Household Salt Research Articles

Household Salt Storage and Seasoning Consumption Are Predictors of Insufficient Iodine Status Among Pregnant Women in Southeastern Brazil.

Iodine deficiency in pregnancy may lead to adverse maternal and fetal outcomes, including impaired child development. Sociodemographic factors and different dietary habits may be related to iodine status in pregnant women. The aim of this study was to evaluate the iodine status and its predictors among pregnant women in a city of Southeastern Brazil. This cross-sectional study was conducted with 266 pregnant women receiving prenatal care in 8 primary health care units. Sociodemographic, obstetric and health, habits of acquisition, storage and consumption of iodized salt, and dietary iodine intake data were collected through a questionnaire. The iodine content was evaluated in urinary iodine concentration (UIC), household salt and seasonings, and drinking water samples. Pregnant women were categorized into three groups according to the UIC, determined by iodine coupled plasma-mass spectrometry (ICP-MS): insufficient (< 150μg/L), adequate (150-249μg/L), and more than adequate iodine nutrition (≥ 250μg/L). The median (p25-p75) UIC was 180.2μg/L (112.8-262.7). It was found 38% and 27.8% of insufficient and more than adequate iodine nutrition, respectively. Number of gestations, KI content of supplement, alcohol consumption, salt storage, and frequency of using industrialized seasoning were associated to iodine status. Alcohol consumption (OR = 6.59; 95%CI 1.24-34.87), pack the salt in opened container (OR = 0.22; 95%CI 0.08-0.57), and use industrialized seasoning weekly (OR = 3.68; 95% CI 1.12-12.11) were predictors of iodine insufficiency. The pregnant women evaluated have adequate iodine nutrition. Household salt storage and seasoning consumption were risk factors for insufficient iodine status.

Excessive iodine status among school‐aged children in the State of Qatar: Results of the National Iodine Deficiency Disorder Survey

AbstractBackgroundIodine deficiency poses a significant public health challenge worldwide, particularly in preschool children and pregnant women. Assessing the iodine intake at a population level is essential, as both deficient and excessive iodine status can have adverse health consequences. The main objective of this survey is to understand the iodine deficiency status in schoolchildren aged 6–12 years in the State of Qatar.MethodsA cross‐sectional survey was conducted from March to June 2014 among school‐aged children using a two‐stage cluster sampling technique. Anthropometric, biochemical, clinical, and dietary parameters for seafood were collected. Spot urine samples were collected from 967 participants, and a repeat random subsample urine was collected from 288 participants. Overall median urinary iodine concentration (UIC) was calculated. Iodine content in household salt samples was estimated by qualitative and quantitative methods. Mann–Whitney U test was used for comparison.ResultsThe median UIC was 333.2 μg/L (IQR = 228.6). UIC prevalence rates between 300–999 and &gt;1000 μg/L were 56.7% and 2.8%, respectively. The goiter prevalence was 0.4%. A significant difference was noted in overall median UIC levels between boys and girls (p = 0.003). Adequate iodized salt consumption was reported by 74.9% of households, and weekly seafood consumption was reported by one third of the respondents.ConclusionThe results indicate an excess intake of iodine among the studied population in the State of Qatar, and national efforts are needed to bring iodine intake and concentration levels within the cutoff value for the concerned survey population's age group. In addition, a surveillance system needs to be set up for continuous monitoring of iodine content and salt intake at the population level in the State of Qatar.

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.

Sustained Elimination of Iodine Deficiency Within the Third Decade After Compulsory Iodine Supplementation Policy in the South of Iran: A Population-Based Cross-Sectional Study

ObjectivesRecently, some studies in Iran have shown mild to moderate iodine concentrations in adult and pregnant women populations despite iodine sufficiency in children. This study aimed to evaluate the urine iodine status and salt intake among adult households in the city of Sadra, Fars province in southern Iran, and to assess its possible influencing factors. MethodParticipant households for this cross-sectional study were selected using randomized cluster sampling in the city of Sadra, Fars province, southern Iran from 1 February, 2021 to 30 November, 2021. Two subjects >18 y of age from each household were invited. Ninety-two subjects (24 men, 68 women) were enrolled. The participants were asked to collect their 24 h urine. They were then examined for thyroid disorders and subjected to thyroid ultrasonography and thyroid function tests. Urine samples were tested for iodine, sodium, and creatinine concentrations. Household salt intake was also estimated. ResultsMedian urine iodine content (UIC) in the participants was 175 (IQR: 117, 250) μg/L, whereas the median salt consumption per person per day was 9.6 (IQR, 7.3-14.5) g. Sex, methods of salt storage, presence of goiter or thyroid nodules, the addition of salt in the cooking stage, and subclinical hypothyroidism had no effect on UIC, whereas individuals with hypertension and lower education had significantly lower iodine concentrations. UIC had a significant positive correlation with urine sodium and thyroid stimulating hormones (TSH) concentrations (P < 0.001, 0.046) and a negative correlation with thyroid volume and T4 (P = 0.029, 0.018). ConclusionIodine status in the adult population of Sadra city was categorized as sufficient, although the iodine concentrations reported in Tehran were insufficient. The contributing factor can be higher salt consumption or possible higher environmental iodine concentrations in Sadra city than Tehran.

Assessment of iodine deficiency disorders among pregnant women residing in an urban slum of west Delhi

Iodine deficiency disorders (IDDs) constitute a significant public health problem globally, particularly among pregnant women. This study aimed to assess the prevalence of IDDs among pregnant women during third trimester of pregnancy residing in an urban slum of west Delhi. This was a community based cross sectional observational study conducted on 178 pregnant women from October 2014 to July 2016. Socio demographic information was collected through questionnaire cum interview method. The presence of iodine deficiency disorders was observed through urinary iodine concentration (UIC), thyroid profile, presence of goiter and level of iodization of household salt samples and analyzed respectively using Spectrophotometer, IMMULITE 1000 analyzer, palpation method and standard iodometric titration method. A total of 59.9% pregnant women had insufficient iodine nutrition with the median UIC 132.5 μg/L and interquartile range (IQR) of 145 μg/L. Grade 1 goitre was detected in 2 participants (1.15%) through palpation method. Inadequate iodine content (<15 ppm) was found in 19.8% household salt samples. Results reported the prevalence of hypothyroidism among 27.9% pregnant women. The mean ± SD values of TSH, T4 and T3 were 2.51 ± 1.19 mIU/L, 11.6 ± 2.38 μg/dl and 170.7 ± 41.5 ng/dl respectively. High prevalence of iodine deficiency reflecting low iodine intake along with prevalence of hypothyroidism was recognized among pregnant women residing in slum area of Delhi.

Iodine status, household salt iodine content, knowledge and practice assessment among pregnant women in Butajira, South Central Ethiopia.

Iodine is one of the crucial micronutrients needed by the human body, and is vitally important during pregnancy. This study aimed to determine the relationship between the iodine status of pregnant women and their knowledge, and practices regarding iodized salt. All participants were enrolled in the Butajira nutrition, mental health and pregnancy (BUNMAP) cohort, Butajira, Ethiopia in February-May, 2019. In this cross-sectional study, 152 pregnant women without hypertension or known thyroid disease before or during pregnancy were randomly selected from the BUNMAP mother to child cohort (n = 832). Spot urine samples were collected to estimate the level of urinary iodine concentration (UIC). Salt samples were also collected from their homes. The Sandall-Kolthoff (S-K) method was used to measure the level of iodine in the urine samples, and iodometric titration was used to measure the level of iodine in the salt. Data was entered and cleaned using Epi-info version 3.5.3 and then exported to SPSS version 20 for further analysis. Multivariate logistic regression analysis was performed to identify associations in the collected data. The WHO recommended level of iodine for populations of pregnant women is 150-249 F06Dg/L. The median UIC among pregnant women in this study was 151.2 μg/L [interquartile range (IQR) = 85.5-236.2 F06Dg/L], at the low end of this range. About half (49.65%) of the participants were likely to be iodine deficient. There was a significant association between having a formal job (AOR = 2.56; CI = 1.11-5.96) and iodine sufficiency. Based on a cutoff of >15 ppm (mg/kg), 91.7% (95% CI: 87.2-96.2) of the salts collected from the household had adequate iodine content. The median iodine level of the collected salt samples was 34.9 mg/kg (ppm) (IQR = 24.2-44.6 mg/kg). The UNICEF 2018 guidelines for adequate iodine nutrition in pregnant women include both a recommended median range of 150-249 μg/L, and an upper limit of 20% on the fraction of the population with UIC below 50 μg/L. Because our study population's median level is 151.2 μg/L and the percentage of pregnant women with urinary iodine concentration of less than 50 μg/L is 9.7% (14/145), the women received adequate iodine nutrition. The availability of adequately iodized salt in households is more than 90%, as recommended by WHO. In light of previous iodine deficiency in this region of Ethiopia, the salt iodization program promotes the health of babies and mothers.

Household salt production by the Late Classic Maya: underwater excavations at Ta'ab Nuk Na

Salt is an essential commodity; archaeological remains around the world attest to the importance of its production, exchange and consumption. Often located in coastal locations, many production sites were submerged by rising seas, including the Paynes Creek Salt Works on the southern Belize coast. Survey and excavation of these sites has identified ‘kitchens’ for brine boiling, as well as Terminal Classic residential structures at Ek Way Nal. The authors report the discovery of an earlier residential building alongside salt kitchens at the nearby site of Ta'ab Nuk Na. This finding indicates that surplus household production began during the Late Classic, when demand for salt from inland cities was at its peak.

Universal salt iodization potentially contributes to health equity: socio-economic status of children does not affect iodine status.

Many studies have shown that socio-economic status (SES) contributes to health inequalities, with nutrition as one of the major risk factors. Iodine intake entirely depends on external sources, and deficiencies are known to be more prevalent in lower social groups, especially in countries with limited access to iodized salt. This study aimed to determine the influence of SES on iodine status and iodine availability from household salt in North Macedonia. Using cluster sampling, 1,200 children were recruited, and 1,191 children participated (response rate: 99.2%). Iodine status was assessed through urinary iodine concentration (UIC), and iodine availability through iodine content in household salt requested from participants. SES was assessed using standardized Family Affluence Score (FAS). No statistically significant correlation was found between FAS and iodine in salt. Median regression revealed no significant associations of middle vs. low FAS (β=0.00; 95%-confidence interval (CI)=[-0.61, 0.62]; p=0.999) or high vs. low affluence (β=0.48; 95% CI=[-1.37, 0.41]; p=0.291) with iodine content in household salt. UIC levels were significantly lower in middle FAS children compared to low FAS children (β=-16.4; 95% CI=[-32.3,-0.5]; p=0.043). No statistically significant differences in UIC were found between children with high and low affluence (β=-12.5; 95% CI=[-35.5, 10.5]; p=0.287), possibly due to lowered statistical power for this comparison. Universal salt iodization (USI) proves to be a cost-effective measure for appropriate iodine intake in healthy children and adults, irrespective of their social status. It can thus be concluded that USI contributes to reducing health inequalities related to iodine status among population of different social strata.

The relationship between different iodine sources and nutrition in pregnant women and adults.

BackgroundDifferent iodine supplement measures emerge along with the economy development in China. The article objectives are to compare and explore the relationship between iodine sources and nutrition of pregnant women and adults.MethodsA total of 2,145 pregnant women and 1,660 adults were investigated by multi-stage random method. Questionnaire was used to collect basic information and the consumption of food, water, and iodine preparations. Household salt and individual urine and blood samples were collected, and thyroid function and morphology of pregnant women were measured.ResultsThe median urinary iodine concentration (MUIC) of pregnant women (164.49 μg/L) was lower than adults (187.30 μg/L, p < 0.05). Iodine supplement with IS (iodized salt) was the main measure for pregnant women and adults, and the difference was mainly on the consumption of iodine preparations between pregnant women (5.19%) and adults (0.85%). Moreover, adults’ dietary iodine intake from food (100.6 μg/day), IS (140.8 μg/day), and drinking water (6.0 μg/day) was higher than those of pregnant women (86.5, 107.2, and 3.5 μg/day, respectively). Compared with iodine supplement with IS, ISFP (IS + iodine-rich food + iodine preparations) could reduce the risk of iodine deficiency for pregnant women. The MUICs for pregnant women and adults of iodine supplements with IF (iodine-rich food) and ISF (IS + iodine-rich food) were lower. For pregnant women, thyroid nodule (11.90%) and peroxidase antibody (TPOAb) positive (9.32%) were high prevalent thyroid diseases, and habitation (urban/rural), gestation, annual income, and drinking water type would affect them.ConclusionPregnant women and adults had adequate iodine nutrition in four provinces. Their iodine supplement measures were different, the consumption of iodine preparations in pregnant women was higher, and their dietary iodine intake was lower than adults. ISFP was an effect measure for pregnant women to supplement iodine.

Factors Associated with Goiter Incidence in Farmers in Kismantoro Sub-District, Wonogiri Regency

Background: Kismantoro Sub-district has been an endemic area of ​​severe goiter since 1982, with a total goiter rate of 35.5% until 2007, when was declared a mild endemic goiter area (TGR 10.79%). Monitoring in 2017 on salt circulating in Wonogiri exposed that there were still 26.01% of brands that did not meet the Indonesian national standard. Objective: This study aimed to analyze the factors associated with goiter incidence in Kismantoro Sub-district, Wonogiri Regency. Methods: This research applied analytic observational with a case-control design. The samples were 41 respondents in the case group and 41 respondents in the control group, taken by purposive sampling. The history of goiter was obtained from the medical records of Kismantoro Community Health Center. The data analysis method employed was logistic regression analysis. Results: The results showed a significant correlation between age (p 0.005, OR 5.88, 95%CI 1.53-22.62), gender (p 0.003, OR 0.15, 95%CI 0.04-0.58), and salt iodine content (p 0.007, OR 0.14, 95%CI 0.03-0.68) with the goiter incidence in farmers in Kismantoro. Moreover, the multiple logistic regression test results revealed that age was the most dominant variable influencing the goiter incidence (p 0.006, OR 8.103, 95%CI (1.799-36.499). Conclusion: There was a relationship between age and the goiter incidence, gender with the goiter incidence, and iodine content in household salt with the goiter incidence, the multiple logistic regression test results indicated that the age variable most influenced goiter incidence among farmers in Kismantoro Sub-District, Wonogiri Regency.

Comparison of Methods for Estimating Discretionary Salt Intake in Field Settings

ObjectivesAccurate and precise estimates of discretionary salt (DS) intake are critical for designing salt fortification interventions and counseling on salt intake reduction. This study compared four methods of estimating DS intake among non-pregnant women of reproductive age (NPWRA) in northern India to inform the design of a trial of multiply-fortified salt. MethodsParticipants were NPWRA (18–49 y) in Punjab, India. Weighed food records (WFR), same-day duplicate diet (DD) composites, and samples of household (HH) salt were collected simultaneously from 100 women and repeated on a subset of 40. Sodium (Na) and iodine contents of the DD composites were analyzed using Inductively Coupled Plasma (ICP)-Optical Emission Spectrometry and ICP-Mass Spectrometry. HH salt samples were also analyzed for iodine. Methods for estimating DS intake included: 1) WFR: DS consumed from recipes or added at time of consumption were weighed; 2) HH salt disappearance (HHSD): total DS used by HH on the observation day divided by number of HH members; 3) Sodium estimation (NaE): Na content of 40 replicate DD composites prepared without DS were subtracted from the Na content of the corresponding original DD and difference multiplied by the molar mass of NaCl; 4) Iodine method (IM): analyzed iodine content of milk and milk products and commercial snacks were subtracted from DD iodine content, and difference divided by the iodine content of the HH’s salt sample. The relations between methods were explored using Pearson correlation and Bland Altman analyses. ResultsMean ± SD intake of DS according to the WFR, HHSD, and NaE methods were 4.7 ± 1.8 g/d, 5.8 ± 3.3 g/d, and 4.1 ± 2.1 g/d, respectively. Results of IM are pending. Pearson correlation coefficients for DS intake estimates obtained from WFR vs. NaE and WFR vs. HHSD were 0.82 (p < 0.001) and 0.48 (p < 0.001), respectively. Mean ± SD bias (limits of agreement) were 0.68 ± 1.25 g/d (–1.77, 3.13) for WFR vs. NaE, and 1.8 ± 2.93 g/d (–4.56, 6.92) for HHSD vs. WFR methods. ConclusionsDiscretionary salt intake from WFR and NaE showed good agreement and are feasible to implement in field settings. Funding SourcesBill & Melinda Gates Foundation.

Estimated Consumption of Discretionary Salt and Salt From Bouillon Among Households, Women, and Children in the Northern Region of Ghana: CoMIT Project

ObjectivesTo 1) estimate discretionary salt (‘table salt’) consumption and the proportion of salt from bouillon, among households, women and children; 2) compare estimated salt consumption of women and children to recommendations; and 3) identify factors related to household salt consumption in 2 districts in the Northern Region, Ghana. MethodsWe enrolled households in the Condiment Micronutrient Innovation Trial (CoMIT) Project pilot survey from 14 urban and 14 rural clusters in the Tolon and Kumbungu districts. Using the Fortification Assessment Coverage Toolkit (FACT), households (n = 369) reported most recent purchases of discretionary salt (DS) and bouillon cubes (SB, ‘salt from bouillon’; bouillon assumed to be 55% salt). From the purchase data, we calculated median (IQR) household salt consumption (g/d) by summing DS and SB, and calculated the proportion from SB. Salt consumption for women of reproductive age (15–49 yrs, WRA) and children 2–5 yrs was estimated by the Adult Male Equivalent method and compared to recommendations from the World Health Organization (WRA < 5 g/d) and the National Academy of Sciences (children 2–5 yrs < 3.75 g/d). We used Spearman’s rank test to assess partial correlations between household salt consumption and household size, food insecurity (USAID Household Food Insecurity Access Scale score), socioeconomic status (SES, index score of home asset ownership), and household head education level while controlling for district, setting (urban/rural), and cluster. ResultsMedian (IQR) household salt consumption was 56.2 (40.3,116.2) g/d, 23% of which was contributed by SB. Median household size was 10 (8, 14) members. Estimated salt consumption was 6.0 (4.0, 10.2) g/d for WRA and 2.9 (1.9, 5.2) g/d for children; an estimated 50% of WRA and 31% of children potentially exceeded recommendations. Household size and food insecurity, but not education level or SES, were positively correlated with household salt consumption (r = 0.3, p < 0.001; r = 0.2, p < 0.001). ConclusionsHousehold salt and bouillon purchase data suggest that salt consumption among women and children in this area exceeds recommendations; food prepared outside the home may further contribute to salt consumption. Salt reduction interventions may be warranted in this context. Funding SourcesHelen Keller International through support from the Bill & Melinda Gates Foundation.

Community Access to Adequately Iodized Salt in Rural Amhara, Ethiopia

ObjectivesTo assess community access to adequately iodized salt in rural Amhara, Ethiopia. MethodsWe collected market and household salt samples from December 2020-January 2021 in West Gojam and South Gondar, Amhara, Ethiopia. A total of 24 salt samples were collected from markets randomly chosen in proximity to six rural health centers prior to the Enhancing Nutrition and Antenatal infection Treatment (ENAT study). 12 salt samples were unpackaged salt sold in open markets and 12 samples were packed samples procured from local shops. Household salt samples were also collected among mothers consecutively enrolled in the ENAT study over a one-month period at baseline. Quantitative assessment of iodine content was performed by iodometric titration at a central referral laboratory. In addition, a rapid qualitative salt assessment (MBI rapid test, Chennai, India) was done for 238 randomly selected households in walking proximity to the study health centers. The MBI test used rapid qualitative colorimetric methods, to test for adequacy of iodization (no color change: 0 ppm, light purple: <15 ppm, dark purple >15 ppm). ResultsThe median iodine titration level for local market salt was 37.1 ppm (range: 14.3–116.4). Fifteen (62.5%) samples were at recommended levels (15–40 ppm), 8(33.3%) were >40 ppm and one sample <15 ppm. The median iodine titration test for household samples was 42.7 ppm (range: 10.1–89.8); with 19 (33.3%) samples at the recommended levels, 33(57.9%) >40 ppm, and 5(8.8%) of samples <15 ppm. On the other hand, among the community based, household-level samples (n = 238) tested by MBI rapid kits, 8(3.4%) had no iodization, 116 (48.7%) were inadequately iodized (<15 ppm), and 114(47.9%) were >15 ppm. ConclusionsThere is heterogeneity in the level of iodization in salts available in the markets in Amhara, with the majority of samples were iodized >15 ppm; though almost 40% were above WHO recommended levels. At the household level, iodine content in nearly half of community-based samples were inadequate. Standardization of quality of market salt and optimal storage of iodized salt to prevent degradation at the household level are needed. Funding SourcesBill & Melinda Gates Foundation.

Excessive iodine in iodized household salt in Nepal.

Iodine is an essential trace element required for the regulation of physiological processes involving the thyroid gland. However, inadequate and excessive intake of iodine are responsible for health problems, such as iodine deficiency disorders, hypothyroidism, hyperthyroidism, thyroiditis, thyroid papillary cancer, and thyrotoxicosis. The Universal Salt Iodization (USI) program has become successful in providing supplemental iodine at the population level globally. Packaging quality, fortification level, and transportation and storage conditions of iodized salt determine the availability of iodine. Previous studies have reported severe health issues caused by excessive iodine intake after the implementation of the USI program. To understand the levels of iodine, we collected 2117 household salt samples from seven districts of Nepal and tested them for iodine content; among them, 98.1% were iodized. Overall median concentration of iodine was 53.9ppm (range: 43.5-61.4ppm). The majority (67.2%) of samples had iodine in the range of 45-75ppm. Approximately 0.9% of samples had inadequate, 13.3% contained adequate, and 83.9% had excessive iodine than the World Health Organization-recommended value. Iodine content varied among the sampling districts and seasons, to some extent. Our study confirmed that iodized salt is widely used in Nepal and is excessively iodized. Excessive intake of iodine through iodized salt requires further attention by policy makers. The iodine level may need adjustment to address the health impact.

Assessment of iodine fortification of salt in the Danish population.

We assessed the effect of the current iodine fortification level (20µg/g household salt and salt included in bread and bakery products) on inadequate and excessive intake in the general Danish population. Intake models with/without the contribution from food supplements and effects of excluding specific food groups were evaluated. Data from the Danish National Survey of Dietary Habits and Physical Activity in 2011-13 (N = 3946, aged 4-75years) stratified by age-group and sex were used to estimate habitual dietary iodine intakes, and compared with established dietary reference values. The proportion with an estimated inadequate iodine intake was ≤ 3% for males and ≤ 5% for females, except for 15-17-year-old girls, where the probable prevalence of an inadequate intake was 11%. Including the contribution from food supplements gave similar results (10%). High intakes (as defined by 95th percentile) from food sources generally did not exceed the tolerable upper intake level (UL). However, for the youngest age-groups (4-6-year-old boys/girls and 7-10-year-old boys), the 95th percentiles exceeded the UL with 11%, 4% and 7%, respectively, when food supplements were included in the estimates. Especially exclusion of dairy products and bread led to an inadequate intake for both boys and girls. The current fortification level may provide an inadequate iodine intake for some females and on the other hand lead to excessive intakes in the youngest age-groups. The study shows the importance of choosing iodine-rich alternatives when excluding major sources of iodine in the Danish diet.

Cost-Effectiveness of a Household Salt Substitution Intervention: Findings From 20 995 Participants of the Salt Substitute and Stroke Study.

SSaSS (Salt Substitute and Stroke Study), a 5-year cluster randomized controlled trial, demonstrated that replacing regular salt with a reduced-sodium, added-potassium salt substitute reduced the risks of stroke, major adverse cardiovascular events, and premature death among individuals with previous stroke or uncontrolled high blood pressure living in rural China. This study assessed the cost-effectiveness profile of the intervention. A within-trial economic evaluation of SSaSS was conducted from the perspective of the health care system and consumers. The primary health outcome assessed was stroke. We also quantified the effect on quality-adjusted life-years (QALYs). Health care costs were identified from participant health insurance records and the literature. All costs (in Chinese yuan [¥]) and QALYs were discounted at 5% per annum. Incremental costs, stroke events averted, and QALYs gained were estimated using bivariate multilevel models. Mean follow-up of the 20 995 participants was 4.7 years. Over this period, replacing regular salt with salt substitute reduced the risk of stroke by 14% (rate ratio, 0.86 [95% CI, 0.77-0.96]; P=0.006), and the salt substitute group had on average 0.054 more QALYs per person. The average costs (¥1538 for the intervention group and ¥1649 for the control group) were lower in the salt substitute group (¥110 less). The intervention was dominant (better outcomes at lower cost) for prevention of stroke as well as for QALYs gained. Sensitivity analyses showed that these conclusions were robust, except when the price of salt substitute was increased to the median and highest market prices identified in China. The salt substitute intervention had a 95.0% probability of being cost-saving and a >99.9% probability of being cost-effective. Replacing regular salt with salt substitute was a cost-saving intervention for the prevention of stroke and improvement of quality of life among SSaSS participants.

Probabilistic Health Risk Assessment of Iodine Exposure in Bangladesh.

In this study, the concentrations of iodine in household salt samples (n = 690) were determined by following the iodometric titration method, and the health risks of Bangladeshi people were assessed based on the semi-probabilistic approach and the US Environmental Protection Agency (USEPA) deterministic model. After adjusting 20% of cooking losses, the iodine concentration (mean, range) in salt samples of Phultala, Dighalia, Terokhada, Rupsha, Batiaghata, Dumuria, Paikgacha, Koyra, Dacope, and KCC was (29.68 ± 8.67, 14.39-48.26), (31.05 ± 6.68, 15.24-43.18), (26.94 ± 5.57, 16.09-45.72), (24.33 ± 5.61, 12.70-37.26), (26.69 ± 6.73, 10.16-44.87), (27.20 ± 8.44, 9.31-53.34), (27.71 ± 8.09, 8.46-47.42), (28.39 ± 7.80, 11.01-46.57), (28.20 ± 7.97, 3.38-49.10), and (29.21 ± 6.62, 18.62-40.64) mg/kg, respectively. The iodine contents in 97.25% of samples were within the standard fortification level of Bangladesh (15-50mg/kg), while 2.61% of samples were below this limit. The semi-probabilistic risk assessment studies showed that 80.14% of samples at a low ingestion rate could provide optimal nutrition (150-299μg/day) to the whole population. Contrarily, at medium, moderate-high, and high consumption rates 34.93%, 65.22%, and 85.94% of samples, respectively, belonged to above the requirements to excessive exposure categories (300-1100μg/day), which might cause iodine-induced diseases. The target hazard quotient (THQ) values for the adults in most of the samples were within the threshold risk limit (THQ < 1.0), whereas THQ values in 6.82% to 85.97% of samples for the children at low to high ingestion rates, respectively exceeded this limit, which revealed that the adults were almost safe, but the children might face non-carcinogenic health effects. Therefore, regular monitoring of iodine concentration in iodized salts should be done to prevent iodine deficiency or iodine-induced disorders.

Modelling the contribution of iodised salt in industrially processed foods to iodine intake in Macedonia.

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.

The effect of sodium restriction on iodine prophylaxis: a review.

Sodium is essential to life. However, its dietary excess is detrimental to the cardiovascular system, and sodium restriction is a crucial step in cardiovascular prevention. Iodine deficiency has been fought worldwide for decades, and substantial success has been achieved introducing the use of iodine-enriched salt. Nevertheless, areas of iodine deficiency persist around the world, both in developing and industrialized countries, and a major concern affecting dietary sodium reduction programs is represented by a possible iodine intake deficiency. There are substantial differences in the source of alimentary iodine among countries, such as iodized salt added, household tap water, seafood, or salt employed in packaged food. It is clear that a sodium-restricted diet can induce differences in terms of iodine intake, depending on the country considered. Moreover, iodine status has undergone relevant changes in many countries in the last years. Systematic review of literature evidence about the possible effects of sodium restriction on population iodine status. To date, the available results are conflicting, depending on country, salt iodization policy, as well as time frame of data collection. However, to ensure an optimal iodine supply by salt fortification, without exceeding the current recommendation by World Health Organization for salt intake, seems to be an achievable goal. A balanced approach may be obtained by an adequate iodine concentration in fortified salt and by promoting the availability of iodized salt for household consumption and food industry use. In this scenario, updated prospective studies are strongly needed.

No Association Was Found Between Mild Iodine Deficiency During Pregnancy and Pregnancy Outcomes: a Follow-up Study Based on a Birth Registry

BackgroundSevere iodine deficiency during gestation is associated with adverse pregnancy outcomes; however, the impact of mild-to-moderate iodine deficiency, though prevalent in pregnancy, remains unclear.MethodsWe extracted follow-up data for 7435 pregnant women from a national iodine deficiency disorders monitoring program from 2016 to 2018 and a mother–child cohort study in 2017 based on a birth registry in Shanghai. Birth outcomes were collected from the registry. Spot urine and household salt samples were collected for iodine testing. Single-factor analysis and logistic regression were used to evaluate the association between maternal iodine status and pregnancy outcomes.ResultsThe median urine iodine level in pregnant women was 137.5 μg/L (interquartile range 82.4–211.5), suggesting mild deficiency according to WHO standards. The incidence of pregnancy termination, preterm birth, congenital malformations, low birth weight, and cesarean section was 3.2%, 4.3%, 1.4%, 2.7%, and 45.2% in the mildly iodine-deficient group and 3.4%, 4.5%, 1.4%, 2.7%, and 44.5% in the normal group, respectively. After adjusting for maternal age and education, trimesters, and preterm birth rate in the general population, the odds ratios for any outcome did not differ significantly between the two groups.ConclusionThe present study suggests that mild maternal iodine deficiency is not associated with adverse pregnancy outcomes.