Network E-Bulletin
Volume 2 Issue 3, March 2006
Welcome to the Electronic Bulletin from the Network for Sustained Elimination of Iodine Deficiency.
The current Bulletin includes:
1. Gambia Launched National Salt Producers and Traders to Eliminate Iodine Deficiency.
By Sarata Jabbi –Dibba (The Point, 1 March 2006)
The Vice President Njie-Saidy of Gambia launched the National Association of Salt Producers and Traders (NASPAT) at the Corinthia Atlantic Hotel in February 2006 and has confirmed the commitment of the government to the virtual elimination of iodine deficiency disorders. During the launching, she stated “Universal salt iodization remains the key to eliminating iodine deficiency disorders. Unfortunately for us in The Gambia, we produce only 10% of the salt we consume, and the rest (90%) is imported. It has also been established recently too, that only 13% of the salt we consume in our households is iodized”. She therefore described as an opportune moment the coming together of salt producers and traders from all over the country to form a national association of salt producers and traders to support government. Mr Saikou Manneh an executive of NASPAT, revealed that there are several potential salt producing areas such as Darsilami, Karantaba, Bali, Sami among others which could be effectively utilized to enable the country become self-sufficient in salt. The launch of the
association, complementing the efforts of Government through the National Nutrition Agency (NaNA) to ensure the universal salt iodisation in The Gambia, is indeed a step in the right direction.
2. Controlling Iodine Deficiency In Upper East of Ghana
Source: The Ghanaian Times, 11 March 2006
Dr Joseph Amankwah, the Upper East Regional Director of Health Services launched the Universal Salt Iodization Programme in the Upper East Regional Launch on 10 March 2006. It is estimated that 120,000 children born in Ghana each year are at risk of intellectual impairment because of Iodine Deficiency. Some 15,600 of these babies are severely impaired and may never be able to develop properly and this led to an average of 22 million dollars loss in productivity each year in Ghana. To reverse the trend, Dr Amankwah said that Ghana as a member of ECOWAS, was making every effort to ensure that only iodized salt was put on the market to achieve the universal salt iodization by the end of 2006. As part of efforts, the government passed the Food and Drugs Amendment Act 523, making iodization of salt mandatory for both human and animal consumption.
3. Iodine Deficiency in Australian Children
Li M, Eastman CJ, Waite KV, Ma G, Zacharin MR, Topliss DJ, Harding PE, Walsh JP, Ward LC, Mortimer RH, Mackenzie EJ, Byth K, Doyle Z., Are Australian children iodine deficient? Results of the Australian National Iodine Nutrition Study, Med J Aust. 2006 Feb 20;184(4):165-9.
A national study of Australian schoolchildren aged 8-10 years has found that there is an inadequate iodine intake in the Australian population, leading to a call for mandatory iodization of all edible salt in Australia. Another finding of the study by University of Sydney experts was a marginal increase in thyroid volumes in Australian schoolchildren when compared to international data from iodine sufficient countries. The results of the Australian National Iodine Nutrition Study are reported in the latest edition of the Medical Journal of Australia by Professor Creswell J Eastman, Chairman of the Australian Centre for Control of Iodine Deficiency Diseases and ICCIDD Regional Coordinator for Asia and Pacific, Dr Mu Li, a senior researcher of the Centre and Senior Lecturer at the School of Public Health, University of Sydney and their colleagues. Between July 2003 and December 2004, 1709 students from 88 schools in mainland Australia were surveyed to document the population iodine nutritional status in Australian schoolchildren. Dr Li says the decline in iodine intake in Australia is due to two major factors - the change from iodine-containing sanitisers in the dairy industry to chlorine-containing or other acid-based sanitisers; and the low consumption of iodized salt - with the latter the easiest to remedy. The mainland children as a group are borderline iodine deficient, but there are significant and unexpected variations across the continent. Western Australian and Queensland children are iodine replete and Victorian and NSW children are mildly iodine deficient, with the differences linked to variations in ingestion of iodised salt, in regional milk iodine content, and drinking water iodine levels. Although the study showed an increase in thyroid volumes compared with international data, but it doesn’t conclude that iodine deficiency is causing endemic goitre in Australia. It is alarming that many Australian schoolchildren have mild iodine deficiency and no action has been taken by public health authorities to increase iodine intake in our population.
4. Longitudinal examination of 24-h urinary iodine excretion in schoolchildren as a sensitive, hydration status–independent research tool for studying iodine status.
Thomas Remer, Nadine Fonteyn, Ute Alexy and Shoma Berkemeyer American Journal of Clinical Nutrition, Vol. 83, No. 3, 639-646, March 2006
Background: Because worldwide iodine status (IS) depends on continuous fortification, the adequacy of IS needs to be regularly monitored.
Objective: Our study aimed to evaluate IS in a longitudinal sample of healthy schoolchildren who regularly used table salt iodized with 20 µg I/g.
Design: Urine osmolality (Uosm) and 24-h urinary excretion rates of iodine (24-h UI), sodium, creatinine, and total urine volume (24-h Uvol) were measured in 1046 specimens that were collected at repeated intervals from 1996 to 2003 in a sample of 358 German children aged 6–12 y. Energy intake and food consumption were calculated from 3-d weighed dietary records that were collected in parallel to the urine samples.
Results: During the 4-y period from 1996 to 1999, the median 24-h UI increased from 87 to 93 µg I/d (P = 0.017), whereas urinary iodine concentration (UIC), Uosm, and 24-h Uvol did not change significantly. Thereafter (from 2000 to 2003), UIC stagnated and Uosm decreased (P = 0.004), whereas 24-h Uvol (P = 0.008) and 24-h UI (P = 0.002) increased. The final median 24-h UI reached 120 µg I/d. Milk, fish, egg, and meat intakes and 24-h sodium excretion were all significant predictors of IS, with an almost doubled contribution from milk intake during the second 4-y period.
Conclusions: Our study shows a continuous improvement of IS in a longitudinal sample of German schoolchildren. This improvement was masked when UIC was used as an IS index, especially from 2000 to 2003 because of changes in hydration status. Thus, in research-oriented studies that focus on UIC measurements, hydration status can be a relevant confounder. Longitudinal analyses of 24-h UI in cohort studies may represent an alternative hydration status–independent tool to examine trends in IS and the contribution of relevant foods to IS.
5. Power from below: Enabling communities to ensure the provision of iodated salt in Kyrgyzstan.
Schuth T, Jamangulova T, Janikeeva S, Tologonov T. Food Nutr Bull. 2005 Dec;26(4):366-75.
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.
6. Iodine nutritional status & prevalence of goitre in Sundarban delta of South 24-Parganas, West Bengal.
Chandra AK, Tripathy S, Ghosh D, Debnath A, Mukhopadhyay S. Indian J Med Res. 2005 Nov;122(5):419-24.
BACKGROUND & OBJECTIVE: In post salt iodization phase endemic goitre and associated iodine deficiency disorders (IDD) were found prevalent in a randomly selected rural area of Sundarban delta and its adjoining areas of West Bengal. The present investigation was thus undertaken to study the total goitre rate, urinary iodine and thiocyanate excretion pattern of the school going children, iodine content in edible salt and drinking water in the Sundarban delta of South 24-Parganas in West Bengal.
METHODS: A total of 4656 school children (6-12 yr) were clinically examined for goitre from 13 different areas in the delta region. Urinary iodine and thiocyanate levels were measured in 520 (40 from each area) samples collected randomly to evaluate the iodine nutritional status and consumption pattern of dietary goitrogen. Simultaneously iodine content was determined in 104 (8 from each area) drinking water samples and 455 (35 from each area) edible salt samples collected from the areas.
RESULTS: Children of all the areas were affected by endemic goitre. The prevalence rates were in the ranges from 25-61 per cent; overall goitre prevalence was 38.2 per cent (grade 1--34.0%; grade 2--4.2%). Median urinary iodine level in the studied areas was 225 microg/l (range 115-525 microg/l) indicating no biochemical iodine deficiency in the region. Mean urinary thiocyanate levels were in the range from 0.326-1.004 mg/dl. Iodine content in drinking water samples were in the ranges from 22-119 microg/l, and 55.6 per cent edible salt samples had iodine level above the recommended 15 ppm at the consumption point.
INTERPRETATION & CONCLUSION: The severity of endemic goitre was high in the studied population though the iodine nutritional status was found satisfactory in the region indicating no biochemical iodine deficiency. The people of the region consumed iodine through iodized salt but about 44 per cent of the salt samples at household level contained inadequate iodine, however their iodine intake was compensated through iodine in water and food. They also consumed dietary goitrogen. Environmental factors other than iodine deficiency may have possible role for the persistence of endemic goitre in the region. More investigations are thus necessary to arrive at certain definite cause of high goitre rates in this population.
7. Goiter prevalence and urinary iodine status in urban and rural/mountain areas of Piedmont region.
Saggiorato E, Arecco F, Mussa Ab, Sacerdote C, Rossetto R, Origlia C, Germano L, Deandreis D, Orlandi F; Piedmont Goiter Study Committee. J Endocrinol Invest. 2006 Jan;29(1):67-73.
Piedmont region was reported in the 70s as a mild iodine-deficient area with a goiter prevalence > 10%. This study aimed at characterizing the current status of iodine deficiency in Piedmont, with special attention to putative differences between urban and rural/mountain areas. A cross-sectional, observational study was performed according to the surveillance methods for iodine deficiency disorders recommended by the World Health Organization (WHO). Ultrasound local thyroid volume reference values and median urinary iodine concentration were obtained in 2178 schoolchildren aged 11-15 yr, resident in Piedmont region for more than 5 yr to assess both goiter prevalence and iodine intake. Anamnestic and anthropometric data, thyroid volume by both bimanual palpation and ultrasound were assessed, and spot urinary iodine samples were collected. The median urinary iodine concentration was 115.8 microg/l and the prevalence of goiter 3.1%, indicating this area as iodine-sufficient. Nevertheless, 39% of the schoolchild population had urinary iodine levels < 100 microg/l and 6.8% < 50 microg/l. No differences in goiter prevalence and median urinary iodine excretion were observed between urban and rural/ mountain populations. In conclusion, Piedmont is now an iodine-sufficient region. As no programs of salt iodization have been carried out in the last 30 yr, a silent iodine replacement has occurred. Despite a sufficient median urinary iodine excretion, a program of iodine prophylaxis is strongly recommended due to a large part of iodine-deficient population.
The Iodine Network Bulletin is prepared by the Network for Sustained Elimination of Iodine Deficiency and posted on its website, www.IodineNetwork.net. If you have any information to share or queries please contact Dr. Juliawati Untoro, IDD Network Secretary at Info@IodineNetwork.net
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