title: Triple fortification of salt with microcapsules of iodine, iron, and vitamin A.
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.
  
  
  METHODS
  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 mum). We used the microcapsules to create triple-fortified salt (TFS) with 30 mug I, 2 mg Fe, and 60 mug 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 approximately 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Human Nutrition Laboratory and the Food Process Engineering Laboratory, Swiss Federal Institute of Technology, Zürich, Switzerland. michael.zimmermann@ilw.agrl.ethz.ch
authors.forename: Michael B
authors.initials: MB
authors.lastname: Zimmermann
authors.forename: Rita
authors.initials: R
authors.lastname: Wegmueller
authors.forename: Christophe
authors.initials: C
authors.lastname: Zeder
authors.forename: Nourredine
authors.initials: N
authors.lastname: Chaouki
authors.forename: Ralf
authors.initials: R
authors.lastname: Biebinger
authors.forename: Richard F
authors.initials: RF
authors.lastname: Hurrell
authors.forename: Erich
authors.initials: E
authors.lastname: Windhab
mesh_terms: D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000453:epidemiology; D002214:Capsules; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004338:Drug Combinations; D004356:Drug Storage; D005260:Female; D006042:Goiter / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007455:Iodine / Q000627:therapeutic use*; D007501:Iron / Q000627:therapeutic use*; D008297:Male; D009018:Morocco / Q000453:epidemiology; D015995:Prevalence; D017673:Sodium Chloride, Dietary / Q000627:therapeutic use*; D014801:Vitamin A / Q000627:therapeutic use*; D014802:Vitamin A Deficiency / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D002214:Capsules; D004338:Drug Combinations; D017673:Sodium Chloride, Dietary; C034024:iodized salt; D014801:Vitamin A; D007455:Iodine; D007501:Iron