Letters Folic acid fortification for Europe?

Decision on folic acid fortification in Europe must consider both risks and benefits

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i734 (Published 16 February 2016) Cite this as: BMJ 2016;352:i734
  1. A David Smith, professor emeritus1,
  2. Helga Refsum, professor of nutrition2,
  3. Jacob Selhub, senior scientist and professor3,
  4. Irwin H Rosenberg, senior scientist and university professor4
  1. 1Department of Pharmacology, University of Oxford, Oxford, UK
  2. 2Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
  3. 3Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA
  4. 4Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
  1. david.smith{at}pharm.ox.ac.uk

We are worried by the following statement in a recent editorial on the safety of folic acid fortification: “No important adverse effects have been identified to date, probably because a modest level of fortification has proved very effective in preventing these devastating birth defects.”1 It is unusual in medicine to claim that a treatment is safe just because it is effective in treating or preventing one condition—objective evidence is needed on overall safety and the side effect profile in all people exposed to the “treatment,” not only those who benefit. It seems that WHO also has not fully assessed the possible harmful effects of folic acid because its guideline on folate and neural tube defects (NTDs) states: “high folic acid intake has not reliably been shown to be associated with negative health effects.”2

The editorial’s claim that half of all NTDs could be prevented by mandatory fortification in Europe is misleading, because the effectiveness of fortification depends on the baseline prevalence of NTDs, …

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