Urgent need for folic acid fortification of flour and grains: response to the 2019 UK Government’s public consultation
Bibliographic record
Abstract
In June 2019, the UK Government took a step forward towards making a decision on the mandatory fortification of flour with folic acid (vitamin B9) in the prevention of neural tube defects (NTDs). It issued an open public consultation on the proposal in the form of a set of questions. The questions covered a range of issues including efficacy, safety, feasibility and cost. This review sets out the nine main questions and our answers. The aim is to present the rationale for mandatory fortification, what products should be fortified and the mean daily folic acid intake increase fortification should achieve across the population. ### Do you agree or disagree with the proposal for mandatory fortification of non-wholemeal wheat flour in the UK with folic acid to help prevent NTDs? Answer: The evidence strongly supports agreeing with the proposal. In 1991, the report of the Medical Research Council (MRC) Vitamin Study,1 a randomised trial, showed that most cases of NTDs can be prevented by increasing folic acid intake immediately prior to pregnancy and in the early stages of pregnancy. Other studies have confirmed these results and over 80 countries have introduced mandatory fortification of flour and/or grains with folic acid. There has been no indication of any adverse effect in any of these countries, including the USA and Canada. The Centers for Disease Control and Prevention (CDC) have recently estimated that in the USA, fortification has saved 1300 children each year from death or a lifetime of handicap—a total of more than 27 000 since 1998 when fortification was introduced in the USA.2 In 2015, it was estimated that over 2000 children would have been saved each year from death or a lifetime handicap if folic acid fortification had been implemented in the UK at the same time as it was in the USA.3 Women have been advised to take folic acid supplements before pregnancy and in early pregnancy. This is the current …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.075 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.004 | 0.005 |
| Scholarly communication | 0.007 | 0.007 |
| Open science | 0.003 | 0.006 |
| Research integrity | 0.051 | 0.030 |
| Insufficient payload (model declined to judge) | 0.022 | 0.007 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".