Relationship between Dining Place, Iodine Source, and Iodine Nutrition in School-Age Children: A Cross-Sectional Study in China / 生物医学与环境科学（英文）

OBJECTIVE@#This study assesses the impact of iodine-rich processed foods and dining places on the iodine nutritional status of children.@*METHODS@#School-aged children (SAC) in seven provinces in China were selected by school-based multi-stage sampling. Urinary iodine, salt iodine, and thyroid volume (TVOL) were determined. Questionnaires were used to investigate dining places and iodine-rich processed foods. The water iodine was from the 2017 national survey. Multi-factor regression analysis was used to find correlations between variables.@*RESULTS@#Children ate 78.7% of their meals at home, 15.1% at school canteens, and 6.1% at other places. The percentage of daily iodine intake from water, iodized salt, iodine-rich processed foods, and cooked food were 1.0%, 79.2%, 1.5%, and 18.4%, respectively. The salt iodine was correlated with the urinary iodine and TVOL, respectively (r = 0.999 and -0.997, P < 0.05). The iodine intake in processed foods was weakly correlated with the TVOL (r = 0.080, P < 0.01). Non-iodized salt used in processed foods or diets when eating out had less effect on children's iodine nutrition status.@*CONCLUSION@#Iodized salt remains the primary source of daily iodine intake of SAC, and processed food has less effect on iodine nutrition. Therefore, for children, iodized salt should be a compulsory supplement in their routine diet.

The epidemiological burden of reducing salt intake in Paraguay: A modeling study / A carga epidemiológica da redução do sal no Paraguai: um estudo de modelagem

ABSTRACT Objective This study aims to estimate the epidemiological burden of excessive salt intake reduction and achieve the World Health Organization salt reduction target for 2025 in Paraguay, in 2019. Methods We used the Preventable Risk Integrated Model, a comparative risk assessment macro-simulation model, to estimate the averted deaths, disease incidence, and disability-adjusted life years from cardiovascular disease attributable to salt intake in the population of Paraguay for different salt reduction policy scenarios. Results As a result, in Paraguay, excessive salt intake (over 5 g/day) is responsible for approximately 2,656 cardiovascular disease deaths (95% Uncertainty Interval: 1,250-3,765), 4,816 cardiovascular disease cases (95% UI: 2,251-6,947), and 60,529 disability-adjusted life years (95% UI: 27,828-86,258) per year. By reducing salt consumption by 30%, as recommended by the World Health Organization until 2025, approximately 1,188 deaths (95% UI: 520 to 1,820), 2,100 incident cases (95% UI: 923-3,234), and 27,272 disability-adjusted life years (95% UI: 11,999-41,675) from cardiovascular disease could be averted every year. Conclusion In conclusion, the burden of cardiovascular disease attributable to excessive salt intake is significant and salt reduction policies must become a priority in Paraguay.

RESUMO Objetivo Este estudo visa estimar a carga epidemiológica do consumo excessivo de sal e o alcance da meta da Organização Mundial de Saúde para 2025 no Paraguai, em 2019. Métodos Foi usado um modelo de avaliação comparativa de risco (Preventable Risk Integrated Model) para análise comparativa de risco para estimar mortes, casos incidentes e anos de vida ajustados por incapacidade (DALYs) por doenças cardiovasculares atribuíveis ao consumo excessivo de sal na população paraguaia em diferentes cenários. Resultados No Paraguai, o consumo excessivo de sal é responsável por aproximadamente 2.656 mortes (Intervalo de Incerteza 95%: 1.250-3.765), 4.816 casos incidentes (95% II: 2.251-6.947) e 60.529 DALYs (95% II: 27.828-86.258) por doenças cardiovasculares por ano. Com uma redução de 30% no consumo de sal, como recomendado pela Organização Mundial de Saúde até 2025, aproximadamente 1.188 mortes (95% II: 520-1.820), 2.100 casos incidentes (95% II: 923-3.234) e 27.272 DALYs (95% II: 11.999-41.675) por doenças cardiovasculares poderiam ser prevenidos ou adiados por ano. Conclusão Concluiu-se que a carga de doenças cardiovasculares atribuível ao consumo excessivo de sal no Paraguai é significante e políticas de redução deveriam ser priorizadas no país.

Concentración de fluoruros en la sal de uso doméstico comercializada en Montevideo, Uruguay / Concentration of fluorides in household salt marketed in Montevideo, Uruguay / Concentração de flúor no sal de uso doméstico comercializado em Montevidéu, Uruguai

Objetivos: Evaluar la concentración de fluoruro en la sal de mesa disponible comercialmente en Montevideo, Uruguay. Método: Fueron analizados catorce paquetes de sal para determinar la concentración de iones fluoruro libres. Las muestras se pesaron, se diluyeron en agua desionizada, se mezclaron con TISAB II y se utilizó un electrodo específico conectado a un analizador de iones para determinar la concentración de fluoruro Resultado: La mayoría de los paquetes presentaron valores inferiores a 250 mgF / kg. Las muestras de sal gruesa mostraron concentraciones mayores a las de sal fina (p <0.05). Aquellas conteniendo fluoruro de sodio presentaron mayor concentración de fluoruro que aquellas conteniendo fluoruro de potasio (p <0.05). Dos marcas presentaron concentraciones de fluoruro cercanas a las informadas en el envase. Conclusiones: Las sales de mesa comercializadas en Montevideo, Uruguay presentaron gran variabilidad en las concentraciones de fluoruro

Objectives: The aim of this study was to evaluate the concentration of fluoride (F) in household salt marketed in Montevideo, Uruguay. Methods: Fourteen household salt brands marketed in Montevideo, Uruguay were analyzed to determine the F concentrations. Salt samples were prepared and F concentrations were determined using a fluoride-specific electrode connected to an ion analyzer. Results: Most of the salt brands showed values lower than 250 mgF/kg. Coarse salt samples showed higher F concentrations compared to the refined salt samples (p < 0.05). Salt brands contained sodium fluoride presented higher F concentrations than salt brands contained potassium fluoride (p < 0.05). Only two brands had F concentrations close to that informed in product packages. Conclusions: Household salt brands marketed in Montevideo (Uruguay) present a great variability in their F concentrations.

O objetivo deste estudo foi avaliar as concentrações de flúor (F) no sal de uso doméstico comercializado em Montevidéu, Uruguai. Métodos: Quatorze marcas de sal doméstico comercializadas em Montevidéu (Uruguai) foram analisadas para determinar as concentrações de F. As amostras de sal foram preparadas e as concentrações de flúor foram determinadas através de um eletrodo específico para F conectado a um analisador de íons. Resultados: A maioria das marcas de sal mostraram valores menores que 250mgF/ kg. Amostras de sal grosso apresentaram as maiores concentrações de F comparadas às amostras de sal refinado (p < 0,05). Apenas duas marcas tiveram as concentrações de F próximas àquelas informadas nas embalagens dos produtos. Conclusões: As marcas de sal de uso doméstico comercializadas em Montevidéu (Uruguai) apresentam uma grande variabilidade em suas concentrações de F.

Sodium content and food additives in major brands of Brazilian children's foods / Conteúdo de sódio e aditivos alimentares das maiores marcas de alimentos destinados para crianças brasileiras

Abstract The objective of this paper is to evaluate the sodium content and additive usage in packaged food products targeted at Brazilian children. Commercial database and manufactures' websites were used to identify major brands of child-oriented foods. Samples were categorized as "children's foods" (n = 214) and "infant's foods" (n = 86). Nutrition Facts labels were used to calculate the median Na content (mg/serving, mg/kcal, and mg/100g); the ingredient lists to note the use of food additives. The sodium content found in samples varied widely among brands. The amount of sodium was high (> 210 mg/serving) in 20% of the products. Sodium density exceeded 1 mg/kcal in 40% of the products with the savory foods had the highest densities. More than 30% of the foods categories (corn snacks, filled biscuits, sliced loaf bread, and cereals) did not fulfill the 2014 sodium reduction targets. Food additives present in all children's foods varied from two to nine additives numbers. However, some products had incredible numbers of additives, such as instant noodles and mini cakes. Although some infants' foods categories were additives free, most products contained up to three numbers of additives. Continuing surveillance is crucial to evaluate the progress of salt reduction and to revise the maximum permissible limit of additives.

Resumo O objetivo deste trabalho é avaliar o teor de sódio e a utilização de aditivos em alimentos industrializados destinados às crianças no Brasil. Bancos de dados comerciais foram usados para identificar as principais marcas de alimentos. Foram classificadas como "alimentos para crianças" (n = 214) e "alimentos infantis" (n = 86). Os rótulos nutricionais foram usados para calcular a mediana de sódio (mg/porção, mg/kcal e mg/100g) e a lista de ingredientes comprovou o uso de aditivos alimentares. O teor de sódio encontrado em amostras variou entre as marcas. A quantidade de sódio foi elevada (> 210 mg/porção) em 20% dos produtos. A concentração de sódio superior a 1 mg/kcal em 40% dos produtos com os alimentos salgados representou as maiores quantidades. Mais de 30% das categorias (salgadinho de milho, biscoitos recheados, pão de forma e cereais) não cumpriram as metas de 2014 de redução de sódio. Os aditivos presentes em alimentos de crianças variaram de dois a nove aditivos. No entanto, alguns produtos tiveram mais aditivos, tais como macarrão instantâneo e mini bolo. Alguns alimentos infantis estavam livres de aditivos, mas a maioria dos produtos continha até três. Um constante monitoramento é fundamental para avaliar o progresso na redução de sódio e no limite máximo admissível de aditivos.

Sodium chloride composition of commercial white bread in Morocco

This study aimed to evaluate the amount of salt provided by the consumption of bread in daily food intake and compare it to recommended salt intake. Chloride ion concentrations were measured using Mohr's Method to indirectly quantify added salt in bread samples from 80 professional bakeries in Casablanca, Morocco. Results showed that the average amount of added salt during the preparation of white bread is 17.42 +/- 1.28 g / kg, which is the equivalent of a daily intake of 8 to 9 g of salt through bread alone, and exceeds all recommendations. The high salt content of white bread might be a contributing factor to the high sodium intake in Morocco, especially considering that bread is a staple food in the country. Any policies or initiatives to reduce sodium consumption should target bread as a strategic vehicle to reduce salt intake

Impacto da redução do teor de sódio em alimentos processados no consumo de sódio no Brasil / Impacto de la reducción del contenido de sodio en los alimentos procesados en la ingestión de sodio en Brasil / The impact of the reduction of sodium content in processed foods in salt intake in Brazil

Resumo: O objetivo do presente estudo foi avaliar o potencial impacto da redução do teor de sódio em alimentos processados no consumo médio de sódio na população brasileira. Um total de 32.900 participantes do primeiro Inquérito Nacional de Alimentação (2008-2009), com 10 anos e mais de idade, que forneceram dados de dois dias de consumo foram avaliados. As metas de redução de sódio pactuadas pelo Ministério da Saúde em 2010 e 2013 foram utilizadas como referência para determinar o teor máximo de sódio em 21 grupos de alimentos processados. Os resultados indicam que as metas de redução de sódio em alimentos processados têm pequeno impacto no consumo médio de sódio na população brasileira. Em 2017, a redução média esperada é de 1,5%, ficando os valores de consumo médio de sódio ainda acima do limite máximo recomendado de 2.000mg/dia. Portanto, dificilmente será possível alcançar a redução necessária no consumo de sódio no Brasil a partir de acordos voluntários nos moldes dos que aconteceram até o momento.

Resumen: El objetivo del presente estudio fue evaluar el potencial impacto de la reducción del contenido en sodio en alimentos procesados en el consumo medio de sodio de la población brasileña. Un total de 32.900 participantes de la primera Encuesta Nacional de Alimentación (2008-2009), con 10 años y más de edad, proporcionaron datos sobre dos días de consumo, que fueron evaluados. Las metas de reducción de sodio, indicadas por el Ministerio de Salud en 2010 y 2013, fueron utilizadas como referencia para determinar el contenido máximo de sodio en 21 grupos de alimentos procesados. Los resultados indican que las metas de reducción de sodio en alimentos procesados tiene un pequeño impacto en el consumo medio de sodio en la población brasileña. En 2017, la reducción media esperada es de un 1,5%, quedando los valores de consumo medio de sodio todavía por encima del límite máximo recomendado de 2.000mg/día. Por tanto, difícilmente será posible alcanzar la reducción necesaria en el consumo de sodio en Brasil, a partir de acuerdos voluntarios en los términos de los que se han ido sucediendo hasta el momento.

Abstract: This study aimed at assessing the potential impact of the reduction of sodium content in processed foods in the average salt intake in the Brazilian population. A total of 32,900 participants of the first National Dietary Survey (NDS 2008-2009), age 10 years and older who provided information about food intake over two days were evaluated. The sodium reduction targets established by the Brazilian Ministry of Health in 2010 and 2013 were used as the reference to determine the maximum content of sodium in 21 groups of processed food. The results show that sodium reduction targets in processed food have small impact in mean Brazilian population intake of salt. For 2017, the expected mean reduction is of 1.5%, the average sodium intake being still above the recommended 2,000mg/day maximum. Therefore, it will hardly be possible to reach the necessary reduction in salt intake in Brazil from volunteer agreements like the ones made so far.

Sodio en panes y snacks de mayor consumo en Costa Rica: Contenido basal y verificación del etiquetado nutricional / Sodium in breads and snacks of high consumption in Costa Rica: Basal content and verification of nutrition labeling

Una categoría de alimento de amplio consumo por la población es el pan, constituyendo una de las principales fuentes de sodio en la alimentación, a pesar de ser moderada en sal. Mientras, los snacks o bocadillos tienen un elevado contenido de sodio, pero son menos consumidos por la población general. El objetivo del presente trabajo fue determinar mediante análisis directo el contenido basal de sodio en panes y snacks de mayor consumo en Costa Rica y verificar el cumplimiento del Reglamento Técnico Centroamericano de Etiquetado Nutricional. Los alimentos se clasificaron según: tipo, marca comercial, método y lugar de producción. Las muestras se recolectaron en supermercados y panaderías del Gran Área Metropolitana entre el 2011 y el 2012. La muestra primaria la constituyeron 99 panes y 84 snacks, y la analítica de 33 y 28, respectivamente. El contenido de sodio se determinó mediante espectrofotometría de emisión de llama. Los panes presentaron entre 496 y 744 mg/100g de sodio, 45% incluían etiquetado nutricional y 80% declararon mayor cantidad que el encontrado por análisis directo. Los panes industrializados, excepto el integral cumplieron con la normativa. En los snacks el contenido de sodio osciló entre 276 y 1221 mg/100g, todos presentaron etiquetado nutricional y 43% declararon menor contenido que lo analizado, incumpliendo con la normativa. El estudio provee datos basales para iniciar la reducción de sodio y confirma que el análisis directo resulta indispensable para conocer con certeza el contenido de sodio en los alimentos.

Bread is highly consumed by population, making it one of the main sources of sodium in the diet, despite being moderate in salt. Mean while, snacks have high sodium content, but are less consumed by the general population. The aim of this study was to determine by direct analysis the baseline of sodium in breads and snacks most consumed in Costa Rica and verify compliance with the Central American Technical Regulation on Nutritional Labeling. Foods samples were classified by type, trade mark, method and place of production. Samples were collected in supermarkets and bakeries in the Great Metropolitan Area between 2011and 2012. Primary sample comprised 99 breads and 84 snacks, and analytical sample 33 and 28, respectively. The sodium content was determined by flame emission spectrophotometer. Breads showed between 496 and 744mg/100g sodium, 45% included nutritional labeling and 80% reported greater amount than found by direct analysis. Industrialized breads except the whole grain varieties, complied with regulations. In snacks, sodium content ranged from 276 to 1221mg/100g, all had nutritional labeling and 43% reported less content, in breach of the regulations. The study provides baseline data to initiate sodium reduction and direct analysis confirms that it is essential to know with certainty the sodium content in foods.

Iodine nutrition in elementary state schools of Queretaro, Mexico: correlations between urinary iodine concentration with global nutrition status and social gap index / Consumo de iodo em escolas de ensino fundamental de Querétaro, México: correlação entre a concentração urinária de iodo, o estado nutricional geral e o índice de desigualdade social

OBJECTIVE AND METHODS: To estimate median urinary iodine concentration (UIC), and to correlate it with global nutrition indicators and social gap index (SGI) in 50 elementary state schools from 10 municipalities in the State of Queretaro, Mexico. RESULTS: 1,544 students were enrolled and an above of requirements of iodine intake was found (median UIC of 297 µg/L). Iodine status was found as deficient, adequate, more than adequate and excessive in 2, 4, 19 and 25 schools, respectively. Seventy seven percent of table salt samples showed adequate iodine content (20-40 ppm), while 9.6% of the samples had low iodine content (< 15 ppm). Medians of UIC per school were positively correlated with medians of body mass index (BMI) by using the standard deviation score (SDS) (r = 0.47; p < 0.005), height SDS (r = 0.41; p < 0.05), and overweight and obesity prevalence (r = 0.41; p < 0.05). Medians of UIC per school were negatively correlated with stunting prevalence (r = -0.39; p = 005) and social gap index (r = -0.36; p < 0.05). Best multiple regression models showed that BMI SDS and height were significantly related with UIC (p < 0.05). CONCLUSIONS: There is coexistence between the two extremes of iodine intake (insufficient and excessive). To our knowledge, the observed positive correlation between UIC and overweight and obesity has not been described before, and could be explained by the availability and consumption of snack food rich in energy and iodized salt.

OBJETIVO E MÉTODOS: Estimar a concentração de iodo urinário (CIU) mediana e correlacioná-la com os indicadores de nutrição geral e com o índice de desigualdade social (IDS) de 50 escolas estaduais de ensino fundamental de 10 municípios do estado de Querétaro, no México. RESULTADOS: Utilizou-se um total de 1.544 crianças e encontrou-se uma ingestão acima das necessidades de iodo (CIU mediana de 297 µg/L). O nível de iodo determinado foi deficiente, adequado, mais do que adequado e excessivo em 2, 4, 19 e 25 escolas, respectivamente. Setenta e sete por cento de amostras de sal de mesa mostraram uma quantidade de iodo adequada (20-40 ppm), enquanto 9,6% das amostras tinham um teor de iodo baixo (< 15 ppm). As medianas de CIU por escola foram correlacionadas positivamente com as medianas do índice de massa corporal (IMC) usando o desvio-padrão da contagem (DP) (r = 0,47; p < 0.005), o DP da altura (r = 0,41; p < 0.05) e a prevalência de sobrepeso e de obesidade (r = 0,41; p < 0,05). As medianas de CUI por escola foram correlacionadas negativamente com a prevalência de desnutrição (r = -0.39; p = 005) e com o índice de desigualdade social (r = -0.36; p < 0,05). Os melhores modelos de regressão múltipla mostraram que a DP do IMC e a altura foram relacionados significativamente com a CIU (p < 0,05). CONCLUSÃO: Existe uma convivência entre os dois extremos de ingestão de iodo (insuficiente e excessiva). Em nosso conhecimento, a correlação positiva entre a CIU, o excesso de peso e a obesidade não foi descrita anteriormente e poderia ser explicada pela disponibilidade e consumo de alimentos ou refeições ricos(as) em energia e sal iodado.

Iniciativas desenvolvidas no Brasil para a redução do teor de sódio em alimentos processados / Initiatives developed in Brazil to reduce sodium content of processed foods

A construção de estratégias para a redução do teor de sódio em alimentos processados faz parte de um conjunto de iniciativas para diminuir o consumo desse nutriente no Brasil — dos atuais 12 g de sal por pessoa ao dia para menos de 5 g por pessoa por dia (2 000 mg de sódio) até 2020. Nesse processo, uma ação central é a pactuação, entre o governo e a indústria de alimentos, de metas de redução voluntária, gradual e sustentável dos teores máximos de sódio nos alimentos industrializados. Este artigo apresenta a experiência brasileira na construção e implementação de estratégias para a redução dos limites máximos de sódio nos alimentos processados e os atores sociais envolvidos.

The construction of strategies for reducing the sodium content of processed foods is part of a set of actions to decrease the intake of this nutrient in Brazil—from the current 12 g of salt per person per day to less than 5 g per person per day (2 000 mg sodium) by 2020. In this process, a central action is the pact between the government and the food industry to establish voluntary, gradual, and sustainable targets to reduce the maximum sodium content of industrial foods. This article describes the Brazilian experience in building and implementing strategies for the reduction of these maximum limits in processed foods and the social actors involved in this effort.

Deficiência de iodo e fatores associados em lactentes e pré-escolares de um município do semiárido de Minas Gerais, Brasil, 2008 / Iodine deficiency and associated factors in infants and preschool children in an urban community in the semiarid region of Minas Gerais State, Brazil, 2008

O objetivo do estudo foi avaliar a prevalência de deficiência de iodo em crianças de 6 a 71 meses em Novo Cruzeiro, Minas Gerais, Brasil. Foram analisadas 475 crianças alocadas por amostragem probabilística estratificada em relação às concentrações de iodo no sal de consumo familiar e excreção urinária de iodo. Observou-se excreção deficiente de iodo em 34,4 por cento das crianças; entre as quais, 23,5 por cento apresentaram deficiência leve; 5,9 por cento, moderada; e 5 por cento, grave. Diferença na distribuição da deficiência de iodo urinário foi constatada entre o meio urbano e rural (p < 0,001), registrando concentrações medianas de iodúria de 150,8µg/L e 114,3µg/L, respectivamente. Observou-se alta proporção de deficiência entre crianças cujo teor de iodo no sal de consumo encontrava-se abaixo da recomendação. A deficiência de iodo em Novo Cruzeiro não constitui problema de saúde pública segundo a Organização Mundial da Saúde (OMS), embora apresente prevalência ainda expressiva. A distribuição limítrofe de iodúria associada a baixos níveis de iodo no sal sugere que as ações de controle dessa carência ainda não são completas no país.

The aim of this study was to evaluate the prevalence of iodine deficiency in children aged 6 to 71 months in Novo Cruzeiro, Minas Gerais State, Brazil. A total of 475 children, allocated by stratified probability sampling, were analyzed with respect to the iodine concentrations in the salt consumed by the family and urinary iodine. Iodine deficiency was verified in 34.4 percent of the children, of which 23.5 percent showed slight deficiency, 5.9 percent moderate and 5 percent serious deficiency. A difference in the distribution of iodine deficiency was observed between the urban and the rural environments (p < 0.001) where average urinary iodine concentrations of 150.8 and 114.3µg/L respectively were found. A greater proportion of iodine deficiency was observed among children where the proportion of iodine in the salt consumed was below the recommended level. Although expressive, iodine deficiency in Novo Cruzeiro is not a public health problem according to World Health Organization (WHO), The limitrophe distribution of the urinary iodine associated with low iodine levels in salt suggests that efforts to control this deficiency are not yet complete.

Fuentes Alimentarias de sal: sodio en mujeres, Costa Rica / Food sources of salt: sodium in women, Costa Rica

Conocer las fuentes alimentarias de sal/sodio, mediante la cuantificación de este mineral presente en los alimentos de consumo usual en mujeres. Método: Estudio tipo mixto, descriptivo y transversal. Participaron 383 mujeres entre 20 y 64 años residentes de los cantones de Escazú y Santa Ana, en el año 2011. Se definió un muestreo no probabilístico sin reemplazo bajo el método de muestras en cadena o por redes. Se estableció una entrevista estructura con preguntas cerradas y el método de consumo usual con cuantificación de cantidades para conocer el consumo de alimentos de las participantes. El contenido de sodio fue calculado con el programa de computo “valornut” y se compararon los resultados con las recomendaciones establecidas por la OMS de consumo de sal por día de 5g por persona. Resultados: El consumo de sal registrado en el estudio es coincidente con el reportado en la encuesta de hogares 2001 realizada por el Ministerio de Salud y Instituto Nacional de Estadística y Censos. Los datos arrojados corresponden a 7,6 g/persona/día de sal, mientras tanto el consumo aparente de sal del 2001 fue de 7g/persona/día. Conclusiones: Los principales alimentos que aportan mayor cantidad de sodio en la dieta de las mujeres son los cereales y derivados y, las carnes y embutidos...

Knowing food sources of salt / sodium, by quantifying the mineral present in foods of women. Materials and Methods: Study mixed type, descriptive and transversal. Involved 383 women between 20-64 years living in the Escazú and Santa Ana in 2011. We defined a non-probability sampling without replacement method samples under chain or network. We established a structured interview with closed questions and the usual consumption method to quantify amounts to meet the food consumption of participants. The sodium content was calculated using the computer program “valornut” and compared the results with the recommendations established by the WHO daily salt intake of 5g per person. Results: Salt intake recorded in the study is consistent with that reported in the 2001 household survey conducted by the Ministry of Health and National Institute of Statistics and Censuses. The data provided correspond to 7.6 g / person / day of salt, while apparent consumption of salt in 2001 was 7g/people/day. Conclusion: The main foods contributing most sodium in the diet of women are cereals and cereal products and meat and sausages...

Feasibility of salt reduction in processed foods in Argentina / Factibilidad de reducir el contenido de sal de los alimentos procesados en la Argentina

OBJECTIVE: To assess an intervention to reduce salt intake based on an agreement with the food industry. METHODS: Salt content was measured in bakery products through a national survey and biochemical analyses. Low-salt bread was evaluated by a panel of taste testers to determine whether a reduced salt bread could remain undetected. French bread accounts for 25 percent of the total salt intake in Argentina; hence, reducing its salt concentration from 2 percent to 1.4 percent was proposed and tested. A crossover trial was conducted to evaluate the reduction in urinary sodium and blood pressure in participants during consumption of the low-salt bread compared with ordinary bread. RESULTS: Average salt content in bread was 2 percent. This study evaluated low-salt bread containing 1.4 percent salt. This reduction remained mostly undetected by the panels of taste testers. In the crossover trial, which included 58 participants, a reduction of 25 milliequivalents in 24hour urine sodium excretion, a reduction in systolic blood pressure of 1.66 mmHg, and a reduction in diastolic blood pressure of 0.76 mmHg were found during the low-salt bread intake. CONCLUSIONS: The study showed that dietary salt reduction was feasible and well accepted in the population studied through a reduction of salt content in bread. Although the effects on urinary sodium and blood pressure were moderate, a countrywide intervention could have a greater public health impact.

OBJETIVO: Evaluar una intervención destinada a reducir el consumo de sal a partir de un convenio con la industria alimentaria. MÉTODOS: Se midió el contenido de sal de los productos de panadería por medio de una encuesta nacional y análisis bioquímicos. Un grupo de catadores evaluó el pan con bajo contenido de sal para determinar si la disminución pasaba inadvertida. Dado que el pan francés representa 25 por ciento del consumo total de sal en la Argentina, se propuso someter a prueba este tipo de pan con una disminución de la concentración de sal de 2 por ciento a 1,4 por ciento. Se realizó un estudio cruzado con el fin de evaluar si los participantes presentaban una concentración urinaria de sodio más baja y una presión arterial menor durante el período en que consumieron pan con bajo contenido de sal respecto del período en que consumieron pan común. RESULTADOS: El pan común contiene un porcentaje promedio de sal de 2 por ciento. En este estudio, el pan con bajo contenido de sal contenía 1,4 por ciento, disminución que, en general, pasó inadvertida a los catadores. En el estudio cruzado, en el que participaron 58 sujetos, la eliminación urinaria de sodio disminuyó 25 miliequivalentes en 24 horas, la presión arterial sistólica bajó 1,66 mmHg y la presión arterial diastólica bajó 0,76 mmHg durante el período en que los participantes consumieron pan con bajo contenido de sal. CONCLUSIONES: El estudio demuestra que es factible reducir la ingesta de sal alimentaria y que la población estudiada considera aceptable que el pan contenga esta menor concentración de sal. Aunque los efectos sobre la concentración urinaria de sodio y la presión arterial fueron moderados, es probable que una intervención nacional tenga repercusiones más importantes para la salud pública.

Iodação do sal e ingestão excessiva de iodo em crianças / Salt iodination and excessive iodine intake among schoolchildren

O presente trabalho tem como objetivo avaliar a excreção urinária de iodo e relacionar com a sua quantidade presente no sal de consumo humano. Participaram do estudo 145 crianças de duas escolas: uma de zona rural e outra de urbana. Foram realizadas avaliação antropométrica e coleta de amostra de urina e do sal de cozinha cada uma das crianças voluntárias. Na escola rural, 3,8% das crianças apresentaram deficiência de iodo. Entretanto, a maioria dos valores de iodúria ficou acima de 300μg/L (62,03%) com 59,49% das amostras do sal de cozinha entre 20 e 60mg de iodo por quilo de sal. Para a escola urbana, 3,03% das crianças apresentaram iodúria inferior à 100μg/L, sendo que, 90,91% das crianças apresentaram valores de iodúria superior a 300μg/L. Desse total, 84,85% das amostras do sal de cozinha encontrava-se entre 20 e 60mg de iodo por quilo de sal. A deficiência de iodo na população estudada está controlada, destacando-se agora uma nova realidade de alta prevalência de excesso de iodo urinário.

The objective of the present study was to evaluate the urinary excretion of iodine and relate it to the amount present in salt for human consumption. The study involved 145 children from two schools: a rural one and an urban one. We performed anthropometric measurements and collected a urine sample and a kitchen salt sample from each child. In the rural school, 3.38% of children had iodine deficiency. However, most of the values of urinary iodine were above 300 μg/L (62.03%) and 59.49% of the kitchen salt samples contained 20 to 60 mg iodine per kilo of salt. In the urban school, 3.03% of the children had urinary iodine excretion of less than 100 μg/L and 90.91% of the children had urinary iodine values exceeding 300 μg/L. Of this total, 84.85% of the kitchen salt samples contained 20 to 60 mg iodine per kilo of salt. Iodine deficiency is controlled in this population, with the current reality showing a high prevalence of excess urinary iodine.

Goiter prevalence and iodine nutritional status of school children in a sub-Himalayan Tarai region of eastern Uttar Pradesh.

OBJECTIVES: The present work was undertaken to evaluate the prevalence of goiter, state of iodine nutrition of the population, distribution of iodine through edible salt, bioavailability of iodine, consumption of common goitrogenic food that generally interfere with iodine nutrition in Naugarh sub-division of Siddharthnagar district in Uttar Pradesh, India. SETTING: Five areas were selected from 5 Community Development (CD) Blocks taking one from each by purposive sampling method. In each area, Primary and Junior high schools were selected by simple random sampling to get representative target population. METHODS: Clinical goiter survey was conducted in 1663 school-aged children from both sexes (6-12 yrs), along with the biochemical analysis of iodine (I) and thiocyanate (SCN) in 200 urine samples, iodine content in 175 edible salt samples and 20 water samples collected from the selected study areas. RESULTS: The studied region is severely affected by Iodine deficiency disorders (IDD) as goiter prevalence is 30.2% (grade 1: 27.1% grade 2:3.1%).Median urinary iodine level was 96 microg/L indicating biochemical iodine deficiency. The mean urinary thiocyanate was 0.810+/-0.490 mg/dL and mean of I/SCN ratios in all the studied areas were above the critical level of 7. However, 22% of the individual had I/SCN ratio <or=7 indicating their susceptibility for the development of goiter. Only 12.6% of the salt samples had adequate iodine i.e., >or=15 ppm while iodine content in drinking water varied between 7.5-10.7 microg/L.CONCLUSION: Iodine deficiency is the primary cause, however the consumption of cyanogenic food may have important role for the persistence of IDD in the studied region during post salt iodization phase.

Tracking progress towards sustainable elimination of iodine deficiency disorders in Bihar.

OBJECTIVES: To assess the status of the iodine deficiency in the population of Bihar and track progress of the elimination efforts. METHODS: A community based field survey was conducted. Using quantitative and qualitative research methods, data was collected by following internationally recommended protocol and methodology. Thirty clusters were selected using population proportionate to size technique. School age children (6 to 12 years) were the target group studied. Urinary iodine in target children and iodine content of salt at households were the indicators used. RESULTS: Total of 1169 children were studied. The median urinary iodine concentration was found to be 85.6 microg/L. Urinary iodine concentration was less than 50 microg/L in 31.5% of the subjects. Only 40.1% of the household salt samples were found to be adequately iodised as determined by titration method (> or =15 ppm iodine). CONCLUSIONS: Study results show existence of iodine deficiency in the state. There is need to accelerate our efforts to achieve iodine sufficiency and this should be done on a war-footing.

Iodine nutritional status of children in North East India.

OBJECTIVE: To assess the iodine nutritional status of school children in selected areas of Imphal West District of Manipur where endemic goitre and associated iodine deficiency disorders (IDD) are prevalent in the post-salt iodization period. METHODS: A total of 961 school children in the age group 6-12 yrs of both sexes were clinically examined for goiter from three study areas- one from rural block and two from urban areas. One hundred twenty urine samples were analysed for iodine and thiocyanate respectively. One hundred and five edible salt samples were also collected from the households to evaluate the iodine content. Drinking water samples from different sources were collected and iodine level was analysed to study the bioavailability of iodine in the region. RESULTS: The total goiter rate was 34.96% (Grade 1- 32.15%; Grade 2- 2.81%) showing that IDD is a severe public health problem. The median urinary iodine levels in the studied areas were in the ranges from 12.5-17.5 microg/dl indicating no biochemical iodine deficiency in the region. Mean urinary thiocyanate level was 0.839+/-0.33 mg/dl showing that the people consume sufficient foods containing thiocyanate precursors. About 82% salt samples had iodine level more than 30 ppm and the iodine content in salt samples less than 15 ppm was only about 3% indicating the salt samples at house hold contain adequate iodine. CONCLUSION: Iodine content in drinking water samples ranged from 1.8-2.6 microg/l showing that the studied region is environmentally iodine deficient. Inspite of the consumption of adequate iodine, the existing goiter prevalence among school children during post salt iodization phase ensures that environmental factors other than iodine deficiency may have the possible role in the persistence of endemic goiter in the population. The role of thiocyanate in this regard may not be ruled out.

Propuesta de sistema de vigilancia de la producción, distribución y consumo de la sal yodada en cuba / Proposal of a surveillance system for the production, distribution and consumption of iodized salt in Cuba

La implementación de componentes de vigilancia constituye un elemento esencial en cualquier programa de fortificación de alimentos para garanta nacional. El presente trabajo aborda la propuesta de diseño del sistema de vigilancia de la yodación de la sal, elemento indispensable para lograr la sostenibidad del programa

Profile of iodine content of salt and urinary iodine excretion levels in selected districts of Tamil Nadu.

OBJECTIVE: Iodine deficiency disorders (IDD) is the most common cause of preventable mental retardation in world today. Out of 29 districts in Tamil Nadu, 24 have been surveyed and all have been found to be endemic to IDD. There is a complete ban on the sale of non iodised salt in the state since 1995. The present study was conducted to assess the iodine content of salt and urinary iodine excretion levels amongst the beneficiaries in the state to help the government to strengthen the existing Universal salt iodisation (USI) programme activities. METHODS: The study was undertaken in 24 districts of Tamil Nadu during the year 2001. The guidelines recommended by WHO/UNICEF/ICCIDD for a rapid assessment of salt iodisation in a district was adopted. A minimum of 150 salt samples were collected from each district by utilising the uniform sampling methodology. The iodine content of salt samples was analysed using the standard iodometric titration method. At least 60 children from each school were randomly selected and were requested to provide "on the spot" casual urine samples. The urinary iodine excretion (UIE) levels were analysed using the wet digestion method. RESULTS: It was observed that 62.3% of the families were consuming iodised salt with more than 5 ppm of iodine. It was found that district Perambalour had deficient iodine nutriture as revealed by the median UIE levels less than 100 micro g/l. CONCLUSION: The findings of the present study reveals the success of USI programme and highlights need for continued monitoring of the quality of salt provided to the population in order to achieve the goal of IDD elimination.