Contemporary challenges to iodine status and nutrition: the role of foods, dietary recommendations, fortification and supplementation

Abstract

Iodine deficiency (ID) in women of childbearing age remains a global public health concern, mainly through its impact on fetal and infant neurodevelopment. While iodine status is improving globally, ID is still prevalent in pregnancy, when requirements increase. More than 120 countries have implemented salt iodisation and food fortification, strategies that have been partially successful. Supplementation during pregnancy is recommended in some countries and supported by the WHO when mandatory salt iodisation is not present. The UK is listed as one of the ten countries with the lowest iodine status globally, with approximately 60 % of pregnant women not meeting the WHO recommended intake. Without mandatory iodine fortification or recommendation for supplementation in pregnancy, the UK population depends on dietary sources of iodine. Both women and healthcare professionals have low knowledge and awareness of iodine, its sources or its role for health. Dairy and seafood products are the richest sources of iodine and their consumption is essential to support adequate iodine status. Increasing iodine through the diet might be possible if iodine-rich foods get repositioned in the diet, as they now contribute towards only about 13 % of the average energy intake of adult women. This review examines the use of iodine-rich foods in parallel with other public health strategies, to increase iodine intake and highlights the rare opportunity in the UK for randomised trials, due to the lack of mandatory fortification programmes.

Low intake of iodized salt and iodine containing supplements among pregnant women with apparently insufficient iodine status - time to change policy?

“…Fortification of basic foods is the best way to prevent silent malnutrition [36,38]. Around the world, iodine fortification has been practiced for nearly a century [36,39]. In Israel, the MOH has debated the development of policy and the implementation of practical guidelines for decades [37], with gradual progress with partial salt iodization [40].…”

“…In early 2017, the MOH published guidelines for the general public encouraging voluntary use of IS [13]. Importantly, it is currently unclear whether fortification alone can provide adequate iodine intake during pregnancy and lactation [39,42,43], and the range of appropriate iodine levels is narrow. Moreover, if a country moves ahead with a Universal Salt Iodization Program, then its ICS recommendations for PW must be carefully calibrated so that women of child bearing age and PW get the appropriate amount of iodine neither too little nor too much [39,[43][44][45][46][47][48].…”

“…Importantly, it is currently unclear whether fortification alone can provide adequate iodine intake during pregnancy and lactation [39,42,43], and the range of appropriate iodine levels is narrow. Moreover, if a country moves ahead with a Universal Salt Iodization Program, then its ICS recommendations for PW must be carefully calibrated so that women of child bearing age and PW get the appropriate amount of iodine neither too little nor too much [39,[43][44][45][46][47][48]. Intake of both IS and ICS, together with other iodine rich food sources, may potentially lead to excessive iodine intake [16,30,39,49] 1 .…”

“…Adopt WHO guidelines for iodization of salt and the development of a national universal salt iodization program, in coordination with the ICS recommendations for PW [38,39,[44][45][46][47]50]; Encourage cooperative industry engagement using regulation and financial incentives [43]; Initiate a professional advisory board composed of clinicians, public policy makers and industry representatives; Promote ICS adherence and knowledge of dietary iodine sources by caregivers and possibly by health maintenance organizations; Promote awareness (among both professionals and pregnant women themselves) of the importance of adequate iodine intake during pregnancy; accelerating public health information campaign and professional education initiatives; Institute appropriate regulations and a monitoring program to ensure adequate and safe fortification and supplementation [37].…”

Стан Йодного Забезпечення Дітей Та Жінок Репродуктивного Віку В Західному Регіоні України

“…IDD are still major public health problems in developing countries although significant progress has been made towards their control strategies [6]. Historically, the territory of Ukraine is considered an endemic region UDC 612.392.64:618.17:616-053.…”