Increasing the iodine concentration in the Swiss iodized salt program markedly improved iodine status in pregnant women and children:: a 5-y prospective national study

Background: Many industrialized countries struggle to maintain adequate iodine intake because of changes in dietary habits and the food supply. In Switzerland, because of declining iodine intakes in children and pregnant women, the iodine concentration in table salt was increased from 15 to 20 mg/kg. Objective: We evaluated Swiss iodine nutrition after the 1999 increase in the salt iodine concentration. Design: In 1999 and 2004, a 3-stage probability proportionate-to-size cluster sampling was done to obtain a representative national sample of primary schoolchildren and pregnant women. Urine and household salt were collected for iodine measurement. The frequency of elevated thyrotropin concentrations found in the newborn screening program was evaluated before and after the increase. Results: In 1999, median urinary iodine (UI) concentrations among children (n = 610) and pregnant women (n = 511) were 115 mu g/L (range: 5-413 mu g/L and 138 mu g/L (range: 5-1881 mu g/L), respectively, which indicated marginal iodine status. In 2004, median UI concentrations among children (n = 386) and pregnant women (n = 279) were 141 mu g/L (range: 0-516 mu g/L) and 249 mu g/L (range: 8-995 mu g/L), respectively (P < 0.01). Newborn thyrotropin concentrations > 5 mU/L decreased from 2.9% in 1992-1998 (n 259 035) to 1.7% in 1999-2004 (n = 218 665) (P < 0.0001). Conclusions: A 25% increase in iodine concentration in iodized table salt markedly improved iodine status in Switzerland, which showed the value of monitoring and adjusting iodine concentrations in national salt programs. The frequency of newborn thyrotropin concentrations > 5 mU/L appears to be a sensitive indicator of iodine nutrition during pregnancy.