{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:40:57Z","timestamp":1792176057430,"version":"4.4.0"},"reference-count":31,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T00:00:00Z","timestamp":1751068800000},"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":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There is a high prevalence of neural tube defects (NTDs) and nutritional anemias that increase the risk of birth defects in India. The current staple food fortification regulations for folic acid and vitamin B12 are ineffective in the country. We provide an evidence\u2010based viewpoint urging for WHO\u2010recommended levels of fortificants (i.e., 1300 mcg of folic acid and 10\u2009mcg of vitamin B12 per kilogram of wheat flour or rice) to be included in the regulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Micronutrient fortified foods are being distributed through various governmental safety\u2010net programs under the National Food Security Act in India. Packaged flour produced by some private companies is fortified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Food fortification regulation, recommended in 2018 by the Food Safety and Standards Authority of India, allows adding 75\u2013125\u2009micrograms (mcg) of folic acid per kilogram (kg), and 0.75\u20131.25\u2009mcg of vitamin B12 per kg, as fortificants in wheat flour or rice. These levels are 90% lower than what WHO recommends based on daily consumption of staple foods in India.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Re\u2010setting fortification standards for folic acid and vitamin B12 to levels recommended by the WHO in India will avert thousands of NTD\u2010associated pregnancies each year, as well as morbidity and mortality associated with them.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.2498","type":"journal-article","created":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T03:34:22Z","timestamp":1751081662000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Food Fortification Ineffective in Preventing Neural Tube Defects in India due to Regulation Promoting Inadequate Levels of Folic Acid and Vitamin <scp>B12<\/scp>"],"prefix":"10.1002","volume":"117","author":[{"given":"Vijaya","family":"Kancherla","sequence":"first","affiliation":[{"name":"Department of Epidemiology Emory University Rollins School of Public Health  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parveen","family":"Bhalla","sequence":"additional","affiliation":[{"name":"Food Fortification Initiative  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subrata Kumar","family":"Dutta","sequence":"additional","affiliation":[{"name":"Food Fortification Initiative  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Mehta","sequence":"additional","affiliation":[{"name":"Former Regional Advisor, WHO\u2010SEARO  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravindra M.","family":"Vora","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Centre and Post\u2010Graduate Institute  Sangli Maharashtra India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santosh","family":"Karmarkar","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery Lilavati Hospital and Research Center  Mumbai Maharashtra India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0118961"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40609\u2010023\u201000291\u2010w"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23153"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13548"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199911113412006"},{"key":"e_1_2_8_7_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. M.","year":"2015","journal-title":"Morbidity and Mortality Weely Report Morbidity Mortality Weekly Report"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g4554"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.110.004671"},{"key":"e_1_2_8_10_1","unstructured":"Duggal M. andR.Das.2023.\u201cAssessing the Impact of Fortification on Micronutrient Status [Conference Presentation]. Micronutrient Forum 6th Global Conference The Hague the Netherlands.\u201d"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13499"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/cdn\/nzab069"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajcnut.2023.01.016"},{"key":"e_1_2_8_14_1","unstructured":"FSSAI.2021.\u201cFood Safety and Standards Authority of India (FSSAI).\u201dhttps:\/\/fssai.gov.in\/upload\/advisories\/2021\/07\/60f1798019f94Direction_RDA_16_07_2021.pdf."},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13579"},{"key":"e_1_2_8_16_1","unstructured":"Global Fortification Data Exchange.2024a.\u201cIndia Fortification Dashboard.\u201dhttps:\/\/fortificationdata.org\/country\u2010fortification\u2010dashboard\/?alpha3_code=IND&lang=en."},{"key":"e_1_2_8_17_1","unstructured":"Global Fortification Data Exchange.2024b.\u201cFood Fortification Dashboard.\u201dhttps:\/\/fortificationdata.org\/list\u2010of\u2010countries\u2010for\u2010the\u2010food\u2010fortification\u2010dashboard\/."},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu15133024"},{"key":"e_1_2_8_19_1","unstructured":"Government of India\u2014National Sample Survey Office.2024.\u201cSurvey on Household Consumption Expenditure: 2022\u201323 Ministry of Statistics and Programme Implementation. NDD Report No. 591 (HCES: 2022\u201323).\u201dhttps:\/\/www.mospi.gov.in\/sites\/default\/files\/publication_reports\/Report_591_HCES_2022\u201023New.pdf."},{"key":"e_1_2_8_20_1","first-page":"23","article-title":"Food Expenditure and Intake in the NSS 66th Round","volume":"47","author":"Gupta S.","year":"2012","journal-title":"Economic and Political Weekly"},{"key":"e_1_2_8_21_1","unstructured":"International Institute for Population Sciences (IIPS) and ICF.2021.\u201cNational Family Health Survey (NFHS\u20105) 2019\u201321: India: Volume 1. Mumbai: IIPS.\u201d"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.1175"},{"key":"e_1_2_8_23_1","unstructured":"Ministry of Health and Family Welfare (MoHFW) Food Safety and Standards Authority of India (FSSAI).2018.\u201cThe Gazette of India Extraordinary Part III \u2010 Section\u00a04 Food Safety and Standards (Fortification of Foods) Regulations 2018 No 290 REGD. No. D. L. \u2010 33004\/99. India. 3\/August\/2018.\u201dhttps:\/\/www.fssai.gov.in\/upload\/uploadfiles\/files\/Compendium_Food_Fortification_Regulations_04_03_2021.pdf."},{"key":"e_1_2_8_24_1","unstructured":"Ministry of Health and Family Welfare (MoHFW) Government of India UNICEF and Population Council.2019.\u201cComprehensive National Nutrition Survey (CNNS) National Report. 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