Campaigners are celebrating after the UK government passed legislation that will make fortifying all non-wholemeal wheat flour with folic acid mandatory by the end of 2026.
The new legal requirement is estimated to prevent as many as 200 cases of neural tube defects such as spina bifida each year, and is also hoped to improve the health of pregnant women.
It will bring the UK in line with other countries, such as the US and Canada, where mandatory fortification programmes have been implemented since the 1990s.
Global non-profit agency Nutrition International welcomed the news, saying: “Nutrition International encourages other countries to follow in the UK’s footsteps by putting in place mandatory large-scale food fortification legislation and standards which are meeting the needs of their population ‒ and offering ongoing dedicated attention to ensure the standards continue to address those needs.
“Through these informed and persistent measures, deleterious impacts of micronutrient deficiencies and insufficiencies may be prevented. Furthermore, the measures will help to reduce healthcare costs for generations to come.”
Folate, also known as vitamin B9, is found in foods such as beans and dark-green, leafy vegetables; most people receive a sufficient dose from their diet.
Folic acid is the synthetic form of the nutrient, supplied in multivitamins and fortified foods. It is particularly important in early pregnancy, as it is essential for the proper development of the baby’s brain, skull, and spinal cord.
In the UK, the National Health Service (NHS) recommends that expectant mothers and women trying to conceive take 400 micrograms (µg) folic acid daily for three months before getting pregnant, and for at least 12 weeks after becoming pregnant.
It is estimated that half of all pregnancies in the UK are unplanned, and mandatory flour fortification is hoped to help boost intake of folic acid across the population, indirectly protecting the health of unborn babies.
Flour is already fortified with calcium, niacin, thiamine, and iron as a means of improving public health.
However, some experts said the new legislation failed to go far enough.
Sir Nicholas Wald, professor of preventive medicine at University College London, said: “The decision by the UK government to fortify non-wholemeal wheat flour to prevent an estimated 200 cases of anencephaly and spina bifida every year is good news.
“However, more could be done to prevent an estimated 800 cases instead of 200 if all flour and rice were fortified (unless labelled as unfortified) and the level of fortification mandated by the government were increased.”
Others drew attention to the possibility of widening existing health inequalities.
Neena Modi, professor of neonatal medicine at Imperial College London, said: “The news that fortification of flour with folic acid is to be implemented at long last is welcome. Folic acid (vitamin B9) supplementation was shown to reduce neural tube defects by about 80% in a landmark UK randomised trial funded by the Medical Research Council and published in the Lancet in 1991.
“However, this news is tempered by the decision to restrict fortification to non-wholemeal flour only as this will disadvantage groups such as women who are sensitive to gluten, eat rice in preference to bread, and products made from wholemeal flour, excluding them and their babies from benefiting, and thus add to the considerable health inequities that already exist in the UK.”
Small-scale millers (producing less than 500 metric tonnes of flour a year) will be exempt from the new legislation.
