Prevalence of goiter in children 6 to 12 years of age in Ethiopia

BACKGROUND: Iodine-deficiency disorders are a major public health problem in Ethiopia. In conjunction with implementing control programs, baseline information needs to be established. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.     

Progress in salt iodization and improved iodine nutrition in China, 1995--99

In 1993, the State Council of China announced the policy to virtually eliminate iodine-deficiency disorders (IDD) by 2000 and adopted universal salt iodization (USI) as the national strategy. Biennial province-based monitoring from 1995 onward aimed at capturing the use and iodine content of household salt, along with urinary iodine concentrations among schoolchildren from the same households. This paper reports on the progress made in China toward the goal of virtually eliminating iodine-deficiency disorders on the basis of 85 population-representative surveys in China's provinces during 1995--99. The percentage of households using adequately iodized salt (iodine > or = 20 mg/kg) increased from 43.1 % in 1995, to 82.2% in 1997, to 89.0% in 1999. In 1999, at least 90% of the households in 15 (48%) of the 31 provinces used adequately iodized salt, and a median urinary iodine concentration of less than 100 microg/L in children was reported in only one province. Across provinces, the median urinary iodine concentrations in children were positively correlated in each survey year with the median household salt iodine contents (combined r(s) = 0.74, p < .001) and with the proportions of households using adequately iodized salt (combined r(s) = 0.81, p <.001). Also in each survey year, the percentage of children with urinary iodine concentrations of at least 300 microg/L was correlated (combined r(s) = 0.69, p < .001) with the proportion of households using salt with iodine content of at least 40 mg/kg. The median urinary iodine concentration in children had reached 300 microg/L or more in 13 provinces (42%) by 1999. In a little more than five years, then, China has achieved outstanding progress toward the goal of virtual elimination of IDD through USI. Policy recommendations include improvement of quality assurance by salt manufacturers, along with a modest reduction in the mandated salt iodization levels.     

Thirty years of a ban on the sale of noniodized salt: impact on iodine nutrition in children in Himachal Pradesh, India

BACKGROUND: A survey conducted by the central iodine-deficiency disorders team in Himachal Pradesh, a state in the goiter-endemic belt of India, revealed that 10 of its 12 districts have an endemic prevalence of goiter. The survey was conducted to provide health program managers data to determine whether it would be necessary to initiate intervention measures. OBJECTIVE: To assess the status of urinary iodine excretion and household salt iodization levels after three decades of a complete ban on the sale of noniodized salt in this goiter-endemic state in India as measured by assessment of urinary iodine excretion levels and iodine content of salt at the household level. METHODS: The guidelines recommended by WHO/ UNICEF/ICCIDD for a rapid assessment of salt iodization were adopted. In each of the 12 studied districts, all senior secondary schools were enlisted and one school was selected by using a random sampling procedure. Two hundred fifty children 11 to 18 years of age were included in the study. Urine samples were collected from a minimum of 170 children and analyzed using the wet digestion method. Salt samples were also collected from a minimum of 170 children and analyzed using the spot testing kit. RESULTS: All districts had a median urinary iodine excretion level > 200 microg/L and 82% of the families were consuming salt with an iodine content of 15 ppm or higher. CONCLUSIONS: The results of the present study high-light the successful implementation of the salt iodization program in the state of Himachal Pradesh. This positive impact may be due to the comprehensive strategy adopted by the state government to improve the quality of salt, development of an effective monitoring information system and effective information, education, and communication activities.     

Assessment of the sustainability of the iodine-deficiency disorders control program in Lesotho

BACKGROUND: Evaluation of the sustainability of iodine-deficiency disorders control programs guarantees successful and sustained virtual elimination of iodine deficiency. The Lesotho universal salt iodization legislation was enacted in 2000 as an iodine-deficiency disorders control program and has never been evaluated. OBJECTIVES: To assess the sustainability of the salt iodization program in Lesotho, 2 years after promulgation of the universal salt iodization legislation. METHODS: The proportion to population size method of sampling was used in 2002 to select 31 clusters in all ecological zones and districts of Lesotho. In each cluster, 30 women were selected to give urine and salt samples and 30 schoolchildren to give urine samples. The salt samples were analyzed by the iodometric titration method, and the ammonium persulfate method was used to analyze the urine samples. The chairperson of the iodine-deficiency disorders control program was interviewed on programmatic indicators of sustainability. SAS software was used for statistical analysis of the data. RESULTS: The urinary iodine concentrations of very few children (10.1% and 21.5%) and women (9.8% and 17.9%) were lower than 50 microg/L and 100 microg/L, respectively. At the household level, 86.9% of the households used adequately iodized salt. Only four indicators of sustainability have been attained by the salt iodization program in Lesotho. CONCLUSIONS; Iodine-deficiency disorders have been eliminated as a public health problem in Lesotho, but this elimination is not sustainable. Effective regular monitoring of salt iodine content at all levels, with special attention to iodization of coarse salt, is recommended, together with periodic evaluation of the iodization program.     

Combating iodine deficiency: lessons from China,Indonesia, and Madagascar

This study investigated the factors contributing to a successful and sustainable elimination of iodine-deficiency disorders, drawing from salt fortification experiences in China, Indonesia, and Madagascar. Government officials, salt farmers, salt producers, and wholesalers were interviewed to collect data during field visits. Analyses used in the study include simple correlation, and wherever data permit, regression. The study found that measures crucial for combating iodine deficiency include raising public awareness of the disorders, ensuring easy access to iodated salt, promoting compliance in the salt industry, and monitoring and enforcement. Factors that ensure a reliable supply of iodated salt are equally important as those that create the demand for it. Governments must ensure that surveillance and enforcement mechanisms are functioning right from the time that salt iodation is made compulsory. For sustainability during later years, the adequacy of iodine in iodated salt must be monitored, and incentives must be modified as needed to increase compliance rates in the salt industry. Once national coverage of iodated salt reaches over 90%, the government can concentrate on fine-tuning and targeting resources at areas with a low consumption of iodated salt. Elimination of micronutrient deficiencies has a long-term impact on public health; moreover, poorer segments of the population, who are more vulnerable to such deficiencies, have more to gain from fortification programs. Thus, lessons from the successful elimination of iodine-deficiency disorders are valuable for future similar micronutrient activities.     

Standardized evaluation of iodine nutrition in West Africa: the African phase of the thyromobil program

Extensive programs of iodine supplementation by iodated salt have been implemented in Africa during the last decade. The present work evaluated their effectiveness in Benin, Burkina Faso, Mali, and Togo. A van equipped with a sonographic device visited 39 sites in the four countries. The prevalence of goiter was evaluated on the basis of the determination of thyroid volume by ultrasonography in 4,011 randomly selected 6- to 12-year-old schoolchildren of both sexes in the 39 sites. The concentration of urinary iodine was measured in 1,545 of these children. The iodine content of table salt collected at home by the children was measured by test kits in 3,202 salt samples, 415 of which were also analyzed by titration. Based on the results obtained by the kits, 83.7% to 97.9% of the salt samples contained iodine. However, the test kits had a low sensitivity and specificity in comparison with titration. The median urinary iodine was within an acceptable range (100-300 14 g/L) in the four countries, but almost one-third of the values were still below normal. The prevalence of goiter was normal (< 5%) in Benin and Togo, and it was 22.4% and 13.4%, respectively, in Burkina Faso and Mali. These results indicate marked improvement of the status of iodine nutrition in comparison with the situation reported only a few years ago in the same countries, but quality control of the iodine content of salt and monitoring of the iodine status of the populations need to be improved.     

Urinary iodine concentration of pregnant women and female adolescents as an indicator of excessive iodine intake in Sri Lanka

BACKGROUND: Mild deficiencies and excesses of iodine have deleterious effects in both females and males. The iodine status of the population after implementation of the universal salt iodization program in Sri Lanka is not known. OBJECTIVE: This cross-sectional study was carried out to assess the iodine status of pregnant women and female adolescents, with urinary iodine concentration used as the measure of outcome. METHODS: The participants were 100 women in the first trimester of pregnancy and 99 female adolescents in Kuliyapitiya, Kurunegala District, North-Western Province, Sri Lanka. The urinary iodine concentration was measured in a casual urine sample from each subject. The iodate contents of salt samples collected from households of the adolescents participating in the study were also measured. RESULTS: The median urinary iodine concentration of 185.0 microg/L and the prevalence of values under 50 microg/L of only 1% among the pregnant women indicate adequate iodine intake and optimal iodine nutrition. The median urinary iodine concentration (213.1 microg/L) among female adolescents indicates a more than adequate iodine intake and a risk of iodine-induced hyperthyroidism. Approximately 8% and 4% of the adolescents and pregnant women, respectively, had urinary iodine concentrations in the range of mild iodine deficiency (51 to 100 microg/L). More than half of the adolescents (56%) and 39% of the pregnant women had urinary iodine concentrations higher than optimal. The median iodine content in salt samples was 12.7 ppm. Only 20.2% of the samples were adequately iodized, and 10.1% of the samples had very high iodine levels. CONCLUSIONS: Female adolescents and pregnant women had no iodine deficiency, but a considerable proportion of them, especially female adolescents, were at risk for iodine-induced hyperthyroidism. There is thus a need for proper monitoring of the salt iodization program to achieve acceptable iodine status.     

Effect of iodine status and other nutritional factors on psychomotor and cognitive performance of Filipino schoolchildren

BACKGROUND: Until 1998, iodine deficiency was a public health problem in the Philippines. A law entitled "An Act Promoting Salt Iodization Nationwide" (ASIN) has been passed and implemented by the government to eliminate iodine deficiency. The contribution of salt iodization, as well as dietary, health, and environmental factors, to improving the intellectual performance of Filipino schoolchildren remains to be determined. OBJECTIVE: The objectives of the study were to determine the relationship between iodine status and levels of psychomotor and cognitive performance in first-grade children aged 6 to 10 years, and to examine the extent to which dietary, biochemical, health, and environmental factors contribute to children's mental performance. METHODS: Two hundred ninety children in six classroom sections from a public school in Manila were examined by measurement of urinary iodine excretion (UIE) and thyroid palpation. The median UIE level for each section was determined. Sixty-five children classified as iodine deficient (UIE < 90 microg/L with grade 1 goiter, n = 34) and non-iodine deficient (UIE > 100 microg/L without goiter, n = 31) were given psychomotor and cognitive function tests (Bender-Gestalt and Raven's Colored Progressive Matrices). Scores from the two tests were used to determine each child's general ability percentile rank. Other variables examined were dietary intake (% RDA of nutrients ingested based on two nonconsecutive 24-hour recalls); deficiencies in iron, vitamin A, and selenium; parasitic infection; coliform contamination of drinking water; household use of iodized salt; illness in the past 2 weeks; and wasting and stunting. RESULTS: Children whose general ability scores were at or above the 50th percentile had higher UIE levels, but the relationship was not significant. Children from sections with higher median UIE levels had higher percentile ranks for general ability (p = .002). Backward logistic regression showed that the variance in deficient and adequate mental performance was explained by dietary intakes that met > or = 80% of the RDA for energy, protein, thiamin, and riboflavin; the use of iodized salt; child's iodine status; and stunting (R2 = .520, p = .0016). Higher class median UIE was associated with better psychomotor and cognitive performance in children who were tested. Factors that contributed to better performance include higher intakes of energy, protein, thiamin, and riboflavin; household use of iodized salt; normal iodine status; and absence of stunting or chronic malnutrition. CONCLUSIONS: Salt iodization, accompanied by adequate intakes of energy, protein, and foods rich in thiamin and riboflavin, can contribute to improved mental performance in Filipino schoolchildren. Longer-term factors that can contribute to improved performance are achievement of normal iodine status and elimination of protein-energy malnutrition.     

Power from below: enabling communities to ensure the provision of iodated salt in Kyrgyzstan

BACKGROUND: In Kyrgyzstan, as in many countries around the world, progress in universal salt iodization has been slow because of difficulties in enforcing existing national regulations. OBJECTIVE: To study the effects of community testing of the iodine content of salt in households, at local retailers, and at wholesale markets on the percentage of households using iodized salt in Naryn Oblast, a region of Kyrgyzstan. METHODS: In response to a stated community priority to address iodine deficiency in Naryn Oblast, volunteers from village health committees and personnel of Primary Health Care units living in the communities were trained in testing salt using test kits. A phased introduction of two testing components was conducted in 2002-2003 in two areas with a combined population of 160,000. The two components included testing of salt for iodine content by community members in as many households as possible (Component 1) and testing of retail salt for iodate content by community members and by retailers at wholesale markets (Component 2). Results from these two components provided the data for this study. RESULTS: For Component 1, salt testing reached 65% of households; coverage of iodized salt increased from 87.6% to 96.8% within 5 to 7 months (averages of the two areas; p < .001), mostly owing to a great decrease in the variation among settlements. For Component 2, in area 1, the percentage of households using iodated salt increased from 71.0% to 90.3% within 5 to 7 months, whereas the percentage of households using iodinated salt decreased from 18.6% to 5.6%. In area 2, the percentage of households using iodated salt increased from 65.2% to 76.2% within 5 to 7 months, with no change in the percentage of households using iodinated salt (21.7% and 20.8%). The differences between areas I and 2 are highly significant (p < .001). At 18 to 21 months, the percentage of households using iodated salt was 97.5% in area 1 and 90.2% in area 2. The intervention cost around U.S. dollars 1500. CONCLUSIONS: Testing salt in a large percentage of households is an effective, low-cost approach to increasing the percentage of households using iodized salt to satisfactory levels in a very short time. Empowering community members to check salt at retailers and retailers to check salt at wholesale markets with test kits for iodated salt can rapidly ensure almost exclusive consumption of iodated salt in households.     

A multicenter community study on the efficacy of double-fortified salt

BACKGROUND: Iron and iodine deficiencies affect more than 30% of the world's population. Typical Indian diets contain adequate amounts of iron, but the bioavailability is poor. This serious limiting factor is caused by low intake of meat products rich in heme iron and intake of phytates in staple foods in the Indian diet, which inhibits iron absorption. OBJECTIVE: To test the stability of double-fortified salt (DFS) during storage and to assess its efficacy in improving the iron and iodine status of the communities. METHODS: The stability of both iodized salt and DFS during storage for a 2-year period was determined. The bioefficacy of DFS was assessed in communities covering three states of the country for a period of 1 year. This was a multicenter, single-blind trial covering seven clusters. The experimental group used DFS and the control group used iodized salt. The salts were used in all meals prepared for family members, but determination of hemoglobin by the cyanmethemoglobin method was performed in only two or three members per family, and not in children under 10 years of age (n = 393 and 436 in the experimental and control groups, respectively). The family size was usually four or five, with a male: female ratio of 1:1, consisting of two parents with two or three children. Hemoglobin was measured at baseline, 6 months (midpoint), and 12 months (endpoint). Urinary iodine was measured in only one cluster at baseline and endpoint. All the participants were dewormed at baseline, 6 months, and 12 months. RESULTS: The iron and iodine in the DFS were stable during storage for 2 years. Over a period of 1 year, there was an increase of 1.98 g/dL of hemoglobin in the experimental group and 0.77 g/dL of hemoglobin in the control group; the latter increase may have been due to deworming. The median urinary iodine changed from 200 microg/dL at baseline to 205 microg/dL at the end of the study in the experimental group and from 225 microg/dL to 220 microg/dL in the control group. There was a statistically significant (p < .05) improvement in the median urinary iodine status of subjects who were iodine deficient (urinary iodine < 100 microg/L) in both the experimental and the control groups, a result showing that DFS was as efficient as iodized salt in increasing urinary iodine from a deficient to sufficient status. There was a statistically significant increase (p < .05) in hemoglobin in all seven clusters in the experimental group compared with the control. CONCLUSIONS: The iron and iodine in the DFS are stable in storage for 2 years. The DFS has proved beneficial in the delivery of bioavailable iron and iodine.     

2013-2020年郑州市二七区碘缺乏病监测结果统计分析

目的 统计分析2013-2020年郑州市二七区碘缺乏病(IDD)监测结果.方法 2013-2020年按照《全国碘缺乏病监测方案》在郑州市二七区开展盐碘监测,同时收集同期新婚育龄妇女、孕妇、哺乳期女性、0～2岁婴幼儿、8～10岁儿童5类人群的尿样,测定尿碘含量.结果 2013-2020年,郑州市二七区居民盐碘含量中位数与...     

Lessons from successful micronutrient programs. Part III: program impact

Micronutrient-deficiency control programs have been greatly extended at the national level in the last 10 to 15 years. However, rigorous evaluations of these are scarce, so that conclusions on impact are tentative and based mainly on indirect evidence. The coverage of vitamin A capsule distribution programs has exceeded 70% in most study countries. In countries implementing national iodized salt programs, the coverage reaches 60% to 90% of households with adequately iodized salt. Of the three micronutrients, coverage of iron tablet supplementation is the least well documented due to inadequate program monitoring systems and population survey data. Supplementation of preschool children 6 to 59 months of age with vitamin A capsules has plausibly contributed to the reduction in clinical vitamin A deficiency and its near-elimination in many countries. The impact of vitamin A capsule supplementation on children's biochemical vitamin A status (serum retinol) in national programs may be less. National data on salt iodization show a consistent relation to reduced prevalence of iodine-deficiency disorder symptoms (goiter); the rates of cretinism and other results of iodine deficiency are almost certainly falling too. The evaluation of the impact of salt iodization programs on biochemical iodine status is limited by a lack of data. Although trials have demonstrated the efficacy of iron supplementation in reducing the prevalence of anemia, the interpretation of national-level data is not so clear. Given the substantial financial and technical commitment required to implement national micronutrient-deficiency control programs, it is vital that investment enable the evaluation of the impact of these programs. It is becoming increasingly important to collect data on subclinical deficiency (e.g., biochemical data) to assess program impact.     

Iodine fortification is related to increased weight-for-age and birthweight in children in Asia

Severe iodine deficiency causes stunting and mental retardation in utero, but the relation between mild deficiency and child growth is not well known. The use of iodated salt in relation to anthropometric data was examined from recent survey data. After potential confounding factors had been controlled for, significant associations were seen in Bangladesh, India, Nepal, and Sri Lanka. The use of iodated salt was related to increased weight-for-age and mid-upper-arm circumference, most strongly in the second year of life, mainly affecting soft tissue (thinness). The relation with weight-for-age was greater among children of mothers with lower body mass index. The use of iodated salt was related to birthweight in Sri Lanka and in the Philippines, where iodized oil capsules given during pregnancy had a negative effect when used with high levels of iodine in salt. The associations generally were concentrated in large geographic areas, possibly because of interactions with other environmental factors (e.g., selenium and arsenic). The apparent growth response to iodine may reflect functional effects of mild deficiency, which is widespread, possibly including effects on brain development.     

Difference in goiter rates between regular and occasional users of iodized salt in Mongolia

In Mongolia many households use iodized salt only occasionally. We investigated whether the occasional use of iodized salt had an impact on the reduction of goiter size. We examined 685 children (8-11 years old) in five groups of households that (1) used iodized salt regularly, (2) used more than 10 kg of iodized salt annually, (3) used 6 to 10 kg annually, (4) used less than 6 kg annually, (5) and regularly used noniodized salt. The prevalence of goiter as determined by ultrasound in these five groups was 31.1%, 30.3%, 40.6%, 52.1%, 56.6%, respectively. There was no difference between goiter rates among the first three groups, but these groups had significantly lower rates than the last two groups. We concluded that annual use of more than 6 kg of iodized salt, preferably more than 10 kg, by a household had a beneficial effect on the rate of goiter. In addition, the possibility was suggested that households that consumed only iodized salt consumed less salt than other households.     

Iodine stability in salt double-fortified with iron and iodine

Deficiencies in small quantities of micronutrients, especially iodine and iron, severely affect more than a third of the world's population, resulting in serious public health consequences, especially for women and young children. Salt is an ideal carrier of micronutrients. The double fortification of salt with both iodine and iron is an attractive approach to the reduction of both anemia and iodine-deficiency disorders. Because iodine is unstable under the storage conditions found during the manufacturing, distribution, and sale of salt in most developing countries, the effects of packaging materials and environmental conditions on the stability of salt double-fortified with iron and iodine were investigated. Salt was double-fortified with potassium iodide or potassium iodate and with ferrous sulfate or ferrous fumarate. The effects of stabilizers on the stability of iodine and iron were followed by storing the salt under three conditions that represent the extremes of normal distribution and sale for salt in developing countries: room temperature (25 degrees C) with 50%-70% relative humidity, 40 degrees C with 60% relative humidity, and 40 degrees C with 100% relative humidity. The effects of stabilizers, such as sodium hexametaphosphate (SHMP), calcium carbonate, calcium silicate, and dextrose were investigated. None of the combinations of iron and iodine compounds was stable at elevated temperatures. Essentially all of the iodine was lost over a period of six months. SHMP effectively slowed down the iodine loss, whereas magnesium chloride, a typical hygroscopic impurity, greatly accelerated this process. Calcium carbonate did not have a sparing effect on iodine, despite contrary indications in the literature. Ferrous sulfate-fortified salts generally turned yellow and developed an unpleasant rusty flavor. Salt fortified with ferrous fumarate and potassium, iodide was reasonably stable and maintained its organoleptic properties, making it more likely to be acceptable to consumers. We confirmed that application of the iodine compounds as solutions resulted in a more even distribution of the iodine throughout the sample. The effect of the packaging materials was overshadowed by the other variables. None of the packaging materials was clearly better than any other. This may have been due to the fact that the polymer bags were not heat sealed, and thus some moisture penetration was possible. The results indicate that with careful control of processing, packaging, and storage conditions, a double-fortified salt could be stabilized for the six-month period required for distribution and consumption. Unfortunately, the processing and storage required are difficult to attain under typical conditions in developing countries.     

Stability of salt double-fortified with ferrous fumarate and potassium iodate or iodide under storage and distribution conditions in Kenya

The stability of table salt double-fortified with iron as ferrous fumarate, and with iodine as potassium iodide or potassium iodate, has been investigated under actual field conditions of storage and distribution in the coastal and highland regions of Kenya. Seven 200-g sample packets of double-fortified salt in sealed polyethylene bags and a similar packet containing a datalogger for monitoring temperature and humidity were packaged with 21 sample bags of salt from another study into a bundle, which then entered the distribution network from a salt manufacturer's facility to the consumer. Iodine retention values of up to 90% or more were obtained during the three-month study. Double-fortified salt was prepared using ferrous fumarate microencapsulated with a combination of binders and coloring agents and coated with soy stearine, in combination with either iodated salt or salt iodized with potassium iodide microencapsulated with dextrin and coated with soy stearine. Most of the ferrous iron was retained, with less than 17% being oxidized to the ferric state. The polyethylene film overwrap of salt packs in the bundles provided significant protection from ambient humidity. Salt double-fortified with iodine and microencapsulated iron ferrous fumarate premix was generally quite stable, because both iodine and ferrous iron were protected during distribution and retail in typical tropical conditions in Kenya's highlands and humid lowlands.     

Stability of iodine in salt fortified with iodine and iron

BACKGROUND: Determining the stability of iodine in fortified salt can be difficult under certain conditions. Current methods are sometimes unreliable in the presence of iron. OBJECTIVE: To test the new method to more accurately estimate iodine content in double-fortified salt (DFS) fortified with iodine and iron by using orthophosphoric acid instead of sulfuric acid in the titration procedure. METHODS: A double-blind, placebo-controlled study was carried out on DFS and iodized salt produced by the dry-mixing method. DFS and iodized salt were packed and sealed in color-coded, 0.5-kg, low-density polyethylene pouches, and 25 of these pouches were further packed and sealed in color-coded, double-lined, high-density polyethylene bags and transported by road in closed, light-protected containers to the International Council for the Control of Iodine Deficiency Disorders (ICCIDD), Delhi; the National Institute of Nutrition (NIN), Hyderabad; and the Orissa Unit of the National Nutrition Monitoring Bureau (NNMB), Bhubaneswar. The iodine content of DFS and iodized salt stored under normal room conditions in these places was measured by the modified method every month on the same prescribed dates during the first 6 months and also after 15 months. The iodine content of DFS and iodized salt stored under simulated household conditions was also measured in the first 3 months. RESULTS: After the color code was broken at the end of the study, it was found that the DFS and iodized salt stored at Bhubaneswar, Delhi, and Hyderabad retained more or less the same initial iodine content (30-40 ppm) during the first 6 months, and the stability was not affected after 15 months. The proportion of salt samples having more than 30 ppm iodine was 100% in DFS and iodized salt throughout the study period. Daily opening and closing of salt pouches under simulated household conditions did not result in any iodine loss. CONCLUSIONS: The DFS and iodized salt prepared by the dry-mixing method and stored at normal room conditions had excellent iodine stability for more than 1 year.     

Determinants of specific food consumption in the Canary Islands (Spain)

The consumption of specific functional foods (FF) and some determinants of FF item selection were assessed using a questionnaire administered to 1112 individuals in the Canary Islands (Spain). Food items considered were Milk products: easily digestible milk (or milk low in lactose), milk enriched with vitamins and/or minerals, skimmed milk with soluble fiber, milk with royal jelly, milk with modified fatty acids (omega 3), milk products low in fat, pro-biotic foods (yoghurt and fermented milk) and yoghurt with phytosterols; Cereals: fortified breakfast cereals, wholemeal cereals and energy bars; Drinks: juices and enriched drinks, stimulating drinks and isotonic drinks; DHA-enriched, low cholesterol eggs; Meat products: low salt sausages and cooked low fat ham; Fats: enriched margarine, margarine rich in phytosterols and sunflower oil rich in oleic acid; Condiments: iodated salt. These food items were organized into 7 FF groups (milk products, cereals, fortified drinks, DHA eggs, meat product, fats, condiments). The results indicated that the highest prevalence was fortified drinks (63.6%; 95% CI: 60.7-66.5). Overall FF consumption prevalence was 80.1% (95% CI: 77-83): single FF item consumption being rare. There were significant inter-group relationships, and some group intakes (milk products, cereals and drinks) were related to age but with no overall relationship between consumption and age. The education level was significantly related to the consumption of cereals, drinks, meat products and condiments (χ2 test p = 0.04). Some specific FF item consumption segregated with environment (rural or urban) but with no overall significant relationship between the FF group and environment or gender.     

Reaching the goal of Universal Salt Iodization (USI): experience of Uttar Pradesh, India

BACKGROUND: In 2002, the percentage of households consuming iodized salt in the state of Uttar Pradesh (UP) in India dropped to as low as 6%. This implied that 3.5 million newborns in this non-salt producing state, with 180 million population, were at risk of brain damage unless universal accessibility and consumption of iodized salt was ensured and sustained. OBJECTIVES: Urgent measures were introduced in 3 phases in the statefor accelerating procurement, distribution and consumption of iodized salt. METHODS: In the first phase, a study on mapping of salt wholesalers and understanding the salt trading system--including understanding the knowledge, attitudes, and practices of salt traders was undertaken to accelerate efforts to influence availability, marketing, and accessibility of iodized salt. The study revealed that a total of only 344 primary wholesalers supplied salt to the entire state. Of these, 126 wholesalers marketed 80% of salt and were located in only 15 of the total 70 districts of the state. This finding became a very strong basis for the program in phase II, which focused on the critical group of wholesalers and set up a system to frequently interact with them. The salt wholesalers were equipped with Salt Testing Kits (STKs) to ensure adequate iodine content in the salt procured by them and adherence to the legal ban on the sale of non-iodized salt for human consumption. Simultaneously, a "child-to-community" approach was launched through involvement of middle and high school children to create demand and monitor consumption of iodized salt at the household level. Over 217,000 salt samples (about 26,000 samples per quarter) were brought in by school children and tested for iodine content. RESULTS: The school activities resulted not only in influencing consumption of iodized salt, but also galvanized the entire chain linking consumers, retailers, and wholesalers. In less than 2 years, salt procured with nil iodine decreased from 38% to 15.3%, and salt marketed with adequate iodine level increased from 28.6% to 64.9%. School data revealed an increase in consumption of iodized salt from 6% to 46.7%. In phase 3, additional standardized activities at the school level were included and the program was taken to scale in the state. CONCLUSION: The findings revealed that identification and inclusion of salt wholesalers-not only the salt manufacturers-was important for achieving a rapid positive shift in iodized salt marketing and consumption practices.     

Iodine content in bread,milk and the retention of inherent iodine in commonly used Indian recipes

Iodine deficiency disorders (IDD) is still a major public health problem and iodized salt remains the most effective means to control IDD in India. Few reports indicate that vegans have inadequate iodine intake while at the same time concerns are being raised on the implementation of universal salt iodization in the country. Therefore, we investigated the iodine content in bread, milk and commonly used Indian recipes prepared without iodized salt and the retention of inherent iodine therein. Results showed considerable iodine content in bread (25 μg/100 g) and milk (303 μg/L) as a positive fallout of universal salt iodization. Iodine content in 38 vegetarian recipes prepared without iodized salt was very low (2.9 ± 2.4 μg/100 g). Retention of inherent iodine (65.6 ± 15.4%) and iodine from iodized salt (76.7 ± 10.3%) in the same recipes was comparable. Thus, universal salt iodization programme remains the single most important source of dietary iodine for the Indian population.