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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