Since 1990, many countries world-wide implemented salt iodisation programs in an effort to<p>tackle iodine deficiency. It was however only during the last few years that an effort was<p>undertaken in order to eliminate iodine deficiency as a public health problem in Belgium. In autumn 1998, a nation-wide study among children clearly showed mild iodine deficiency in<p>Belgium, but no action was taken before 2009. It was only in the framework of the first<p>National Nutrition and Health Plan 2005-2010 that iodine deficiency was formally recognized<p>as a public health problem. An agreement between the Ministry of Health and the bakery<p>sector in April 2009 aimed to encourage and increase the use of iodised salt in the<p>production of bread. A selective and progressive approach was used in order to keep control<p>and to avoid a too rapid increase of iodine intake or an excessive iodine intake among the<p>population. It was calculated that the net yearly savings after installation of such a program<p>amount to at least 14 million Euros a year.<p>A recent national survey among school-aged children in autumn 2010 showed a clear and<p>significant improvement in iodine status compared to more than 10 years ago, suggesting<p>iodine sufficiency among school-aged children. The median urinary iodine concentration was<p>however at the lower end of the optimal range and seasonal effects were not taken into<p>account. The improvement was at least partly linked to the increasing use of iodised salt in<p>the bakery industry. However, some further silent iodine prophylaxis might also have<p>occurred, due to changing dietary habits (milk and fish consumption). Pregnant women and<p>women of child-bearing age in Belgium were found to still suffer from mild iodine deficiency<p>according to the current recommendations. This is at least partly linked to their lower<p>consumption of milk and dairy drinks compared to children and due to the higher iodine<p>requirements during pregnancy. Although the use of iodine-containing supplements among<p>pregnant women was found to be quite high in Belgium compared to other European<p>countries, because of the low iodine status among women of child-bearing age, women<p>became pregnant with a suboptimal iodine status.<p>In view of these findings, a further increase in the use of iodised instead of non-iodised<p>household salt and iodised salt by the bakers is recommended. In addition, one should put<p>efforts in increasing awareness among the public and among health professionals with<p>regard to iodine-rich food sources and with regard to the use of iodine-containing<p>supplements starting before conception and continuing during lactation.<p>In order to further improve iodine status in Belgium and sustain an optimal iodine status<p>over time, a legal framework is necessary. Mandatory fortification of all household salt and<p>bread is recommended, while non-iodised alternatives could still be offered upon specific<p>request. A rigorous monitoring program is indispensable, including vulnerable groups such as<p>pregnant and lactating women and infants. In addition, sustainability is a key issue as iodine<p>deficiency re-emerged in several industrial countries due to lack of interest, regulations and<p>monitoring. Political willing, salt reduction measures, changes in dietary habits among the<p>population and changes in industrial practices all may affect iodine status in Belgium in the<p>future. Therefore the strategy of controlling iodine deficiency needs to be directed and<p>monitored by a Belgian Scientific Committee for the Control of iodine deficiency disorders. / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished