It is understood that a few months ago, the Ministry of Health published the draft of "Iodine Content in Edible Salt", which changed the fortified amount of salt iodine from 20 mg/kg to 60 mg/kg to the average level of iodine content in edible salt of 20 mg/kg to 30 mg/kg, and at the same time gave local governments corresponding autonomy. However, some experts pointed out that this is only a technical adjustment, and the iodized salt policy has not changed fundamentally. It is suggested that the adjustment of iodized salt policy and even the reform of salt industry system should be further strengthened.
In reality, the whole people "take too much iodine"
To Ms. Xu's regret, the new standards and instructions for iodized salt of the Ministry of Health say nothing about residents' consumption rights in non-iodized salt, which means that thyroid patients, including her, must "iodize" whether they need it or not.
15 years ago, in order to solve the iodine deficiency problem of more than 700 million people in China, the state promulgated the Regulations on the Administration of Iodized Salt to eliminate the harm of iodine deficiency, requiring all provinces and cities to add iodized salt except eight high-iodine provinces and cities. Because of the monopoly of salt, the policy of iodized salt was controversial from the beginning, especially the indiscriminate "universal iodization".
According to a report by the Nutrition Society of China, the average daily salt intake of urban residents in China is 1 1g, while that of rural residents is 17g. According to the calculation that most iodized salt in the market contains 20 to 50 micrograms of iodine per gram, the daily iodine intake of China people has reached an astonishing 220 to 850 micrograms, far exceeding the safety line of 200 micrograms per day stipulated by the World Health Organization.
Professor Teng Weiping of China Medical University has confirmed through five years' research that in some areas with high iodine, if iodine is added to salt, hyperthyroidism and thyroid nodules will be easily induced. 15 after the implementation of the national iodine supplement policy, more and more local epidemiological surveys show that some areas are welcoming the peak of thyroid diseases, and the time period of disease outbreaks coincides with the compulsory consumption of iodized salt. Experts put forward the principle of "scientific iodine supplementation, classified guidance, adapting to local conditions, no more or less".
In August 2009, the media collectively tortured the "one size fits all" policy of universal iodine supplementation, questioned the monopoly interests of salt companies, and triggered a big discussion on iodized salt policy. Soon, the Ministry of Health responded to the controversy over iodized salt, acknowledging that the iodine content in salt is high at present, and excessive iodine can increase the risk of hyperthyroidism within 10 years after the implementation of iodized salt, and said that the current dosage of iodized salt will be appropriately lowered from next year.
"Is 20m g/kg a safe bottom line for iodine content of iodized salt?" Hu Yonghua, executive vice president of Peking University College of Public Health, said in an interview that the introduction of the new standard has positive significance, but we should pay attention to where iodine is lacking and where it is not; Who needs more supplements, who needs micro-supplements and who doesn't, and make different iodine content standards according to different regions, which is more objective and detailed.
The iodine content of seafood such as laver, laver, seafood fish, scallop, mussel, jellyfish and lobster is relatively high. Some coastal areas in China are rich in seafood. After years of compulsory iodization, many people in some areas have "over-supplemented iodine" and even caused physical diseases. At the request of the masses, these areas began to quietly sell non-iodized salt many years ago.
201May 15 is the 7th "IDD Prevention Day" in China, and Shandong Yantai Salt Company 176 non-iodized salt sales outlets announced it to the public on the same day. Qiu Haijun, director of the Salt Bureau of Wudi County, Shandong Province, told this reporter that as early as many years ago, Wudi County, located in the northernmost part of Shandong Province and bordering Bohai Bay, had already sold non-iodized salt in Liubao Township.
According to experts, drinking water sources in some areas are already rich in iodine. About160,000 people in China live in 9 1 counties of 8 provinces including Shandong, Hebei, Henan, Anhui, Jiangsu, Shanxi, Inner Mongolia and Xinjiang. Worryingly, in high iodine areas, there are still quite a few people who can't buy non-iodized salt and have to eat iodized salt.
It is difficult to adjust public opinion by questioning mandatory standards.
The revision of iodized salt standard is full of twists and turns. The Ministry of Health announced the "Iodine Content in Edible Salt (Draft for Comment)", aiming to lower the upper limit of iodine content in table salt. Compared with the previous spokesperson of the Ministry of Health, "salt iodization did not cause residents' iodine intake to exceed the standard; Compared with the statement that the health risk of iodine deficiency is greater than that of iodine excess, it is undoubtedly a great progress to openly admit that iodine excess is a potential health hazard, admit that the iodine content in salt is high at present, and greatly reduce the upper limit standard of iodine content in salt.
It seems that the relevant state departments have an objective and rational understanding of the long-disputed "forced excessive iodine supplementation" and various health problems it brings, and have begun to take measures to improve it. Professor Jian Huang from the School of Public Health of Peking Union Medical College said in an interview that the detailed policy adjustment and changes and the "one size fits all" unified consumption of iodized salt in the past, regardless of region and population, are gratifying signals for the change of iodized salt policy from strict control to "opening the mouth".
At the same time, Jian Huang pointed out that any policy adjustment involving the whole country, specifically implemented in one province and one city, will always have the problem of adaptation or basic adaptation. Even if the national health department reduces the upper limit of iodized salt content, it may not be so applicable to individual iodine-rich areas and individuals. A policy of continuing to maintain the "compulsory standard" of iodized salt, even if the standard is lowered, the daily intake of some people may still be high, which will eventually bring harm to public health.
Jian Huang questioned: The average iodine content of the improved edible salt is 20mg/kg to 30mg/kg, but it is really unknown how to make "the provinces, autonomous regions and municipalities directly under the Central Government choose the average iodine content of the edible salt suitable for the local people according to the actual iodine nutrition level of the local people".
He pointed out that the iodine-rich or iodine-deficient area itself is a geological and geographical division, not an administrative division. Even in a province (even a county), the situation of water iodine is different, and iodine-rich areas and iodine-deficient areas may cross. For example, most areas in Liaoning are iodine-deficient areas, but Benxi and Liaoyang areas in the province are still iodine-deficient areas, and Shanxi is relatively iodine-deficient, but Xiaoyi County and other places in Shanxi are high in iodine.
It is suggested that the variety of salt should be fully liberalized.
Liu Shoujun, director of the Institute of Iodine Deficiency Disorders Prevention and Control of the Center for Endemic Disease Prevention and Control of China CDC, said that under the premise of keeping the general direction of iodine supplementation unchanged, it is necessary to enhance the scientific nature of the salt iodization policy and truly achieve "highlighting key points, adapting to local conditions, and classifying guidance"
"The future trend can be summarized as' one center, two basic points'. Liu Shoujun said that a center is the center to seize the "high-risk areas". At present, 104 counties in China have been designated as high incidence areas of iodine deficiency disorders, mainly distributed in the central and western regions. While vigorously supplying iodized salt, these places should implement emergency iodine supplementation measures for key populations to stop the harm of iodine deficiency disorders in time.
"According to local conditions and classified guidance" are two basic points. More than 700 million people in China live in iodine deficiency environment, and more than 500 million people live in iodine deficiency environment. Taking different preventive measures for different groups of people is "adapting to local conditions". Iodine supplementation is needed in iodine-deficient areas, but the iodine deficiency situation is different in different provinces (autonomous regions and municipalities) and counties, and the dietary structure and salt intake of people in different areas are also different. How to determine the concentration of iodized salt according to the specific situation is the content of "classification guidance".
"It's easier said than done, especially the classification guidance. It is difficult to balance various factors. But no matter how difficult it is! " Liu Shoujun said that the relevant departments should do more detailed work, launch different iodized salt products close to the "city situation", "county situation" and even "rural situation", and scientifically guide the public to make choices according to their own conditions.
A public health expert, who asked not to be named, said in an interview that in recent years, the reason why universal iodized salt is unimpeded and universal iodine supplementation is uniform is rarely questioned because the interests of iodized salt have formed a huge interest body. The government health department regards the elimination of iodine deficiency disorders as a political achievement, and also provides "just" support for salt monopoly. Without the support of objective data, relevant health experts continue to positively imply and strengthen iodized salt. However, salt companies use administrative resources to completely crowd out other production enterprises in the industry, and the whole salt industry has become a dead end of China's economic marketization.
"The reduction of iodized salt consumption by the Ministry of Health is largely an expedient measure to deal with the pressure of public opinion, and it is not of great significance to solve the deep-seated problem of iodized salt." The expert said that the correct approach is to reform the existing national unified compulsory iodized salt system and establish a multi-center salt supply system. China has a vast territory, and the natural environment and people's diet structure in different regions are very different, not to mention that the natural iodine intake level of residents in different provinces, townships and villages in the same county cannot be the same. In this case, the national unified iodization standard is unreasonable, and the reasonable institutional arrangement is to establish a multi-center salt supply system.
Experts said that after the reform of the existing national "iodine content of edible salt", it can be determined by all provinces, autonomous regions and municipalities, and even counties and townships. Local standards are only recommended standards. Just like nutrition standards, no local department may force residents in its jurisdiction to eat iodized salt with a certain concentration, and people reserve the right to eat iodized salt.
"Excessive iodine supplementation" will threaten health, and failure to supplement iodine will also threaten health. Now, it seems that this is a dilemma. But experts believe that, in fact, it is possible to solve this problem if monopoly can be truly broken and market competition can be fully introduced. Under the invisible hand of the free competitive market, various salt varieties that can meet different consumption needs, such as "non-iodized salt", "low-iodized salt" and "high-iodized salt", will naturally emerge one after another, allowing consumers to choose independently. What the government should do, in addition to strengthening the supervision of salt quality, is mainly to investigate and inform consumers of all kinds of iodine supplementation information, including which health conditions need iodine supplementation or not.
(Feng Li)