Iodine Intake from Food and Iodized Salt as Related to Dietary Salt Consumption in the Italian Adult General Population

Roberto Iacone, Paola Iaccarino Idelson, Ornella Russo, Chiara Donfrancesco, Vittorio Krogh, Sabina Sieri, Paolo Emidio Macchia, Pietro Formisano, Cinzia Lo Noce, Luigi Palmieri, Daniela Galeone, Domenico Rendina, Ferruccio Galletti, Andrea Di Lenarda, Simona Giampaoli, Pasquale Strazzullo, On Behalf Of The Minisal-Gircsi Study Group, Roberto Iacone, Paola Iaccarino Idelson, Ornella Russo, Chiara Donfrancesco, Vittorio Krogh, Sabina Sieri, Paolo Emidio Macchia, Pietro Formisano, Cinzia Lo Noce, Luigi Palmieri, Daniela Galeone, Domenico Rendina, Ferruccio Galletti, Andrea Di Lenarda, Simona Giampaoli, Pasquale Strazzullo, On Behalf Of The Minisal-Gircsi Study Group

Abstract

Since the Italian iodoprophylaxis strategy is based on the use of iodized salt, we assessed the relationship between dietary salt consumption and iodine intake in the Italian adult population. We estimated the relative contribution given by the use of iodized salt and by the iodine introduced by foods to the total iodine intake. The study population included 2219 adults aged 25-79 years (1138 men and 1081 women) from all Italian regions, participating to the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 2008-2012 (OEC/HES), and examined for sodium and iodine intake in the framework of the MINISAL-GIRCSI Programme. Dietary sodium and total iodine intake were assessed by the measurement of 24 h urinary excretion, while the EPIC questionnaire was used to evaluate the iodine intake from food. Sodium and iodine intake were significantly and directly associated, upon accounting for age, sex, and BMI (Spearman rho = 0.298; p < 0.001). The iodine intake increased gradually across quintiles of salt consumption in both men and women (p < 0.001). The European Food Safety Authority (EFSA) adequacy level for iodine intake was met by men, but not women, only in the highest quintile of salt consumption. We estimated that approximately 57% of the iodine intake is derived from food and 43% from salt. Iodized salt contributed 24% of the total salt intake, including both discretionary and non-discretionary salt consumption. In conclusion, in this random sample of the Italian general adult population examined in 2008-2012, the total iodine intake secured by iodized salt and the iodine provision by food was insufficient to meet the EFSA adequate iodine intake.

Keywords: 24 h urinary excretion; adult age; iodine deficiency disorders; iodine intake; iodine prophylaxis; iodized salt; salt intake; salt restriction; thyroid.

Conflict of interest statement

PS declares to be an unpaid member of WASSH (World Action on Salt, Sugar and Health). All the other authors have nothing to disclose.

Figures

Figure 1
Figure 1
Flowchart of the study population.
Figure 2
Figure 2
Iodine intake from foods and by sex.
Figure 3
Figure 3
Estimates of iodine intake from food and iodized salt and their respective proportions.
Figure 4
Figure 4
Proportion of estimated iodized salt intake referred to the total salt consumption.

References

    1. World Health Organization (WHO) WHO Guideline: Fortification of Food-Grade Salt with Iodine for the Prevention and Control of Iodine Deficiency Disorders. World Health Organization; Geneva, Switzerland: 2014. [(accessed on 23 July 2021)]. Available online: .
    1. WHO. UNICEF. ICCIDD . Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination. World Health Organization; Geneva, Switzerland: 2007. [(accessed on 23 July 2021)]. Available online: .
    1. Report of a WHO Expert Consultant. World Health Organization; Luxembourg: 2007. [(accessed on 23 July 2021)]. Salt as a Vehicle for Fortifcation. Available online: .
    1. Law 21 March 55/2005. [(accessed on 23 July 2021)]. Available online: .
    1. WHO Reducing Salt Intake in Populations: Report of a WHO Forum and Technical Meeting World Health Organization 2007. [(accessed on 23 July 2021)]. Available online: .
    1. D’Elia L., Galletti F., La Fata E., Sabino P., Strazzullo P. Effect of dietary sodium restriction on arterial stiffness: Systematic review and meta-analysis of the randomized controlled trials. J. Hypertens. 2018;36:734–743. doi: 10.1097/HJH.0000000000001604.
    1. WHO . Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. World Health Organization; Geneva, Switzerland: 2013. [(accessed on 23 July 2021)]. Available online: .
    1. Donfrancesco C., Ippolito R., Lo Noce C., Palmieri L., Iacone R., Russo O., Vanuzzo D., Galletti F., Galeone D., Giampaoli S., et al. Excess dietary sodium and inadequate potassium intake in Italy: Results of the MINISAL study. Nutr. Metab. Cardiovasc. Dis. 2013;23:850–856. doi: 10.1016/j.numecd.2012.04.004.
    1. Cappuccio F.P., Ji C., Donfrancesco C., Palmieri L., Ippolito R., Vanuzzo D., Giampaoli S., Strazzullo P. Geographic and socioeconomic variation of sodium and potassium intake in Italy: Results from the MINISAL-GIRCSI programme. BMJ Open. 2015;5:e007467. doi: 10.1136/bmjopen-2014-007467.
    1. Iacone R., Iaccarino Idelson P., Formisano P., Russo O., Lo Noce C., Donfrancesco C., Macchia P.E., Palmieri L., Galeone D., di Lenarda A., et al. Iodine Intake Estimated by 24h Urine Collection in the Italian Adult Population: 2008–2012 Survey. Nutrients. 2021;13:1529. doi: 10.3390/nu13051529.
    1. Giampaoli S., Palmieri L., Donfrancesco C., Lo Noce C., Pilotto L., Vanuzzo D. Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey Research Group. Cardiovascular health in Italy. Ten-year surveillance of cardiovascular diseases and risk factors: Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 1998–2012. Eur. J. Prev. Cardiol. 2015;22((Suppl. S2)):9–37.
    1. Donfrancesco C., Lo Noce C., Russo O., Minutoli D., Di Lonardo A., Profumo E., Buttari B., Iacone R., Vespasiano F., Vannucchi S., et al. Trend of salt intake measured by 24-h urine collection in the Italian adult population between the 2008 and 2018 CUORE Project surveys. NMCD. 2020;31:802–813. doi: 10.1016/j.numecd.2020.10.017.
    1. Pisani P., Faggiano F., Krogh V., Palli D., Vineis P., Berrino F. Relative validity and reproducibility of a food frequency dietary questionnaire for use in the Italian EPIC centres. Int. J. Epidemiol. 1997;26((Suppl. S1)):S152–S160. doi: 10.1093/ije/26.suppl_1.S152.
    1. Campanozzi A., Rutigliano I., Macchia P.E., De Filippo G., Barbato A., Iacone R., Russo O., D’Angelo G., Frigeri M., Pensabene L., et al. Iodine deficiency among Italian children and adolescents assessed through 24-hour urinary iodine excretion. Am. J. Clin. Nutr. 2019;109:1080–1087. doi: 10.1093/ajcn/nqy393.
    1. Institute of Medicine . Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. The National Academies Press; Washington, DC, USA: 2001. p. 264.
    1. EFSA NDA Panel (EFSA Panel on Panel on Dietetic Products Nutrition and Allergies) Scientific Opinion on Dietary Ref-erence Values for iodine. [(accessed on 23 July 2021)];EFSA J. 2014 12:3660. doi: 10.2903/j.efsa.2014.3660. Available online: .
    1. Cogswell M.E., Maalouf J., Elliott P., Loria C.M., Patel S., Bowman B.A. Use of Urine Biomarkers to Assess Sodium Intake: Challenges and Opportunities. Annu. Rev. Nutr. 2015;35:349–387. doi: 10.1146/annurev-nutr-071714-034322.
    1. Salvini S., Parpinel M., Gnagnarella P., Maissoneuve P., Turrini A. Banca Dati di Composizione Degli Alimenti Per Studi Epidemiologici in Italia. European Institute of Oncology; Milan, Italy: 1998. [(accessed on 23 July 2021)]. Available online: .
    1. Pastorelli A.A., Stacchini P., Olivieri A. Daily iodine intake and the impact of salt reduction on iodine prophylaxis in the Italian population. Eur. J. Clin. Nutr. 2015;69:211–215. doi: 10.1038/ejcn.2014.206.
    1. Iacone R., Iaccarino Idelson P., Campanozzi A., Rutigliano I., Russo O., Formisano P., Galeone D., Macchia P.E., Strazzullo P. MINISAL-GIRCSI Study Group. Relationship between salt consumption and iodine intake in a pediatric population. Eur. J. Nutr. 2020 doi: 10.1007/s00394-020-02407-w.
    1. Leclercq C., Arcella D., Piccinelli R., Sette S., Le Donne C., Turrini A. INRAN-SCAI 2005-06 Study Group. The Italian National Food Consumption Survey INRAN-SCAI 2005-06: Main results in terms of food consumption. Public Health Nutr. 2009;12:2504–2532. doi: 10.1017/S1368980009005035.
    1. Olivieri A., Vitti P. Istituto Superiore Di Sanità. Rapporti ISTISAN 14/6. Attività Di Monitoraggio Del Programma Nazionale per la Prevenzione Dei Disordini Da Carenza Iodica. Epidemiologia E Sanità Pubblica. [(accessed on 19 July 2021)];2014 Available online: .
    1. Leclercq C., Ferro-Luzzi A. Total and domestic consumption of salt and their determinants in three regions of Italy. Eur. J. Clin. Nutr. 1991;45:151–159.
    1. Iaccarino Idelson P., D’Elia L., Cairella G., Sabino P., Scalfi L., Fabbri A., Galletti F., Garbagnati F., Lionetti L., Paolella G., et al. On Behalf Of The Sinu-Gircsi Working Group. Salt and Health: Survey on Knowledge and Salt Intake Related Behaviour in Italy. Nutrients. 2020;12:279. doi: 10.3390/nu12020279.
    1. Istituto Superiore di Sanità L’epidemiologia per La Sanità Pubblica: Sorveglianza PASSI. [(accessed on 19 July 2021)]. Available online: .
    1. Consiglio per La Ricerca in Agricoltura E L’analisi Dell’economia Agraria (CREA) Linee Guida per Una Sana Alimentazione. Revisione. [(accessed on 19 July 2021)];2018 Available online: .
    1. Zimmermann M.B., Aeberli I., Torresani T., Bürgi H. Increasing the iodine concentration in the Swiss iodized salt program markedly improved iodine status in pregnant women and children: A 5-y prospective national study. Am. J. Clin. Nutr. 2005;82:388–392. doi: 10.1093/ajcn/82.2.388.
    1. Haldimann M., Bochud M., Burnier M., Paccaud F., Dudler V. Prevalence of iodine inadequacy in Switzerland assessed by the estimated average requirement cut-point method in relation to the impact of iodized salt. Public Health Nutr. 2015;18:1333–1342. doi: 10.1017/S1368980014002018.
    1. Remer T., Neubert A. A never-ending story of an insufficient iodine status without mandatory iodization of foods? A German experience. J. Clin. Endocrinol. Metab. 1998;83:3755–3756. doi: 10.1210/jc.83.10.3755-a.
    1. Esche J., Thamm M., Remer T. Contribution of iodized salt to total iodine and total salt intake in Germany. Eur. J. Nutr. 2020;59:3163–3169. doi: 10.1007/s00394-019-02154-7.
    1. Charlton K., Ware L.J., Menyanu E., Biritwum R.B., Naidoo N., Pieterse C., Madurai S., Baumgartner J., Asare G.A., Thiele E., et al. Leveraging ongoing research to evaluate the health impacts of South Africa’s salt reduction strategy: A prospective nested cohort within the WHO-SAGE multicountry, longitudinal study. BMJ Open. 2016;6:e013316. doi: 10.1136/bmjopen-2016-013316.
    1. He F.J., Wu Y., Feng X.X., Ma J., Ma Y., Wang H., Zhang J., Yuan J., Lin C.P., Nowson C., et al. School based education programme to reduce salt intake in children and their families (School-Edu Salt): Cluster randomised controlled trial. BMJ. 2015;350:h770. doi: 10.1136/bmj.h770.
    1. König F., Andersson M., Hotz K., Aeberli I., Zimmermann M.B. Ten repeat collections for urinary iodine from spot samples or 24-hour samples are needed to reliably estimate individual iodine status in women. J. Nutr. 2011;141:2049–2054. doi: 10.3945/jn.111.144071.

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