BBM Magazine Issue-Sayı: 57 October - Ekim 2022

42 COVER STORY • KAPAK DOSYASI BBM / EKİM 2022 • OCTOBER 2022 While a balanced diet of leafy greens and pulses is usually sufficient to maintain healthy folate levels, a higher intake is typically required during pregnancy.2 However, in the UK a recent National Diet and Nutrition Survey (NDNS) found that 90% of women of childbear- ing age have a poor folate status, meaning that if they fell pregnant their baby would be at an increased risk of developing NTDs.3 In the UK, women are advised to consume 400mg of folic acid per day for a month before conception and during the first 12 weeks of pregnancy via the ingestion of folate supplements.4 However, with unplanned pregnancies accounting for 50% of all preg- nancies in the UK per year and awareness of the impor- tance of folic acid remaining low, there is a likelihood that voluntary supplementation is not the most effective tool in preventing folate deficiency in expectant moth- ers.5 The universal fortification of a staple food product – like wheat flour – with folic acid can therefore help to plug the gap and reduce the number of unborn babies at risk of developing life-threatening conditions. FORTIFICATION AND THE GLOBAL STAGE Historically, the results of mandatory fortification initia- tives have been extremely positive. Since the addition of folic acid to flour became US policy in 1998, there has been a 28% decrease in the prevalence of NTDs in ba- bies.6 New Zealand has also recently announced that, by 2023, millers must incorporate between 2 and 3mg/ kg of folic acid into their flour.7 This follows on from a 2014 Code of Practise where the New Zealand Associa- tion of Bakers agreed to fortify 25-50% of bread with folic acid.9 In 2021, the UK became the most recent country to introduce a mandate that requires folic acid fortifica- tion in all non-wholemeal flour.10 This aims to reduce the number of babies born with NTDs by around 200 each year – around 20% of the UK annual total.11 Flour has been fortified in the UK for over 80 years with the addition of calcium, niacin, iron and thiamin – nutrients typically lost during the milling process.12 This means that the addition of folic acid is neither a logistical nor a financial challenge. Beyond an initial investment, the cost of incorporating folic acid is far outweighed by the total healthcare costs that are saved by doing so, with the benefit to cost ratios typically sitting at 12-48:1.13 SEEING THE OPPORTUNITY TO PROVIDE BETTER FUTURES FOR ALL Similar steps are being taken in lower-income coun- tries, with major flour and milling companies in India agreeing in 2017 to introduce fortified flour into their flagship brands. Around 50% of the Indian population lives with some form of health deficiency due to malnutri- tion.14 Even more crucially, between 4-8 in 1000 babies Sağlıklı folat seviyelerini korumak için yeşil yapraklı sebze- ler ve bakliyatlardan oluşan dengeli bir diyet genellikle yeterli olsa da, hamilelik sırasında daha yüksek bir alım gerekir. 2 Bununla birlikte, Birleşik Krallık’ta yakın zamanda yapılan bir Ulusal Diyet ve Beslenme Araştırması (NDNS), doğurganlık çağındaki kadınların %90’ının folat durumunun zayıf olduğu- nu, yani hamile kalırlarsa bebeklerinin NTD geliştirme riskinin yüksek olduğu bulgusuna ulaşmıştır.3 Birleşik Krallık’ta kadın- lara, gebe kalmadan önce bir ay boyunca ve gebeliğin ilk 12 haftası boyunca folat takviyeleri yoluyla günde 400 mg folik asit tüketmeleri tavsiye edilmektedir.4 Bununla birlikte, Birle- şik Krallık’ta her yıl tüm gebeliklerin %50’sinin planlanmamış gebelikler olması ve folik asidin önemine dair farkındalığın düşük kalmasıyla beraber, anne adaylarında folat eksikliğini önlemede gönüllü takviyenin en etkili araç olmaması ihtimali vardır.5 Bu sebeple, buğday unu gibi temel bir gıda ürününün dünya genelinde folik asitle zenginleştirilmesi, açığı kapatma- ya ve insan hayatını tehdit eden şartlar geliştirme riski taşıyan doğmamış bebeklerin sayısını azaltmaya yardımcı olabilir. ZENGINLEŞTIRME VE KÜRESEL AŞAMA Tarihsel olarak, zorunlu zenginleştirme girişimlerinin so- nuçları son derece olumlu olmuştur. 1998’de una folik asit eklenmesi ABD politikası haline geldiğinden, bebeklerde