ELIMINATION OF IODINE DEFICIENCY IN LATVIA Dr.Med. Guntars Selga, Latvian Food Center

Historical divisions of Latvia Vidzeme Kurzeme Latgale Zemgale ESTONIA LITHUANIA BELORUSIA

Population Latvia (January 8, 1998): 2,434,469. Ethnic composition (1998): 57.1% Latvian, 29.5% Russian, 4.1% Belarusian, 2.7% Ukrainian, 2.5% Polish, 2.3% Lithuanian, 1.8% others. Riga (January 1998): 790,608. Citizens: 1,770,355 (72.72% of total population) Non-Citizens: 646,723 (26.56% of total population) Foreigners: 17,391 (0.72% of total population)

The definition of the degrees of severity of iodine deficiency (WHO) Severe< 2,0  g/dl Moderate2,0-4,9  g/dl Mild 5,0-9,9  g/dl Normal> 10,0  g/dl

50% FREQUENCY DISTRIBUTION OF IODINE EXCRETION in Baltic States (1995) n=5762; 86 Schools; Mean=9,6 LATVIA n= 30 schools, 1500 children age 8-12 years Urinary iodine in Latvia - 98  g/l

98  g/l 60  g/l 65  g/l  g/l  g/l  g/l  g/l

PATIENTS WITH GOITRE IN CHILDREN’S CLINICAL HOSPITAL

CHRONICAL THYREOIDITIS IN CHILDREN’S CLINICAL HOSPITAL

PATIENTS WITH THYROTOXICOSIS IN CHILDREN’S CLINICAL HOSP.

Ventspils Tārāles pamatsk. Vaiņodes 1.vsk. Talsu 2.vsk. Kandavas vsk. Matkules vsk. Tukuma 2. vsk Liepājas 15.vsk Līvānu 1.vsk Ļaudonas vsk. Varaklānu vsk. Svētciema vsk. Annenieku vsk. Viesītes p.sk Viļānu vsk. Valmieras Kauguru 9 g. sk. Jēkabpils 4.vsk. - K.Videnieka Rīgas 77.vidusskola - Rīgas 1.bāreņu internātskola -Rīgas 33.vidusskola -Berģu pamatskola 20 SCHOLS INCLUDED IN THE IODINE SURVAY 2000 ( n - 600) age 8-12 years

Median Urinary Iodine Excretion Among Latvian Schoolchildren in 2000 (n-600). 23%

SCHOLS INCLUDED IN THE IODINE SURVAY 2000 ( n - 600) age 8-12 years

Iodine In The Food (J – 200  g RDA draft in Latvia ) Source Iodine  g/100g Cod 135 Salmon62 Sea perch57 Mackerel45 Goose meet42 Herring41 Chockbery40 Egg20 Shampinion18 Milk16 Source Iodine  g/100g Kefir 14 Yoghurt 14 Set milk 13 Beans 12 Swine liver 12 Wheat (summer)11 Lard 10 Rue 9 Cream 9 Garlic 9 Barlay 9

Synergistic assimilation Mineral or vitamin deficiency Iodine Ca P Zn Vit. B6 For assimilation necessary Iron, manganese, phosphorum Boron, PUFA, lisin, Mg Ca, Fe, Vit. B (comlex), Vit. E Ca, Cu, P, Vit. B6 K, Vit. B (comlex), Vit.C, Vit. E

Intake Of Kcalories From Food Group By Sex In Latvia Nutrition and lifestyle in the Baltic Republics. 1999

Estimated requirement for edible salt in Latvia  8750 tonnes of salt/year (3,5 kg/person year x 2,5 million populatio of Latvia) Salt situation Analysis in Latvia (1999) (during 10 months) tonnes of edible salt - 60 tonnes iodized salt Less than 0,9%

Nutrition and lifestyle in the Baltic Republics During summer 1997, cross sectional survays were conducted among representative national samples of adults in each country (Estonia: n=2108; Latvia: n=2308; Lithuania: n=2153). salt consumption

Proportion of Respondents Adding Salt at the Table (males in all age groups) Nutrition and lifestyle in the Baltic Republics. 1999

PROPORTION OF RESPONDENTS (womens) ADDING SALT AT THE TABLE (all age groups) Nutrition and lifestyle in the Baltic Republics. 1999

Proportion Of Respondents Never Adding Salt At The Table (males in all age groups) Nutrition and lifestyle in the Baltic Republics. 1999

PROPORTION OF RESPONDENTS (womens) NEVER ADDING SALT AT THE TABLE Nutrition and lifestyle in the Baltic Republics. 1999

Proportion Of Respondents Almost Always Adding Salt Before Tasting (males in all age groups) Nutrition and lifestyle in the Baltic Republics. 1999

PROPORTION OF RESPONDENTS (womens) ALMOST ALWAYS ADDING SALT BEFORE TASTING Nutrition and lifestyle in the Baltic Republics. 1999

USE OF SALT WITH ADDITIVES (mens all age groups ) Nutrition and lifestyle in the Baltic Republics. 1999

USE OF SALT WITH ADDITIVES (womens all age groups ) Nutrition and lifestyle in the Baltic Republics. 1999

TYPE OF SALT WITH ADDITIVES USED BY COUNTRY (mens all age groups) Nutrition and lifestyle in the Baltic Republics. 1999

TYPE OF SALT WITH ADDITIVES USED BY COUNTRY (womens all age groups) Nutrition and lifestyle in the Baltic Republics. 1999

Dietary belief by country: “More dietary salt in the diet is of no consequence for your health (mens all age groups) Nutrition and lifestyle in the Baltic Republics. 1999

Dietary belief by country: “More dietary salt in the diet is of no consequence for your health (womens all age groups) Nutrition and lifestyle in the Baltic Republics. 1999

ELIMINATION OF IODINE DEFFICIENCY IN LATVIA To meet iodine requirements, the current recommmended daily iodine intakes necessary: –50  g for infants (first 12 months of age) –90  g for children (2-6 years of age) –120  g for school children (7-12 years age) –150  g for adults (beyond 12 years of age) –200  g for pregnant and lacting women Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness, WHO, 1996

Required iodine levels in salt In order to provide 150  g/day of iodine via iodized salt, iodine concentration in salt at the point of production should be in the range mg of iodine per kg of salt. When all salt used in processed food is iodized, the lower limit (20 mg) is recommended. Under these circumstances median urinary iodine levels will vary from  g/l. “ Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness”, WHO, 1996

Process Model for IDD Elimination Program in Latvia