Improving Public Health by Optimizing Iodine and Sodium Intakes

Background WHO Expert Consultation “Salt as a Vehicle for Fortification” 2007 Policies for salt iodization and reduction of salt to <5 g/day are compatible, cost effective and of great public health benefit. At the country level, close collaboration between salt iodization and salt reduction programs as a coalition is urgently required so that their aims are congruent.

Background: Jan.3&4 meeting: Confirmed: Recommendations of WHO consultancy “Salt as vehicle for fortification “2007 and PAHO Expert Group Policy Statement are relevant and that it is necessary to put them in practice . Agreed on: common goal to secure “optimum salt and iodine intake in the Americas”.

Background: Jan.3&4 meeting The same small group of stakeholders will serve to prepare the next extended stakeholders meeting, planned after Iodine Network Task Force meting in DC. This group will draft objectives, expected results and background document for the stakeholders meeting PAHO will convey the stakeholders meeting in DC to facilitate a next level of collaboration and initiate its introduction in some counties in the Region.

Draft position document proposal

Iodine network 2009 resolution BE IT FURTHER RESOLVED THAT the World Health Organization is urged to share with the Network Board any data, when and if it becomes available, about the achievement of salt reduction in various countries and its projected trends of salt consumption to inform Board discussion and national salt iodization programs to enable ongoing efforts to calibrate iodine fortification levels to ensure appropriate population iodine intakes.

2009 Policy Statement for the Americas Salt intake should be reduced without compromising micronutrient fortification efforts. National governments are to review national salt fortification policies and recommendations to be in concordance with the recommended salt intake [national targets or in their absence, the internationally recommended target of less than 5 g/day/person by 2020].

Optimal intakes of iodine and sodium Goal: Iodine fortification and salt reduction programs to converge reaching the common goal of: Optimal intakes of iodine and sodium in the population

Framework for collaboration: baseline surveillance of iodine and sodium intakes and of sources of iodized and total salt in the diet, referring but not limited to co-surveillance using the 24 hour urine excretion method to benefit both programs systematic literature reviews and additional research if needed to determine the validity of spot urine methods for assessing iodine and salt consumption carrying out food intake surveys to identify the sources of salt in the diet – both the discretionary use at the table and in cooking in households and what is in processed foods – and the proportion of salt that is iodized investigating whether and which iodine analysis laboratories can also analyze sodium (and potassium, creatinine) and where possible the marginal additional costs to do so identifying/mobilizing funds for combined surveillance assessing knowledge, attitudes and behaviors towards salt consumption

Framework for collaboration Advocacy to governments for joint development/adjustment of iodine fortification and salt reduction policies and programs synchronized national efforts to monitor iodine intake in order to adjust standards for salt iodization cross country harmonization of approvals processes for new food products with low salt content and an adequate amount of iodine cross country harmonization of salt iodization standards and criteria to judge epidemiological performance of the programs

Framework for collaboration Sharing forums for engagement with food industry Common and coordinated messaging to policy and decision makers and to the public Monitoring and evaluation of joint iodine and salt programs

Next steps: Convene a working group of stakeholder institutions involved in iodine fortification – ICC-IDD, MI, UNICEF, WFP, CDC-surveillance, nutrition and NCDs, PAHO micronutrient program – and salt reduction – the PAHO/WHO salt experts group, World Hypertension League, Latin American Society of Nephrology and Hypertension  (SLANH), WHO CC on nutrition in Warwick, UK to facilitate/secure a next level of collaboration for Central and South America and the Caribbean. Approach countries with active salt reduction and iodine fortification programs in the region to pilot the coordination/collaboration and harmonization of programs (choose from Mexico, Brazil, Chile, Argentina, Costa Rica, Canada, US)