Global iodine nutrition 2020. Italy is an iodine sufficient country

Dear Editor, Every year, the Iodine Global Network (IGN), which is a non-profit, non-government organization for the sustainable elimination of iodine deficiency worldwide (www.ign.org), releases a global scorecard of iodine nutrition in populations based on median urinary iodine concentration (UIC) in school-age children as a proxy for the general population. Based on the most recent scorecard [1, 2], 115 countries are classified as having optimal iodine nutrition, while 23 countries are still classified as iodine deficient (in Europe: Finland, Germany, and Norway). It is worth to note that the iodine intake in several countries formerly classified as optimal has declined, including Cambodia, Nicaragua, Tajikistan, and Germany, which reflects the risk of program backsliding and the need for vigilance and continuous monitoring. The scorecard also indicates that the iodine intake is classified as excessive in 14 countries, which reinforces the need for measures to reduce the excessive iodine exposure in these countries. In 2020 IGN scorecard, for the first time, Italy is reported among iodine sufficient countries. This achievement results from a long-standing nationwide program of iodine prophylaxis on a voluntary basis approved by law in 2005 (law n.55/2005), and from an efficient monitoring system carried out by the Italian National Observatory for Monitoring Iodine Prophylaxis (OSNAMI). The first surveillance conducted by OSNAMI in the period 2007–2012 still showed iodine deficiency in most of the Italian regions [3]. On the basis of these data, the General Direction of Food Safety and Nutrition at the Ministry of Health together with a panel of OSNAMI experts at the National Institute of Health decided to intensify nationwide informative campaigns on the use of iodized salt promoting the slogan “less salt but iodized”, in agreement with the nationwide strategy of reducing sodium intake in the population. These efforts have finally led to iodine sufficiency, as demonstrated by results of the second survey conducted in the period 2015–2019 on 4000 schoolchildren aged 11–13 years and residing in nine regions representative of Northern, Central, and Southern Italy. The analysis of spot urine samples showed a median UIC of 125 μg/L, with no significant differences b Query ID="Q2" Text="Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary." between rural and urban areas (126 μg/L and 118 μg/L, respectively). The study also showed the disappearance of goiter among schoolchildren in all but one studied region. These results represent an undoubted success of public health in our country. Nevertheless, these are only the first steps of the nationwide iodine prophylaxis program. In fact, three further important goals need to be achieved: (i) to ensure optimal intake for the entire population, included subgroups still at risk of insufficient iodine intake like pregnant women, newborns, and young children; (ii) to reinforce the notion that strategies for both salt reduction and salt iodization are compatible, although requiring effective monitoring to ensure sufficient iodine intake; and (iii) to obtain political commitment to ensure the sustainability of the iodine prophylaxis program. Once these goals will be achieved, the fight against iodine deficiency will be definitely won in our country.