Salt-Containing Recipes in Popular Magazines with the Highest Circulation in the United States Do Not Specify Iodized Salt in the Ingredient List

Iodine deficiency is a public health problem in the US, with the iodine status of women of reproductive age decreasing in recent years. This may be attributable to voluntary salt iodization in the US. Magazines, a common source of recipes and nutritional information, may influence salt use and iodine intake. The aim of this study is to assess whether the magazines with the highest circulation in the US include recipes that contain salt and, if so, whether they specify "iodized salt" in the recipes. Recipes in eight of the top ten magazines by circulation in the US were examined. Standardized information was collected on the presence and type of salt in recipes in the last 12 issues reviewed per magazine. About 73% of the 102 issues reviewed contained recipes. A total of 1026 recipes were surveyed for salt; 48% of the recipes listed salt as an ingredient. None of the 493 recipes containing salt specified iodized salt as the type of salt to be used. About half of the recipes in the last 12 issues of popular magazines published in the US included salt in the ingredient list; however, none recommend the use of iodized salt. There is potential for editorial changes among magazines to call for iodized salt in recipes, which may further prevent iodine deficiency in the US.

Key Considerations for Policymakers-Iodized Salt as a Vehicle for Iron Fortification: Current Evidence, Challenges, and Knowledge Gaps

Could DFS help prevent iron deficiency and anemia? Studies in controlled settings (efficacy) demonstrate that double-fortified salt (DFS; iron added to iodized salt) reduces the prevalence of anemia and iron deficiency anemia. Studies in program settings (effectiveness) are limited and reported differing levels of DFS coverage, resulting in mixed evidence of impact on anemia. What iron formulations are available and how do they affect iodized salt? Ferrous sulfate and encapsulated ferrous fumarate (both with various enhancers and/or coating materials) are the main iron formulations currently in use for DFS. Adding iron to iodized salt may lead to adverse changes in the product, specifically discoloration and losses in iodine content. These changes are greatest when the iodized salt used in DFS production is of low quality (e.g., contain impurities, has high moisture, and is of large crystal size). DFS requires iodized salt of the highest quality and a high-quality iron formulation in order to minimize adverse sensory changes and iodine losses. Appropriate packaging of iodized salt is also important to prevent losses. What is known about the minimum requirements to manufacture DFS? DFS producers must use high-quality refined iodized salt meeting the minimum standards for DFS production (which is higher than standards for salt intended for iodization alone), and an iron formulation for which there are rigid quality-assurance measures to ensure consistent quality and blending techniques. The actual proportion of iodized salt meeting the stringent requirements necessary for DFS production is unclear, but likely to be low in many countries, especially those with fragmented salt industries and a low proportion of industrially produced salt. What are the financial implications of adding iron to iodized salt? As a result of higher input costs both for input salt and the iron compound, DFS is more expensive to produce than iodized salt and thus has a higher production cost. Various grades of iodized salt are produced and consumed in different sectors of the market. Experience in India indicates that, on average, producing DFS costs 31-40 US dollars/metric ton or 0.03-0.04 US dollars/kg more than high-quality refined iodized salt. The exact impact of this production-level cost difference on profit margins and consumer price is specific to the conditions of different salt markets. Factors such as transport costs, customary wholesale and retail mark-ups, and taxes all vary greatly and need to be assessed on a case by case basis. Is DFS in alignment with salt-reduction efforts? The WHO has long recognized that salt iodization is an important public health intervention to achieve optimal iodine nutrition and is compatible with salt-reduction goals. Fortification of salt (with any nutrient) should not be used to justify or encourage an increase in salt intake to the public. Any effort to expand salt fortification to other nutrients should be done in close consultation with WHO and those working on salt reduction. What has been the experience with DFS delivery under different platforms? To date, DFS has been introduced into the retail market and in social safety net (primarily in India) programs, but sensory changes in DFS have been raised as concerns. The higher price for DFS has limited expansion in the retail market. In social safety net programs where the cost of DFS is subsidized for beneficiaries, programs must consider long-term resourcing for sustainability. Overall: The optimal production and delivery of DFS are still under development, as many challenges need to be overcome. There is a beneficial impact on hemoglobin in efficacy trials. Thus, if those conditions can be replicated in programs or the technology can be adapted to better fit current production and delivery realities, DFS may provide an effective contribution in countries that need additional food-fortification vehicles to improve iron intake.

The Double-Fortified Salt (Iodized Salt with Iron) Consultation: A Process for Developing Evidence-Based Considerations for Countries

The addition of iodine to edible salt has been one of the most important public health successes of the past half century, enabling most countries to achieve optimal iodine intake and protect the brains of unborn children from the adverse consequences of iodine deficiency. Salt has been an ideal vehicle for this effort because of its near universal and narrow range of consumption, relative ease of technology for salt iodization, and capacity for virtually all salt producers to add iodine. As a result of the success of salt iodization, there has been growing interest in using salt as a vehicle for other important micronutrients, particularly the addition of iron to iodized salt to produce double-fortified salt (DFS), to combat the persistent problem of iron deficiency and iron deficiency anemia. Because of this growing interest in DFS and the need for a comprehensive review of evidence to support the viability of this intervention, the Iodine Global Network (IGN) initiated a global consultation to gather all available data on different aspects of DFS. IGN identified 4 key areas considered essential to understand for a successful fortification intervention: 1) efficacy and effectiveness, or how well DFS produces a health impact in controlled and real-life settings; 2) technical considerations for production, or what are the minimum requirements to manufacture DFS; 3) program implementation to describe experiences thus far with the delivery of DFS across multiple platforms; and 4) comparison of DFS with other iron fortification efforts to determine the comparative advantage of DFS to improve iron intake and prevent iron deficiency anemia. This preface provides an overview of the DFS Consultation objectives, process, and objectives.

Matrix-Independent Highly Conductive Composites for Electrodes and Interconnects in Stretchable Electronics

Electrically conductive composites (ECCs) hold great promise in stretchable electronics because of their printability, facile preparation, elasticity, and possibility for large-area fabrication. A high conductivity at steady state and during mechanical deformation is a critical property for ECCs, and extensive efforts have been made to improve the conductivity. However, most of those approaches are exclusively functional to a specific polymer matrix, restricting their capability to meet other requirements, such as mechanical, adhesive, and thermomechanical properties. Here, we report a generic approach to prepare ECCs with conductivity close to that of bulk metals and maintain their conductivity during stretching. This approach iodizes the surfactants on the commercial silver flakes, and subsequent photo exposure converts these silver iodide nanoparticles to silver nanoparticles. The ECCs based on silver nanoparticle-covered silver flakes exhibit high conductivity because of the removal of insulating surfactants as well as the enhanced contact between flakes. The treatment of silver flakes is independent of the polymer matrix and provides the flexibility in matrix selection. In the development of stretchable interconnects, ECCs can be prepared with the same polymer as the substrate to ensure strong adhesion between interconnects and the substrate. For the fabrication of on-skin electrodes, a polymer matrix of low modulus can be selected to enhance conformal contact with the skin for reduced impedance.

Two-Step Physical Deposition of a Compact CuI Hole-Transport Layer and the Formation of an Interfacial Species in Perovskite Solar Cells

A simple and practical approach is introduced for the deposition of CuI as an inexpensive inorganic hole-transport material (HTM) for the fabrication of low cost perovskite solar cells (PSCs) by gas-solid phase transformation of Cu to CuI. The method provides a uniform and well-controlled CuI layer with large grains and good compactness that prevents the direct connection between the contact electrodes. Solar cells prepared with CuI as the HTM with Au electrodes displays an exceptionally high short-circuit current density of 32 mA cm(-2) , owing to an interfacial species formed between the perovskite and the Cu resulting in a long wavelength contribution to the incident photon-to-electron conversion efficiency (IPCE), and an overall power conversion efficiency (PCE) of 7.4 %. The growth of crystalline and uniform CuI on a low roughness perovskite layer leads to remarkably high charge extraction in the cells, which originates from the high hole mobility of CuI in addition to a large number of contact points between CuI and the perovskite layer. In addition, the solvent-free method has no damaging side effect on the perovskite layer, which makes it an appropriate method for large scale applications of CuI in perovskite solar cells.

Trends of thyroid function and autoimmunity to 5 years after the introduction of mandatory iodization in Italy

Background. Mandatory iodine fortification of salt was introduced in Italy in 2005. The purpose of our study is to estimate the trend of thyroid diseases in Italy before and after mandatory iodization in Italy. Methods. 7976 patients (6802 females; 1174 males) were examined between 2003 and 2010. We divided the patients into categories according to their clinical diagnosis. Later, we evaluated for each patient if there was the positivity for antibodies anti TPO. Finally, we collected data about TSH values of all patients who did not use therapy for thyroid disease at the time of the examination. To evaluate the differences percentages for categorical variables, χ2-Pearson test was used; to evaluate the percentage differences of TSH values we used the Kruskal-Wallis test. Values were considered statistically significant at p < 0.05. Results. We considered diagnosis of "toxic adenoma / goiter", diagnosis of "Graves' disease" and diagnosis of "hyperthyroidism / thyrotoxicosis" before and after the introduction of mandatory iodization in Italy, to demonstrate the possible presence of iodine-induced hyperthyroidism. Diagnosis of toxic adenoma / goiter before 2005 were 3.7%, while after 2005 they were reduced to 3.1%. Diagnosis of Graves' disease before 2005 were 2.4%, and they remained unchanged after 2005. Finally, diagnosis of hyperthyroidism / thyrotoxicosis decreased from 2.5% to 2.1%. Comparing these results, there were no significant differences (P = 0.261) between the percentages of diagnosis of hyperthyroidism before and after the introduction of mandatory iodization. We considered diagnosis of Hashimoto's thyroiditis before and after 2005 to demonstrate a link between the administration of iodine and thyroid autoimmunity. Prevalence of Hashimoto's thyroiditis between 2003 and 2005 was 37%; prevalence between 2006 and 2010 dropped to 34.7%. This small difference has a borderline statistical significance (P = 0.049). Stratifying TSH values from year to year, we found a small increase in TSH value, which, in any case, remains in the normal range. TSH values passed from 1.37 in 2003, to 1.61 in 2010. Although this increase is modest, it is statistically significant (P values < 0.001). Conclusion. In this study there isn't a connection between iodine fortification and iodine-induced hyperthyroidism, and between iodine fortification and Hashimoto's thyroiditis. This small increase of TSH values can not find a clear explanation yet. We considered several mechanisms to explain this phenomenon: alterations of Na/I symporter reduce intracellular levels of iodine, and cause a state of hypothyroidism; excessive levels of iodine can increase apoptosis of thyrocytes, as it is demonstrated by several studies; interference from external agents (endocrine disruptors).

Iodized salt in Cambodia: trends from 2008 to 2014

Though the consequences of nutritional iodine deficiency have been known for a long time, in Cambodia its elimination has only become a priority in the last 18 years. The Royal Government of Cambodia initiated the National Sub-Committee for Control of Iodine Deficiency Disorders in 1996 to fight this problem. Using three different surveys providing information across all provinces, we examined the compliance of salt iodization in Cambodia over the last 6 years. Salt samples from the 24 provinces were collect at the household level in 2008 (n = 566) and 2011 (n = 1275) and at the market level in 2014 (n = 1862) and analysed through a wavelength spectrophotometer for iodine content. According to the samples collected, the median iodine content significantly dropped from 22 mg/kg (25th/75th percentile: 2/37 mg/kg) in 2011 to 0 mg/kg in 2014 (25th/75th percentile: 0/8.9 mg/kg) (p < 0.001). The proportion of non-iodized salt within our collected salt drastically increased from 22% in 2011 to 62% in 2014 (p < 0.001). Since the international organizations ceased to support the procurement of iodine, the prevalence of salt compliant with the Cambodian declined within our samples. To date, the current levels of iodine added to tested salt are unsatisfactory as 92% of those salts do not meet the government requirements (99.6% of the coarse salt and 82.4% of the fine salt). This inappropriate iodization could illustrate the lack of periodic monitoring and enforcement from government entities. Therefore, government quality inspection should be reinforced to reduce the quantity of salt not meeting the national requirement.