Abstract
Evidence from the 1950s showed that Macedonia was iodine deficient. After the introduction of mandatory universal salt iodisation, the country saw a steady increase in iodine intake and decline in goitre prevalence, earning iodine-deficiency free status in 2003. Iodine status assessments in 2007 and 2016 showed adequate iodine intake among school age children (median urinary iodine concentration of 241 μg/L and 236 μg/L respectively). Macedonia participated in piloting the Iodine Global Network Programme Guidance on the use of iodised salt in industrially processed foods to better understand potential iodised salt intake from processed foods. One objective of implementation was to identify the need, opportunities, and required actions to strengthen the processed food component of the national salt iodisation policy. Data from the 2017 Household Consumption and Expenditure Survey (HCES) was used to determine household salt consumption, to identify widely-consumed, salt-containing industrially processed foods, and estimate typical daily intake of these foods. Their estimated contribution to iodine intake was estimated based on their salt content and the percentage of food industry salt that is iodised. Although the study has limitations, including a relatively small selection of foods, the results indicate potential iodine intake from iodised household salt and iodised salt in the selected foods of nearly 300% of the Estimated Average Requirement and over 220% of the Recommended Nutrient Intake for adults. This was approximately 50% of the tolerable safe Upper Level for iodine intake. The study confirmed high daily salt intake (11.2 grams from household salt only). Successful salt reduction would be expected to reduce iodine intake, however, modelling with 10% and 30% reduction implied this is unlikely to put any population group at risk of deficiency. It is recommended that implementation of salt iodisation and salt reduction policies are harmonized, alongside continued regular iodine status monitoring for different population groups.
Highlights
There is evidence that Macedonia, a land-locked country in Southern Europe, was historically iodine deficient, with goitre prevalence of up to 30% in some regions [1, 2]
We looked at the availability of national standard for salt content in each of these products, and further eliminated products for which: 1) there was no national standard; and/or 2) the wide variety of types classified under that product made it difficult to estimate the salt content
Even though the assessment presented in this paper provides only an indication of the estimated total salt and iodine intake through household salt and some processed food products, it can be concluded that the general population has sufficient access to iodine as a result of a well-implemented universal salt iodisation policy
Summary
There is evidence that Macedonia, a land-locked country in Southern Europe, was historically iodine deficient, with goitre prevalence of up to 30% in some regions [1, 2]. Decline in goitre prevalence was recorded in 1980s [5], the first nationwide iodine status assessment was conducted post-independence in 1996. This survey showed median urinary iodine concentration (MUIC) of 117 μg/L among 2,380 schoolchildren and goitre prevalence of 18.7% among the 11,486 schoolchildren tested [3]. To sustain adequate iodine intake among children and further reduce the goitre prevalence, the Macedonian government established a multisectoral Committee on Iodine Deficiency in 1997 and enacted a new national policy on mandatory iodisation of all food grade salt in 1999, with 20–30 mg of iodine per kg salt, using potassium iodate which is more stable than the iodide form. The 2016 iodine status re-evaluation confirmed proper implementation of the salt iodisation program, suggesting optimal iodine intake among schoolchildren (MUIC of 236 μg/L) [5]
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