- Email: [email protected]
Europe is iodine deficient
CORRESPONDENCE
original curvature, and myopia returns. Furthermore, some corneae, even after minor surgery is done and the cornea healthy before surgery, become conical (a condition called keratoconus), which if sufficiently progressive can be repaired only by corneal transplantation. No one knows the rate of risk or the timescale of this serious complication. No warnings are carried in advertisements and almost all treatments are bilateral, so patients are unable to assess the effect of surgery on one eye, before surgery on the second is undertaken. On their website, the US Food and Drug Administration (http://www.fda. gov) note that LASIK eye surgery is an option for risk takers. The time has come to issue health warnings. William Jory 21B Devonshire Place, London W1G 6HZ, UK (e-mail: [email protected]) 1
2
3
4
5
Kriegerowski M. Photorefractive keratectomy impairs night driving ability. ASCRS Symposium. Seattle: June, 1996. Lohmann C. Low contrast after LASIK. Symposium of ESCRS. Brussels: September, 2000. Casson E, Racette L. Vision standards for driving in Canada and the United States. Can J Ophthalmol 2000; 35: 192–203. Coombes B. Contrast sensitivity after PRK and LASIK. Refractive Surgery Symposium. London: March 16, 2001. Nagy Z, Munkacs, G, Krueger R. Changes in mesopic vision after photorefractive keratectomy for myopia. J Refract Surg 2002; 18: 249–52.
Europe is iodine deficient Sir—Iodine deficiency causes mental defects, goitre, reproductive damage, childhood mortality, and hypothyroidism and hyperthyroidism,1 all of which can be prevented by iodine supplementation. Although the adverse effects of iodine deficiency disorders on health and socioeconomic development are well known, they persist as a public-health problem, with 2·2 billion people at risk worldwide.2 The national representatives from the West and Central European Region of the International Council for Control of Iodine Deficiency Disorders (ICCIDD) met on Sept 7, 2002, in Goteborg, Sweden, and designated 15 countries iodine sufficient, 13 deficient, four likely sufficient, and one likely deficient (panel). Overall, more than 60% of the nearly 600 million people in the region live in countries that harbour iodine deficiency.3–5 National responsibility for iodine nutrition and its prophylaxis is weaker in most European countries than
1226
Iodine nutrition status by country, based on urinary iodine excretion (g/L) Sufficient (⭓100 g/L)
Likely sufficient
Austria Bosnia Bulgaria Croatia Cyprus Czech Republic Finland Macedonia Netherlands Poland Portugal Slovak Republic Serbia Switzerland UK
Iceland Luxembourg Norway Sweden
elsewhere in the world. Awareness of the importance of iodine deficiency can be underestimated in countries `without assessment and monitoring programmes, and unrecognised pockets of deficiency might exist in remote areas. Laws with respect to iodised salt vary widely in Europe, as do the types and amounts of iodine compound used for fortification.3–5 Several actions should be implemented to eradicate iodine deficiency in Europe. Methods for effective monitoring programmes should be standardised. If voluntary use of iodised salt does not result in iodine sufficiency, strong consideration should be given to making supplementation compulsory. The high costs of iodised salt in some countries, together with low public awareness of its importance, are causes of poor acceptance by consumers, and should be corrected. ICCIDD and its partners can help countries achieve iodine sufficiency by: providing models of successful legislation already in place in other countries (such as Austria); assisting the formation of national coalitions to address iodine nutrition; offering guidelines for Europe-wide standardised programmes for monitoring both iodine nutrition and the quality of iodised salt; and recommending a uniform content of iodine for salt fortification. Many of these issues should be addressed together with WHO and UNICEF through the European Union and in cooperation with groups such as the European Thyroid Association, national endocrine societies, and the European Salt Producers Association. Countries without a national committee for iodine nutrition should be encouraged to form one that includes representatives from the national
Deficient (<100 g/L) Belgium Denmark France Germany Greece Hungary Italy Ireland Montenegro Romania Slovenia Spain Turkey
Likely deficient Albania
health authority, nutritionists, endocrinologists, paediatricians, epidemiologists, and salt producers. More than half of the population in Western and Central Europe is at risk of iodine deficiency, and most nations have weak or non-existent governmental programmes to address this problem. Consequently, much of the responsibility is shouldered by others, especially thyroidologists, the health sector, academic institutions, and the salt industry. National coalitions of these groups can and should play a major part in achieving and sustaining optimum iodine nutrition in the continent. We find it remarkable that Europe donates substantial funds towards the elimination of iodine deficiency in the developing world, but has not yet corrected its own. All authors are officials of the ICCIDD.
Paolo Vitti, Francois Delange, Aldo Pinchera, Michael Zimmermann, *John T Dunn Instituto di Endocrinologia, Tirrenia-Pisa, Italy (PV); Avenue de la Fauconnerie 153, 1170 Brussels, Belgium (FD); Department of Endocrinology, University of Pisa, Pisa (AP); Laboratory for Human Nutrition, Swiss Federal Institute of Technology Zürich, Rüschlikon, Switzerland (MZ); and *Box 801416, Health Sciences Center, University of Virginia, Charlottesville, VA 22908 USA (JTD) (e-mail: [email protected])
1
2
3
4 5
Hetzel BS. Iodine deficiency disorders (IDD) and their eradication. Lancet 1983; 2: 1126–29. ICCIDD/UNICEF/WHO. Assessment of iodine deficiency disorders and monitoring their elimination. Geneva: WHO, 2001. Anon. West and Central Europe assesses its iodine nutrition. IDD Newsletter. November, 2002: 53–56. Delange F. Iodine deficiency in Europe. Thyroid Int 2002; 5: 3–18. Vitti P, Rago T, Aghini-Lombardi F, Pinchera A. Iodine deficiency disorders in Europe. Public Health Nutr 2001; 4: 529–35.
THE LANCET • Vol 361 • April 5, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
original curvature, and myopia returns. Furthermore, some corneae, even after minor surgery is done and the cornea healthy before surgery, become conical (a condition called keratoconus), which if sufficiently progressive can be repaired only by corneal transplantation. No one knows the rate of risk or the timescale of this serious complication. No warnings are carried in advertisements and almost all treatments are bilateral, so patients are unable to assess the effect of surgery on one eye, before surgery on the second is undertaken. On their website, the US Food and Drug Administration (http://www.fda. gov) note that LASIK eye surgery is an option for risk takers. The time has come to issue health warnings. William Jory 21B Devonshire Place, London W1G 6HZ, UK (e-mail: [email protected]) 1
2
3
4
5
Kriegerowski M. Photorefractive keratectomy impairs night driving ability. ASCRS Symposium. Seattle: June, 1996. Lohmann C. Low contrast after LASIK. Symposium of ESCRS. Brussels: September, 2000. Casson E, Racette L. Vision standards for driving in Canada and the United States. Can J Ophthalmol 2000; 35: 192–203. Coombes B. Contrast sensitivity after PRK and LASIK. Refractive Surgery Symposium. London: March 16, 2001. Nagy Z, Munkacs, G, Krueger R. Changes in mesopic vision after photorefractive keratectomy for myopia. J Refract Surg 2002; 18: 249–52.
Europe is iodine deficient Sir—Iodine deficiency causes mental defects, goitre, reproductive damage, childhood mortality, and hypothyroidism and hyperthyroidism,1 all of which can be prevented by iodine supplementation. Although the adverse effects of iodine deficiency disorders on health and socioeconomic development are well known, they persist as a public-health problem, with 2·2 billion people at risk worldwide.2 The national representatives from the West and Central European Region of the International Council for Control of Iodine Deficiency Disorders (ICCIDD) met on Sept 7, 2002, in Goteborg, Sweden, and designated 15 countries iodine sufficient, 13 deficient, four likely sufficient, and one likely deficient (panel). Overall, more than 60% of the nearly 600 million people in the region live in countries that harbour iodine deficiency.3–5 National responsibility for iodine nutrition and its prophylaxis is weaker in most European countries than
1226
Iodine nutrition status by country, based on urinary iodine excretion (g/L) Sufficient (⭓100 g/L)
Likely sufficient
Austria Bosnia Bulgaria Croatia Cyprus Czech Republic Finland Macedonia Netherlands Poland Portugal Slovak Republic Serbia Switzerland UK
Iceland Luxembourg Norway Sweden
elsewhere in the world. Awareness of the importance of iodine deficiency can be underestimated in countries `without assessment and monitoring programmes, and unrecognised pockets of deficiency might exist in remote areas. Laws with respect to iodised salt vary widely in Europe, as do the types and amounts of iodine compound used for fortification.3–5 Several actions should be implemented to eradicate iodine deficiency in Europe. Methods for effective monitoring programmes should be standardised. If voluntary use of iodised salt does not result in iodine sufficiency, strong consideration should be given to making supplementation compulsory. The high costs of iodised salt in some countries, together with low public awareness of its importance, are causes of poor acceptance by consumers, and should be corrected. ICCIDD and its partners can help countries achieve iodine sufficiency by: providing models of successful legislation already in place in other countries (such as Austria); assisting the formation of national coalitions to address iodine nutrition; offering guidelines for Europe-wide standardised programmes for monitoring both iodine nutrition and the quality of iodised salt; and recommending a uniform content of iodine for salt fortification. Many of these issues should be addressed together with WHO and UNICEF through the European Union and in cooperation with groups such as the European Thyroid Association, national endocrine societies, and the European Salt Producers Association. Countries without a national committee for iodine nutrition should be encouraged to form one that includes representatives from the national
Deficient (<100 g/L) Belgium Denmark France Germany Greece Hungary Italy Ireland Montenegro Romania Slovenia Spain Turkey
Likely deficient Albania
health authority, nutritionists, endocrinologists, paediatricians, epidemiologists, and salt producers. More than half of the population in Western and Central Europe is at risk of iodine deficiency, and most nations have weak or non-existent governmental programmes to address this problem. Consequently, much of the responsibility is shouldered by others, especially thyroidologists, the health sector, academic institutions, and the salt industry. National coalitions of these groups can and should play a major part in achieving and sustaining optimum iodine nutrition in the continent. We find it remarkable that Europe donates substantial funds towards the elimination of iodine deficiency in the developing world, but has not yet corrected its own. All authors are officials of the ICCIDD.
Paolo Vitti, Francois Delange, Aldo Pinchera, Michael Zimmermann, *John T Dunn Instituto di Endocrinologia, Tirrenia-Pisa, Italy (PV); Avenue de la Fauconnerie 153, 1170 Brussels, Belgium (FD); Department of Endocrinology, University of Pisa, Pisa (AP); Laboratory for Human Nutrition, Swiss Federal Institute of Technology Zürich, Rüschlikon, Switzerland (MZ); and *Box 801416, Health Sciences Center, University of Virginia, Charlottesville, VA 22908 USA (JTD) (e-mail: [email protected])
1
2
3
4 5
Hetzel BS. Iodine deficiency disorders (IDD) and their eradication. Lancet 1983; 2: 1126–29. ICCIDD/UNICEF/WHO. Assessment of iodine deficiency disorders and monitoring their elimination. Geneva: WHO, 2001. Anon. West and Central Europe assesses its iodine nutrition. IDD Newsletter. November, 2002: 53–56. Delange F. Iodine deficiency in Europe. Thyroid Int 2002; 5: 3–18. Vitti P, Rago T, Aghini-Lombardi F, Pinchera A. Iodine deficiency disorders in Europe. Public Health Nutr 2001; 4: 529–35.
THE LANCET • Vol 361 • April 5, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.