A Randomized Trial of Quadruple-Fortified Salt for Anemia and Birth Defects Prevention in Southern India: Protocol Design and Methods

Finkelstein, Julia L.; Guetterman, Heather; Fothergill, Amy; Johnson, Christina B.; Qi, Yan; Jabbar, Shameem; Zhang, Mindy; Pfeiffer, Christine M.; Rose, Charles E.; Yeung, Lorraine F.; Williams, Jennifer L.; Krisher, Jesse T; Ruth, Caleb; Choudhury, Dripta Roy; Venkatramanan, Sudha; Haas, Jere D.; Kuriyan, Rebecca; Mehta, Saurabh; Bonam, Wesley; Crider, Krista S.

doi:10.1016/j.cdnut.2023.100052

Cited by 3 publications

(1 citation statement)

References 81 publications

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“…Furthermore, it is pivotal to identify safer and more effective routes of passive folic acid supplementation, such as additional stable grain products or fortified salt. [55][56][57] These efforts can be further integrated into existing regional and national policies. It is difficult to eliminate the role of toxic exposures as this is strongly linked with economic livelihood of many families.…”

Section: Future Directionsmentioning

confidence: 99%

Epidemiology and morbidity of spina bifida in Hispanic Americans: a systematic review

Abdelmageed,

Votoupal,

Lam

et al. 2024

bmjph

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ObjectiveTo comprehensively describe the epidemiology and morbidity of spina bifida in Hispanic Americans and identify risk factors associated with the increased prevalence of spina bifida.DesignA systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesThree databases (MEDLINE, Embase and Scopus) were searched between inception of the database and June 2023. Study designs included case–control, descriptive, cross-sectional and databases.Eligibility criteriaObservational and experimental analytical studies reporting epidemiology or morbidity of spina bifida in Hispanic Americans or Latinx individuals were eligible.Data extraction and synthesisData were extracted independently by authors. Descriptive analysis was used to summarise findings.ResultsOf 392 publications, 32 studies met inclusion criteria. Study periods ranged from 1955 to 2020. A total of 50 382 patients with spina bifida were included and 13 209 identified as Hispanic American (26.2%). Five studies report higher prevalence of spina bifida at birth per 10 000 births in Hispanic Americans compared with non-Hispanic white individuals, while one reported no significant difference (2.11 vs 2.24). Risk factors associated with spina bifida included prenatal exposures, sociodemographic factors and maternal clinical characteristics. Lower levels of maternal education, age and income were associated with an increased risk of spina bifida. Eleven papers found spina bifida had high morbidity among Hispanic Americans resulting in high financial, physical and socioeconomic impacts. There was high study heterogeneity that can be explained by the varying time periods and geographical distribution.ConclusionIncreased prevalence and morbidity of spina bifida in Hispanic Americans are due to a variety of inter-related factors relating to existing health disparities. High heterogeneity across the studies suggests a need for future studies and increased standardisation of reporting guidelines.

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Section: Future Directionsmentioning

confidence: 99%

Epidemiology and morbidity of spina bifida in Hispanic Americans: a systematic review

Abdelmageed,

Votoupal,

Lam

et al. 2024

bmjph

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A Randomized Crossover Trial of Acceptability of Quadruple-Fortified Salt in Women and their Households in Southern India

Guetterman,

Rajagopalan,

Fox

et al. 2024

The Journal of Nutrition

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Improvement of serum folate status in the US women of reproductive age with fortified iodised salt with folic acid (FISFA study)

Arynchyna-Smith,

Arynchyn,

Kancherla

et al. 2024

Public Health Nutr.

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Objective: Mandatory folic acid fortification of enriched grains has reduced neural tube defect prevalence in several countries. We examined salt as an additional vehicle for folic acid fortification. The primary objective was to examine the change in serum folate concentration after 1 month of consumption of fortified iodised salt with folic acid (FISFA) among women of reproductive age. The secondary objectives were to examine (1) the feasibility of implementing FISFA intervention and (2) the acceptability of FISFA. Design: We conducted a pre–post intervention study (January–April 2023). Participants received a FISFA saltshaker with the study salt (1 g of sodium chloride salt fortified with 100 mcg of folic acid) to use instead of regular table salt for 1 month. Serum folate was measured using the Elecsys Folate-III immunoassay method at baseline and 1-month endpoint. Change in serum folate was assessed using a two-tailed Wilcoxon signed rank test for paired samples. Setting: Metropolitan city, Southern USA. Participants: Non-pregnant, 18–40-year-old women who lived alone/with a partner. Results: Thirty-two eligible women consented to participate, including eleven non-Hispanic-White, eleven non-Hispanic-Black and ten Hispanic. Post-intervention, there was a significant increase in median serum folate concentration of 1·40 nmol/l (IQR 0·74–2·05; P < 0·001) from 24·08 nmol/l to 25·96 nmol/l in an analytical sample of n 29. An increase was seen in 28/29 (93 %) participants. Feasibility: 100 % study consent and compliance. FISFA acceptability: 25 d average use; 1·28 g average daily intake; 96·7 % and 90 % reported taste and colour of FISFA as highly acceptable, respectively. Conclusions: FISFA is an effective approach to increasing serum folate concentrations among women of reproductive age. Findings should be replicated in a larger study.

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A Randomized Trial of Quadruple-Fortified Salt for Anemia and Birth Defects Prevention in Southern India: Protocol Design and Methods

Cited by 3 publications

References 81 publications

Epidemiology and morbidity of spina bifida in Hispanic Americans: a systematic review

Epidemiology and morbidity of spina bifida in Hispanic Americans: a systematic review

A Randomized Crossover Trial of Acceptability of Quadruple-Fortified Salt in Women and their Households in Southern India

Improvement of serum folate status in the US women of reproductive age with fortified iodised salt with folic acid (FISFA study)

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