New Statistical Approach to Apportion Dietary Sources of Iodine Intake: Findings from Kenya, Senegal and India. 2018

Frits van der Haar, and Jacky Knowles, and Zipporah Bukania, and Boubacar Camara, and Chandrakant S Pandav, and John Maina Mwai, and Ndeye Khady Toure, and Kapil Yadav
Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. fvander@emory.edu.

Progress of national Universal Salt Iodization (USI) strategies is typically assessed by household coverage of adequately iodized salt and median urinary iodine concentration (UIC) in spot urine collections. However, household coverage does not inform on the iodized salt used in preparation of processed foods outside homes, nor does the total UIC reflect the portion of population iodine intake attributable to the USI strategy. This study used data from three population-representative surveys of women of reproductive age (WRA) in Kenya, Senegal and India to develop and illustrate a new approach to apportion the population UIC levels by the principal dietary sources of iodine intake, namely native iodine, iodine in processed food salt and iodine in household salt. The technique requires measurement of urinary sodium concentrations (UNaC) in the same spot urine samples collected for iodine status assessment. Taking into account the different complex survey designs of each survey, generalized linear regression (GLR) analyses were performed in which the UIC data of WRA was set as the outcome variable that depends on their UNaC and household salt iodine (SI) data as explanatory variables. Estimates of the UIC portions that correspond to iodine intake sources were calculated with use of the intercept and regression coefficients for the UNaC and SI variables in each country's regression equation. GLR coefficients for UNaC and SI were significant in all country-specific models. Rural location did not show a significant association in any country when controlled for other explanatory variables. The estimated UIC portion from native dietary iodine intake in each country fell below the minimum threshold for iodine sufficiency. The UIC portion arising from processed food salt in Kenya was substantially higher than in Senegal and India, while the UIC portions from household salt use varied in accordance with the mean level of household SI content in the country surveys. The UIC portions and all-salt-derived iodine intakes found in this study were illustrative of existing differences in national USI legislative frameworks and national salt supply situations between countries. The approach of apportioning the population UIC from spot urine collections may be useful for future monitoring of change in iodine nutrition from reduced salt use in processed foods and in households.

UI MeSH Term Description Entries
D007194 India A country in southern Asia, bordering the Arabian Sea and the Bay of Bengal, between Burma and Pakistan. The capitol is New Delhi. Republic of India
D007455 Iodine A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. Iodine-127,Iodine 127
D007630 Kenya A republic in eastern Africa, south of ETHIOPIA, west of SOMALIA with TANZANIA to its south, and coastline on the Indian Ocean. Its capital is Nairobi. Republic of Kenya
D008297 Male Males
D004032 Diet Regular course of eating and drinking adopted by a person or animal. Diets
D005260 Female Females
D005504 Food Analysis Measurement and evaluation of the components of substances to be taken as FOOD. Analysis, Food,Analyses, Food,Food Analyses
D005511 Food Handling Any aspect of the operations in the preparation, processing, transport, storage, packaging, wrapping, exposure for sale, service, or delivery of food. Food Processing,Handling, Food,Processing, Food
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012424 Rural Population The inhabitants of rural areas or of small towns classified as rural. Rural Residence,Rural Communities,Rural Spatial Distribution,Communities, Rural,Community, Rural,Distribution, Rural Spatial,Distributions, Rural Spatial,Population, Rural,Populations, Rural,Residence, Rural,Rural Community,Rural Populations,Rural Residences,Rural Spatial Distributions

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