ELIMINATION OF IODINE DEFICIENCY IN LATVIA

Dr.Med. Guntars Selga,

Latvian Food Center

Historical divisions of Latvia

VidzemeKurzeme

LatgaleZemgale

ESTONIA

LITHUANIABELORUSIA

Population

• Latvia (January 8, 1998): 2,434,469. Ethnic composition (1998): 57.1% Latvian, 29.5% Russian, 4.1% Belarusian, 2.7% Ukrainian, 2.5% Polish, 2.3% Lithuanian, 1.8% others. Riga (January 1998): 790,608.

Citizens: 1,770,355 (72.72% of total population)

Non-Citizens: 646,723 (26.56% of total population)

Foreigners: 17,391 (0.72% of total population)

The definition of the degrees of severity of iodine deficiency (WHO)• Severe < 2,0 g/dl

• Moderate 2,0-4,9 g/dl

• Mild 5,0-9,9 g/dl

• Normal > 10,0 g/dl

2 , 5

1 3

3 5 , 5

2 9 , 5

2 0 , 5

0

5

1 0

1 5

2 0

2 5

3 0

3 5

4 0

%

M i c r o g r a m I o d i n e / d l U r i n e

L i t h u a n i a

L a t v i a

E s t o n i a

50%

FREQUENCY DISTRIBUTION OF IODINE EXCRETION in Baltic States (1995)

n=5762; 86 Schools; Mean=9,6

LATVIA n= 30 schools, 1500 children age 8-12 years

Urinary iodine in Latvia - 98 g/l

98g/l60 g/l

65 g/l

70-90 g/l

23-80 g/l

60-70 g/l30-90 g/l

PATIENTS WITH GOITRE IN CHILDREN’S CLINICAL

HOSPITAL

0

50

100

150

200

250

300

350

400

93 94 95 96 97 98 99

SL.SK.

CHRONICAL THYREOIDITIS IN CHILDREN’S CLINICAL

HOSPITAL

0

1

23

4

5

67

8

9

10

93 94 95 96 97 98 99

SLSK

PATIENTS WITH THYROTOXICOSIS IN

CHILDREN’S CLINICAL HOSP.

0

2

4

6

8

10

12

14

16

93 94 95 96 97 98 99

SL.SK.

Ventspils Tārāles pamatsk.

Vaiņodes 1.vsk.

Talsu 2.vsk.

Kandavas vsk.

Matkules vsk.

Tukuma 2. vsk

Liepājas 15.vsk

Līvānu 1.vsk

Ļaudonas vsk.

Varaklānu vsk.

Svētciema vsk.

Annenieku vsk.

Viesītes p.sk

Viļānu vsk.

Valmieras Kauguru 9 g. sk.

Jēkabpils 4.vsk.

- K.Videnieka Rīgas 77.vidusskola - Rīgas 1.bāreņu internātskola -Rīgas 33.vidusskola -Berģu pamatskola

20 SCHOLS INCLUDED IN THE IODINE SURVAY 2000 (n - 600) age 8-12 years

Median Urinary Iodine Excretion Among Latvian Schoolchildren in 2000 (n-600).

19

25

33

20

3

0

5

10

15

20

25

30

35

0 - 1,90,8

2 - 4,93,4

5 - 9,97,1

10 - 19,913,9

>2023,1

Microgram Iodine / dl Urine

% 23%

7.09

5.09

6.7

5.82

6.07

5.51

8.65

3.96

5.14

3.63

5.44

8.655.76

4.9

7.26

3.68

5.77-

7.26

20 SCHOLS INCLUDED IN THE IODINE SURVAY 2000 (n - 600) age 8-12 years

Iodine In The Food(J – 200 g RDA draft in Latvia)

Source Iodine g/100g

Cod 135

Salmon 62

Sea perch 57

Mackerel 45

Goose meet 42

Herring 41

Chockbery 40

Egg 20

Shampinion 18

Milk 16

Source Iodine g/100g

Kefir 14

Yoghurt 14

Set milk 13

Beans 12

Swine liver 12

Wheat (summer)11

Lard 10

Rue 9

Cream 9

Garlic 9

Barlay 9

Synergistic assimilationMineral or vitamin deficiency

Iodine

Ca

P

Zn

Vit. B6

For assimilation necessary

Iron, manganese, phosphorum

Boron, PUFA, lisin, Mg

Ca, Fe, Vit. B (comlex), Vit. E

Ca, Cu, P, Vit. B6

K, Vit. B (comlex), Vit.C, Vit. E

Intake Of Kcalories From Food Group By Sex In Latvia

0 100 200 300 400 500 600

Milk

Meat

Fish

Fats

Alcohol

Cereals

Vegetables

Fruit

Other

Fo

od

Gro

up

kcal

TotalFemalesMales

Nutrition and lifestyle in the Baltic Republics. 1999

Estimated requirement for edible salt in Latvia

8750 tonnes of salt/year (3,5 kg/person year x 2,5 million populatio of Latvia)

Salt situation Analysis in Latvia (1999)

(during 10 months)

- 7000 tonnes of edible salt

- 60 tonnes iodized salt Less than 0,9%

INFORMATIOM ABOUT TURNOVER OF SALT (tons)IN LATVIA

Company Edible Salt (tons) Iodized salt (tons)1997 1998 1999 (I-X) 1997 1998 1999 (I-X)

LSTC 5880.0 4600.0 3500.0 25.0 25.0 25.0Dangas 2725.0 3250.0 3500 - 20.0 20.0A.R.Skorpions - 13.1 15,7 - 12,9 15,6Oriola - Riga 1,7 6,2 5,1 1,1 6,2 5,1Vizmas AT 4,8 8,8 8,8 2,0 - -

Salt Situation Analysis In Latvia 1999

Nutrition and lifestyle in the Baltic Republics. 1999

During summer 1997, cross sectional survays were conducted among representative national samples of adults in each country (Estonia: n=2108; Latvia: n=2308; Lithuania: n=2153).

• salt consumption

Proportion of Respondents Adding Salt at the Table

(males in all age groups)

0

10

20

30

40

50

60

70

%

Estonia (n-902) Latvia (n-1062) Lithuania (n-986)

Never

If food is not saltyenough

Almost alwaysbefore tasting

Nutrition and lifestyle in the Baltic Republics. 1999

PROPORTION OF RESPONDENTS (womens) ADDING SALT AT THE TABLE

(all age groups)

0

10

20

30

40

50

60

%

Estonia (n1116) Latvia (n-1232) Lithuania (n-1165)

Never

If food is notsalty enough

Almost alwaysbefore tasting

Nutrition and lifestyle in the Baltic Republics. 1999

Proportion Of Respondents Never Adding Salt At The Table

(males in all age groups)

0

10

20

30

40

50

60

70

%

Estonia (n902) Latvia (n-1062) Lithuania (n-986)

All men18-34 yrs35-49 yrs50+ yrs

Nutrition and lifestyle in the Baltic Republics. 1999

PROPORTION OF RESPONDENTS (womens) NEVER ADDING SALT AT

THE TABLE

0

10

20

30

40

50

60

70

%

Estonia (n1116) Latvia (n-1232) Lithuania (n-1165)

All women18-34 yrs35-49 yrs50+ yrs

Nutrition and lifestyle in the Baltic Republics. 1999

Proportion Of Respondents Almost Always Adding Salt Before Tasting

(males in all age groups)

0

2

4

6

8

10

12

14

16

%

Estonia (n902) Latvia (n-1062) Lithuania (n-986)

All men18-34 yrs35-49 yrs50+ yrs

Nutrition and lifestyle in the Baltic Republics. 1999

PROPORTION OF RESPONDENTS (womens) ALMOST ALWAYS ADDING

SALT BEFORE TASTING

0

2

4

6

8

10

12

14

16

%

Estonia (n1116) Latvia (n-1232) Lithuania (n-1165)

All women18-34 yrs35-49 yrs50+ yrs

Nutrition and lifestyle in the Baltic Republics. 1999

USE OF SALT WITH ADDITIVES (mens all age groups)

0

10

20

30

40

50

60

70

80

90

%

Estonia(n-902) Latvia (n-1062) Lithuania (n-986)

YesNoDK

Nutrition and lifestyle in the Baltic Republics. 1999

USE OF SALT WITH ADDITIVES (womens all age groups)

0

10

20

30

40

50

60

70

80

90

%

Estonia (n1116) Latvia (n-1232) Lithuania (n-1165)

Yes

No

DK

Nutrition and lifestyle in the Baltic Republics. 1999

TYPE OF SALT WITH ADDITIVES USED BY COUNTRY

(mens all age groups)

0

10

20

30

40

50

60

70

80

90

%

Estonia (n-136) Latvia (n-25) Lithuania (n-37)

PansaltIodizedWith K,MgVegetta

Nutrition and lifestyle in the Baltic Republics. 1999

TYPE OF SALT WITH ADDITIVES USED BY COUNTRY

(womens all age groups)

0

10

20

30

40

50

60

70

80

90

%

Estonia (n-179) Latvia (n-58) Lithuania (n-70)

PansaltIodizedWith K,MgVegetta

Nutrition and lifestyle in the Baltic Republics. 1999

Dietary belief by country: “More dietary salt in the diet is of no consequence for your health

(mens all age groups)

0

10

20

30

40

50

60

70

%

Estonia (n-902) Latvia (n-1058) Lithuania (n-986)

WrongRightDK

Nutrition and lifestyle in the Baltic Republics. 1999

Dietary belief by country: “More dietary salt in the diet is of no consequence for your health

(womens all age groups)

0

10

20

30

40

50

60

70

80

%

Estonia (n-1116) Latvia (n-1219) Lithuania (n-1161)

WrongRightDK

Nutrition and lifestyle in the Baltic Republics. 1999

ELIMINATION OF IODINE DEFFICIENCY IN LATVIA

• To meet iodine requirements, the current recommmended daily iodine intakes necessary:– 50 g for infants (first 12 months of age)– 90 g for children (2-6 years of age)– 120 g for school children (7-12 years age)– 150 g for adults (beyond 12 years of age)– 200 g for pregnant and lacting women

Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness, WHO, 1996

Required iodine levels in salt

• In order to provide 150 g/day of iodine via iodized salt, iodine concentration in salt at the point of production should be in the range 20-40 mg of iodine per kg of salt.

• When all salt used in processed food is iodized, the lower limit (20 mg) is recommended.

• Under these circumstances median urinary iodine levels will vary from 100-200 g/l. “Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness”, WHO, 1996

Process Model for IDD Elimination Program in Process Model for IDD Elimination Program in LatviaLatvia