Salt Iodization Program Research Articles

Iodine: It's Important in Patients that Require Parenteral Nutrition

Iodine deficiency has multiple adverse effects on growth and development because of inadequate thyroid hormone production. Four methods are generally recommended for assessment of iodine nutrition: urinary iodine concentration, thyroid size, and blood concentrations of thyroid-stimulating hormone and thyroglobulin. Iodine intakes < or = 1 mg/d are well tolerated by most adults, because the thyroid is able to adjust to a wide range of intakes. A daily dose of 1 microg iodine/kg body weight is recommended for infants and children receiving parenteral nutrition (PN), but this is far below their requirement. Daily iodine requirements in adults receiving enteral nutrition or PN are estimated to be 70-150 microg, but most PN formulations do not contain iodine. Despite this, deficiency is unlikely because absorption from iodine-containing skin disinfectants and other adventitious sources can provide sufficient iodine. However, if chlorhexidine replaces iodine-containing disinfectants for catheter care, iodine deficiency may occur during long-term PN, and periodic testing of thyroid functions may be prudent. Infants may be particularly vulnerable because of their small thyroidal iodine store, but available data do not yet support routine supplementation of preterm infants with iodine. Adults may be less vulnerable because thyroidal iodine stores may be able to support thyroid hormone production for several months. More studies to clarify this issue would be valuable.

The status of iodine nutrition in newborn infants, schoolchildren, adolescents and adults in former East Germany.

In the former East Germany (GDR) like in the former West Germany (FRG) iodine deficiency and endemic goiter have been described since more than 2 decades. After a program of salt iodization which was started in East Germany in 1985 the urinary iodine excretion of the population increased significantly. The thyroid gland of the newborn is much more sensible to changes of the iodine supply than the thyroid of older children. A total of 1732 subjects was enrolled in the study. After the implementation of the mandatory salt iodization the goiter prevalence in newborns decreased markedly to less than 1%. After the reunification of Germany in 1990 the mandatory prophylaxis was stopped and the urinary iodine excretion in newborns, school-children, adolescents and adults diminished markedly. So in newborns the renal iodine excretion decreased to 2.82 micrograms I/dl in 1992. Since 1994 a reasonable improvement of the iodine supply is observed in the region of Leipzig. In school-children, adolescents and adults the mean value of the urinary iodine excretion is now above 10.0 micrograms I/dl. This value may be considered as an indicator for a normal iodine supply. In a small cohort (n = 28) of newborns infants we found a renal iodine excretion of 18.74 micrograms/dl in 1997. That value also means a significant increase since 1992 and a normal iodine supply in the fetal period. The present results from the region of Leipzig/Saxonia are not representative for the whole of East Germany. To provide an optimal iodine nutrition the use of iodized salt for food manufacturing must be significantly increased.

Beneficial effects of iodized salt prophylaxis on thyroid volume in an iodine deficient area of southern Italy

Goitre prevalence in school-age children is an indicator of the severity of iodine deficiency disorders (IDD) in an endemic area. The aims of the present study were (i) to provide ultrasound thyroid volume (TV) reference values in a healthy population of school-children aged 11-14 year living in iodine-sufficient areas of Calabria region (ii) to assess both goitre prevalence and urinary iodine (UI) concentration in all children aged 11-14 year from four mildly iodine-deficient areas in which we have carried out a program of salt iodization and (iii) to evaluate the efficacy of the iodoprophylaxis in an adult population living in a small village of the same endemic area. Cross-sectional and prospective studies. TV was assessed by ultrasonography and iodine intake was estimated by measuring iodine excretion in spot urine samples. Results We provided the ultrasound normal reference values as a function of age and body surface area, which displayed significant differences from those recommended by the World Health Organization. By adopting local criteria, the prevalence of goitre in children ranged from 23.4% to 27.7% normalized for age and body surface area, respectively, while the UI excretion was < 100 microg/l in 38% of subjects studied. In an adult population living in the same endemic area, goitre prevalence was lowest in the 18-27-year-old age group, and increased progressively with age. We propose for the first time local reference ultrasound values for TV in a population of 11-14-year-old school-children that should be used for monitoring IDDs and have demonstrated the beneficial effects of iodoprophylaxis in consistent with reduced goitre prevalence in children and in the young adult population studied.

Universal salt iodization programs: Evidence of implementation and impact

Universal salt iodization programs: Evidence of implementation and impact

The role of thyroid autoantibodies in the etiology of endemic goiter in schoolchildren of Isfahan, Iran

Eleven years after the initiation of universal salt iodization program in Iran, the prevalence of goiter is still high in some areas. To investigate the role of thyroid autoimmunity in the etiology of residual goiter in schoolchildren of Isfahan, Iran. In a cross-sectional study, 2331 schoolchildren were selected by multi-stage random cluster sampling. Thyroid size was estimated in each child by inspection and palpation. Urinary iodine concentration (UIC), serum anti-thyroperoxidase antibody (anti-TPO Ab), and anti-thyroglobulin antibody (Anti-Tg Ab) were measured. Overall, 32.9% of children had goiter. The median UIC was 1955.5 microg/dl. There was significant difference in prevalence of positive anti-TPO Ab in goitrous (grade 2) and non-goitrous children (9.7 vs 3.7%, p= 0.02). Goitrous children had higher prevalence of positive anti-Tg Ab than non-goitrous ones (15.1 vs 3.1%, p<0.001). According to the present study, goiter is still a public health problem in this region. This study suggests that thyroid autoimmunity is among the contributors of goiter persistence after elimination of iodine deficiency in Isfahan.

Toward an Ecosocial Epidemiological Approach to Goiter and Other Iodine Deficiency Disorders: A Case Study of India's Technocratic Program for Universal Iodization of Salt

The program of universal salt iodization (USI) was intensified in the 1990s. Unfortunately, a recent World Health Organization review finds that there was a global increase of 31.7 percent in total goiter rate from 1993 to 2003. However, the WHO review places only 1 country as severely, 13 as moderately, and 40 as mildly deficient in populations' iodine nutrition, and places 43 countries at optimal, 24 at high, and 5 at excessive levels of iodine nutrition. Thus, it is imperative to weigh the benefits and risks of intensifying USI further. The WHO review places India in the category of "adequate" iodine nutrition, but in 2005 the Government of India promulgated a universal ban on sale of non-iodized salt, calling iodine deficiency disorders (IDDs) a major public health problem. This article attempts to understand these contradictions and weigh the benefits and costs of USI. Based on a review of studies since the 1920s, the authors reconstruct the evolution of IDD control in India. Conceptual and methodological limitations challenge the evidence base and rationale of stricter implementation of USI now. Finding evidence for its negative impact, the authors recommend a reexamination of the USI strategy and propose a safer, people-centered, ecosocial epidemiological approach rather than a universal legal ban.

Iodine status and thyroid function of pregnant, lactating women and infants (0-1 yr) residing in areas with an effective Universal Salt Iodization program.

To assess the iodine nutrition and thyroid function of pregnant women, lactating women and infants residing in areas where the Universal Salt Iodization program is in place. Pregnant women, lactating women and infants were selected randomly in the regions where iodized salt coverage rate is more than 90% since 2000. Urine iodine levels of pregnant woman, lactating woman and infants, milk iodine of lactating woman, thyroid-stimulating hormone (TSH) and free T4 of women were tested respectively. Median Urinary Iodine (MUI) of infants, three groups of pregnant women (first, second and third trimester) and two groups lactating women (breastfeeding less than or more than six months) were 233, 174, 180, 147, 126 and 145 microg/L, respectively. Median milk iodine of lactating women was 163 microg/L. Percentage of milk iodine < 150 microg/L of early lactating women was 40% less than that of late lactating women (p < 0.01).There was a positive correlation between urine iodine of infants and milk iodine of lactating women (r = 0.526, p = 0.000). T4 of two women were above or below the reference range. Total 15.4% women's TSH were abnormal. Most of these women's urinary iodine were lower than 150 microg/L. Iodine status of most of the target population for Universal Salt Iodization program is adequate, but iodine deficiency still existed in some. To assure every new life's brain not be damaged by iodine deficiency, iodine status of targeted populations should be monitored and supplements provided according to the monitoring outcomes.

Iodine deficiency disorders in Bangladesh, 2004-05: ten years of iodized salt intervention brings remarkable achievement in lowering goitre and iodine deficiency among children and women.

A survey was conducted to monitor the current status of iodine deficiency disorders in children aged 6-12 years and women aged 15-44 years in Bangladesh as measured by goitre prevalence and urinary iodine excretion. Conducted between September 2004 and March 2005, the survey followed a stratified multistage cluster sampling design to provide nationally representative data, with self-weighted rural-urban disaggregation. A total of 7233 children and 6408 women were examined for goitre and 4848 urine samples (2447 from children and 2401 from women) were analyzed for iodine. In addition, 5321 household salt samples were analyzed for iodine. In children, the total goitre rate (TGR) was 6.2%, compared to 49.9% in 1993 and the TGR among women was 11.7%, while in 1993 it was 55.6%. Prevalence of iodine deficiency (Urinary Iodine Excretion <100 microg/L) was 33.8% in children and 38.6% in women (compared to 71.0% and 70.2%, respectively in 1993). Iodine nutrition status in urban areas was considerably better than in rural areas. There was a clear inverse relationship between iodine deficiency and the coverage of households using adequately iodized salt (> or =15 ppm). The findings of the survey revealed that Bangladesh has achieved a commendable progress in reducing goitre rates and iodine deficiency among children and women ever since the universal salt iodization programme was instituted 10 years ago. However, physiological iodine deficiency still persists among more than one-third of children and women, which points to the need for all stakeholders to redouble their efforts in achieving universal salt iodization.

Research on Iodine Deficiency and Goiter in the 19th and Early 20th Centuries

In 1811, Courtois noted a violet vapor arising from burning seaweed ash and Gay-Lussac subsequently identified the vapor as iodine, a new element. The Swiss physician Coindet, in 1813, hypothesized the traditional treatment of goiter with seaweed was effective because of its iodine content and successfully treated goitrous patients with iodine. Two decades later, the French chemist Boussingault, working in the Andes Mountains, was the first to advocate prophylaxis with iodine-rich salt to prevent goiter. The French chemist Chatin was the first to publish, in 1851, the hypothesis that iodine deficiency was the cause of goiter. In 1883, Semon suggested myxedema was due to thyroid insufficiency and the link between goiter, myxedema, and iodine was established when, in 1896, Baumann and Roos discovered iodine in the thyroid. In the first 2 decades of the 20th century, pioneering studies by Swiss and American physicians demonstrated the efficacy of iodine prophylaxis in the prevention of goiter and cretinism. Switzerland’s iodized salt program has been operating uninterrupted since 1922. Today, control of the iodine deficiency disorders is an integral part of most national nutrition strategies.

Gynecological malignancies in Maroua, Cameroon

doi:10.1016/j.ijgo.2008.09.020 The mean UIC in the control group was 137.2±5.9 μg/L (median 112 μg/L, range 62–465), but it was significantly lower in the pregnant women (Pb0.01). MeanUIC in thewomenwhowere in the first, second, and third trimesters of pregnancy were 93.6±6.6 μg/L (median 85 μg/L, range 28–223), 90.11±6.4 μg/L (median 82 μg/L, range 25–165), and 89.8 ±3.6 μg/L (median 88 μg/L, range 39–113), respectively (Fig. 1). Notably, severe iodinedeficiency (UIC less than 50 μg/L)was found in 12 pregnant womenwhowere in thefirst trimester, 2 in thesecond, and2 in the third. These results demonstrate that even in an urban areawhere iodine intake is expected to be adequate, pregnant women may be at risk of IDD. They also indicate the need to monitor iodine intake during pregnancy in areas with recently established salt iodization programs, and raise the question of whether iodine supplementation in pregnancy should be generalized or tailored on an individual basis.

Adequate iodine nutrition in Sweden: a cross-sectional national study of urinary iodine concentration in school-age children

Sweden has a long-standing salt iodization program; however, its effects on iodine intake have never been monitored on a national level. The objective of this study was to evaluate iodine nutrition in the Swedish population by measuring the urinary iodine concentration (UIC) in a national sample of Swedish school-age (6-12 years of age) children. A stratified probability proportionate to size cluster sampling method was used to obtain a representative national sample of school-age children from 30 clusters. Spot urine samples were collected for UIC analysis using a modified Sandell-Kolthoff method. The median UIC of the children (n=857) was 125 microg/l (range 11-757 microg/l). The proportion of children with a UIC <100 microg/l was 30.0% and the proportion of children with a UIC <50 and >300 microg/l was 5.5 and 3.0%, respectively. The iodine nutritional status of the Swedish population is adequate. Iodized table salt remains the main dietary source of iodine in Swedish diet. Recommendations to reduce total salt intake in the population urge increased use of iodized salt in the production of processed foods. Pregnant and lactating women with high iodine requirements may still be at risk for low iodine intake. This study will serve as the basis for future monitoring of iodine nutritional status in Sweden.

The Average of Dietary Iodine Intake due to the Ingestion of Seaweeds is 1.2 mg/day in Japan

The Average of Dietary Iodine Intake due to the Ingestion of Seaweeds is 1.2 mg/day in Japan

Incidence of iodine deficiency in Turkish patients with congenital hypothyroidism

Turkey is located in an area of mild to moderate iodine deficiency. The aim of the present study was to investigate the incidence of iodine deficiency in patients with congenital hypothyroidism. Twenty five patients with a median age of 12 days (6 days-6 months) at diagnosis and followed for a median time of 7 months (1-60 months) were enrolled in the study. Thyroid function tests, thyroid scintigraphy, ultrasonography and urine iodine measurements of the patients and mothers were performed. Congenital hypothyroidism was diagnosed within postnatal day 13, between days 13 and 30, and after 30 days of age in 68%, 20% and 12% of the patients, respectively. At the time of diagnosis mean serum thyroid-stimulating hormone and total T4 were 85.3 +/- 27.6 mIU/L and 3.9 +/- 2.8 microg/dL, respectively. Incidence of iodine deficiency was 36% in the patients (median, 110 microg/L) and 88% in the mothers (median, 40 microg/L). Thyroid scintigraphy and ultrasound were normal in all of the patients with iodine deficiency. At scintigraphic evaluation, thyroid gland was not visualized in 28% of patients; in the patients whose thyroid glands were not visualized scintigraphically thyroid ultrasonography indicated agenesis in 57%, and hypoplasia in 43%. In all the patients with thyroid agenesis or hypoplasia iodine levels were normal. In 36% of the patients imaging studies of thyroid gland and urine iodine measurements were normal. Despite salt iodization program, incidence of iodine deficiency is still high in patients with congenital hypothyroidism and mothers. National measures are urgently required for correction of iodine deficiency in Turkey.

Sustainability of a well-monitored salt iodization program in Iran: Marked reduction in goiter prevalence and eventual normalization of urinary iodine concentrations without alteration in iodine content of salt

Two yr after legislation of salt iodization of 40 parts per million (ppm) in 1994, goiter was still endemic and urinary iodine concentration (UIC) remained elevated in many provinces of Iran. Goiter prevalence and UIC were compared 2 and 7 yr after sustained consumption of uniformly iodized salt by Iranian households. Schoolchildren (7-10 yr) of all provinces were randomly selected by cluster sampling from December 2000 to June 2001. Goiter rate, UIC, and household salt iodine values were compared to those in 1996. Factory salt iodine was also compared in 2001 vs 1996. Ultrasonographically determined thyroid volumes of 7-10 yr old children were compared in 2001 vs 1999. In 2001 (no.=33600) vs 1996 (no.=36178), total, grade 1, and grade 2 goiter rates were 13.9 vs 53.8%, 11.0 vs 44.8%, and 2.9 vs 9.0%, respectively (p<0.0001). Weighted total goiter rate was 9.8% in 2001. Median (range) UIC in 2001 (no.=3329) was 165 (18-499) microg/l and in 1996 (no.=2917) was 205 (10-2300) microg/l (p<0.0001). In 2001 vs 1996, mean+/-SD for iodine salt content was 32.7+/-10.1 vs 33.0+/-10.2 ppm (p=0.68) in households and was 33.2+/-13.4 and 33.8+/-13.2 ppm (p=0.57) in factories, respectively. Among 7-10 yr old children in 2001 (no.=400) vs 1999 (no.=396), only 7-yr-old children in 2001 (the only group with probably no history of iodine deficiency) showed significant smaller thyroid volumes by ultrasonography compared to those in 1999. After 7 yr of optimized iodized-salt supplementation in Iran, adequate UIC values and marked reduction in goiter rate have been achieved.

The Interaction of Agricultural Pesticides and Marginal Iodine Nutrition Status as a Cause of Autism Spectrum Disorders

Roberts et al. (2007) recently reported on the results of their investigation into the relationship between agricultural pesticides and autism spectrum disorders (ASD) and found an association between organochlorines and ASD. One possible mechanism for this relationship is through thyroid disruption (Cheek et al. 1999). There is evidence to suggest that iodine deficiency might be associated with some of the increase in the reported prevalence/incidence of autism (Sullivan and Maberly 2004). For pregnant women who have a marginal iodine nutrition status, the disruption of the thyroid due to exposure to organochlorines could induce iodine deficiency and result in negative effects on the brain of the developing fetus. The U.S. iodine nutrition status has declined markedly over the last three decades, with the current iodine nutrition status among pregnant women being marginal (Caldwell et al. 2005; Hollowell et al. 1998). Because of the current iodine status of pregnant women, the Public Health Committee of the American Thyroid Association (2006) has recently recommended that all pregnant and lactating women take daily iodine supplements. It is interesting that the ASD case mothers tended to be older and more likely to be non-Hispanic white and non-Hispanic black than controls, which is consistent with a poorer iodine nutrition status in older women and in non-Hispanics in the United States (Caldwell et al. 2005; Hollowell et al. 1998). Ensuring adequate iodine nutrition status of women, especially throughout pregnancy, is an extremely important public health goal. Given the negative effects of a number of environmental chemicals on the thyroid (Zoeller and Crofton 2000), it becomes increasingly important to ensure that all women have an adequate iodine intake and that the recommended approach to assuring adequate iodine nutrition is through a comprehensive iodized salt program (International Council for Control of Iodine Deficiency Disorders/United Nations Children’s Fund/World Health Organization 2001; Sullivan 2007).

Desenvolvimento de um método para a determinação da iodúria e sua aplicação na excreção urinária de iodo em escolares brasileiros

In this study we developed a semi-automated method for the measurement of urinary iodine using firstly ammonium persulfate for digestion of urine followed by estimation of iodine content in the Sandell-Kolthoff reaction, in which iodine acts as a catalyst for the reduction of cerium. This method was validated in the 3rd Brazilian National Survey of iodine deficiency in 1994. We studied 16,803 casual urine samples from schoolchildren of 401 cities and found 4 moderately-deficient towns (Almas, Arraias, and Parana, in the State of Tocantins, and Cocos, in the State of Bahia), and 116 mildly-deficient. This work suggests that despite the salt iodization program, there was some iodine-deficient areas in Brazil in 1994. Recent surveys, involving less cities, are indicating an excess of iodine ingestion. Therefore, in a country of continental dimensions and very heterogeneous in terms of public health, periodical evaluations are necessary to monitor the real situation of iodine nutrition in Brazil. The method developed in this paper is suitable for these surveys.

Prevalence of Goiter in Children 6 to 12 Years of Age in Ethiopia

Iodine-deficiency disorders are a major public health problem in Ethiopia. In conjunction with implementing control programs, baseline information needs to be established. To investigate the distribution and degree of severity of iodine-deficiency disorders in terms of goiter prevalence, urinary iodine excretion (UIE) levels, and proportion of households with iodated salt in Ethiopia. A nationwide, community-based, cross-sectional study was conducted from February to May 2005 among 10,965 children aged 6 to 12 years. A multistage, proportional-to-population-size sampling method was used. Goiters were classified by the method recommended by the World Health Organization/UNICEF/International Council for the Control of Iodine Deficiency Disorders (WHO/UNICEF/ICCIDD), in which the thyroid gland is graded as 0 (normal), 1 (palpable goiter), or 2 (visible goiter); urinary iodine was determined by the wet digestion method; and salt samples were analyzed by a rapid test kit. The national total goiter weighted prevalence rate among children aged 6 to 12 years was 39.9% (95% confidence interval, 38.6% to 41.2%), representing more than 4 million children. The median UIE was 2.45 microg/ dL; 45.8% of children had UIE values of 2 microg/dL or less, and 22.8% had UIE values of 2.01 to 5.0 pg/dL. Only 4.2% of the households had iodated salt. According to the WHO/UNICEF/ ICCIDD classification, both goiter prevalence and UIE levels indicate that the whole country appears to be severely affected by iodine deficiency. Furthermore, the virtual absence of iodated salt in the households shows that currently there is no salt iodization program in the country. Dietary sources of iodine in Ethiopia are not dependable, and hence a sustainable universal salt iodization program needs to be implemented without delay.

The impact of iodised salt or iodine supplements on iodine status during pregnancy, lactation and infancy

Monitoring of iodine status during pregnancy, lactation and infancy is difficult as there are no established reference criteria for urinary iodine concentration (UI) for these groups; so it is uncertain whether iodized salt programs meet the needs of these life stages. The method used in this paper was: 1) to estimate the median UI concentration that reflects adequate iodine intake during these life stages; and 2) to use these estimates in a review of the literature to assess whether salt iodisation can control iodine deficiency in pregnant and lactating women, and their infants. For pregnancy, recommended mean daily iodine intakes of 220-250 microg were estimated to correspond to a median UI concentration of about 150 microg l- 1, and larger surveys from the iodine sufficient countries have reported a median UI in pregnant women > or = 140 microg l- 1. Iodine supplementation in pregnant women who are mild-to-moderately iodine deficient is beneficial, but there is no clear affect on maternal or newborn thyroid hormone levels. In countries where the iodine intake is sufficient, most mothers have median breast milk iodine concentration (BMIC) greater than the concentration (100-120 microg l- 1) required to meet an infant's needs. The median UI concentration during infancy that indicates optimal iodine nutrition is estimated to be > or = 100 microg l- 1. In iodine-sufficient countries, the median UI concentration in infants ranges from 90-170 microg l- 1, suggesting adequate iodine intake in infancy. These findings suggest pregnant and lactating women and their infants in countries with successful sustained iodised salt programs have adequate iodine status.

Salt iodisation in Port Harcourt metropolis: a survey of households and markets

Background: Consequent on the recognition of the public health importance of Iodine Deficiency Disorders (IDD), especially in developing countries, the goal of iodising at least 90% of edible salts by 2000 was set at the 1990 World Summit for Children. Aim: To determine the salt iodisation level in Port Harcourt. Methods: In April 2000, using pre-tested questionnaires and MBI field test kits, traders from 8 markets and residents of 2181 households in Port Harcourt were interviewed and samples of their edible salts tested to determine their iodine content. Results: The major salt brands of the 336 market and 2182 household samples were Union Dicon (70.54% and 25.52%) and Cassava (11.9% and1.92%). About 17% of salt samples tested from markets compared to 72.55% from households, were of unknown brands (p=0.00000). Over 99% of samples from markets and households (99.7% and 99.13% respectively) had >30 ppm of iodine. All 27 traders interviewed were ignorant of salt iodisation programme and IDD; 92.6% had seen persons with \'goitre\' but were ignorant of its causes and prevention. Conclusion: Salt iodisation at the point of production has proved effective in increasing the consumption of iodised salts in Port Harcourt despite the widespread ignorance of the programme and its importance in controlling IDD. That most of the salts had >30 ppm of iodine portends the danger of toxicity with long-term use. There is need for close monitoring to ensure the safety of the intervention and its sustainability. Keywords: Universal salt iodisation, Iodine deficiency disorders, Ignorance, Community mobilization Port Harcourt Medical Journal Vol. 2 (1) 2007: pp. 27-34

Iodine Intake of Slovenian Adolescents

Background: Slovenia is classified as being iodine-deficient. We recently found that Slovenian adolescents are iodine-sufficient (median urinary iodine concentration of the population 140 µg/l) and the prevalence of goiter is low (0.9%). The objective of this study was to evaluate iodine intake, the prevalence of marginal, low and excessive intake (<50, 50–100 and ≧300 µg/day), as well as the main sources of iodine in the diet of Slovenian adolescents. Methods: A cross-sectional study included 2,581 adolescents (1,415 girls, 1,166 boys, mean age ± SD 15.6 ± 0.5 years) representing 10% of 15-year-old Slovenian adolescents. Iodine intake was determined using a food frequency questionnaire (FFQ) in the whole population studied (n = 2,485) and weighted 3-day dietary protocols (3DPs) in a subgroup of participants (n = 191). Results: Median iodine intake determined from FFQ was 155.8 µg/day. There was no significant difference between genders. Marginal, low and excessive iodine intake was observed in 3.3, 20.3 and 11.3% of the adolescents, respectively. The major food sources of dietary iodine included table salt (39 % of the mean daily iodine intake), beverages (22%) and milk/milk products (19%). Conclusions: Dietary iodine intake in Slovenian adolescents is adequate, illustrating the effective salt iodization program.