Wheat Flour Fortification Status in Eastern and Western Europe
From Portugal to Russia, Europe is often viewed as a more developed part of the world where the clinical signs of vitamin and mineral deficiencies are not prevalent. In reality, however, certain countries in this region are still characterized by deficiencies at a level of public health significance which deserve attention.
Wheat is the most commonly consumed grain in this region. Fortifying wheat flour in Europe and Central Asia is especially appropriate given high consumption of bread and pasta. In addition, common fortification challenges, such as non-industrial mills and an underdeveloped transportation infrastructure, are not evident here.
Adding vitamins and minerals to food is permitted in the European Union through regulation 1925/2006.
The United Kingdom has fortified wheat flour since the 1940s, but it does not include folic acid. Turkmenistan and Uzbekistan have fully implemented mandatory programs to fortify wheat flour. Kazakhstan, Kosovo, Kyrgyzstan, and Moldova each have wheat flour fortification mandates that are not yet fully implemented.
About 4500 pregnancies in the European Union are affected by a birth defect of the brain and spine every year, and an estimated 72% of the pregnancies are terminated. From 1980 to 2012, Europe saw no decline in these birth defects despite efforts to increase folic acid supplement intake.
For more information on how fortifying flour with folic acid (a form of vitamin B9) could be used throughout Europe to prevent birth defects of the brain and spine, see the following three documents:
In Switzerland, about 250 food products are voluntarily fortified with folic acid said, Erich P. Meyer, one of the founders of a national campaign to increase awareness about the need for folic acid intake. At one time Ireland had extensive voluntary fortification of foods with folic acid, but the percentage of fortified foods has decreased, and the incidence of birth defects of the brain and spine is increasing. Also, older adults in Ireland have a high prevalence of deficiency of vitamin B12 and folate (another form of vitamin B9).
In Europe, we frequently collaborate with two key partners - the International Federation for Spina Bifida and Hydrocephalus (IF) and UNICEF. Both entities have significant experience and knowledge related to country-specific flour fortification efforts in the region.
The countries in this region and the legislative status of grain fortification are listed below. Click on the country name to see more information.