Large-scale staple food fortification as a complementary strategy to address vitamin and mineral vulnerabilities in India: A critical review.

The slow improvement in micronutrient malnutrition globally and in India warrants a need for scaling-up scientifically proven, cost-effective public health interventions. The present review discusses the potential of staple food fortification as a complementary strategy to tackle micronutrient deficiencies, while addressing the current concerns raised regarding its implementation. The review indicates the below par status of current strategies like dietary diversity and supplementation to address multiple micronutrients deficiencies in India and the need for complementary strategies to tackle this problem. Based on systematic reviews and meta-analysis, global and national evidence has identified staple food fortification as a proven and recognized cost-effective solution to address micronutrient deficiencies. The Government of India has shown a strong leadership to promote this proven intervention. Further, the paper addresses the concern that large-scale staple food fortification (LSFF) may lead to excessive nutrient intakes when delivered together with other interventions, e.g., supplementation, dietary diversity, among the same populations. A key message that emerges from this review is that LSFF is safe with current dietary intake and deficiencies and low coverage of other interventions. Given the current situation of food and nutrition insecurity which the COVID-19 pandemic has further exacerbated, and the critical role that nutrition plays in building immunity, it is even more important that health and nutrition of the population, especially vulnerable age groups, is not only safeguarded but also strengthened. LSFF should be implemented without any further delay to reach the most vulnerable segments of the population to reduce the dietary nutrient gap and prevent micronutrient deficiencies. Effective monitoring and regular dietary surveys will help ensure these interventions are being deployed correctly.

Trimester specific reference intervals for thyroid function tests in normal Indian pregnant women.

CONTEXT: Accurate assessment of thyroid function during pregnancy is critical, for initiation of thyroid hormone therapy, as well as for adjustment of thyroid hormone dose in hypothyroid cases. AIMS: We evaluated pregnant women who had no past history of thyroid disorders and studied their thyroid function in each trimester. SETTINGS AND DESIGN: 86 normal pregnant women in the first trimester of pregnancy were selected for setting reference intervals. All were healthy, euthyroid and negative for thyroid peroxidase antibody (TPOAb). These women were serially followed throughout pregnancy. 124 normal nonpregnant subjects were selected for comparison. MATERIAL AND METHODS: Thyrotropin (TSH), free thyroxine (FT4), free triiodothyronine (FT3) and anti-TPO were measured using Roche Elecsys 1010 analyzer. Urinary iodine content was determined by simple microplate method. The 2.5th and 97.5th percentiles were calculated as the reference intervals for thyroid hormone levels during each trimester. STATISTICAL ANALYSIS: SPSS (version 14.0, SPSS Inc., Chicago, IL, USA) was used for data processing and analysis. RESULTS: The reference intervals for the first, second and third trimesters for the following parameters: TSH 0.09-6.65, 0.51-6.66, 0.91-4.86 µIU/mL, FT4 9.81-18.53, 8.52-19.43, 7.39-18.28 pM/L and FT3 3.1-6.35, 2.39-5.12, 2.57-5.68 pM/L respectively. Thyroid hormone concentrations significantly differed during pregnancy at different stages of gestation. The pregnant women in the study had median urinary iodine concentration of 150-200 µg/l during each trimester. CONCLUSIONS: The trimester-specific reference intervals for thyroid tests during pregnancy have been established for pregnant Indian women serially followed during pregnancy using 2.5th and 97.5th percentiles.

A multicentric study on validation of spot testing kit.

OBJECTIVE: To assess the validity of the Spot testing kit (against the Standard iodometric titration) in the semi-quantitative estimation of iodine in salt. METHODS: The project was conducted at four centers in the country, namely, Vadodara, Jodhpur, Dibrugarh and New Delhi (AIIMS, coordinating centre). Uniform protocol was utilized at all the four centres. The school going children were asked to bring 30 g of iodine from their kitchen in an auto-seal polythene pouche with an identification slip. The iodine content of 3,010 salt samples (more than 700 salt samples from each center) was estimated independently by two different methods i.e., Iodometric Titration (used as reference standard) and Spot Testing Kit (STK) method, and the results were compared. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the STK method in relation to the Standard iodometric titration (SIT) were calculated. RESULTS: From total of 3,010 salt samples, majority (98%) of the salt samples collected were of powdered salt. The specificity of various research centers ranged from 60.5% to 88.9%. The positive predictive value of the various research centers ranged from 69.9% to 98%. The NPV of the various research centers ranged from 96.8% to 100%. The pooled sensitivity and specificity of the STK method (against IT method) for four centers together was 99.6% and 66.7%, respectively. CONCLUSIONS: The STK method is reliable for semi quantitative estimation of iodine content in salt and it can be used for monitoring the quality of iodized salt available in the community.

Community monitoring of the National Iodine Deficiency Disorders Control Programme in the National Capital Region of Delhi.

OBJECTIVE: The present study was conducted to assess the current status of iodine-deficiency disorders (IDD) in the National Capital Region of Delhi (NCR Delhi) and evaluate the implementation and impact of the National Iodine Deficiency Disorders Control Programme (NIDDCP). DESIGN: Cross-sectional study. SETTING: School-going children (n 1230) in the age group of 6-12 years were enrolled from thirty primary schools in the Municipal Corporation of Delhi. Thirty schools were selected using the probability-proportional-to-size cluster sampling methodology. In each identified school forty-one children were surveyed. Urine and salt samples were collected and studied for iodine concentration. A total of sixty salt samples from retail level were also collected. SUBJECTS: Schoolchildren aged 6-12 years. RESULTS: The median urinary iodine excretion (UIE) was found to be 198·4 µg/l. The percentage of children with UIE levels of <20·0, 20·0-49·9, 50·0-99·9 and ≥100·0 µg/l was 1·9, 4·3, 9·5 and 84·2%, respectively. The proportion of households consuming adequately iodized salt (salt with iodine levels of at least 15 ppm at consumption level) was 88·8%. The assessment of iodine content of salt revealed that only 6·1% of the families were consuming salt with iodine content less than 7 ppm. At retail level 88·3% of salt samples had >15 ppm iodine. CONCLUSIONS: Significant progress has been achieved towards elimination of IDD from NCR Delhi. There is a need for further strengthening of the system to monitor the quality of iodized salt provided to the beneficiaries under the universal salt iodization programme and so eliminate IDD from NCR Delhi.