Folic acid and iodine in bread: a wide success

Mandatory fortification of bread with folic acid and iodine in Australia has seen health improvements across the population

Since the introduction of mandatory fortification in 2009, mean folic acid intake for women of childbearing age (16-44 years) has increased from 102 to 247 µg per day – a 142% increase.

This shift in intake has led to a significant (14.4%) overall decrease in the rate of neural tube defects (NTDs) in Australia, according to a new report by the Australian Institute of Health and Welfare (AIHW).

The biggest improvements were found among Aboriginal and Torres Strait Islander women and teenagers, for whom the rate of NTDs decreased by 74% and 55% respectively.

Prior to mandatory fortification, many pregnant women had inadequate folic acid intakes, leaving their children at risk of NTDs.

This was largely due to the considerable number of unplanned pregnancies, lack of knowledge, and barriers to supplement use such as cost and access.

Types of NTDs caused by inadequate folic acid during pregnancy include:

  • Spina bifida – exposure of the spinal cord, nerves of the tissue that covers them, and one or more of the backbones
  • Anencephaly – total or partial absence of the upper part of the brain, the bones of the top of the skull, and the covering skin
  • Encephalocoele – Exposure of part of the brain or issues through an opening in the skin and skull bones
  • Isolated neural tube defects – Neural tube defects with no coexisting birth defects or with coexisting anomalies directly related to the neural tube defect

Iodine has also been acknowledged as important to the physical and cognitive development of fetuses and young children.

Similar to folic acid, levels of iodine have been raised across the population due to mandatory fortification.

The estimated mean iodine intake for women aged 16–44 has increased from 98 µg to 149 µg per day (a 52% increase) and for children aged 2–3 from 127 µg to 164 µg/day (a 29% increase).

These changes have helped to reduce mild iodine deficiency across the general population, which in turn has reduced the risk of physical and mental impairment in children, and thyroid disease across all age groups.

The results are “a very positive outcome,” says AIHW spokesperson Ann Hunt.

However, more work in needed to ensure these early, promising results are accurate and sustained, she says.

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