Mandatory Salt Iodization Research Articles

Salt production and iodization practices among artisanal salt producers in selected districts within the Greater Accra and Central Regions of Ghana

BackgroundThis study was conducted to assess salt production and iodization practices by artisanal salt producers located at six districts across Greater Accra and Central regions. MethodsOne Hundred and Sixty-Six (166) salt miners in Greater Accra and Central Regions were interviewed using a structured questionnaire and their production sites inspected for salt iodization practices. ResultsThe study revealed that salt iodization is not practiced among majority (69.28 %) of artisanal salt producers. They were conversant with salt iodization (93.98 %) and had fair knowledge on the health effects on consumers when iodine is absent in salt. Some of the producers attributed the nonadherence to the mandatory salt iodization to the unavailability of potassium iodate/iodide on the market. All artisanal salt producers interviewed utilise the solar evaporation method for salt production. The evaporation is done on tarpaulin/polyethylene lined pans and concrete pans. The tarpaulin/polyethylene lined pans were predominantly used in Greater Accra, and concrete pans in Central region. ConclusionFor Ghana to increase availability of iodized salt on the market and improve household consumption of iodized salt, regulatory authorities need to enforce the laws and regulations on salt iodization and also create the enabling environment for artisanal salt producer to have access to potassium iodate for production.

IODINE STATUS IN ROMANIA AFTER 20 YEARS OF MANDATORY SALT IODIZATION: DISCORDANT RESULTS IN SCHOOLCHILDREN AND NEONATES.

To monitor the iodine status in Romanian schoolchildren and neonates after 20 years of mandatory salt iodization. In a national representative sample of 1352 children (7-12 years) we measured median urinary iodine concentration (mUIC) and creatinine (UCC) in spot urine samples and investigated household use of iodized salt. From 18349 neonates registered in the MEDILOG program for TSH screening we calculated the percentage of neonatal TSH >5 mIU/L (<3% indicating adequate iodine intake). mUIC in schoolchildren was 141 µg/L (bootstrapped 95% CI 134, 146), showing adequate iodine intake in all but 1 county; mUIC was similar in historical endemic and non-endemic counties (140 µg/L and 143 ug/L, respectively) and in urban and rural areas (140 µg/L and 142 µg/L, respectively); mUIC/UCC = 118 ug/g. Iodized salt was used in 62% of households. In children using iodized salt (61.7%), mUIC was higher than in those using coarse (non-iodized) salt (24.6%): 150 vs. 121 µg/L (p<0.001). The percentage of nTSH >5 mIU/L was 14.7% (3.2%-27.3%), higher in non-endemic counties and urban areas. The current salt iodization program for households and bakery industry ensures an adequate iodine intake in schoolchildren. Discordantly, nTSH levels indicate a mild-moderate ID in neonates, suggesting ID in pregnant women. The percentage of households using iodized salt is below the recommended >90% needed for an efficient ID prevention program. More efforts should be directed to increase the public awareness on the health risks of ID and the benefits of ID prevention, notably for the neurointellectual development in children.

Awareness, practices and perspectives on ensuring access to ideally packaged iodized salt in Nigeria

Salt iodization is a positive exemplar of a sustainable public-private partnership in promoting better nutrition outcomes in many countries. However, the gains in the past decades are gradually being eroded, following laxity in policy implementation, monitoring and regulatory roles resulting in increasing access to non-labelled salt in the Nigerian market. This study was designed to evaluate the awareness, practices and perspectives on salt iodization and regulations among salt marketers and consumers in Ibadan, Oyo state.This mixed-method study was carried out in seven major markets across Ibadan metropolis. A three-stage sampling technique was used to select 77 salt users/clients, 103 salt vendors, 12 salt wholesalers and four regulators/producers. Interviewer-administered questionnaire was used to collect information on types/brands of salt, handling, retail practices, awareness, and salt purchase preference. Structured in-depth interview was used to elicit information on existing regulations, compliance level, and monitoring activities. Descriptive statistics were used to analyse quantitative data. Interviews were tape-recorded, transcribed verbatim and analyzed thematically.Males constituted 66.7%, 1.0% and 14.3% of respondents among wholesalers, retail vendors, and clients, respectively, with 100.0%, 58.3% and 84.4% having at least primary education. All wholesalers and 30.1% of retail vendors used shaded structure. About 67% of the wholesalers and 58.3% of the retailers sold branded salt. Clients’ basis for the use of non-branded salt included cheapness and greater quantity (54.5%), higher intensiveness/saltiness and greater quantity (22.1%), and cheaper cost (18.2%). Only 3% of the consumers were aware of mandatory salt iodization, 3.9% were aware of guidelines on salt marketing and only 18.2% handled salt safely. Safe handling practices were found among all wholesalers and 44.7% of the retailers. Qualitative findings revealed the existence of regulation on the production, packing and marketing of salts in Nigeria, however, enforcement and monitoring at the market level is weak.The demand and use of industrial salt in food preparation remain widespread among consumers in Ibadan, Nigeria following limited awareness of salt iodization programme and its benefits. Regulations on salt marketing should be enforced at all levels and nutrition education on salt iodization should be intensified.

Comparison of Salt Iodization Requirements in National Standards with Global Guidelines

ABSTRACTBackgroundFood fortification is the addition of 1 or more micronutrients to commonly consumed foods and is utilized by many countries as a public health intervention to prevent and control micronutrient deficiencies. As iodine deficiency was a major public health issue globally, the WHO developed evidence-based guidelines for the fortification of salt with iodine. The implementation of salt iodization has been highly successful in reducing iodine deficiency disorders worldwide and is recommended as the main strategy to prevent iodine deficiency.ObjectivesThis analysis compared salt iodization requirements specified in countries’ salt standards with WHO 2014 Guidelines on salt fortification.MethodsFor countries with mandatory salt iodization legislation, data from the Global Fortification Data Exchange regarding iodine amounts and iodine compounds, to be added to salt per the country standard and corresponding national salt intake quantities, were compared with 2014 WHO Guidelines.ResultsAs of 4 September 2021, 110 countries with mandatory salt iodization legislation had national salt standards that specified iodine amounts and compounds and salt intake data. All but 1 specified at least 1 recommended iodine compound, but the majority specified higher iodine amounts in salt standards than indicated in the guidelines, taking salt consumption levels into account. Our analysis did not find excess iodine intake as a result; however, we did not have data on the extent of compliance with national salt standards.ConclusionsExisting iodization requirements in salt standards appear to be appropriate for most countries. Countries in which iodine amounts in salt standards are significantly higher than those recommended in the 2014 Guidelines, in particular those with low compliance with national standards or excess iodine intake, may wish to review program process and output indicators and assess whether current iodine amounts in standards would result in excessive intake if implementation was improved.

Mandatory Versus Voluntary Implementation of Salt Iodization Program for the Last Two Decades in Ethiopia: A Comparative Review of Existing Literatures.

Ethiopian government was implementing mandatory salt iodization program for the last decade to eliminate iodine deficiency disorders, but several recent studies reported mixed findings. This review aimed to assess the difference in implementation of iodized salt program 10 years before and after mandatory salt iodization being implemented in Ethiopia since 2011. In Ethiopia, legislation that enforces salt producers to iodize all salts used for human consumption started in February 2011. All studies about iodine deficiency and iodized salt conducted in Ethiopia in the last 2 decades were searched. Searches were performed in PubMed database. Google Scholar, Iodine Global Network, and Ethiopian Public Health Institute websites were also searched. A total of 235 titles and abstracts were identified. After scanning the abstracts and full papers, 43 articles were remained for final data synthesis. In this review, all studies conducted before 2011 reported a urinary iodine concentration (UIC) value of < 100 μg/L and 66.7% of them reported a goiter prevalence of > 30%. On the other hand, among studies conducted after 2011, 88.9% reported UIC value < 100 μg/L and 73.7% reported goiter prevalence of > 30%. Household availability of adequately iodized salt increased from nearly 20% in pre 2011 to more than 50% in post 2011 period. Despite the efforts made by the Ethiopian government on mandatory salt iodization for the last decade, iodine deficiency is sustained in the country. Moreover, the goal of universal salt iodization program is offtrack and needs urgent revision. Registered on PROSPERO register with reg. no CRD42021251124.

ЙОДОДЕФИЦИТНЫЕ СОСТОЯНИЯ И ПУТИ ПРОФИЛАКТИКИ В РОССИЙСКОЙ ФЕДЕРАЦИИ И РЕСПУБЛИКЕ САХА (ЯКУТИЯ)

The Russian Federation (RF) refers to countries with proven natural iodine deficiency. The relevance of this topic is due to the fact that iodine deficiency diseases (IDD) rank first in prevalence among thyroid diseases, and represent pathological conditions that develop as a result of iodine deficiency in the diet, which can be prevented by normalization of its consumption. The purpose of the work is to clarify the relevance of already known information about iodine deficiency states by reviewing modern literary material. About 2 billion people live in conditions of natural iodine deficiency. More than 70 % of the territories of the Russian Federation are geochemical provinces with iodine deficiency, currently there are noticeable disparities between individual regions in the country. Among Russians, there was a decrease in iodine consumption to an average of 50-80 micrograms per day, which is 3 times less than the established norm (150-250 micrograms). With a high prevalence of iodine deficiency, foci of severe iodine deficiency were found in some regions of the North, Siberia and the Far East (in the Republics of Sakha (Yakutia), Tyva, Khakassia, and some districts of Arkhangelsk Oblast). Salt iodization is recommended by WHO and UNICEF as a universal and highly cost-effective method of eliminating IDD on a global scale. In many countries of the world, it has become possible to achieve a significant reduction in the incidence of thyropathies associated with iodine deficiency in the diet by legislatively adopting a decision on mandatory salt iodization, but in the Russian Federation the problem persists.

Prevalence of Iodine Insufficiency Is High Among Pregnant and Lactating Women in Northern Bangladesh Three Decades After Initiating Mandatory Salt Iodization

ObjectivesOptimum Iodine status during pregnancy and lactation is crucial for normal fetal growth and child development. We assessed the urinary iodine concentration of pregnant and lactating women to determine their iodine status and measured salt iodine from their households. MethodsWe collected spot urine samples and corresponding household salt samples from 80 pregnant women (37 and 43 second and third-trimester women, respectively) and 49 lactating women (with children <6 months). Urinary iodine was determined by manual digestion with ammonium persulfate followed by Sandell-Kolthoff Reaction using 96 multi-well plates and a micro-plate reader at 405 nm. The iodine content in salt was measured by iodometric titration method. Samples were analyzed at the icddr, b Immunology, Nutrition, and Toxicology Laboratory, Dhaka, Bangladesh. ResultsThe median [IQR] UIC in the second-trimester women, third-trimester women, and lactating women was 90.6[41.9–171.5] mcg/L, 67.9[24.2–144.5] mcg/L, and 74.7[48.1–134.8] mcg/L, respectively. More than three-quarters of pregnant women (73% of the second-trimester women and 79% of the third-trimester women) and more than half of the lactating mothers (57%) were below the WHO recommended cut-offs. Only 42% of the household salts were adequately iodized. A moderate positive linear relationship was found between urinary and household salt iodine content (r = 0.51, P < 0.0001). ConclusionsEven with mandatory salt iodization policy in Bangladesh for about three decades, the iodine insufficiency among pregnant and lactating women is widespread and needs to be improved through ensuring the availability of adequately iodized salt or supplement. Funding SourcesETH Zurich, Switzerland.

Dynamics of epidemiological indicators of thyroid pathology in the population of the Russian Federation: analytical report for the period 2009-2018

ОБОСНОВАНИЕ. Уровень потребления йода населением во многом определяет спектр тиреоидной патологии. На сегодняшний день в РФ йододефицитные заболевания (ЙДЗ) занимают лидирующие позиции в структуре всех заболеваний щитовидной железы (ЩЖ). Хронический дефицит йода (ЙД) приводит к неблагоприятным последствиям для здоровья и существенным экономическим затратам на их устранение в масштабах страны. Кроме того, спектр тиреоидной патологии в условиях ЙД не ограничивается проблемой ЙД, и изучение остальных заболеваний ЩЖ также представляет интерес.ЦЕЛЬ. Проанализировать динамику основных эпидемиологических показателей ЙДЗ и других заболеваний ЩЖ у всего населения РФ за период 2009–2018 гг., используя данные официальной государственной статистики.МЕТОДЫ. Проанализированы заболеваемость и распространенность заболеваний ЩЖ у всего населения РФ с использованием данных официальной государственной статистики. Использованы статистические формы №63 МЗ СР РФ «Сведения о заболеваниях, связанных с микронутриентной недостаточностью» и №12 «Сведения о числе заболеваний, зарегистрированных у больных, проживающих в районе обслуживания лечебного учреждения, РОССТАТ». Анализируемый период — 2009–2018 гг. Для оценки динамики распространенности и заболеваемости были построены линейные регрессионные модели.РЕЗУЛЬТАТЫ. Данные проанализированы в соответствии с представленной в статистической отчетности структурой заболеваний: зоб, тиреоидит, гипотиреоз, тиреотоксикоз, синдром врожденной йодной недостаточности. За десятилетний период 2009–2018 гг. отмечается статистически значимый рост распространенности различных форм зоба, тиреотоксикоза, синдрома врожденной йодной недостаточности у всего населения РФ. В течение периода наблюдения выявлен рост заболеваемости тиреотоксикозом. В отношении заболеваемости синдромом врожденной йодной недостаточности выявлена лишь тенденция к росту. Несмотря на то что в течение периода наблюдения число новых случаев различных форм зоба уменьшилось, распространенность зоба среди населения РФ остается высокой: 1,2% населения к 1 января 2019 г. В отношении тиреоидита выявлен статистически значимый рост распространенности и заболеваемости, что может быть связано с ростом аутоиммунной патологии, совершенствованием уровня диагностики, а также, в некоторых случаях, с гипердиагностикой (например, при постановке диагноза аутоиммунного тиреоидита у лиц с бессимптомным носительством антитиреоидных антител). Существующие на сегодняшний день подходы к йодной профилактике недостаточно эффективны.ЗАКЛЮЧЕНИЕ. Результаты проведенного анализа свидетельствуют преимущественно о росте распространенности тиреоидной патологии среди населения РФ на фоне проводимых региональных мероприятий. Проблема ЙДЗ остается нерешенной, что диктует необходимость внедрения всеобщего обязательного йодирования соли на территории РФ.

GLOBAL ENDOCRINOLOGY: Global perspectives in endocrinology: coverage of iodized salt programs and iodine status in 2020

Iodine deficiency has multiple adverse effects on growth and development. Diets in many countries cannot provide adequate iodine without iodine fortification of salt. In 2020, 124 countries have legislation for mandatory salt iodization and 21 have legislation allowing voluntary iodization. As a result, 88% of the global population uses iodized salt. For population surveys, the urinary iodine concentration (UIC) should be measured and expressed as the median, in μg/L. The quality of available survey data is high: UIC surveys have been done in 152 out of 194 countries in the past 15 years; in 132 countries, the studies were nationally representative. The number of countries with adequate iodine intake has nearly doubled from 67 in 2003 to 118 in 2020. However, 21 countries remain deficient, while 13 countries have excessive intakes, either due to excess groundwater iodine, or over-iodized salt. Iodine programs are reaching the poorest of the poor: of the 15 poorest countries in the world, 10 are iodine sufficient and only 3 (Burundi, Mozambique and Madagascar) remain mild-to-moderately deficient. Nigeria and India have unstable food systems and millions of malnourished children, but both are iodine-sufficient and population coverage with iodized salt is a remarkable 93% in both. Once entrenched, iodine programs are often surprisingly durable even during national crises, for example, war-torn Afghanistan and Yemen are iodine-sufficient. However, the equity of iodized salt programs within countries remains an important issue. In summary, continued support of iodine programs is needed to sustain these remarkable global achievements, and to reach the remaining iodine-deficient countries.

Iodine nutrition optimization: are there risks for thyroid autoimmunity?

Iodine deficiency is still the main cause of preventable thyroid disorders, worldwide. To optimize iodine intake, programs of voluntary or mandatory iodization of salt have been implemented in several iodine-deficient countries and iodine sufficiency has been achieved in many. Despite the clear beneficial effects on thyroid health, some concerns have been raised on the presumed detriment of iodine prophylaxis on thyroid autoimmunity. Very recent studies aimed at evaluating the long-term consequences of iodine supplementation on thyroid autoimmunity and related dysfunction, have clearly demonstrated that the early post-iodization increase in thyroid antibody positivity is largely transient and not clinically relevant, since the prevalence of overt thyroid dysfunction has remained reassuring low over two decades. The recommended iodine intake is therefore safe with regard to thyroid autoimmunity, the benefits largely outweighing the risks in a population with a stable median iodine concentration not exceeding 300μg/L. Thus, a possible increase in thyroid autoimmunity should not represent a limitation to promoting iodine supplementation in the general population, also taking into account the steady rise in prevalence of autoimmune disorders which has occurred in the last few decades because of environmental factors other than iodine.

Iodine concentration and prevalence of thyroid disease in older people after salt iodization in Turkey.

Iodine uptake is a main factor affecting thyroid disease. In Turkey, mandatory salt iodization began in 1999-2000. This study in 2009 determined the prevalence of thyroid diseases in older people in Mamak district, Ankara after iodization to ascertain if salt iodization alone is sufficient to reach adequate iodine levels in the older population. All Mamak residents ≥ 65 years were eligible for inclusion in the study. Demographic data and medical history were recorded. All participants had a thyroid ultrasound. Blood samples were taken to assess thyroid function and autoantibodies, and urine samples to assess iodine concentration. Participants with low levels of thyroid stimulating hormone underwent scintigraphy to assess thyroid uptake. Fine-needle aspiration biopsy was done of nodules ≥ 1.5 cm where thyroid stimulating hormone was not suppressed. Of 1200 eligible residents, 979 were included. Their mean age was 70.9 (standard deviation (SD) 5.7) years; 49.7% were women. Mean urinary iodine concentration was 98 (SD 81.29) μg/L. Goitre was found in 18.2% (89/487) of women and 6.7% (33/492) of men (P < 0.001) and 43.8% (428/979) had nodules. Subclinical hypothyroidism was found in 5.8% (57/979) of the participants, overt hyperthyroidism in 0.8% (8/979), subclinical hyperthyroidism in 2.2% (22/979) and T3 thyrotoxicosis in 0.3% (3/979). Toxic multinodular goitre and toxic adenoma caused 80% of hyperthyroidism cases. Biopsy detected no malignant pathology. After salt iodization, iodine levels have not yet reached favourable levels in older people. Iodization of salt seems insufficient to achieve these levels in older people; alternative iodine supplementation should be considered.

IODINE STATUS AND THYROID FUNCTION IN LACTATING WOMEN AND INFANTS - A SURVEY IN THE ZAGREB AREA, CROATIA.

SUMMARYLactating women (LW) and infants have high dietary iodine requirements and are at risk of iodine deficiency. The aim of the study was to assess iodine status and thyroid function in LW and their breastfed infants in Zagreb, Croatia. The study included 133 LW and breastfed infant pairs. Urinary iodine concentration (UIC) and thyroid function parameters were measured in all subjects. In LW, breast milk iodine concentration (BMIC) was measured and iodine and salt rich food frequency questionnaire data were collected. Results of analysis indicated that 99.2% of the LW used iodized salt in household and 20.4% used iodine-containing vitamin and mineral supplements. Median (IQR) UIC was 75 µg/L (19.0-180.5 µg/L) in LW and 234 µg/L (151.0-367.5 µg/L) in infants, whereas BMIC was 121 µg/kg (87.8-170.8 µg/kg). Multivariate regression analysis revealed BMIC to be a significant predictor of infant UIC (p<0.001). Positive correlation was recorded between LW and infant thyroid function. This was the first study in Croatia demonstrating BMIC to be a reliable biomarker of iodine status during lactation and predicting iodine intake in breastfed infants. The study confirmed that mandatory salt iodization in Croatia ensured sufficient dietary iodine for LW and optimal iodine intake for breastfed infants via breast milk.

The nearest prospect of iodine production in Ukraine

Ukraine ranks the last place in Europe in iodized salt consumption per head of population, and mandatory salt iodization level has not yet been legalized. Iodine deficiency causes growth inhibition and memory impairment in children, efficiency decrease and endocrine system diseases – in adults. Iodized salt has not been widely used in Ukraine and the increase in the laminaria prices has been constraining its consumption. Since 1972 iodine reserves of Ukraine are recorded to be found in the waters of Severo-Sivaskoye field in Azov Sea, but due to high cost of drilling the offshore wells, iodine had not been extracted from the reservoir. The growing demand of Ukraine for iodine is met by its import from the producing countries. The rate of consolidated sediments accumulation in Krukenitsk depression of the Sarmatian basin reached 1 cm/year, and its current thickness is 6 (!) km. Formation waters from wells overfilled from flow rates up to 300 m3/d. The layers of oligomictic and polymictic sandstones with carbonaceous cement thickness up to 5 m, porosity up to 26 %, permeability –10 mD and carbonate content level up to 20 % serve as reservoirs of formation waters in Sarmatian molasses. There are no records of regularities in change of iodine content in waters of Krukenitsk depression; iodine concentration in Chop-Mukachevo depression increases to the southwest from the axis of the Vihorlat-Gutin Area. Iodinated waters contain dissolved hydrocarbon gas in small volumes with a methane content of up to 92 %. The iodine resources estimated within the studied areas of 15 km2 at Krukenitsky depression and 10 km2 at Chop-Mukachevo depression, allow its profitable commercial production for more than 50 years. Waste formation waters will be disposed through available highly permeable aquifers. In order to perform iodine production feasibility evaluation, further formation water study and detailed iodine compounds analyses are needed.

Iodine Status and Thyroid Functions of Turkish and Syrian Mother-Newborn Dyads in a County of Istanbul

Background: Inappropriate iodine intake can result in thyroid disorders in mothers and newborns in addition to their adverse effects on prenatal and postnatal developmental processes. Determination of median urinary iodine concentration (MUIC) is an established tool for monitoring of iodine nutrition. Aim: The aim of this cross-sectional study was to investigate iodine status by measuring the MUIC and serum TSH and free T4 levels of Turkish and Syrian mother-newborn dyads in a county of Istanbul. Methods: In a tertiary care center, in the Turkish and Syrian, low-risk, term-pregnant mothers and their newborns, urine samples were collected from mothers and newborns within first 24 hours after birth. For the measurements of TSH and free T4, blood samples were obtained from mothers at admission to labor and delivery unit and from newborns on day 5 of neonatal life. Results: In the study population of mothers, mild iodine deficiency was more prominent with an incidence of about 18%, followed by moderate and severe forms with an incidence of about 5% and 0.5%, respectively. Turkish and Syrian mothers had similar incidence of mild, moderate, and severe iodine deficiencies. The incidence of iodine deficiency of newborns were 41%. Overall, in the Turkish and Syrian participants, there were no prominent correlations between the MUICs of mothers and newborns. Regarding serum TSH and free T4 levels, the median TSH concentration of Turkish mothers was significantly lower (p 0.05). Considering TSH values of newborns, in 40 of them, there was higher TSH values requiring attention during neonatal follow-up. They had mild and moderate but not severe form of TSH elevation. Conclusion: Despite the mandatory salt iodization and official health care support for all mothers and newborns, daily iodine supplementation during pregnancy and breastfeeding seems to be a helpful measure to prevent the adverse effects of iodine deficiency to newborns and children. Funding Statement: This study was supported by a grant of Turk Pediatri Kurumu Dernegi (the Association of Turkish Pediatrics Institution). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Association of Turkish Pediatrics Institution. Declaration of Interests: The authors declare that they have no conflict of interest. Ethics Approval Statement: The study was approved by the Human Research Ethics Committee (Registry No. 464). All participants provided written informed consent.

Iodine deficiency disorders as a non-infectious epidemic: a look at the problem at the tome of COVID-19 pandemic

Radioactive iodine, flying out of the destroyed reactor of the Chernobyl nuclear power plant, like a corona virus quickly spread throughout Europe. Iodine deficiency in the regions of Ukraine, Belarus and Russia adjacent to nuclear power plants became a factor in increased uptake of radioactive iodine by the thyroid gland in children and after 5 years led to an epidemic of thyroid cancer. Optimal iodine intake could become a kind of vaccination, which sharply reduces the risk of developing thyroid cancer, as has happened after the accident at the Fukushima nuclear power plant in Japan. Endemic goiter was eliminated 50 years ago, but returned to the country in the early 1990s after the collapse of iodized salt production and has not been eliminated to this day due to the lack of a legislative framework for mandatory salt iodization. The actual average consumption of iodine by residents of Russia is from 40 to 80 mcg per day, which is 23 times less than the recommended norm. Mild and moderate iodine deficiency was detected throughout the Russian Federation, and it is more typical for the the rural population. The iodine deficiency has the greatest negative effect on the psychomotor development of the child during the critical period the first 1000 days of life from the moment of conception to the end of the second year of life. According to WHO, over the past 20 years, iodine deficiency has been eliminated in 115 countries of the world, and the number of iodine-deficient countries has dropped to 25, but Russia is still among them. We believe that after the COVID-19 pandemic, it will no longer be necessary to prove the need for effective support for the prevention of both infectious and non-infectious diseases, and the declared preventive direction of Russian medicine will indeed become such.

Modern Problems of Food Security and Nutrition in Russia

The most important target indicators of food security in Russia are rational norms of food consumption and norms of physiological demand for energy and nutrients on average per person. An analysis of actual consumption shows that the diet of Russians is unbalanced and there is a deterioration in the quality of the diet in a number of positions, especially noticeable negative changes occurred after 2014 as a result of the introduction of the food embargo, the devaluation of the ruble and the subsequent decline in household incomes and effective demand for food. Unbalanced diet is one of the main reasons for the increasing prevalence in Russia of overweight and obesity, anemia, iodine and other micronutrients deficiency, diabetes, high prevalence of high blood pressure. In this regard, it is necessary to take policy measures in the area of nutrition, in particular, improving the system of assessing the quality of nutrition of population, to implement mandatory salt iodization, and fortification of bread with vitamins and minerals, implement a program of domestic food aid, including in the area of school meals and, in particular, the implementation the "school milk" programs, aimed at ensuring all children of preschool and school age free milk in accordance with the recommendations for healthy nutrition in educational institutions, as well as measures to inform the population and promote education in the field of healthy nutrition. In modern conditions of the pandemic and overcoming its consequences, the relevance and importance of food aid, which should mitigate the deterioration of the economic situation and the decrease in incomes, are increasing. In addition, recent events show that healthy nutrition is a significant factor in the resistance of the COVID-19 pandemic, from which humanity does not yet have vaccines and specific medicines.

Memories of the future

With bated breath we follow the fate of the long-suffering law On the prevention of diseases caused by iodine deficiency. What can be expected in terms of improving public health after the adoption and successful implementation of this bill, which provides for the enrichment with iodine of edible salt of extra, higher and first varieties, grinding No. 0 and No. 1? In addition, in the production of bakery products, the recipe of which contains edible salt, the use of iodized salt will become mandatory. According to the experience of many near and far countries, within 23 years from the start of the program of mandatory salt iodization, one can expect a significant (at times) reduction in the incidence of endemic goiter. This trend will not exhaust itself in subsequent years. In the medium term (after about 10 years), a decrease (by half or more) in the incidence of thyrotoxicosis can also be expected in Russia. However, in the short term (57 years), a transient increase in the incidence of thyrotoxicosis in people over 60 years of age is possible, which can be considered a kind of payment for the previous iodine deficiency. The trend towards an increase in the incidence of subclinical and, possibly, manifest hypothyroidism may continue, but this will not be a consequence of an increase in iodine supply. Optimization of iodine intake against the background of mandatory salt iodization should reduce the frequency of transient disorders of thyroid function in newborns and, possibly, congenital hypothyroidism.

Salt iodization decreased the risk of thyrotoxicosis in Denmark by the halve

The status of iodine nutrition is a key factor in determining the prevalence of thyroid disorders in adults. The study under discussion provides data on the change in the incidence of nosological subtypes of overt thyrotoxicosis and hypothyroidism in adults during an increase in iodine intake after the introduction of mandatory salt iodization in Denmark. The authors carefully studied the case histories of all new patients with thyrotoxicosis and hypothyroidism registered in 2014–2016 in an open cohort of the population of Northern Jutland (n = 309,434), in which a moderate iodine deficiency has historically been observed and compared with incidence rates in 1997–1998 years before introduction of mandatory salt iodization began 2001. Over this period of time, iodine intake almost doubled. At the same time, the incidence rate of confirmed overt thyrotoxicosis significantly decreased: from the initial rate of 97.5 cases per 100,000 people per year in 1997–2000 to 48.8 cases per 100,000 people per year in 2014–2016. This result was due to a significant decrease in the incidence of multinodular toxic goiter, toxic adenoma and Graves’ disease in all age groups in both women and men. Moreover, the overall incidence of primary overt hypothyroidism has not changed.

Salt iodization halves risk ofthyrotoxicosis in Denmark.

A study in Danish adults over the period 1997–2016 reports a 50% reduction in thyrotoxicosis caused by multinodular toxic goiter, solitary toxic adenoma or Graves disease after the introduction of mandatory salt iodization. During the same period, there was no significant increase in overt hypothyroidism.

Never have been and here again…

The discussion in this column is not about legislation but about issues that are closer to the readership. What products mainly provide for the need of the human body in iodine in Russia and other (near and far) countries of the world? For example, is there such a substance as an “optimal thyroid diet” and how can it be achieved both by healthy people and patients with thyroid disorders? Unlike North America, Australia and New Zealand, the Scandinavian and some other European countries, dairy products are not the main sources of iodine in the diet of the Russian population. There are not so many of these sources, let alone their availability and price. Even the high iodine content in feijoa is proven fake. And what will happen to our “thyroid” diet, when, finally, Russia will adopt a law on mandatory salt iodization? If everything goes as planned, in a few years, bakery products will become the main source of iodine in our diet, and the daily intake of iodine due to the use of iodized salt in baking will increase by an average of 80–100 mcg per day. Then the dream of an “optimal thyroid diet” will come true even without expensive seafood and amazing feijoa.