Background – A recent Food Regulation Ministerial Council policy guideline endorsed mandatory fortification of the food supply with folic acid as an effective public health strategy for reducing the prevalence of neural tube defects.
Objective – To conduct a comprehensive risk assessment including the determination of an appropriate food vehicle for adding folic acid and assessing the potential impact of a mandatory fortification program on intakes.
Design – The steps involved in assessing folic acid intakes include (1) the compilation and evaluation of nutrient data from sources such as food composition programs and the uptake of provisions allowing voluntary fortification of foods with folic acid by manufacturers; (2) the identification of food composition and/or food consumption data gaps and addressing them; and (3) dietary modelling of different scenarios and interpretation of results. Bread was selected as the vehicle for folic acid fortification due to the high consumption of bread by the target group, women of child-bearing age. A number of levels of fortification were assessed Mean intakes and proportion of respondents exceeding the Upper Level of intake were determined for women of child-bearing age and selected non-target groups.
Outcomes – There was no level of fortification that resulted in the target group reaching the recommended 400 μg of folic acid a day which reduces the risk of neural tube defects without at least one other population group having an undesirable proportion exceeding the Upper Level of intake. However a fortification level that maximises benefit but minimises risk can be identified.
Conclusion – Mandatory food fortification can assist in increasing folic acid intakes in women of child-bearing age but other strategies, such as voluntary fortification in a number of foods and peri-conceptional supplement use must still be continued.