Jakobsen Lea Sletting, Nielsen Josefine Ostenfeld, Paulsen Sophie Egesø, Outzen Malene, Linneberg Allan, Møllehave Line Tang, Christensen Tue, Ravn-Haren Gitte
National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark.
Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark.
Foods. 2022 Apr 28;11(9):1281. doi: 10.3390/foods11091281.
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.
碘缺乏是全球最常见的营养失调问题之一。在丹麦，2000年引入了13 ppm的食盐强制碘强化措施以消除轻度至中度碘缺乏，2019年强化水平提高到了20 ppm。然而，最佳碘摄入量范围很窄，摄入量低于或高于此范围都会增加患病风险。在本研究中，我们通过提高强制强化水平来量化丹麦成年人群中的风险效益平衡。我们采用了一种风险效益评估方法，将强化措施提高前后的人群碘摄入量与碘营养状况和相关疾病风险之间关联的流行病学证据相结合，以估计引发或预防的病例数，并根据伤残调整生命年（DALY）来估计对健康的影响。我们估计，随着强化水平的提高，每年每10万成年人中总体健康效益和预防效果为34.9（95% UI：-51.6；-21.7）个DALY。预防因母亲碘缺乏导致儿童智商低下是总体健康改善的主要因素。健康生命年的增加是以碘过量导致的额外甲状腺肿病例为代价的。由于缺乏数据，未纳入与碘状态相关的甲状腺功能减退和亢进情况。儿童作为一个人群组也未纳入。因此，以及模型和所用数据中固有的不确定性，结果应谨慎解释。我们认为，对强化计划的公共卫生影响进行国别定量评估可提供透明的、基于证据的决策支持。未来的研究应旨在使评估中能够纳入所有相关健康影响以及儿童。
