Flour fortification with folate to reduce risk of Spina Bifida

Summary:

Spina bifida is the most common neural tube defect (NTD) and is caused by an interaction of genetic and environmental factors. The congenital condition results from the failure of closure of the caudal neural tube and can led to a variety of complications. Current prevention and management interventions include taking folic acid supplements and undergoing operation before or after birth. The compulsory fortification of flour with folic acid has been successful in countries such as the USA, where studies have found that the prevalence of spina bifida declined by 31% since fortification was introduced. Despite the evidence to support the legislation, there are many concerns regarding folic acid fortification. These include certain ethical considerations regarding the feelings of those already living with NTDs as well as a potentially increased risk of cancer due to excess folic acid in the diet. 

Relevance:

The British Government has recently announced plans to discuss the mandatory fortification of flour with folic acid. This is in response to the establishment of a causal link between NTDs such as spina bifida and low folic acid levels in mothers during the embryonic stage of pregnancy. Evidence suggests that a diet containing folic acid reduces the risk of spina bifida in offspring by up to 70%. 

Take Home Messages: 

Further research is needed to explore the long-term effects of increased folic acid in the diet; however, it appears as though the evidence for the mandatory fortification of flour with regards to a significant reduction in the risk of developing NTDs such as spina bifida outweigh potential risks.