The impact of replacing milk with plant-based alternatives on iodine intake: a dietary modelling study.

Abstract

Cow's milk is the primary source of iodine in the UK, but consumption of plant-based milk alternatives (PBMA) is increasing and these products are often not fortified with iodine. We evaluated the impact that replacing current milk consumption with PBMA would have on iodine intake. We used data from the National Diet and Nutrition Survey (2016-2019) for children (1.5-10years), girls 11-18years, and women of reproductive age (WRA). We used a dietary modelling approach with scenarios using brand-leveliodine-fortification data (0, 13, 22.5, 27.4 and 45µg/100mL). Relative to usual diet, we calculated change in iodine intake, and the proportion with intake below the Lower Reference Nutrient Intake (LRNI) or above the upper limit. For all groups, replacement with PBMA, either unfortified or fortified at the lowest concentration, resulted in a meaningful decrease in iodine intake, and increased the proportion with intake < LRNI; compared to usual diet, iodine intake reduced by 58% in children 1.5-3years (127 vs. 53µg/day) and the proportion with intake < LRNI increased in girls (11-18years;20% to 48%) and WRA (13% to 33%) if anunfortified PBMA was used. Replacement of milk with PBMA fortified at 27.4µg/100mL had the lowest impact. Replacing milk with commercially available PBMAs has potential to reduce population iodine intake, depending on the fortification level. PBMAs fortified with ≥ 22.5 and < 45µg iodine/100mL would be required to minimize the impact on iodine intake. Research is needed on the impact of total dairy replacement.