Dear All please find enclosed "The Italian National Program of Iodine Prophylaxis"
proposed by Ministry of Health - DGISAN and OSNAMI - ISS, Rome
Kind Regards
Denise Giacomini
Proponent
Ministry of Health – DGISAN (General Directorate for Hygiene, Food Safety and Nutrition) and OSNAMI (Italian National Observatory for Monitoring Iodine Prophylaxis) ISS, Rome
Date/Timeframe and location
2017, Italy
Main responsible entity
Ministry of Health
Nutrition context
The Italian National Program of Iodine Prophylaxis.
To eradicate iodine deficiency disorders, the World Health Organization (WHO) recommended salt iodization as the preferred strategy. Salt iodization is safe, equitable, largely self-financing and extremely cost - effective. In Italy, a nationwide salt iodization program on a voluntary basis was implemented in 2005 after the approval of the law n.55/2005 aimed at preventing endemic goiter and other iodine deficiency disorders. According to the Law, iodine is added to course and table salt at 30 mg/kg in the form of potassium iodate and the availability of iodized salt in food shops and supermarkets is mandatory, whereas no iodized salt can be sold only on costumers’ request. Moreover, the law permits the use of iodized salt in the food industry and communal eating areas. In 2009 a nationwide monitoring program of universal salt iodization was implemented and the Italian National Observatory for Monitoring Iodine Prophylaxis (OSNAMI) was established at the Italian National Institute of Health with the aim of evaluating the efficiency and effectiveness of the nationwide program of iodine prophylaxis.
Key characteristics of the food system(s) considered
Micronutrient and Food System.
The recently published WHO guidance on dietary salt consumption in population recommended maximum 5 g/day salt in adults and even less in children 2–15 years of age. However, the WHO promotes both the implementation of programs to reduce population salt intake, as one of the cost-effective strategies to reduce the burden of non-communicable diseases, and universal salt iodization to prevent and control iodine deficiency disorders. An optimal implementation of each program is ensured by promoting their commonalities and complementarities. Commonalities between the two programs are that both are aimed at improving public health; both programs adopt a multi-stakeholder approach and concern health promotion and prevention; both involve working closely with the food industry.
Over the years, the iodine nutritional status of the Italian population has improved. Data collected by the Observatory OSNAMI showed that iodized salt sold in 2016 was 60% of all sold salt, whereas it was only 30% in 2005. This increment was essentially due to a multi-stakeholders approach, which implied a proactive involvement of scientific societies and civil associations, particularly the associations of patients with endocrine pathologies. However, despite of the increased sale of iodized salt, data provided by Observatory OSNAMI have recently shown that some Italian regions are still mildly iodine deficient and goiter is still prevalent in these areas.
Key characteristics of the investment made
In the last two years, the Italian Ministry of Health, DGISAN, has invested resources for research projects (developed by the Italian National Institute of Health) with the aim to monitor iodine nutritional status of the Italian population and to evaluate regional interventions. Again, the General Directorate for the Hygiene, Food Safety and Nutrition (DGISAN) organized, in cooperation with the Italian National Institute of Health, the first National Consensus Conference on the use of the iodized salt (6th April 2017). During the conference 13 Scientific Societies operating in the field of endocrinology, gynecology, pediatrics, and nutrition signed a POSITION Statement, on the safety of use of iodized salt in adults and children.
Key actors and stakeholders involved (including through south-south/triangular exchanges, if any)
The National Coordinating Group promoted this initiative for the Iodine Prophylaxis. This National Group was established at the Italian Ministry of Health (DGISAN) with the aim to provide a national strategy of the nationwide program of iodine prophylaxis. In the past iodine prophylaxis was an issue almost exclusively covered by endocrinologists because iodine deficiency disorders are frequently thyroid disorders, especially goiter which is the most frequent consequence of iodine deficiency.
Key changes (intended and unintended) as a result of the investment/s
With the signature of the aforementioned Position Statement, iodine prophylaxis in our country has become “a field of action” also for gynecologists, pediatricians and nutritionists.
Challenges faced
For the future, to improve the iodine nutritional status of the population and to simultaneously reduce population salt intake, DGISAN foresees to involve the food industry and the communal eating areas more actively, upon the principle of a multi-sectorial and multi-stakeholders approach, as recommended by WHO. In fact, recent data of the Observatory OSNAMI have shown that the use of iodized salt is less than 10% in the food industry and about 25% in the communal eating areas. These low percentages imply that the iodized household salt is still the major contributor to iodine intake in our country. Since in industrialized countries only 10-20% of the consumed salt is household salt, whereas most of the daily salt intake is due to salt used in food production, it will be critical to convince the food industry to use iodized salt in their products to successfully correct iodine deficiency in Italy.
Lessons/Key messages
According to these WHO recommendations, in the last years DGISAN and OSNAMI have implemented policies to synergize salt reduction and iodine fortification strategies. Currently these are focused on: i) the engagement of different departments in support of universal salt iodization and effective policies and regulations to reduce salt consumption; ii) communication to population by promoting campaigns sharing messages emphasizing the importance of reducing salt and optimizing iodine intake.
Dr. Denise Giacomini