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Folic acid intake in Germany is inadequate

30/2005, 27.09.2005

BfR advises women of child-bearing age and pregnant women to take folic acid supplements

Folic acid intake in Germany is inadequate: 80 to 90 percent of the population take far less than the recommended dose of this vitamin. Folic acid plays a particularly important role before and during pregnancy. A deficiency can cause severe deformities in the embryo. Discussions are, therefore, underway on how to lastingly improve the folic acid intake of the population in general and of women of child-bearing age in particular. One option is the fortification of a staple food like flour. In a research project the Federal Institute for Risk Assessment, together with the Berlin Robert Koch Institute and the Dortmund Research Institute of Child Nutrition, examined the effectiveness of various measures. The result: the mandatory fortification of flour with folic acid could effectively increase total intake in all echelons of the population in a calculable manner. Pregnant women or women wishing to have children would still have to take additional folic acid-containing food supplements. If the public agencies responsible for management should decide in favour of mandatory fortification of flour, the fortification of other foods with folic acid would have to be restricted in order to avoid excessive intake by the rest of the population.

Folic acid is a water soluble vitamin which is essential for the human organism. It is a natural ingredient – folate – in foods like spinach, lettuce, white cabbage, tomatoes, oranges, liver, cereals and wholemeal products made from them. Synthetic folic acid is used in food supplements and for food fortification. Ideally, adults should have a daily dietary folate intake of 400 microgram (µg). However, only 10-20 percent of the population achieves this level. That’s why various foods like breakfast cereals, dairy products and soft drinks are already fortified with folic acid today. As people’s eating habits differ, this does not lead to an even supply of the recommended amount of folic acid across all the groups in the population. The fortification of a staple food with folic acid has, therefore, been under discussion for some time now.

Prior to and during the first three weeks of pregnancy, adequate folic acid intake is an essential prerequisite for the healthy development of the embryo. Insufficient folic acid intake during this period may lead to newborn babies suffering from deformities of the central nervous system. This defect is called Spina bifida or neural tube defect (NTD). It is popularly referred to as “open spine”. It leads to severe to very severe health damage and can be fatal. Spina bifida is one of the most frequent congenital deformities. The number of children who are born every year in Germany with NTD is estimated to be around 8,000. Approximately 500 pregnancies are terminated every year after the diagnosis of a neural tube defect in the womb.

Women who wish to or could become pregnant, therefore, need a higher folic acid intake than the rest of the population. In order to prevent neural tube defects in newborn babies, they should take 400 µg folic acid daily in the form of a food supplement in addition to dietary folate intake. Experience from countries like the USA, Canada and Childe, in which flour is already fortified with folic acid, show that this can lead to a significant reduction in the incidence of neural tube defects. However, this does not mean that it is no longer necessary to take folic acid in food supplements.

If the public agencies responsible for management in Germany decide in favour of the mandatory fortification of a staple food with folic acid, the additional fortification of foods with folic acid should be restricted to maximum 100 µg per portion. There should be no fortification at all of soft drinks in order to avoid excessive intake by the rest of the population. Particularly in the case of older people, very high folic acid intakes can have adverse effects on their health if this coincides with a vitamin B₁₂ deficiency.

The report on the research project entitled “Folic acid intake of the German population” (in German) has been published as Volume 01/2005 in the series BfR-Wissenschaft. It can be ordered in writing from the BfR Press and Public Relations Office (Thielallee 88-92, 14195 Berlin, Fax: 030-8412-4970, pressestelle@bfr.bund.de) for a price of EUR 10. It is also accessible on the BfR website (www.bfr.bund.de) under Publikationen/BfR-Wissenschaft. On the website you will also find an overview of all other publications in the series BfR-Wissenschaft.

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