15-Year Celebration: Fortifying with folic acid prevents 22,000 birth defects annually
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Digital Re-print - September | October 2011 15-Year Celebration: Fortifying with folic acid prevents 22,000 birth defects annually
In just 15 years, adding folic acid to flour has become a life-altering business practice resulting in the
prevention of more than 22,000 serious birth defects every year. That’s 60 babies a day born worldwide without these birth defects because flour is fortified. The Flour Fortification Initiative (FFI) is celebrating the progress made in helping children get a healthy start in life and encouraging fortification to become standard milling practice globally.
“The success is obviously in the numbers of healthy children born as a result of flour fortification, but it is also the success of mul-tiple partners working together,” said Scott Montgomery, FFI director. “This achieve-ment required flour millers to implement fortification, and it required the collaboration of international scientists, non-governmental organizations, individual country officials and premix suppliers. In highlighting this 15-year milestone, we are celebrating the contribu-tions of many.”
In 1996, Oman Flour Mills began fortifying flour on a trial basis with enough folic acid to prevent birth defects like spina bifida. This is
now mandatory milling practice in 54 coun-tries and voluntary practice in approximately 20 other countries. In addition to preventing birth defects, countries report significant cost savings by averting the healthcare expendi-tures required to treat children with spina bifida.
Spina bifida is one of three birth defects known as neural tube defects. In spina bifida, the baby’s spine does not form correctly, leading to loss of movement in mild cases or paralysis in severe cases. Spina bifida can be
treated but cannot be cured. Anencephaly is another neural tube defect in which the brain does not form properly. It is always fatal. The least common neural tube defect is encepha-locele that leads to a sac-like protrusion of the brain. Its severity depends on where the sac is located.
Research published in 1991 unequivocally showed that folic acid prevents neural tube defects. Now it is estimated that 50 to 70 percent of these birth defects can be pre-vented if a woman gets 400 micrograms of folic acid daily at least a month before a baby is conceived and very early in her pregnancy. Fortification provides an extra supply of folic
acid through bread, noodles, pizza crust, crackers and every other food made with the fortified wheat or maize flour.
In 1996, the same year that Oman began fortifying, the United States changed its regu-lation for enriched cereal grains to include the addition of folic acid, and flour millers had until January 1998 to comply with the new law. Implementation moved faster in Oman because the country has only one mill.
“The mill was well-equipped to introduce the fortification with no major investments,
and the Minister of Health, Dr Ali Moussa, was also the chairman of the board of the Oman Flour Mills,” recalled Dr Deena Alasfoor who is now the director of Nutrition for the Ministry of Health in Oman.
Iron and other B vitamins have been added to flour in some countries since the 1940s, and several countries in the Middle East were considering this in 1996 as part of a broader focus on improving nutrition. Oman Flour Mills began fortification as a trial to see if it was feasible before a multi-sector regional workshop was held in Oman in October of 1996. By the time of the work-shop, fortification was deemed successful,
15-Year Celebration:Fortifying with folic acid prevents 22,000 birth defects annually
“The Flour Fortification
Initiative (FFI) is a network
of public, private, and civic
sector partners working
together to make flour
fortification standard milling
practice so that people
worldwide are smarter,
stronger, and healthier”
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and the Oman mill continued to fortify with no interruption.
Before 1996, some countries added folic acid to flour because everyone needs this vitamin to produce and maintain new cells and decrease the risk of anemia caused by folic acid deficiency. However, the addition levels were too low to significantly reduce the rates of neural tube defects. With encouragement from international consult-ants, Oman added folic acid to flour at the rate of 1.5 parts per million. This proved to be an adequate amount to reduce the number of children born with spina bifida in Oman from an average of 3.17 per 1,000 births before fortification to an average of 0.96 per 1,000 births after fortification.
The World Health Organization now offers recommendations for fortifying flour with folic acid based on a country’s level of flour consumption. The recommendations range from 1 to 5 parts per million.
As the practice of fortifying flour with folic acid has spread, countries from Canada to Argentina and South Africa to Iran report 30 to 70 percent declines in neural tube defects. The declines vary based on how much folic acid is added to flour and the rate of these birth defects before fortifica-tion. In the United States, fortification of flour and breakfast cereals is credited with preventing 1,000 neural tube defects a year. The U.S. Centers for Disease Control and
Prevention has called it one of the “Ten Great Public Health Achievements” in the last decade.
Children born with spina bifida require multidisciplinary medical treatment, including surgeries, physical therapy and continence care. Wellington Hospital in New Zealand found that a newborn with spina bifida had undergone surgeries costing US$ 569,000 before his second birthday. The hospital’s study also found the direct surgery and hospital costs for six teenagers with spina bifida, from their birth, was US$ 790,000 per individual.
The cost to fortify flour with iron, zinc, folic acid and other B vitamins is between US$1 and US$3 per metric ton of flour. When countries compare the cost of for-tifying flour with the healthcare savings averted by having fewer children born with spina bifida, prevention always proves more economical. Chile’s cost for fortification compared with the savings in surgical treat-ment and rehabilitative services for children with spina bifida represented a cost:benefit ratio of 1:12. South Africa saved 30 rand for every one rand spent on fortification when it calculated the cost of treating a child with spina bifida during the first three years of life.
“Children born with spina bifida need the best medical care available; and the money spent to help them be more
comfortable and productive is certainly worth every penny,” Montgomery noted. “Preventing these birth defects, however, saves millions of healthcare dollars and keeps thousands of children from struggling with a life-long disability.”
Millers who fortify flour may see buying premix and conducting quality control tests as standard business practice. Families whose children who may have been born with a neural tube defect without flour fortification, however, surely see it as a life-altering busi-ness practice.
The Flour Fortification Initiative (FFI) is a network of public, private, and civic sector partners working together to make flour fortification standard milling practice so that people worldwide are smarter, stronger, and healthier. Wheat and maize flours are most commonly fortified with iron, folic acid and other B vitamins such as riboflavin, niacin, and thiamine. Other nutrients often added to flour at each country’s discretion include zinc, vitamin A, vitamin B12, and vitamin D.
for More inforMation:Sarah ZimmermanFFI Communications CoordinatorUSA
Tel: + 1 404 7275477Email: [email protected]: www.FFInetwork.org
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LINKS• Seethefullissue• VisittheGFMTwebsite
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In this issue:
• Sample preparation of feeds and forage for NIR analysis
• 15-Year Celebration: Fortifying with folic acid prevents 22,000 birth defects annually
• Global Feed Markets:Wheat supply grows and grows as corn crop shrinks
• Producing Flaked breakfast Cereals
• Direct Cold Plasma: The innovative answer to odour control in the food and feed industry
• Milling Technology Redefined
GFMT11.05.indd 1 04/10/2011 15:14
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