To the Editor:
In his letter, Mottiar  incorrectly interpreted our cited contribution , as having examined whether an increased intake of iodized salt improved iodine status. We undertook a cross-sectional analysis to investigate whether iodine status differed according to repeated measures of 24-h urinary sodium excretion, the gold standard to assess habitual salt intake, in South African adults. The study demonstrated that, in a country with a well-functioning salt iodization program, urinary iodine concentration (UIC) did not differ across salt-intake levels—no intervention was performed, rather dietary practices were described. Consumers with salt intakes <5 g/d had similarly optimal UIC levels to those with the highest salt-intake levels, suggesting that most salt was provided from non-iodated sources, presumably through processed foods. Our study is likely the first to provide data to inform the public health debate whether population-level reduction in salt intake is compatible with prevention of iodine deficiency through salt iodization. To our knowledge, interventions in which iodine levels of salt are manipulated have not been performed. Dietary modeling in the Netherlands  showed that only at a 50% salt reduction would iodine intake become inadequate for a small percentage of the population.