Royal Prince Alfred Hospital Royal Prince Alfred Hospital
Allergy Unit

Student research

Mandatory Folate Fortification:
Eat your Bread

Erin Caruana
Master of Science (Nutrition and Dietetics), University of Wollongong
Supervisors: Velencia Soutter, Robert Loblay, Anne Swain
October 2006

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Introduction: Despite public-health campaigns recommending peri-conceptional daily supplementation of folic acid (400�g/day), many women are failing to reach these recommendations. As a result, Food Standards Australia and New Zealand (FSANZ) have proposed mandatory folic acid fortification in bread-making flour in an effort to reduce the incidence of Neural Tube Defects (NTDs). The purpose of this study was to determine patterns of eating behaviour in women of childbearing age (18-45years), and to evaluate the appropriateness of bread-making flour as the selected medium for folic acid fortification.

Methods: A sample of 178 women aged between 18 and 45 years were recruited to complete a food frequency questionnaire (FFQ).

Results Women of child-bearing age were found to consume sufficient amounts of fruit, vegetables and meat products, whereas bread and cereal intakes were significantly lower than recommended dietary guidelines of 4 serves per day (P= 0.000). Mean daily intake of bread was 3.6 slices (95% CI, 3.2–4.0 slices/day), indicating that with fortification dietary folate would increase to 112�g/day. This would meet FSANZ’s prediction of an increase to 100�g of folic acid with fortification. However, it was revealed 50% of women of child-bearing age consuming less then 3 slices of bread per day will not benefit from fortification.

Discussion: Convincing evidence supports that increased folic acid intake among women of child-bearing age reduces the risk of NTDs. Although bread-making flour is an effective food vehicle for mandatory fortification, educational strategies are essential in promoting increased folate intakes in those women who currently would not benefit from fortification due to dietary choices.