Triple fortification of salt with microcapsules of iodine, iron, and vitamin A

• Published in: The American journal of clinical nutrition 2004-11, Vol.80 (5), p.1283-1290
• Main Authors: Zimmermann, M.B, Wegmueller, R, Zeder, C, Chaouki, N, Biebinger, R, Hurrell, R.F, Windhab, R
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anemia, Iron-Deficiency - drug therapy; Anemia, Iron-Deficiency - epidemiology; Biological and medical sciences; Capsules; Child; Child, Preschool; Children & youth; Developing countries; Double-Blind Method; Drug Combinations; Drug Storage; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Goiter - drug therapy; Goiter - epidemiology; Hemoglobin; Humans; Iodine - therapeutic use; Iron; Iron - therapeutic use; LDCs; Male; Morocco - epidemiology; Nutrition; Prevalence; Salt; Sodium Chloride, Dietary - therapeutic use; Thyroid gland; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vitamin A; Vitamin A - therapeutic use; Vitamin A Deficiency - drug therapy; Vitamin A Deficiency - epidemiology
• ISSN: 0002-9165; 1938-3207
• DOI: 10.1093/ajcn/80.5.1283

Background: In many developing countries, children are at high risk of goiter, vitamin A deficiency, and iron deficiency anemia. Objective: We aimed to develop a stable, efficacious salt fortified with iodine, iron, and vitamin A. Design: A novel spray-cooling technique was used with hydrogenated palm oil to package potassium iodate, micronized ferric pyrophosphate, and retinyl palmitate into microcapsules (mean particle size: 100 micrometer). We used the microcapsules to create triple-fortified salt (TFS) with 30 microgram I, 2 mg Fe, and 60 microgram vitamin A/g salt. After storage trials, we compared the efficacy of TFS with that of iodized salt in a 10-mo, randomized, double-blind trial in goitrous schoolchildren (n = 157) who had a high prevalence of vitamin A deficiency and iron deficiency anemia. Results: After storage for 6 mo, losses of iodine and vitamin A from the TFS were approximately equal to 12-15%, and color was stable. In the TFS group, mean hemoglobin increased by 15 g/L at 10 mo (P < 0.01), iron status indexes and body iron stores improved significantly (P < 0.05), and mean serum retinol, retinol-binding protein, and the ratio of retinol-binding protein to prealbumin increased significantly (P < 0.01). At 10 mo, prevalences of vitamin A deficiency and iron deficiency anemia were significantly lower in the TFS group than in the iodized salt group (P < 0.001). Conclusion: Newly developed microcapsules containing iodine, iron, and vitamin A are highly stable when added to local African salt. TFS was efficacious in reducing the prevalence of iron, iodine, and vitamin A deficiencies in school-age children.