{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:35:00Z","timestamp":1789580100342,"version":"build-2803163510"},"reference-count":23,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>India has a disproportionately high prevalence of neural tube defects, including spina bifida and anencephaly (SBA), causing a high number of stillbirths, elective pregnancy terminations, and child mortality; India contributes a large proportion of the global burden of SBA. Thirty years after folic acid was shown to be effective in reducing SBA prevalence, only about one-quarter of such births are prevented globally through cereal grain fortification.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine the association of folic acid\u2013fortified iodized salt with serum folate concentrations among nonpregnant and nonlactating women of reproductive age.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This nonrandomized controlled trial using a preintervention and postintervention design was conducted in 4 rural villages in Southern India from July 1 to November 30, 2022. All households in the villages agreed to participate in the study. Preintervention and postintervention serum folate levels were analyzed among study participants at baseline and after 4 months, respectively.<\/jats:p><\/jats:sec>Intervention<\/jats:title>Consumption of approximately 300 \u00b5g\/d of folic acid using double fortified salt (folic acid plus iodine). Median serum folate concentrations were assessed at baseline and 4 months.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Change in median serum folate levels between baseline and study end point as the primary outcome of the study.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 83 nonpregnant nonlactating women aged 20 to 44 years (mean [SD] age, 30.9 [5.1] years) were eligible for the study and provided serum samples for analysis at baseline and the end point of the intervention. The median serum folate concentration increased from 14.6 (IQR, 11.2-20.6) nmol\/L at baseline to 54.4 (IQR, 43.5-54.4) nmol\/L at end of study, a 3.7-fold increase from baseline to study end point. Two-tailed Wilcoxon signed rank test showed the median difference in preintervention and postintervention serum folate concentrations to be highly significant (P<\/jats:italic>\u2009&amp;lt;\u2009.001). The participants found the salt acceptable in color and taste.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Use of folic acid\u2013fortified iodized salt was associated with increased serum folate concentrations in women of reproductive age. This novel evidence can inform public health policy to accelerate SBA prevention.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT06174883<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.1777","type":"journal-article","created":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T16:31:21Z","timestamp":1709915481000},"page":"e241777","source":"Crossref","is-referenced-by-count":13,"title":["Folic Acid\u2013Fortified Iodized Salt and Serum Folate Levels in Reproductive-Aged Women of Rural India"],"prefix":"10.1001","volume":"7","author":[{"given":"Jogi V.","family":"Pattisapu","sequence":"first","affiliation":[{"name":"Pediatric Neurosurgery, University of Central Florida College of Medicine, Orlando"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijayasekhar V.","family":"Manda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King George Hospital at Andhra Medical College, Visakhapatnam, India"},{"name":"Department of Neurosurgery, Rangaraya Medical College, Kakinada, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhu Narayana Rao","family":"Kottakki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King George Hospital at Andhra Medical College, Visakhapatnam, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phani Madhavi","family":"Kajana","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King George Hospital at Andhra Medical College, Visakhapatnam, India"},{"name":"Department of Community Medicine, Government Medical College, Rajamahendravaram, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijaya","family":"Kancherla","sequence":"additional","affiliation":[{"name":"Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, 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Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levente","family":"Diosady","sequence":"additional","affiliation":[{"name":"Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Godfrey P.","family":"Oakley","sequence":"additional","affiliation":[{"name":"Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,3,8]]},"reference":[{"issue":"8760","key":"zoi240090r1","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/0140-6736(91)90133-A","article-title":"Prevention of neural tube defects: results of the Medical Research Council Vitamin Study.","volume":"338","author":"MRC Vitamin Study Research 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