mandatory folic acid fortification of flour: for and against

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Inpharma 1594 - 30 Jun 2007 Mandatory folic acid fortification of flour: for and against A delay in fortifying flour with folic acid in the UK is "unjustified", say Nicholas J Wald and Godfrey P Oakley from University of London, UK, and Emory University, Atlanta, Georgia, US, respectively. 1 They contend that voluntary fortification has proved inadequate, and that mandatory fortification is "necessary, effective, and safe". Other health benefits indicated Wald and Oakley point out that, with such fortification on a global basis, each year 250 000 children could be saved from spina bifida or anencephaly and its "devastating consequences". They also note that other benefits are indicated for folic acid fortification, such as a "modest but important protection against cardiovascular disease", and a suggested reduction in cleft lip and the rate of age-related cognitive decline. Regarding concerns raised about a possible link with cancer, Wald and Oakley assert that, "if judgement were to be made, it would be that folic acid prevented cancer, not that it caused it". Possible cancer link requires more research However, new data suggest that folate supplements "may promote cancer", state Richard A Hubner and colleagues from the UK. 2 They acknowledge that reducing neural tube defects is a "worthy aim", but argue that further investigation of the potential cancer- promoting effects of folic acid exposure in susceptible individuals is "desirable" before initiating mandatory fortification. Folate metabolism influences ’"several crucial pathways", including DNA synthesis and methylation, "aberrations of which play a role in carcinogenesis", comment Hubner and colleagues. This effect may be "further complicated" by using synthetic folic acid, they suggest. Hubner and colleagues also note that the level of exposure to folic acid may be "crucial", and that levels of folate intake after fortification are "hard to predict". See also Inpharma 1518, p 2; 801002609 1. Wald NJ, et al. Should folic acid fortification be mandatory? Yes BMJ 334: 1252, No. 7606, 16 Jun 2007. 2. Hubner RA, et al. Should folic acid fortification be mandatory? No BMJ 334: 1253, No. 7606, 16 Jun 2007. 801069482 1 Inpharma 30 Jun 2007 No. 1594 1173-8324/10/1594-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Inpharma 1594 - 30 Jun 2007

Mandatory folic acid fortification offlour: for and against

A delay in fortifying flour with folic acid in the UK is"unjustified", say Nicholas J Wald and Godfrey P Oakleyfrom University of London, UK, and Emory University,Atlanta, Georgia, US, respectively.1 They contend thatvoluntary fortification has proved inadequate, and thatmandatory fortification is "necessary, effective, andsafe".

Other health benefits indicatedWald and Oakley point out that, with such

fortification on a global basis, each year 250 000children could be saved from spina bifida oranencephaly and its "devastating consequences". Theyalso note that other benefits are indicated for folic acidfortification, such as a "modest but important protectionagainst cardiovascular disease", and a suggestedreduction in cleft lip and the rate of age-related cognitivedecline. Regarding concerns raised about a possible linkwith cancer, Wald and Oakley assert that, "if judgementwere to be made, it would be that folic acid preventedcancer, not that it caused it".

Possible cancer link requires more researchHowever, new data suggest that folate supplements

"may promote cancer", state Richard A Hubner andcolleagues from the UK.2 They acknowledge thatreducing neural tube defects is a "worthy aim", but arguethat further investigation of the potential cancer-promoting effects of folic acid exposure in susceptibleindividuals is "desirable" before initiating mandatoryfortification.

Folate metabolism influences ’"several crucialpathways", including DNA synthesis and methylation,"aberrations of which play a role in carcinogenesis",comment Hubner and colleagues. This effect may be"further complicated" by using synthetic folic acid, theysuggest. Hubner and colleagues also note that the levelof exposure to folic acid may be "crucial", and that levelsof folate intake after fortification are "hard to predict".

See also Inpharma 1518, p 2; 8010026091. Wald NJ, et al. Should folic acid fortification be mandatory? Yes BMJ 334:

1252, No. 7606, 16 Jun 2007.2. Hubner RA, et al. Should folic acid fortification be mandatory? No BMJ 334:

1253, No. 7606, 16 Jun 2007.801069482

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Inpharma 30 Jun 2007 No. 15941173-8324/10/1594-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved