World Iodine Deficiency Day 2024, A Comprehensive Overview

World Iodine Deficiency Day, also known as Global Iodine Deficiency Disorders Prevention Day, is observed annually on 21st October. The primary goal of this observance is to raise awareness about the importance of iodine in maintaining good health and to emphasize the adverse consequences of iodine deficiency, which remains a global public health issue. This article provides a detailed overview of iodine’s essential role, the impacts of deficiency, national and global efforts to eradicate iodine deficiency, and the achievements of various programs aimed at ensuring adequate iodine intake.

Importance of Iodine in Daily Nutrition

Iodine is a critical micronutrient that plays an indispensable role in human health, particularly in the production of thyroid hormones, thyroxine (T4), and triiodothyronine (T3). These hormones regulate various aspects of metabolism and are crucial for fetal and infant development. Iodine exists in multiple forms, such as sodium and potassium salts, inorganic iodine (I2), iodate, and iodide. The most common form, iodide, is rapidly absorbed in the stomach and utilized by the thyroid gland to produce hormones. Excess iodide is primarily excreted through urine.

Foods like fish, dairy, and grains are natural sources of iodine, but iodized salt remains the most effective means of preventing iodine deficiency on a population level. Despite these efforts, iodine deficiency continues to be a public health concern, particularly in regions with iodine-deficient soil where food sources are less reliable.

What Happens in Iodine Deficiency?

Iodine deficiency is the leading cause of preventable intellectual disabilities worldwide, with a multitude of adverse effects on physical growth and neurological development. Iodine deficiency primarily results in hypothyroidism, which is characterized by an underactive thyroid gland due to insufficient iodine intake. When daily iodine intake falls below 10-20 mcg, thyroid hormone production declines, leading to the condition.

Goitre: The First Sign of Iodine Deficiency

Goitre, an enlargement of the thyroid gland, is typically the earliest clinical sign of iodine deficiency. The body tries to compensate for low thyroid hormone levels by enlarging the thyroid gland, resulting in goitre. This visible swelling is a tell-tale indicator of inadequate iodine intake and can have severe health consequences if left untreated.

Effects on Pregnant Women and Infants

Iodine deficiency during pregnancy is especially concerning, as it can cause significant neurodevelopmental deficits in the fetus, resulting in mental retardation, growth retardation, miscarriage, or stillbirth. Severe iodine deficiency during pregnancy can lead to cretinism, a condition characterized by irreversible intellectual disability, deaf mutism, stunted physical growth, delayed sexual maturation, and various neurological impairments.

For infants and young children, even mild to moderate iodine deficiency can have lasting effects, such as lower-than-average IQ scores, cognitive deficits, and an increased risk of attention deficit hyperactivity disorder (ADHD). Early intervention with adequate iodine supplementation is crucial to prevent these life-altering effects.

Effects on Adults

In adults, prolonged iodine deficiency can result in hypothyroidism, leading to a decrease in cognitive function and reduced work productivity. A chronic lack of iodine may also increase the risk of developing the follicular form of thyroid cancer. In mild cases, iodine deficiency primarily manifests as goitre and can be managed through dietary improvements.

National Efforts to Eradicate Iodine Deficiency

The National Goitre Control Programme (NGCP) – 1962

Recognizing the significant health challenges posed by iodine deficiency, the Government of India launched the National Goitre Control Programme (NGCP) in 1962. This initiative aimed to reduce the prevalence of goitre and related health problems caused by iodine deficiency, such as cretinism, mental and physical retardation, stillbirths, and miscarriages.

The National Iodine Deficiency Disorders Control Programme (NIDDCP) – 1992

To expand the scope of addressing iodine deficiency, the NGCP was restructured in 1992 as the National Iodine Deficiency Disorders Control Programme (NIDDCP). The revised program aimed to cover a broader range of iodine deficiency disorders (IDD) across India, including goitre, cognitive and developmental impairments, and other iodine-related health problems.

Objectives of the NIDDCP

The NIDDCP is focused on achieving the following key goals:

• Reducing the prevalence of IDD to below 5% nationwide.
• Ensuring 100% consumption of adequately iodized salt (containing 15 parts per million of iodine) at the household level.
• Monitoring and improving iodized salt quality, alongside conducting regular surveys to assess iodine deficiency across different regions.
• Promoting public awareness of iodine’s importance in preventing iodine deficiency disorders through health education initiatives.

Salt Iodization Policy – A Landmark Decision

In 1984, the Indian government made a landmark decision to mandate the iodization of all edible salt in the country. This policy was gradually implemented, starting in 1986, and by 1992, India had transitioned to nationwide use of iodized salt. Today, India produces 65 lakh metric tonnes of iodized salt annually, which is sufficient to meet the population’s dietary iodine requirements. This initiative has been instrumental in preventing iodine deficiency disorders in India.

Achievements of the National Iodine Deficiency Disorders Control Programme (NIDDCP)

The NIDDCP has achieved significant success in reducing the incidence of iodine deficiency across India. Some of the key accomplishments include:

• Reduction in Total Goitre Rate (TGR): The program has led to a substantial decrease in goitre cases, one of the key indicators of iodine deficiency.
• Increased Iodized Salt Production and Consumption: India’s annual production of iodized salt has reached 65 lakh metric tonnes, which is sufficient to meet the needs of the population.
• Regulatory Measures: Regulation 2.3.12 of the Food Safety and Standards (Prohibition and Restriction on Sales) Regulation, 2011, mandates that all salt sold for direct human consumption must be iodized.
• Establishment of Monitoring Laboratories: Laboratories for monitoring iodine deficiency have been established, including the National Reference Laboratory at the National Centre for Disease Control (NCDC), Delhi, and regional labs in Hyderabad, Kolkata, and AIIMS.
• State-Level Implementation: 35 States and Union Territories have established IDD Control Cells and State IDD Monitoring Laboratories, ensuring effective implementation at the local level.
• Information, Education, and Communication (IEC) Campaigns: Extensive efforts have been made to raise awareness about the importance of iodized salt in preventing iodine deficiency.

Global Efforts to Combat Iodine Deficiency

Globally, iodine deficiency affects an estimated 1.88 billion people, including nearly 30% of school-aged children. Recognizing the importance of addressing this issue, the World Health Organization (WHO) and UNICEF have been advocating for universal salt iodization since 1993. Over 120 countries have implemented salt iodization programs, resulting in a significant reduction in iodine deficiency disorders worldwide.

These global initiatives have not only improved iodine intake but also significantly reduced the prevalence of goitre, cognitive deficits, and other iodine-related health problems. The success of these programs highlights the need for sustained efforts to ensure adequate iodine intake, particularly in regions with iodine-deficient soil.