Effects of quintuply-fortified salt on the micronutrient status of children 12-59 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. OBJECTIVE: To determine the effect of QFS vs. iodized salt (IS) for 12 months on the micronutrient status of PSC. METHODS: This was a sub-study of a double-blinded, household-randomized, controlled, community-based trial involving non-pregnant women of reproductive age whose households were randomly assigned to receive: 1) QFS with zinc, vitamin B12, 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 (12-59 months of age) 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 B12 insufficiency, and folate deficiency was 35%, 30%, 14%, 17.0, and 5.5%, respectively. Effects of QFS at 6 and 12 months were greatest for vitamin B12 and folate. At 12 months, the eFePP-QFS group had higher serum B12 (GMR=1.16, 95% CI=1.03,1.30), serum folate (GMR=1.29, 95% CI=1.09,1.53), and RBC folate (GMR=1.21, 95% CI=1.05,1.39) concentrations compared to the IS group. Effects were similar among the two QFS groups. There were no significant differences in serum zinc, ferritin, or urinary iodine between groups at 6 and 12 months. CONCLUSIONS: Preschool children consuming QFS for 12 months demonstrated greater improvements in vitamin B12 and folate status compared to children consuming IS. QFS may be a useful vehicle to address micronutrient deficiencies, especially vitamin B12 and folate, in this population.