Monitoring of folic acid fortification
Australia introduced mandatory folic acid fortification of wheat flour for bread-making in 2009. In the same year fortification (with iodine) of salt used in making bread, also become mandatory.
Before the introduction of mandatory folic acid fortification, the Australia and New Zealand Food Regulation Ministerial Council (now the Legislative and Governance Forum on Food Regulation) committed to a comprehensive and independent review of mandatory fortification to begin two years after implementation. This review has begun and the completion date will depend on the timing of availability of data from the 2011-13 Australian Health Survey.
Since implementation state, territory and Commonwealth food regulatory authorities have undertaken a number of projects to monitor folic acid fortification. The findings of these projects will be used to inform the review.
Food Standards Australia New Zealand (FSANZ) has undertaken dietary modelling to determine whether intake of folic acid has increased since mandatory folic acid fortification commenced. Data from the 1995 Australian National Nutrition Survey and the 2007 National Children’s Nutrition and Physical Activity Survey was used in this study.
A report estimating current intake by Australians of dietary folic acid and dietary iodine was presented to the FSANZ Board in early December 2011 for comments before being sent to the Implementation Sub-Committee and the Food Regulation Standing Committee.
FSANZ analysed commonly consumed breads in June and July 2010, nine to ten months after mandatory folic acid fortification was implemented. Samples were bought from representative food retail outlets in the capital cities of all states and territories.
The samples were chemically analysed by the National Measurement Institute of Australia laboratories in Melbourne. The survey provided data for the amount of folic acid and iodine in breads consumed by Australians after implementation of mandatory folic acid fortification. This data together with food consumption data from two national nutrition surveys was used to estimate the Australian population’s intake of dietary folic acid and iodine.
In general, estimated folic acid and iodine intakes had increased as expected for the target groups and the rest of the population, resulting in an increase in the proportion of these populations meeting nutrient requirements. However, as currently advised by FSANZ and health authorities, pregnant women and women planning pregnancy still need to continue to take folic acid and iodine supplements.
FSANZ will repeat the bread analysis survey in 2012 as part of its monitoring program and will then collate all results.
In 2010 Australian state and territory food regulatory authorities conducted a survey of Australian flour millers to assess compliance with the mandatory folic acid fortification standard.
In total, 21 flour mills throughout Australia took part in the study, and all showed they had arrangements in place to demonstrate compliance with mandatory folic acid fortification. These arrangements included review of documents to support implementation, sampling protocols and auditing processes.
The survey also included analysis of folic acid concentrations in flour samples taken from the mills. The levels of folic acid were within the correct limits for 16 of the mills. There was some variance at the other mills (with some slightly over or under the limits). These mills continue to work with food regulatory authorities to ensure the levels remain within the correct limits for fortification.
A survey of consumer attitudes to fortification of food is currently underway and is expected to be finalised by June 2012.
In 2009 FSANZ commissioned Ipsos-Eureka Social Research Institute to undertake a qualitative analysis of current Australian and New Zealand consumers’ awareness, attitudes and behaviours towards fortified foods. This work helped in the design of a quantitative survey. Data collection for this survey was completed in 2011 and is being analysed.
Review of mandatory folic acid fortification
The Department of Health and Ageing is managing an independent review of mandatory folic acid fortification. It is expected this review will take some time as it will require data from the 2011-13 Australian Health Survey being conducted by the Australian Bureau of Statistics. This review will take into account work already undertaken to monitor mandatory fortification.
State, territory and Commonwealth food regulatory and health authorities have agreed to a wide range of data being collected and reported to monitor mandatory folic acid and iodine fortification, including the activities mentioned above. Pre-fortification data was published this year by the Australian Institute of Health and Welfare (AIHW) in three reports; a baseline report, a supplementary data report, and a report on monitoring neural tube defects.
The web addresses for the three AIHW publications in the order in which they are listed above are:
- Mandatory folic acid and iodine fortification in Australia and New Zealand: baseline report for monitoring
- Mandatory folic acid and iodine fortification in Australia and New Zealand: supplement to the baseline report for monitoring
- Neural tube defects in Australia: prevalence before mandatory folic acid fortification