|
Current Iodine Deficiency Disorder Situation
Population
Population: 83.25 million
Population growth rate: 0.26%
Population < 15 years: 15.4%
Birth rate: 8.99 per 1000
Life expectancy at birth: 81.09 years
Infant mortality: 4.65 per 1000
Prevalence of Goiter/ UIE
Median urinary iodine: 88-148 mcg/L
Iodine deficiency continues in some areas, with a median urinary iodine excretion of 88 mcg/L. However, a 2000 national survey of 3,065 schoolchildren in 128 sites reported a national median of 148 mcg/L, i.e., iodine sufficiency.
In the 1970's the goiter prevalence was 30-60%, urinary iodine excretion was in the general range of 30 mcg/g creatinine in the north, about 22 mcg/g creatinine in the south. Transitory neonatal hypothyroidism was common and a high recall rate on TSH screening occurred. In the 1990's, the iodine intake increased considerably. Thyroid volume in neonates decreased by nearly half. Thyroid volumes in Thuringea and Mecklenburg regions reported 22.5% enlarged in 1996. In Berlin , thyroid volumes normal for iodine sufficiency reported in schoolchildren in 1997.
A 1996 study of 5,932 persons from 32 regions of Germany , median value 72.4 mcg/g creatinine; 19% below 50 mcg/day. Above study in Thuringea/Mecklenberg was 98 mcg/L median in 1995/96, but 28% below 50. Other figures are 99 mcg/g creatinine in Potsdam area, 122 mcg/L in Berlin , and > 100 in Leipzig .
Iodized salt Coverage
Household iodized salt use: 84%
Salt Situation Analysis Production
Production is local and population coverage is estimated to be about 75%.
Consumption
- Estimated daily per capita salt consumption: no data.
- Estimated % of all salt consumed by people which is adequately iodized (household level): 84 %
Iodine Procurement and Utilization
KIO3 at 20 ppm
Industrial salt iodization was first allowed in 1991. In 1993, the government declared that iodized salt is not required for bakeries, meat, sausages, or industrial foods.
By 1996, 70% of packed salt was iodized, acceptance in households was 80%, 80% of bakers and butchers used iodized salt, iodized salt use in the food industry was about 50%, about 80% in the catering business was iodized, and about 90% in gastronomy. 30-40% of the daily iodine requirement was covered by bread. These increases were reflected as 26 mcg iodine in bread, 40 mcg in rolls, and 60 mcg in salami, per 100 grams fresh weight.
Universal Salt Iodization Program
Information, Education, Communication (IEC) Activities
Legislation
- Legislation: The former East Germany had compulsory iodization of salt with KIO3, 20 mg iodine/kg, and also 10 mg iodine/kg for livestock feeds. With reunification in 1990, iodization became voluntary. Several previously restricted regulations on food additives have been removed since. Iodized salt use has become more widespread, but remains voluntary. Leading German thyroidologists have advocated mandatory salt iodization.
- Legislation for Animals: none but livestock mineral mixtures contain about 10-40 mg iodine/kg, and by 1996 cows' milk contained 130 mcg/L.
- Year Enacted: n/a
Program Monitoring and Evaluation
No official government program. National coordinating committee consisting of thyroidologists, the German Society of Nutrition, salt producers, and pharmacologists, in existence since 1984. Strong involvement of endocrinologists and other physicians as expert working groups, with support of Federal Department of Health.
Urinary iodine and thyroid size by ultrasound are used for periodic surveys, mostly by academic thyroidologists.
Other Interventions
No organized supplementation. KI tablets often prescribed on individual basis.
Key Lessons Learned
Challenges and Constraints
Future Plans for Sustained IDD Elimination
Sources:
IDD NL 18(4):54, 2002
IDD NL 14(2):27, 1998
IDD NL 14(1):11, 1998
IDD NL 13(4):62, 1997
IDD NL 12(3):50, 1996
IDD NL 9(1):6, 1993
|
