FSA: update on folic acid fortification

Agency Chair Deirdre Hutton has written to the Chief Medical Officer Liam Donaldson to update him on current scientific work on folic acid and cancer risk.

In October 2007, the Chief Medical Officer (CMO) of England, on behalf of all the UK CMOs, asked the independent Scientific Advisory Committee on Nutrition (SACN) to give further consideration
to two studies suggesting that folic acid may increase colorectal cancer (CRC) risk (Cole et al and Mason et al). This was in order to inform the Minister’s final decision on whether to go
ahead with mandatory fortification. These studies were considered in SACN’s review but were published in full after the review had been completed.

As part of SACN’s examination of these two studies, an independent expert group, including members of SACN, members of the Committee on Carcinogenicity and two external cancer experts, was
convened. After considering the Cole et al and Mason et al studies, the group agreed with SACN’s original recommendation for mandatory fortification with controls on voluntary fortification.
The group also agreed that the recommendation for voluntary controls should be strengthened.

Current trials
At its February meeting, SACN discussed the expert group’s advice, plus new information on the publication dates of additional ongoing trials on folic acid, which will provide further
information on cancer risk. These trials will report later this year. As a result of this new information, SACN has decided to wait to include an assessment of this further evidence in its
overall recommendation. The FSA takes its responsibility to base all its decisions on the best and most up-to-date scientific evidence very seriously and therefore supports this approach, which
will enable health ministers to make a fully considered final decision.

These new studies are:

? a trial in the USA, looking at the effect of folic acid on bowel cancer risk
? an assessment of pooled data from trials in a number of countries investigating the effect of folic acid on cardiovascular disease that are also collecting data on cancer risk

It is expected that the results of these ongoing studies on folic acid will be published in late 2008. SACN will then consider the results and advise the Agency. It is expected that the Agency
will be able to announce the outcome of this examination in mid-2009.

In the meantime, the Agency will continue to work with industry on controls on folic acid levels in foods fortified on a voluntary basis, and on advice on the appropriate use of folic acid

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