Folic acid fortification

On 17 May 2007, the Food Standards Agency Board agreed unanimously that 'mandatory fortification' with folic acid should be introduced, alongside controls on voluntary fortification and advice on the use of supplements.

Mandatory fortification means that it would be compulsory to add folic acid to either bread or flour. The purpose of mandatory fortification with folic acid is to reduce the number of neural tube defects. The Scientific Advisory Committee on Nutrition (SACN) estimated that there are between 700 and 900 pregnancies affected by neural tube defects each year.

The Board’s decision on this issue was made after an extensive and scientifically robust process. This included analysis and advice from SACN, which is an independent committee of scientific experts that advises the Government. All the scientific evidence considered by SACN is detailed in its report, Folate and Disease Prevention (December 2006) – see the link at the bottom of the page.

In reaching its decision the Board also considered: the risks and benefits to both specific groups of the population as well as the whole population; the public consultation on a range of options; consumer research on the options; the ethics of adding folic acid to a food; and the impact that mandatory fortification has had in other countries. The Board paper sets out clearly all of the arguments and the results of consultations with experts, ethical advisers, business sectors and consumer groups. The paper is available from the link at the bottom of the page.

The consumer research, ethics paper, literature review and consultation summary have been published and links to these can also be found below.

In October 2007, SACN was asked by the Chief Medical Officer (CMO) to consider in depth two papers, which were published after the SACN report, suggesting that folic acid may increase the risk of colorectal cancer: Cole et al (2007)¹ and Mason et al (2007)². SACN co-opted members of the Committee on Carcinogenicity and experts in cancer epidemiology for this task. As well as considering the two papers by Cole et al (2007) and Mason et al (2007), SACN also considered the results of a meta-analysis of a number of B-vitamins trials that have investigated the association between B vitamins (including folic acid) and cardiovascular disease, and which also collected data on cancer outcomes.

In October 2009, the Agency advised the CMO of the outcome of SACN’s review. SACN has published a summary of its report to the CMO (see the link at the bottom of the page), and will make its full report available once the results of the meta-analysis are published by the researchers. Overall, SACN concluded that the new evidence does not provide a substantial basis to change its previous recommendation for the introduction of mandatory fortification with folic acid, with controls on voluntary fortification. However, SACN’s recommendation has been amended to clarify the advice on supplement use for particular population groups.

Links to letters from the Agency to the Minister of State for Public Health and the CMO on mandatory folic acid fortification, and the letters received in response, can be found below.

The CMO is expected to advise UK Health Ministers of SACN’s recommendation shortly, and Health Ministers will then decide whether to approve mandatory fortification with folic acid in the UK.

If mandatory fortification is approved, the FSA will produce a plan of how it can be implemented, including details of which types of bread or flour would be fortified and how the added folic acid would be labelled.