Quadruple fortification of salt for the delivery of iron, iodine, folic acid, and vitamin B12 to vulnerable populations.

A process for simultaneous delivery of iron, iodine, folic acid, and vitamin B12 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 B12 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 B12 was added through the iron premix. Four approaches used to incorporate B12 into the iron premix were investigated: (1) co-extruding B12 with iron, (2) spraying B12 on the surface of the iron extrudate, (3) adding B12 to the colour masking agent, and (4) adding B12 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-B12 premix and sprayed iodine and folic acid solution contained 1000 ppm iron, 50 ppm iodine, 25 ppm folic acid, and 0.25 ppm B12. Over 98% of B12, 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 B12 in a safe and stable salt enabling public health measures for improved health at a minimal additional cost.