Review of regulation and practice of use of iodine supplements in countries of Eastern/Central Europe and Central Asia

This review focuses on the regulation and practice of iodine supplementation (IS) use with a focus on Eastern/Central European and Central Asian (ECE-CA) countries, based on new evidence on the benefits and harms of IS use depending on the salt iodization status. Information on IS use was analyzed for population groups particularly vulnerable to iodine deficiency: pregnant and lactating women, infants aged 6–36 months, and preschool and school-age children. The review preparation process included several repeated searches using PubMed and other sources. Open access articles published in English, Russian, and Romanian over the past 10–15 years were included in the analysis. Analysis of available sources showed that 9 ECE-CA countries had official recommendations on IS use in different population groups, usually pregnant and lactating women. However, in 5 of them, the median urinary iodine concentration in pregnant women was below the optimal level (150 μg/L). Experience in the ECE-CA region shows that mandatory salt iodization ensures adequate iodine intake for all population groups. Further efforts should be aimed at increasing the use of iodized salt to cover more than 90% of households and expanding the use of iodized salt in food production. However, IS may still be necessary for individuals at risk of iodine deficiency due to dietary and lifestyle factors (vegan/vegetarian and other restrictive diets). Such targeted use of IS requires the development of official guidelines to assess the effectiveness of this approach and methods for monitoring its implementation.