Improving Folate Intake in New Zealand: Policy implications

Improving Folate Intake in New Zealand: Policy implications

Public Health Intelligence Occasional Bulletin Number 18

ISBN 0-478-25663-9 (Book)
ISBN 0-478-25664-7 (Website)
HP 3647

Date of Publication: September 2003

This publication examines the evidence for a very unusual situation in public health. Rarely has there been a case where the science has been so unequivocal, uncontentious and universally accepted, yet the development and implementation of appropriate policy continues to be problematic.

10 September 1992 was a seminal date in the history of public health. On that day the US Public Health Service recommended that women of childbearing age should consume 400 µg of folic acid per day to reduce the risk of neural tube defects (NTDs). NTDs are a major category of birth defects and a leading cause of infant morbidity and mortality.

The recommendation was based on the results of two randomised controlled trials, the so-called ‘gold standard’ of study designs. The trials emphatically and rigorously confirmed the finding from a number of earlier observational studies that increasing the daily intake of folic acid decreases the risk of NTDs.

Subsequently, a number of other countries, including New Zealand in September 1993, also recommended that women planning a pregnancy increase their daily intake of folic acid.

Folic acid intake can be increased by three methods: increased consumption of a folaterich diet, taking supplements or tablets containing folic acid, and the population health approach of food fortification.

The current New Zealand policy is to recommend that women planning a pregnancy take 800 µg of folic acid daily for four weeks prior to conception and for 12 weeks after conceiving to reduce the risk of NTDs. Since 1996 voluntary fortification of certain food products with folic acid has been permitted. Evidence shows that New Zealand women do not have a sufficient daily intake of folic acid to reduce the risk of NTDs.

This report links to the New Zealand Disability and Health Strategies by evaluating and discussing the available policy options for increasing folate levels to reduce the occurrence of neural tube defects, a major contributor to infant mortality and morbidity. In addition, the report examines the evidence that folic acid may reduce the risk of other major health conditions while assessing any risks from the increased intake of folic acid.

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