Guideline: Fortification of wheat flour with iron and folic acid

Summary

This WHO guideline provides normative, evidence-based recommendations for the fortification of wheat flour with iron and folic acid as a public health strategy to address micronutrient deficiencies, particularly iron deficiency anaemia and folate-preventable neural tube defects. It draws on systematic reviews of efficacy and safety evidence to specify appropriate compound types and concentrations relative to flour extraction rates and consumption patterns. The document is intended to support national governments and food regulatory bodies in designing and implementing effective flour fortification programmes.

UK applicability

The UK has historically mandated fortification of white and brown wheat flour with iron, calcium, and B vitamins under the Bread and Flour Regulations 1998; this WHO guideline provides internationally applicable standards that may inform UK policy review, particularly in the context of folic acid mandatory fortification, which was approved in the UK in 2021 following longstanding public health debate.

Key measures

Recommended fortification levels (mg/kg flour); iron compound forms; folic acid dosage; population coverage indicators; prevalence of iron deficiency anaemia and neural tube defects

Outcomes reported

The guideline sets out evidence-based recommendations for the fortification of wheat flour with iron and folic acid, including recommended compound forms, concentrations, and monitoring indicators to reduce micronutrient deficiencies at population level.

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