Case for Folic Acid and Vitamin B₁₂Fortification in Europe

Abstract

The number of pregnancies affected by neural tube defects has been estimated to be 4000/year in Europe, with a higher prevalence in Celtic populations and in women of low socioeconomic status. Since the 1980s, it has been shown that supplementation with folic acid during the periconceptual period reduces the risk of neural tube defects in the fetus. However, in view of the period during which supplementation should be taken (< 4 weeks before conception until 8-10 weeks after) and the fact that in some countries 30-50% of pregnancies are unplanned, a public health initiative based solely on increasing dietary folate intake or recommendations on use of folic acid supplements is likely to be insufficient. Mandatory fortification has been started in 38 countries throughout the world. Several European countries have advocated mandatory flour folic acid fortification over the last 6 years, but none has introduced it. A recent public health decision in Hungary stimulated flour fortification on a voluntary basis, but it remains the only European country to take this action. Many European countries have deferred a decision to introduce fortification because of concerns about possible masking of vitamin B (12) deficiency. This review advocates a proposal for combined fortification of folic acid and vitamin B (12) to address possible hazards of fortification with folic acid alone.

Market Potential of Folate Biofortified Rice in China

“…Although the folic acid fortification policy in the United States did not cause a major increase in the number of vitamin B12 deficient people (Mills et al, 2003), a multi-micronutrient fortification or supplementation policy to increase both folic acid and vitamin B12 could be a partial solution (Czernichow et al, 2005;Finglas et al, 2006). Nevertheless, the debate about the adverse health effects of high folic acid intake still hampers the introduction of (mandatory) folic acid fortification in many (European) countries (Cornel et al, 2005).…”

“…In 2005, about 38 mainly industrialized countries had opted for a mandatory folic acid fortification policy (Czernichow et al, 2005). In the United States (Choumenkovitch et al, 2002;Quinlivan and Gregory, 2003;Rader and Schneeman, 2006) and Canada (De Wals et al, 2007;Shakur et al, 2010), for example, cereal grain products were fortified with folic acid to a level of 140 and 150 μg per 100 g, respectively, and proved to successfully enhance folate status.…”

“…Due to its importance for women of childbearing age, folic acid supplementation is often promoted in countries with low rates of unplanned pregnancies, such as with countries in Europe (Cornel and De Smit, 2010). Although folic acid supplementation policies are well established in Western and Northern Europe, their effectiveness to reduce NTDs is rather limited Czernichow et al, 2005;EUROCAT, 2005), partly due to incorrect use . The success of supplementation programs depends on the duration and the intensity of supplementation efforts, the accessibility and adequate supply of supplements, the effectiveness of the health system, the involvement of health personnel and/or the 2003) for instance, increased knowledge about folic acid, but were less effective in stimulating the use of folic acid supplements.…”

“…deficiency (Czernichow et al, 2005)(see section 2.3.1). Although the folic acid fortification policy in the United States did not cause a major increase in the number of vitamin B12 deficient people (Mills et al, 2003), a multi-micronutrient fortification or supplementation policy to increase both folic acid and vitamin B12 could be a partial solution (Czernichow et al, 2005;Finglas et al, 2006).…”

An intervention trial to determine the response of vitamin B12 biomarkers to chronic supplementation with low dose vitamin B12 after folate repletion

“…It has been proposed that the inclusion of vitamin B12 together with FA may provide added health benefits and alleviate the problem of 'masking' of vitamin B12 deficiency by FA in the elderly (1)(2) . However, the response to supplementation with vitamin B12 at low doses has not been sufficiently investigated to date.…”