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A Randomized Crossover Trial of Acceptability of Quadruple-Fortified Salt in Women and their Households in Southern India.
J Nutr
January 2025
Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States; Joan Klein Jacobs Center for Precision Nutrition and Health, Cornell University, Ithaca, NY, United States; Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States; Division of Nutrition, St. John's Research Institute, Bengaluru, Karnataka, India. Electronic address:
Background: Double-fortified salt (DFS; iron, iodine) improved iron status in randomized trials and was incorporated into India's social safety net programs, suggesting opportunities to address other micronutrient deficiencies.
Objectives: To evaluate the acceptability of quadruple-fortified salt (QFS; iron, iodine, folic acid, and vitamin B) in women and their households, using a randomized crossover trial design and triangle tests.
Methods: Women 18-49 y (n = 77) and their households were randomly assigned to receive QFS or DFS in a randomized crossover design over a 3-wk period (week 1: QFS/DFS, week 2: iodized salt, week 3: DFS/QFS).
Protocol for a community-based, household-randomised, dose-response trial to assess the acceptability, nutritional effects and safety of double-fortified salt containing iodine and folic acid compared with iodised salt among non-pregnant Ethiopian women of reproductive age (DFS-IoFA).
BMJ Open
October 2024
Global Technical Services, Nutrition International, Ottawa, Ontario, Canada.
Article Synopsis
- Ethiopia has a high prevalence of neural tube defects (NTDs), largely due to folate insufficiency among women of reproductive age, prompting a study on fortifying iodized salt with folic acid as a potential solution.
- The study will involve 360 non-pregnant women aged 18-49, randomly assigned to receive iodized salt fortified with either 30 ppm or 90 ppm of folic acid, or regular iodized salt, over a 26-week period to assess its acceptability and impact on nutritional status.
- Outcomes will include monitoring women's consumption of the salts, changes in biomarker levels for folate and iodine, and any adverse events, with results analyzed to determine the effectiveness of the fortification strategy
Introducing double fortified salt in social safety net programmes in Madhya Pradesh and Gujarat in India: Success factors, challenges and lessons learned.
Matern Child Nutr
June 2024
Nutrition International, Ontario, Ottawa, Canada.
Double fortified salt (DFS; with iron and iodine) was introduced in social safety net programmes (SSNPs) in Madhya Pradesh (MP) and Gujarat states in 2018. Nutrition International (NI) provided critical support for the intervention. An impact evaluation in MP found high DFS uptake, exceeding 90%.
View Article and Find Full Text PDFFolic Acid-Fortified Iodized Salt and Serum Folate Levels in Reproductive-Aged Women of Rural India: A Nonrandomized Controlled Trial.
JAMA Netw Open
March 2024
Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Importance: India has a disproportionately high prevalence of neural tube defects, including spina bifida and anencephaly (SBA), causing a high number of stillbirths, elective pregnancy terminations, and child mortality; India contributes a large proportion of the global burden of SBA. Thirty years after folic acid was shown to be effective in reducing SBA prevalence, only about one-quarter of such births are prevented globally through cereal grain fortification.
Objective: To determine the association of folic acid-fortified iodized salt with serum folate concentrations among nonpregnant and nonlactating women of reproductive age.
A Randomized Trial of Quadruple-Fortified Salt for Anemia and Birth Defects Prevention in Southern India: Protocol Design and Methods.
Curr Dev Nutr
March 2023
The National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Background: Women of reproductive age are at an increased risk of anemia and micronutrient deficiencies. Evidence supports the role of periconceptional nutrition in the development of neural tube defects (NTDs) and other pregnancy complications. Vitamin B deficiency is a risk factor for NTDs and may modify folate biomarkers that predict NTD risk at the population level.
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