Eduardo A. PretellEduardo A. Pretell

Regional Coordinador for America, ICCIDDRegional Coordinador for America, ICCIDD

Improving Public Health Through the Optimal Intake of Iodine and Sodium

Washington DC, PAHO; March 31, April 1, 2011

Plans of ICCIDD for LAC and participation of IRLI Network

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ITS POTENTIAL TO SECURE THE SUSTAINED ELIMINATION OF IDD

WHILE REDUCING THE CONSUMPTION OF SALT TO PREVENT CVD

IODIZED SALT IODIZED SALT

IN LATIN AMERICAN COUNTRIESIN LATIN AMERICAN COUNTRIES

What do we have in favor ?

What is needed to be worked our for ?

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North America Mexico

Central America Belize

Costa Rica

Salvador

Guatemala

Honduras

Nicaragua

Panama

The Caribbean Cuba

Dominican Rep.

Haiti

South America Argentina

Bolivia

Brazil

Chile

Colombia

Guyana

Ecuador

Paraguay

Peru

Uruguay

Venezuela

Official IDD Control Program

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

?

No

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Iodization level (ppm)

20-40

--

25-40

30-100

20-60

50-100

30-100

20-60

18-23

30-100

--

20-40

40-60

20-60

20-60

50-100

--

30-50

40-60

30-40

30-40

40-70

Coverage %

100

?

100

100

60

100

100

100

100

78

?

?

94

100

100

100

?

100

100

100

100

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Advanced technology (large scale producers)

Rudimentary technology (small/median scale producers)

> 70 % > 70 % 100 %

Argentina (?) Panama Bolivia

Brasil Costa Rica

Colombia Cuba

Chile El Salvador

Ecuador Guatemala

Mexico Honduras

Paraguay Nicaragua

Peru Dominican Rep

Uruguay

Venezuela

Production of iodized salt

44

GUATEMALA (small scale producerss)

Quality of iodized salt

Iodization level Production plants Retail

30 - 60 ppm 43.5 %

> 15 ppm 64 %

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Quality control at retail

Large Median Small

> 15ppm 96 % 90 % 54 %

MEXICO

Production of iodized salt

Scale producers

Large Median Small

83 % 12 % 5 %

66

0 10 20 30 40 50 60 70 80 90 100Haiti 2006

Rep Dom 2006Guatemala 2003

Argentina 1999Venezuela 2006

Salvador 2005Cuba 2006

Bolivia 2005Belice 1994

Mexico 2006Peru 2006

Colombia 2006Paraguay 2006Nicaragua 2006

Chile 2006 Brasil 2006

Panama 2006Honduras 2004

Costa Rica 2006Ecuador 2006Uruguay 2006

Iodine content in salt at retail/household level

≥15 ppm, %

Country Year

Data collected more than 5 years ago

77

International Resource Laboratories for Iodine (IRLI) Network

Resource laboratory for Latin America:

Laboratory of Endocrinology, High Altitude Research Institute, Cayetano Heredia Peruvian University, Lima, Peru

(IRLI Harmonization Workshop in Cape Town, South Africa, Nov. 2002)

 

Main activities:

1.Quality assurance of laboratories for urinary iodine.

2.Technical support to improve their capacity for diagnosis and monitoring

3.Processing urine samples (surveys, research), as requested by

countries

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Accomplishments

Starting point: 20 laboratories were recorded: only 12 operating with different methods, 1-2 times/year. A quality control disclosed that only 2/3 were OK By 2006 the number of registered laboratories increased up to 25.

1.Technical support provided to laboratories in Argentine, Bolivia, Brazil, Chile, Costa Rica, Cuba, El Salvador, Mexico, Panama, Paraguay, and Uruguay.

2.Training of personnel and support to set up their own labs: 6 professionals from Argentina, Brazil, Cuba, and Mexico.

3.Processing of urine samples from Bolivia, Brazil, Ecuador, Haiti, and Peru.

4.Interlaboratories Assay was run from 2003 to 2006 (interrupted because of lack of funds). In the last run 12 out of 21 labs sent back their results. showing a significant progress.

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LIST OF LABORATORIES ACTUALLY PROCESSING IODINE IN URINELIST OF LABORATORIES ACTUALLY PROCESSING IODINE IN URINE

1. Centro Nacional de Investigaciones Nutricionales. Salta, Argentina

2. Instituto Nacional de Laboratorios de Salud. La Paz, Bolivia

3. Centro de Investigación y Desarrollo de Tecnología de Alimentos. Santa Cruz, Bolivia

4. Instituto de Nutrición y Tecnología de los Alimentos, Univ. de Chile. Santiago, Chile

5. Iinstituto Nacional de Salud. Bogotá ,Colombia

6. Inst. Costarricense Nutr & Enseñanza Nutr y Salud. MOH. San José, Costa Rica

7. Instituto de Nutrición e Higiene de los Alimentos, MOH. La Habana, Cuba

8. Laboratorio de Yodurias. MOH. Quito, Ecuador

9. Laboratorio de Bioquímica. INCAP. Guatemala, Guatemala

10.Lab Central de Referencia de Estudios en Salud Pública. Panamá

11. Instituto Nacional de Alimentación y Nutrición. Asunción, Paraguay

12. Laboratorio de Micronutrientes. Fac Ciencias y Filosofía, UPCH. Lima, Perú

13. Centro Nacional de Alimentación y Nutrición, MOH. Lima, Perú

14. Fac. Química. Univ. Rep. Oriental del Uruguay. Montevideo, Uruguay

15. Dep. Bioquímica, Universidad de los Andes. Mérida, Venezuela1010

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 320 340 360 380 400 420 440

Rep Dom 1993Haití 2002

Guatemala 1999Argentina 2000

Guyana 1997Mejico 1999

El Salvador 2000Belice 1995

Venezuela 2005Bolivia 2005

Panama 2006Cuba 2005

Costa Rica 1996Nicaragua 2004

Chile 2006Ecuador 2005

Peru 2006Uruguay 2004

Honduras 2005Brasil 2000

Colombia 2002Paraguay 2006

Urinary iodine

Median µg/l

Country Year

Data collected more than 5 years ago

1111

Plans of ICCIDD

Mainly pursuing of:

1. Improvement of the salt industry

2. Implementation of effective monitoring systems, and reporting

3. Sustained comunication and education

4. Regional LAC meeting, August 1-2, Lima, Peru, to address these subjects. The agenda includes the following:

- Discussion of the IDD control programs’ situation in each country- Discussion of the IDD control programs’ situation in each country

- H- How to improve the capacity and responsibility of the salt industryow to improve the capacity and responsibility of the salt industry

- Importance of optimal iodine nutrition in early life - Importance of optimal iodine nutrition in early life

- Implementation of WHO recommendations: - Implementation of WHO recommendations:

a) Securing the elimination of IDD by USI strategya) Securing the elimination of IDD by USI strategy

b) Reduction of salt consumption (sodium) to prevent CVDb) Reduction of salt consumption (sodium) to prevent CVD

- Current and future role of Agencies and NGOs- Current and future role of Agencies and NGOs

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The posibility of starting pilot trials to reduce dietary salt consumption, without risking optimal iodine intake, could be considered in one or more countries where programs for the control of IDD are well implemented.

Reaching the above objectives, will facilitate to start implementing a program towards an optimal sodium intake.

For this task, the recommended colaborating/integrating/coordinating work of stakeholders, including ICCIDD, is needed to be implemented on the field. The ICCIDD is a network of voluntary experts strongly commited to reach the goal of IDD elimination. In LAC we have focal points in almost all the countries.

ICCIDD is the only organization specifically dedicated to this objective, mainly through advocacy and scientific and technical assistance.

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