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Risk–Benefit Assessment of an Increase in the Iodine Fortification Level of Foods in Denmark—A Pilot Study
Iodine deficiency is one of the most common nutritional disorders worldwide. In Denmark, the mandatory iodine fortification of salt of 13 ppm was introduced in 2000 to eradicate mild to moderate iodine deficiency and the fortification level was increased to 20 ppm in 2019. However, the optimal iodin...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9104615/ https://www.ncbi.nlm.nih.gov/pubmed/35564002 http://dx.doi.org/10.3390/foods11091281 |
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author | Jakobsen, Lea Sletting Nielsen, Josefine Ostenfeld Paulsen, Sophie Egesø Outzen, Malene Linneberg, Allan Møllehave, Line Tang Christensen, Tue Ravn-Haren, Gitte |
author_facet | Jakobsen, Lea Sletting Nielsen, Josefine Ostenfeld Paulsen, Sophie Egesø Outzen, Malene Linneberg, Allan Møllehave, Line Tang Christensen, Tue Ravn-Haren, Gitte |
author_sort | Jakobsen, Lea Sletting |
collection | PubMed |
description | Iodine deficiency is one of the most common nutritional disorders worldwide. In Denmark, the mandatory iodine fortification of salt of 13 ppm was introduced in 2000 to eradicate mild to moderate iodine deficiency and the fortification level was increased to 20 ppm in 2019. However, the optimal iodine intake is a narrow interval, and the risk of disease increases with intakes both below and above this interval. In this study, we quantified the risk–benefit balance in the Danish adult population by increasing the mandatory fortification level. We applied a risk–benefit assessment approach in which population-level iodine intakes before and after the increase in fortification were integrated with epidemiological evidence of the association between iodine nutrition status and risk of relevant diseases to estimate the number of cases caused or prevented and estimated health impact in terms of disability-adjusted life years (DALY). We estimated an overall beneficial health impact and prevention of 34.9 (95% UI: −51.6; −21.7) DALY per 100,000 adults in the population annually with the increase in fortification level. Prevention of low IQ in children due to maternal iodine deficiency was the primary contributor to overall health gain. The gain in healthy life years comes at the expense of extra cases of goiter due to iodine excess. Due to lack of data, hypo- and hyperthyroidism related to iodine status were not included. Neither were children as a population group. Because of this, as well as uncertainties inherent in the model and data used, results should be interpreted with caution. We argue that nation-specific, quantitative assessments of the public health impact of fortification programs provide transparent, evidence-based decision support. Future research should aim to enable the inclusion of all relevant health effects as well as children in the assessment. |
format | Online Article Text |
id | pubmed-9104615 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-91046152022-05-14 Risk–Benefit Assessment of an Increase in the Iodine Fortification Level of Foods in Denmark—A Pilot Study Jakobsen, Lea Sletting Nielsen, Josefine Ostenfeld Paulsen, Sophie Egesø Outzen, Malene Linneberg, Allan Møllehave, Line Tang Christensen, Tue Ravn-Haren, Gitte Foods Article Iodine deficiency is one of the most common nutritional disorders worldwide. In Denmark, the mandatory iodine fortification of salt of 13 ppm was introduced in 2000 to eradicate mild to moderate iodine deficiency and the fortification level was increased to 20 ppm in 2019. However, the optimal iodine intake is a narrow interval, and the risk of disease increases with intakes both below and above this interval. In this study, we quantified the risk–benefit balance in the Danish adult population by increasing the mandatory fortification level. We applied a risk–benefit assessment approach in which population-level iodine intakes before and after the increase in fortification were integrated with epidemiological evidence of the association between iodine nutrition status and risk of relevant diseases to estimate the number of cases caused or prevented and estimated health impact in terms of disability-adjusted life years (DALY). We estimated an overall beneficial health impact and prevention of 34.9 (95% UI: −51.6; −21.7) DALY per 100,000 adults in the population annually with the increase in fortification level. Prevention of low IQ in children due to maternal iodine deficiency was the primary contributor to overall health gain. The gain in healthy life years comes at the expense of extra cases of goiter due to iodine excess. Due to lack of data, hypo- and hyperthyroidism related to iodine status were not included. Neither were children as a population group. Because of this, as well as uncertainties inherent in the model and data used, results should be interpreted with caution. We argue that nation-specific, quantitative assessments of the public health impact of fortification programs provide transparent, evidence-based decision support. Future research should aim to enable the inclusion of all relevant health effects as well as children in the assessment. MDPI 2022-04-28 /pmc/articles/PMC9104615/ /pubmed/35564002 http://dx.doi.org/10.3390/foods11091281 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Jakobsen, Lea Sletting Nielsen, Josefine Ostenfeld Paulsen, Sophie Egesø Outzen, Malene Linneberg, Allan Møllehave, Line Tang Christensen, Tue Ravn-Haren, Gitte Risk–Benefit Assessment of an Increase in the Iodine Fortification Level of Foods in Denmark—A Pilot Study |
title | Risk–Benefit Assessment of an Increase in the Iodine Fortification Level of Foods in Denmark—A Pilot Study |
title_full | Risk–Benefit Assessment of an Increase in the Iodine Fortification Level of Foods in Denmark—A Pilot Study |
title_fullStr | Risk–Benefit Assessment of an Increase in the Iodine Fortification Level of Foods in Denmark—A Pilot Study |
title_full_unstemmed | Risk–Benefit Assessment of an Increase in the Iodine Fortification Level of Foods in Denmark—A Pilot Study |
title_short | Risk–Benefit Assessment of an Increase in the Iodine Fortification Level of Foods in Denmark—A Pilot Study |
title_sort | risk–benefit assessment of an increase in the iodine fortification level of foods in denmark—a pilot study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9104615/ https://www.ncbi.nlm.nih.gov/pubmed/35564002 http://dx.doi.org/10.3390/foods11091281 |
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