Vijayasekhar V Manda, Vijaya Kancherla, Madhu Narayana Rao Kottakki, Phani Madhavi Kajana, Hayagriva Rao Bhaganagarapu, Azadeh Vatandoust, M G Venkatesh Mannar, Levente Diosady, Jogi V Pattisapu
Our study showed significant rises in serum levels of folate, vitamin B12, and iron after the intervention. Since over 80% of households use iodized salt in India, addition of other micronutrients provides an excellent reach to prevent anemia, SBA, and other disorders effectively.
BACKGROUND: India has a high prevalence of anemia, vitamin B12 deficiency, and maternal folate insufficiency with associated spina bifida and anencephaly (SBA). Fortifying household iodized table salt can be a strategy to prevent several micronutrient deficiencies.
OBJECTIVE: To examine the effectiveness of quadruple fortified salt (QFS) on serum folate, vitamin B12, and iron concentrations after 4 months of intervention.
METHOD AND MATERIAL: A nonrandomized controlled trial using a pre- and post-intervention evaluation design was implemented from July 1, 2022, to November 30, 2022 in four remote rural villages in India. Study participants included non-pregnant, non-lactating women of reproductive age. Serum levels were analyzed at baseline and after 4 months of consuming QFS. The QFS was made using commercially available edible iodized salt (containing 22 ppm iodine), fortified with 37 ppm folic acid, 0.35 ppm vitamin B12, and 1080 ppm iron. Descriptive statistics were assessed, and a two-tailed Wilcoxon signed-rank test for paired samples measured median differences, and mean differences were measured using paired sample t-tests.
RESULTS: A total of 91 participants were examined. The median serum folate concentration increased 3-fold from 18.3 nmol/L [interquartile range (IQR), 13.6-21.1 nmol/L ] at baseline to 54.4 nmol/L (IQR, 24.7-54.4 nmol/L; the ceiling effect) at the study endpoint. Median serum vitamin B12 concentration increased 2.6-fold from 287 pg/mL (IQR, 241-341 pg/mL) to 735 pg/mL (IQR, 624-890 pg/mL), and median serum iron concentration increased 1.7-fold, from 74 mcg/dL (IQR, 50-95 mcg/dL) to 128 mcg/dL (IQR, 97-156 mcg/dL) at endpoint. All increases were statistically significant (P < 0.0001). There were no complaints regarding QFS acceptability or adverse side effects.
CONCLUSION: Our study showed significant rises in serum levels of folate, vitamin B12, and iron after the intervention. Since over 80% of households use iodized salt in India, addition of other micronutrients provides an excellent reach to prevent anemia, SBA, and other disorders effectively.