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Supply of the German population with folic acid still unsatisfactory

10/2000, 08.06.2000

Folic acid deficiency is particularly problematic amongst women of childbearing age since this vitamin can prevent neural tube defects.

The supply of the German population with folic acid is still inadequate. This was explained by specialists at a seminar on "The need to improve measures to offer protection from neural tube defects" in BgVV on 8 May 2000.

In the opinion of the nutrition experts the daily need for folic acid (folates) from foods is 400 µg for children aged 10 and upwards and adults. This need is not covered by a normal diet in Germany with an average of 200 µg folate. A folic acid deficiency increases the risk of arteriosclerosis and the risk of developing certain types of cancer . However, scientific confirmation has still to be obtained through intervention studies in man.

Folic acid in its various forms (folates) plays an important role in the formation and stability of nucleic acids which carry hereditary information. The vitamin is, therefore, involved in all cell division and growth processes and, beyond that, in protein metabolism. The body cannot itself form folic acid. It must be supplied to the organism through food (or through supplements). The need for folates could be covered with a balanced diet involving a large proportion of fruit and vegetables.

The situation of women of childbearing age, who are planning to have a family or who do not want to rule out a pregnancy by contraceptive measures, constitutes a special problem. Studies have shown that the increased intake of folic acid as a supplement can help to reduce the risk of malformations in unborn children by 40-70%. These malformations involve severe neural tube defects like spina bifida (open back). Every year between 800 and 1,600 pregnancies are diagnosed in Germany in which the unborn child has a neural tube defect. Around one-third of these pregnancies go full term and the babies are often severely disabled despite optimum surgical care. In roughly two-thirds of all cases the pregnancy is terminated after diagnosis of a neural tube defect.

Neural tube defects occur very early on in the development of the embryo (between the 22nd and 28th day after conception). At that point in time many women are not aware that they are pregnant. Women of childbearing age should, therefore, take 400 µg folic acid as a supplement in addition to the folates contained in food in order to avoid neural tube defects and other malformations which can be influenced by this vitamin. According to the available surveys, this recommendation which was already made in 1995 by expert medical associations is frequently not passed on. It is, therefore, followed by less than 10% of the women concerned.

Together with the competent expert associations of German doctors, consumer organisations, the German Society for Nutrition and the Central Federal Office for Health Awareness, BgVV is endeavouring to find ways of improving the folate or folic acid supply of the population. In this context their efforts are focussing first and foremost on ways of preventing neural tube defects through additional folic acid intake.

The positive effect of additional intake of folic acid tablets has been confirmed. In order to dramatically reduce the risk of the development of neural tube defects, it is therefore urgently necessary in the opinion of BgVV, by means of a widespread campaign, to encourage women wishing to start a family or not wanting to consciously exclude pregnancy, to take more folic acid. Gynaecologists, schools, women's associations and public health advice centres are to be involved in this campaign. It should be anchored in the federal government's Action Programme - Health Reform 2000.

Another possibility is to fortify staple foods like flour with folic acid. Some countries like the USA and Canada have adopted this approach. All the same, at present there are no studies which confirm the effectiveness of this measure in preventing neural tube defects.

For that reason the necessary data should also be collected and tested in model calculations in order to establish whether folic acid fortification of flour could be a promising and safe path in Germany, too, as a means of achieving the goal of reducing neural tube defects. This would be one alternative if prophylaxis cannot be improved by means of the intake of folic acid tablets. Experts suggest the setting up of a working group "Folic Acid" which should accompany and co-ordinate the studies.

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