Estimation of population iodine intake from iodized salt consumed through bouillon seasoning in Senegal

Transcription

1 Ann. N.Y. Acad. Sci. ISSN ANNALS OF THE NEW YORK ACADEMY OF SCIENCES Issue: Fortification of Condiments and Seasonings with Vitamins and Minerals in Public Health I Estimation of population iodine from iodized salt consumed through bouillon seasoning in Senegal Rebecca Spohrer, 1 Jacqueline Knowles, 1 Vincent Jallier, 1 Banda Ndiaye, 2 Caroline Indorf, 3 Philippe Guinot, 1 and Roland Kupka 4 1 Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland. 2 Micronutrient Initiative, Dakar, Senegal. 3 Intertek Food Services, Bremen, Germany. 4 United Nations Children s Fund (UNICEF), New York Address for correspondence: Rebecca Spohrer, Global Alliance for Improved Nutrition, 1st Floor Churchill House, Old Street, London EC1V 9BW, United Kingdom. rspohrer@gainhealth.org Universal salt iodization (USI) is the main global strategy to eliminate iodine deficiency. Regulation of USI programs often omits salt used in processed foods, despite their increasing contribution to salt. In West Africa, bouillon seasoning is a widely consumed source of salt and is therefore relevant to USI effectiveness. To develop program guidance around iodine in bouillon, iodine retention in 13 bouillon brands commercially available in Senegal was measured over 6 months. Iodine content was measured in broth using various water volumes and cooking times, as well as in rice cooked in the broth. Average iodine loss in bouillon over 6 months in 95% humidity at Cwas 4.5% (13.6% for cubes and 0.8% for powder sachets). Iodine was retained in broth with cooking times of up to an hour and in rice cooked in broth. Modeling of contribution to iodine revealed that bouillon is an important source of dietary iodine in Senegal. Results may inform salt iodization standards and regulation in Senegal and countries with similar bouillon consumption levels. Keywords: iodine deficiency disorders; universal salt iodization; bouillon seasoning; optimal iodine nutrition; condiment fortification Introduction Global household coverage of iodized salt has improved remarkably since 1990, when the United Nations World Summit for Children established the goal of eliminating iodine deficiency. In 2013, an estimated 75% of households had access to adequately iodized salt. 1 Household access to adequately iodized salt (defined as containing ppm iodine) is one of the main criteria used to track the progress of universal salt iodization (USI) programs. The goal of USI is to achieve access to adequately iodized salt for 90% of households in acountry. 2 While USI is the primary public health strategy to ensure sufficient consumption of iodine, iodine adequacy indicated by a median urinary iodine concentration (UIC) of 100 g/l in children and nonpregnant women has been observed in some populations despite <90% household coverage of iodized salt. This may be explained by assuming an of iodine from alternative sources to iodized household salt, such as iodine in ground water or seaweed or from food that contains iodine from a process other than salt iodization, such as milk produced by cattle with iodine-enriched feed. 3 7 A survey in Cambodia found the median UIC of school children to be 236 g/l in 2011, while household coverage was 70%, which may be due to the consumption of fish sauce containing iodine. 8 In the Philippines, the median UIC among 6- to 12-year-old children in 2008 was 132 g/l, despite adequately iodized salt coverage being only 25%; 9 in Indonesia, the 2007 median UIC among school-age children was 229 g/l, while adequately iodized salt coverage was 63%. 10,11 In addition to potential alternative iodine sources, in these cases, iodine may also have been delivered via iodized salt used (hidden) in processed foods and condiments. The World Health Organization (WHO) recognized and referred to this in its 2014 guideline on salt doi: /nyas Ann. N.Y. Acad. Sci (2015) C 2015 New York Academy of Sciences. 43

2 Bouillon contribution to iodine in Senegal Spohrer et al. iodization: countries that focus on iodization of table salt alone may not achieve optimal iodine nutrition of their population 12 and it is necessary to include iodized salt in processed foods. 13 Across West Africa, seasoning products in the form of bouillon cubes and powders are increasingly popular cooking ingredients among all socioeconomic groups. These products can either be used in place of or in addition to regular salt in recipes. In Cameroon, 96% of households use stock cubes at least once a week, with an average consumption frequency of 14 times per week. 14 These products are composed of 50 70% salt alongside dehydrated stock, solid vegetable fat, spices, and flavor enhancers, usually in the form of monosodium glutamate (MSG). Typical packaging refers to amount of sodium per cube, but does not indicate whether that sodium comes from MSG or salt. MSG content is also typically not quantified on the label. Therefore, without accessing the product recipe or conducting laboratory analysis, it is impossible to calculate the potential amount of iodine from iodized salt contained per cube solely from the amount of sodium. Labeling also sometimes indicates the amount of recommended dietary allowance (RDA) of iodine delivered; however, it does not indicate whether this is from iodized salt or direct iodine fortification. Little is known about the type of salt or iodine content used in these bouillon products, as this is neither monitored nor enforced. In Senegal, a 2010 national iodine survey showed that household coverage of iodized salt is 56%. Forty-eightpercentofhouseholdsaltisadequately iodized. The mean iodine level is 22.2 ppm, and the median level is 14.8 ppm. Median UICs for children 6 12 years and for nonpregnant women aged years were 104 g/l and 92 g/l, respectively. 15 The domestic salt production in Senegal is divided between one large and one medium industrial salt company, which mainly export their salt, and multiple artisanal salt producers. According to program estimates, about half of the artisanal salt in Senegal is iodized. Women also tend to wash their salt before cooking, which if iodized using traditional methods (knapsack sprayers) may result in loss of iodine. Meanwhile, the estimated daily consumption of bouillon stock cubes per person was estimated to be 8.6 g in urban and 4.3 g in rural areas. 15 The bouillon industry in Senegal is a significant channel for dietary salt to consumers, and is a relatively concentrated and formalized sector, lending itself to regulatory monitoring. The Senegalese national decree on salt iodization states that iodization of all salt, regardless of its destination or origin, is mandatory at the level of ppm iodine in the form of potassium iodate (KIO 3 ) at the production, importation, and exportation levels, and at ppm at the retail distribution level. Therefore, the salt used in the bouillon seasoning products examined in this study should contain iodine at levels in line with the national legislation. However, there is no indication that the compulsory use of iodized salt by the food industry is being monitored and enforced by government authorities. If bouillon producers demanded and used adequately iodized salt from producers, this could improve iodine nutrition in the population of Senegal. The use and regulation of iodized salt in the food industry is an emerging issue. With the emergence of diet-related chronic diseases in West Africa, there have been calls to limit the consumption of dietary sodium from all sources, including bouillon seasoning products. 16 Such calls are in line with current WHO recommendations to limit sodium to <2 g/day (5 g salt/day) in adults (and equivalent amounts in children after differences in energy s are taken into account). 17 The high salt content and consumption of seasonings and condiments highlights a need for new USI program guidance to set iodine levels appropriate to overall not just household salt and related monitoring indicators to better assess and optimize iodized salt from all sources. In this paper, we use Senegal as a case study to estimate potential iodine from bouillon seasoning. We present data on iodine retention in uncooked bouillon seasoning over time, as well as for bouillon cooked as a broth and for rice cooked in bouillon broth. We then combine these data with available information on bouillon consumption in Senegal to estimate current likely s and potential if all salt used in bouillon was adequately iodized. Our analysis does not representatively establish the contribution of all bouillon to iodine status in Senegal, but only demonstrates iodine presence and retention in selected brands of bouillon for consideration. Our indicative findings are intended to advocate for and inform program guidance for incorporating bouillon seasoning and other food products into USI regulation, monitoring, and enforcement activities. 44 Ann. N.Y. Acad. Sci (2015) C 2015 New York Academy of Sciences.

3 Spohrer et al. Bouillon contribution to iodine in Senegal Methods Shelf life test Thirteen different brands of bouillon cubes and powder sachets produced by five manufacturers in Senegal were collected from retail shelves in Dakar, Senegal, from November to December, The purpose of collecting samples from retail shelves and not directly from producers was to avoid biasing the results. These 13 separate product packages were sent to Intertek in Bremen, Germany, for testing. Each of the 13 products was tested in triplicate for sodium and iodine using an inductively coupled plasma mass spectrometry (ICP- MS) instrument (X-Series II, Thermo Fisher Scientific). MSG was determined by enzymatic analysis of glutamic acid and a subsequent calculation from glutamic acid to MSG. An enzymatic reaction was conducted using an r-biopharm enzymatic kit. The converted product was then measured using an ultraviolet (UV)/visible (VIS) spectrophotometer (Evolution 300, Thermo). Samples were stored for over 6 months in 95% humidity at C conditions to emulate real storage conditions in Senegalese households. a At each interval, three aliquots were taken from a mixed sample made from three sachets. These aliquots were prepared and measured individually at 0, 1, 3, and 6 months for a total of 156 sachets tested. Moisture was measured by drying the samples for 2 h at 103 C in a drying cupboard and weighing the sample before and after drying. The 6-month shelf life test took place from April 2013 to September Unless otherwise stated, all data presented are expressed as related to dry matter. Cooking studies Bouillon cube selection. Results from the shelf life test were analyzed in order to select which bouillon cube products would be used during the cooking study. The intended inclusion criterion for the cooking study was that iodine content at 0 months needed to be over 10 ppm. Out of the 13 separate brands, five products fit the criterion, which were produced by three manufacturers. However, a In Senegal, the temperature varies between 18 and 31 C, with an average high during the warm season of above 30 C. Relative humidity ranges from 42% to 95%. 1 year later when the second round of samples was ready to be collected for the cooking study, one of the three manufacturers products was no longer available. The manufacturer selected as an alternative had an iodine content lower than 10 ppm in the shelf life tests. One sample was produced by each manufacturer (labeled in this report as samples F, J, and M). Sample M was in 10-g cube form, and samples F and J were in 15-g powder sachet form. Retention of iodine in bouillon during preparation as a broth. Cooking time and proportion of bouillon to water in West African recipes vary widely depending on the tastes, styles, and preferences of individual cooks; therefore, various concentrations of bouillon in water were tested. In order to evaluate iodine retention in broth cooked with bouillon seasoning, 20 g of one sample of bouillon seasoning (sample J) was mixed with water volumes of 0.5, 1.5, and 3 L for cooking times of 0, 15, 60, and 180 min in a traditional pot with the lid on and lid off. Tests were performed in triplicate for each bouillon type and each cooking scenario, for a total of 189 measurements. Iodine content was measured in the final broth using ICP-MS. Analysis of the results of the first sample revealed that the iodine retention was not affected by the volume of water used or the cooking time. Therefore, for samples F and M, the method was revised to test 20 g of bouillon in only one quantity of water (1.5 L) and in fewer cooking time scenarios in order to reduce redundancy. All samples were tested in the same pot adequately cleaned between each test in order to exclude any effects of different pots on the results. New samples of the three selected bouillon brands and typical white rice were purchased in a local market in Dakar and sent to Intertek in November 2013 to conduct the broth and rice cooking tests. The iodine content of the broth after cooking was adjusted for loss of water volume (iodine content (mg/kg) = (measured iodine content of the broth after cooking/starting weight of the broth) (weightofthebrothafter cooking)). Absorption of iodine in rice cooked with bouillon broth. For sample J, 430 g of local rice was cooked in 1 L of water and 20 g of bouillon until all the water was absorbed or evaporated. For the second and third bouillon test series (samples Ann. N.Y. Acad. Sci (2015) C 2015 New York Academy of Sciences. 45

4 Bouillon contribution to iodine in Senegal Spohrer et al. F and M), 100 g of rice, 230 ml of water, and 4.6 g of bouillon were used to maintain the ratio (approximately 0.43 parts rice to 0.02 parts bouillon to one part water), and this was cooked until the water was fully absorbed or evaporated. Iodine content was measured in the cooked rice for each sample using an ICP-MS instrument (X-Series II, Thermo). The process was repeated in triplicate for each of three samples for each brand, or 27 measurements in total. Modeling the potential contribution of bouillon to recommended daily iodine. As all the products included in this study displayed quantitative information about sodium content in the nutrition information but did not specify how much sodium came from salt versus from MSG, both sodium and MSG content needed to be measured, along with iodine content, to calculate the approximate iodization level of the salt used in the bouillon. The salt content of each type of bouillon was calculated based on the total sodium and MSG content as follows: Dry matter = 100 moisture content MSG related to dry matter = MSG/dry matter 100 Sodium (Na) related to dry matter = sodium/dry matter 100 Sodium (Na) from MSG = MSG related to dry matter Sodium related to dry matter from salt (NaCl) = sodium related to dry matter sodium from MSG Sodium related to dry matter from salt (g) = sodium related to dry matter from salt sample weight expressed as dry matter (g) Salt content related to dry matter (g) = sodium related to dry matter from salt 2.54 The iodine content (mg/kg or ppm) of salt used to produce the bouillon was estimated from the measured iodine content (mg/kg) and the above calculation of salt content. This calculation assumes that the only source of iodine in the bouillon was iodized salt. The potential contribution of iodine (assumed to be from iodized salt) in bouillon to the recommended adequate daily of iodine of 150 g was based on the measured iodine content for each type of bouillon together with the estimated daily bouillon consumption from the 2010 survey (8.6 g/day in urban areas and 4.3 g/day in rural areas). Results The sodium (Na) content of the samples ranged from 20.8% to 26.1% by weight related to dry matter, of which % came from salt (NaCl) and the remainder from MSG. The iodine content of the products was g (Table 1). This corresponds to an estimation of iodine in the salt used in the production of the products of mg/kg. Shelf life test Moisture content over time. Of the 13 brands, the average percent moisture at baseline was 3.5% (SD 1.8%). After 1 month in storage at 95% humidity and a temperature of C, the average moisture was 5.5% (SD 1.5%). The average moisture increased over the period of storage to 8.1% (SD 1.8%) after 3 months and to 9.7% (SD 2.3%) after 6 months (Table 2). On average, the bouillon cubes (n = 4) had a lower moisture content than the powder sachets (n = 9); however, bouillon cubes also experienced a greater average change in moisture than powder sachets (Table 2). Bouillon cube average moisture content at baseline was 2.0% and increased to 7.9% over 6 months. The average moisture content for powder sachets was 4.2%, and this increased to 10.5% over 6 months. The sample with the lowest moisture content at baseline was a bouillon cube with a moisture content of 1.2%. This increased to 8.1% after 6 months, while the sample with the highest baseline moisture content of 7.6% was a powder sachet, which increased to 8.8% in the same time frame (Table 2). Iodine content over time. Of the 13 brands, the average iodine content related to dry matter at baseline was 8.7 ppm (SD 5.9). After 1 month of storage, it was 9.7 ppm (SD 6.1); at 3 months, 9.5 ppm (SD 6.5); and at 6 months, it was 8.3 ppm (SD 6.1) (Table 3). The average loss of iodine for all 13 samples during 6 months in storage was 4.5%, with a range of 24.2% to 46.2%. Losses were lower in powder sachets than in bouillon cubes. Average losses were 13.6% for bouillon cubes and 0.8% for powder sachets (Table 3). The sample containing the highest iodine level (20.0 ppm at baseline) was a bouillon cube, which also had the lowest moisture content 46 Ann. N.Y. Acad. Sci (2015) C 2015 New York Academy of Sciences.

5 Spohrer et al. Bouillon contribution to iodine in Senegal Table 1. Percentbyweightsodium,%byweightMSG,sodiumfromsalt,saltcontent,andiodinecontentofthe 13 bouillon brands related to dry matter at start of shelf life test and potential contribution to daily iodine in urban and rural settings, based on 2010 consumption estimates Sample Sample weight (g) % Sodium a %MSG a Sodium from salt (g) Salt in sachet (g) Iodine content ( g) Iodine content of salt in sachet (mg/kg) b Potential daily iodine from bouillon: urban ( g) Potential expressed as %ofrecommended (150 g): urban Potential daily iodine from bouillon: rural ( g) Potential expressed as %ofrecommended (150 g) rural: A (0.3) 9.5 (0.2) B (0.2) 0.7 (0.1) C (0.1) 10.7 (0.2) D (0.3) 7.7 (0.1) E (0.1) 4.7 (0.1) F (0.2) 4.1 (0.1) G (0.5) 3.6 (0.1) H (0.1) 12.9 (0.1) I (0.7) 13.1 (0.1) J (0.1) 6.2 (0.1) K (0.3) 9.4 (0.1) L (0.7) 9.8 (0.3) M (0.7) 16.4 (0.2) a Percent sodium and MSG values are mean (SD). b Assume that all iodine in the sachet comes from salt. at baseline (1.2%). In this brand, iodine losses were 19%. The brand with the lowest iodine level was a powder sachet (1.1 ppm at baseline), which suffered iodine losses of 32%. This sample also had low moisture content at baseline (1.9%). Mean iodine content was slightly higher throughout the 6-month period in powder sachets than in bouillon cubes (Table 3). The largest mean reduction in iodine content took place between 3 and 6 months, which was also the longest time increment measured. Retention of iodine in bouillon during preparation as a broth Fresh samples collected in November 2013 of the brands selected for the cooking study showed different initial iodine concentrations than those collected in November December 2012 for the shelf life study. The initial iodine content in April 2013 for the new samples is shown in Table 4. Results for iodine concentration over time in broth cooked using the three samples are displayed in Figures 1 and 2. These results indicate a higher Table 2. Moisture content changes for 13 brands of bouillon stored at 95% humidity and a temperature of C over 6 months Baseline 1month 3months 6months Difference over 6 months Average % moisture (n = 13) a 3.5 (1.8) 5.5 (1.5) 8.1 (1.7) 9.7 (2.2) 6.2 Bouillon cube average % moisture (n = 4) Powder sachet average % moisture (n = 9) Moisture content for sample with lowest % moisture at 0 months (bouillon cube) Moisture content for sample with highest % moisture at 0 months (powder sachet) a All % moisture values presented are mean (SD). Ann. N.Y. Acad. Sci (2015) C 2015 New York Academy of Sciences. 47

6 Bouillon contribution to iodine in Senegal Spohrer et al. Table 3. Average iodine content related to dry matter of 13 brands of bouillon at baseline and changes over a 6-month period when stored at 95% humidity and a temperature of C Baseline (mg/kg) 1month (mg/kg) 3months (mg/kg) 6months (mg/kg) Loss over 6months Average iodine content (mg/kg) a 8.7 (5.9) 9.7 (6.1) 9.5 (6.5) 8.3 (6.1) 4.5 Average bouillon cube iodine content Average powder sachet iodine content Iodine content for sample with lowest starting iodine sample Iodine content for sample with highest starting iodine sample a All values presented are mean (SD). concentration of iodine when the water volume decreased considerably owing to long cooking times with the lid off, concentrating the iodine in the remaining broth. In order to standardize results in consideration of this volume of water loss, the iodine concentration was adjusted to the precooking volume. The results indicated that almost no iodine was lost from the bouillon after cooking as a broth. Cooking methods, including time, concentration of bouillon to water, and cooking with the lid on or off, have no impact on iodine retention in bouillon broth. Absorption of iodine into rice Iodine was absorbed into rice in all three brands tested. The resulting iodine content measured in the rice cooked in bouillon broth was 0.03 mg/kg in sample F, 0.13 mg/kg in sample J, and 0.41 mg/kg in sample M (Table 4). Modeling the potential contribution of bouillon to recommended daily iodine The iodine content of different types of bouillon ranged from 14 g (in a 12-g cube) to 243 g (in a 15-g cube). Based on the iodine content of the bouillon and an estimated average daily bouillon consumption of 8.6 g in urban areas and 4.3 g in rural areas, it was found that the bouillon included in the study could, on average, have delivered from 6.5% to 114.8% of recommended adequate daily iodine in urban areas and half these amounts in rural areas (Table 1). Ninety to 100 g of dry rice is considered to be a typical single serving. Therefore, one serving of rice cookedusingathirdtoahalfofatypicallysized bouillon sachet or cube, respectively, was sufficient to contribute approximately 2 27% of the recommended adequate daily iodine for an adult (Table 4). Discussion The products selected for this study contained iodine content ranging from 14 to 243 g iodine at baseline, which corresponds to mg/kg iodine in salt used to manufacture the bouillon. Since the iodine content of bouillon was not substantially affected by storage time and virtually unaffected by cooking conditions, this estimated contribution to daily iodine should not change according to these factors. The primary factor influencing the availability of iodine in broth or rice cooked in bouillon is the original iodine content of the salt used in the product; the amount of time spent on the shelf also exhibits a small effect on iodine availability. Iodine retention over time in storage was higher in powder sachets than in bouillon cubes. While the reasons underlying this difference were not explored in this study, we hypothesize that this could be related to the larger increase in moisture content of the cubes during storage and other factors related to the different packaging types, and should be tested further. Iodine remains in bouillon broth independent of cooking time, whether the lid is kept on during cooking, or the bouillon concentration in water. In addition, rice cooked in bouillon broth appears to absorb the majority of iodine originating from the iodized salt in bouillon. In Senegal, iodine content in salt used in bouillon is not regulated at the food-producer level. The wide range of iodine content discovered in the products 48 Ann. N.Y. Acad. Sci (2015) C 2015 New York Academy of Sciences.

7 Spohrer et al. Bouillon contribution to iodine in Senegal Figure 1. Iodine retention in 1.5 L bouillon broth cooked 0 60 min for samples F, J, and M adjusted to precooking volume. reflects this lack of regulation. We learned anecdotally that no producer was fortifying bouillon with iodine directly; therefore, the iodine in the products can be assumed to come solely from use of iodized salt. The second round of sample collection for the cooking trials revealed that iodine concentration is not constant or homogeneous from batch to batch, even within the same brand. The wide variation in iodine content of the different brands and the interpretation of what those levels mean in terms of average iodine illustrate the need for regulation of the level of iodine in salt used in production. USI program managers should engage with bouillon producers to understand their challenges and encourage them to order salt according to the Senegal iodized salt standard, to check the certificate of analysis for salt purchases, and, where feasible, to conduct periodic quality checks to ensure that the iodine content is within the standard range. In order to strengthen enforcement and increase iodine to optimum levels across population groups in Senegal, regulation of iodized salt at the seasoning-producer level may be more feasible than monitoring small-scale iodization facilities. The seasoning industry is more consolidated and formalized, with only a few large-scale producers with wide market reach, lending itself to more feasible and cost-effective monitoring. As the main factor influencing the level of iodine delivered in the bouillon is the level of iodization of the salt used, regulators would not need to test the final product for iodine using ICP-MS, but rather could test the salt used in the product using simple, low-cost, and accurate quantitative methods. There were some limitations to this study. Because the start of the shelf life study was delayed by 4 months from the sample collection in December 2012, the shelf life test actually took place 4 10 months after purchase, rather than 0 6 months later. However, as iodine content during storage was relatively stable, it is unlikely that this delay affected the results. The iodization level of the salt used to manufacture the bouillon samples was not measured, so the initial iodization level of the salt in the bouillon was derived by first calculating the amount of salt in the sample (in grams) and then dividing by the iodine content of the sample. This calculation assumes that all iodine in the sample came from salt, which was confirmed by informal conversations with the bouillon cube manufacturers. The consumption information used to conduct the modeling exercise of bouillon consumption to iodine came from a 2010 survey that used Ann. N.Y. Acad. Sci (2015) C 2015 New York Academy of Sciences. 49

8 Bouillon contribution to iodine in Senegal Spohrer et al. Table 4. Iodine content in rice cooked in bouillon in the ratio of approximately 0.43 parts rice to 0.02 parts bouillon to one part water and potential contribution to daily iodine Sample Initial iodine content in pure precooked bouillon samples mg/kg a Calculated iodine in broth used to cook rice (0.02:1 bouillon:water) mg/kg Measured iodine content in rice cooked in bouillon mg/kg a Iodine consumed through one 100-g portion of rice cooked in bouillon ( g) Equivalent contribution to recommended adequate dietary iodine (150 g) F: powder sachet 1.4 (0.0) (0.0) J: powder sachet 12.2 (0.2) (0.0) M: bouillon cube 24.4 (0.2) (0.0) a Values presented are mean (SD). population-based, average consumption levels only. However, we intend to collaborate with others to apply the findings on iodine retention in bouillon to the outcome of a more comprehensive survey conducted in Senegal in late 2014, and we will model the approximate contribution of iodine from table salt, bouillon, and other sources based on urinary iodine and spot urinary sodium levels. Incorporating the use of iodized salt in bouillon seasoning into USI programs may be contentious owing to the wider context regarding salt iodization andsaltreduction,aswellasconcernsaroundthe consumption of MSG. On the first issue, the importance of aligning salt iodization and salt reduction strategies has been recognized by the WHO. 13 In fact, joint implementation of both strategies may create mutually beneficial synergies. 18 The focus of both programs should therefore be to ensure that salt consumption is limited and that all salt consumed is adequately iodized. Modeling exercises indicate that, as salt falls, the impact on iodine will be highly context and country specific. 19 This emphasizes the importance of careful monitoring of iodine status as salt reduction efforts advance and the need to adjust salt iodine levels if necessary. On the second issue, even though MSG has been used as a flavor enhancer for more than a century and has been classified as generally recognized as safe by the U.S. Food and Drug Administration and Figure 2. Iodine retention in 3 L bouillon broth cooked min sample J adjusted to precooking volume. 50 Ann. N.Y. Acad. Sci (2015) C 2015 New York Academy of Sciences.

9 Spohrer et al. Bouillon contribution to iodine in Senegal similar international bodies, its role in human health remains controversial. Claims of adverse health effects, such as the Chinese restaurant syndrome characterized by headache, throbbing of the head, dizziness, light-headedness, and other self-limiting symptoms, have been shared in the popular press. However, scientific studies on MSG use in food have generally not reported any potential risks. 20 Where quantitative table salt iodine, urinary iodine, and urinary sodium data are available, these can be used at the population level to estimate the proportion of iodine from table salt and other salt sources. For example, urinary iodine levels among the population consuming salt with no iodine can be taken to represent sources of iodine other than table salt. This can be further differentiated by the urinary sodium content: where this is low, iodine may originate from nonsalt sources such as ground water; where urinary sodium is considerable, the iodine could be from iodized salt used in processed foods and condiments. The data obtained can be cross-checked against consumption patterns for the target products (Frits Van der Haar, personal communication, 2013). Inclusion of stronger assessments of the amount and sources of dietary salt and, potentially, iodine, along with measurement of the iodine status among population groups with different consumption habits, will help governments decide on the appropriate level of iodine in both table and food industry salt to maintain optimal iodine nutrition. Conclusions This study showed that iodine is retained in broth and absorbed into rice cooked in broth containing bouillon produced with iodized salt, independent of the cooking method used. Therefore, bouillon is a useful vehicle for the dietary of iodine. In settings where salt iodization is mandatory and well enforced, it is likely that bouillon producers use iodized salt. However, where enforcement of salt producers presents challenges, monitoring of salt used in bouillon production would be an important additional process to assure the population s dietary iodine and to approximate the level. The most feasible way to regulate the use of adequately iodized salt in bouillon is to monitor the bouillon industry s iodized salt orders and the actual iodization levels of the salt supplied. The consumption of condiments, which contribute a large proportion to overall salt across population groups, should be taken into account when developing standards on iodization levels in salt in order to optimize iodine nutrition. Acknowledgments This work was commissioned by the Evidence and Programme Guidance Unit, the Department of Nutrition for Health and Development of the WHO (Geneva, Switzerland), and financial support was provided by the WHO and the Micronutrient Initiative. This manuscript was presented at the WHO consultation Fortification of condiments and seasonings with vitamins and minerals in public health: from proof of concept to scaling up in collaboration with the Micronutrient Initiative and the Sackler Institute for Nutrition Science, convened on August 26 28, 2014, at the New York Academy of Sciences in New York, New York. This paper is being published individually but will be consolidated with other manuscripts as a special issue of Annals of the New York Academy of Sciences, the coordinators of which were Maria Nieves Garcia-Casal, Mireille McLean, Luz Maria De Regil, and Juan Pablo Peña-Rosas. The special issue is the responsibility of the editorial staff of Annals of the New York Academy of Sciences,who delegated to the coordinators preliminary supervision of both technical conformity to the publishing requirements of Annals of the New York Academy of Sciences and general oversight of the scientific merit of each article. The workshop was supported by the WHO, the Micronutrient Initiative, and the Sackler Institute for Nutrition Science at the New York Academy of Sciences. The authors alone are responsible for the views expressed in this paper; they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated or the decisions, policies, or views of the WHO. The opinions expressed in this publication are those of the authors and are not attributable to the sponsors, publisher, or editorial staff of Annals of the New York Academy of Sciences. The authors would like to recognize the organizations that sponsored the authors time: the Global Alliance for Improved Nutrition (GAIN), UNICEF, and the Micronutrient Initiative; and Intertek in Bremen, Germany, who provided quality laboratory analysis. Conflicts of interest The authors declare no conflicts of interest. Ann. N.Y. Acad. Sci (2015) C 2015 New York Academy of Sciences. 51

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