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...
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| Jezik: | English |
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MDPI AG
2022-04-01
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| Serija: | Foods |
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| Online pristup: | https://www.mdpi.com/2304-8158/11/9/1281 |
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| author | Lea Sletting Jakobsen Josefine Ostenfeld Nielsen Sophie Egesø Paulsen Malene Outzen Allan Linneberg Line Tang Møllehave Tue Christensen Gitte Ravn-Haren |
| author_facet | Lea Sletting Jakobsen Josefine Ostenfeld Nielsen Sophie Egesø Paulsen Malene Outzen Allan Linneberg Line Tang Møllehave Tue Christensen Gitte Ravn-Haren |
| author_sort | Lea Sletting Jakobsen |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-10T04:09:51Z |
| format | Article |
| id | doaj.art-1372725fff1b4bd4aadf433677ee0e7c |
| institution | Directory Open Access Journal |
| issn | 2304-8158 |
| language | English |
| last_indexed | 2024-03-10T04:09:51Z |
| publishDate | 2022-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Foods |
| spelling | doaj.art-1372725fff1b4bd4aadf433677ee0e7c2023-11-23T08:13:14ZengMDPI AGFoods2304-81582022-04-01119128110.3390/foods11091281Risk–Benefit Assessment of an Increase in the Iodine Fortification Level of Foods in Denmark—A Pilot StudyLea Sletting Jakobsen0Josefine Ostenfeld Nielsen1Sophie Egesø Paulsen2Malene Outzen3Allan Linneberg4Line Tang Møllehave5Tue Christensen6Gitte Ravn-Haren7National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, DenmarkNational Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, DenmarkNational Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, DenmarkNational Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, DenmarkCenter for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, DenmarkCenter for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, DenmarkNational Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, DenmarkNational Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, DenmarkIodine 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.https://www.mdpi.com/2304-8158/11/9/1281iodine fortificationrisk–benefitpublic health impactDALY |
| spellingShingle | Lea Sletting Jakobsen Josefine Ostenfeld Nielsen Sophie Egesø Paulsen Malene Outzen Allan Linneberg Line Tang Møllehave Tue Christensen Gitte Ravn-Haren Risk–Benefit Assessment of an Increase in the Iodine Fortification Level of Foods in Denmark—A Pilot Study Foods iodine fortification risk–benefit public health impact DALY |
| 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 | iodine fortification risk–benefit public health impact DALY |
| url | https://www.mdpi.com/2304-8158/11/9/1281 |
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