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Modeling Shows High Potential of Folic Acid Fortified Salt to Accelerate Global Prevention of Major Neural Tube Defects

33 Pages Posted: 9 Apr 2020

See all articles by Vijaya Kancherla

Vijaya Kancherla

Emory University - Center for Spina Bifida Prevention

Becky Tsang

Food Fortification Initiative

Kaustubh Wagh

Emory University, Rollins School of Public Health, Hubert Department of Global Health

Meredith Dixon

Emory University, Center for Spina Bifida Prevention

Godfrey P. Oakley

Emory University - Center for Spina Bifida Prevention

More...

Abstract

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

Suggested Citation

Kancherla, Vijaya and Tsang, Becky and Wagh, Kaustubh and Dixon, Meredith and Oakley, Godfrey P., Modeling Shows High Potential of Folic Acid Fortified Salt to Accelerate Global Prevention of Major Neural Tube Defects (3/8/2020). Available at SSRN: https://ssrn.com/abstract=3551320 or http://dx.doi.org/10.2139/ssrn.3551320

Vijaya Kancherla (Contact Author)

Emory University - Center for Spina Bifida Prevention ( email )

Atlanta, GA
United States

Becky Tsang

Food Fortification Initiative

Atlanta, GA
United States

Kaustubh Wagh

Emory University, Rollins School of Public Health, Hubert Department of Global Health

United States

Meredith Dixon

Emory University, Center for Spina Bifida Prevention

Atlanta, GA
United States

Godfrey P. Oakley

Emory University - Center for Spina Bifida Prevention

Atlanta, GA
United States

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