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Food Focus August 2007

Fortified bread to help reduce neural tube defects

In June 2007, a joint decision was made between New Zealand and Australia to add folic acid to bread in a bid to reduce birth defects in babies

We get some folate (the natural form of folic acid) from a healthy balanced diet, but women looking to conceive, and in early pregnancy, need more folic acid than usual to reduce the risk of having a baby with congenital malformations.

New Zealand and Australia have now made it compulsory to add folic acid to bread to increase the daily intake of this critical vitamin. Australia will fortify the flour directly, while New Zealand will add folic acid during the bread-making process itself. To provide some consumer choice, organic and non-yeast leavened breads will not contain added folic acid.

The importance of folate

Pregnant women who don’t get enough folic acid have a higher risk of their babies developing abnormalities known as neural tube defects (NTDs). The neural tube is the nerve centre of the foetus which grows into the spinal cord. The most common NTDs are spina bifida and hydrocephalus.

How much is enough?

Adults currently get about 200 micrograms of folate each day, from foods naturally rich in folate and a range of foods permitted to add folic acid, such as breakfast cereals. The optimum level to reduce the risk of NTDs is 400 micrograms of folic acid a day.

The Ministry of Health recommends a supplement of 800 micrograms of folic acid per day for women planning to get pregnant, or who are in the first three months of their pregnancy. If there is a family history of neural tube defects like spina bifida, an even higher dose may be necessary (so check with your doctor).

What foods contain folate?

Food labels will list the vitamin added as folic acid or folate in the ingredients list, and/or sometimes in the nutrition information panel.

Foods naturally high in folate include vegetables, especially green vegetables such as broccoli, spinach, salad greens; citrus fruit; wholegrain breads and breakfast cereals. Chick peas, nuts, dried beans and peas are also high in folate, although cooking reduces this level. Some foods can have folic acid added on a voluntary basis, such as breakfast cereals.

Which other countries fortify?

In the US and Canada mandatory fortification with folic acid was introduced in 1998 and in both countries the number of pregnancies affected by NTDs has fallen. (A Canadian study published in 2004 showed that the proportion of babies born with NTDs in the province of Newfoundland and Labrador dropped by 78% after folic acid was added to flour, cornmeal and pasta.)

In Chile, mandatory fortification of flour with folic acid was introduced in 2000. Brazil and Israel have legislation coming up that will introduce mandatory fortification.

So far, no European countries have introduced it but the Republic of Ireland is currently working on legislation to implement mandatory fortification of bread. In May this year the UK Food Standards Agency Board agreed unanimously that mandatory fortification with folic acid be introduced.

New Zealand bakers can begin fortification any time after the standard has been gazetted but there will be a two-year transition period before it is mandatory. An independent review will be held two years after implementation to consider health impacts, effectiveness, cost impacts on the industry and adequacy of the monitoring framework.