Iodine is a micronutrient of crucial importance for the health and over all well-being of all individuals. It is a trace element. It is required daily in the body in minute quantity. The total lifetime requirement of iodine in an individual is just 5gms. Iodine is required for the synthesis of Thyroid hormone which plays a very vital role in body metabolism, heart health, and many more body functions. A healthy adult body contains 15-20 mg of iodine, 70-80% of which is stored in the thyroid gland. Iodine deficiency is the single most important & preventable causes of mental retardation worldwide. The deficiency of iodine in body leads to multiple health problems right from the fetal stage to adulthood. The age wise daily Iodine requirement is as mentioned in the below table:

Age Group	Daily Iodine Requirement (µg/day)
0 – 11 months	50
12 – 59 months	90
6 – 12 years	120
> 12 years	150
Pregnant & Lactating Women	200 (for the mothers health and for mental & physical development of the fetus)

Iodine deficiency is a major health problem in all over world. Iodine is naturally found in the upper layer of soil and in sea. The deficiency of iodine is actually a disease of soil. Due to climate change i.e. glaciations, flooding, deforestation, gradual leaching of iodine from the soil is observed due to which environmental iodine deficiency happens which in turn makes low availability of iodine for feeds and fodder.

Sources of Iodine: Food is the main source of Iodine, meat, fish, dairy products, vegetables & cereals (grown in iodine rice soil), a very high amount of iodine is found in sea fish and seaweeds.

Causes of Iodine deficiency: Mental & Physical retardation, Goiter, loss of hearing and speech, dwarfism, Spontaneous abortion, still birth, Cretinism, 13 point loss in IQ. Loss of IQ can be understood as iodine plays a very important role in brain cell branching. In iodine deficient brains diminished brain cell branching is observed in turn less connections in brain resulting in low IQ. Most of the Iodine deficiency disorders are irreversible.

Supplementation of Iodine:  Common salt is used as a vehicle for Iodine supplementation due to 3 simple reasons: 1. Salt is one such food item consumed everyday by everyone rich or poor, urban or rural, man or woman, child or adult. 2. Salt consumption is in fixed quantity. 3. Salt is price inelastic.

What is Iodized salt?

• Salt in which iodine is added. Potassium iodide (KI) or Potassium Iodate (KIO3) is added in the salt. KIO3 being less soluble and more stable is proffered for adding in common salt.
• The ratio of adding iodine into salt is in the form of PPM (Parts Per Million). The value varies at different level of distribution. At production level there should be 30PPM iodine in the salt i.e. there should be 30 parts of iodine in one million parts (crystals) of salt. And after that, at retail level till consumption level there should not be less than 15PPM iodine in the salt.
• There are two ways of testing the salt for presence of iodine in it – 1. Kit based method, 2. Laboratory method. Kit based method includes a spot testing of salt by added drops of testing solution and checking for colour change. Darker the colour more is the iodine, but it gives the value of iodine in the range of 0-7ppm, 7-15ppm, 15-30ppm & 30ppm and above. Laboratory method via iodometric titration is more sophisticated form of testing which involves expertise of laboratory technicians and give a exact ppm of iodine i.e. 0 ppm to 30 ppm even till two decimal places.

Major milestones and Studies:

• The Kangra Valley Study (1956-1972) please refer the article PANDAV et al : Iodine deficiency in India by Dr C S Pandav (‘The Iodine Man of India’) and other co-authors to know about the 16 year long study.
• National Goiter Control Program (NGCP-1962)
• Universal Iodisation of Salt (1984)
• Re-launch of NGCP with new nomenclature – National Iodine Deficiency Disorder Control Program (NIDDCP) with aim to address the wide spectrum of iodine deficiency in India.
• Ban on human consumption of non-iodized salt (2006)
• Food safety and standard act (2010)

Currently, NIDDCP is functional in all states and UT’s of India with 5 major objectives:

1. Survey to access the magnitude of the iodine deficiency disorders – Goiter survey is conducted among the children of age group from 06 to 12 years at the village level. Salt and urine samples are collected and tested in the laboratory for expected level of iodine to rule out deficiency in the area.
2. Ensure supply of iodated salt in place of common salt.
3. Resurvey to assess the extent of idd and impact of iodized salt supply after every 5 years.
4. Laboratory monitoring of iodized salt and urinary iodine excretion.
5. Health education & publicity for IDD & consumption of iodated salt in place of common salt.

Role of Health Education and Publicity:

Iodine deficiency disorders are marginalized and less discussed reason for the major health problems like physical & mental retardation, Hypothyroidism and complications during pregnancy, even though the prevention is very simple i.e. just the use of iodized salt in place of common salt. Apart from that if the natural intake of iodine through proper diet is also ensured it is an add-on benefit. But that is mainly possible in coastal areas by consumption of sea foods and sea weeds; still the problem persists at the hilly and plain areas. Hence, the use of supplementation via iodized salt is the best way for prevention of IDD.

The common people should be aware about the IDD (iodine deficiency disorders) and benefits of iodized salt. They should know about the maintenance of iodized salt at home. How and when the iodized salt to be added to food for 100% benefits. This awareness is very important to be spread in the rural areas. Below are some of the main points which everyone should be aware of about the iodized salt–

• There is no change in the characteristics or taste of salt by adding iodine into it.
• It should be kept in an air tight container.
• It should not be touched with moist hands; spoon should be used to take out the salt.
• It should be kept away heat & moisture.
• Salt should be added at the last in the food, once it is cooked.

21^st October is celebrated as Global Iodine Deficiency Disorders Prevention Day. So, on this occasion lets all of us come together to spread the awareness about IDD and the ways of prevention and its control.

Conclusion : Iodine Deficiency is so easy to prevent that it is a crime to let a single child be born mentally handicapped for that reason.

The above article is written by Mrs. Abhilasha, Raipur Chhattisgarh India.