{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:33:19Z","timestamp":1785864799376,"version":"3.56.0"},"reference-count":39,"publisher":"Wiley","issue":"18","license":[{"start":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T00:00:00Z","timestamp":1596240000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We estimated the global proportion of folic acid\u2010preventable spina bifida and anencephaly (FAP SBA) potentially prevented through mandatory double fortification of iodized salt with folic acid.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using United Nations Children's Fund (UNICEF) and Global Fortification Data Exchange (GFDx) data sets, we modeled country\u2010specific number of FAP SBA cases prevented annually using (a) current coverage of the salt in households worldwide and (b) expected daily amount of folic acid intake from folic acid\u2010fortified iodized salt. Our evidence\u2010based modeling strategy assumed mandatory folic acid fortification of salt at 20\u2009ppm, and that at 200\u2009\u03bcg\/day intake of folic acid through fortified salt, should achieve 100% prevention of all FAP SBA in countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred countries that have data on percent of households consuming iodized salt globally were examined; 55 of them have \u226580% households consuming iodized salt. Our model estimated approximately 180,000 cases of FAP SBA could be prevented in these 100 countries through folic acid\u2010fortified iodized salt, and 150,000 of them would be in countries where \u226580% households consuming iodized salt that can be potentially fortified with folic acid. Salt fortification with folic acid could contribute to the prevention of about 65% global FAP SBA cases annually.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our evidence\u2010based model shows that there is high potential to prevent FAP SBA using folic acid\u2010fortified iodized salt. Prevention will reach countries where there is a limited reach of centrally processed folic acid\u2010fortified wheat or maize flour. If this intervention is made feasible by the salt industry, it can accelerate the prevention of FAP SBA significantly.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.1769","type":"journal-article","created":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T10:19:36Z","timestamp":1596277176000},"page":"1461-1474","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Modeling shows high potential of folic acid\u2010fortified salt to accelerate global prevention of major neural tube defects"],"prefix":"10.1002","volume":"112","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2803-8030","authenticated-orcid":false,"given":"Vijaya","family":"Kancherla","sequence":"first","affiliation":[{"name":"Center for Spina Bifida Prevention, Department of Epidemiology Emory University Rollins School of Public Health  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Becky","family":"Tsang","sequence":"additional","affiliation":[{"name":"Food Fortification Initiative  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaustubh","family":"Wagh","sequence":"additional","affiliation":[{"name":"Department of Global Health Emory University Rollins School of Public Health  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith","family":"Dixon","sequence":"additional","affiliation":[{"name":"Center for Spina Bifida Prevention, Department of Epidemiology Emory University Rollins School of Public Health  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2185-3929","authenticated-orcid":false,"suffix":"Jr.","given":"Godfrey P.","family":"Oakley","sequence":"additional","affiliation":[{"name":"Center for Spina Bifida Prevention, Department of Epidemiology Emory University Rollins School of Public Health  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3182227887"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23529"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-014-1542-8"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0206212"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199911113412001"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13548"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199911113412006"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980012003576"},{"key":"e_1_2_8_10_1","volume-title":"March of Dimes global report on birth defects: The hidden toll of dying and disabled children","author":"Christianson A.","year":"2006"},{"key":"e_1_2_8_11_1","first-page":"421","article-title":"Optimal serum and red blood cell folate concentrations in women of reproductive age for prevention of neural tube defects: World Health Organization guidelines","volume":"64","author":"Cordero A. 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