Declining folate status in the UK prior to fortification

14th December 2023


A recent study has revealed a significant drop in folate status in the UK between 2008 and 2019, and a high prevalence of folate deficiency. The University of Cambridge researchers used data from the cross-sectional, nationally-representative National Diet and Nutrition Survey. Between 2008 and 2019 folate levels in the serum and red blood cells (RBC) showed a marked decrease across the population, and a high proportion of females of child-bearing age had RBC folate concentrations below the cut-off for increased chance of a pregnancy affected by neural tube defect (NTD).  

Folate is used in making DNA so is essential for cell growth and repair, and particularly vital during phases of rapid growth and development. During pregnancy lack of folate can result in pregnancy affected by NTDs such as anencephaly and spina bifida. Folate deficiency is also a risk factor for other conditions including anaemia, cardiovascular disease, cancer, and neurological disorders.

If you have any questions please get in touch with us at and they can put you in touch with the health team.  

During the period of the survey (2008-2019), England and Wales had an average prevalence of around 1 in 740 pregnancies affected by neural tube defects. Half of these pregnancies were affected by anencephaly which over the 11 years of the survey translates to thousands of babies lost.

Enhancing folate intake before pregnancy through supplements or fortified foods has been shown to reduce the chance of NTDs. Fortification of flour with folic acid has been shown to be effective and economical, currently more than 80 countries have a folic acid fortification programme. Shine was integral to a long campaign for fortification in the UK. In September 2021, the UK Government announced their intention to introduce mandatory fortification of non-wholemeal flour with folic acid. Consultations have followed looking at the level of fortification needed and the practicalities of implementation. The timeline for roll out of fortification is expected from the government soon but no announcement has yet been made. We will continue to pursue this with our government contacts and will keep our members updated.

Monitoring folate levels before and after fortification alongside NTD prevalence is an important means of measuring the success of the mandate in influencing public health outcomes. The findings of the latest National Diet and Nutrition Survey suggest there is lots of scope for improvement.

If you have any questions, please get in touch with us at  and they can connect you with the health team.

Fight for fortification

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