title: Processed foods as an integral part of universal salt iodization programs: a review of global experience and analyses of Bangladesh and Pakistan.
abstract: BACKGROUND
  Despite the reference to salt for food processing in the original definition of universal salt iodization (USI), national USI programs often do not explicitly address food industry salt. This may affect program impact and sustainability, given the increasing consumption of processed foods in developing countries.
  
  
  OBJECTIVE
  To review experience of the use of iodized salt in the food industry globally, and analyze the market context in Bangladesh and Pakistan to test whether this experience may be applicable to inform improved national USI programming in developing countries.
  
  
  METHODS
  A review of relevant international experience was undertaken. In Bangladesh and Pakistan, local rural market surveys were carried out. In Bangladesh, structured face-to-face interviews with bakers and indepth interviews with processed food wholesalers and retailers were conducted. In Pakistan, face-to-face structured interviews were conducted with food retailers and food labels were checked.
  
  
  RESULTS
  Experience from industrialized countries reveals impact resulting from the use of iodized salt in the food industry. In Bangladesh and Pakistan, bread, biscuits, and snacks containing salt are increasingly available in rural areas. In Bangladesh, the majority of bakers surveyed claimed to use iodized salt. In Pakistan, 6 of 362 unique product labels listed iodized salt.
  
  
  CONCLUSIONS
  Successful experience from developed countries needs to be adapted to the developing country context. The increasing availability of processed foods in rural Bangladesh and Pakistan provides an opportunity to increase iodine intake. However, the impact of this intervention remains to be quantified. To develop better national USI programs, further data are required on processed food consumption across population groups, iodine contents of food products, and the contribution of processed foods to iodine nutrition.
authors: Global Alliance for Improved Nutrition (GAIN), P.O. Box 55, Geneva 1211, Switzerland. rspohrer@gainhealth.org
authors: Rebecca
authors: R
authors: Spohrer
authors: Greg S
authors: GS
authors: Garrett
authors: Arnold
authors: A
authors: Timmer
authors: Rajan
authors: R
authors: Sankar
authors: Basanta
authors: B
authors: Kar
authors: Faiz
authors: F
authors: Rasool
authors: Lorenzo
authors: L
authors: Locatelli-Rossi
mesh_terms: D001459:Bangladesh; D001939:Bread / Q000032:analysis; D019049:Developed Countries; D003906:Developing Countries; D004034:Diet Surveys; D057140:Fast Foods; D005511:Food Handling; D005527:Food, Fortified; D006801:Humans; D007455:Iodine / Q000008:administration & dosage* / Q000032:analysis*; D010154:Pakistan; D062410:Snacks; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage* / Q000032:analysis*
chemical_list: D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007455:Iodine