Modeling Shows High Potential of Folic Acid Fortified Salt to Accelerate Global Prevention of Major Neural Tube Defects
33 Pages Posted: 9 Apr 2020More...
Background: We estimated the global proportion of folic acid-preventable spina bifida and anencephaly (FAP SBA) potentially prevented through mandatory double fortification of iodized salt with folic acid.
Methods: Using UNICEF and Global Fortification Data Exchange (GFDx) datasets, we modelled country-specific number of FAP SBA cases prevented annually using: 1) current coverage of the salt in households worldwide; and 2) expected daily amount of folic acid intake from folic acid fortified-iodized salt. Our evidence-based modeling strategy assumed mandatory folic acid fortification of salt at 20 ppm, and that at 200 μg/day intake of folic acid through fortified salt, should achieve 100% prevention of all FAP SBA in countries.
Findings: One hundred countries that have data on percent of households consuming iodized salt globally were examined; 65 of them have ≥80% households consuming iodized salt. Our model estimated approximately 180,000 cases of FAP SBA could be prevented in these 100 countries through folic acid fortified-iodized salt, and 150,000 of them would be in countries where ≥80% households consuming iodized salt that can be potentially fortified with folic acid. Salt fortification with folic acid could contribute to the prevention of about 65% global FAP SBA cases annually.
Interpretation: Our evidence-based model shows that there is high potential to prevent FAP SBA using folic acid-fortified iodized salt. Prevention will reach countries where there is a limited reach of centrally-processed folic acid-fortified wheat or maize flour. If this intervention is made feasible by the salt industry, it can accelerate the prevention of FAP SBA significantly.
Funding Statement: No funding was received to conduct any aspect of this study
Declaration of Interests: The authors have no financial relationships relevant to this article
to disclose. Dr. Godfrey P. Oakley Jr. is a co-inventor (while at CDC, compensation is under the regulations of CDC) of a patent that covers adding folic acid to contraceptive pills, and he has been a consultant to Ortho McNeil on this issue.
Keywords: Folic Acid; Fortification; Neural Tube Defects; Salt; Spina Bifida
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