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In May last year the Food Standards Agency said ministers should order the mandatory fortification of food with folic acid.
In November 1998, Canada began its mandatory fortification of all flour, and some corn and rice products, with folic acid.
Recent debate has focused principally on the need for mandatory fortification of grain products with this vitamin.
Importantly, Australia recently introduced a policy of mandatory fortification of certain foods with folic acid for additional protection against NTD.
Therefore, mandatory fortification of maize flour was more likely to have a greater impact on rural children's intake of micronutrients and minerals.
Among the responses to this research evidence were calls in the early 1990s for mandatory fortification of food with folic acid.
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Mean red cell folate levels measured in a large sample of Australians undergoing diagnostic blood tests increased from 881 nmol/L prior to mandatory fortification to 1071 nmol/L in the year ended April 2010 [ 35].
Given the bread consumption data collected in this study, to achieve the targeted additional intake of 140 μg/d, a mandatory fortification level of 160 μg folic acid/100 g bread may be required.
What this study adds In the absence of mandatory fortification, the prevalence of NTD has not decreased in Europe despite longstanding recommendations aimed at promoting peri-conceptional folic acid supplementation and existence of voluntary folic acid fortification.
In the USA, which has mandatory fortification, 13.6% of those ≥60 years-old had tHcy concentrations >13 µmol/L in 2003-4 [40], a level at which we found a >50% reduction in the rate of atrophy upon treatment with high doses of B vitamins.
Respondents from both sectors believed that incentives, as they are currently used, could improve in their effectiveness in encouraging compliance with mandatory fortification legislation; 8 of the 27 respondents (30%) reported incentives are "very" effective, while 9 (33%) considered incentives "moderately" effective, and 10 (37%) considered them "slightly" or "not at all" effective.
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