1.gif (1892 bytes)

Letters to the Editor

Indian Pediatrics 1999; 36:203-204

Current Status of Iodine Deficiency Disorders Control Program


There are a few factual errors On the recent Editorial on this subject(1): On page 832 second column, 4th line - Rajasthan (3.19%) should have been 31.9% and on page 833 first column, 1st line - than 80% of the salt samples - Table II shows it should have been 70%. There are also other anomalies in the data presented and the ,arguments raised in the paper. On page 831 second column, 12th line it is stated - ''The goiter prevalence was documented to be as high as 20.5% in district of Bikaner, Rajasthan, to be as low as 0.8% in district Pauri, U.P. However, when the median urinary iodine excretion cut off of
10 mcg/dl was used as a criterion for assessing iodine deficiency in a population, no state included in the study was deficient. It was found that 68 to 100% population in the study area was consuming iodized salt." If in Rajasthan 68.1 % of population consumes iodized salt, then how is that there is 20.5% goiter prevalence there? And if median UIE of 10 mcg/dl is a crietrion for assessing iodine deficiency and no state included in the study was found to be deficient, then why should there be emphasis on iodized salt consumption? The argument that 68% to 100% population in the study area was consuming iodized salt holds no ground because the iodine content of salt at the beneficiary level and at traders level show 20 to 30% of the samples tested to be below 15 ppm iodine content, the minimum made man- datory by Government.

Again there is a misguided approach in considering percentage of samples with nil io- dine(Table II) as the percentage of population not consuming iodized salt (Table I)and showing the difference (100-% of nil iodine samples) as the percentage population consuming iodized salt.

The data presented seem to be at great variance from reports appearing in the news media, where it is alleged that majority of the "iodized salts" sold in the market are not iodized at all, only the container bears that printing but the material inside is just plain salt. This carries weight because goiter has been prevalent in specified hilly areas.

Again, the variance between the samples tested at beneficiary level and at traders level for iodine content of salt, needs a careful study. Why was there such a great variation in the iodine content for the two types of samples? It is well known that iodine content becomes less on storage, loss depending on the storage conditions. Manufacturers are required to add excess of iodine (up to 45 ppm) to compensate for this loss and maintain mini- mum of 15 ppm level at the beneficiary level.

The alternative technology of iodized oil for supplying iodine will be beset with major problem of stability because oils will be oxidized much faster in the presence of iodine and become more rancid. As it is, there is a great time lag in the date of manufacture of oils and the date of their actual consumption by the users. If oils are iodized they will be required to be consumed much faster, which is not likely to happen. So, even though that technology is available, it has no better advantage.

Dr. Umesh Kapil presents the data and the arguments as if he is pro-salt manufacturers rather than pro-Government, whose intention should be goiter control and not iodization of salt. Majority of the references quoted are based on data and arguments on similar lines. I feel that the Government has to rethink on the whole issue - why should there be compulsion to use iodized salt only and not ordinary salt? Those who are deficient in iodine can re- sort to iodine supplements (iodized oil, iodicasein, iodoiourea). Iodine excess can lead to more serious complications than its deficiency state-iodism, rashes, coryza and bronchitis are already well known. In severe cases purging, excessive thirst and circulatory failure and severe renal failure may develop. The daily requirements can be easily met from sea foods, dairy products, iodized salt, and water (variable).
 

Hasmukh C. Shah,
Educational Consultant,
B-1/62, Lokmanya Society, Veer Savarkar Marg,
Thane 400 602, MS, India.
 

References

1. Kapil U. Current status of Iodine Deficiency Disorders Control Program. Indian Pediatr 1998; 35: 831-836.
 

Home

Past Issue

About IP

About IAP

Feedback

Links

 Author Info.

  Subscription