The state passed laws that from October 2003 required the milling industry to fortify maize meal and wheat flour with eight micronutrients: vitamins A, B1, B2, B6, B3, folic acid, zinc, pyridoxine and iron. Folic acid is needed for the very early stages of foetal development if a pregnant woman suffers from a deficiency, her foetus is at increased risk of neural tube defects, in which the spine and brain do not develop properly. The most common birth defect of this kind is spina bifida, which leads to varying degrees of paralysis. Although folic acid occurs naturally in food, many people do not eat a sufficiently varied diet to obtain optimal levels of the vitamin. Supplementation after a woman knows she is pregnant may be too late, as neural tube defects occur in the first few weeks after conception.A recent study published in the international journal Birth Defects Research shows that before SAs food fortification programme began, an estimated 970 babies were born each year with spina bifida, and the addition of folic acid to staple foods saw that figure drop to about 570.
Its a marvellous public health initiative, saving 400 lives a year, and a huge amount of (money), said study co-author David Bourne, a scientist at the University of Cape Towns School of Public Health and Family Medicine. SA saved more than R40m a year from the cases of spina bifida that were averted by the folic acid component of the food fortification programme, said Bourne. He and his colleagues estimated that the folic acid component of the fortification mixture added to staple food cost just R1,4m a year. The researchers collected data from 12 public hospitals in Eastern Cape, KwaZulu-Natal, Mpumalanga and Free State. They found the overall rate of neural tube defects fell from 1,41 a 1000 births in the 18 months to June 2004 to 0,98 a 1000 births in the nine months to June 2005. The prevalence of spina bifida a 1000 births fell from 0,93 pre-fortification to 0,54 post-fortification. There was a small dip in the prevalence of another neural tube defect called anencephaly, from 0,41 cases a 1000 births to 0,37 cases a 1000 births. The researchers estimated there were 1,05-million births each year.The British government is considering introducing a programme to fortify flour with folic acid, but concerns have been raised about the risks this might pose, particularly to older people, as it can mask anaemia and raise the risk of several kinds of cancer. Bourne said the overall benefits of the food fortification programme in SA outweighed the small risks of cancer and other concerns.
There is a downside to everything. The decision ultimately lies with the government, and hopefully they will weigh up the pros and cons and make the right choice, he said. Previous studies have linked unmetabolised folic acid in the blood to an increased risk of cancers of the bowel, prostate and breast.
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