Summary

The Australia and New Zealand Food Regulation Ministerial Council (the Ministerial Council) requested that Food Standards Australia New Zealand (FSANZ) consider mandatory folic acid fortification to help reduce the incidence of neural tube defects (NTDs) (serious birth defects), and mandatory iodine fortification to tackle the re-emergence of iodine deficiency in the population. In response, FSANZ developed two mandatory standards, effective from October 2009, which require the addition of folic acid to bread-making flour in Australia, and iodine (via iodised salt) to bread in Australia and New Zealand.

In developing the mandatory standards, the Ministerial Council agreed that these need to be monitored to assess the effectiveness of these public health interventions. As a consequence, monitoring frameworks for mandatory folic acid and iodine fortification were developed by expert groups of the Food Regulation Standing Committee. The frameworks were then agreed by the Australian Population Health Development Principal Committee and the Australian Health Ministers’ Advisory Council.

These monitoring frameworks are based on five main components:

  1. food composition and food industry compliance
  2. nutrient intake
  3. nutrient status
  4. health benefits
  5. adverse health effects.

This report presents baseline data for each component of the monitoring framework, and makes observations for future monitoring. Recommendations are provided on how to manage the various data available, and to consider data not yet available for publication as part of the monitoring process. A summary of the monitoring questions and quality of the baseline data questions for each component of the framework for folic acid and iodine fortification is at Table S.1 and Table S.2 (see Section 2.6 for details on baseline quality data). The success of the monitoring program will be dependent on ongoing data collection.

Key baseline data, outlined below, will form the basis of future monitoring to determine the effectiveness of the two mandatory fortification standards. Before mandatory folic acid fortification was introduced:

  • the mean dietary folic acid intakes for women aged 16–44 years (the target population) in Australia was 108 micrograms (μ) of folic acid per day and in New Zealand was 62 μ of folic acid per day, well below the recommended 400 μ per day.
  • there were 149 pregnancies affected by NTDs in 2005 in Australia (rate of 13.3 per 10,000 births) in the three states that provide the most accurate baseline of NTD incidence (South Australia, Western Australia and Victoria), and 63 pregnancies affected by NTDs in 2003 in New Zealand (rate of 11.2 per 10,000 births).

Before mandatory iodine fortification was introduced:

  • large proportions of the Australian and New Zealand population had inadequate iodine intakes.

  • national surveys measuring median urinary iodine concentration (MUIC) in schoolchildren, an indicator of overall population status, confirmed mild iodine deficiency in both countries. The concentration was 96 μg per litre in Australia, and 66 μg per litre in New Zealand, less than the 100–200 μg per litre considered optimal.

Table S.1: Folic acid fortification monitoring questions and quality of baseline data
Framework component Monitoring question Baseline data quality: Australia Baseline data quality: New Zealand
Food composition and industry compliance Has the level of folic acid in our food supply increased? High Moderate
Is the food industry adequately complying with the mandatory fortification standards? . . . .
Nutrient intake Have folic acid intakes in women of child-bearing age increased? Moderate–high(a) High(a)
Nutrient status Has the folate status of women of child-bearing age improved? Low–moderate(a) High(a)
Health benefits Has the incidence of NTDs decreased? High(a) High(a)
Adverse health effects Does mandatory folic acid fortification result in adverse health effects for the population? Moderate–high(a) High(a)

  1. Pending the release of some data not yet available for publication.

Table S.2: Iodine fortification monitoring questions and quality of baseline data
Framework component Monitoring question Baseline data quality: Australia Baseline data quality: New Zealand
Food composition and industry compliance Has the level of iodine in our food supply increased? High High
Is the food industry adequately complying with the mandatory fortification standards? . . . .
Nutrient intake Have iodine intakes in the population increased? Moderate–high(a) High(a)
Nutrient status Has the iodine status of the population improved, in particular in women of child-bearing age? High High(a)
Health benefits Has iodine deficiency been tackled? High High(a)
Adverse health effects Does mandatory iodine fortification result in adverse health effects for the population? Moderate–high(a) High(a)

  1. Pending the release of some data not yet available for publication.