Dr. R K Bhardwaj, Himani Sharma
The World Iodine Deficiency Day or Global Iodine Deficiency Disorders Prevention Day is observed every year on 21st of October. This year the theme is:Nurturing Health with Iodine: Deficiency Prevention for All with the moto to raise awareness to prevent health issues caused by iodine deficiency and its devastating effects on brain development.
Iodine is an essential micro-mineral required for normal thyroid function, growth, and development. Iodine deficiency (ID) can result in multifarious health and developmental disorders known as Iodine Deficiency Disorders (IDDs).These disorders may result in preventable mental retardation and can cause miscarriage, hypothyroidism, stillbirth, impaired mental function, congenital anomalies and iodine-induced hyperthyroidism or hypothyroidism. The consequences of ID range from loss of intelligence quotient (IQ) to cretinism. The main visible sign of severe ID is goitre and learning disability in mild deficiency.There is IQ level of 13 points difference between iodine deficient and normal children. One point increase in IQ associated with 0.11% increase in GDP.

World Iodine Deficiency Day

Statistics
IDDs are a major public health concern worldwide. The prevalence of self-reported goitre or thyroid disorder in National Family Health Survey IV [NFHS IV (2015-2016)] was 2.2%, which has increased to 2.9% in NFHS-V (2019-2021).It has been estimated that more than 200 Million people in India and 1.5 billion people worldwide are susceptible to IDDs with approximately 71 million persons presently suffering from goitre and other IDDs. IDDs can affect every stage of life, but most vulnerable age group is between 6 and 12 years and these disorders together constitute the single largest preventable cause of brain damage leading to learning disabilities and psychomotor impairment.
A study of 2023 conducted by Department of Community Medicine, GMC, Srinagar, UT of J&K to determine the prevalence of goiter among school-aged group of 6-12 years in district Ganderbal of Kashmir valley. Out of 2700 children examined, Grade-1 goiter was found in 90 (3.3%) children and Grade-2 goiter was found in 6 (0.3%) with a total goiter rate of 3.6%. On analyzing the urine samples, about 19.1% of the children had mild to moderate iodine deficiency. Iodine deficiency was a serious concern in all of Jammu’s neighbouring districts except Jammu. Females had a greater frequency of goitre than males (16.12 percent vs 10.10 percent).
Powdered salt was also found to be consumed by 75% of the people in Jammu, with more than 98.5 percent of powdered salt having an iodine level of more than 15 ppm. A study published in the Indian Journal of Medical Research (IJMR) in 2013 indicated that the entire population of India is at risk of IDD due to the soil of the subcontinent lacking in iodine. As a result, the wide variety of grains, lentils, fruits, vegetables, nuts and seeds grown in India do not have sufficient amounts of iodine. No matter what type of diet you have in India, the amount of iodine in it is, therefore, very low and needs to be supplemented with the use of salt that is fortified with iodine.
Iodine requirement and sources
Iodine is not synthesised in our body and requirement can be met through the food and water that we ingest. According to WHO guidelines, a daily iodine intake of 150 microgram is required to prevent IDDs and this can be achieved by using adequately iodised salt (15ppm) of iodine.
As per expert member of Indian Dietetic Association, the average salt intake in Indian homes range from 5-10g/day, of which, 30% is lost during cooking and 70% is absorbed, providing an average amount of 70µg/day. Apart from salt, milk is another source of iodine with 303µg/litre. Half a litre of milk is the minimum quantity needed by adults to obtain the 150µg recommended dietary allowance. Seafood such as tuna, shrimps, cod, scallops and egg yolks are also considered excellent sources of iodine along with vegetables and fruits like sweet potato, onion, spinach, banana, and cantaloupe contain adequate iodine.The WHO currently recommends a dietary intake of 250µg of iodine daily to meet adequate iodine during the pregnancy,. Iodine shortage during pregnancy can lead to stillbirths, spontaneous abortions and congential abnormalities including cretinism, some of which are extremely dangerous.
Pink or Himalayan salt use has seen some rise in a large number of Indian households and almost 25% of the households in Jammu region use this crystalline salt, but in a study only 3.87% samples had adequate Iodine levels. Some researchers have found out that the Himalayan pink salt lacks iodine.
Iodine losses and Cooking methods
About 30% of iodine is lost during cooking and 70% is absorbed. Many studies indicated that the lowest losses were observed during shallow frying, where the salt cooking time was around a minute, while the highest losses were observed during pressure cooking, where the salt cooking time was around half an hour. Cooking losses were observed to be maximum during boiling followed by microwaving although least in roasting and deep frying.
In high temperature and high relative humidity circumstances, an opened packet of iodized table salt may rapidly lose its iodine content due to oxidation and iodine sublimation. Therefore, salt should be properly stored in air tight container to prevent the iodine losses.
Prevention and Control of IDDs in Humans
National Goitre Control Programme was launched in 1962 upon realizing the severity of the problem by Government of India. At the Central Council of Health’s Annual Meeting in 1983, it was determined that all edible salt in India will be iodized by 1992. In April of 1986, the nation began a gradual implementation of the iodization salt process. The amended Prevention of Food Adulteration (PFA) Act of 1988 authorised the use of iodized salt. Upon incorporation of Iodine Deficiency Disorders, its name was changed to National Iodine Deficiency Disorders Control Programme (NIDDCP) in 1992. It is being implemented in all States/UTs of India encompassing entire population.The Salt Commissioner’s Organisation (SCO), Jaipur, Rajasthan, an attached office under the Ministry of Commerce & Industry (Department of Industrial Policy & Promotion), Government of India, is the authority entrusted with controlling and regulating all aspects of the Salt Industry. Iodised salt is produced by mixing potassium iodate with salt using spray, drip feed, dry mixing and submersion processes. SCO has facilitated establishment of 518 salt iodisation units including 119 refineries & washeries (152.39 lakh tonnes) with an annual installed capacity of 221.86 lakh tonnes up to March 2021. Production of 78.58 lakh tonnes of iodised salt during 2020-21 was reported. During the year 2020-21, the production of refined salt was 59.11 lakh tonnes as compared to 49.95 lakh tonnes during last year 2019-20.
The two main goals of NIDDCP were to bring the prevalence of IDD to below 5% in the country and ensuring 100% consumption of iodised salt (15 ppm) at household level. The main objective of this program is to survey magnitude of Iodine Deficiency Disorders, supply of Iodized salt, monitoring of urine iodine excretion and health education of people.
Regulation 2.3.12 of Food Safety and Standards (Prohibition and Restriction on Sales), Regulation, 2011 restricts the sale of common salt for direct human consumption unless the same is iodized.National Reference Laboratory for monitoring of IDD has been set up at NCDC, Delhi. Four Regional laboratories one each at NIN, Hyderabad, AIIH&PH, Kolkata, AIIMS and NCDC, Delhi have been set up to conduct training, monitoring, quality control of salt and urine testing.
According to the findings of the National Family Health Survey-V (NFHS, 2019-21), 96.9 percent in urban and 93 percent in rural of households consume iodized salt, compared to 94.3 percent total in the NFHS-IV (2015-16).
Jeevanbindi
It is medically enhanced version of regular bindi, embedded with iodine. It delivers the daily requirement of iodine i.e., 100-150 micro grams, absorption through the skin. These are being supplied in Maharashtra to iodine deficient people, particularly tribals. This initiative is supplemented with iodine pills available at community health centre.
An iodine patch, designed like a regular bindi, is expected to help one lakh tribal women in North-West Maharashtra battle iodine deficiency. Since these tribals don’t consume iodized salt, they are usually deficiency in this nutrient. Almost every Indian woman wears a bindi. Transforming these into iodine patches ensured that women got the required dosage of iodine without making changes to their daily behaviour.
Let’s take a message to aware our self and others about the importance of iodine in maintaining normal health by consumption ofiodine rich foods, adequate iodised salt, taking all precautions tocheck iodine losses while cooking or addition of salt after cooking to prevent Iodine Deficiency Disorders.
(The authors are from SKUAST-Jammu)

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