Intended for healthcare professionals


Delaying folic acid fortification of flour

BMJ 2002; 324 doi: (Published 08 June 2002) Cite this as: BMJ 2002;324:1348

This article has a correction. Please see:

Governments that do not ensure fortification are committing public health malpractice

  1. Godfrey P Oakley (, visiting professor
  1. Department of Epidemiology, Rollins School of Public Health of Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA

    The failure of European governments to mandate universal fortification of flour with folic acid has allowed a continuing epidemic of preventable human illness. It is ironic that the United Kingdom has not required fortification, as it was a randomised controlled trial from the United Kingdom that conclusively proved that supplementation with synthetic folic acid prevents about 75% of spina bifida and anencephaly—common and serious birth defects.1 This study provided the primary scientific basis for the United States, Canada, Chile, and other countries to require fortification.

    In Europe fortification has been delayed because it has erroneously been portrayed as having definitive benefits for embryos and children and no benefits for adults, especially elderly people. Speculation of possible harm from fortification for elderly people, though hypothetical and not data driven, has resulted in unnecessary delay. Strong evidence exists that universal fortification benefits adults, including elderly people, and that it is safe. 2 3 Policy discussions should compare the definite …

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