Review and comment “Guidance for salt fortification with iodine: a renewed commitment to achieve optimal iodine nutrition”

Abstract

During the first quarter of the 21st century, iodized salt became available almost everywhere, and only isolated pockets of iodine deficiency remain in the world. By 2024, 126 countries had introduced mandatory iodine fortification of salt, 89% of the world’s population consumes iodized salt, and 101 countries have achieved adequate iodine status among their populations, whereas in 1993, low iodine intake was observed in 113 countries. This is why iodine fortification of salt is recognized as one of the greatest achievements in public health. The new recommendations reviewed in this paper update existing guidelines regulating salt fortification programs, their monitoring and evaluation, and propose using new approaches in combination with maintaining and strengthening measures that have proven effective and sustainable. Of the six "analytical notes" included in the guidelines, the section on improving the availability of data on the iodine status of the population may be of greatest interest to readers. According to the authors, the effectiveness of salt iodization programs should be assessed by integrating iodine status surveys into more comprehensive health and nutrition surveys of the population or through sentinel epidemiological monitoring in areas at high risk of iodine deficiency. Collecting urine samples in antenatal clinics during routine visits by pregnant women is likely to be a less resource-intensive approach than representative cross-sectional surveys of iodine status.