The Multiply-Fortified Salt (MFS) trial was conducted to evaluate the nutritional impact of salt fortified with iron, zinc, vitamin B12, folic acid, and iodine on biomarkers of micronutrient status among non-pregnant women of reproductive age and preschool children in Punjab, India. Different forms of iron were also evaluated, and secondary analyses examined the effects of MFS on the gut microbiome. The trial was conducted as a collaboration between UCSF; Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh; UC Davis; and the University of Colorado. The trial was funded by the Gates Foundation, the Thrasher Research Fund, and the Waterloo Foundation.
In a separate collaboration between UC Davis, the Ethiopian Public Health Institute (EPHI), UCSF, the University of Rhode Island, and Nutrition International, the effects of folic acid fortification of iodized salt (DFS-IoFA) on women’s discretionary salt intakes, biomarkers of folate and iodine status, and the occurrence of adverse events among non-pregnant women in the Oromia region of Ethiopia were evaluated. Results of the trial informed Ethiopia’s national fortification policy and led to a subsequent initiative to scale-up DFS-IoFA throughout the country, which is being led by EPHI, Nutrition International, and UC Davis. Both stages of the project are supported by Nutrition International with funding from the Gates Foundation.
Contact: Christine McDonald and Kenneth Brown
Primary publications:
- Goh et al. AJCN 2025. Effects of quintuply-fortified salt on the micronutrient status of females of reproductive age in Punjab, India: a randomized, community-based trial.
https://www.sciencedirect.com/science/article/pii/S0002916525001959
- Goh et al. Nutrients 2023. Women in Selected Communities of Punjab, India Have a High Prevalence of Iron, Zinc, Vitamin B12, and Folate Deficiencies: Implications for a Multiply-Fortified Salt Intervention.
https://www.mdpi.com/2072-6643/15/13/3024
- Thompson et al. J Nutr 2025. The Effect of Quintuply-Fortified Salt on the Gut Microbiome of Nonpregnant Women of Reproductive Age in Punjab, India: A Substudy of a Randomized, Community-Based Trial
https://www.sciencedirect.com/science/article/pii/S0022316625001968
- Brown et al. BMJ Open 2024. Protocol for a community-based, household-randomised, dose-response trial to assess the acceptability, nutritional effects and safety of double-fortified salt containing iodine and folic acid compared with iodised salt among non-pregnant Ethiopian women of reproductive age (DFS-IoFA).
https://bmjopen.bmj.com/content/14/10/e084494
- Agbemafle et al. Matern Child Nutr 2025. Assessment of Women's Discretionary Salt Intake and Household Salt Utilization in Preparation for a Salt Fortification Trial in Oromia Region, Ethiopia
https://onlinelibrary.wiley.com/doi/10.1111/mcn.13768