Quadruple fortification of salt for the delivery of iron, iodine, folic acid, and vitamin B12 to vulnerable populations

Abstract

A process for simultaneous delivery of iron, iodine, folic acid, and vitamin B₁₂ through salt as a potential and holistic approach to ameliorate anaemia and reduce maternal and infant mortality is presented. Two approaches for adding folic acid and B₁₂ to salt during double fortification with iron and iodine were investigated. Attempts to add both micronutrients through the iodine spray solution were unsuccessful. Hence, folic acid was added through a stabilized iodine solution, and B₁₂ was added through the iron premix. Four approaches used to incorporate B₁₂ into the iron premix were investigated: (1) co-extruding B₁₂ with iron, (2) spraying B₁₂ on the surface of the iron extrudate, (3) adding B₁₂ to the colour masking agent, and (4) adding B₁₂ to the outer coating. Of these approaches, coextrusion (1) was the best, based on the ease of production and stability of fortificants. The salt formulated with the solid iron-B₁₂ premix and sprayed iodine and folic acid solution contained 1000 ppm iron, 50 ppm iodine, 25 ppm folic acid, and 0.25 ppm B₁₂. Over 98% of B₁₂, 93% folic acid, and 94% iodine were retained after 6-month storage in the best formulation. This technology can simultaneously deliver iron, iodine, folic acid, and vitamin B₁₂ in a safe and stable salt enabling public health measures for improved health at a minimal additional cost.