In just 15 years, adding folic acid to flour has become a life-altering business practice resulting in the prevention of more than 22,000 serious birth defects every year. That’s 60 babies a day born worldwide without these birth defects because flour is fortified. The Flour Fortification Initiative (FFI) is celebrating the progress made in helping children get a healthy start in life and encouraging fortification to become standard milling practice globally.

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15-Year Celebration: Fortifying with folic acid prevents 22,000 birth defects annually
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2. FEATURE FEATURE
and the Oman mill continued to fortify with Prevention has called it one of the “Ten comfortable and productive is certainly
no interruption. Great Public Health Achievements” in the worth every penny,” Montgomery noted.
Before 1996, some countries added folic last decade. “Preventing these birth defects, however,
acid to flour because everyone needs this Children born with spina bifida require saves millions of healthcare dollars and
vitamin to produce and maintain new cells multidisciplinary medical treatment, including keeps thousands of children from struggling
and decrease the risk of anemia caused by surgeries, physical therapy and continence with a life-long disability.”
folic acid deficiency. However, the addition care. Wellington Hospital in New Zealand Millers who fortify flour may see buying
levels were too low to significantly reduce found that a newborn with spina bifida had premix and conducting quality control tests
the rates of neural tube defects. With undergone surgeries costing US$ 569,000 as standard business practice. Families whose
encouragement from international consult- before his second birthday. The hospital’s children who may have been born with a
ants, Oman added folic acid to flour at the study also found the direct surgery and neural tube defect without flour fortification,
rate of 1.5 parts per million. This proved hospital costs for six teenagers with spina however, surely see it as a life-altering busi-
to be an adequate amount to reduce the bifida, from their birth, was US$ 790,000 per ness practice.
15-Year Celebration: number of children born with spina bifida
in Oman from an average of 3.17 per 1,000
births before fortification to an average of
individual.
The cost to fortify flour with iron, zinc,
folic acid and other B vitamins is between
The Flour Fortification Initiative (FFI)
is a network of public, private, and civic
sector partners working together to make
Fortifying with folic acid prevents 22,000 0.96 per 1,000 births after fortification. US$1 and US$3 per metric ton of flour. flour fortification standard milling practice
When countries compare the cost of for-
birth defects annually The World Health Organization now
offers recommendations for fortifying flour tifying flour with the healthcare savings
so that people worldwide are smarter,
stronger, and healthier. Wheat and maize
with folic acid based on a country’s level of averted by having fewer children born with flours are most commonly fortified with
flour consumption. The recommendations spina bifida, prevention always proves more iron, folic acid and other B vitamins such
range from 1 to 5 parts per million. economical. Chile’s cost for fortification as riboflavin, niacin, and thiamine. Other
I
n just 15 years, adding folic acid now mandatory milling practice in 54 coun- acid through bread, noodles, pizza crust, As the practice of fortifying flour with compared with the savings in surgical treat- nutrients often added to flour at each
to flour has become a life-altering tries and voluntary practice in approximately crackers and every other food made with the folic acid has spread, countries from Canada ment and rehabilitative services for children country’s discretion include zinc, vitamin A,
business practice resulting in the 20 other countries. In addition to preventing fortified wheat or maize flour. to Argentina and South Africa to Iran report with spina bifida represented a cost:benefit vitamin B12, and vitamin D.
prevention of more than 22,000 serious birth defects, countries report significant cost In 1996, the same year that Oman began 30 to 70 percent declines in neural tube ratio of 1:12. South Africa saved 30 rand
birth defects every year. That’s 60 babies savings by averting the healthcare expendi- fortifying, the United States changed its regu- defects. The declines vary based on how for every one rand spent on fortification for More inforMation:
a day born worldwide without these tures required to treat children with spina lation for enriched cereal grains to include much folic acid is added to flour and the when it calculated the cost of treating a Sarah Zimmerman
birth defects because flour is fortified. bifida. the addition of folic acid, and flour millers had rate of these birth defects before fortifica- child with spina bifida during the first three FFI Communications Coordinator
The Flour Fortification Initiative (FFI) is Spina bifida is one of three birth defects until January 1998 to comply with the new tion. In the United States, fortification of years of life. USA
celebrating the progress made in helping known as neural tube defects. In spina bifida, law. Implementation moved faster in Oman flour and breakfast cereals is credited with “Children born with spina bifida need Tel: + 1 404 7275477
children get a healthy start in life and the baby’s spine does not form correctly, because the country has only one mill. preventing 1,000 neural tube defects a year. the best medical care available; and the Email: szimme2@emory.edu
encouraging fortification to become leading to loss of movement in mild cases or “The mill was well-equipped to introduce The U.S. Centers for Disease Control and money spent to help them be more Website: www.FFInetwork.org
standard milling practice globally. paralysis in severe cases. Spina bifida can be the fortification with no major investments,
“The Flour Fortification Look for
Initiative (FFI) is a network the NIR solution INFRANeO
JUNIOR
of public, private, and civic that best matches your needs
sector partners working
y Measure chemical composition as soon as you
together to make flour
receive your raw materials.
fortification standard milling y Estimate technical values of flours, semolinas, grits, glutens,
starches (and other powders products).
practice so that people
y Moisture, protein, ash content, zeleny, hydration*.
worldwide are smarter, (* choose from over 60 calibrations available)
stronger, and healthier” INFRANeO Junior can also analyse whole grains.
“The success is obviously in the numbers treated but cannot be cured. Anencephaly is and the Minister of Health, Dr Ali Moussa, wITh
of healthy children born as a result of flour another neural tube defect in which the brain was also the chairman of the board of SIMPLe NO OPeRATOR COST SAvINg
fortification, but it is also the success of mul- does not form properly. It is always fatal. The the Oman Flour Mills,” recalled Dr Deena INFLUeNCe
tiple partners working together,” said Scott least common neural tube defect is encepha- Alasfoor who is now the director of Nutrition
Montgomery, FFI director. “This achieve- locele that leads to a sac-like protrusion of for the Ministry of Health in Oman.
ment required flour millers to implement the brain. Its severity depends on where the Iron and other B vitamins have been
fortification, and it required the collaboration sac is located. added to flour in some countries since the
of international scientists, non-governmental Research published in 1991 unequivocally 1940s, and several countries in the Middle
organizations, individual country officials and showed that folic acid prevents neural tube East were considering this in 1996 as part FAST ACCURATe
premix suppliers. In highlighting this 15-year defects. Now it is estimated that 50 to 70 of a broader focus on improving nutrition.
milestone, we are celebrating the contribu- percent of these birth defects can be pre- Oman Flour Mills began fortification as a trial
tions of many.” vented if a woman gets 400 micrograms of to see if it was feasible before a multi-sector
In 1996, Oman Flour Mills began fortifying folic acid daily at least a month before a baby regional workshop was held in Oman in
flour on a trial basis with enough folic acid to is conceived and very early in her pregnancy. October of 1996. By the time of the work- 20, avenue Marcellin Berthelot • 92396 Villeneuve-la-Garenne • FRANCE
prevent birth defects like spina bifida. This is Fortification provides an extra supply of folic shop, fortification was deemed successful, Tél. : + 33 1 41 47 50 29 • Fax : + 33 1 41 21 07 10 • Mail : info@chopin.fr • www.chopin.fr
Photo credits : www.istockphoto.fr-© Elena Elisseeva-© Kristian Septimius Krogh-© Srdjan Stefanovic-© Dr. Heinz Linke-© Stratesigns, Inc.-© Kaupo Kikkas.
infraneo_junior_GB_190x132mm.indd 1 24/02/2011 14:24:49
28 | September - october 2011 Grain &feed millinG technoloGy Grain &feed millinG technoloGy September - october 2011 | 29

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