De la investigación científica al diseño de políticas de salud: la experiencia con la eliminación de la deficiencia de yodo en Perú / From scientific research to health policy design: the experience of iodine deficiency elimination in Peru

RESUMEN La investigación científica es una función esencial en salud pública; permite reconocer problemas y situaciones que comprometen la salud y la identificación de soluciones. La investigación es esencial para formulación de políticas desalud. Es imperativo para los países tener sistemas nacionales de investigación. Últimamente, ha habido un significativo avance global, pero el crecimiento no es uniforme, las condiciones son escasas en países con ingresos medianos y bajos. Una experiencia que ilustra esta situación ha sido la investigación de la deficiencia de yodo (DI) en Perú y la aplicación de resultados para la creación de un programa de salud pública. La investigación demostró persistente DI, que durante la gestación causa daño cerebral y retardo mental, que el uso de aceite yodado en la prevención y tratamiento tiene efecto inmediato y larga duración, y validó la concentración urinaria del yodo como el mejor indicador de nutrición de yodo. Estos resultados fueron tomados en cuenta por el Ministerio de Salud y en 1983 se creó el Programa Nacional de Control del Bocio y Cretinismo Endémicos, que ha logrado la eliminación virtual de la DI desde 1995.

ABSTRACT Scientific research is an essential public health function, enabling recognition of problems that compromise health and facilitating solutions. Research is essential to formulate health policy at a national level. There has been significant but inconsistent overall progress, due to economic conditions in low- and middle-income countries. An example that illustrates this situation is the investigation of iodine deficiency (ID) in Peru, and the application of the results for development of a public health program. The research demonstrated persistent ID, which causes fetal brain damage and subsequent mental retardation. The use of iodinated oil to prevent and treat ID was shown to have an immediate and long-term effect, and confirmed that urinary concentration of iodine was the best indicator of iodine intake. These results were accepted by the Ministry of Health, and the National Program for the Control of Endemic Goiter and Cretinism was created in 1983, achieving virtual elimination of ID by 1995.

Impacto de las acciones para la eliminación sostenible de la deficiencia de yodo en Cuba / Impact of the actions for the sustainable elimination of iodine deficiency in Cuba

Objetivos: Evaluar la efectividad del “Programa de Eliminación Sostenible de Deficiencia de Yodo” mediante determinación de yoduria y prevalencia de bocio. Materiales y métodos. Se realizó un estudio transversal en el cual se incluyó a la población escolar cubana de 6 a 11 años que cursaba estudios en el periodo 2011-2012. Se empleó un muestreo estratificado polietápico. En el cual se determinaron los niveles de excreción de yodo en la orina (yoduria) y la presencia de bocio. Resultados. La mediana de yoduria fue de 176,3 µg/L; el 7,6% de los escolares presentaron alguna deficiencia de yodo, solo el 2,2% estaba por debajo de 50 µg/L (deficiencia severa) y el 15,3% tenía yodurias por encima de 300 µg/L. El porcentaje de escolares con nutrición óptima de yodo fue de 43,5%, esta categoría presentó una frecuencia significativamente mayor ( p=0,03) en el estrato montaña (52,5%). La prevalencia de bocio encontrada fue de 17,6%, que corresponde a una endemia ligera. Sin embargo, en el estrato montaña se encontró una prevalencia de 32,6 % (endemia severa). Conclusiones. El análisis integral del impacto de las acciones de control de la deficiencia de yodo evaluado a través de la excreción urinaria de yodo y la prevalencia de bocio refleja que ha dejado de ser un problema de salud poblacional en los estratos urbano y rural de Cuba, atribuible a un adecuado proceso de yodación de la sal. Sin embargo, aún se observa una alta prevalencia de bocio en la zona de montaña de Cuba.

Objectives: To assess the effectiveness of the Sustainable Elimination of Iodine Deficiency Program through determination of urinary iodine and goiter prevalence. Materials and methods. A cross-sectional study was conducted in Cuban school children aged 6 to 11 years old in 2011-2012. A stratified multistage sample was used in which the levels of iodine excretion in urine (urinary iodine) and the presence of goiter were determined. Results. The median urinary iodine was 176.3 µg/L; 7.6% of the students showed some deficiency of iodine, only 2.2% were below 50 µg/L (severe deficiency), and 15.3% had urinary iodine above 300 µg/L. The percentage of school children with optimal iodine nutrition was 43.5%, this category showed a significantly higher frequency (p=0.03) in the mountain areas (52.5%). Goiter prevalence was 17.6% which corresponds to a mild endemic. However, in the mountain area the prevalence was 32.6% (severe endemic). Conclusions. The comprehensive analysis of the impact of iodine deficiency control measures assessed by urinary iodine excretion and goiter prevalence reflects that it is no longer a population health problem in urban and rural areas of Cuba, attributable to a proper process of salt iodization. Nevertheless, high goiter prevalence is still observed in the mountain area of Cuba.

Composição mineral de folhas de Oliveira (Olea europaea L. ) em sistema de produção convencional / Mineral composition of olive (Olea europaea L. ) leaves in conventional production system

Objetivou-se com este trabalho quantificar a composição mineral das folhas de Oliveira a fim de diagnosticar o estado nutricional das plantas cultivadas em sistema convencional. O experimento foi conduzido com sete cultivares Arbequina, MGS Asc 315, MGS Mariense, MGS Grap 541, MGS Grap 561, Grappolo 575 e Leccino, em blocos casualizados com 4 repetições e parcelas com cinco plantas. Em maio de 2010 foram coletadas 60 folhas de cada cultivar (12 por planta) e submetidas a analise foliar. As cultivares apresentaram diferenças significativas entre si quanto aos teores foliares médios de nutrientes. Observou-se também que apesar da analise de solo apontar níveis elevados de Fe e Mn, a análise foliar acusou deficiência para esses elementos em todas as cultivares de Oliveira avaliadas. Os resultados alertam para os altos níveis de Cu, como consequência do uso abusivo de fungicidas a base de oxicloreto e calda bordalesa nos pomares. A concentração elevada desse elemento nas folhas pode causar fitotoxidez às plantas. Desta forma, sugere-se o uso racional de fertilizantes e de produtos fitossanitários no cultivo da oliveira a fim de evitar fitotoxidez ou deficiências nutricionais.

This study aimed to quantify the mineral composition of olive leaves to diagnose nutritional status of plants grown in conventional system. The experiment was conducted with seven cultivars: Arbequina, MGS Asc 315, MGS Mariense, MGS Grap 541, MGS Grap 561, Grappolo 575 and Leccino, in a randomized block design with four replications and five plants perplot. In May 2010, we collected 60 leaves for each cultivar (12 per plant),whichwere dried and subsequently analyzed. The results advert to the high levels of Cu, a consequence of the excessive use of fungicides based on copper oxychloride and Bordeaux mixture in the orchards. The high concentration of this element in the leaves can bephytotoxicity to plants and harmful to human health, since the leaves are used popularly as an aid in procedures for weight loss. Thus, we suggest the rational use of fertilizers and pesticides in the cultivation of olive trees to prevent nutritional deficiency or phytotoxicity and, if the research acknowledges the phytotherapic effect of leaves, the adoption of crops in the differentiated system of production, to obtain raw material with good quality and suitable for consumption in natura.

Need for coordinated programs to improve global health by optimizing salt and iodine intake / Necesidad de programas coordinados para mejorar la salud a escala mundial mediante la optimización de la ingesta de sal y yodo

High dietary salt is a major cause of increased blood pressure, the leading risk for death worldwide. The World Health Organization (WHO) has recommended that salt intake be less than 5 g/day, a goal that only a small proportion of people achieve. Iodine deficiency can cause cognitive and motor impairment and, if severe, hypothyroidism with serious mental and growth retardation. More than 2 billion people worldwide are at risk of iodine deficiency. Preventing iodine deficiency by using salt fortified with iodine is a major global public health success. Programs to reduce dietary salt are technically compatible with programs to prevent iodine deficiency through salt fortification. However, for populations to fully benefit from optimum intake of salt and iodine, the programs must be integrated. This review summarizes the scientific basis for salt reduction and iodine fortification programs, the compatibility of the programs, and the steps that need to be taken by the WHO, national governments, and nongovernmental organizations to ensure that populations fully benefit from optimal intake of salt and iodine. Specifically, expert groups must be convened to help countries implement integrated programs and context-specific case studies of successfully integrated programs; lessons learned need to be compiled and disseminated. Integrated surveillance programs will be more efficient and will enhance current efforts to optimize intake of iodine and salt. For populations to fully benefit, governments need to place a high priority on integrating these two important public health programs.

El alto contenido de sal en la dieta es una causa principal de incremento de la presión arterial, el principal factor de riesgo de muerte a escala mundial. La Organización Mundial de la Salud (OMS) ha recomendado que el consumo de sal sea inferior a 5 g/d, una meta que solo logran una pequeña proporción de personas. La falta de yodo puede causar deficiencia cognoscitiva y motora y, si es grave, hipotiroidismo, con grave retraso mental y del crecimiento. Más de dos mil millones de personas en todo el mundo presentan riesgo de carencia de yodo. La prevención de la carencia de yodo mediante el empleo de sal yodada constituye una importante conquista de salud pública a escala mundial. Los programas cuyo objeto es reducir el contenido de sal en la dieta son técnicamente compatibles con los programas de prevención de la carencia de yodo mediante el enriquecimiento de la sal. Sin embargo, para que las poblaciones se puedan beneficiar plenamente de una ingesta óptima de sal y yodo, es preciso integrar ambos tipos de programa. Este estudio resume las bases científicas de los programas de reducción de sal y enriquecimiento con yodo, la compatibilidad de esos programas, y las medidas que deben adoptar la OMS, los gobiernos nacionales y las organizaciones no gubernamentales para garantizar que las poblaciones se beneficien plenamente de una ingesta óptima de sal y yodo. En concreto, es preciso reunir a grupos de expertos para ayudar a los países a aplicar programas integrados y llevar a cabo estudios de casos en contextos específicos de programas integrados eficaces; es preciso recopilar y difundir las enseñanzas extraídas. La integración de los programas de vigilancia los hará más eficaces y mejorará las iniciativas actuales para optimizar la ingesta de yodo y sal. Para que las poblaciones puedan beneficiarse plenamente, es preciso que los gobiernos asignen una alta prioridad a la integración de estos dos importantes tipos de programas de salud pública.

Estado nutricional relativo ao zinco de crianças que frequentam creches do estado da Paraíba / Zinc nutritional status in children attending public daycare centers in the state of Paraíba, Brazil

OBJETIVO: Avaliar o estado nutricional relativo ao zinco de crianças assistidas em creches do Estado da Paraíba. MÉTODOS: O estado nutricional relativo ao zinco de 235 crianças pré-escolares foi avaliado através de sua concentração no soro, da ingestão dietética de zinco e da estatura para idade, como recomendado pelo International Zinc Consultative Group. As concentrações séricas de zinco foram determinadas por espectrofotometria de absorção atômica de chama, considerando deficiência de zinco valores <65µmol/L. O consumo alimentar foi registrado mediante o recordatório de 24 horas, considerando a alimentação da criança no dia anterior e o consumo de alimentos na creche, e foi analisada a inadequação dietética de zinco de acordo com as necessidades médias estimadas de zinco segundo etapa da vida e tipo de dieta estabelecido pelo International Zinc Consultative Group. Adotou-se o Padrão de Crescimento Infantil da Organização Mundial da Saúde para o índice estatura para idade, considerando-se com deficit de estatura as crianças que apresentaram esse índice dois escores-Z abaixo do valor mediano da população de referência. Empregou-se o teste t ou análise de variância na análise estatística, programa Statistical Package for the Social Sciences-16.0. RESULTADOS: As prevalências de deficiência de zinco no soro, inadequação dietética de zinco e deficit de estatura foram de 16,2 por cento, 16,6 por cento e 7,7 por cento, respectivamente. A média de zinco no soro foi estatisticamente menor nas crianças de mães com baixo peso em comparação com as crianças de mães com peso normal. CONCLUSÃO: As crianças estudadas apresentaram risco moderado de deficiência de zinco, pois são indicadas prevalências significativas de baixos níveis séricos de zinco, de consumo inadequado de zinco e de desnutrição crônica.

OBJECTIVE: This study assessed the zinc levels of children attending public daycare centers in the state of Paraíba. Brazil. METHODS: The zinc levels of 235 preschool children were evaluated through serum zinc concentration, dietary zinc intake and height-for-age, as recommended by the International Zinc Nutrition Consultative Group. Baseline zinc levels in the serum were measured by flame atomic absorption spectrophotometry, considering values <65µmol/L indicative of zinc deficiency. The 24-hour recall method was used to record food consumption, considering the food consumption of the child the day before and in the daycare center. Zinc inadequacy was analyzed according to the estimated average zinc requirement by life stage and diet type recommended by the International Zinc Nutrition Consultative Group. The World Health Organization Growth Reference was used as the reference for the height-for-age indices. Children with indices two z-scores below the median value of the reference population were considered stunted. Statistical analysis was performed by the t-test or analysis of variance by the software Statistical Package for the Social Sciences -16.0. RESULTS: The prevalence of inadequate serum zinc concentration, inadequate zinc intakes and stunting were 16.2 percent, 16.6 percent and 7.7 percent, respectively. Mean serum zinc was lower in children of underweight mothers than in children of normal weight mothers. CONCLUSION: The studied children presented moderate risk of zinc deficiency because there was a significant prevalence of low serum zinc concentrations, inadequate zinc intakes and stunting. Also, some children were chronically malnourished.

Consumo alimentar de crianças em municípios de baixo índice de desenvolvimento humano no nordeste do Brasil / Food consumption of children from cities with a low human development index in the Brazilian northeast

OBJETIVO: Este trabalho tem como objetivo analisar o consumo alimentar de crianças em Gameleira, na Zona da Mata Meridional de Pernambuco, e em São João do Tigre, no Semi-Árido da Paraíba, municípios do Nordeste do Brasil. MÉTODOS: Trata-se de estudo transversal envolvendo crianças menores de dois anos, das quais 238 em Gameleira, e 207 em São João do Tigre. O consumo alimentar foi registrado utilizando o método recordatório de 24 horas. Os nutrientes foram analisados utilizando as Dietary Referency Intakes. RESULTADOS: O consumo médio de energia e da maioria dos nutrientes esteve acima das ingestões de referência, em todas as faixas etárias e em ambos os municípios. A maioria dos valores de prevalência de risco de inadequação dos nutrientes foram elevados, principalmente de ferro e zinco, nas crianças entre 7 e 11 meses. O município de São João do Tigre apresentou prevalência de risco, com inadequação em todas as faixas etárias e nutrientes analisados, com exceção da proteína e do ferro na faixa etária entre 12 e 23 meses, embora sem diferença estatisticamente significante. CONCLUSÃO: A situação nutricional da população estudada ainda preocupa devido às acentuadas prevalências de risco de inadequação dos nutrientes. Portanto, é necessária a elaboração de estratégias que reforcem e promovam a segurança alimentar e nutricional para essas populações, a fim de evitar o risco de instalação de distúrbios nutricionais.

OBJECTIVE: This study analyzes the food consumption of children from Gameleira, located in the Southern Forest Area of Pernambuco, and from São João do Tigre, located in the semiarid region of Paraíba, in the Brazilian Northeast. METHODS: This cross-sectional study included 238 children from Gameleira and 207 from São João do Tigre aged <2 years. Food consumption was investigated using a 24-hour dietary recall. Nutrient intake adequacy was classified according to the Dietary Reference Intakes. RESULTS: Mean intakes of energy and most nutrients were above the reference values for all ages in both cities. The prevalences of risk of inadequate nutrient intake were high for most nutrients, especially iron and zinc, in children aged 7 to 11 months. São João do Tigre presented higher said prevalences for most studied age groups and nutrients, except for protein and iron in children aged 12 to 23 months, although the difference was not statistically significant. CONCLUSION: The nutrition situation of this population is still of concern because of the high prevalence of risk of inadequate nutrient intake. Therefore, strategies that promote and ensure food and nutrition security are needed for these populations to prevent risk of nutrition disorders.

El zinc en la salud humana -1 / Zinc in human health - I

Zinc Is a divalent cation with multiple functions In the human body. Zinc absorption occurs In the small Intestine and, together with zinc excretion via feces, is the point of control for zinc homeostasis. Zinc Is an essential nutrient with a specific role In more than 300 enzymes, which participate In all Important biochemical reactions of the human body. Therefore, zinc status has a direct effect In growth, neurological and behavioral development and In the Immune system. The diagnosis of zinc deficiency In Individuals Is difficult given that there Is still no Indicator with adequate sensitivity. Nevertheless, It Is acceptable to use serum zinc to evaluate populations. Finally, Intervention strategies such as supplementation, food fortification and/or dietary modification can be used to control and/or prevent zinc deficiency.

El zinc es un catión divalente con múltiples funciones en el cuerpo humano. La absorción de zinc ocurre en el intestino delgado y es junto con la excreción de zinc vía heces, los puntos de control de la homeostasis de zinc. El zinc es un nutriente esencial con un rol específico en más de 300 enzimas, las cuales participan en todas las reacciones bioquímicas importantes del cuerpo humano. Por ende, el estado de zinc tiene un efecto directo en el crecimiento, el desarrollo neurológico y de comportamiento y en el sistema inmune. El diagnóstico de deficiencia de zinc en individuos no es posible pues aun no existe un marcador lo suficientemente sensible. Sin embargo, el zinc sérico es aceptable para evaluar a poblaciones. Finalmente, se pueden usar las estrategias de suplementación, fortificación y/o modificación alimentaria para controlar y/o prevenir la deficiencia de zinc.

El zinc en la salud humana - II / Zinc in human health - II

Zinc is a divalent cation with multiple functions in the human body. Zinc absorption occurs in the small intestine and is, together with its excretion via faeces, the point of control for zinc homeostasis. Zinc is an essential nutrient with a specific role in more than 300 enzymes, which participate in all important biochemical reactions of the human body. Therefore, zinc status has a direct effect in growth, neurological and behavioral development and in the immune system. The diagnosis of zinc deficiency in individuals is not yet possible given that there still is no indicator with adequate sensitivity. Nevertheless, it is acceptable to use serum zinc levels to evaluate populations. Finally, intervention strategies such as supplementation, food fortification and/or dietary modification can be used to control and/or prevent zinc deficiency.

El zinc es un catión divalente con múltiples funciones en el cuerpo humano. La absorción de zinc ocurre en el intestino delgado y es junto con la excreción de zinc por las heces, uno de los dos puntos de control de la homeostasis de zinc. El zinc es un nutriente esencial con un rol específico en más de 300 enzimas, las cuales participan en todas las reacciones bioquímicas importantes del cuerpo humano. Por ende, el estado de la nutrición de zinc tiene un efecto directo en el crecimiento, el desarrollo neurológico y de comportamiento y en el sistema inmune. El diagnóstico de deficiencia de zinc en seres humanos no es posible pues aun no existe un marcador lo suficientemente sensible. Sin embargo, el zinc sérico es aceptable para evaluar poblaciones. Finalmente, se pueden usar las estrategias de suplementación, fortificación y/o modificación alimentaria para controlar y/o prevenir la deficiencia de este elemento.

Evolução do estado nutricional de crianças submetidas a um programa de suplementação alimentar em município do Estado de São Paulo / Evolution of the nourishing condition on children submitted to additional feeding program in county of state of São Paulo, Brazil

OBJETIVO: O objetivo deste estudo foi avaliar o impacto do Programa de Incentivo ao Combate às Carências Nutricionais no município de Assis, estado de São Paulo. MÉTODOS: Foram acompanhadas 132 crianças menores de 24 meses, que permaneceram por um ano no Programa de Incentivo ao Combate às Carências Nutricionais. O estado nutricional foi avaliado pelo índice Peso para Idade expresso em escore-Z da mediana da população de referência do Nacional Center Health Statistics no início, aos 2, 6, 9 e 12 meses de acompanhamento. RESULTADOS: Entre as crianças estudadas, 70% foram classificadas como desnutridas ou em risco nutricional no momento do ingresso no Programa Incentivo ao Combate às Carências Nutricionais. Em relação ao incremento de peso, comparando-se o início e após 12 meses, 64% das crianças ganharam peso. Analisando-se a variação média do escore-Z de Peso para Idade nos intervalos de tempo estudados, segundo as faixas etárias e o estado nutricional na entrada ao programa, observou-se que as crianças menores de um ano de idade foram as que apresentaram um significativo incremento de peso. CONCLUSÃO: Pode-se concluir que as crianças com déficits nutricionais e menores de um ano de idade foram as que mais se beneficiaram do programa de suplementação alimentar Incentivo ao Combate às Carências Nutricionais.

OBJECTIVE: The objective of this study was to assess the impact of the Program Incentive to Fight Nutritional Deficiencies in the city of Assis, state of São Paulo. METHODS: A total of 132 children under 24 months who participated in the Program Incentive to Fight Nutritional Deficiencies for one year were followed. Their nutritional status was determined by comparing their weight-for-age in z-scores at baseline and after 2, 6, 9 and 12 months of follow-up to that of the reference population median given by the National Center for Health Statistics. RESULTS: Most (70%) of the children were classified as undernourished or at risk of malnutrition when they joined the Program Incentive to Fight Nutritional Deficiencies. After 12 months in the program, 64% of the children presented an increase in their weight-for-age z-score. Analysis of the mean weight-for-age z-score variation over time, according to age group and nutritional status at baseline, showed that children under 12 months of age had a significant increase in weight-for-age z-score. CONCLUSION: Malnourished children under one year of age were the ones who benefited most from the Program Incentive to Fight Nutritional Deficiencies.

[Food intake during and outside Ramadan]

We explored the effect of fasting in the month of Ramadan on the dietary pattern of a group of 130 healthy adults. During Ramadan, there was an increase in total energy intake, as a result of protein and lipid intake but not carbohydrate intake compared to the diet througout the rest of the year, in both students and parents. The meal eaten after sunset was an important contributor to calories [65%], lipids [74%], proteins [71%] and carbohydrates [56%]. These findings show the eating behaviour during Ramadan may contribute to improved nutritional status of people at risk of nutritional deficiency

Double fortified salt at crossroads.

Iron Deficiency Anemia (IDA) and Iodine Deficiency Disorders (IDD) are the major public health problems often co-existing in many regions in our country. National Institute of Nutrition (NIN) has promoted the technology of double fortification of common salt with iodine and iron as a strategy to control both deficiencies under food-based approaches. Two other formulations of double fortified salt (DFS) have been subsequently developed by other agencies. NIN formulation & Nutrisalt have a stabilizer/promoter to maintain the stability of iodine in the presence of iron. The Micronutrient Initiative (MI) formulation uses physical separation of iodine by microencapsulation. NIN carried out extensive studies on stability, bioavailability, acceptability, safety and impact (including in community) of DFS. Feasibility both at factory level production and community level implementation have been worked out. MI salt had also undergone stability, acceptability and impact studies. No data is reported on the stability of Nutrisalt except that good stability is claimed in the available reports. In principle, the strategy of double fortification of salt with iron and iodine is sound with uniformly good impact on urinary iodine excretion and prevention of anemia. However, striking increments in hemoglobin (Hb) were not readily demonstrated since the intended purpose of DFS was only to provide iron at maintenance level and not therapeutic level. Complexities in the experimental designs, confounding variables and quality of the ingredients in salts also contributed to difficulties in interpretation of Hb status in studies involving DFS. Along with improvements contemplated in formulation to enhance the stability and bioavailibility, DFS should be able to fulfil the promise and realise its potential in reducing iron and iodine deficiency amongst our poor population in the next few years.

Micronutrient dietary supplements--a new fourth approach

Currently the three main widely used strategies to control micronutrient deficiencies are food diversification, fortification, and consumption of medicinal supplements. In Tanzania a fourth strategy has been evaluated in school children, and is to be studied in pregnant and lactating women. The dietary supplement comes in the form of a powder used to prepare a fruit flavored drink. Children consumed for six months 25 grams per school day attended, the powder being added to 200 ml of water. The dietary supplement provides between 40 and 100 percent of the RDA of 10 micronutrients, which includes iron, vitamin A and iodine. Unlike medicinal supplements it provides the multiple vitamins and minerals in physiologic, not megadoses. In a well conducted randomized double blind placebo controlled trial, a dietary supplement in the form of a fortified powder fruit drink produced statistically significant differences not only in vitamin A and iron status, but also in the growth of young school age children.

Iodine loss from iodised salt on heating.

Iodine deficiency disorders constitute a major public health problem in India. The national IDD control programme (NIDDCP) relies solely on iodine supplementation through fortification of common salt with potassium iodate. However, data regarding iodine loss due to high temperatures of cooking procedure is scarce. Using iodometric titration methods, we calculated iodine content of iodised salt samples subjected to incremental heat up to 350 degree Celsius. The results of the study indicate a gradual but minimal loss of iodine content from the iodised salt samples when subjected to high temperature with a maximum loss noticed being 18.5% at 350 degree Celsius. We conclude that there is minimal loss of iodine from the salt fortified with potassium iodate when subjected to heating (temperature normally attained during cooling process).

Manual de combate aos distúrbios por deficiência de iodo no Brasil / Manual for control and prevention of iodine deficiency disorders in Brazil

O manual tem o objetivo de ampliar o conhecimento sobre a deficiência de iodo e seu controle, destinando-se, principalmente, aos profissionais de saúde näo-especialistas e às autoridades estaduais e municipais, a quem deverá caber a operacionalizaçäo e acompanhamento das açöes de combate à deficiência de iodo. Compöem-se de duas partes: a primeira, trata dos aspectos técnicos e científicos da deficiência de iodo e a segunda apresenta a técnica de dosagem de iodato, com ênfase na iodaçäo do sal.