Assessment of iodine concentration in dietary salt at household level in Morocco

Investigation of the effects of heat and light on iodine content of packaged and open salt brands collected from Jimma town

Iodine deficiency is one of the most common micronutrient deficiencies in developing countries, which leads to iodine deficiency disorders (IDD). To combat iodine deficiency disorders, universal salt iodization is mandatory. However, iodized salt can lose its iodine due to environmental factors such as heat, light, moisture, and so on. Therefore, the aim of this study is to investigate the effects of heat and light on the iodine content of packaged and open salt brands available in Jimma town, Oromia, Ethiopia. An experimental study design was employed to determine the effects of heat and light on the iodine content of salts. A total of six salt samples were collected from retailers selected based on convenience sampling technique. Among six different salt brands, three were packaged salts, and the rest were non-packaged (open) salts. The iodine content of the salt samples was determined by the iodometric titration method, and the effects of heat and light on the concentration of iodine were also investigated. It has been revealed that heat and light decrease the iodine content of salt samples. The findings of this study provide valuable insights into the stability of iodized salt against heat and light. It is also helpful in identifying the right time at which salt should be added while cooking and the appropriate storage conditions for salt in households.

Prevalence of iodine deficiency among Moroccan women of reproductive age

BACKGROUND

Iodine deficiency disorders (IDD) affects nearly 1.9 million people worldwide. Iodine deficiency (ID) remains a public health concern not only for pregnant women, but for women of reproductive age (WRA) as well. This study was planned to evaluate the iodine status and the prevalence of iodine deficiency in a nationally representative sample of Moroccan WRA according to their socio-economic data and living areas.

METHODS

This study is a cross-sectional national survey conducted on 1652 WRA aged between 18 and 49 years. Iodine status was assessed by the evaluation of the urinary iodine concentration (UIC) on spot urinary samples, using the Sandell-Kolthoff reaction, and by the estimation of iodine-rich food consumption, using a food frequency questionnaire. The World Health Organization cutoff of a median UIC of < 100 μg/l was used to define ID in the population.

RESULTS

The median UIC [20th- 80th] was 71.3 μg/l [37.5-123.1] and 71% of participants had UIC < 100 μg/L, indicating insufficient iodine status and mild iodine deficiency. WRA from urban and rural areas showed an UIC median of 75.94 μg/l [41.16-129.97] and 63.40 μg/l [33.81-111.68], respectively. Furthermore, ID prevalence was significantly higher in rural areas (75.6%) as compared to urban areas (67.9%) (p < 0.05). Food frequency questionnaires analyses highlighted that dairy products are the most commonly consumed iodine-rich food, reported to be consumed daily by 43.1% of WRA. Of particular interest, 83.5% of WRA reported a weekly consumption of fish.

CONCLUSION

ID is still a public health problem in Morocco highlighting the necessity to implement effective national program, including efficient salt iodization, effective nutritional education and awareness, to control iodine deficiency and prevent IDD development.

Inadequate intake of vitamins and minerals among high-school pupils in the Moroccan Rif region

BACKGROUND: Inadequate nutrient intakes in adolescents may negatively affect their future health. The identification of inadequate micronutrient intakes by dietary study provides essential information to guide educational strategies for promoting healthy eating habits. OBJECTIVE: To assess the daily micronutrient intake and the prevalence of inadequacy in a sample of middle and high-school pupils in the Rif region of Morocco. METHODS: A cross-sectional study collected dietary information from food records over three non-consecutive days in a sample (n = 302) of Moroccan Riffian adolescents (12–18 years). The DIAL software, adapted for commonly eaten Moroccan foods, was used to estimate micronutrient intakes. The proportion of individuals with intakes below the Estimated Average Requirement (EAR) or the Adequate Intake (AI) level and the probability approach were used to estimate the prevalence of inadequacy. RESULTS: Regardless of gender and age group, our subjects were found to be particularly at risk of inadequate intakes of vitamins E and D, calcium and potassium. Older adolescents (14–18 years) also showed a risk of inadequate intake of folate, biotin, magnesium, iodine and zinc (among boys). CONCLUSION: For many nutrients, the daily diets of our Riffian adolescents do not meet the recommended intake levels. We emphasize the need for monitoring the dietary habits of adolescents and the development of nutrition education programs. Further studies which include the clinical and biological assessment of nutritional status, as well as the regular collection of quality and nationally representative micronutrient data, are recommended.

Adequately Iodized Salt Utilization and Associated Factors among Households in Tach Armachio District, Northwest Ethiopia: A Community-Based Cross-Sectional Study

Background

For the synthesis of thyroid hormones, iodine is a crucial trace element. Iodine deficiency disorders affect all groups particularly: pregnant, young women and children. Iodine deficiency disorder has been recognized as a serious public health issue in Ethiopia. Therefore, this study planned to assess iodized salt utilization and associated factors at the household level.

Methods

A community-based cross-sectional study was conducted from January 25 to February 24, 2019, in Tach Armachio district, Northwest Ethiopia. A single population proportion formula was used to calculate the sample size and a total of 555 households were sampled. A multistage sampling technique was conducted to select the household. An iodometric titration method was performed. A structured, pretested, and face-to-face interview questionnaire was used to collect data; then, it was entered in Epi Info 7 and exported to SPSS version 25 for analysis. Bivariable and multivariable analyses were done to identify predictor variables. A 95% confidence interval and adjusted odd ratio were reported. P values less than 0.05 were considered statistically significant in the multivariable analysis.

Results

This study showed that iodized salt was adequately utilized by 61.1% (CI = 57%–65%) of households. Good knowledge of iodine deficiency disorder (AOR = 2.25, 95% CI = (1.44, 3.50)), keeping salt in the kitchen house away from fire (AOR = 5.09, 95% CI = (3.25, 7.98)), buying packed salt [AOR = 1.89, 95% CI = (1.12, 3.19)), keeping salt in a covered container (AOR = 2.18, 95% CI = (1.24, 3.81)), and exposing salt to sunlight (AOR = 0.39, 95% CI = (0.23, 0.65)) were significantly associated.

Conclusion

In the district, adequately iodized salt utilization was low. Therefore, it is necessary to enforce the current law for merchants to sell iodized packed salt and teach the community how to handle it.

Household Iodized Salt, Iodine Intake, and Thyroid Dysfunction in Reproductive Age Women in Different Regions of Iodine Adequacy

Iodine deficiency affects people of all age groups and yields detrimental health effects known as Iodine Deficiency Disorders (IDD). Universal Salt Iodization (USI) where above 90% household use iodized salt became the main program to optimized population iodine status. This study aimed to analyze iodine in salt, iodine status and thyroid functions from three different IDD endemic regions.

METHODS

This was a cross-sectional study, with women of reproductive age (15 to 45 y old) as subjects, conducted in plain area (Yogyakarta) city (n=250), mountainous area (Bukit Tinggi city) (n=249), and combination of mountaneous and plain area (Purworejo regency) (n=249). Urinary iodine (UIE), prevalence of hyperthyroidism, and hypothyroidism (diagnostic based on combination of TSH and fT4 level), also the presence or absence and level of iodine in salt were assessed.

RESULT

Iodized salt coverage have reached >90% household in all three region, while titration found 75.6% with adequate level of iodine in salt (>30 ppm), with wide range of iodine level in salt (0.00-218.2 ppm). With that condition, population in plain and combination of plain and mountainous area have more than adequate iodine status (218 μg/L and 224 μg/L), while population in mountaneous area still in mild iodine deficiency status (UIE median of 88 μg/L). Most population is in euthyroid condition. Hyperthyroidism, subclinical hyperthyroidism, secondary hyperthyroidism, subclinical hypothyroidism, and hypothyroidism were found in 0.7%, 4.8%, 0.4%, 8.9%, and 0.9% population consecutively. There were no relationship between iodine status and prevalence of hyperthyroidism and hypothyroidism, but subclinical hypothyroidism most prevalent in excess UIE population (12.5% vs 8.3%).

CONCLUSION

All three regions have achieved USI target. But the risk of iodine deficiency still found in mountaneous area. Household iodized salt coverage discrepancy between rapid test and titration strengthen the need of more accurate but efficient test of iodine level in salt.

Trend of Iodine Status in the Eastern Mediterranean Region and Impact of the Universal Salt Iodization Programs: a Narrative Review

Recognizing the importance of iodine deficiency as a single most important preventable cause of brain damage, World Health Organization (WHO) urged all countries to scale up salt iodization since 1991 where iodine deficiency was declared as a global public health problem. All countries committed to report on the national iodine status of school-aged children (6-12 years), every 3 years. This paper aims to evaluate the progress of countries in Eastern Mediterranean Region (EMR) toward the eradication of iodine deficiency disorders (IDD) and recommend operational action to support implementation of the WHO Regional Nutrition Strategy (2020-2030). Salt iodization in EMR has been scaled up with significant progress in increasing the proportion of dietary salt which is adequately iodized. As a result, many countries such as Qatar, Kuwait, Bahrain, Jordan, Oman, and Iran have achieved, or are now on the threshold of achieving IDD elimination. The WHO in coordination with United Nations Children's Fund is working with member states to ensure suitability of these achievements. Hence, efficient monitoring will help member states to measure the magnitude of IDD as a public health problem and to monitor the effects of the intervention on the iodine status of a population. Policy makers should take proactive steps to enforce mandatory regulatory measures for USI, through a multi-sectoral coordination, and careful assessments and estimates of iodine nutritional status. Coordination between the two national programs of USI and salt reduction intake is necessary.

Has iodized salt reduced iodine-deficiency disorders among school-aged children in north-west Iran? A 9-year prospective study

OBJECTIVE

Low iodine intakes are associated with goitre and other iodine-deficiency disorders (IDD) that have affected billions of people worldwide. We aimed to assess total goitre rate (TGR) and urinary iodine concentration (UIC) in schoolchildren between 2007 and 2015, percentage of iodized salt consumption by households, and salt iodine content at production, distribution and household levels in north-west Iran. Design/Setting/Subjects UIC assessed among schoolchildren in nine consecutive years; 240 schoolchildren aged 8-10 years selected by systematic random sampling each year in the West Azerbaijan Province.

RESULTS

Median UIC was >100 μg/l in all years. More than 50 % of children had iodine deficiency (UIC≤99 μg/l) in 2010 and 2011, while this rate was approximately 15-35 % in other years. Proportion with UIC below 50 μg/l was <20 % in all years except 2010 and 2011. Excessive UIC (≥300 μg/l) rate was between 5·4 and 27·5 %. TGR decreased from 44 % in 1996 to 7·6 % and 0·4 % in 2001 and 2007, respectively. Regular surveys from 2002 to 2015 showed that 98 % or more of households consumed iodized salt. Iodine level ≥20 ppm was observed in 87·5, 83 and 73 % of salt at production, distribution and household level, respectively (data from national study in 2007). The last national study in 2014 showed that median iodine level in household salt was 27 ppm.

CONCLUSIONS

Our focused data suggest that the universal salt iodization programme is improving the iodine status of schoolchildren in the West Azerbaijan Province of Iran. Reduction of TGR to less than 5 % in schoolchildren indicates successful elimination of IDD as a major public health problem.

Availability of adequately iodized in Northwest Ethiopia: a cross-sectional study

Background

Universal salt iodization is the most cost-effective, safe and sustainable strategy to eliminate iodine deficiency disorders. However, little is known about the availability of adequately iodized salt in the northwestern part of Ethiopia. Thus, the aim of this study was to assess the availability of adequately iodized salt at the household level and associated factors in Dabat District, northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted from February 21 to March 31, 2016. We included 705 households in the study. A stratified multistage followed by simple random sampling technique was employed to select households. The level of salt iodine content was determined using the rapid field test kit. Accordingly, the value of <15 parts per million (PPM) and ≥15 PPM with the corresponding color chart on the rapid test kit were used to classify the level of iodine content in the sampled salt. A multivariable binary logistic regression model was fitted to identify factors associated with the availability of adequately iodized salt. Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) was calculated to show the strength of association.

Results

This study indicated that about 33.2% [95% CI: 29.6, 36.7%] of households had adequately iodized salt. Urban residence (AOR = 2.15, 95% CI: 1.23, 3.76), use of packed salt (AOR = 2.23, 95% CI: 1.01, 4.89), and good respondents' knowledge on iodized salt use (AOR = 1.49, 95% CI: 1.08, 2.08) were positively associated with the availability of adequately iodized salt. However, longer distance to buy salt was inversely related with availability of adequately iodized salt (AOR = 0.68, 95% CI: 0.48, 0.99).

Conclusions

The availability of iodized salt is well under the WHO recommendation in Dabat District in spite of the fact that Ethiopia has been implementing universal salt iodization since the last five years. Therefore, intensifying strategies targeting to enhance community awareness on the benefit and handling practice of iodized salt is essential to improve availability of iodized salt. In addition, the focus needs to be on improving accessibility of iodized salt.

Moderate-to-Severe Iodine Deficiency in the "First 1000 Days" Causes More Thyroid Hypofunction in Infants Than in Pregnant or Lactating Women

Background: Iodine deficiency early in the life cycle-the "first 1000 days"-can cause hypothyroidism and irreversibly impair neuromotor development. However, the relative vulnerability among women and infants during this critical period is unclear, making it difficult for country-based programs with limited resources to prioritize their iodine interventions.Objective: Our aim was to determine the prevalence of thyroid hypofunction in women and infants living in an area of moderate-to-severe iodine deficiency.Methods: In a cross-sectional survey in Morocco, we measured urinary iodine concentrations (UICs) and concentrations of thyroid-stimulating hormone (TSH) and total or free thyroxine (TT4 or fT4, respectively) in women of reproductive age (n = 156), pregnant women (n = 245), and lactating women (n = 239) and their young infants (n = 239). We calculated daily iodine intakes and measured iodine concentrations in breast milk and household salt. We compared the incidence of hypothyroidism between the 3 groups of women and with the infants.Results: Women of reproductive age, pregnant women, and lactating women had median (IQR) UICs of 41 (29-63), 32 (17-58), and 35 (19-62) μg/L; and estimated iodine intakes were ∼60%, 22%, and 26% of Recommended Nutrient Intakes (RNIs). The infants' median UIC was 73 (28-157) μg/L, which was greater than for all 3 groups of women (P < 0.001), and their dietary intakes were 27% of the RNI. The prevalence of hypothyroidism was not significantly different between the 4 groups, whereas the prevalence of hypothyroxinemia was higher in infants (40%) than in the 3 groups of women (11-14%) (P < 0.001). The median breast-milk iodine concentration was 42 (26-81) μg/L. Only 6% of salt samples were adequately iodized to a concentration of ≥15 ppm; 54% were inadequately iodized and 40% contained no measurable iodine.Conclusions: In an area of moderate-to-severe iodine deficiency, the prevalence of thyroid hypofunction is ∼4-fold higher in young infants compared with the 3 groups of women, suggesting that, in the "first 1000 days," infants are more vulnerable than their mothers and that programs should prioritize iodine prophylaxis for this group.