Eduardo A. Pretell Regional Coordinador for America, ICCIDD Improving Public Health Through the Optimal Intake of Iodine and Sodium Washington DC, PAHO; March 31, April 1, 2011 Plans of ICCIDD for LAC and participation of IRLI Network 1

ITS POTENTIAL TO SECURE THE SUSTAINED ELIMINATION OF IDD WHILE REDUCING THE CONSUMPTION OF SALT TO PREVENT CVD IODIZED SALT IN LATIN AMERICAN COUNTRIES What do we have in favor ? What is needed to be worked our for ? 2

North America Mexico Central America Belize Costa Rica Salvador Guatemala Honduras Nicaragua Panama The Caribbean Cuba Dominican Rep. Haiti South America Argentina Bolivia Brazil Chile Colombia Guyana Ecuador Paraguay Peru Uruguay Venezuela Official IDD Control Program Yes No Yes ? No Yes No Yes Iodization level (ppm) Coverage % 100 ? ? ? ? 3

Advanced technology (large scale producers) Rudimentary technology (small/median scale producers) > 70 % 100 % Argentina (?) Panama Bolivia Brasil Costa Rica Colombia Cuba Chile El Salvador Ecuador Guatemala Mexico Honduras Paraguay Nicaragua Peru Dominican Rep Uruguay Venezuela Production of iodized salt 4

GUATEMALA (small scale producerss) Quality of iodized salt Iodization level Production plantsRetail ppm43.5 % > 15 ppm64 % 5

Quality control at retail LargeMedianSmall > 15ppm96 %90 %54 % MEXICO Production of iodized salt Scale producers LargeMedianSmall 83 %12 %5 % 6

Data collected more than 5 years ago 7

International Resource Laboratories for Iodine (IRLI) Networ k Resource laboratory for Latin America: Laboratory of Endocrinology, High Altitude Research Institute, Cayetano Heredia Peruvian University, Lima, Peru ( IRLI Harmonization Workshop in Cape Town, South Africa, Nov. 2002) Main activities: 1.Quality assurance of laboratories for urinary iodine. 2.Technical support to improve their capacity for diagnosis and monitoring 3.Processing urine samples (surveys, research), as requested by countries 8

Accomplishments Starting point: 20 laboratories were recorded: only 12 operating with different methods, 1-2 times/year. A quality control disclosed that only 2/3 were OK By 2006 the number of registered laboratories increased up to Technical support provided to laboratories in Argentine, Bolivia, Brazil, Chile, Costa Rica, Cuba, El Salvador, Mexico, Panama, Paraguay, and Uruguay. 2.Training of personnel and support to set up their own labs: 6 professionals from Argentina, Brazil, Cuba, and Mexico. 3.Processing of urine samples from Bolivia, Brazil, Ecuador, Haiti, and Peru. 4.Interlaboratories Assay was run from 2003 to 2006 (interrupted because of lack of funds). In the last run 12 out of 21 labs sent back their results. showing a significant progress. 9

LIST OF LABORATORIES ACTUALLY PROCESSING IODINE IN URINE 1. Centro Nacional de Investigaciones Nutricionales. Salta, Argentina 2. Instituto Nacional de Laboratorios de Salud. La Paz, Bolivia 3. Centro de Investigación y Desarrollo de Tecnología de Alimentos. Santa Cruz, Bolivia 4. Instituto de Nutrición y Tecnología de los Alimentos, Univ. de Chile. Santiago, Chile 5. Iinstituto Nacional de Salud. Bogotá,Colombia 6. Inst. Costarricense Nutr & Enseñanza Nutr y Salud. MOH. San José, Costa Rica 7. Instituto de Nutrición e Higiene de los Alimentos, MOH. La Habana, Cuba 8. Laboratorio de Yodurias. MOH. Quito, Ecuador 9. Laboratorio de Bioquímica. INCAP. Guatemala, Guatemala 10.Lab Central de Referencia de Estudios en Salud Pública. Panamá 11. Instituto Nacional de Alimentación y Nutrición. Asunción, Paraguay 12. Laboratorio de Micronutrientes. Fac Ciencias y Filosofía, UPCH. Lima, Perú 13. Centro Nacional de Alimentación y Nutrición, MOH. Lima, Perú 14. Fac. Química. Univ. Rep. Oriental del Uruguay. Montevideo, Uruguay 15. Dep. Bioquímica, Universidad de los Andes. Mérida, Venezuela 10

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Plans of ICCIDD Mainly pursuing of: 1. Improvement of the salt industry 2. Implementation of effective monitoring systems, and reporting 3. Sustained comunication and education 4. Regional LAC meeting, August 1-2, Lima, Peru, to address these subjects. The agenda includes the following: - Discussion of the IDD control programs’ situation in each country - Discussion of the IDD control programs’ situation in each country - How to improve the capacity and responsibility of the salt industry - How to improve the capacity and responsibility of the salt industry - Importance of optimal iodine nutrition in early life - Importance of optimal iodine nutrition in early life - Implementation of WHO recommendations: - Implementation of WHO recommendations: a) Securing the elimination of IDD by USI strategy a) Securing the elimination of IDD by USI strategy b) Reduction of salt consumption (sodium) to prevent CVD b) Reduction of salt consumption (sodium) to prevent CVD - Current and future role of Agencies and NGOs - Current and future role of Agencies and NGOs 12

The posibility of starting pilot trials to reduce dietary salt consumption, without risking optimal iodine intake, could be considered in one or more countries where programs for the control of IDD are well implemented. Reaching the above objectives, will facilitate to start implementing a program towards an optimal sodium intake. For this task, the recommended colaborating/integrating/coordinating work of stakeholders, including ICCIDD, is needed to be implemented on the field. The ICCIDD is a network of voluntary experts strongly commited to reach the goal of IDD elimination. In LAC we have focal points in almost all the countries. ICCIDD is the only organization specifically dedicated to this objective, mainly through advocacy and scientific and technical assistance. 13