Effects of Quintuply-Fortified Salt on the Micronutrient Status of Children 12 to 59 Months of Age in Punjab, India: Results from a Randomized, Community-Based, Household Trial.

BACKGROUND

Micronutrient deficiencies remain prevalent among preschool-aged children (PSC) in India. Quintuply-fortified salt (QFS) is one of many potential interventions to improve micronutrient intake and status at the population level.

OBJECTIVES

To determine the effect of QFS compared with iodized salt (IS) for 12 mo on the micronutrient status of PSC.

METHODS

This was a substudy of a double-blinded, household-randomized, controlled, community-based trial involving nonpregnant females of reproductive age whose households were randomly assigned to receive: 1) QFS with zinc, vitamin B-12, folic acid, iodine, and iron as encapsulated ferrous fumarate (eFF-QFS); 2) QFS with the same micronutrients, but iron as encapsulated ferric pyrophosphate plus ethylenediaminetetraacetic acid (eFePP-QFS); or 3) IS. The micronutrient status of 470 PSC (aged 12-59 mo) residing in these households was assessed at enrollment, 6 mo, and 12 mo. Continuous outcomes were analyzed with linear regression and reported as means or geometric mean ratios, and binary outcomes were analyzed with logistic regression and reported as odds ratios.

RESULTS

At baseline, the prevalence of anemia, iron deficiency anemia, hypozincemia, vitamin B-12 insufficiency, and folate deficiency was 35%, 30%, 14%, 17%, and 5.5%, respectively. Effects of QFS at 6 and 12 mo were greatest for vitamin B-12 and folate. At 12 mo, the eFePP-QFS group had higher serum vitamin B-12 [geometric mean ratio (GMR) = 1.16, 95% confidence interval (CI) = 1.03, 1.30], serum folate (GMR = 1.29, 95% CI = 1.09, 1.53), and red blood cell folate (GMR = 1.21, 95% CI = 1.05, 1.39) concentrations compared with the IS group. Effects were similar among the 2 QFS groups. There were no significant differences in serum zinc, ferritin, hemoglobin, or urinary iodine between groups at 6 and 12 mo.

CONCLUSIONS

Preschool children consuming QFS for 12 mo demonstrated greater improvements in vitamin B-12 and folate status compared with children consuming IS. QFS may be a useful vehicle to address micronutrient deficiencies, especially vitamin B-12 and folate, in this population.