LONDON — Mandatory fortification of food staples with folic acid should be considered in Europe for the prevention of neural tube defects, according to a study appearing Nov. 24 in the BMJ. Recommendations and voluntary fortification failed to significantly decrease neural tube defects in Europe over a 20-year period, according to the study.
“Our data suggest that recommendations, voluntary fortification, or both have not been effective in decreasing the prevalence of N.T.D. in Europe,” the researchers said. “Hence, policies for mandatory fortification of food staples with folic acid should be considered as an important and more effective means for prevention of N.T.D., while weighing the evidence for its proven benefits and possible risks.”
The researchers used data from 28 EUROCAT (European Surveillance of Congenital Anomalies) registries covering about 12.5 million births in 19 countries between 1991 and 2011. They found 11,353 cases of neural tube defects not associated with chromosomal anomalies. The pooled total prevalence of N.T.D. was 9.1 per 10,000 births. Prevalence fluctuated slightly but without an obvious downward trend. There was an annual increase of 4% in 1995-99 and a decrease of 3% per year in 1999-2003. Stable rates followed thereafter. The final estimate of the pooled total prevalence of N.T.D. in 2011 was similar to the estimate in 1991.
The researchers said “convincing evidence” show folic acid supplementation substantially may decrease N.T.D. prevalence. The European Public Health Commission funded the study.The U.S. Food and Drug Administration mandated folic acid fortification of enriched grains in 1998. Since then, the rate of neural tube defects in the United States has decreased by 38%.