Food Law News - UK - 2006

FSA Press Release (2006/0672), 12 December 2006

FORTIFICATION - Food Standards Agency launches final consultation on measures to increase the folate intake of young women

The Food Standards Agency (FSA) today launched a consultation setting out options for improving the intake of the vitamin folate for young women in order to reduce the number of neural tube defect (NTD) affected pregnancies in the UK (see note 1 below).

This coincides with the publication today of the Scientific Advisory Committee on Nutrition's (SACN) final report on Folate and Disease Prevention (see note 2 below) in which SACN recommends the implementation of mandatory fortification of flour with folic acid in the UK (see note 3 below).

In the Agency's 13-week consultation, four options are outlined for consideration and public response:

The FSA Board will consider SACN's report on Folate and Disease Prevention and the consultation feedback before providing advice to Health Ministers after the FSA's Board meeting in May 2007.

The Board will also have the opportunity to consider some consumer research exploring people's attitudes around some of the issues (see note 4 below).

SACN's recommendation of implementing mandatory fortification has not changed since the issue was discussed at the FSA open Board meeting in April 2006. This recommendation has, however, been further informed by emerging scientific studies, data analysis and a rigorous exploration of the potential risks relating to increased intakes of folic acid.

Rosemary Hignett, Head of Nutrition at the Food Standards Agency, said: 'Taking action to improve the folate status of young women, in order to help prevent neural tube defects such as spina bifida occurring during pregnancy, is a particularly complex one. Over the past few years this issue has raised many interesting and important issues. The Food Standards Agency is committed to policy-making that will benefit people's health and we do this on the basis of weighing up the evidence in relation to risks and benefits. This consultation is an opportunity for consumers, industry, health charities and other stakeholders to express their views and opinions on this issue.'

The consultation package is currently available on the FSA web site at:



Folate is a B vitamin which is found naturally in many foods, especially green leafy vegetables. As a vitamin, the body normally needs relatively small amounts of folate regularly. It cannot make folate and must therefore get it from the diet. Folic acid is a synthetic form of folate.

There are around 700-900 pregnancies every year in the UK that are classed as having a neural tube defect, such as spina bifida (live births, still births and therapeutic abortions), with many more affected foetuses being lost as miscarriages.


The SACN report on Folate and Disease Prevention updates the report by the Committee on Medical Aspects of Food Policy (COMA) 'Folic Acid and Disease Prevention, (2000). The 2000 COMA report concluded that fortification of flour with folic acid would reduce the number of NTD-affected affected pregnancies. However, it did not find sufficient evidence of other health benefits of folate, e.g. reducing the incidence of cardiovascular disease, to justify fortification for that purpose.

After considering COMA's advice and listening to the views of stakeholders, the Food Standards Agency Board recommended to Health Ministers, in 2002, that mandatory fortification should not be introduced due to the lack of available evidence on the benefits and risks at that time.

In 2003 SACN agreed to assess new evidence regarding the health effects of folate which has arisen since the COMA report. This decision coincided with a request from the Minister of Health in 2004 to consider the wider implications of folic acid fortification.

In November 2005 SACN published its draft report into folate and disease prevention and a consultation into the science behind folate was launched.

In April 2006, the issue was discussed at the FSA's Open Board Meeting and it was decided that SACN needed further time to consider the potential risks to some groups of the population relating to increased intakes of folic acid.

SACN's initial recommendation remains unchanged, but is informed by additional data analysis and a rigorous exploration of the potential risks and benefits relating to increased intakes of folic acid.


SACN recommends mandatory fortification of flour with folic acid as the most effective way to increase folate intakes of women most at risk of NTD-affected pregnancies, providing voluntary fortification is controlled and advice is given about appropriate supplement use.

SACN also recommends that if mandatory fortification is implemented, women should continue to follow current Department of Health advice and take a daily 400 microgram folic acid supplement prior to conception and until the 12th week of pregnancy.


The consumer research focused on participants from different socio-economic backgrounds and ages, who were asked to consider the options for increasing folate intakes in women of child bearing age.

In addition to these workshops, paired depth interviews with women from black and minority ethnic groups were conducted. Five pairs of consumer workshops were held across the UK . Twelve adults aged 18-65+ years took part in each workshop.

Participants were from all socio-economic backgrounds, with an equal number of men and women attending and there was representation of young people, family and older people lifestages.

Four paired in-depth interviews were also undertaken with women from the following ethnic backgrounds: 1 pair of African origin, 1 pair of Caribbean origin, 1 pair Muslim, 1 pair Hindu.

The consumer research is available in the consultation package for information.

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