(P17-025-23) A Randomized Crossover Trial To Evaluate the Acceptability of Quadruple-Fortified Salt in Women and Their Households in Southern India

Objectives: To evaluate the acceptability of quadruple-fortified salt (QFS; iron, iodine, folic acid, vitamin B₁₂) among women and their households, using a randomized crossover trial design and triangle tests.

Methods: Households of women aged 18-49 y (n=77) residing in Southern India were randomized to receive QFS or double-fortified salt (DFS; iron and iodine) in a crossover design over a 3-week period (i.e., week 1: QFS or DFS, week 2: iodized salt, week 3: QFS or DFS). Each week, participants completed a 9-point hedonic questionnaire (1=dislike extremely to 9=like extremely) to evaluate the salt intervention on color, odor, taste, texture, and overall acceptability, and the remaining salt was weighed using a digital scale. Triangle tests were conducted at a central research facility to evaluate sensory discrimination between QFS and DFS, consumed in foods (i.e., plain rice, lemon rice) prepared using standardized recipes. Mixed models were used to examine hedonic ratings and salt use of QFS; salt type, sequence, and period were included as fixed effects, and participant [or household] were included as random effects. Binomial tests were used to evaluate sensory discrimination of salt type in triangle tests (i.e., whether the observed percentage of correctly identified samples was more than expected due to chance, i.e., 33.3%).

Results: Acceptability of salt was high: mean hedonic ratings were >7 for overall acceptability and did not differ by salt type (mean [SD]: QFS: 7.8 [0.7] vs. DFS: 7.7 [1.2]; p=0.68). Findings were similar in color, odor, taste, and texture. Household salt use did not differ by salt type (p=0.23). Overall, weighed salt use and reported hedonic ratings increased during the 3-week period, from week 1 to week 3 (p < 0.05). In triangle tests, food samples (i.e., rice) prepared with QFS or DFS were not distinguishable (p >0.05).

Conclusions: Acceptability of QFS was high, based on reported hedonic ratings and weighed household salt use. Household members could not distinguish between foods prepared with DFS and QFS. Findings informed the design and implementation of a randomized efficacy trial of QFS in this population.

Funding Sources: US Centers for Disease Control and Prevention, University of South Carolina Disability Research and Dissemination Center; NIH T32DK007158 (HMG); NIH 5T32HD087137 (AF)