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Contribution of iodized salt to total iodine and total salt intake in Germany

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Abstract

Background

Salt reduction campaigns without a parallel increase of iodine fortification will lead to a worsened iodine status in countries with a relevant salt iodization. A decline in iodine supply bears the risk of higher prevalences of goiter, thyroid nodules, and cognitive delay in children. Against this background, we analyzed the contribution of iodized salt to total iodine and salt intake in Germany and compared the results with data from Switzerland.

Methods

Analyses were performed with data of the representative German Health-Interview and Examination-Survey for Adults (DEGS1, 2008–2011) using spot urine measurements of creatinine, iodine, and sodium (n = 6738). Median daily iodine and salt intakes were calculated by estimating 24-h iodine and sodium excretions from urinary analyte/creatinine ratios. Linear regressions were used to deduce iodine intake that originates from iodine containing foods (i.e., salt-independent iodine). From this, ingested iodine originating from salt and the proportion of iodized salt to total salt intake were calculated. Data from Switzerland were obtained from the literature.

Results

In Germany, only 42% (52.2 µg/d) of the predicted median total iodine intake (126.2 µg/d), i.e., 12% less than in Switzerland, were found to originate from salt, whereas 73.7 µg/d came from iodine containing foods. 28% (2.6 g/d) of the median salt intake (9.3 g/d) of the German population was calculated to represent iodized salt against 43% in Switzerland.

Conclusions

Along with an almost identical inherent iodine intake in Germany and Switzerland, the average total iodine intake, the contribution of iodized salt to total iodine intake, and the proportion of iodized salt to total salt are higher in Switzerland than in Germany. Despite this, iodine fortification of table salt has recently been increased in Switzerland from 20 to 25 mg/kg to ensure iodine sufficiency in the population, whereas in Germany fortification still remains at a mean level of 20 mg/kg implying a growing risk of increasing iodine deficiency rates if general salt intake drops.

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Abbreviations

DEGS1:

German Health Interview and Examination Survey for Adults

RKI:

Robert Koch Institute

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Funding

This work was funded by the German Federal Ministry of Food and Agriculture (BMEL) based on a decision of the Parliament of the Federal Republic of Germany, granted by the Federal Office for Agriculture and Food (BLE; Grant number: 2817HS007). DEGS1 was financially supported by the German Ministry of Health.

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Authors and Affiliations

  1. DONALD Study Center Dortmund, IEL-Nutritional Epidemiology, University of Bonn, Dortmund, Germany

    Jonas Esche & Thomas Remer

  2. Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany

    Michael Thamm

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  1. Jonas Esche
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  2. Michael Thamm
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  3. Thomas Remer
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Contributions

TR designed the research and was responsible for the project conception. JE and TR were responsible for statistical analyses and interpretation of the data. JE drafted the manuscript, together with TR. MT took responsibility for urinary measurements. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Thomas Remer.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Esche, J., Thamm, M. & Remer, T. Contribution of iodized salt to total iodine and total salt intake in Germany. Eur J Nutr 59, 3163–3169 (2020). https://doi.org/10.1007/s00394-019-02154-7

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