Optimizing iodine nutrition in Belgium: a selective, progressive and monitored approach to control iodine deficiency

tackle iodine deficiency. It was however only during the last few years that an effort was

undertaken in order to eliminate iodine deficiency as a public health problem in Belgium. In autumn 1998, a nation-wide study among children clearly showed mild iodine deficiency in

Belgium, but no action was taken before 2009. It was only in the framework of the first

National Nutrition and Health Plan 2005-2010 that iodine deficiency was formally recognized

as a public health problem. An agreement between the Ministry of Health and the bakery

sector in April 2009 aimed to encourage and increase the use of iodised salt in the

production of bread. A selective and progressive approach was used in order to keep control

and to avoid a too rapid increase of iodine intake or an excessive iodine intake among the

population. It was calculated that the net yearly savings after installation of such a program

amount to at least 14 million Euros a year.

A recent national survey among school-aged children in autumn 2010 showed a clear and

significant improvement in iodine status compared to more than 10 years ago, suggesting

iodine sufficiency among school-aged children. The median urinary iodine concentration was

however at the lower end of the optimal range and seasonal effects were not taken into

account. The improvement was at least partly linked to the increasing use of iodised salt in

the bakery industry. However, some further silent iodine prophylaxis might also have

occurred, due to changing dietary habits (milk and fish consumption). Pregnant women and

women of child-bearing age in Belgium were found to still suffer from mild iodine deficiency

according to the current recommendations. This is at least partly linked to their lower

consumption of milk and dairy drinks compared to children and due to the higher iodine

requirements during pregnancy. Although the use of iodine-containing supplements among

pregnant women was found to be quite high in Belgium compared to other European

countries, because of the low iodine status among women of child-bearing age, women

became pregnant with a suboptimal iodine status.

In view of these findings, a further increase in the use of iodised instead of non-iodised

household salt and iodised salt by the bakers is recommended. In addition, one should put

efforts in increasing awareness among the public and among health professionals with

regard to iodine-rich food sources and with regard to the use of iodine-containing

supplements starting before conception and continuing during lactation.

In order to further improve iodine status in Belgium and sustain an optimal iodine status

over time, a legal framework is necessary. Mandatory fortification of all household salt and

bread is recommended, while non-iodised alternatives could still be offered upon specific

request. A rigorous monitoring program is indispensable, including vulnerable groups such as

pregnant and lactating women and infants. In addition, sustainability is a key issue as iodine

deficiency re-emerged in several industrial countries due to lack of interest, regulations and

monitoring. Political willing, salt reduction measures, changes in dietary habits among the

population and changes in industrial practices all may affect iodine status in Belgium in the

future. Therefore the strategy of controlling iodine deficiency needs to be directed and

monitored by a Belgian Scientific Committee for the Control of iodine deficiency disorders.