Ying Zhang

Background/Objectives: With the rising trend of out-of-home dining in China, the use of iodized salt (IS) in eating-out venues plays a key role in preventing iodine deficiency disorders (IDDs). However, the coverage rate of iodized salt (CRIS) and the utilization rate of adequately iodized salt (URAIS) in these venues in China remain underexplored, potentially undermining IDD prevention strategies. This study aims to assess the CRIS and URAIS in such venues across China and identify the factors influencing their prevalence. Methods: From 2021 to 2024, a nationwide cross-sectional study was conducted in China, involving 19,346 venues. A 50 g sample of cooking salt was collected from each venue, and the iodine content was measured. The CRIS and URAIS were calculated, and associations with various factors were assessed using Chi-square tests, the Cochran–Armitage trend test, and multivariate logistic regression. Results: Of the 19,346 samples, 18,519 tested positive for IS, and 17,588 contained adequately iodized salt (AIS), resulting in a CRIS of 95.7% and a URAIS of 90.9%. Significant regional differences were found, with coastal areas showing a lower CRIS and URAIS than inland areas (87.0% vs. 97.8%; 81.0% vs. 93.2%) and urbanized areas having lower rates compared to less urbanized areas (94.1% vs. 97.3%; 88.9% vs. 92.9%). Higher per capita income was associated with a lower CRIS and URAIS (Z = −19.72, p < 0.0001; Z = −13.85, p < 0.0001). Lower per capita income (OR = 3.24, OR = 1.36, p < 0.0001), inland areas (OR = 4.14, OR = 2.68, p < 0.0001), and mountainous areas (OR = 2.48, OR = 1.27, p < 0.0001) were associated with a higher likelihood of IS and AIS use. Conclusions: While the CRIS and URAIS in dining venues meet national standards, regional disparities persist, particularly in coastal, plain, and economically advanced areas. Strengthening regulatory oversight and public education on iodized salt’s health benefits is essential.

Dairy products are a significant source of iodine, and their contribution to iodine intake must be evaluated regularly. However, there is a lack of data on iodine intake from dairy products in China. Through a cross-sectional study, we determined the iodine content of dairy products in the Chinese diet and estimated iodine intake among Chinese children. Intake records for 30 consecutive days were used to investigate the consumption of dairy products by 2009 children from Yunnan and Liaoning Provinces. The iodine contents of 266 dairy products with high intake frequency were determined using inductively coupled plasma–mass spectrometry (ICP-MS). We then calculated the iodine intake and contribution of dairy products and explored the related factors of dairy iodine intake through a generalized linear mixed model. Ultra-high-temperature (UHT) sterilized milk accounted for 78.7% of the total dairy products, with an iodine content of 23.0 μg/100 g. The dairy product intake rate of children in China was 83.6%, with an average daily intake of 143.1 g. The median iodine intake from milk and dairy was 26.8 μg/d, 41.5% of the estimated average recommendation (EAR) for younger children and 31.8% of the EAR for older children. The daily milk iodine intake of children in Yunnan Province was 9.448 μg/day lower than that of children in Liaoning Province (p < 0.001), and the daily iodine intake of children in rural areas was 17.958 μg/day lower than that of children in urban areas (p < 0.001). Chinese dairy products were rich in iodine, and the content of iodine was intermediate to that reported in Europe and the USA. However, children’s daily intake of milk iodine was lower than that of children in other developed countries due to the lower daily intake of dairy products, especially those in rural areas.

Purpose There were only two definitions of iodine-deficient (water iodine concentration < 10 μg/L) and iodine-excess areas (water iodine concentration > 100 μg/L) in China before 2020. Areas with water iodine concentration between 10 and 100 μg/L implement the same policy as iodine-deficient areas to provide iodized salt. The definition of iodine-adequate areas was formulated in 2020 for the first time. The paper aims to investigate the coverage rate of iodized salt (CR) in different areas defined according to the latest national standards, evaluate the iodine status of local women, and provide a basis for the revision and improvement of relevant policies. Methods A total of 1948 women aged 18–60 were recruited from the iodine extra-high areas (IEHA), iodine-excess areas (IEA), iodine-adequate areas (IAA), inland iodine-deficient areas (IIDA), and coastal iodine-deficient areas (CIDA). Information on daily diet was collected with the Food Frequency Questionnaire. Drinking water, salt, food, and urine samples were collected and tested in our laboratory. Based on the recommended daily iodine intake, we assessed whether the subjects' daily iodine intake levels were adequate. Results The CR and the median urinary iodine concentrations (UICs) were 4.02% and 98.03 μg/L in CIDA, 89.74% and 144.93 μg/L in IIDA, 26.55% and 178.60 μg/L in IAA, 8.78% and 446.5 μg/L in IEA, 3.95% and 605.4 μg/L in IEHA, respectively. The differences among these five areas were statistically significant (P < 0.0001). The daily dietary iodine intakes were mainly from drinking water in IAA (63.92%), IEA (92.29%), and IEHA (92.93%), and were mainly from iodized salt in IIDA (59.22%) and food in CIDA (86.6%). Conclusion Women in IAA and IIDA were in an adequate iodine state. Women in IEA and IEHA were in an iodine-excess state, and it is necessary to carry out water improvements projects. Women in CIDA were in a slight iodine-deficient state, and health education on scientific iodine fortification should be strengthened to increase iodine intake.

What is already known about this topic? The National Iodine Deficiency Disease Surveillance system is exclusively focused on monitoring cooking salt used within households. Currently, there is a lack of nationally representative data on the use of iodized salt in dining establishments. What is added by this report? This study evaluated 7,889 salt samples obtained from dining establishments located in 13 provincial-level administrative divisions across China. The findings indicated that coverage rate of iodized salt (CRIS) and the consumption rate of adequately iodized salt (CRAIS) were found to be 95.2% and 90.2%, respectively. Further, 880 samples were classified as iodized salt and 804 as adequately iodized salt. In coastal areas, the CRIS and CRAIS showed a significant decrease to 77.1% and 70.5%, respectively, when compared to the inland regions (P<0.01). What are the implications for public health practices? The data compiled could potentially fill the void in the national data concerning the use of iodized salt in dining establishments throughout China. It is of the utmost importance to increase the awareness of restaurant operators, particularly those located in coastal areas, about the benefits of iodine supplementation. Moreover, they should be encouraged to use adequately iodized salt.