Alignment of Iodization Requirements in Countries with Mandatory or Voluntary Salt Fortification to the World Health Organization Recommendations Open Access
Greenwald, Rachel Paige (Spring 2020)
Published
Abstract
Objective
Compare salt fortification standards of countries with mandatory or voluntary salt fortification to World Health Organization (WHO) recommendations for salt fortification.
Methods
For countries with mandatory or voluntary salt fortification, data were downloaded from the Global Fortification Data Exchange (GFDx) regarding iodine amounts and iodine compounds to be added to salt per the country standard, legislation scope, and national salt intake quantities. Data were then compared to current WHO recommendations and the WHO recommendation available at the time the standards were issued. For iodine amounts in standards, countries were classified as lower than the range, within the range, or greater than the range of the current WHO recommendations, or lower than, equal to, or greater than the range for WHO recommendations available at the time the standards were issued. For iodine compounds in standards, countries were classified as all of the compounds in the country’s standard are WHO-recommended compounds, there are both WHO-recommended compounds and not recommended compounds, or all of the compounds in the country’s standard are not WHO-recommended compounds.
Findings
Of the 117 countries with mandatory salt fortification included in the analysis, 82% of countries’ iodine amounts in salt standards were greater than the range indicated by current (2014) WHO recommendations. Of the 16 countries with voluntary salt fortification included in the analysis, 81% of countries’ iodine amounts in salt standards were greater than the range indicated by current (2014) WHO recommendations. The majority of countries’ iodine compounds specified in their standards were only WHO-recommended compounds. Additionally, the majority of countries with mandatory or voluntary salt fortification iodine amounts specified in their standards exceeded the WHO recommendations available at the time their standards were issued.
Conclusion
Countries for which their standards do not follow WHO recommendations may want to review if they have pertinent data to support their current standards or if following WHO recommendations may improve the effectiveness of salt iodization in their countries for achieving optimal iodine status.
Table of Contents
Introduction. 1
Background. 1
Objectives. 6
Methods. 12
Definitions. 12
Study Design. 12
Objective 1: Alignment of current country iodine fortification requirements with current (2014) WHO recommendations, taking into consideration salt intake quantities. 14
Objective 2: Alignment of current country standards with WHO recommendations available at the time standards were issued, taking into consideration salt intake quantities (1994, 1996 or 2014 WHO recommendations). 16
Percentage of WHO recommendations met. 21
Results. 29
Participants. 29
Main results. 29
Results for Objective 1 for countries with mandatory legislation of salt fortification. 29
Results for Objective 2 for countries with mandatory legislation of salt fortification. 30
Results for Objective 1 for countries with voluntary legislation of salt fortification. 32
Results for Objective 2 for countries with voluntary legislation of salt fortification. 32
Percentage of 2014 WHO recommendations met. 34
Potential factors influencing results. 34
Discussion. 40
Key Results. 40
Interpretation. 42
Generalizability. 44
Strengths and Limitations. 46
Future Directions. 47
Conclusion. 49
Funding. 49
References. 50
Appendix. 55
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