Quadruple fortification of salt for the delivery of iron, iodine, folic acid, and vitamin B(12) to vulnerable populations

A process for simultaneous delivery of iron, iodine, folic acid, and vitamin B(12) 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 B(12) 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 B(12) was added through the iron premix. Four approaches used to incorporate B(12) into the iron premix were investigated: (1) co-extruding B(12) with iron, (2) spraying B(12) on the surface of the iron extrudate, (3) adding B(12) to the colour masking agent, and (4) adding B(12) 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-B(12) premix and sprayed iodine and folic acid solution contained 1000 ppm iron, 50 ppm iodine, 25 ppm folic acid, and 0.25 ppm B(12). Over 98% of B(12), 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 B(12) in a safe and stable salt enabling public health measures for improved health at a minimal additional cost.