340 Investigating the Effectiveness of Folic Acid-Fortified Iodized Salt on Serum Folate Concentration- a Primary Prevention Strategy for Spina Bifida in India

Abstract Aim Investigate the effectiveness of folic acid-fortified iodized salt in increasing serum folate concentrations among non-pregnant and non-lactating women of reproductive age Method All households in four rural Indian villages agreed to consume FA-fortified iodized salt (study salt) in a pre- and post-intervention study. Pre- and post-intervention serum folate levels were analysed from 83 eligible participants. A cohort study was done after consumption of approximately 300 mcg of FA daily using double fortified salt (FA + Iodine). We assessed the differences in median serum folate concentrations at baseline and 4 months. Results The median serum folate concentration increased from 14.6 nmol/L at baseline to 54.4 nmol/L at end of study. Two-tailed Wilcoxon Signed Rank Test showed the difference to be highly significant (p-value = 1.8 × 10-14). The villagers found the salt acceptable in color, taste and cooking properties. No untoward effects related to the study salt were noted. Conclusions Folic Acid for the prevention of Spina Bifida has over 3 decades of evidence to support it. In 2023, the World Health Assembly unanimously recommended FA to prevent incidence of Spina Bifida. India, currently estimated to bear a third of the global Spina Bifida burden, poses a unique challenge to mandatory fortification due to the heterogeneity in population, culture, and dietary patterns. FA-fortified salt presents an equitable opportunity to reach the entire population of India and avert a significant burden of Spina Bifida and its associated morbidity and mortality. Moreover, salt fortification infrastructure currently exists so FA-fortified salt poses a cost-effective primary prevention method.