Iodized Research Articles

Household Consumption of Adequately Iodized Salt: A Multi-Country Analysis of Socioeconomic Disparities.

Despite global efforts to promote universal salt iodization, iodine deficiency remains a public health issue in developing countries. This study assessed the proportion and sociodemographic characteristics of households consuming adequately iodized salt in 49 low- and middle-income countries. Data from DHS surveys of 49 low- and middle-income countries (2005-2021) were used to analyze household iodized salt prevalence. R version 4.0 was employed for statistical analyses. A random-effects meta-analysis was conducted to estimate overall and regional prevalence. We found that 83.4% of households consume adequately iodized salt, although with high heterogeneity (I2 = 100.0%). The East Asia and Pacific and the Europe and Central Asia regions showed high consumption rates of 87.6% and 87.7%, respectively, while Latin America and the Caribbean presented a significantly lower proportion of 30.8%. The study highlights the need for enhanced public health strategies to increase iodized salt consumption, especially in low-income and rural households. Addressing disparities in access, education, and affordability is crucial for improving iodine intake and preventing deficiency disorders, particularly among vulnerable populations like children and pregnant women.

Iodine Nutritional Status and Thyroid Autoimmunity in Chinese Children and Adolescents Aged 6-17 Years.

Background: Thyroid autoimmunity (TAI), marked by thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb), affects over 10% of the general population, with children and adolescents experiencing significant impacts on growth and quality of life despite lower prevalence rates compared to adults. Methods: In the context of over 20 years of universal salt iodization (USI) in China, this study investigated the relationship between iodine nutritional status and TAI in children and adolescents aged 6-17. Results: Our findings suggest that while iodine levels are generally sufficient (median urinary iodine concentration [UIC] was 205.2 µg/L), TAI remains a significant concern due to its potential impact on growth and development. TAI was significantly associated with age, sex, and urban-rural residency (p < 0.05). Positive TPOAb and TgAb were identified as risk factors for subclinical hypothyroidism (OR = 2.274, 95% CI: 1.171-1.916). Although some literature suggests that excessive iodine may exacerbate TAI and others propose iodine deficiency as a risk factor, this study did not find a significant overall association between iodine status and TAI. Notably, a low urinary iodine-to-creatinine ratio (UI/Cr) level was linked to an increased risk of TgAb positivity in males (OR = 3.470, 95% CI: 1.200-10.036). In individuals with negative thyroid antibodies, increased BMI (OR = 1.062, 95% CI: 1.032-1.093) and high UI/Cr levels (OR = 1.510, 95% CI: 1.175-1.941) were risk factors for subclinical hypothyroidism, whereas older age (OR = 0.710, 95% CI: 0.555-0.908 for the age 9-11 group; OR = 0.681, 95% CI = 0.484-0.959 for the age 12-17 group) and high UIC levels (OR = 0.739, 95% CI: 0.554-0.985) were associated with reduced risk. No significant associations were observed in the thyroid antibody-positive group. Conclusions: These results highlight the importance of considering individual TAI status when devising iodine supplementation policies.

Iodine status and knowledge among pregnant and lactating women in Large City in Northern China after nearly 30years of the universal salt iodization.

With the implementation of the universal salt iodization, the iodine nutrition for children and adults has been appropriate, but pregnant women are still at risk of iodine deficiency. It is of great public health significance to explore the iodine status and knowledge, and influence factors and the appropriate health education methods among pregnant and lactating women. From January 2022 to December 2023, at least 50 pregnant women and 50 lactating women were randomly selected from the resident population annually in 16 districts of Tianjin, North China. A total of 1671 pregnant women and 1658 lactating women were recruited. All participants' households salt and random urine samples were collected. A questionnaire was conducted to collect data on iodine related knowledge and behaviors as well as needs of health education from all participants. Logistic regression models were constructed to analyze the factors affecting the iodine related knowledge level. We used the Rasch model and the quadrantal graph to analyze the participants' knowledge level on different iodine-related questions and their needs for health education. The median urine iodine concentration (UIC) of pregnant and lactating women in Tianjin were 152.40 μg/L and 124.60μg/L. In some districts, the median UIC of pregnant and lactating women below the appropriate range. The iodized salt coverage rate of pregnant and lactating women in Tianjin was 76.12% and 77.40%, respectively. In pregnant and lactating women who did not actively supplement with iodine, the median UIC in those who consumed non-iodized salt were significantly lower than that in those who consumed iodized salt (139.26μg/L and 154.40μg/L, P = 0.044; 94.60μg/L and 123.80μg/L, P < 0.001). Compared with the low knowledge score group, pregnant women in the high knowledge score group had a higher proportion of iodized salt consumption (71.25% and 78.05%, P = 0.003), and pregnant and lactating women in the high knowledge score group had a higher proportion of actively supplement iodine (44.61% and 55.34%, P < 0.001; 39.26% and 49.78%, P < 0.001). Health education may be the main factor affecting the iodine related knowledge scores for pregnant and lactating women, with adjusted odds ratios (OR) and 95% confidence intervals (CI) of 2.89 (2.30, 3.62) and 2.46 (1.97, 3.07), respectively. Pregnant and lactating women are most expected to acquire knowledge through healthcare professionals (72.11%) and wechat/website (74.91%), respectively. Pregnant and lactating women in some areas of Tianjin are at risk of iodine deficiency. Iodized salt consumption is an important way to ensure iodine nutrition of the population, and the lack of iodine related knowledge is an important factor affecting the consumption of iodized salt. Health education in different ways can be carried out for different people to improve the acceptance and efficiency of health education.

Quantitative determination of iodine content in iodized table salt marketed in Jordan as an indicator of compliance with national salt iodization standards: A cross-sectional study

Iodine deficiency (ID) is a significant global public health issue, particularly affecting low-income countries. The iodization of salt is a widely adopted method to prevent iodine deficiency. This study aimed to assess the iodine content of iodized salt at the market level in various cities within the Hashemite Kingdom of Jordan (HKJ). We collected 152 salt samples from 24 different brands across three cities in Jordan: Amman, Zarqa, and Mafraq. The analysis was conducted using a titration method. The mean iodine content in salt samples varied by city, with values of 5.45 ppm in Mafraq, 10.33 ppm in Amman, and 13.22 ppm in Zarqa, ranging from 0 to 36 ppm. Significant differences in iodine concentration were observed within the same city across different brands (P ≤ 0.05). Additionally, variations were noted in iodine content for samples from the same brand collected in different cities, and even among samples from the same brand at the same location. Of the 152 samples evaluated, an average of 76.5% had iodine levels below the 15 ppm recommended by UNICEF. There was considerable variation in mean iodine content among brands, cities, and even within samples of the same brand. This indicates that the salt iodization process requires ongoing monitoring, and the government should enhance efforts to oversee the iodization process and improve the accessibility and utilization of iodized salt.

Agronomic Biofortification of Plants with Iodine and Selenium: A Potential Solution for Iodine and Selenium Deficiencies.

Iodine and selenium deficiencies are widespread both in developed countries and developing countries. The soil is the fundamental source of iodine and selenium for plants, and iodine and/or selenium-depleted soil restrains the cultivation of crops to cover recommended daily intakes of iodine and selenium. Although food fortification strategies, including salt iodization, increase the dietary intake of these minerals, their global deficiencies have not been eliminated. Therefore, new strategies have been developed to prevent iodine and selenium deficiencies, and biofortification is one of them. The aim of this review is to assert the outcomes of the studies that investigate the optimum conditions for biofortification with iodine and selenium and to recognize the role of biofortification practices as a potential solution for preventing iodine and selenium deficiencies. The findings of studies show that biofortification with iodine and selenium can be a solution for iodine and selenium deficiencies. Agronomic biofortification is currently a more convenient method to increase selenium and iodine contents in plants. However, the most effective agronomic biofortification conditions are crucial to acquire biofortified food. Moreover, increasing the awareness of the producers and consumers on biofortification has a determinative role in the achievement of biofortification practices for human health. Although research about iodine and selenium biofortification has been increased, the effectiveness of biofortified foods to meet recommended daily intakes is still unknown. More research is needed to understand most effective biofortification conditions for plants and bioavailability of biofortified foods for humans.

Salt Reduction and Iodine Fortification Policies Are Compatible: Perspectives for Public Health Advocacy.

Cardiovascular diseases account for almost 18 million deaths annually, the most of all non-communicable diseases. The reduction of dietary salt consumption is a modifiable risk factor. The WHO recommends a daily sodium intake of <2000 mg but average consumption exceeds this in many countries globally. Strategies proposed to aid effective salt reduction policy include product reformulation, front of pack labelling, behavioural change campaigns and establishing a low-sodium-supportive environment. Yet, salt for household and processed food use is, in countries wholly or partially adopting a universal salt iodisation policy, the principal vehicle for population-wide iodine fortification. With salt reduction policies in place, there is concern that iodine deficiency disorders may re-emerge. Recognising the urgency to tackle the rising prevalence of NCDs yet not risk the re-emergence and detrimental effect of inadequate iodine intakes, this review lays out the feasibility of integrating both salt reduction and salt iodine fortification strategies. Reducing the burden of health risks associated with an excessive sodium intake or inadequate iodine through population-tailored, cost-effective strategies involving salt is both feasible and achievable, and represents an opportunity to improve outcomes in public health.

Dietary Iodine Intake and Sources among Residents in Zhejiang Province 10 Years after Reducing Iodine Concentration in Iodized Salt.

We aimed to assess dietary iodine intake and sources in Zhejiang Province a decade after a reduction in iodine concentration in iodized salt. Three-day 24 h dietary recall and household weighing were used, complemented by "Chinese Food Composition" data. Household water and salt samples were collected from 5890 residents and analyzed. Differences in iodized salt consumption rates were observed across the following regions: inland (84.20%), subcoastal (67.80%), and coastal (37.00%) areas. The median (P25, P75) iodine concentration in water and diet were 2.2 (0.9, 4.0) μg/L and 142.05 (58.94, 237.11) μg/d, respectively, with significant regional differences in dietary concentration (inland [185.61 μg/d], subcoastal [153.42 μg/d], and coastal [75.66 μg/d]). Males (149.99 μg/d) and iodized salt consumers (191.98 μg/d) had a significantly higher dietary iodine intake than their counterparts. Regions were ranked as follows based on the proportions of individuals meeting the recommended dietary iodine intake: inland (69.40%), subcoastal (56.50%), and coastal (34.10%) areas. Dietary sources included salt (48.54%), other foods (32.06%), drinking water (8.84%), laver (4.82%), kelp (3.02%), and other seafood (2.32%). The qualified iodized salt consumption rate was significantly lower than the national standard. Zhejiang Province should continue implementing measures to control iodine deficiency through salt iodization, education efforts, and increasing the qualified iodized salt consumption rate.

A survey on the management practices of graves’ disease by Egyptian physicians and a comparison to similar reports from USA, Italy, China, and Brazil

BackgroundGraves’ disease is the commonest cause of hyperthyroidism in iodine replete areas. Following universal salt iodization, most Egyptians are considered iodine sufficient. The present study aims to report a survey of real-life practices in the management of graves’ disease among Egyptian physicians and compare them to other similar reports.MethodsAn online survey was sent to members and affiliates of Alexandria thyroid association. Egyptian physicians were surveyed about initial diagnostics workup, management of an index case of uncomplicated graves’ disease not desiring pregnancy. Two modified scenarios were proposed to the index case to survey the impact on treatment preferences. Anonymous responses were collected, analyzed, presented, and compared to other published similar reports.ResultsSixty-eight participated out of 120 invited physicians (56.67%). Initial workup included TSH receptor antibodies 46/68 (67. 6%), thyroid ultrasound 45/68 (66.2%), and thyroid scintigraphy 25/68 (36.8%). Treatment preferences in the index case were antithyroid drugs (ATD’s) 52/68 (76.5%), radioiodine 12/68 (17.5%), and surgery 4/68 (6%). Compared to other reports, treatment preferences were almost identical to Italian ones, ATD’s (77.1%), radioiodine (16.2%), and surgery (4.5%). If the patient is complicated with graves’ orbitopathy, treatment preferences would change into ATD’s 37/67 (55%), radioiodine 1/67 (2%), radioiodine with corticosteroids 14/67 (21%), and surgery 15/67 (22%). If the patient is desiring pregnancy, treatment preferences would be ATD’s 32/68 (47%), radioiodine 5/68 (7.4%), and surgery 31/68 (45.6%).ConclusionA high participation rate was observed. Similar to other reports, medical treatment is the preferred modality of treatment in graves’ disease and surgery is the least utilized modality. Similar treatment preferences to Italians were observed in the index case.

Prevalence of iodine deficiency and associated factors among school-age children in Ethiopia: a systematic review and meta-analysis

BackgroundCurrently, iodine deficiency has become a significant burden globally; where 2 billion people and 29.8% of school-age children are iodine deficient. It is a leading cause of preventable brain damage among children, resulting in impaired cognitive and motor development. Even though salt iodization was started to be implemented to alleviate this burden in Ethiopia, primary studies assessing iodine deficiency in the country show highly variable findings, and no systematic review was conducted to determine the pooled prevalence of the problem which makes it difficult to assess the effect of the intervention as well as to design appropriate and timely measures. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of iodine deficiency and the common factors affecting its occurrence among school-age children in Ethiopia.MethodTo obtain the eligible studies, databases (EMBASE, Scopus, Hinari, and PubMed), websites (Google and Google Scholar), and references of the eligible studies were searched systematically. Data were extracted using an Excel spreadsheet and analyzed using the STATA 17 version. The I2 test was used to assess heterogeneity between the studies. A DerSimonian and Laird random-effects model was used to estimate the pooled prevalence and pooled odds ratio. A funnel plot and Egger’s test were used to detect publication bias.ResultA total of 15 eligible studies, representing 15,611 school-age children, were included in the systematic review and meta-analysis. The pooled prevalence of iodine deficiency among school-age children in Ethiopia was found to be 58% (95%CI 44.00–77.00), while the highest prevalence was recorded in the Oromia Region, which was 64% (95% CI 49–79). Goitrogenic food consumption (adjusted odds ratio (AOR) 2.93, 95% CI 1.60–5.35) and being female (adjusted odds ratio (AOR) 1.87, 95% CI 1.43–2.44) showed a significant association with the prevalence of iodine deficiency.ConclusionIodine deficiency among school-age children in Ethiopia was noticeably high. Goitrogenic food consumption and the sex of the child were determinant factors for the occurrence of iodine deficiency among the children. Therefore, appropriate advice should be given to households to limit goitrogenic foods in the diet of their children by giving due attention to their female children.

Evaluation of Iodine and Goitrogens in Selected Vegetables from Owerri Imo State in Nigeria

The prevalence of iodine deficiency disorders remains a challenge in numerous developing nations despite widespread advocacy for iodized salt and iodine-fortified foods. As a result, this study assesses the iodine content of ten selected vegetables—water leaf, okra, green, tomatoes, lettuce, “okazi”, “ugu”, cabbage, “uha” leaf, and garden egg leaf. The result revealed varying iodine concentrations among these vegetables: 159.93±2.25 μg/kg for water leaf, 151.27±1.61 μg/kg for okra, and 160.43±4.37 μg/kg for green. Tomatoes exhibited 110.10±2.76 μg/kg, while lettuce had 181.27±1.76 μg/kg. “Okazi”, “ugu”, cabbage, “uha” leaf, and garden egg leaf showed iodine levels of 155.10±3.50 μg/kg, 153.43±2.47 μg/kg, 96.10±2.00 μg/kg, and 127.77±3.01 μg/kg, respectively. The evaluation for goitrogens demonstrated sufficient presence in these vegetables, with notable exceptions such as zinc, which was found in lower concentrations in “ugu”, lettuce, “okazi”, and cabbage, and was absent in “uha” leaf, garden egg leaf, green, water leaf, and okra. Based on these results, it was concluded that Owerri's vegetables exhibit relatively high iodine content within recommended dietary allowances. Consequently, ongoing vigilance is advised for the salt iodization program to prevent excess iodine intake, particularly among high-risk populations.

Assessment of Household Coverage of Iodized Salt and Measurement of Salt Iodine Content

Сравнительный анализ «ожидаемого» охвата населения йодированной солью (вторичные данные) и фактического охвата домохозяйств (первичные данные) показал, что ежегодный ожидаемый охват населения йодированной солью оставался стабильным в течение последнего десятилетия, при этом снижение внутреннего производства компенсировалось ростом импорта. Только 5,7% всех проб поваренной соли, взятых в 210 домохозяйствах на 7 полевых участках, были нейодированными и только 2% содержали &lt;15 мг/кг йода, в то время как более 92% были адекватно йодированы (&gt;15 мг/кг йода). Средняя концентрация йода в 198 пробах соли составила 32,8 мг/кг, то есть находилась в пределах национального стандарта. Принимая во внимание полученные на основе дополнительной информации данные, согласно которым наблюдается стабильно высокий «ожидаемый» охват населения йодированной солью, а также результаты статистически репрезентативных обследований охвата домохозяйств йодированной солью, можно сделать вывод, что установление факта охвата домохозяйств адекватно йодированной солью в Армении в 2023 году на уровне 92,3% является достаточно надежным результатом. Стоимость «пилотного» внедрения подхода FORTIMAS в качестве начального этапа «ежегодного» мониторинга и эпиднадзора за программой йодированной соли в Армении составила лишь часть стоимости общенационального репрезентативного исследования йодирования соли и статуса йодного питания населения. Поскольку в рамках этого проекта была разработана общая структура потенциальной «Системы FORTIMAS Армении», можно предположить, что в будущем в Армении можно будет проводить около 10 ежегодных раундов мо-ниторинга и эпиднадзора за программой йодирования соли, за ту же стоимость, что и одно национально репрезентативное исследование программы йодирования соли. Յոդացված աղով բնակչության «սպասվող» ծածկույթի (երկրորդային տվյալներ) և տնային տնտեսությունների փաստացի ընդգրկվածության (առաջնային տվյալներ) համեմատական վերլուծությունը ցույց է տվել, որ յոդացված աղով բնակչության սպասվող ծածկույթի տարեկան ցուցանիշը վերջին տասնամյակում մնացել է կայուն. ներքին արտադրության նվազումը փոխհատուցվել է ներկրման ավելացմամբ: 7 դետքային տեղամասերի 210 տնային տնտեսություններից վերցրած կերակրի աղի բոլոր նմուշների միայն 5,7%-ն է եղել չյոդացված, և միայն 2%-ն է պարունակել &lt;15 մգ/կգ յոդ, մինչդեռ 92%-ից ավելին եղել է համարժեք յոդացված (&gt;15 մգ/կգ յոդ): Աղի 198 նմուշներում յոդի միջին խտությունը կազ-մել է 32,8 մգ/կգ, այսինքն՝ գտնվել է ազգային ստանդարտի սահմաններում: Հաշվի առնելով լրացուցիչ ինֆորմացիայից ստացված տվյալները՝ համաձայն որոնց հետևողականորեն առկա է յոդացված աղով բնակչության «սպասվող» բարձր ծածկույթ, նկատի ունենալով նաև յոդացված աղով տնային տնտեսությունների ընդգրկվածության վիճակագրորեն ներկայացուցչական հետազոտությունների արդյունքները՝ կարելի է եզրակացնել, որ 2023 թվականին Հայաստանում որակյալ յոդացված աղով տնային տնտեսությունների 92,3% ընդգրկվածության բացահայտումը բավականին վստահելի արդյունք է: ՖՈՐՏԻՄԱՍ մոտեցման «պիլոտային» իրականացման արժեքը՝ որպես Հայաստանում յոդացված աղի ծրագրի «տարեկան» մոնիթորինգի և էպիդհսկողության սկզբնական փուլ, կազմել է աղի յոդացման և բնակչության յոդային սնուցման կարգավիճակի ազգային ներկայացուցչական հետազոտության արժեքի միայն մի մասը: Քանի որ «Հայաստանի ՖՈՐՏԻՄԱՍ համակարգի» ընդհանուր շրջանակը մշակվել է այս նախագծի շրջանակներում, կարելի է կանխատեսել, որ ապագայում Հայաստանում կարող է իրականացվել աղի յոդացման ծրագրի մոնիթորինգի և էպիդհսկողության առնվազն10 տարեկան փուլ մոտավորապես նույն գնով, ինչ աղի յոդացման ծրագրի ազգային ներկայացուցչական հետազոտությունը:

Indian Thyroid society expert consensus on salt Iodisation

ABSTRACT Iodine, an essential micronutrient, is crucial for the production of thyroid hormones - triiodothyronine(T3) and thyroxine(T4). Thyroid hormones regulate the optimum mental development, physical growth and development, regulation of body metabolism, heat generation, and maintenance of body temperaturein an individual. Geological processes like flooding, soil erosion, deforestation, and rivers changing course, deplete the surface soil of iodine, as it is present in the top layers of soil and easily soluble in water. As a result, the population residing in the area with iodinedeficient soil, becomes susceptible to a spectrum of functional and developmental abnormalities due to dietary deficiency of iodine. Universal Salt Iodization (USI) for prevention of IDDs in India is a public health success story. The adoption of the salt iodization strategy serves as a textbook example of the journey of an intervention through the iterative loop of research to policy to programme. Salt iodization has proved to be a safe, accessible, available, affordable, and cost-effective strategy to address the burden of IDDs in India. India has been at the forefront of the efforts to control IDDs globally. India is on its way to achieving the target of &gt; 90 percent household coverage of adequately iodized salt. Revised Food Safety and Standards (Fortification of Foods) Regulations released in 2019 introduced an upper limit for iodine concentration in salt, the adequate iodine level required at the production and consumer level, including the distribution channel at 15 – 30 ppm. Universal Salt Iodisation (USI) is India's public health success story. There is a need to consolidate progress so far and focus on strategy to reach the “last mile”. Sustainable elimination of Iodine Deficiency Disorders (IDDs) with Universal Salt Iodisation (USI) being the primary strategy needs to also factor in harmonisation with salt reduction strategy for control of non-communicable diseases.

Changing trends in the global, regional, and national burden of iodine deficiency among adolescents and young adults: population-based study.

Globally, the iodine deficiency burden among adolescents has substantially decreased since 1990; however, low-SDI countries still bear a great burden. Implementation measures and monitoring systems should be strengthened to reduce the iodine deficiency burden, especially among adolescents. • Iodine deficiency can cause severe or irreversible developmental disorders, particularly in adolescents and young adults. • Universal Salt Iodization was implemented for ensuring appropriate iodine intake. • We found substantial declines in the prevalence rates of iodine deficiency among adolescents during the past three decades. Globally, the disability-adjusted life-year rate of iodine deficiency among adolescents decreased from 56.17 in 1990 to 35.38 in 2019. • Iodine deficiency among adolescents in low- sociodemographic index countries still bear a great burden.

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.

Impact of use of iron fortified iodised salt beyond 12 months on haemoglobin levels

Background: Use of iron fortified iodised salt (IS) for 12 months, resulted in improvement in haemoglobin (Hb) in women, children and men. There is no published data on impact of DFS use beyond 12 months on Hb levels. Methods: A community based open randomised study to assess impact of use of DFS on Hb was discontinued after 12 months due to COVID 19 related lockdown. These families used IS for six months during lockdown; they were willing to continue using the salt provided for further one year. These families were re-randomized into three groups and given the assigned salt for further 12 months and Hb, ferritin and C-reactive protein (CRP) were estimated at 12 months. Results: Improvement in the mean Hb was 0.5 g/dl in women who had used IS earlier and DFS under second randomisation and 0.3 g/dl in those who had used DFS under first and second randomisation. Mean Hb at 30 months was higher in those who had used DFS for 24 months as compared to those who had used IS for 18 months and DFS for 12 months. The deterioration in mean Hb following discontinuation of DFS for 6 and 18 months was small. Conclusions: DFS use for the second year resulted in a further increase in Hb in those who had used DFS earlier. The relatively small deterioration in mean Hb following discontinuation of DFS might at least be in part due to the impact of nutrition and health education and access to health and nutrition services.

Iodine Status in Cyprus and Neighboring Countries: A Review Article.

Despite the implementation of global iodine supplementation initiatives in the past decade, the problem of iodine deficiency persists as a significant public health concern in numerous countries. Although cretinism is now rare in developed countries, iodine deficiency can still lead to less severe cognitive deficits, which can negatively impact academic achievement, intellectual capacity, and work productivity. There is a scarcity of studies regarding the status of Cyprus, and the global database does not have any information pertaining to the prevalence of iodine deficiency in Cyprus. The geographical setting of the research is of importance as it pertains to the separation of Cyprus into two distinct areas. One region is predominantly inhabited by Greek Cypriots, where the practice of salt iodization is not mandatory. Conversely, the other region is primarily inhabited by Turkish Cypriots, who may potentially experience higher amounts of iodine contact due to their reliance on food imports from Turkey, where salt-iodisation is compulsory. The main objective of this study is to provide an overview of recent research conducted on the prevalence of iodine deficiency in Cyprus and neighboring Mediterranean nations. In this study, we assess the current method and subsequently offer public health recommendations for future research endeavors.

Detecting iodine deficiency risks from dietary transitions using shopping data

Plant-based product replacements are gaining popularity. However, the long-term health implications remain poorly understood, and available methods, though accurate, are expensive and burdensome, impeding the study of sufficiently large cohorts. To identify dietary transitions over time, we examine anonymised loyalty-card shopping records from Co-op Food, UK. We focus on 10,626 frequent customers who directly replaced milk with alternative milk. We then use product nutritional information to estimate weekly nutrient intake before and after the transition. 83% who converted to alternative milk saw a fall in iodine (44%), calcium (30%) and vitamin B12 (39%) consumption, with 57% reducing iodine purchase by more than 50%. The decline is even higher for those switching dairy and meat products. Our findings suggest that dietary transitions - such as replacing milk with alternative milk - could lead to nutritional deficiencies, notably iodine, which, if not addressed, may represent a significant public health concern, particularly in countries which do not mandate salt iodisation.

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.

Trend analysis of thyroid carcinoma incidence: a retrospective analysis of 2705 cases from an endemic goiter region Runnig title: Trend analysis of thyroid carcinoma an endemic goiter region

Introduction: To provide further data from a population with different genetic background for the contrary views on the ensuing question of “whether iodine status influence the onset and course of thyroid cancer (TC)” by examining trends in TC incidence and prevalence of main sub types of TC in a population from formerly iodine deficient geographic area in Turkey. Methods: Data were retrieved for 2,705 patients (2,161 female, 544 male) who were diagnosed with histopathologically confirmed thyroid cancer at Karadeniz Technical University Farabi Hospital, a university hospital serving a geographic region which remains an endemic goiter area and was formerly iodine-deficient, shortly after mandatory national salt iodization, between 2000 and 2018. Age, gender, subtype, tumor size, stage, and the changes and trends over the years were retrospectively evaluated. Results: Thyroid cancer rates had a trend of increase from 2000 to 2012 and then began to decline. In our region, PTC is more prevalent (93.5%). Among all thyroid cancers, the ratio of micro papillary thyroid cancer (mPTC) is 46.5%, FTC is only 3.5%. mPTC (tumor size ≤10 mm) (49.8%) and macroPTC (tumor size &gt;10 mm) (50.2%) are approximately equal in proportion, and these ratios remained similar over the years covered in this analysis. Stage I PTC is 95.3%. M0 PTC is %98.9. Conclusion: Data from this retrospective epidemiologic study indicates that the rate of PTC is notably high and TC may have a more benign course in our endemic goiter region probably due to iodine supplementation that may affect late-stage thyroid carcinogenesis.

Evaluation of the Universal Salt Iodization (USI) surveillance system in Tanzania, 2022.

The evaluation of surveillance systems has been recommended by the World Health Organization (WHO) to identify the performance and areas for improvement. Universal salt iodization (USI) as one of the surveillance systems in Tanzania needs periodic evaluation for its optimal function. This study aimed at evaluating the universal salt iodization (USI) surveillance system in Tanzania from January to December 2021 to find out if the system meets its intended objectives by evaluating its attributes as this was the first evaluation of the USI surveillance system since its establishment in 2010. The USI surveillance system is key for monitoring the performance towards the attainment of universal salt iodization (90%). This evaluation was guided by the Center for Disease Control Guidelines for Evaluating Public Health Surveillance Systems, (MMWR) to evaluate USI 2021 data. The study was conducted in Kigoma region in March 2022. Both Purposive and Convenient sampling was used to select the region, district, and ward for the study. The study involved reviewing documents used in the USI system and interviewing the key informants in the USI program. Data analysis was done by Microsoft Excel and presented in tables and graphs. A total of 1715 salt samples were collected in the year 2021 with 279 (16%) of non-iodized salt identified. The majority of the system attributes 66.7% had a good performance with a score of three, 22.2% had a moderate performance with a score of two and one attribute with poor performance with a score of one. Data quality, completeness and sensitivity were 100%, acceptability 91.6%, simplicity 83% were able to collect data on a single sample in < 2 minutes, the system stability in terms of performance was >75% and the usefulness of the system had poor performance. Although the system attributes were found to be working overall well, for proper surveillance of the USI system, the core attributes need to be strengthened. Key variables that measure the system performance must be included from the primary data source and well-integrated with the Local Government (district and regions) to Ministry of Health information systems.