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.

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
Abkhazia------
Albania------
Andorra------
Armenia------
Austria------
Azerbaijan------
Belarus------
Belgium------
Bosnia and Herzegovina------
Bulgaria------
Channel Islands------
Croatia------
Cyprus------
Czech Republic------
Denmark------
Estonia------
Faroe Islands------
Finland------
France------
Georgia------
Germany------
GibraltarTerritoryTerritoryTerritory
Greece------
GreenlandTerritoryTerritoryTerritory
Holy See------
Hungary------
Iceland------
Ireland------
Isle of Man------
Italy------
KazakhstanMandatory----
KosovoMandatory----
KyrgyzstanMandatory----
Latvia------
Liechtenstein------
Lithuania------
Luxembourg------
Macedonia, former Yugoslav Republic------
Malta------
Moldova, Republic ofMandatory----
Monaco------
Montenegro------
Netherlands------
Northern Cyprus------
Norway------
Poland------
Portugal------
Romania------
Russian Federation------
San Marino------
Serbia------
Slovakia------
Slovenia------
South Ossetia------
Spain------
Svalbard and Jan Mayen Islands------
Sweden------
Switzerland------
Tajikistan------
Turkey------
TurkmenistanMandatory----
Ukraine------
United KingdomMandatory----
UzbekistanMandatory----
Vatican City------

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.
  • Territory: Countries that are not listed as United Nations countries or observers or are not recognized by at least one UN country are listed as a territory.
  • Dashes in the table indicate that no information is available. Please send missing 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

Annual Meeting of the Clearinghouse (ICBDSR)

30 September 2018

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

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

2017 Annual Report
21 March 2018

Shamil Tazhibayev, UNICEF Consultant, Republic of Kazakhstan #FFI15
24 October 2017

Agron Gashi, Health and Nutrition Officer, Head of Health and Nutrition Section at UNICEF Kosovo Office #FFI15
24 October 2017

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?