Description
Iodine is essential for the synthesis of thyroid hormones. Thyroid hormones, especially during periods of increased susceptibility, are crucial for neurodevelopment. Inadequate levels of iodine in the diet leading to a strong and decisive cognitive impairment poses a major public health problem. The World Health Organization prioritized the intake of iodine and recommends the universal enrichment of salt with iodine, so it may reach the general population. In 2013 the Portuguese General Directorate of Education - DGE (Direção Geral de Educação) issued, as a result of the collaboration between the Portuguese General Directorate of Health - DGS (Direção Geral de Saúde) under the National Program to Promote Healthy Eating and DGE a directive introducing the use of iodized salt in school canteens. To ensure the effectiveness, and the impact, of these policies in Portugal, this project aims to: 1) monitor urinary iodine in children (6-12 y); (2) educate food service professionals regarding the use of iodized salt and; (3) inform the community about the impact of iodine in health, based on the Norwegian model.
Summary of project results
Iodine deficiency among children is a public health challenge. The use of iodized salt (IS) in school canteens is mandatory since 2012 in Portugal (PT), however no iodine control program is established. Since children are highly vulnerable to iodine deficiency, it is crucial to evaluate their iodine status and understand the impact of supplementation programs. This project aimed to: 1) evaluate the iodine status in children (6-12 years) in the north of PT; 2) find a correlation between iodine levels and markers of cognitive development; 3) evaluate the effectiveness of the use of IS in school canteens and at children’s homes; 4) increase the population´s awareness for the importance of iodine. The median urinary iodine was 129ug/L, corresponding to a suitable value according to the WHO criteria. However, 32% of the children presented iodine deficiency. Regarding the use of IS in canteens, none of the samples analyzed was IS, fact that is in disagreement with the Education Directorate (DGE) directive. The use of IS in households was low (2%) and 68% of parents have never heard about IS. Besides contributing to a better characterization of iodine status in children, this project raised awareness about the importance of an adequate intake of iodine among teachers, families, children, general population, scientific authorities and policy-makers. 19.7% of the parents reported started using IS at home, and 13.8% reported consuming more often foods high in iodine. These results were achieved through a strong presence in the media, in conferences and through the organization of a Scientific Seminar. This Seminar gathers agents of relevant national public health institutions, policy making entities, food industries and the WHO, and allowed the elaboration of a policy proposal regarding IS usage and implementation of universal fortification in Portugal (still at a validation phase). Technical-scientific final reports were also written and will be deliver to schools, Directorate-General of Health, DGE, Iodine Global Network and National Economic and Food Safety Authority. This project also allowed to test and implement a series of effective monitoring procedures and methodologies for large scale iodine monitoring programs. This know-how puts the project team in a favorable position for future successful funding applications for the establishment of monitoring programs.
Summary of bilateral results
The partnership with the Norwegian University of Science and Technology was useful as an exchange of experience and knowledge. The development of an effective monitoring survey with the Iogeneration gathers a number of relevant outputs, including protocols and execution strategies that can be shared in the future through bilateral relations. Currently, both Portugal and Norway lack on iodine monitoring programs and recent data from Norway indicates high iodine deficiency prevalence in the population. At this stage, the Promoter know-how fosters an opportunity to strengthen the collaborative work with international and experts (IGN – Iodine Global Network) primarily by work group meetings. This will contribute to establish bilateral cooperation actions for effective interventions in both countries through the evaluation and comparison of the actual research opportunities both in Portugal and Norway.