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Iodine Deficiency in Europe

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Iodine Deficiency in Europe Every European nation endorsed the goal of eliminating iodine defi ciency at the World Health IODINE DEFICIENCY IN EUROPE Assembly in 1992. Globally, great progress has been made since that time. However, the World Health Organization’s (WHO) European Region has been identifi ed as having the lowest coverage Iodine of salt iodization of all the regions. The primary purpose of this document is to review the current extent of iodine defi ciency in the defi ciency European Union (EU) Member States, applicant countries and those in the European Free Trade Association (EFTA). Its ultimate goal is the mobilization of all European governments to implement in Europe and monitor sustainable programmes to control and prevent iodine defi ciency in their populations. Part one of the report gives the background, historical context and global strategies. The second part addresses the main issues related to iodine defi ciency: its magnitude, the public health A continuing signifi cance, and the health and economic consequences of iodine defi ciency, and outlines the public health current strategies being used to reach the goal of iodine defi ciency elimination. In the third part, the focus is on the iodine defi ciency situation in 40 of the countries of Europe. The fi nal part problem highlights the need for sustainable programmes and makes recommendations to help achieve this. The report concludes that iodine defi ciency remains a public health concern in Europe; the health, social and economic consequences of this are well established. Salt iodization remains the recommended strategy for eliminating iodine defi ciency. Foremost among the challenges are (i) to strengthen monitoring and evaluation of national programmes for the prevention and control of iodine defi ciency in the countries of an enlarged EU, including the surveillance of the iodine status of national populations; (ii) to ensure the sustainable implementation of USI in all countries of the enlarged EU, by harmonizing relevant legislation and regulations; (iii) to ensure adequate quality control and quality assurance procedures to strengthen the monitoring of foods fortifi ed with iodine, especially salt iodization, from the producer to the consumer; (iv) to increase the awareness of political leaders and public health authorities on the public health and social dimensions of iodine defi ciency and the need to implement and sustain programmes for its control; (v) to educate the public on the need to prevent iodine defi ciency by consuming iodized salt, and thereby also increase consumer awareness and demand; and (vi) to consider alternative iodine supplementation for the most susceptible groups – pregnant women and young infants – where there is insuffi cient iodized salt and to take into account public health policies to reduce salt consumption. ISBN 978 92 4 159396 0 WHO Iodine Defi ciency in Europe: A continuing public health problem EDITORS Maria Andersson Swiss Federal Institute of Technology Zurich, Switzerland Bruno de Benoist World Health Organization Geneva, Switzerland Ian Darnton-Hill UNICEF New York, NY, USA François Delange International Council for Control of Iodine Defi ciency Disorders Brussels, Belgium WHO Library Cataloguing-in-Publication Data Iodine defi ciency in Europe : a continuing public health problem. “Editors: Maria Andersson ... [et al.]”--T.p. verso. Published jointly with Unicef. 1. Iodine – defi ciency. 2. Defi ciency diseases – prevention and control. 3. Europe. I. Anders- son, Maria. II. World Health Organization. III. UNICEF. ISBN 978 92 4 159396 0 (NLM classifi cation: QV 283) This report is dedicated to the late François Delange who relentlessly dedicated his energy and expertise to combat iodine defi ciency throughout the world and especially in Europe. He was eagerly anticipating the release of this report, which he believed would be critical in focusing the attention of the European public health community on the signifi cance of iodine defi ciency, the main cause of preventable cognitive impairment in children. © World Health Organization 2007 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organi- zation, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 3264; fax: +41 22 791 4857; email: bookorders@who. int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specifi c companies or of certain manufacturers’ products does not imply that they are endorsed or recom- mended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for dam- ages arising from its use. The named editors alone are responsible for the views expressed in this publication. Cover photos by James Nalty, Carlos Gaggero, G. Diez Designed by minimum graphics Printed in France Contents Foreword vii Preface viii Acknowledgements ix Abbreviations xii Glossary xiii Executive Summary 1 1. Introduction 3 1.1 Iodine defi ciency in Europe: overview and historical context 3 1.2 Global strategy for the prevention and control of iodine defi ciency 4 1.2.1 Commitment of the international community 4 1.2.2 Salt iodization as the main strategy to control iodine defi ciency 4 1.2.3 Sustainability of salt iodization programmes 5 1.2.3.1 Political commitment 5 1.2.3.2 Monitoring and evaluation 5 1.2.3.3 Partnership 6 2. Iodine defi ciency, health consequences, assessment and control 8 2.1 The disorders induced by iodine defi ciency 8 2.1.1 Defi nition of iodine defi ciency disorders, epidemiology and magnitude 8 2.1.2 Health outcomes 8 2.1.2.1 Iodine defi ciency in the fetus 8 2.1.2.2 Iodine defi ciency in the neonate 9 2.1.2.3 Iodine defi ciency in children and adults 10 2.2 Social and economic consequences 10 2.2.1 Cost-effectiveness and cost-benefi t 10 2.2.2 Social benefi ts of the elimination of iodine defi ciency 11 2.2.3 Economic benefi ts of the elimination of iodine defi ciency 12 2.2.4 Conclusion 12 2.3 Assessment of iodine defi ciency 13 2.3.1 Prevalence of goitre 13 2.3.2 Urinary iodine 13 2.3.3 Serum concentrations of TSH, thyroid hormones and thyroglobulin 14 2.4 Prevention and control 14 2.4.1 Salt iodization 14 2.4.2 Iodized oil 15 2.4.3 Other methods 15 2.4.4 Adverse effects associated with the correction of iodine defi ciency 16 2.5 Monitoring and evaluation 18 2.5.1 Monitoring of salt iodization 18 iii CONTENTS 2.5.2 Monitoring iodine status 18 2.5.3 Monitoring thyroid function 18 2.5.4 Indicators to monitor progress towards the international goal of elimination of iodine defi ciency 19 3. Iodine defi ciency in Europe and its control: current status, progress and recent trends 20 3.1 Methods used to record information 20 3.1.1 Urinary iodine and goitre prevalence 20 3.1.1.1 Data sources 20 3.1.1.2 Selection of survey data 20 3.1.1.3 Population coverage 21 3.1.1.4 Classifi cation of iodine nutrition 21 3.1.1.5 Proportion of population and the number of individuals with insuffi cient iodine intake 21 3.1.1.6 Total goitre prevalence 21 3.1.2 Serum concentrations of TSH, thyroid hormones and thyroglobulin 21 3.1.3 Salt iodization programmes 21 3.2 Epidemiology and severity of iodine defi ciency 21 3.2.1 Urinary iodine 21 3.2.1.1 Population coverage 21 3.2.1.2 Classifi cation of countries based on median UI 22 3.2.1.3 Proportion of population and number of individuals with insuffi cient iodine intake 23 3.2.2 Goitre prevalence 23 3.2.2.1 Population coverage 24 3.2.3 Assessment of iodine nutrition based on thyroid function 24 3.2.4 Progress and recent trends 24 3.3 Policy and legislation 25 3.4 Iodized salt 27 3.4.1 Access to iodized salt 27 3.4.2 Recent trends and obstacles to effective iodization programmes 27 3.4.2.1 Political and social changes 27 3.4.2.2 Increased exchange of food trade between countries 27 3.4.2.3 Changes in dietary sources of salt 28 3.4.2.4 Dietary sources of salt covered by regulations on iodization 29 3.4.2.5 Decreased levels of salt intake 29 3.4.2.6 Other factors 30 3.4.3 Quality assurance 31 3.4.4 Process indicators 31 3.4.5 Other iodine defi ciency control measures 32 3.5 Economic consequences 32 4. The major issue for EUROPE: sustained prevention and control 34 4.1 Main policy issues regarding the elimination of iodine defi ciency 35 4.1.1 Assessment of iodine status 35 4.1.2 Implementation of USI 35 4.1.3 Focus on infants and pregnant women 36 4.1.4 Implementing alternative strategies to correct iodine defi ciency 36 4.1.5 Monitoring and evaluation 36 4.1.6 Legislation 37 4.1.7 Economic
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