Double fortified salt: an effective measure to control micronutrient deficiencies in Indian pregnant women

Abstract

Background: Pregnant women and children are extremely affected by micronutrient deficiencies with reference to fetal growth manifestations as well as post birth. Iodine and iron deficiency leads to poor life quality during early fetal development and young children may compromise on their IQ and cognitive development. It is reported that there is an interrelations between iron and iodine metabolism. However, references on using double fortified salt (DFS) as a tool to improve micronutrient status among pregnant women are limited; hence this study was designed. Methods: Pregnant women (n=150) were enrolled from a semi government hospital of urban Vadodara, Gujarat, India during first trimester (<12 weeks) and followed up till the end of gestation, n=75 were divided in experimental (DFS supplemented) and control (IS consumers) group. Impact on iron and iodine status was assessed by Hb concentration and UIE respectively. Results: Mean Hb improved significantly (p<0.001) (+0.42 g/dl) in experimental group and reduced insignificantly (0.20 g/dl) in control group at the end, since DFS provided additional ~93 mg of iron within 6 months of supplementation. Median UIE improved insignificantly (278.6 to 299.01µg/L) in experimental group and decreased significantly (p<0.05) (376.59 to 288.66 µg/L) in control group. Conclusions: Hence, we conclude that DFS could improve iron and iodine status of experimental group compared to control group. It is an effective measure to control two essential micronutrient deficiencies together.

Performance Factors Influencing Efficacy and Effectiveness of Iron Fortification Programs of Condiments for Improving Anemia Prevalence and Iron Status in Populations: A Systematic Review

“…As presented in Table 1, the most tested condiment, as a vehicle for efficacy or effectiveness of iron fortification, was salt. This fortification approach included 13 Double-fortified Salt (DFS) [21][22][23][24][25][26][27][28][29][30][31][32][33] and five Multiple Micronutrient Fortified Salt (MMFS) studies [34][35][36][37][38]. Only one study evaluated a seasoning powder [39], two studies evaluated fish sauce [40,41], and two studies evaluated soy sauce [42,43].…”

“…There were no efficacy or effectiveness studies of iron-fortified bouillon cubes. All studies were conducted in Asia or Africa using as subjects children or women of reproductive age during different time lengths using as fortificants a variety of iron forms that included micronized ground ferric pyrophosphate [21,30,33,38], encapsulated ferrous fumarate [21,31], ferrous fumarate [22], ferrous sulfate [23,28], microencapsulated ferrous fumarate [24], unknown iron source [25][26][27], ferrous sulfate monohydrate chelated with malic acid and sodium hexametaphosphate [29], ferrous sulfate hydrate encapsulated with partially hydrogenated vegetable oil [32], chelated ferrous sulfate [34][35][36][37], H-reduced elemental iron encapsulated with partially hydrogenated vegetable oil [39], ferrous sulfate citrate [40], or NaFeEDTA [40][41][42][43]. Blood hemoglobin was the main hematological indicator in all studies to evaluate the effect of iron fortification.…”

“…Similarly, Reddy et al (2016) showed a large positive effect size (0.81) using ferrous sulfate fortified DFS with pregnant women. However, blinding and statistical analyses (e.g., power calculations, ANOVA assumptions) were not used or described in the study design [28]. Blinding is a critical component in randomized, placebo-controlled trials [52].…”

“…The full quality assessment table can be seen in Supplementary Materials Table S1. There were n = 12 studies classified as strong [21,24,[30][31][32][33]35,[38][39][40][41][42], n = 7 studies classified as moderate [22,26,28,29,36,37,43], and n = 4 studies classified as weak [23,25,27,34].…”

“…Regarding the studies assessing iron-deficient populations (n = 4) [23,30,40,43], the average effect size was 1.18. On the contrary, studies assessing a general population (not necessarily iron deficient, n = 18) [21,22,24,[26][27][28][29][31][32][33][34][35][36][37][38][39]41,42] had an average effect size of 0.39. This difference illustrates that iron-deficient populations show a relatively larger effect size because iron is absorbed more readily than in the general population.…”