The increasing popularity and availability of plant-based alternatives to key sources of iodine, such as milk, dairy, and fish, is contributing to persistent and increased insufficient iodine intake in the WHO European Region, according to a report released today by WHO/Europe and the Iodine Global Network (IGN). This increases risks for people’s health, particularly for women during pregnancy who have higher iodine needs.
Milk and dairy products are important sources of iodine in many western and central European countries, especially for children. Many animal feeds and supplements are enriched with iodine to improve farm animals’ health and milk yields. Yet consumption of dairy products is declining among adolescents and adults, heightening their risk of iodine deficiency.
The risks of changing diets
Iodine intake is especially important for fetal brain development prior to and during pregnancy. “The shift towards plant-based dairy alternatives, particularly among women, who already bear a higher risk of iodine deficiency and thyroid diseases than men, is concerning for their iodine nutrition, especially in countries relying on milk as a source of iodine, as most dairy alternatives do not contain it,” said Dr Hans Henri P. Kluge, WHO’s Regional Director for Europe. “This report has been crucial in highlighting a problem that still exists or is re-emerging in countries in the Region.”
Salt iodization remains the main strategy to ensure adequate iodine intake in the Region but that too is affected by dietary and lifestyle changes. Foods produced or cooked outside the home, such as bread, processed meats or ready-to-eat meals, are now the main sources of salt in a western diet, comprising 70–80% of the total. Yet recent market surveys found that only 9% of salt in processed food products in Germany and 34% in Switzerland was iodized. In 24 countries with voluntary or no iodization, commonly consumed foods are often produced with non-iodized salt.
“Countries need more flexible policy strategies to protect people from iodine deficiency, including mandatory policies for the use of iodized food-grade salt in processed foods and integration of salt reduction and salt iodization measures,” said Dr Gauden Galea, WHO/Europe Strategic Adviser to the Regional Director, Special Initiative on NCDs (noncommunicable diseases) and Innovation (SNI). “Considering the change in dietary landscapes, there is also a need to ensure appropriate fortification of alternative milk and dairy products with iodine.”
These recommendations reflect the WHO/Europe Race to The Finish campaign that promotes evidence-based practices that help countries to fulfill their global health commitments, including the UN Sustainable Development Goals. They also support WHO’s policies both to reduce sodium intake and to prevent iodine deficiency by advising to use less, but always iodized, salt.
Iodine deficiency: impact on the WHO European Region
“In addition to these developments, there is a lack of knowledge about the consequences of iodine deficiency among the general public and among health authorities, health professionals and food producers. The result is that progress may be stalling or even declining in some countries. And there are other costs – even mild deficiency, which exists throughout Europe, has a major impact on population health and the economy,” said Dr Werner Schultink, Executive Director, IGN.
Beyond the visible sign of goitre, which is a lump or swelling at the front of the neck caused by a swollen thyroid, iodine deficiency also increases the frequency of preventable thyroid disorders, such as thyroid nodules, multinodular goitre, and hyperthyroidism, particularly in adults and older people. Untreated hyperthyroidism increases the risk of cardiac arrhythmia, heart failure, osteoporosis, adverse pregnancy outcomes, and cognitive impairment in older people.