Adjusting the Iodine Content of Iodized Salt to Meet the Recommended Intake for Females of Reproductive Age: A Simulation Study with a Reduced Sodium Scenario.

BACKGROUND: The use of iodized salt is a key strategy to increase iodine intake worldwide. In many countries, including New Zealand, females of reproductive age are still at risk of being mildly iodine deficient. OBJECTIVE: This study aimed to determine the level of iodization of salt needed to ensure that females aged 18 to 40 y have an adequate intake of iodine in 2 scenarios: current discretionary salt intake and reduced discretionary salt intake. METHOD: Data from nonpregnant, nonlactating females aged 18 to 40 y (n = 795) who took part in the 2008/09 New Zealand Adult Nutrition Survey and completed a 24-h dietary recall were used. Iodine intake was determined from all foods except bread and discretionary salt, which are fortified with iodine. Iodine from bread and salt was estimated at different levels of salt iodization, starting at 25 mg iodine/kg salt and increasing incrementally by 5 mg/kg, and added to calculate total iodine intake. The simulation concluded when the appropriate iodine content in salt was found using the estimated average requirement (EAR) cut-point method. RESULTS: In the 2 scenarios, current discretionary salt intake (i.e., 400 mg/d) and reduced discretionary salt intake (i.e., 304 mg/d), the iodine concentration of salt is required to be 55 mg/kg and 70 mg/kg for no more than 2% of females to have an iodine intake below the EAR of 100 µg of iodine/d, respectively. In both scenarios and at all levels of iodine concentration, no one was above the upper level of intake of iodine of 1100 µg/d. CONCLUSIONS: This study found that females of reproductive age need to consume iodized salt at the higher end of the legislated range of 25 to 65 mg/kg. If strategies to reduce sodium intake were adopted, the range would need to increase, or iodized salt would need to be included in a wider range of staple foods.

Survey of iodized salt coverage in areas with different water iodine concentrations and the iodine status of local women.

PURPOSE: There were only two definitions of iodine-deficient (water iodine concentration < 10 µg/L) and iodine-excess areas (water iodine concentration > 100 µg/L) in China before 2020. Areas with water iodine concentration between 10 and 100 µg/L implement the same policy as iodine-deficient areas to provide iodized salt. The definition of iodine-adequate areas was formulated in 2020 for the first time. The paper aims to investigate the coverage rate of iodized salt (CR) in different areas defined according to the latest national standards, evaluate the iodine status of local women, and provide a basis for the revision and improvement of relevant policies. METHODS: A total of 1948 women aged 18-60 were recruited from the iodine extra-high areas (IEHA), iodine-excess areas (IEA), iodine-adequate areas (IAA), inland iodine-deficient areas (IIDA), and coastal iodine-deficient areas (CIDA). Information on daily diet was collected with the Food Frequency Questionnaire. Drinking water, salt, food, and urine samples were collected and tested in our laboratory. Based on the recommended daily iodine intake, we assessed whether the subjects' daily iodine intake levels were adequate. RESULTS: The CR and the median urinary iodine concentrations (UICs) were 4.02% and 98.03 µg/L in CIDA, 89.74% and 144.93 µg/L in IIDA, 26.55% and 178.60 µg/L in IAA, 8.78% and 446.5 µg/L in IEA, 3.95% and 605.4 µg/L in IEHA, respectively. The differences among these five areas were statistically significant (P < 0.0001). The daily dietary iodine intakes were mainly from drinking water in IAA (63.92%), IEA (92.29%), and IEHA (92.93%), and were mainly from iodized salt in IIDA (59.22%) and food in CIDA (86.6%). CONCLUSION: Women in IAA and IIDA were in an adequate iodine state. Women in IEA and IEHA were in an iodine-excess state, and it is necessary to carry out water improvements projects. Women in CIDA were in a slight iodine-deficient state, and health education on scientific iodine fortification should be strengthened to increase iodine intake.

Factors associated with recent iodine intake level among household food handlers in Southwest Ethiopia: a cross-sectional study.

BACKGROUND: Iodine deficiency is a global public health threat, affecting an estimated two billion people. The median urinary iodine concentration is more reliable in determining recent iodine intakes and the risks of iodine deficiency. Therefore, this study was aimed to identify the factors associated with recent iodine intake level using median urinary iodine concentration as an indicator among household food handlers in southwest Ethiopia. METHODS: A community-based survey was conducted with selected households using a pretested interviewer-administered questionnaire in southwest Ethiopia. A 20-gram sample of table salt and a 5 ml causal urine samples were also collected and analyzed using rapid test kit and a Sandell-Kolthoff reaction, respectively. A salt iodine concentration above 15 ppm was classified as adequately iodized and a median urinary iodine concentration between 100 and 200µgl- 1 was considered as adequate iodine intake. A bivariable and multivariable logistic regression model was fitted. Crude and adjusted odds ratios with their 95% confidence levels were reported. Associations with a p-value ≤ 0.05 were used to declare statistical significance. RESULTS: A total of 478 women were included, with a mean age of 33.2 (± 8.4 years). Only 268 (56.1%) of the households had adequately iodized salt (> 15 ppm). The median urinary iodine concentration (interquartile range) was 87.5 µg l- 1 (45.6-107.6). In a fitted multivariable logistic regression model (p-value = 0.911), illiterate women (AOR = 4.61; 95% CI: 2.17, 9.81), poorly iodized salt in the household (AOR = 25.0; 95% CI: 13-48), salt purchased from open market (AOR = 1.93; 95% CI: 1.0, 3.73) and women who do not read the label during purchasing the salt (AOR = 3.07; 95% CI: 1.31, 7.17) were important predictors of the risk of Iodine deficiency. CONCLUSION: Despite public health efforts to improve iodine intake, its deficiency is still a major public health problem among southwest Ethiopian women.

Multiple micronutrients fortified salt: consumers' acceptability survey, Tanzania.

BACKGROUND: Food fortification with micronutrients is an insufficiently used technology in developing countries. Salt is consumed in small, constant daily amounts by most people globally. Salt has been instrumental in delivering iodine to a wide population globally through fortification. There is a proven effective technology for fortifying iodinated salt with iron, folate, and Vitamin B12. Findings have shown that both Double (Iodine and iron) fortified salt (DFS) and quadruple (iron, iodine, folate, and vitamin B12) fortified salt (QFS) are effective in raising hemoglobin levels. AIM: To assess the acceptability and gauge consumers' willingness to use double-fortified and quadruple-fortified salt formulations. METHODS: We conducted an observational study involving 300 households at Haydom Lutheran Hospital catchment area in Northern rural Tanzania between October 2021 and April 2022. Each household was supplied with one type of salt (iodized salt (IS), DFS or QFS) for cooking common family dishes for one week. Thereafter, at least two adult members of the family who used the dishes cooked with study salt were interviewed using the adopted 5-point Hedonic scale. RESULTS: A total of 899 individuals were interviewed after using study salt for one week: 286 IS, 305 DFS, and 308 QFS. The overall acceptability for the salts was QFS (82%), DFS (78%), and IS (79%). The mean sensory (taste, color and appearance) scores of the QFS (1.7) and DFS (1.7) were comparable to standard iodized salt (1.6). CONCLUSION: Quadruple-fortified salt and double-fortified salt are equally acceptable and have similar sensory scores as standard iodized salt when used to cook commonly eaten dishes in the study population.

[Assessing of iodine consumption with iodized salt in organized nutrition of children of preschool and school age in the Tyumen region].

The territory of the Tyumen region is an endemic region with insufficient iodine content in the environment, in which, since the early 1990s, active preventive measures have been taken to increase the use of iodized salt (IS) in households, catering and the food industry. The purpose of the research was to assess the consumption of iodine with IS used in the organized nutrition of children in the Tyumen region. Material and methods. The assessment of iodine intake was carried out in preschool institutions and schools randomly selected the city of Tyumen and rural areas (village of Isetskoye). Modeling of iodine consumption in organized groups was carried out for children aged 1-3, 3-7, 7-11 and 12 years and older in urban and rural areas, respectively, using a standard menu and a technological map of dishes. Iodine intake was estimated based on the content of 40 µg of iodine in 1 g of salt and its 30% loss during cooking. Model 1 assumed the mandatory use of IS in the preparation of all salt-containing meals for preschoolers and schoolchildren. Model 2, in addition to the mandatory use of IS in school and preschool meals accounted the consumption of iodine with bakery products (BP) produced with IS. Results. The modeling showed that the average intake of iodine with meals (model 1) in preschool institutions in Tyumen was 89±16 µg/day for children aged 1-3 years. When BP with IS were included in the menu (model 2), iodine intake increased to 101±14 µg/day. In children aged 4-7 years iodine intake was 115±18 and 126±18 µg/day, respectively. In rural areas, iodine intake was lower: in children aged 1-3 years, under model 1, iodine intake was 66±3 µg/day, under model 2 - 76±4 µg/day. In children aged 4-7 years, these figures were 83±3 and 92±4 µg/day, respectively. Iodine consumption in a school in Tyumen under model 1 in children 7-11 years old was 24±5 µg/day, and in children 12 years and older - 27±6 µg/day. When BP with IS were included in the menu (model 2), iodine intake increased to 32±5 µg/day in children 7-11 years old and to 39±6 µg/day in children 12 years of age and older. In rural areas, when using model 1, iodine intake in children aged 7-11 years was 37±15 µg/day, in children aged 12 and over 40±21 µg/day. When BP with IS were included in the menu (model 2), iodine intake increased to 44±15 µg/day in children aged 7-11 years and to 50±21 µg/day in children 12 years of age and older. Conclusion. The use of IS in the preparation of salt-containing meals in preschool educational institutions of the Tyumen region fully covered the iodine requirements of preschool children, which confirms the effectiveness of the chosen strategy for the prevention of iodine deficiency and can be considered as an important part of the concept of universal salt iodization. The use of IS in preparation of school breakfast meals provides 23.5-36.9% of the recommended nutrient intake for iodine in rural schools and 15.4-26.4% of the recommended nutrient intake in urban schools, which can be a significant contribution to the total intake of this micronutrient.

The DONALD study as a longitudinal sensor of nutritional developments: iodine and salt intake over more than 30 years in German children.

PURPOSE: Mild-to-moderate iodine deficiency was present in large parts of Germany up to the beginning 1990s and improved from then on. Current epidemiological data on spot urine iodine measurements in German children strongly suggest the re-occurrence of an impaired iodine status. We thus examined whether this re-occurrence is identifiable in more detail, through iodine analyses of 24-h urine samples of a well-characterized cohort of German children in whom samples have been systematically collected from 1985 onward. As iodized salt is a major source for iodine supply, urinary sodium excretion was additionally studied. METHODS: Daily iodine and sodium excretions were measured in 2600 24-h urine samples collected between 1985 and 2018 by 677 healthy children aged 6-12 years (participants of the DONALD study). These data were compared with 24-h iodine and sodium excretion estimates obtained from spot urine samples collected in the representative German Health Interview and Examination Surveys for Children and Adolescents KiGGS-baseline (2003-2006) and KiGGS-wave-2 (2014-2017). RESULTS: Between 1985 and1992, DONALD participants started with a median daily iodine excretion level of 40.1 µg/d. Then, during 1993-2003, iodine excretions mounted up to an approximate plateau (~ 84.8 µg/d). This plateau lasted until 2012. Thereafter, iodine concentrations started to decrease again resulting in a median iodine excretion of only 58.9 µg/d in 2018. Sodium excretion, however, had increased. The marked decrease in iodine status along with an abundant sodium excretion corresponded closely with nationwide KiGGS data. CONCLUSIONS: As exemplified for the clearly worsening iodine status in German children, longitudinal cohort studies collecting detailed biomarker-based prospective data have the potential to reliably capture health-relevant nutritional changes and trends, applicable on a more comprehensive and even representative population level.

Concerns of iodized salt and its effects for women seeking antenatal care in Pakistan.

Background and Objective: Pregnant women are the most susceptible group for Iodine deficiency disorder (IDD) whose neonate are at the risk of brain impairment, if they are iodine deficient in utero. The study was carried out to analyze the concerns and effects regarding iodized salt and IDD in women seeking antenatal care in Pakistan. Methods: A descriptive cross-sectional study was conducted in Obstetrics OPD at Civil Hospital Karachi from April 2017 to January 2018. In this study, antenatal care seeking women (n=360) visiting obstetric outpatient department (OPD) at public sector tertiary care hospital of Karachi were interviewed face to face using a structured questionnaire. Systematic random sampling method was employed. Kruskal Wallis test was applied to assess the significance among study variables. Results: Sixty-three (63.6%) of pregnant women heard about iodized salt. Approximately 40.6% of them received iodized salt related information through mass media. Ninety (90.6%) were ignorant that their unborn child needs iodine for brain development. A statistically significant association was found between the educational status (p<0.001), household income (p<0.001), age (p=0.016), ethnicity (p=0.018), trimester (p=0.005) with the knowledge of study participants regarding iodized salt and IDD. Conclusion: There is an immense need to address the present concerns of women seeking antenatal care by advocacy and health education on individual and at mass level regarding the use of iodized salt among women seeking antenatal care. Advocacy can be done by governmental initiatives, medical personnel and through mass media in all tertiary care hospitals of Pakistan.

Factors affecting the consumption of iodized salt by pregnant women in Karachi.

Background and Objective: Globally iodine deficiency disorder (IDD) is a major preventable cause of cognitive impairment in new born. In developing countries, every year 38 million newborn develop cognitive impairment as a result of iodine deficiency. Iodine consumption by pregnant women is affected by many factors. Hence, we conducted this study to identify factors associated with IDD. To know the effects of different factors on use of iodized salt by pregnant women visiting antenatal outpatient department (OPD) at a public sector tertiary care hospital of Karachi. Methods: Pregnant women (n=360) visiting antenatal OPD at public sector tertiary care hospital of Karachi were interviewed using a structured questionnaire. Systematic random sampling method was employed. Data was collected from March 2017 to January 2018. Chi-square test was applied to identify factors associated with IDD. Results: Thirty one (31% ) of pregnant women were consuming iodized salt in their homes. The percentage of participants who heard about iodized salt for the first time was 24%. Twelve percent (12%) reported that price of iodized salt is more than that of normal salt. Ninety eight (98%) of pregnant women replied that they were not informed about the importance of iodine or iodine requirement during pregnancy by their doctor or health care provider. A statistically significant association was observed between educational status (p=0.001) and household income (p<0.001) with the use of iodized salt. Conclusion: Low education, low income of study participants are identified as factors related to limited consumption and incorrect practices related to the use of iodized salt. In order to address iodine deficiency, there is a need to not only sensitize the expectant mothers about the adverse outcome of maternal iodine deficiency for their unborn child but also to introduce an awareness program at the antenatal clinics by the Health Professional for the antenatal care seeking women. There is also an immense need of support from Government side as well to make strategies and policy changes at the national level to ensure the availability, accessibility and affordability of iodized salt.

Exploring the status of iodine deficiency disorders control program in Nagaland.

Globally, 1.9 billion individuals have inadequate iodine nutrition, of whom 285 million are school-aged children. Universal salt iodization is the favored preventive strategy for iodine deficiency disorders (IDD), the single largest cause of preventable mental retardation. Two thousand and twenty estimates show nearly 1 billion people do not consume iodized salt. When at least 90% of households consume adequately iodized salt (≥15 ppm), a country is said to have attained USI. Only 23 countries had household coverage of 90% or higher. India has a household coverage of 76.3%. One 67 million people are at risk of IDD, 54 million suffer from goiter, and 2 million from cretinism. Yearly, 9 million pregnant women and 8 million newborns are at risk. Nagaland, with the second highest coverage of iodized salt in India, the study aims to assess the state-specific approach, track various mitigating measures that effectively sustained the gains of the program.

[On integration of the iodine deficiency elimination and salt reduction programs].

Excessive salt intake is a risk factor for noncommunicable diseases, but salt iodization is the most effective method of population-based prevention of iodine deficiency. Therefore, an assessment of dietary iodine intake from the use of iodized salt in the food industry and potential reductions in salt intake is needed. Objective. To assess the feasibility of integrating iodine deficiency prevention and salt reduction programmes among the adult population in the Republic of Belarus. Material and methods. Using the thiocyanate-nitrite method, the determination of iodine in various types of foods was carried out. Taking into account the actual dietary intake, estimated using the frequency method among 583 respondents over 18 years old, living in Minsk, from various socioeconomic groups, alimentary iodine intake was assessed at different levels of salt use in households. The level of iodine sufficiency was additionally estimated on the base of urinary excretion data obtained by the cerium-arsenite spectrophotometric method in 100 healthy adults over the age of 18 living in Minsk (65 women and 35 men). Results. As part of the legal framework for the use of iodized salt in food production, there has been a steady increase in iodine levels in the target products (bakery and meat products to 42.0 and 133.3 µg/100 g respectively). The content of the discussed micronutrient in the diet of the adult population has raised at least 1.9-fold in recent decades, to 237.3 µg/day in the most realistic consumption model. The main source of iodine among this subpopulation is commercially produced foods with iodized salt, which forms 30-58% of the alimentary iodine exposure. Consumption of salt in Belarus averages 10.6 g per day, which poses a risk of developing noncommunicable diseases and necessitates programmes to reduce the level of salt in the diet. Modeling of scenarios with reduction of salt use in households in accordance with the recommendations of the World Health Organization (WHO) shows that the main contribution to dietary iodine exposure will be made by bread products (38%), about 1/3 will be formed by table salt, the value of non-target fortified products (milk and eggs) will increase (up to 21%). The contribution of table iodized salt to the dietary iodine exposure reaches 43% at actual consumption levels and will decrease to 18% if it is reduced to the WHO recommended values. The median of ioduria among those surveyed is 136.8 µg/l, indicating adequate iodine supply. Conclusion. In implementing joint programs on prevention of iodine deficiency and cardiovascular diseases associated with excessive salt intake, it is necessary to consider national conditions - mandatory use of iodized salt in food industry, its level of fortification, content of this micronutrient in foodstuffs and structure of their consumption among certain population groups.

Analysis of the correlation between high iodized salt intake and the risk of thyroid nodules: a large retrospective study.

BACKGROUND: Currently, whether daily excess iodized salt intake increases the risk of thyroid nodules and even thyroid cancer remains controversial. Our research group aimed to provide a theoretical basis for the clinical guidance of daily iodized salt intake and the prevention of thyroid nodules through a retrospective analysis of the correlation between daily iodized salt intake and the risk of thyroid nodules and thyroid cancer in Hunan, China. METHODS: This study retrospectively analyzed the data of subjects who underwent a physical examination at the Health Management Center, Third Xiangya Hospital of Central South University, between January 1, 2017, and December 31, 2019. Subjects enrolled in this study underwent thyroid ultrasonography and tests to urine routines and liver and kidney function, and all subjects completed a questionnaire survey. The daily iodized salt intake of the study subjects was estimated based on spot urine methods (Tanaka). A multivariate logistic regression model was used to analyze the relationship between daily iodized salt intake and thyroid nodules and thyroid cancer. RESULTS: Among the 51,637 subjects included in this study, the prevalence of thyroid nodules was 40.25%, and the prevalence of thyroid cancer was 0.76%; among all enrolled subjects, only 3.59% had a daily iodized salt intake less than 5 g. In addition, we found that a daily intake of more than 5 g of iodized salt was not only an independent risk factor for the occurrence of thyroid nodules (odds ratio (OR): 2.08, 95% confidence interval (CI): 1.86-2.31, p < 0.001) but also an independent risk factor for the occurrence of thyroid cancer (OR: 5.81, 95% CI: 1.44-23.42, p = 0.012). A pooled analysis showed a significantly higher risk of thyroid nodules in subjects aged > 60 years with a daily iodized salt intake of more than 5 g compared to subjects aged < 60 years with a daily iodized salt intake of no more than 5 g (OR: 4.88, 95% CI: 4.29-5.54, p < 0.001); the risk of thyroid cancer was not significantly different between subjects aged > 60 years with a daily iodized salt intake of more than 5 g and those aged < 60 years with a daily iodized salt intake of no more than 5 g (OR: 2.15, 95% CI: 0.52-8.95, p = 0.281). The risk of thyroid nodules was not increased in physically active subjects with a daily iodized salt intake of more than 5 g compared to physically inactive subjects with a daily iodized salt intake of no more than 5 g (OR: 1.12, 95% CI: 0.97-1.28, p = 0.111). The same protective effect of physical activity was observed for thyroid cancer in subjects whose daily iodized salt intake exceeded 5 g. The risk of thyroid nodules was reduced for subjects with an education level of postgraduate and above, even when the daily iodized salt intake exceeded 5 g, compared to those with high school education and below and a daily iodized salt intake of no more than 5 g (OR: 0.79, 95% CI: 0.66-0.93, p = 0.005); however, a protective effect of education level on the occurrence of thyroid cancer was not observed. Independent risk factors affecting daily iodized salt intake greater than 5 g included age, triglycerides, family history of tumors, physical activity, and marital status. CONCLUSIONS: Daily intake of more than 5 g of iodized salt increased the risk of thyroid nodules and thyroid cancer, while increased physical activity and education level reduced the risk of thyroid nodules and thyroid cancer caused by iodized salt intake.

Iodine status five years after the adjustment of universal salt iodization: a cross-sectional study in Fujian Province, China.

BACKGROUND: Universal salt iodization program was introduced to China to eliminate iodine deficiency disorders in 1995. In 2012, Fujian Province decreased the concentration of iodized table salt according to the national unified requirement. This study aimed to assess the effect on iodine status after the adjustment, providing evidence for further adjustment in Fujian Province. METHODS: Sampling units were selected by multistage cluster sampling method. In each sampling unit, table salt was collected from 30 households. A total of 2,471 people in 2009 and 4,806 people in 2017 provided urine samples and were included in this cross-sectional analysis. Median iodized salt concentration and median urine iodine concentration were present by median and interquartile range. RESULTS: Median iodized salt decreased from 29.8 mg/kg in 2009 to 23.9 mg/kg in 2017. The median urinary iodine concentrations for school-age children in 2017 in coastal urban area, non-coastal urban area, coastal rural area and non-coastal rural area were 163.6µg/L (interquartile range = 100.1-252.0µg/L), 198.9µg/L (interquartile range = 128.0-294.0µg/L), 181.8µg/L (interquartile range = 114.1-257.0µg/L) and 218.2µg/L (interquartile range = 148.1-306.5µg/L), respectively. The median urinary iodine concentrations for adults in 2017 in these areas were 151.1µg/L (interquartile range = 98.3-231.7µg/L), 168.7µg/L (interquartile range = 109.6-242.0µg/L), 167.7µg/L (interquartile range = 105.7-245.7µg/L) and 182.7µg/L (interquartile range = 117.1-258.9µg/L). The median urinary iodine concentrations for pregnant women in 2017 in these areas were 157.7µg/L (interquartile range = 106.9-223.8µg/L), 141.5µg/L (interquartile range = 97.7-207.6µg/L), 127.3µg/L (interquartile range = 90.0-184.5µg/L) and 144.8µg/L (interquartile range = 99.9-184.5µg/L). The median urinary iodine concentrations for lactating women in 2017 in these areas were 122.7µg/L (interquartile range = 84.1-172.0µg/L), 123.7µg/L (interquartile range = 70.7-184.7µg/L), 105.8µg/L (interquartile range = 67.1-152.3µg/L) and 110.2µg/L (interquartile range = 74.1-170.3µg/L). CONCLUSIONS: The overall urinary iodine concentrations among school-age children, adults and lactating women dramatically decreased after implementing the new standard. Almost all of them were iodine adequate, suggesting we reached the expected aim of iodized salt adjustment. However, pregnant women were iodine insufficient after adjustment. Therefore, we should continue the surveillance of iodine status of populations and focus on the additional iodine supplement strategies for pregnant women.

Iodine intake among pregnant mothers residing in hilly terrains of two districts of Himachal Pradesh, India.

BACKGROUND: Under programmatic settings, routine monitoring and evaluation of household consumption of iodized salt are recommended to track the reach of universal salt iodization strategy. The program needs evaluation in different settings and locations. OBJECTIVE: The objective of this study was to assess urine-based estimation for recent iodine intake among pregnant women living in hilly terrains of two districts of northern state of India. METHODS: A community-based cross-sectional observational study was conducted during September- December 2019 among 202 randomly selected pregnant women in two districts of Himachal Pradesh. With a predesigned schedule, data regarding sociodemographic and behavioral factors and salt consumption were collected by interview. Iodine level of salt was assessed by spot iodine testing kit and urinary iodine concentration (UIC) was measured using ammonium persulfate digestion using spectrophotometer. RESULTS: Women had a mean age of about 26 years, and the period of gestation was of mean 163.7 days. The consumption of iodized salt (>15 ppm) at family level was found to be 83.7%, and the median UIC was 169.0 µg/L. Among assessed, 26.7% had an acceptable level of UIC, whereas 41.1% and 32.2% of women had less (<150 µg/L) and excessive (>250 µg/L) level of UIC, respectively. CONCLUSION: Recent iodine intake among pregnant women was observed to be adequate, but efforts are to be done to assess the reasons for less and excessive UIC among women.

[Modeling of iodine consumption with industrial processed foods made with iodized salt in the adults and pregnant in Armenia and Moldova].

In recent years, significant progress has been made at the global level in eliminating of iodine deficiency. However, until recently, there has been a gap in methods for estimating iodine intake with industrially processed foods (IPF) produced with iodized salt (IS). The aim of this work was to study the iodine consumption with IPF and kitchen salt by the adult population and pregnant women in Armenia and Moldova. Material and methods. For modeling iodine consumption, a special matrix based on MS Excel spreadsheets was used, into which data on the average per capita daily consumption of the main IPF, salt content in IPF, the share of IPF produced with IS in the total volume of their consumption, percentage of households using IS, and the iodine content in salt according to the national standard were entered. Results and discussion. The estimated average daily salt consumption per capita of the adult population of Armenia was 10.6 g. Due to the use of IS in 93% of households and in the production of 82% of bakery products, 7% of cheese, 83% of meat products, 44% of canned vegetables and 5% of pasta, iodine intake in adults was 149% of the recommended daily allowance (RDA). Bakery products and iodized kitchen salt were the main sources of iodine (66 and 70% of the RDA respectively), and the share of other IPF did not exceed 13%. In Moldova, salt consumption was 11.9 g per day. Due to the use of IS for the production of 50% bakery products, 12% of canned vegetables and 20% of pasta, iodine consumption in adults in Moldova amounted to 74% of RDA almost entirely due to bakery products and kitchen salt (37 and 35% of the RDA respectively). The median urinary iodine concentration indicated adequate iodine intake in both countries and was significantly higher in Armenia (242 µg/L) than in Moldova (136 µg/L). A planned 30% reduction in salt intake may lead to an inadequate reduction in iodine intake in pregnant women. Conclusion. Adequate iodine intake among the adult population of Armenia and Moldova is ensured mainly through the use of IS in households and in the production of bakery products.

Contribution of iodized salt to total iodine and total salt intake in Germany.

BACKGROUND: Salt reduction campaigns without a parallel increase of iodine fortification will lead to a worsened iodine status in countries with a relevant salt iodization. A decline in iodine supply bears the risk of higher prevalences of goiter, thyroid nodules, and cognitive delay in children. Against this background, we analyzed the contribution of iodized salt to total iodine and salt intake in Germany and compared the results with data from Switzerland. METHODS: Analyses were performed with data of the representative German Health-Interview and Examination-Survey for Adults (DEGS1, 2008-2011) using spot urine measurements of creatinine, iodine, and sodium (n = 6738). Median daily iodine and salt intakes were calculated by estimating 24-h iodine and sodium excretions from urinary analyte/creatinine ratios. Linear regressions were used to deduce iodine intake that originates from iodine containing foods (i.e., salt-independent iodine). From this, ingested iodine originating from salt and the proportion of iodized salt to total salt intake were calculated. Data from Switzerland were obtained from the literature. RESULTS: In Germany, only 42% (52.2 µg/d) of the predicted median total iodine intake (126.2 µg/d), i.e., 12% less than in Switzerland, were found to originate from salt, whereas 73.7 µg/d came from iodine containing foods. 28% (2.6 g/d) of the median salt intake (9.3 g/d) of the German population was calculated to represent iodized salt against 43% in Switzerland. CONCLUSIONS: Along with an almost identical inherent iodine intake in Germany and Switzerland, the average total iodine intake, the contribution of iodized salt to total iodine intake, and the proportion of iodized salt to total salt are higher in Switzerland than in Germany. Despite this, iodine fortification of table salt has recently been increased in Switzerland from 20 to 25 mg/kg to ensure iodine sufficiency in the population, whereas in Germany fortification still remains at a mean level of 20 mg/kg implying a growing risk of increasing iodine deficiency rates if general salt intake drops.

Effect of nutrition education on iodine deficiency disorders and iodized salt intake in south west Ethiopian women: a cluster randomized controlled trial.

BACKGROUND: Although iodine nutrition status is improving globally, the progress is not uniform throughout the world due to several factors. Among these, poor knowledge, negative attitude and improper practice of iodized salt are the main risk factors for poor iodine nutrition in Ethiopia. This study was aimed to assess the effect of nutrition education intervention on knowledge, attitude and practice (KAP) of iodine deficiency and iodized salt utilization. METHODS: A cluster randomized controlled trial was carried out among 652 women of reproductive age group in southwest Ethiopia. A total of 24 clusters were selected and randomized in to an intervention and control villages. Women in the intervention village received iodine nutrition related education for 6 months; while those in the control village did not receive any education. Baseline and endline data were collected from both groups. Generalized Estimating Equations (GEE) was used to determine the effect of intervention. RESULTS: A total of 647 (99.2%) participants were successfully involved in the study. In the intervention group the median attendance was 10 out of 12 sessions. Women in the intervention group had shown statistically significant change in knowledge, attitude and practice scores as compared to control one. In multivariable GEE linear model, after adjusting for other background characteristics, the mean difference (95% CI) scores were 8.81 (8.46, 9.16) for knowledge, 3.35 (3.17, 3.54) for attitude and 2.90 (2.74, 3.05) for practice in the intervention arm. CONCLUSIONS: Well designed and community-based iodine nutrition education is an effective strategy to improve the KAP of iodine deficiency disorders and iodized salt utilization. Trial registration PACTR201809544276357 (Retrospectively registered on 14, Sept. 2018). https://www.pactr.org .

Non-iodized salt consumption among women of reproductive age in sub-Saharan Africa: a population-based study.

OBJECTIVE: To identify countries in sub-Saharan Africa (SSA) that have not yet achieved at least 90 % universal salt iodization and factors associated with the consumption of non-iodized salt among women of reproductive age. DESIGN: A cross-sectional study using data from Demographic and Health Surveys (DHS). The presence of iodine in household salt (iodized or non-iodized), which was tested during the survey process, was the study outcome. Multivariable logistic regression models were used to determine independent factors associated with the consumption of non-iodized salt among women of reproductive age. SETTING: There were eleven countries in SSA that participated in the DHS since 2015 and measured the presence of iodine in household salt. PARTICIPANTS: Women (n 108 318) aged 15-49 years. RESULTS: Countries with the highest rate of non-iodized salt were Senegal (29·5 %) followed by Tanzania (21·3 %), Ethiopia (14·0 %), Malawi (11·6 %) and Angola (10·8 %). The rate of non-iodized salt was less than 1 % in Rwanda (0·3 %), Uganda (0·5 %) and Burundi (0·8 %). Stepwise multivariable logistic regression showed that women were more likely to be using non-iodized salt (adjusted OR; 95 % CI) if they were poor (1·62; 1·48, 1·78), pregnant (1·16; 1·04, 1·29), aged 15-24 years (v. older: 1·14; 1·04, 1·24) and were not literate (1·14; 1·06, 1·23). CONCLUSIONS: The use of non-iodized salt varies among SSA countries. The higher level of use of non-iodized salt among poor, young women and pregnant women is particularly concerning.

Spatial distribution and determinants of household iodized salt utilization in Ethiopia: a spatial and multilevel analysis of Ethiopian demographic and Health survey.

BACKGROUND: Iodine deficiency disorder is a significant public health problem, affecting both developed and developing nations worldwide. It is associated with poor body growth and irreversible mental retardation. However, little is known about the spatial distribution and determinants of household iodized salt utilization in Ethiopia. Therefore, this study aimed to explore the spatial distribution and determinants of iodized salt utilization at national level. METHODS: Ethiopian Demographic and Health Survey 2016 data was used to investigate the spatial distribution and determinants of household iodized salt utilization in Ethiopia. ArcGIS 10.6 and SaTScan™ version 9.6 software were used to explore the spatial distribution and detect significant clusters, respectively. The odds ratio with its 95% confidence interval (CI) was determined for potential determinants included in the multivariable multilevel logistic regression model. RESULTS: Household iodized salt utilization was spatially clustered in Ethiopia (Moran's Index = 0.076, p-value = 0.01). The significant hotspot areas with high iodized salt utilization were located in Benishangul, Amhara, Gambella, Tigray and Northwest Oromia regions. Significant cold spot areas (areas with low iodized salt utilization) were found in Somali, and East Afar regions. Those households with higher education level ((Adjusted Odds Ratio [AOR] =1.49, 95% CI =1.14-1.93), high community level education (AOR = 1.51, 95% CI = 1.03-2.20), middle wealth index (AOR = 1.31, 95% CI = 1.04-1.65) and high community media exposure (AOR = 1.52, 95% CI = 1.07-2.17) had higher odds of iodized salt utilization. CONCLUSIONS: Household iodized salt utilization had significant spatial variation across the country. Both household and community level variables were found to be associated with household iodized salt utilization in Ethiopia. Therefore, increasing the education level, wealth status and community media exposure is recommended to improve iodized salt utilization in a country. A targeted intervention is also needed for those regions with low household iodized salt utilization.

Artificial Neural Network for Predicting Iodine Deficiency in the First Trimester of Pregnancy in Healthy Women.

Iodine deficiency in Spain is a persisting public health problem and the prescription of potassium iodide is recommended during pregnancy. The purpose of this study was to develop an Artificial Neural Network (ANN) to predict the risk factors of iodine deficiency during pregnancy, and compare the results obtained with a logistic regression model. Two hundred forty-four healthy pregnant women were included in a descriptive and prospective study in their first trimester of pregnancy. The women enrolled were asked specifically about their use of supplements containing potassium iodide, iron, folic acid and/or multivitamins during pregnancy. The consumption of iodine-rich foods was assessed through a food frequency questionnaire. A median UIC of 57.4 µg/L (IQR 32.8-99.3) was obtained, with 89.3% < 150 µg/L, the minimum recommended ioduria level by the WHO. There was no correlation between urinary iodine concentrations and maternal age, BMI or gestation week at recruitment. The urinary iodine concentrations were significantly higher in women who reported taking iodized supplements and/or iodized salt than those who did not. Number of gestations, age, body mass index, and intake of iodized supplements and iodized salt were the most important predictors of iodine deficiency. Based on Receiver Operating Characteristic analysis, the diagnostic performance of the ANN model was superior to the logistic regression model. The ANN model, with variables on pregnancy and the intake of iodine rich foods, iodized supplement and iodized salt may be useful for predicting iodine deficiency in the early pregnancy.

Stopping the supply of iodized salt alone is not enough to make iodine nutrition suitable for children in higher water iodine areas: A cross-sectional study in northern China.

BACKGROUND: For the sake of children's health, iodized salt supply has been stopped in many areas with excessive iodine in the drinking water, but children's iodine nutrition status and thyroid function after terminating the iodized salt supply is unknown. Objective We assessed the iodine nutrition, thyroid function and influencing factors for thyroid abnormalities in children from areas with different concentrations of water iodine; the supply of iodized salt has been stopped in high water iodine areas. This study aimed to evaluate whether the strategy of stopping the supplies of iodized salt alone is enough to avoid thyroid dysfunction in all areas with excess water iodine while still meeting the iodine nutrition needs of children. METHODS: A cross-sectional study was conducted in children from four areas with different drinking water iodine concentrations in Tianjin, China. The drinking water samplings and spot urine samples were collected to estimate the external and internal iodine exposure levels. The thyroid volume was measured, and blood samples were collected to assess thyroid function. Logistic regression analysis was used to analyze risk factors for thyroid abnormalities. A dietary survey was conducted to determine the sources of iodine nutrition among the areas with different iodine concentrations in the drinking water. RESULTS: In the area with a drinking water iodine concentration ≥300 µg/L, the median urinary iodine concentration (UIC) in children was 476.30 (332.20-639.30) µg/L, which was higher than that in other groups (all P < 0.05), and the prevalence of thyroid nodules and the thyroid goiter rate were higher than those in the <100 µg/L, 100-150 µg/L and 150-300 µg/L areas (all P < 0.01). Binary logistic regression analysis indicated that the risk of thyroid abnormalities was significantly increased in the UIC 200-299 µg/L group (OR: 4.534; 95% CI: 1.565, 13.135; bootstrapped 95% CI: 1.689, 21.206, P = 0.004) and in the UIC ≥ 300 µg/L group (OR: 6.962; 95% CI: 2.490, 19.460; bootstrapped 95% CI: 2.838, 32.570, P = 0.001) compared to the 100-199 µg/L group. The iodine contribution rates from water in areas with water iodine concentrations ≥300 µg/L are up to 63.04%. CONCLUSIONS: After termination of the iodized salt supply, the level of iodine nutrition of children in the area with drinking water iodine concentrations ≥300 µg/L is still excessive. The water source needs to be replaced in this area. In the area with a water iodine concentration of 150-300 µg/L, it is proposed that stopping the supply of iodized salt is sufficient to achieve the proper iodine nutrition status in children.