title: Fortification of bread with iodized salt corrected iodine deficiency in school-aged children, but not in their mothers: a national cross-sectional survey in Belgium.
abstract: BACKGROUND
  In the years 1985-1998, it was noted that mild iodine deficiency (MID) was a public health problem in Belgium. Therefore, an agreement was signed in 2009 between the bakery sector and the Ministry of Health, to fortify bread with iodized salt. We tested the hypothesis that the iodine status of Belgian children improved after the introduction of bread fortified with iodized salt. Since the dietary habits of children and adults may differ, we also investigated whether the median urinary iodine concentration (UIC) among the children in this study reflected the iodine status of their mothers.
  
  
  METHODS
  The study was cross-sectional. In a van, equipped with an ultrasound device, the thyroid volumes (Tvol) of children were measured and household salt samples and urine samples were collected from the children and their mothers. From across Belgium, 60 schools were selected and 1541 children participated in the study.
  
  
  RESULTS
  The median UIC in children was 113.1 and 84.4 μg/L among their mothers. The median UIC among children was substantially greater compared to more than 10 years ago (80 μg/L; p<0.001). The median UIC in school-aged children was lower in Wallonia than in Flanders (p<0.001) and was higher in boys than in girls (p<0.001). The percentage of children with goiter was 7.2%. Of the 904 salt samples received, 63.2% did not contain iodine.
  
  
  CONCLUSIONS
  Fortification of bread with iodized salt corrected iodine deficiency in Belgian children, but not in their mothers. To provide these women with an adequate iodine intake, the use of both iodized salt in bread and iodized instead of noniodized household salt needs to increase. Our findings suggest that the median UIC in children may not be an adequate surrogate of adults' iodine status. Therefore, monitoring iodine status should not be limited to children, but should be extended to women of child-bearing age.
authors.affiliation: Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium. stefanie.vandevijvere@wiv-isp.be
authors.forename: Stefanie
authors.initials: S
authors.lastname: Vandevijvere
authors.forename: Ahmed Bensouda
authors.initials: AB
authors.lastname: Mourri
authors.forename: Sihame
authors.initials: S
authors.lastname: Amsalkhir
authors.forename: Freddy
authors.initials: F
authors.lastname: Avni
authors.forename: Herman
authors.initials: H
authors.lastname: Van Oyen
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Moreno-Reyes
mesh_terms: D000293:Adolescent; D000328:Adult; D001530:Belgium / Q000453:epidemiology; D001939:Bread; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005527:Food, Fortified; D006042:Goiter / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D007455:Iodine / Q000008:administration & dosage / Q000172:deficiency* / Q000652:urine; D008297:Male; D009035:Mothers; D015995:Prevalence; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*; D014463:Ultrasonography
chemical_list: D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007455:Iodine