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Presentation by : Omar Dary Place: World Nutrition – 2012 Rio de Janeiro, Brazil 29-April-2012

Monitoring Salt and Iodine Intakes is a Critical I ssue to Adjust S alt F ortification P rograms. Presentation by : Omar Dary Place: World Nutrition – 2012 Rio de Janeiro, Brazil 29-April-2012. Content. The Dietary Reference Intakes (DRI) of iodine

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Presentation by : Omar Dary Place: World Nutrition – 2012 Rio de Janeiro, Brazil 29-April-2012

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  1. Monitoring Salt and Iodine Intakes is a Critical Issue to Adjust Salt Fortification Programs Presentation by: Omar Dary Place: World Nutrition – 2012 Rio de Janeiro, Brazil 29-April-2012

  2. Content • The Dietary Reference Intakes (DRI) of iodine • The misinterpretation of the 100 µg/L cut-off point for urinary iodine to assess appropriate iodine intake • Advantage of estimating the 24-h iodine excretion • Estimating efficacious and safe iodine intakes for the whole population • Transforming those intakes in iodine contents in salt • Conclusions

  3. Iodine Dietary Reference Intakes (µg/day) Iodine: µg/d 450 86 120 Values are for children 6-9 years old 1500 mg/d Na salt: 3.7 g/d Figure modified from Institute of Medicine, the Academies of Science, USA.

  4. Median Urinary Iodine Concentration in 6-12 y old children in Germany Authorizing food industry to use iodized salt Source: Johner et al. Br J Nutr2011.

  5. Iodine and sodium intakes in 6-12 y old children in Germany (Medians) * Assuming that 85% of iodine and 90% sodium intakes are excreted in urine References: EAR iodine = 86-107 µg/d; UL salt = 3.7-4.6 g/d Source: Johner et al. Br J Nutr2011.

  6. UIC and estimated UIE in the USA UIE (ug I/d) estimated by multiplying the reported UIC (ug I/L) for the calculated urinary volume of each age- and gender group, based on body weight: Urinary volume (L/d) = 0.009 L/h.kg x 24 h/d x wt (kg) – from IOM/ Academies of Sciences of the USA: Dietary Reference Intakes for iodine and other nutrients. National Academy Press. 2001. Sources: USA-NHANES; UIC – 2007-2008, except non-pregnant and pregnant women 2005-2008, Caldwell et al. Thyroid 2011; 21: 419; body weight 2003-2006, McDowell et al., Anthropometric reference data for children and adults; National Health Statistics Report 2008; 10.

  7. Ensuring iodine efficacy for everyone: “adjusted” EAR Conclusions: The groups at the highest risk of iodine inadequacy are the pregnant and lactating women. For protecting the whole population the adult females should have an iodine intake 1.87 times higher than their corresponding EAR value of iodine: 95 x 1.87 = 178  180 µg/d.

  8. Ensuring iodine safety for everyone: “adjusted” UL Conclusion: The groups at the highest risk of receiving excessive amounts of iodine are the children 1-3 years old. For protecting the whole population the adult females should have an iodine intake 0.41 times lower than their corresponding UL value of iodine: 1,100 x 0.41 = 451  500 µg/d.

  9. Potential of “fortifiable” salt (hypothetical) Based on data from Elliot and Brown, “Salt intakes around the world”. WHO, 2007. Diet salt is assumed from fish, meat, poultry, milk, cheese, ham, margarine and tomatoes. Conclusion: Both discretionary salt and processed foods should be iodized; depending only on discretionary salt would be insufficient for developed countries and countries in epidemiological and economic transition.

  10. Estimating efficacious and safe iodine contents in “fortifiable” salt *Using the adult females as the reference groups, and as the “average” population group. Data from Elliot and Brown, “Salt intakes around the world”. WHO, 2007. ** Proportions of “fortifiable” salt in prior table. *** Efficacious: “adjusted” EAR at P-10; Safe: “adjusted” UL at P-90. And, assuming that the only source of iodine is the salt. ¶If one assumes that USA received 50% iodine through the diet (milk mainly), then the iodine content in salt could be reduce by half; i.e. around 40 mg I/kg.

  11. Conclusions • UIC (µg/L) is an unreliable indicator to estimate iodine intake; it is preferable using UIE (µg/d) • Intake of iodine from salt and sodium are directly correlated with the energy intake of each person • Estimation of daily excretion of both iodine and sodium (NaCl) is needed to design efficacious and safe iodization programs • Both processed foods and discretional salt should be iodized in a content that is proportional to the sodium intake from these sources in each population

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