Assessment of the contribution of industrially processed foods to salt and iodine intake in Thailand.

Iodization of food grade salt has been mandated in Thailand since 1994. Currently, processed food consumption is increasing, triggered by higher income, urbanization, and lifestyle changes, which affects the source of salt and potentially iodized salt among the population. However, adequate information about the use of iodized salt in processed foods in Thailand is still lacking. Therefore, this study aimed to assess iodine intake through salt-containing processed foods and condiments which were identified using national survey data. Potential iodine intake from iodized salt in food products was modelled using consumption data and product salt content from food labelling and laboratory analysis. Fish sauce, soy sauce and seasoning sauces (salty condiments) have alternative regulation allowing for direct iodization of the final product, therefore modelling was conducted including and excluding these products. Daily salt intake from household salt and food industry salt (including salty condiments) was estimated to be 2.4 g for children 0-5 years of age, 4.6 g for children 6-12 years of age, and 11.5 g for adults. The use of iodized salt in processed foods (excluding salty condiments) met approximately 100% of the estimated average requirement (EAR) for iodine for non-pregnant adults and for children 6 to 12 years of age, and 50% of the EAR for iodine for children aged 0 to 5 years of age. In all cases, iodine intake from processed food consumption was greater than from estimated household iodized salt consumption. Findings suggest that iodized salt from processed foods is an important source of iodine intake, especially in adults. The use of iodized salt by the food industry should be enforced along with population monitoring to ensure sustainability of optimal iodine intake. Currently, the addition of iodine into fish sauce, soy sauce and seasoning sauces has an important role in achieving and sustaining optimal iodine intake.

Household coverage of vitamin A fortification of edible oil in Bangladesh.

Mandatory fortification of edible oil (soybean and palm) with vitamin A was decreed in Bangladesh in 2013. Yet, there is a dearth of data on the availability and consumption of vitamin A fortifiable oil at household level across population sub-groups. To fill this gap, our study used a nationally representative survey in Bangladesh to assess the purchase of fortifiable edible oil among households and project potential vitamin A intake across population sub-groups. Data is presented by strata, age range and poverty-the factors that potentially influence oil coverage. Across 1,512 households, purchase of commercially produced fortifiable edible oil was high (87.5%). Urban households were more likely to purchase fortifiable oil (94.0%) than households in rural low performing (79.7%) and rural other strata (88.1%) (p value: 0.01). Households in poverty were less likely to purchase fortifiable oil (82.1%) than households not in poverty (91.4%) (p <0.001). Projected estimates suggested that vitamin A fortified edible oil would at least partially meet daily vitamin A estimated average requirement (EAR) for the majority of the population. However, certain population sub-groups may still have vitamin A intake below the EAR and alternative strategies may be applied to address the vitamin A needs of these vulnerable sub-groups. This study concludes that a high percentage of Bangladeshi population across different sub-groups have access to fortifiable edible oil and further provides evidence to support mandatory edible oil fortification with vitamin A in Bangladesh.

Regression Analysis to Identify Factors Associated with Household Salt Iodine Content at the Sub-National Level in Bangladesh, India, Ghana and Senegal.

Regression analyses of data from stratified, cluster sample, household iodine surveys in Bangladesh, India, Ghana and Senegal were conducted to identify factors associated with household access to adequately iodised salt. For all countries, in single variable analyses, household salt iodine was significantly different (p < 0.05) between strata (geographic areas with representative data, defined by survey design), and significantly higher (p < 0.05) among households: with better living standard scores, where the respondent knew about iodised salt and/or looked for iodised salt at purchase, using salt bought in a sealed package, or using refined grain salt. Other country-level associations were also found. Multiple variable analyses showed a significant association between salt iodine and strata (p < 0.001) in India, Ghana and Senegal and that salt grain type was significantly associated with estimated iodine content in all countries (p < 0.001). Salt iodine relative to the reference (coarse salt) ranged from 1.3 (95% CI 1.2, 1.5) times higher for fine salt in Senegal to 3.6 (95% CI 2.6, 4.9) times higher for washed and 6.5 (95% CI 4.9, 8.8) times higher for refined salt in India. Sub-national data are required to monitor equity of access to adequately iodised salt. Improving household access to refined iodised salt in sealed packaging, would improve iodine intake from household salt in all four countries in this analysis, particularly in areas where there is significant small-scale salt production.

Household Coverage with Adequately Iodized Salt Varies Greatly between Countries and by Residence Type and Socioeconomic Status within Countries: Results from 10 National Coverage Surveys.

Background: Household coverage with iodized salt was assessed in 10 countries that implemented Universal Salt Iodization (USI).Objective: The objective of this paper was to summarize household coverage data for iodized salt, including the relation between coverage and residence type and socioeconomic status (SES).Methods: A review was conducted of results from cross-sectional multistage household cluster surveys with the use of stratified probability proportional to size design in Bangladesh, Ethiopia, Ghana, India, Indonesia, Niger, the Philippines, Senegal, Tanzania, and Uganda. Salt iodine content was assessed with quantitative methods in all cases. The primary indicator of coverage was percentage of households that used adequately iodized salt, with an additional indicator for salt with some added iodine. Indicators of risk were SES and residence type. We used 95% CIs to determine significant differences in coverage.Results: National household coverage of adequately iodized salt varied from 6.2% in Niger to 97.0% in Uganda. For salt with some added iodine, coverage varied from 52.4% in the Philippines to 99.5% in Uganda. Coverage with adequately iodized salt was significantly higher in urban than in rural households in Bangladesh (68.9% compared with 44.3%, respectively), India (86.4% compared with 69.8%, respectively), Indonesia (59.3% compared with 51.4%, respectively), the Philippines (31.5% compared with 20.2%, respectively), Senegal (53.3% compared with 19.0%, respectively), and Tanzania (89.2% compared with 57.6%, respectively). In 7 of 8 countries with data, household coverage of adequately iodized salt was significantly higher in high- than in low-SES households in Bangladesh (58.8% compared with 39.7%, respectively), Ghana (36.2% compared with 21.5%, respectively), India (80.6% compared with 70.5%, respectively), Indonesia (59.9% compared with 45.6%, respectively), the Philippines (39.4% compared with 17.3%, respectively), Senegal (50.7% compared with 27.6%, respectively) and Tanzania (80.9% compared with 51.3%, respectively).Conclusions: Uganda has achieved USI. In other countries, access to iodized salt is inequitable. Quality control and regulatory enforcement of salt iodization remain challenging. Notable progress toward USI has been made in Ethiopia and India. Assessing progress toward USI only through household salt does not account for potentially iodized salt consumed through processed foods.