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Session: Micronutrients Supplementation and Human Health (Oral 11)

(OR11-04-24) Assessment of Women’s Discretionary Salt Intake and Household Salt Utilization in Preparation for a Salt Fortification Trial in Oromia Region, Ethiopia

Sunday, June 30, 2024
10:24 AM – 10:36 AM CT
Location:  W183
Objectives: There is a high incidence of neural tube defects (NTDs) in Ethiopia; and folate insufficiency, a primary risk factor for NTDs, is common among Ethiopian women of reproductive age (WRA). Folic acid fortification of iodized salt (double-fortified salt, DFS) is a potential strategy to control these problems. To prepare for an intervention trial to evaluate the biological effect of DFS, we assessed women’s usual discretionary salt intake and household (HH) salt utilization rates.

Methods: For this cross-sectional study, we used a semi-structured questionnaire to obtain information on socio-demographic characteristics and measured discretionary salt intakes among 100 non-pregnant WRA using observed weighed food records with repeated measurement in 40. We estimated the distribution of usual discretionary salt intake by adjusting for intra-individual variability using the US National Cancer Institute method, and we simulated the potential effects of two levels of folic acid fortification (30 and 90 ppm folic acid) on folic acid intakes. We assessed HH salt utilization by measuring salt disappearance for one week.

Results: The women’s mean age was 31 years, 55% had completed any primary education, 75% were married, 56% were housewives, 44% were food insecure and mean HH size was 5. Mean ± SD usual discretionary salt intake was 6.8 ± 3.9 g/day. At the 95th percentile of usual discretionary salt intake, the higher fortification level would provide 918 µg folic acid/day; at the 5th percentile of usual discretionary salt intake, the lower fortification level would provide 124 µg folic acid/day. Estimated household salt utilization was 8.80 ± 6.14 g/person/day.

Conclusions: These findings inform plans for a randomized, dose-response intervention trial of DFS and a possible future national program to mandate folic acid fortification of refined, edible salt. The proposed folic acid fortification levels would likely produce a detectable change in red blood cell folate concentration and would not exceed the tolerable upper intake level of 1000 µg/day.

Funding Sources: Nutrition International with support from the Bill & Melinda Gates Foundation