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Aim 1: Assess directional signal of effect of fortified salt with folic acid and iodine on blood serum folate levels.
It will be accomplished by feasibility pre-test/post-test clinical study by estimating mean and variability of serum blood folate levels effects of folic acid fortified salt.
Hypothesis: Fortified salt with folic acid and iodine will increase serum blood folate levels from baseline by month 1.
Aim 2: Assess feasibility and acceptability of salt fortified with folic acid and iodine.
Feasibility will be measured by 1) subjects' refusal rate of consent by 30 subjects during 6-month enrollment period; 2) method of determining salt consumption (weighting the saltshaker pre and post); 3) completion rates of study protocols from baseline to follow up. Hypothesis 1a: Completion of all blood draw visits will be 90-100%.
Acceptability will be measured by 1) completion rate of daily salt logs; 2) consumption of salt by weighting saltshakers; 3) attitude towards taste and color difference. Hypothesis 1b: Completion rate (90-100%) of daily salt logs will range from 90-100% of participants and 2) consumption of salt will range from 90-100% of participants.
Dietary surveys will be employed to document dietary habits and estimated daily FA intake in the sample population. Feasibility and acceptability of dietary surveys will be measured by willingness to answer survey questions. Hypothesis 1c: Completion rate of dietary surveys will range 90-100%.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Salt with folic acid and iodine | Experimental | Intervention is intake of double fortified salt with folic acid and iodine (DFS). We will ask the participants to substitute their current salt with the study saltshaker and use it when preparing food or when eating out. We estimate minimum daily intake from salt consumption by participants will be 200 micrograms (µg) of folic acid per serving. Serving is 2g of salt. Participants will be given portion suggestions: 1/2 teaspoon or 2-3 pinches or 8-10 shakes/5 times a day. Containers (125g) will be weighted at the beginning and end of 1 month. We will ask each day if woman cooked/used the salt for herself only or to list number of people each day. Participants will also agree to complete either daily paper salt log. A commercially available salt that is fortified with folic acid has been provided by AlpenJodSalz produced by Sudwestdeutsche Salzwerk. For 30 participants, we will need 30 containers. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Salt with folic acid and iodine | Dietary Supplement | Assess serum and RBC folate levels in women at baseline and 1 month after ingesting salt with folic acid |
|
| Measure | Description | Time Frame |
|---|---|---|
| Serum blood folate levels | Change in serum blood folate levels from baseline to one month | One month |
| Measure | Description | Time Frame |
|---|---|---|
| Number of participants who are enrolled in the study | Feasibility of enrollment: number of participants who are enrolled in the study | one month |
| Change in weight of salt shakers (in grams) | Acceptability of salt with folic acid and iodine by the participants through weighting salt shackers before and after and calculating amount of salt ingested. |
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Inclusion Criteria:
Exclusion Criteria:
We are focusing on women specifically as we looking at maternal blood folate levels prior to potential pregnancy
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| Name | Affiliation | Role |
|---|---|---|
| Anastasia Arynchyna-Smith, MPH | University of Alabama at Birmingham | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Alabama at Birmingham | Birmingham | Alabama | 35294 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33124747 | Background | Kancherla V, Wagh K, Pachon H, Oakley GP Jr. A 2019 global update on folic acid-preventable spina bifida and anencephaly. Birth Defects Res. 2021 Jan 1;113(1):77-89. doi: 10.1002/bdr2.1835. Epub 2020 Oct 30. | |
| 32738033 | Background | Kancherla V, Tsang B, Wagh K, Dixon M, Oakley GP Jr. Modeling shows high potential of folic acid-fortified salt to accelerate global prevention of major neural tube defects. Birth Defects Res. 2020 Nov;112(18):1461-1474. doi: 10.1002/bdr2.1769. Epub 2020 Aug 1. |
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If another investigator has a valid research question and hypothesis that fits in with the study sample, we will consider sharing de-identified dataset. Participants have consented to share their de-identified data with future researchers.
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Pre-test and post-test of serum folate levels after using salt with folic acid in the same group of women, each serving as their own control.
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| one month |
| Percent of participants who completed all study visits | Percent of participants who completed all study visits | one month |
| Measure of effect salt with folic acid had on taste of food using Likert scale | Did using this salt negatively affect the taste of your food overall? It is measured on Likert scale (1- strongly disagree, 5 strongly agree) | one month |
| Measure of whether the color of salt negatively affect their desire to use it daily using Likert Scale | Did the color of salt negatively affect your desire to use it daily? It is measured on Likert scale (1- strongly disagree, 5 strongly agree) | one month |
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| ID | Term |
|---|---|
| D009436 | Neural Tube Defects |
| D005494 | Folic Acid Deficiency |
| ID | Term |
|---|---|
| D009421 | Nervous System Malformations |
| D009422 | Nervous System Diseases |
| D000013 | Congenital Abnormalities |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D014804 | Vitamin B Deficiency |
| D001361 | Avitaminosis |
| D003677 | Deficiency Diseases |
| D044342 | Malnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
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| ID | Term |
|---|---|
| D012492 | Salts |
| D005492 | Folic Acid |
| D007455 | Iodine |
| ID | Term |
|---|---|
| D007287 | Inorganic Chemicals |
| D011622 | Pterins |
| D011621 | Pteridines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D006219 | Halogens |
| D004602 | Elements |
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