Food Fortification Ineffective in Preventing Neural Tube Defects in India due to Regulation Promoting Inadequate Levels of Folic Acid and Vitamin B12.

BACKGROUND

There is a high prevalence of neural tube defects (NTDs) and nutritional anemias that increase the risk of birth defects in India. The current staple food fortification regulations for folic acid and vitamin B12 are ineffective in the country. We provide an evidence-based viewpoint urging for WHO-recommended levels of fortificants (i.e., 1300 mcg of folic acid and 10 mcg of vitamin B12 per kilogram of wheat flour or rice) to be included in the regulation.

METHODS

Micronutrient fortified foods are being distributed through various governmental safety-net programs under the National Food Security Act in India. Packaged flour produced by some private companies is fortified.

RESULTS

Food fortification regulation, recommended in 2018 by the Food Safety and Standards Authority of India, allows adding 75-125 micrograms (mcg) of folic acid per kilogram (kg), and 0.75-1.25 mcg of vitamin B12 per kg, as fortificants in wheat flour or rice. These levels are 90% lower than what WHO recommends based on daily consumption of staple foods in India.

CONCLUSION

Re-setting fortification standards for folic acid and vitamin B12 to levels recommended by the WHO in India will avert thousands of NTD-associated pregnancies each year, as well as morbidity and mortality associated with them.