New study on folic acid fortification generates incorrect, misleading conclusions

Grain fortification is a large-scale, relatively inexpensive way to build a smarter, stronger, and healthier future. (Pierre Holtz/UNICEF)

Grain fortification is a large-scale, relatively inexpensive way to build a smarter, stronger, and healthier future. (Pierre Holtz/UNICEF)

13 May 2020

A recent study published in Nutrients by scientists from the University of Wisconsin (UW)-Madison has sparked concern among nutrition experts who say the study’s findings are incorrect and misleading.

The UW-Madison study, which uses data from the Food Fortification Initiative (FFI)’s website, concluded that countries fortifying flour with folic acid do not see significant decreases in the population-wide prevalence of birth defects of the brain and spine.

The study contradicts decades of rigorous scientific evidence and global practice. Many countries recommend or require that the food industry produce fortified foods meant to add a small amount of vitamins and minerals—micronutrients—into at least one basic staple almost everyone can afford: for example, iodized salt or wheat flour with added folic acid.

Research has shown that fortified food prevents micronutrient deficiencies that can limit a child’s academic achievement, reduce adult productivity, and cause disabling or fatal birth defects. A 2018 study estimated that folic acid fortification prevented 50,270 birth defects of the brain and spine globally in 2017, an average of 137 healthier babies every day.

In a comment published in the journal, scientists from Emory University, FFI, London School of Hygiene and Tropical Medicine, and Nutrition International, cite a myriad of errors that led to the study’s findings: incorrect considerations on the amount of birth defects of the brain and spine in a population, average grain availability for a country, number of people who have access to and eat fortified foods in a country, and more. Furthermore, FFI data is collected from many sources and intended for fortification advocacy, not for scientific hypothesis testing.

“The flawed study promotes a confusing and incorrect message to stakeholders, misguides policy makers, and hinders progress” in global prevention of disabling birth defects, noted the scientists’ comment. Their conclusion is clear: mandatory, large-scale folic acid fortification of staple foods is a cost-effective, safe, and effective intervention that saves lives. A new study riddled with false assumptions will not change fortification’s positive impact.