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

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Abstract
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 μm). We used the microcapsules to create triple-fortified salt (TFS) with 30 μg I, 2 mg Fe, and 60 μg 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 ≈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.