the end of the 12th week of pregnancy. Those women considered at high risk should take 5mg folic acid per day (others should take 0.8mg). Since 1995 legislation has permitted the addition of folic acid (along with a number of other vitamins and minerals) to selected foods (flour, breakfast cereals, pasta, some biscuits, bread, soy beverages, yeast extracts, fruit juices and vegetable juices). The Ministry, in conjunction with the Australia New Zealand Food Authority (ANZFA), is undertaking a health claims pilot project which allows folate health claims on certain foods (which meet a particular criteria, eg minimum level of folate) that link a decreased risk of NTDs with an increased intake of folic acid in women of child bearing age. When looking at decreasing the incidence of NTDs, it is important to look at all the strategies available such as fortification, supplementation and health promotion. Monitoring of folic acid levels and the effects of any intervention is also essential. It is important to look at the effect on the whole population not just women of child-bearing age - who are a relatively small proportion of the population. It is understood that high folate consumption can mask a B12 deficiency in the elderly.

What research has the Ministry of Health undertaken to feed into folate policy? The Ministry has undertaken a number of research projects to feed into policy regarding folate and NTDs. These include the National Nutrition Survey which looked at dietary and supplementary folate intakes of the population, the Nutrition During Pregnancy study which looked at the number of women taking folate supplements and blood folate status, and the Folate Status Study of Representative Populations in Dunedin which investigated supplement and dietary folate intake, blood folate status and knowledge of women of childbearing age (and young males). The latter study provides baseline data to monitor the folate health claims pilot project and folate fortification of food.

How much is too much? We currently operate under Australian levels of recommended daily intakes (RDIs). The Australian National Health and Medical Research Council suggests that 1000mcg (or 1mg) of folic acid per day is a satisfactory upper level of consumption for the general population, and would avoid the possibility of masking vitamin B12 deficiency. This level needs review, since there is evidence that safe levels are in fact higher than this, and women taking 5mg supplements clearly exceed this dose.

What about potential changes to the regulations regarding supplements? Currently dietary supplements can contain up to 0.3mg of folic acid per day. Levels of folic acid permitted in dietary supplements are historical and need revision. 0.8mcg and 5mg folic acid supplements, as recommended by the Ministry of Health, are pharmacy only medicines and thus can only be purchased over the counter at your pharmacy. These contain only folic acid whereas dietary supplements can contain folic acid in combination with a range of vitamins and minerals.

How do New Zealand NTD levels compare internationally? Birth defects of which NTDs are a category, are the second leading cause of infant mortality and the third leading cause of late foetal death in NZ. Birth defects are also a major cause of hospitalisation of children under four. The NTD which include anencephalus and spina bifida are a major category of severe birth defects.

Please attribute comments to: Dr Pat Tuohy, Chief Advisor Child Health.

For more information contact:

Ministry of Health, Media Advisor Selina Gentry ph: 04-496-2483, pager: 025-277 5411 Internet address: www.moh.govt.nz/media.html

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