Meeting: Iodine Villages Across Thailand to Honor Her Royal Highness Princess Maha Chakri Sirindhorn, Nutritional Princess: Overcoming the Challenges to Sustainability25 June 2015, Bangkok

Sustaining the Prevention and Control of Iodine Deficiency in the Southeast Asia and

Pacific Region

Karen CodlingRegional Coordinator South East Asia and the Pacific

1993

Severe

Moderate

Mild

Adequate

No data 110 countries iodine deficient

Ref: IGN

2014

Severe

Moderate

Mild

Adequate

No data 30 countries remain iodine deficient

Ref: IGN

HH use of adequately iodized salt globally and by region

UNICEF SOWC 2015

Household use of iodised salt in the EAP Region

Ref: National surveys such as DHS, MICS, Living Standards, National Nutrition or IDD. Surveys assessing adequately of iodine with a quantitative methodology, such as titration, shown with an asterix *

Lessons learnt in increasing coverage with iodised salt and

sustaining IDD elimination achievements

The importance of mandatory legislation

Equalizes costs for producers Provides more equitable access to fortified

foods public health impact Can be more easily monitored than

voluntary fortification Does not require consumer behavior

change Sets appropriate fortification standards

Reasons for mandatory legislation

Analysis of salt iodisation programmes has found that in one decade, countries with mandatory legislation had a greater increase in household coverage (from 49% to 72%, compared with the increases in countries with voluntary iodisation (from 40% to 49%)

Ref: Horton, Mannar & Wesley. Micronutrient Fortification (Iron and Salt Iodisation) Copenhagen Best Practice Paper 2008

Ref: National IDD Surveys and Multiple Cluster Indicator Survey in 2011

Decline in coverage of adequately iodized salt in Viet Nam following the end of mandatory legislation

End of mandatory legislation

Malaysia Legislation 1999

Peninsular Malaysia – Voluntary Sarawak – Mandatory in some districts Sabah – Mandatory

2010 survey - UIC and HHIS

Salt iodisation in Malaysia

Ref: Selamat et al. Iodine deficiency status and iodised salt consumption in Malaysia: findings from a national iodine deficiency disorders survey. Asia Pac J Clin Nutr. 2010

The importance of enforcement

Weak point of most fortification programmes Enforcement of food fortification should be

integrated into routine food control systems Industry/enterprises must fortify Government must create safe, fair

environment Best way govt can support mandatory salt

iodisation is ensure all enterprises comply with law – create an even playing field

The importance of use of iodised salt in processed foods & animal feed

WHO recommendations for scope of salt iodization

“universal salt iodization calls for fortification with iodine of all food-grade salt for human and animal consumption, including salt for food processing”

Ref: WHO, 2014 and WHO, UNICEF, ICCIDD, 2007

Iodised salt for food processing and animals

Why iodised salt for food processing?– A significant amount of salt is consumed through

processed foods– As countries develop, proportion of salt consumed

through processed foods increases Why iodised salt for animal?

– Animals also suffer from iodine deficiency; iodised salt improves health and increases productivity

If salt for food processing and animal feed is iodised, there can be no leakage of non-iodised to the market

Estimates of proportion of salt consumed as household salt or through processed food WHO: “in many countries, about 80% of salt in the diet comes

from processed foods”

Country Processed Food

United Kingdom 77

United States 75

South Africa 60

Philippines 57

Indonesia 46

China 45

Ref: WHO, 2014 and various country references (see notes)

Sources of sodium intake in Thanh Oai district of Hanoi

Ref: National Institute of Nutrition. Investigation of dietary sodium intake and sources in adults, aged 25-64 years. 2010

The importance of monitoring and evaluating the impact

Coverage sub-nationally to identify unreached populations

Urinary iodine status of different population groups to ensure adequate iodine for whole population (school age children, pregnant women, reproductive age women)

Urinary iodine status to adjust iodization levels Use of iodized salt in processed foods Salt intake from household salt and processed

foods

Iodized salt has a large effect on reducing the risk of goitre, cretinism, low cognitive function, and iodine deficiency.

Robust monitoring of salt iodization programmes is important to ensure safe and effective levels of iodine consumption, especially as countries implement programmes to reduce population salt intake

2014

For more information:

Web: http://www.ign.org Twitter: @ign_iccidd

Email: kcodling@ign.org