Eliminating Iodine Deficiency in China: Achievements, Challenges and Global Implications

Abstract

The prevention of iodine deficiency through salt iodization has been recognized as a global success story, and China stands at the forefront of this achievement with one of the most successful programs in the world. High level political commitment, national mandatory legislation, a state-managed edible salt industry and a complex and highly sophisticated surveillance system have facilitated the success of the program. Challenges have arisen however, including: (i) concern that adequate iodine status in pregnant women cannot be achieved without causing above adequate iodine intakes in children; (ii) declining iodine intake as a result of reductions in salt consumption and increased consumption of processed foods, which may not be made with iodized salt; (iii) the existence of areas with high iodine content in the water; and (iv) declines in household use of iodized salt due to concerns about excess iodine intake and thyroid disease. This article reviews the achievements and challenges of the Chinese Iodine Deficiency Disorders (IDD) Elimination Program and reflects on lessons learned and implications for other national salt iodization programs.

Iodine status of euthyroid adults: A cross‐sectional, multicenter study

“…Iodine deficiencies were prevalent in China until the introduction of universal salt iodization (USI) in 1995 . In 2000 and 2011, the USI standards were adjusted, and the principle of individualization of cities was proposed .…”

Moderate iodine deficiency among pregnant women in Hong Kong: revisit the problem after two decades

“…27 Mainland China has led the way in sustaining the elimination of iodine deficiency through iodised salt since the early 1990s. 28 Nonetheless dietary iodine intake remains insufficient among pregnant women in Shanghai, Zhejiang, and other coastal cities where iodine is considered sufficient for the general population. 29,30 A national survey from the Mainland reported that the median UIC levels of pregnant and lactating women were 123-224 μg/L and 109-224 μg/L, respectively; median UIC was higher among those in inland cities, because of a higher iodine level in the salt and greater household coverage.…”

Provision of micronutrients in coexisting public health programs and risk of excessive intake: regulatory considerations

“…Micronutrient interventions in China are presented in Table . Salt fortification with iodine has been a highly successful mandatory program since 1994 . It became fully regulated in 2011 under the State Council Order No.…”

“…Salt fortification with iodine has been a highly successful mandatory program since 1994. 37 It became fully regulated in 2011 under the State Council Order No. 163 to prevent iodine deficiency disorders (IDDs), previously documented in the country.…”