Trends in wheat-flour fortification with folic acid and iron--worldwide, 2004 and 2007.

Consumption of adequate amounts of folic acid by women before pregnancy and during early pregnancy decreases their risk for having a pregnancy affected by neural tube defects (NTDs), the most common preventable type of birth defects worldwide. Consumption of iron ameliorates iron deficiency, the most prevalent nutritional deficiency in the world, affecting approximately 2 billion persons. Although certain populations consume substantial amounts of rice and corn, worldwide, the consumption of wheat flour is greater than that of any other cereal grain. Fortification of wheat flour is an effective, simple, and inexpensive strategy for supplying folic acid, iron, and other vitamins and minerals to large segments of the world population. To assess the global change from 2004 to 2007 in 1) the percentage of wheat flour being fortified with folic acid and iron; 2) the total number of persons overall and women in particular with access to fortified wheat flour; and 3) the total number of newborns whose mothers had access to fortified wheat flour during pregnancy, CDC analyzed data from the Flour Fortification Initiative (FFI). This report summarizes the results of that assessment, which indicated that the worldwide percentage of wheat-flour fortification increased from 18% in 2004 to 27% in 2007. The estimated number of persons with access to fortified wheat flour increased by approximately 540 million, and the annual number of newborns whose mothers had access to fortified wheat flour during pregnancy increased by approximately 14 million. Nonetheless, approximately two thirds of the world population lacks access to fortified wheat flour. Programs should continue to expand coverage of wheat-flour fortification as a strategy to increase folic acid and iron consumption.