Why do we need to fortify the food supply with folic acid and iodine?

Folic acid is important for the healthy development of babies, particularly in early pregnancy. The neural tube closes and fuses very early in pregnancy, often before a woman is aware she is pregnant. If it fails to close, neural tube defects such as spina bifida can occur. Folic acid taken at the recommended level of 400 micrograms a day for at least one month before and three months after conception can reduce the risk of neural tube defects [2]. Since the 1990s, various initiatives have encouraged women of child-bearing age to increase their folic acid intakes. Despite these campaigns, folic acid intakes are below recommended intakes.

Iodine deficiency has re-emerged as a public health problem in Australia and New Zealand. Various studies have shown mild to moderate iodine deficiency among different population groups [3, 4]. As iodine is essential for normal brain development, it is particularly important that unborn babies and young children have adequate intakes.

To address these important public health problems, mandatory fortification of bread with folic acid (in Australia only) and iodine (in both Australia and New Zealand) was introduced from September 2009. Folic acid is added to wheat flour for bread-making purposes to further reduce the incidence of neural tube defects. Iodine is added to bread (as iodised salt) to address the re-emergence of iodine deficiency in Australia and New Zealand. Bread labelled as organic is exempt from mandatory fortification with folic acid and iodine.

These changes to the food supply are designed to help shift population intakes of folic acid and iodine toward recommended levels. Bread is a staple food eaten by the majority of the population and is therefore a suitable choice for fortification. Mandatory folic acid fortification is aimed at women of child-bearing age. Mandatory iodine fortification is aimed at the general population, especially infants, young children, pregnant and breastfeeding women.