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Michael B Zimmermann - One of the best experts on this subject based on the ideXlab platform.
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global endocrinology global perspectives in endocrinology coverage of Iodized Salt programs and iodine status in 2020
European Journal of Endocrinology, 2021Co-Authors: Michael B Zimmermann, Maria AnderssonAbstract: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.
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key considerations for policymakers Iodized Salt as a vehicle for iron fortification current evidence challenges and knowledge gaps
Journal of Nutrition, 2021Co-Authors: Adam Drewnowski, Greg S. Garrett, Rishi Kansagra, Noor Khan, Roland Kupka, Anura V Kurpad, Venkatesh Mannar, Reynaldo Martorell, Michael B ZimmermannAbstract:Could DFS help prevent iron deficiency and anemia? Studies in controlled settings (efficacy) demonstrate that double-fortified Salt (DFS; iron added to Iodized Salt) reduces the prevalence of anemia and iron deficiency anemia. Studies in program settings (effectiveness) are limited and reported differing levels of DFS coverage, resulting in mixed evidence of impact on anemia. What iron formulations are available and how do they affect Iodized Salt? Ferrous sulfate and encapsulated ferrous fumarate (both with various enhancers and/or coating materials) are the main iron formulations currently in use for DFS. Adding iron to Iodized Salt may lead to adverse changes in the product, specifically discoloration and losses in iodine content. These changes are greatest when the Iodized Salt used in DFS production is of low quality (e.g., contain impurities, has high moisture, and is of large crystal size). DFS requires Iodized Salt of the highest quality and a high-quality iron formulation in order to minimize adverse sensory changes and iodine losses. Appropriate packaging of Iodized Salt is also important to prevent losses. What is known about the minimum requirements to manufacture DFS? DFS producers must use high-quality refined Iodized Salt meeting the minimum standards for DFS production (which is higher than standards for Salt intended for iodization alone), and an iron formulation for which there are rigid quality-assurance measures to ensure consistent quality and blending techniques. The actual proportion of Iodized Salt meeting the stringent requirements necessary for DFS production is unclear, but likely to be low in many countries, especially those with fragmented Salt industries and a low proportion of industrially produced Salt. What are the financial implications of adding iron to Iodized Salt? As a result of higher input costs both for input Salt and the iron compound, DFS is more expensive to produce than Iodized Salt and thus has a higher production cost. Various grades of Iodized Salt are produced and consumed in different sectors of the market. Experience in India indicates that, on average, producing DFS costs 31-40 US dollars/metric ton or 0.03-0.04 US dollars/kg more than high-quality refined Iodized Salt. The exact impact of this production-level cost difference on profit margins and consumer price is specific to the conditions of different Salt markets. Factors such as transport costs, customary wholesale and retail mark-ups, and taxes all vary greatly and need to be assessed on a case by case basis. Is DFS in alignment with Salt-reduction efforts? The WHO has long recognized that Salt iodization is an important public health intervention to achieve optimal iodine nutrition and is compatible with Salt-reduction goals. Fortification of Salt (with any nutrient) should not be used to justify or encourage an increase in Salt intake to the public. Any effort to expand Salt fortification to other nutrients should be done in close consultation with WHO and those working on Salt reduction. What has been the experience with DFS delivery under different platforms? To date, DFS has been introduced into the retail market and in social safety net (primarily in India) programs, but sensory changes in DFS have been raised as concerns. The higher price for DFS has limited expansion in the retail market. In social safety net programs where the cost of DFS is subsidized for beneficiaries, programs must consider long-term resourcing for sustainability. Overall: The optimal production and delivery of DFS are still under development, as many challenges need to be overcome. There is a beneficial impact on hemoglobin in efficacy trials. Thus, if those conditions can be replicated in programs or the technology can be adapted to better fit current production and delivery realities, DFS may provide an effective contribution in countries that need additional food-fortification vehicles to improve iron intake.
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more than two thirds of dietary iodine in children in northern ghana is obtained from bouillon cubes containing Iodized Salt
Public Health Nutrition, 2017Co-Authors: Abdulrazak Abizari, Roland Kupka, Susanne Dold, Michael B ZimmermannAbstract:Objective Bouillon cubes are widely consumed by poor households in sub-Saharan Africa. Because their main ingredient is Salt, bouillon cubes could be a good source of iodine if Iodized Salt is used in their production and if their consumption by target groups is high. Our objective was to measure the iodine content of bouillon cubes, estimate their daily intake in school-aged children and evaluate their potential contribution to iodine intakes. Design In a cross-sectional study, we measured urinary iodine concentrations (UIC) and estimated total daily iodine intakes. We administered a questionnaire on usage of bouillon cubes. We measured the iodine content of bouillon cubes, household Salt, drinking-water and milk products. Setting Primary schools in northern Ghana. Subjects Schoolchildren aged 6–13 years. Results Among school-aged children (n 250), median (interquartile range) UIC and estimated iodine intake were 242 (163–365) µg/l and 129 (85–221) µg/d, indicating adequate iodine status. Median household Salt iodine concentration (n 100) was only 2·0 (0·83–7·4) µg/g; 72 % of samples contained <5 µg iodine/g. Iodine concentrations in drinking-water and milk-based drinks were negligible. Median iodine content of bouillon cubes was 31·8 (26·8–43·7) µg/g, with large differences between brands. Estimated median per capita consumption of bouillon cubes was 2·4 (1·5–3·3) g/d and median iodine intake from bouillon cubes was 88 (51–110) µg/d. Conclusions Despite low household coverage with Iodized Salt, iodine nutrition in school-aged children is adequate and an estimated two-thirds of their dietary iodine is obtained from bouillon cubes.
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are weaning infants at risk of iodine deficiency even in countries with established Iodized Salt programs
Meeting micronutrient requirements for health and development. 70th Nestlé Nutrition Institute Workshop Cebu Philippines 27-30 March 2011., 2012Co-Authors: Michael B ZimmermannAbstract:Because iodine deficiency (ID) during infancy can irreversibly impair neurodevelopment and increase mortality, it is critical that dietary iodine is adequate in this vulnerable group. Lactating mothers consuming Iodized Salt can transfer adequate iodine to the infant via breast milk, but during the weaning period, infants are at risk for ID for several reasons: (1) requirements per kg bodyweight for iodine and thyroid hormone during infancy are higher than at any other time in the life cycle; (2) experts recommend no extra Salt (Iodized or not) be given to infants during the first year; (3) cow's milk (a major source of dietary iodine in many countries) is also not recommended for infants during the first year; and (4) iron deficiency, a common disorder during infancy, can impair iodine metabolism and reduce thyroid hormone production. For many weaning infants in industrialized countries, iodine fortified into commercial infant foods becomes important. This has recently been demonstrated in Switzerland, where a long-standing Iodized Salt program provides adequate iodine to pregnant women and school-age children, but new national data suggest weaning infants not receiving iodine-containing commercial baby foods have inadequate iodine intakes. Thus, even in countries with effective Iodized Salt programs, infants may be at risk of ID during weaning and may need additional dietary and/or supplemental sources of iodine.
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assessing iodine status and monitoring progress of Iodized Salt programs
Journal of Nutrition, 2004Co-Authors: Michael B ZimmermannAbstract:Despite remarkable progress in the control of the iodine deficiency disorders (IDD), they remain a significant global public health problem. Assessing the severity of IDD and monitoring the progress of Salt iodization programs are cornerstones of a control strategy. Because thyroid size decreases only gradually in response to Iodized Salt, the goiter rate in children may be a poor IDD monitoring indicator for several years after the introduction of Salt iodization. During this period, the goiter rate reflects chronic iodine deficiency, and will be inconsistent with measurements of urinary iodine. Thyroglobulin is a promising new biochemical indicator for monitoring thyroid function after the introduction of Iodized Salt. Recent development of a dried blood spot thyroglobulin assay makes sample collection practical even in remote areas. Interpretation of thyroid volume data from ultrasound surveys requires valid references from iodine-sufficient populations, but defining normal values for thyroid size in children has been difficult. New international reference criteria for thyroid volume were published recently and can be used for goiter screening in the context of IDD monitoring. Ensuring sustainability is one of the great remaining challenges in the global fight to eliminate IDD. A recent cohort study demonstrated the vulnerability of children in IDD-affected areas to even short-term lapses in Iodized Salt programs.
Aregash Samuel - One of the best experts on this subject based on the ideXlab platform.
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tsh mediated the effect of Iodized Salt on child cognition in a randomized clinical trial
Nutrition and Metabolic Insights, 2021Co-Authors: Husein Mohammed, Grace S Marquis, Frances E Aboud, Karim Bougma, Aregash SamuelAbstract:Objectives:This study examines the hormonal mediators of the effect of Iodized Salt in pregnancy on child cognition.Methods:Sixty districts across 6 zones in the Amhara region of Ethiopia were rand...
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TSH Mediated the Effect of Iodized Salt on Child Cognition in a Randomized Clinical Trial
'SAGE Publications', 2021Co-Authors: Husein Mohammed, Grace S Marquis, Karim Bougma, Frances Aboud, Aregash SamuelAbstract:Objectives: This study examines the hormonal mediators of the effect of Iodized Salt in pregnancy on child cognition. Methods: Sixty districts across 6 zones in the Amhara region of Ethiopia were randomly allocated to a control or intervention arm of early market access to Iodized Salt. Twenty-two villages per arm were randomly selected for this sub-study. A total of 1220 pregnant women who conceived after the intervention began were enrolled and assessed for their iodine and iron status. Data were collected once on the household socio-demographic status and Iodized Salt use, and maternal urinary iodine during pregnancy. Then, infants’ diet, urinary iodine level, cognitive development (Bayley III), serum hormonal levels, iron status, and inflammation markers were measured between 2 and 13 months of age. Results: The median maternal urinary iodine concentration was adequate and significantly higher in the intervention mothers than that of the controls (163 vs 121 µg/L, P
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pre pregnancy Iodized Salt improved children s cognitive development in randomized trial in ethiopia
Maternal and Child Nutrition, 2020Co-Authors: Husein Mohammed, Grace S Marquis, Frances E Aboud, Karim Bougma, Aregash SamuelAbstract:The overarching Ethiopia project examined the effects of early market introduction of Iodized Salt on the growth and mental development of young children. Sixty districts were randomly assigned to intervention (early market access to Iodized Salt) or control (later access through market forces), and one community per district was randomly chosen as the sampling unit. For this project, 22 of the districts were included. The participants were 1,220 pregnant women who conceived after the intervention began. When their children were 2 to 13 months old, field staff collected information on household sociodemographic status and Iodized Salt intake, child stimulation, maternal depression symptoms, children's diet, anthropometry, urinary iodine concentration (UIC), hemoglobin, and mental development scores (Bayley III scales). Fewer mothers prepartum (28% vs. 41%, p .05) compared with their controls. Iodized Salt intake improved iodine status of both pregnant women and their children and also child cognitive development.
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a cluster rct evaluating the effect of Iodized Salt on infant development in amhara region of ethiopia
The FASEB Journal, 2015Co-Authors: Husein Mohammed, Grace S Marquis, Frances E Aboud, Karim Bougma, Aregash SamuelAbstract:Iodized has been associated with the physical and mental development of children. We examined the effects of Iodized Salt on the growth and mental development of infant. Forty-four communities in t...
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Iodized Salt benefits children school readiness preliminary results from a cluster randomized trial in ethiopia 635 2
The FASEB Journal, 2014Co-Authors: Karim Bougma, Grace S Marquis, Frances E Aboud, Tizita Melka, Aregash SamuelAbstract:Iodine deficiency is thought to contribute to delayed mental development. The effectiveness of Iodized Salt programs in reducing this delay has not been studied in children 6 years and under. Using a randomized cluster design, 1835 children 54 to 60 mo old were sampled from 60 villages in the Amhara region of Ethiopia. The Iodized Salt and control groups were comparable on all baseline variables, including maternal schooling (89.6% had none) and child dietary diversity (mean: 2.2 out of 7 food categories). Once national production of Iodized Salt began, the project facilitated early delivery to intervention village marketplaces; Iodized Salt arrived to control village marketplaces approximately 6 months later. The same children (92% of the original sample) were re-assessed at 69 to 78 mo of age. Intervention group children had a significantly higher score on the 25-item school readiness test (mean: 8.3 vs 7.8, respectively, p<0.05). No significant differences were found on the two Wechsler tests of reason...
Zhifang Wang - One of the best experts on this subject based on the ideXlab platform.
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poor iodine knowledge coastal region and non Iodized Salt consumption linked to low urinary iodine excretion in zhejiang pregnant women
Nutrients, 2019Co-Authors: Xiaofeng Wang, Xiaoming Lou, Mingluan Xing, Guangming Mao, Wenming Zhu, Yuanyang Wang, Yuan Chen, Zhifang WangAbstract:Background: Iodine deficiency in pregnant women, defined as a median urinary iodine concentration (UIC) of less than 150 μg/L, is an important public health issue. To improve their iodine intake, it is important to understand the knowledge and practices regarding iodine. Methods: A cross-sectional investigation was conducted on 2642 pregnant women during 2016–2017 in Zhejiang province, China. A 3-point Likert scale questionnaire was used to record knowledge. The UIC and iodine content in household Salt were determined. Results: Coastal participants were iodine deficient (median UIC 127.6 μg/L) while inland participants were iodine sufficient (median UIC 151.0 μg/L). The average knowledge scores were significantly lower for the coastal participants (24.2 points vs. 25 points for the inland participants; p < 0.001). The percentage for Iodized Salt consumption was significantly lower for the coastal participants (88.9% vs. 96.0% for those inland; p < 0.001). A generalized linear model analysis showed that non-Iodized Salt consumption, coastal region, and low knowledge scores were independently associated with a low UIC. Conclusions: Comprehensive interventional strategies are needed to develop to achieve an optimal iodine status. We recommend that coastal pregnant women should take iodine supplements based on the consumption of Iodized Salt, and improvement of iodine-related knowledge.
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an increase in consuming adequately Iodized Salt may not be enough to rectify iodine deficiency in pregnancy in an iodine sufficient area of china
International Journal of Environmental Research and Public Health, 2017Co-Authors: Zhifang Wang, Xiaofeng Wang, Guangming Mao, Wenming Zhu, Yuanyang Wang, Xiaoming LouAbstract:Universal Salt iodization (USI) has been implemented for two decades in China. It is crucial to periodically monitor iodine status in the most vulnerable population, such as pregnant women. A cross-sectional study was carried out in an evidence-proved iodine-sufficient province to evaluate iodine intake in pregnancy. According to the WHO/UNICEF/ICCIDD recommendation criteria of adequate iodine intake in pregnancy (150-249 µg/L), the median urinary iodine concentration (UIC) of the total 8159 recruited pregnant women was 147.5 µg/L, which indicated pregnant women had iodine deficiency at the province level. Overall, 51.0% of the total study participants had iodine deficiency with a UIC < 150 µg/L and only 32.9% of them had adequate iodine. Participants living in coastal areas had iodine deficiency with a median UIC of 130.1 µg/L, while those in inland areas had marginally adequate iodine intake with a median UIC of 158.1 µg/L (p < 0.001). Among the total study participants, 450 pregnant women consuming non-Iodized Salt had mild-moderate iodine deficiency with a median UIC of 99.6 µg/L; 7363 pregnant women consuming adequately Iodized Salt had a lightly statistically higher median UIC of 151.9 µg/L, compared with the recommended adequate level by the WHO/UNICEF/ICCIDD (p < 0.001). Consuming adequately Iodized Salt seemed to lightly increase the median UIC level, but it may not be enough to correct iodine nutrition status to an optimum level as recommended by the WHO/UNICEF/ICCIDD. We therefore suggest that, besides strengthening USI policy, additional interventive measure may be needed to improve iodine intake in pregnancy.
Cornelia C Metges - One of the best experts on this subject based on the ideXlab platform.
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influence of knowledge on iodine content in foodstuffs and prophylactic usage of Iodized Salt on urinary iodine excretion and thyroid volume of adults in southern germany
European Journal of Nutrition, 1996Co-Authors: Cornelia C Metges, W Greil, R Gartner, M Rafferzeder, Jakob Linseisen, A Woerl, Gunther WolframAbstract:Thyroid volume, urinary iodine excretion as well as personal nutritional knowledge and individual iodine prophylaxis were determined during a health education program on iodine deficiency and prophylaxis in 1992. Participants were 472 male and 568 female (mean age 27.7 years) students and employees of five universities in the southern part of Germany. The study aimed to clarify the relationship between personal knowledge on iodine, individual iodine prophylaxis and parameters of iodine deficiency (thyroid volume, iodine excretion) in a well known iodine deficient area. Mean thyroid volume (mean±SD) was 19.7±8.3 ml in males and 15.8±7.1 ml in females. 25.5 % of females and 19.9 % of males showed thyroid volume above the upper normal values. Total mean urinary iodine excretion was 70.7±42 µg I/g creatinine reflecting WHO-grade-I iodine deficiency. 80.8 % of total subjects used Iodized Salt and 43.2 % stated to consume Salt-water fish to meet their iodine requirement. The female non-users had significantly lower iodine excretion (no Iodized Salt, no Salt-water fish: 61.4±31.3 vs. +Iodized Salt, +Salt-water fish: 83.9±47.6 µg I/g creatinine; p<0.05), however, thyroid volume was identical in these groups. The area of residence over the last 10 years did not significantly influence the thyroid volume. The goiter incidence increased with age. Although our study population was highly educated (81.8 % students) and the subjects were provided with educational brochures immediately prior to the study, knowledge about iodine content of food was poor. We conclude that despite a high degree of voluntary iodine prophylaxis and educational programs the iodine intake is insufficient. The use of Iodized Salt in households, cafeterias, and also in food manufacturing must be increased for sufficient iodine prophylaxis.
Roland Kupka - One of the best experts on this subject based on the ideXlab platform.
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key considerations for policymakers Iodized Salt as a vehicle for iron fortification current evidence challenges and knowledge gaps
Journal of Nutrition, 2021Co-Authors: Adam Drewnowski, Greg S. Garrett, Rishi Kansagra, Noor Khan, Roland Kupka, Anura V Kurpad, Venkatesh Mannar, Reynaldo Martorell, Michael B ZimmermannAbstract:Could DFS help prevent iron deficiency and anemia? Studies in controlled settings (efficacy) demonstrate that double-fortified Salt (DFS; iron added to Iodized Salt) reduces the prevalence of anemia and iron deficiency anemia. Studies in program settings (effectiveness) are limited and reported differing levels of DFS coverage, resulting in mixed evidence of impact on anemia. What iron formulations are available and how do they affect Iodized Salt? Ferrous sulfate and encapsulated ferrous fumarate (both with various enhancers and/or coating materials) are the main iron formulations currently in use for DFS. Adding iron to Iodized Salt may lead to adverse changes in the product, specifically discoloration and losses in iodine content. These changes are greatest when the Iodized Salt used in DFS production is of low quality (e.g., contain impurities, has high moisture, and is of large crystal size). DFS requires Iodized Salt of the highest quality and a high-quality iron formulation in order to minimize adverse sensory changes and iodine losses. Appropriate packaging of Iodized Salt is also important to prevent losses. What is known about the minimum requirements to manufacture DFS? DFS producers must use high-quality refined Iodized Salt meeting the minimum standards for DFS production (which is higher than standards for Salt intended for iodization alone), and an iron formulation for which there are rigid quality-assurance measures to ensure consistent quality and blending techniques. The actual proportion of Iodized Salt meeting the stringent requirements necessary for DFS production is unclear, but likely to be low in many countries, especially those with fragmented Salt industries and a low proportion of industrially produced Salt. What are the financial implications of adding iron to Iodized Salt? As a result of higher input costs both for input Salt and the iron compound, DFS is more expensive to produce than Iodized Salt and thus has a higher production cost. Various grades of Iodized Salt are produced and consumed in different sectors of the market. Experience in India indicates that, on average, producing DFS costs 31-40 US dollars/metric ton or 0.03-0.04 US dollars/kg more than high-quality refined Iodized Salt. The exact impact of this production-level cost difference on profit margins and consumer price is specific to the conditions of different Salt markets. Factors such as transport costs, customary wholesale and retail mark-ups, and taxes all vary greatly and need to be assessed on a case by case basis. Is DFS in alignment with Salt-reduction efforts? The WHO has long recognized that Salt iodization is an important public health intervention to achieve optimal iodine nutrition and is compatible with Salt-reduction goals. Fortification of Salt (with any nutrient) should not be used to justify or encourage an increase in Salt intake to the public. Any effort to expand Salt fortification to other nutrients should be done in close consultation with WHO and those working on Salt reduction. What has been the experience with DFS delivery under different platforms? To date, DFS has been introduced into the retail market and in social safety net (primarily in India) programs, but sensory changes in DFS have been raised as concerns. The higher price for DFS has limited expansion in the retail market. In social safety net programs where the cost of DFS is subsidized for beneficiaries, programs must consider long-term resourcing for sustainability. Overall: The optimal production and delivery of DFS are still under development, as many challenges need to be overcome. There is a beneficial impact on hemoglobin in efficacy trials. Thus, if those conditions can be replicated in programs or the technology can be adapted to better fit current production and delivery realities, DFS may provide an effective contribution in countries that need additional food-fortification vehicles to improve iron intake.
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household coverage with adequately Iodized Salt varies greatly between countries and by residence type and socioeconomic status within countries results from 10 national coverage surveys
Journal of Nutrition, 2017Co-Authors: Jacky Knowles, Jonathan Gorstein, Greg S. Garrett, Roland Kupka, Ruth Situma, Kapil Yadav, Rizwan Yusufali, Chandrakant S Pandav, Grant J AaronAbstract:Background: Household coverage with Iodized Salt was assessed in 10 countries that implemented Universal Salt Iodization (USI).Objective: The objective of this paper was to summarize household coverage data for Iodized Salt, including the relation between coverage and residence type and socioeconomic status (SES).Methods: A review was conducted of results from cross-sectional multistage household cluster surveys with the use of stratified probability proportional to size design in Bangladesh, Ethiopia, Ghana, India, Indonesia, Niger, the Philippines, Senegal, Tanzania, and Uganda. Salt iodine content was assessed with quantitative methods in all cases. The primary indicator of coverage was percentage of households that used adequately Iodized Salt, with an additional indicator for Salt with some added iodine. Indicators of risk were SES and residence type. We used 95% CIs to determine significant differences in coverage.Results: National household coverage of adequately Iodized Salt varied from 6.2% in Niger to 97.0% in Uganda. For Salt with some added iodine, coverage varied from 52.4% in the Philippines to 99.5% in Uganda. Coverage with adequately Iodized Salt was significantly higher in urban than in rural households in Bangladesh (68.9% compared with 44.3%, respectively), India (86.4% compared with 69.8%, respectively), Indonesia (59.3% compared with 51.4%, respectively), the Philippines (31.5% compared with 20.2%, respectively), Senegal (53.3% compared with 19.0%, respectively), and Tanzania (89.2% compared with 57.6%, respectively). In 7 of 8 countries with data, household coverage of adequately Iodized Salt was significantly higher in high- than in low-SES households in Bangladesh (58.8% compared with 39.7%, respectively), Ghana (36.2% compared with 21.5%, respectively), India (80.6% compared with 70.5%, respectively), Indonesia (59.9% compared with 45.6%, respectively), the Philippines (39.4% compared with 17.3%, respectively), Senegal (50.7% compared with 27.6%, respectively) and Tanzania (80.9% compared with 51.3%, respectively).Conclusions: Uganda has achieved USI. In other countries, access to Iodized Salt is inequitable. Quality control and regulatory enforcement of Salt iodization remain challenging. Notable progress toward USI has been made in Ethiopia and India. Assessing progress toward USI only through household Salt does not account for potentially Iodized Salt consumed through processed foods.
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more than two thirds of dietary iodine in children in northern ghana is obtained from bouillon cubes containing Iodized Salt
Public Health Nutrition, 2017Co-Authors: Abdulrazak Abizari, Roland Kupka, Susanne Dold, Michael B ZimmermannAbstract:Objective Bouillon cubes are widely consumed by poor households in sub-Saharan Africa. Because their main ingredient is Salt, bouillon cubes could be a good source of iodine if Iodized Salt is used in their production and if their consumption by target groups is high. Our objective was to measure the iodine content of bouillon cubes, estimate their daily intake in school-aged children and evaluate their potential contribution to iodine intakes. Design In a cross-sectional study, we measured urinary iodine concentrations (UIC) and estimated total daily iodine intakes. We administered a questionnaire on usage of bouillon cubes. We measured the iodine content of bouillon cubes, household Salt, drinking-water and milk products. Setting Primary schools in northern Ghana. Subjects Schoolchildren aged 6–13 years. Results Among school-aged children (n 250), median (interquartile range) UIC and estimated iodine intake were 242 (163–365) µg/l and 129 (85–221) µg/d, indicating adequate iodine status. Median household Salt iodine concentration (n 100) was only 2·0 (0·83–7·4) µg/g; 72 % of samples contained <5 µg iodine/g. Iodine concentrations in drinking-water and milk-based drinks were negligible. Median iodine content of bouillon cubes was 31·8 (26·8–43·7) µg/g, with large differences between brands. Estimated median per capita consumption of bouillon cubes was 2·4 (1·5–3·3) g/d and median iodine intake from bouillon cubes was 88 (51–110) µg/d. Conclusions Despite low household coverage with Iodized Salt, iodine nutrition in school-aged children is adequate and an estimated two-thirds of their dietary iodine is obtained from bouillon cubes.
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association between household unavailability of Iodized Salt and child growth evidence from 89 demographic and health surveys
The American Journal of Clinical Nutrition, 2016Co-Authors: Marion Kramer, Roland Kupka, S V Subramanian, Sebastian VollmerAbstract:BACKGROUND Although a strong biological basis exists for a role of iodine in somatic growth failure in childhood, this relation has not been previously studied on a large scale to our knowledge. OBJECTIVE We investigated if a general association exists between the household unavailability of Iodized Salt and child growth across countries. DESIGN We used 89 nationally representative, repeated, cross-sectional and mutually comparable demographic and health surveys that were conducted between 1994 and 2012 across 46 low- and middle-income countries. We analyzed the data for the outcome variables of stunting (low height-for-age), underweight (low weight-for-age), wasting (low weight-for-height), and low birth weight in children aged between 0 and 59 mo at the time of the interview with the use of logistic regression models. Our samples consisted of 390,328 children for the stunting analysis, 397,080 children for the underweight analysis, 384,163 children for the wasting analysis, and 187,744 children for the low-birth-weight analysis. Models were adjusted for individual, maternal, and household covariates and fixed effects on the level of the primary sampling unit. RESULTS In the fully adjusted models, the unavailability of Iodized Salt was associated with 3% higher odds of being stunted (95% CI of ORs: 1.00, 1.06; P = 0.04), 5% higher odds of being underweight (95% CI: 1.02, 1.09; P < 0.01), and 9% higher odds of low birth weight (95% CI: 1.02, 1.17; P = 0.01). When India was excluded from the sample, the association was only statistically significant (P = 0.05) for low birth weight. CONCLUSION Although we did not establish causality in our analysis, the findings might indicate that the causal effect of Iodized Salt on child growth, if it exists, is most profound in utero and is not universally effective across all countries with respect to longer-run child-growth outcomes such as stunting and underweight.
