Wheat Flour Fortification Status in Eastern and Western Europe

A bicyclist with bread travels through Uzbekistan which has implemented a mandate to fortify wheat flour. Photo by Carsten ten Brink on Flickr.

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 with iron and other key nutrients since the 1940s and is moving forward with plans to 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.

Fortification Legislation Status by Country and Grain

Click on any of the column headings to sort the list by Country, Wheat Flour, Maize Flour, or Rice.

Country Wheat Flour Maize Flour Rice
AlbaniaNoneNoneNone
AndorraNoneNoneNone
ArmeniaNoneNoneNone
AustriaNoneNoneNone
AzerbaijanNoneNoneNone
BelarusNoneNoneNone
BelgiumNoneNoneNone
Bosnia and HerzegovinaNoneNoneNone
BulgariaNoneNoneNone
Channel Islands------
CroatiaNoneNoneNone
CyprusNoneNoneNone
Czech RepublicNoneNoneNone
DenmarkNoneNoneNone
EstoniaNoneNoneNone
Faroe Islands------
FinlandNoneNoneNone
FranceNoneNoneNone
GeorgiaNoneNoneNone
GermanyNoneNoneNone
Gibraltar------
GreeceNoneNoneNone
Greenland------
HungaryNoneNoneNone
IcelandNoneNoneNone
IrelandNoneNoneNone
Isle of Man------
ItalyNoneNoneNone
KazakhstanMandatoryNoneNone
Kosovo, Republic ofMandatoryNoneNone
KyrgyzstanMandatoryNoneNone
LatviaNoneNoneNone
LiechtensteinNoneNoneNone
LithuaniaNoneNoneNone
LuxembourgNoneNoneNone
Macedonia, The former Yugoslav Republic ofNoneNoneNone
MaltaNoneNoneNone
Moldova, Republic ofMandatoryNoneNone
MonacoNoneNoneNone
MontenegroNoneNoneNone
NetherlandsNoneNoneNone
NorwayNoneNoneNone
PolandNoneNoneNone
PortugalNoneNoneNone
RomaniaNoneNoneNone
Russian FederationNoneNoneNone
San MarinoNoneNoneNone
SerbiaNoneNoneNone
SlovakiaNoneNoneNone
SloveniaNoneNoneNone
SpainNoneNoneNone
Svalbard and Jan Mayen Islands------
SwedenNoneNoneNone
SwitzerlandNoneNoneNone
TajikistanNoneNoneNone
TurkeyNoneNoneNone
TurkmenistanMandatoryNoneNone
UkraineNoneNoneNone
United Kingdom of Great Britain and Northern IrelandMandatoryNoneNone
UzbekistanMandatoryNoneNone
Vatican CityNoneNoneNone

Europe - Fortification Status

Our definition of the legislative status is:

  • Mandatory: Legislation has the effect of mandating fortification of one or more types of wheat or maize flour or rice with at least iron or folic acid.
  • Voluntary: Country has standard for fortification, but fortification is not mandatory.
  • Dashes in the above table indicate territories with fortification legislation under the jurisdiction of another country.
If the information we have is incorrect, please send updated information to info@ffinetwork.org

In updating or creating new policy documents for fortification, review this checklist (in English, French, or Russian) of key topics to include in legislation, standards and monitoring guidelines.

 

Contact

Events

WHO Guideline Development Meeting: Optimal Blood Folate

23 September 2013

European Health Forum Gastein

03 October 2012

UNICEF-FFI Workshops for CEECIS Region

12 June 2012

News

Food Fortification Could Be Next Global Health Success Story - If Countries Close Gaps
28 February 2019

Revisión encuentra que los documentos de fortificación de países a menudo carecen de elementos claves
29 June 2018

L'examen constate que la documentation sur l'enrichissement manque généralement d'éléments clés
29 June 2018

Review finds fortification documents often lack key elements
29 June 2018

2017 Annual Report
21 March 2018

Regional Resources

Ukraine struggles to fortify wheat flour to prevent birth defects of the brain and spine

Neural tube defects in the Republic of Ireland in 2009-11

English women do not take folic acid supplements consistently

Folic acid fortification of wheat flour: a cost-effective public health intervention to prevent birth defects in Europe

Roadblocks to progress: a look at why Ireland and New Zealand halted mandatory flour fortification with folic acid

Flour Fortification - a possible strategy for the prevention of neural tube defects in Germany?

Recomendações de fortificação em português