Role of National Legislation in the Interpretation and Practice of Salt Iodization Standards.

Objectives: The ICCIDD/GN Iodine Task Force was established in response to changing environment and program maturity of salt iodization programs worldwide. It aims to improve the evidence and thus the quality and effectiveness of iodine nutrition programs to help update program guidelines. To assess the role of national legislation in the interpretation and practice of salt iodization standards to achieve optimal iodine intake. Methods: A review of scientific literature, reports and data, including the development of a database to review current legislation and policies regarding universal salt iodization (USI) in national programs for eliminating iodine deficiency disorders, was conducted and analyzed to provide information on the interpretation of iodization standards. Results: Review of legislation governing iodization indicates variation in the interpretation of normative guidance (20-40 ppm) on standards. True USI (iodize all salt for human and animal consumption) is not always mandated or implemented. There are examples of changes in legislation in response to dynamic national contexts such as consumption of processed foods. Varied standards and legislation between countries complicate regional approaches to standards setting and can create trade barriers. When iodization is voluntary, information gaps often exist regarding application of the standard and the extent to which iodized salt is used in processed foods. Conclusions: Adherence to normative guidance for iodization standards is not a prerequisite for achieving optimal iodine intake. Legislation governing iodization should preferably be mandatory and support the use of iodized salt for ALL human consumption, to facilitate an evidence based approach to setting standard in a dynamic context.

Review of Iodine and Salt Sources for Establishing Iodization Standards.

Objectives: The ICCIDD/GN Iodine Task Force was established in response to changing environment and program maturity of salt iodization programs worldwide. It aims to improve the evidence and thus the quality and effectiveness of iodine nutrition programs to help update program guidelines. To review dietary sources of iodine intake, including salt from different sources and other natural iodine sources to inform the development of iodization standards. Methods: A review of published literature and reports, data and/or information from national programs for eliminating iodine deficiency disorders was conducted to gather both knowledge and program experience. Results: Globally salt intake through processed foods is increasing; however, in many countries such salt is not iodized. Except for marine food, most natural food sources are low in iodine. In Western countries without mandatory Universal salt iodization, the most significant food groups contributing to iodine intake are dairy and cereal products, however, there is a large disparity in iodine content within and between foods due to natural variations. Little information exists regarding the additional dietary iodine via iodized livestock salt. Generally, iodine content in drinking water is low and contributes relatively little towards iodine intake of large populations. Conclusions: Natural sources of iodine in the diet as well as the iodine contribution via livestock salt as less informative for establishing national standards however, a key consideration is the source of dietary salt. Since most of the salt intake proceeds from industrial salt, iodine standards should be applicable to the total dietary salt supply.