Iodine deficiency - the risks and solutions

IODINE deficiency is a major public health problem in Pakistan and is a threat to the social and economic development of the country. A WHO survey on iodine status worldwide lists Pakistan as having severe iodine deficiency with 135 million people having insufficient iodine intake. Deficiency of iodine is the single most common cause of preventable mental retardation and brain damage in the world. Iodine is essential for the normal development and growth of the human brain and body. It helps in overseeing that the body efficiently burns calories thus preventing excess calories from being stored as extra fat. Iodine has a role in maintaining the energy level of the body and in helping the skin, teeth, nails and hair to be strong and healthy. The main factor responsible for iodine deficiency is a low dietary supply of iodine. When iodine requirements are not met, thyroid hormone synthesis is impaired, resulting in hypothyroidism and a series of functional and developmental abnormalities grouped under the heading of Iodine Deficiency Disorders (IDD). Goiter is the most visible manifestation of IDD. However, the most damaging disorders induced by iodine deficiency are irreversible mental retardation and cretinism. If iodine deficiency occurs during the most critical period of brain development (from the fetal stage up to the third month after birth), the resulting thyroid failure will lead to irreversible alterations in brain function. While cretinism is the most extreme manifestation, of considerably greater significance are the more subtle degrees of mental impairment leading to poor school performance, reduced intellectual ability and impaired work capacity. Iodine deficiency is a global health problem and 2.2 billion people (38 per cent of the worlds population) live in areas with iodine deficiency and risk its complications, states the International Council for the Control of Iodine Deficiency Disorders (ICCIDD). Large populations living in systems of subsistence agriculture are especially at risk of iodine deficiency as they live in an environment where the soil is deprived of iodine. The deficiency in the soil leads to iodine deficiency in all forms of plant life and cereals grown in the soil. The recommended strategy for IDD control is based on correcting the deficiency by increasing Iodine intake through supplementation or food fortification. There are several sources of iodine. Dairy products are usually a good sources but only if the cows get enough iodine. A wide variation of iodine content is found in breads, Seafood has moderate iodine content. Freshwater fish reflect the iodine content of the water where they swim, which may be deficient. Other foods vary tremendously in iodine content, depending on their source and what may have been added. Plants grown in iodine-deficient soil do not have much iodine, nor does meat or other products from animals fed on iodine-deficient plants. In regions with low iodine intake or and high cases of iodine deficiency, iodine enrichment should be considered. Iodized salt programmes and iodized oil supplements are the most common tools in the fight against IDD. Iodized salt is the first choice for intervention primarily as: salt is universally and regularly consumed and is inexpensive, states ICCIDD. Furthermore, it is manufactured using simple technology. Other tools include iodized oil, social mobilisation and research (multidisciplinary approach). The simplest source to get iodine is through iodized salt, which is normal table salt enriched with iodine. Perhaps the only substance found in every kitchen in the world, salt has long been considered an ideal vehicle for iodine. The concept of salt fortification is not new. Iodization of salt has been practiced as successfully in several countries for over 80 years. Major international efforts have produced dramatic improvements in the correction of iodine deficiency in the 1990s, mainly through use of Iodized salt in iodine-deficient countries. Iodized salt has been introduced in many countries and has resulted in a considerable reduction in the prevalence of goiter and also progressive disappearance of cretinism. Unfortunately, iodized salt consumption in Pakistan is at only 17 per cent, according to the National Nutrition Survey 2001-2002, However, in many developing countries with severe problems of endemic goiter, iodination of salt, bread or water has failed to prevent or eradicate IDD, because various socio-economic, climatic or geographic conditions make systemic iodine supplementation difficult or even impossible. Some countries with previously severe iodine deficiency now appear to be virtually sufficient. This success involves not only the implementation of iodized salt, but effective national programmes, the development of national IDD coordinating groups, extensive education at all levels and monitoring. Salt is therefore the most effective and cost-efficient strategy for providing iodine to iodine-deficient populations, especially in the developing world. Since children and the unborn are those most at risk, it is also important to raise awareness amongst school children about iodine and its impact on health. School teachers, health agencies, salt companies, medical professionals, and concerned citizens all play an important role in helping prevent IDD. Pakistans Network for Consumer Protection and UNICEF announced in July 2008 a joint campaign to promote universal salt iodization in Pakistan. They emphasise the need for close cooperation between government, salt producers, consumers, development partners and civil society to address the public health challenge of IDDs. The focus of the campaign is to educate the general population about benefits of iodized salt, and promotion of iodized salt legislation. In response to the iodine deficiency issue, National Foods Limited launched iodized salt in 1991. This pioneering effort is a part of National Foods commitment to community health within its wide-ranging corporate social responsibility programme. Good quality iodized salt provides the right quantity of iodine as per the bodys daily requirement, therefore regular use of iodized salt cannot lead to excess iodine in the body. The ICCIDD affirms that: daily consumption of iodized salt can protect entire generations of both humans and animals from mental and physical disabilities caused by Iodine deficiency. Consumers should therefore buy and use good quality Iodized salt regularly to protect themselves from the risks of iodine deficiency.