CURRENT STATUS OF PRODUCTION AND DISTRIBUTION OF IODIZED SALT IN INDIA AND FUTURE PERSPECTIVES

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HEALTH IS A DYNAMIC EXPRESSION OF LIFE
Note The loss due to MN deficiency costs India
1 its GDP (Rs. 27,720 Cr/pa)
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BENEFITS AND SAFETY OF IODIZED SALT
Iodine Requirements
and the Risks and Benefits of
Correcting Iodine Deficiency in Populations

• Dr. S. Ranganathan Hyderabad, India

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IODINE (A
NON METALLIC TRACE ELEMENT)
YOU CANT LIVE WITHOUT IT
1811 BARNARD COURTOIS
YOU NEED IT
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Brilliance for Little Minds Strength for Little
Bodies
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IODINE IN HUMAN BODY

• Human body 15 - 20mg I
• Thyroid 70 - 80 I
• Healthy Thyroid 8 - 12mg I
• Goiter Thyroid 1mg I

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Growthdevelopment
T3 T4 synthesis
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THYROID HORMONES

• Influence cellular oxidation rate Calorigenesis,
  Thermoregulation, Intermediary Metabolism.
• Exert calorigenic effect on heart, liver and
  kidney cells.
• Promote N retention, glycogenolysis.
• Intestinal absorption of glucose galactose.
• Lipolysis Glucose uptake by adipocytes.
• Sensitise adipose tissues to action of other
  lipolytic hormones decrease serum cholesterol.

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IODINE / DAY

• DAILY URINARY LOSS 100 - 200µg
• BALANCE STUDIES 44 - 162µg
• ELMER 1938 100 - 200µg
• WAYNE ET AL 1964 160µg
• WOOD 1970 130 - 199µg
• GLOBAL 1983 140 - 200µg
• FAO / WHO JECFA 1991 50 - 200µg

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HOW MUCH IODINE DO WE NEED?

• The amount we need is very small and
• is measured in micrograms (µg).
  
• The recommended daily intake
• depends on age life stage.
  
• 0 to 7 years 90µg
• 7 to 12 years 120µg
• gt 12 years 150µg
• Pregnancy Lactation 200µg
• ICCIDD/WHO/UNICEF

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SOURCES OF IODINE

• Concentrated as iodide in the soil surface and
  absorbed by food crops
• Daily needs 90 from food 10 from water
• Some species of seaweeds (wakame) are the richest
  sources of iodine in Nature
• Iodine in water (µg/L)
• Goitrous areas 3 - 16
• Non - Goitrous areas 37 - 64

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IODINE CYCLE The atmosphere absorbs iodine from
the sea which then returns through the rain and
snow to the mountainous regions. It is then
carried by rivers to the lower hills and plains,
eventually returning to the sea. High rainfall,
snow, glaciation and flooding increase the loss
of soil iodine. This causes the low iodine
content of food for man and animals.
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A mother and child from a New Guinea village who
are severely iodine deficient. The mother has a
large goitre. The bigger the goitre the more
likely it is that she will have a brain damaged
child. This can be prevented by eliminating the
iodine deficiency before the onset of pregnancy
(Hetzel and Pandav 1996).
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IQ

• Meta-analysis of 18 studies comparing the
  performance of iodine-deficient children with
  that of iodine-sufficient peers on a standardized
  intelligence tests, concluded that iodine
  deficiency lowered the mean intelligence quotient
  by 13.5 points (Tiwari et al Am J Clin Nutr
  1996 63 (5) 782-786. Bleichrodt et al. Nut rev.
  199654 (4Pt 2) 572-578), which indicates a
  staggering public health problem.

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IQ

• This shortcoming (lowered IQ points) affects a
  childs ability TO LEARN, and later in life, TO
  EARN.
• Hence, the negative effects iodine deficiency on
  both mental physical health can significantly
  impede worker productivity and the economy at
  large.

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A hypothyroid cretin in Sinjiang, China who is
also deaf mute. This condition is completely
preventable. Right The barefoot doctor of
her village. Both are about
35 years of age
(Photograph courtesy of Dr Ma Tai, China).
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IODINE CONTENT OF SOME COMMON INDIAN FOODS
Mahesh DL (NIN), 1993. PhD Thesis Osmania
University, Hyderabad
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EASY REMEDY
SALT
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THE IMPORTANCE OF SALT

• Sodium chloride play a vital role in body
  functions.
• Sodium helps in sending messages to and from the
  brain, regulates body fluids and helps our
  muscles-including those of the heart-to contract.
• Chloride preserves the acid-base balance of the
  body, absorption of K and helps the blood to
  carry CO2 from respiratory tissues to the lungs.

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• Salt sets off an osmosis movement in the body and
  adjusts the amount of fluids within and outside
  the cells.
• Without salt, our bodies cannot perform some of
  the vital functions like regulating blood and
  body fluids and maintaining nerve signals. This
  can lead to muscular weakness, cramps and
  exhaustion.
• Severe salt deprivation can even prove fatal.

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POTASSIUM IODATE IS NOT MENTIONED AMONG THE
HAZARDOUS CHEMICALS

• - Jesis G, Hazardous Chemicals Data Book,
  Environmental Health Review, No. 4, New Jersey
  Noyes Data Corp, 1980 368-370.

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POTASSIUM IODATE IS ACCORDED LOW TOXICITY RATING
BY THE CONDENSED CHEMICAL DICTIONARY.

• - Hawley G.G, The condensed Chemical Dictionary,
  10th edn., NY van Nostrand and Reinhold Co.,
  1984 437-438.

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• Iodized salt has also been blamed often for skin
  rashes but without any basis.
• Not a single case of allergic hypersensitivity to
  iodine in food was reported from 1935 to 1974,
  among 20,000 children in the US suffering from
  allergy.

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• A REQUEST FOR NOTIFICATION OF ALLERGY TO IODINE
• PUBLISHED IN
• THE ANNALS OF ALLERGY
• BETWEEN 1974 AND 1980
• HAS NOT YIELDED
• A SINGLE CASE
• -- Metavinovic I, 1980.

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I. S. Shenolikar, NIN, 1979.
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IODINE TOXICITY

• Wide margin of safety
• Iodate Acute chronic studies in animals man
• No toxic signs from Iodate
• -- Murray M.M.
• Bull WHO 1953 9211

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ADVERSE REACTIONS

• 1. EXTRA THYROIDAL
• Various allergic reactions, edema, eosnophilia,
  iodide fever, dermatitis, iodide mumps.
• These reactions are quite rare. No incidence
  figures.

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• 2. INTRA THYROIDAL
• Iodide induced Thyroiditis,
• Hypothyroidism, Hyperthyroidism.
• On discontinuation of iodide,
• (a) disappears
• (b) transient disappears
• (c) rare in spite of extensive exposure in
  Japan, USA, Brazil, etc.

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Jean A. T. Pennington
A review of iodine toxicity reports J. Am.
Diet. Assoc. 1990 90 1571-81

• Summarizes case reports, population studies and
  experimental from the literature (1880-1988) on
  adverse effects of iodine.
• CONCLUSION Iodine intake of 1000 micrograms per
  day is safe.

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IODINE INTAKE IN JAPAN

• Mean value 3000 µg/day (20
  times more than in India)
• Population bio-chemically and clinically
  normal.
• Thyroid hormone values are not different from
  those in non-goitrous (iodine sufficient) areas
  of other countries.
• Adaptation to high iodine intake.

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• IODINATED WATER SUPPLY AT A PRISON
  COMMUNITY
• Long term tolerance of individuals to iodinated
  water supply. 750 men , women and 13-16 years
  girls.
• For 15 yrs Daily intake 1000 2000 µg iodine
  through water supply.
• No evidence of hypersensitivity or other adverse
  effects of iodine, no allergic reactions.

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• IODINATED WATER SUPPLY AT A PRISON
  COMMUNITY
• No change in serum T4
• 177 women gave birth to 181 infants without
  evidence of adverse effects to the infants
• -- Clinical Research 1978 26 586A
• --Trans Am.Clin.Climatol.1978 90153

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MAXIMUM PERMISSIBLE LEVEL

• Food Nutrition Board, National Academy of
  Sciences, USA, 1970 Daily intake of 1000 µg
  iodine is SAFE.
• American Medical Association, 1980 Healthy
  adults 2000 µg iodine per day Children 1000 µg
  iodine per day
• NO ADVERE PHYSIOLOGIC REACTIONS

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MAXIMUM ACCEPTABLE DAILY INTAKE OF IODINE 1000
µg

• -- Joint FAO/WHO Expert Committee on Food
  Additives Toxicological Evaluation of Certain
  Food Additives and Contaminants.
  WHO FOOD ADDITIVES SERIES No.24, 1989.

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IODINE INTAKE IN COUNTRIES
Nat Med J India 1989
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Tolerable Upper intake Level (UL) for I
Food and Nutrition Board, Institute of Medicine.
Iodine. Washington DC, National Academy Press,
2001.
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DAILY IODINE INTAKE IN INDIA
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IODINE TOXICITY IS
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STATEMENT

• Iodized salt usually increases daily iodine
  intakes by no more than 200-400µg. Ingesting up
  to 1000 µg of iodine per day is medically safe.
  Experience with USI in many countries has shown
  great benefits for the iodine deficient part of
  the population and no adverse effects on iodine
  sufficient people.
• We conclude that the iodine in iodized salt does
  not carry medical risks for people who are
  already iodine sufficient. We strongly recommend
  USI for all countries with iodine deficiency.

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• Issues relating to the safety of USI have been
  carefully examined by WHO/FAO/IAEA Expert groups.
  All concerned agreed that USI is the
  principal Public Health measure for
  eliminating IDD.
• -- IODINE AND HEALTH WHO/NUT/94.4, GENEVA
  AUGUST, 1994.

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National Consultation on Benefits and Safety of
Iodized Salt
April 21, 1999, AIIMS, Salt Dept. GOI.
(UK 33 QA)
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Success of Iodized Salt
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KANGRA VALLEY STUDY (1956 1968)
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TRIBAL COMMUNITY
After 2 years. Comprehensive Reviews in Food
Science and Food Safety 2008 Vol. 7 p. 383.
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PRE POST IS
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Change in Goiter Prevalence
DGHS.
Note GOI lifted the ban on UIS in Sept. 2000
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IODIZED SALT CHILD HEALTH
Shubha Lakshmi Bhat Harvard College
(Class of 2009) Economics
and Health Policy Senior Thesis
Element of
Survival Isolating the casual effect of access
to iodized salt on child health in India
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• NFHS-2 (1998-99) data Captured key
  socioeconomic, cultural, and health information
  about over 92,000 households, 90,000 women and
  33,000 children in India.
• Provided district-level identifiers for each HH,
  which was not available in the recent NFHS-3
  (2005-06) because of privacy issues.
• Allowed for the use of within-state variation by
  district in order to estimate causality, which is
  particularly helpful for planning and
  implementing strategies for improving population
  health and nutrition programs.

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• Casual link ACCESS TO IODIZED SALT Vs. CHILD
  HEALTH in order to justify efforts to actively
  expand the USI.
• Examined HH salt iodine concentration,
  anthropometric outcomes, and birth histories of
  over 18,000 children from the NFHS-2.
• Innovative district-level instruments were
  constructed using Geographic Information Systems
  to predict the link.
• To isolate causality, two-stage least square
  (2SLS) regression were used with
  state-fixed-effects.

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• RESULTS The 2SLS estimate revealed
• Iodine concentration by one level led to,
• 1.168 SD increase in height-for-age (plt0.05)
• 16 decreased likelihood of being small at
  birth (plt0.05)
• 19 increased likelihood of being large at
  birth (plt0.05)
• 2.8 increase in child survival
• (plt0.10)

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Effects of Iodine Interventions and
Measurements of Economic Benefits
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HUMAN POPULATIONS

• REDUCTION IN
• Mental deficiency
• Deaf mutism
• Hypothyroidism
• Goiter

• BENEFITS
• Value of higher work output in household and
  labor market
• Reduced costs of medical and custodial care
• Reduced educational costs from reduced
  absenteeism and grade repetition
• Reduced costs of investigation treatment

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LIVESTOCK POPULATIONS

• REDUCTION IN
• Live births
• Weight
• Muscle mass
• Wool coat in sheep

• BENEFITS
• Value of higher work output of meat and other
  animal products
• Value of higher animal work output
• Increased meat production
• Increased wool production

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Ratio B/C 19.0
KKS 2009
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Rs. 4.15/kg
? 5P/H/D
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Daily Consumption of Iodized Salt is a Healthy
Habit
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From Salt Freedom
To Iodized Freedom from Salt
Brain Damage
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I would be hard-hearted enough to let the sick
die if you can tell me how to
prevent others from falling sick
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Consume 'IS'
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Thank You
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HOW TO STORE IODIZED SALT

• Pick up trusted brands Quality assurance.
• Store in a dark colored bottle.
• Use high-quality plastic/glass jars for storage.
  Keep the lid tightly closed especially during the
  monsoons.
• Avoid wide-mouthed bottles as they let in
  moisture and make the salt damp and lumpy.
• Always use a high quality plastic or ss spoon.
  Dont use a wet spoon.

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N.S. Dodd S. Dighe, 1993
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G. Govindi et al, 1994