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Mullan K, Patterson C, Doolan K, Cundick J, Hamill L, McKeeman G, McMullan P, Smyth P, Young I, Woodside JV. Neonatal TSH levels in Northern Ireland from 2003 to 2014 as a measure of population iodine status. Clin Endocrinol (Oxf) 2018; 89:849-855. [PMID: 30184261 DOI: 10.1111/cen.13849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/01/2018] [Accepted: 09/01/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The re-emergence of iodine deficiency in the UK has recently been reported in a large cohort of teenage girls including from Northern Ireland (NI) using the gold standard spot urinary iodine concentration. We wished to explore and confirm this by analysing neonatal thyroid-stimulating hormone (nTSH) levels in the NI population. DESIGN We analysed the nTSH heel prick tests results from the NI national screening database between 2003 and 2014. The WHO proposes a definition for population iodine sufficiency at <3% of the population with nTSH results >5 mIU/L. METHODS Anonymized results from 288 491 nTSH tests were retrieved, and prevalence rates of results at increasing cut-offs including >2 mIU/L and >5 mIU/L calculated. We also assessed for possible seasonal variation in nTSH results. RESULTS An overall population prevalence of 0.49% with TSH >5 mIU/L was found, indicating population iodine sufficiency with no year attaining a prevalence >3%. The prevalence of nTSH >2 mIU/L decreased to 4.1% in 2007 and subsequently increased to 9.8% in 2014. Modest seasonal variation was also detected, with higher levels among April/May births. CONCLUSIONS The neonatal TSH database suggests iodine sufficiency in the NI population. However, the rising frequency of results >2 mIU/L may indicate an emerging mild iodine deficiency. This is one of the largest and longest studies of its kind in the UK and the first carried out in NI. The summer months may be a time of increased risk of iodine deficiency in our pregnant women whose requirements are increased and who are not currently targeted by any iodine fortification programme in the UK.
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Affiliation(s)
- Karen Mullan
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, UK
| | - Chris Patterson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Katy Doolan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Jennifer Cundick
- Regional Biochemistry Laboratory, Royal Victoria Hospital Belfast, Belfast, UK
| | - Lesley Hamill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Gareth McKeeman
- Regional Biochemistry Laboratory, Royal Victoria Hospital Belfast, Belfast, UK
| | - Paul McMullan
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, UK
| | | | - Ian Young
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Jayne V Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
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Assessment of normal reference values for thyroid uptake of technetium-99m pertechnetate in a single centre UK population. Nucl Med Commun 2018; 39:834-838. [PMID: 29877994 DOI: 10.1097/mnm.0000000000000876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study aims to explore the normal reference values for thyroid uptake of technetium-99m (Tc) pertechnetate in a UK population. PATIENTS AND METHODS A retrospective review of 60 euthyroid patients who underwent thyroid imaging with Tc pertechnetate between January 2012 to April 2014 as part of dual-tracer subtraction parathyroid scintigraphy. Tc pertechnetate thyroid uptake values were determined for each patient. Medical records and biochemical thyroid function tests were reviewed to ensure that all patients were not on medication that could affect thyroid function and they were both clinically and biochemically euthyroid 6 months before and following the scan. RESULTS Median and interquartile uptake range of Tc pertechnetate in euthyroid patients were 0.9 and 0.5-1.4%, respectively. The normal reference range in the study population was 0.2-2.0%. Thyroid uptake inversely correlated with age in females (r=-0.40, P=0.04), males (r=-0.50, P=0.04), and whole group (r=-0.40, P=0.002). CONCLUSION The calculated normal reference range in this study was found to be less than that used in our own and many other UK institutions. The results demonstrate the importance of periodic evaluation of normal uptake values and provide support for prospective studies defining the normal reference range to be performed.
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Knowles RL, Oerton J, Cheetham T, Butler G, Cavanagh C, Tetlow L, Dezateux C. Newborn Screening for Primary Congenital Hypothyroidism: Estimating Test Performance at Different TSH Thresholds. J Clin Endocrinol Metab 2018; 103:3720-3728. [PMID: 30113641 PMCID: PMC6179177 DOI: 10.1210/jc.2018-00658] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/27/2018] [Indexed: 12/03/2022]
Abstract
CONTEXT Active surveillance of primary congenital hypothyroidism (CH) in a multiethnic population with established newborn bloodspot screening. OBJECTIVE To estimate performance of newborn screening for CH at different test thresholds and calculate incidence of primary CH. DESIGN Prospective surveillance from June 2011 to June 2012 with 3-year follow-up of outcomes. Relative likelihood ratios (rLRs) estimated to compare bloodspot TSH test thresholds of 6 mU/L and 8 mU/L, with the nationally recommended standard of 10 mU/L for a presumptive positive result. SETTING UK National Health Service. PATIENTS Clinician notification of children aged <5 years investigated following clinical presentation or presumptive positive screening result. MAIN OUTCOME MEASURE(S) Permanent primary CH status determined by clinician report of continuing T4 requirement at 3-year follow-up. RESULTS A total of 629 newborns (58.3% girls; 58.7% white ethnicity) were investigated following presumptive positive screening result and 21 children (52.4% girls; 52.4% white) after clinical presentation; 432 remained on treatment at 3-year follow-up. Permanent CH incidence was 5.3 (95% CI, 4.8 to 5.8) per 10,000 infants. With use of locally applied thresholds, sensitivity, specificity, and positive predictive value were 96.76%, 99.97%, and 66.88%, respectively. Compared with a TSH threshold of 10 mU/L, positive rLRs for 8 mU/L and 6 mU/L were 1.20 (95% CI, 0.82 to 1.75) and 0.52 (95% CI, 0.38 to 0.72), and negative rLRs were 0.11 (95% CI, 0.03 to 0.36) and 0.11 (95% CI, 0.06 to 0.20), respectively. CONCLUSIONS Screening program performance is good, but a TSH threshold of 8 mU/L appears superior to the current national standard (10 mU/L) and requires further evaluation. Further research should explore the implications of transient CH for screening policy.
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Affiliation(s)
- Rachel L Knowles
- Life Course Epidemiology and Biostatistics, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Correspondence and Reprint Requests: Rachel L. Knowles, PhD, Life Course Epidemiology and Biostatistics, Population Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, United Kingdom. E-mail:
| | - Juliet Oerton
- Life Course Epidemiology and Biostatistics, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Timothy Cheetham
- Newcastle University and Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
| | - Gary Butler
- Paediatric and Adolescent Endocrinology, University College London Hospitals NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Christine Cavanagh
- National Newborn Blood Spot Screening Programme, Public Health England, London, United Kingdom
| | - Lesley Tetlow
- Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Carol Dezateux
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University London, United Kingdom
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Völzke H, Erlund I, Hubalewska-Dydejczyk A, Ittermann T, Peeters RP, Rayman M, Buchberger M, Siebert U, Thuesen BH, Zimmermann MB, Grünert S, Lazarus JH. How Do We Improve the Impact of Iodine Deficiency Disorders Prevention in Europe and Beyond? Eur Thyroid J 2018; 7:193-200. [PMID: 30283737 PMCID: PMC6140605 DOI: 10.1159/000490347] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/14/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Iodine deficiency disorders (IDD) represent a global health threat to individuals and societies. IDD prevention programmes have been introduced in many parts of the world. However, challenges remain, particularly in Europe due to fragmentation and diversity of approaches that are not harmonized. OBJECTIVES This review is dedicated to the public-health impact of IDD prevention programmes. It sums up experiences collected by the EUthyroid consortium so far and provides information on stakeholders that should be involved in actions directed to improve the impact of IDD prevention. METHODS A joint European database for combining registry-based outcome and monitoring data as well as tools for harmonizing study methods were established. Methods for analyzing thyroglobulin from a dried blood spot are available for assessing the iodine status in the general population and at-risk groups. Mother-child cohorts are used for in-depth analysis of the potential impact of mild-to-moderate iodine deficiency on the neurocognitive development of the offspring. A decision-analytic model has been developed to evaluate the long-term effectiveness and cost effectiveness of IDD prevention programmes. RESULTS EUthyroid has produced tools and infrastructure to improve the quality of IDD monitoring and follows a dissemination strategy targeting policymakers and the general public. There are tight connections to major stakeholders in the field of IDD monitoring and prevention. CONCLUSIONS EUthyroid has taken steps towards achieving a euthyroid Europe. Our challenge is to inspire a greater sense of urgency in both policymakers and the wider public to address this remediable deficit caused by IDD.
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Affiliation(s)
- Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Iris Erlund
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | | | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Robin P. Peeters
- Department of Internal Medicine, Rotterdam Thyroid Centre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - Monika Buchberger
- Department of Public Health and Health Technology Assessment, UMIT, University for Health Science, Medical Informatics and Technology, Hall, Austria
| | - Uwe Siebert
- Department of Public Health and Health Technology Assessment, UMIT, University for Health Science, Medical Informatics and Technology, Hall, Austria
| | | | - Michael B. Zimmermann
- Swiss Federal Institute of Technology, Zürich Department of Health Sciences and Technology, Zürich, Switzerland
| | | | - John H. Lazarus
- Institute of Molecular Medicine, Cardiff University, Cardiff, United Kingdom
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55
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Henjum S, Brantsæter AL, Kurniasari A, Dahl L, Aadland EK, Gjengedal ELF, Birkeland S, Aakre I. Suboptimal Iodine Status and Low Iodine Knowledge in Young Norwegian Women. Nutrients 2018; 10:nu10070941. [PMID: 30037088 PMCID: PMC6073112 DOI: 10.3390/nu10070941] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 11/18/2022] Open
Abstract
Previous studies have documented mild to moderate iodine deficiency in pregnant and lactating women in Norway. This study focused on non-pregnant young women because their future children may be susceptible to the adverse effects of iodine deficiency. We assessed urinary iodine concentration (UIC), iodine intake from food and supplements, and iodine knowledge in 403 non-pregnant women, mainly students, aged 18–30 years. Iodine concentration was measured in spot urine samples analyzed by inductively coupled plasma mass spectrometry and iodine intake was calculated from a self-reported food frequency questionnaire. Knowledge about iodine was collected through the self-administered, paper-based questionnaire. Median (p25–p75) UIC was 75 (42–130) µg/L and 31% had UIC < 50 µg/L. Habitual iodine intake was 100 (69–136) µg/day. In multiple regression models, supplemental iodine, use of thyroid medication, and iodine intake from food were positively associated with UIC, while vegetarian practice was negatively associated, explaining 16% of the variance. Approximately 40% of the young women had low iodine knowledge score and no differences were found between women in different study programs. Young women in Norway are mild to moderately iodine-deficient, and public health strategies are needed to improve and secure adequate iodine status.
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Affiliation(s)
- Sigrun Henjum
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, 0310 Oslo, Norway.
| | - Anne Lise Brantsæter
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, 0403 Oslo , Norway.
| | - Astrid Kurniasari
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, 0310 Oslo, Norway.
| | - Lisbeth Dahl
- Institute of Marine Research (IMR), P.O. Box 1870 Nordnes, 5817 Bergen, Norway.
| | - Eli Kristin Aadland
- Faculty of Education, Western Norway University of Applied Sciences, 5063 Bergen, Norway, .
| | - Elin Lovise Folven Gjengedal
- Faculty of Environmental Sciences and Natural Resource Management, Norwegian University of Life Sciences, Aas 1433, Norway.
| | - Susanne Birkeland
- Faculty of Environmental Sciences and Natural Resource Management, Norwegian University of Life Sciences, Aas 1433, Norway.
| | - Inger Aakre
- Institute of Marine Research (IMR), P.O. Box 1870 Nordnes, 5817 Bergen, Norway.
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56
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Is iodine nutrition in the Spanish pediatric population adequate? Historical review and current situation. ACTA ACUST UNITED AC 2018; 65:458-467. [PMID: 30030155 DOI: 10.1016/j.endinu.2018.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/16/2018] [Accepted: 05/16/2018] [Indexed: 11/21/2022]
Abstract
Iodine is an essential component of thyroid hormones, and iodine deficit is the leading cause of preventable mental retardation worldwide. Spain was considered iodine-deficient until 2003. Although iodine urinary levels have been in the optimal range in Spain since 2004, the WHO recognizes that our country does not meet the necessary requirements to ensure that the whole population is not at risk of an iodine deficiency disorder. The aim of this article is to review the current iodine status in Spain. Data from several studies emphasize the low consumption of iodized salt at home. Despite the progress made in recent decades, Spanish children are not exempt from suffering an iodine deficiency disorder. Policies that allow for controlling iodine nutrition and promote universal consumption of iodized salt should therefore be implemented.
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57
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Robinson SM, Crozier SR, Miles EA, Gale CR, Calder PC, Cooper C, Inskip HM, Godfrey KM. Preconception Maternal Iodine Status Is Positively Associated with IQ but Not with Measures of Executive Function in Childhood. J Nutr 2018; 148:959-966. [PMID: 29767745 PMCID: PMC5991217 DOI: 10.1093/jn/nxy054] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/26/2018] [Indexed: 12/30/2022] Open
Abstract
Background Adverse effects of severe maternal iodine deficiency in pregnancy on fetal brain development are well-established, but the effects of milder deficiency are uncertain. Most studies examine iodine status in pregnancy; less is known about iodine nutrition before conception. Objective We examined relations between maternal preconception iodine status and offspring cognitive function, within a prospective mother-offspring cohort. Methods Maternal iodine status was assessed through the use of the ratio of iodine:creatinine concentrations (I/Cr) in spot urine samples [median (IQR) period before conception 3.3 y (2.2-4.7 y)]. Childhood cognitive function was assessed at age 6-7 y. Full-scale IQ was assessed via the Wechsler Abbreviated Scale of Intelligence, and executive function through the use of tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Analyses (n = 654 mother-child dyads) were adjusted for potential confounders including maternal intelligence, education, and breastfeeding duration. Results The median (IQR) urinary iodine concentration was 108.4 µg/L (62.2-167.8 µg/L) and the I/Cr ratio 114 µg/g (76-164 µg/g). The preconception I/Cr ratio was positively associated with child IQ, before and after adjustment for potential confounding influences [β = 0.13 (95% CI: 0.04, 0.21)/SD, P = 0.003]. 8.9% of women had a preconception urinary I/Cr ratio <50 µg/g; compared with those with an I/Cr ratio ≥150 µg/g, the IQ of their offspring was 0.49 (95% CI: 0.79, 0.18) SD lower. There were no associations with the executive function outcomes assessed via CANTAB, before or after adjustment for confounders. Conclusion The positive association between iodine status before conception and child IQ provides some support for demonstrated links between low maternal iodine status in pregnancy and poorer cognitive function reported in other studies. However, given the negative effects on school performance previously observed in children born to iodine-deficient mothers, the lack of associations with measures of executive function in the present study was unexpected. Further data are needed to establish the public health importance of low preconception iodine status.
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Affiliation(s)
- Sian M Robinson
- Medical Research Council (MRC) Lifecourse Epidemiology Unit,National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom,Address correspondence to SMR (e-mail: )
| | | | - Elizabeth A Miles
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Catharine R Gale
- Medical Research Council (MRC) Lifecourse Epidemiology Unit,Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom,National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom
| | - Cyrus Cooper
- Medical Research Council (MRC) Lifecourse Epidemiology Unit,National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom,National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Hazel M Inskip
- Medical Research Council (MRC) Lifecourse Epidemiology Unit,National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom
| | - Keith M Godfrey
- Medical Research Council (MRC) Lifecourse Epidemiology Unit,National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom
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58
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Dairy products as a source of iodine in the UK, and consumers’ perceptions. Proc Nutr Soc 2018. [DOI: 10.1017/s0029665118000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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59
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Wainwright P, Cook P. The assessment of iodine status - populations, individuals and limitations. Ann Clin Biochem 2018; 56:7-14. [PMID: 29703103 DOI: 10.1177/0004563218774816] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Iodine deficiency is a significant global health concern, and the single greatest cause of preventable cognitive impairment. It is also a growing public health concern in the UK particularly among pregnant women. Biomarkers such as urinary iodine concentration have clear utility in epidemiological studies to investigate population-level iodine status, but determination of iodine status in individuals is much more problematic with current assays. This article reviews the available biomarkers of iodine status and their relative utility at the level of both populations and individuals for the investigation of iodine deficiency and iodine excess.
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Affiliation(s)
- Patrick Wainwright
- 1 Chemical Pathology and Metabolic Medicine, Department of Laboratory Medicine, University Hospital Southampton, Southampton, UK.,2 Current affiliation: Department of Blood Sciences, Glan Clwyd Hospital, Bodelwyddan, UK
| | - Paul Cook
- 1 Chemical Pathology and Metabolic Medicine, Department of Laboratory Medicine, University Hospital Southampton, Southampton, UK
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60
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Taylor PN, Albrecht D, Scholz A, Gutierrez-Buey G, Lazarus JH, Dayan CM, Okosieme OE. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol 2018; 14:301-316. [PMID: 29569622 DOI: 10.1038/nrendo.2018.18] [Citation(s) in RCA: 622] [Impact Index Per Article: 103.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Thyroid hormones are essential for growth, neuronal development, reproduction and regulation of energy metabolism. Hypothyroidism and hyperthyroidism are common conditions with potentially devastating health consequences that affect all populations worldwide. Iodine nutrition is a key determinant of thyroid disease risk; however, other factors, such as ageing, smoking status, genetic susceptibility, ethnicity, endocrine disruptors and the advent of novel therapeutics, including immune checkpoint inhibitors, also influence thyroid disease epidemiology. In the developed world, the prevalence of undiagnosed thyroid disease is likely falling owing to widespread thyroid function testing and relatively low thresholds for treatment initiation. However, continued vigilance against iodine deficiency remains essential in developed countries, particularly in Europe. In this report, we review the global incidence and prevalence of hyperthyroidism and hypothyroidism, highlighting geographical differences and the effect of environmental factors, such as iodine supplementation, on these data. We also highlight the pressing need for detailed epidemiological surveys of thyroid dysfunction and iodine status in developing countries.
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Affiliation(s)
- Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Diana Albrecht
- University Medicine Greifswald, Institute for Community Medicine, Greifswald, Germany
| | - Anna Scholz
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Gala Gutierrez-Buey
- Clinica Universidad de Navarra, Department of Endocrinology and Nutrition, Pamplona, Spain
| | - John H Lazarus
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Colin M Dayan
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Onyebuchi E Okosieme
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
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61
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Contemporary challenges to iodine status and nutrition: the role of foods, dietary recommendations, fortification and supplementation. Proc Nutr Soc 2018; 77:302-313. [PMID: 29704906 DOI: 10.1017/s0029665118000137] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Iodine deficiency (ID) in women of childbearing age remains a global public health concern, mainly through its impact on fetal and infant neurodevelopment. While iodine status is improving globally, ID is still prevalent in pregnancy, when requirements increase. More than 120 countries have implemented salt iodisation and food fortification, strategies that have been partially successful. Supplementation during pregnancy is recommended in some countries and supported by the WHO when mandatory salt iodisation is not present. The UK is listed as one of the ten countries with the lowest iodine status globally, with approximately 60 % of pregnant women not meeting the WHO recommended intake. Without mandatory iodine fortification or recommendation for supplementation in pregnancy, the UK population depends on dietary sources of iodine. Both women and healthcare professionals have low knowledge and awareness of iodine, its sources or its role for health. Dairy and seafood products are the richest sources of iodine and their consumption is essential to support adequate iodine status. Increasing iodine through the diet might be possible if iodine-rich foods get repositioned in the diet, as they now contribute towards only about 13 % of the average energy intake of adult women. This review examines the use of iodine-rich foods in parallel with other public health strategies, to increase iodine intake and highlights the rare opportunity in the UK for randomised trials, due to the lack of mandatory fortification programmes.
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62
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Bouga M, Lean MEJ, Combet E. Iodine and Pregnancy-A Qualitative Study Focusing on Dietary Guidance and Information. Nutrients 2018; 10:nu10040408. [PMID: 29587423 PMCID: PMC5946193 DOI: 10.3390/nu10040408] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/16/2018] [Accepted: 03/23/2018] [Indexed: 12/15/2022] Open
Abstract
Iodine is essential for thyroid hormones synthesis and normal neurodevelopment; however, ~60% of pregnant women do not meet the WHO (World Health Organization) recommended intake. Using a qualitative design, we explored the perceptions, awareness, and experiences of pregnancy nutrition, focusing on iodine. Women in the perinatal period (n = 48) were interviewed and filled in a food frequency questionnaire for iodine. Almost all participants achieved the recommended 150 μg/day intake for non-pregnant adults (99%), but only 81% met the increased demands of pregnancy (250 μg/day). Most were unaware of the importance, sources of iodine, and recommendations for iodine intake. Attitudes toward dairy products consumption were positive (e.g., helps with heartburn; easy to increase). Increased fish consumption was considered less achievable, with barriers around taste, smell, heartburn, and morning sickness. Community midwives were the main recognised provider of dietary advice. The dietary advice received focused most often on multivitamin supplements rather than food sources. Analysis highlighted a clear theme of commitment to change behaviour, motivated by pregnancy, with a desired focus on user-friendly documentation and continued involvement of the health services. The study highlights the importance of redirecting advice on dietary requirements in pregnancy and offers practical suggestions from women in the perinatal period as the main stakeholder group.
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Affiliation(s)
- Maria Bouga
- Human Nutrition, School of Medicine, College of Medical, Veterinary and Life Sciences, 10-16 Alexandra Parade, University of Glasgow, Glasgow G31 2ER, UK.
| | - Michael E J Lean
- Human Nutrition, School of Medicine, College of Medical, Veterinary and Life Sciences, 10-16 Alexandra Parade, University of Glasgow, Glasgow G31 2ER, UK.
| | - Emilie Combet
- Human Nutrition, School of Medicine, College of Medical, Veterinary and Life Sciences, 10-16 Alexandra Parade, University of Glasgow, Glasgow G31 2ER, UK.
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63
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Torlinska B, Bath SC, Janjua A, Boelaert K, Chan SY. Iodine Status during Pregnancy in a Region of Mild-to-Moderate Iodine Deficiency is not Associated with Adverse Obstetric Outcomes; Results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Nutrients 2018; 10:nu10030291. [PMID: 29494520 PMCID: PMC5872709 DOI: 10.3390/nu10030291] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 12/26/2022] Open
Abstract
Severe iodine deficiency during pregnancy has been associated with pregnancy/neonatal loss, and adverse pregnancy outcomes; however, the impact of mild–to–moderate iodine insufficiency, though prevalent in pregnancy, is not well-documented. We assessed whether mild iodine deficiency during pregnancy was associated with pregnancy/infant loss, or with other adverse pregnancy outcomes. We used samples and data from the Avon Longitudinal Study of Parents and Children (ALSPAC), from 3140 singleton pregnancies and from a further 42 women with pregnancy/infant loss. The group was classified as mildly-to-moderately iodine deficient with a median urinary iodine concentration of 95.3 µg/L (IQR 57.0–153.0; median urinary iodine-to-creatinine ratio (UI/Creat) 124 µg/g, IQR 82–198). The likelihood of pregnancy/infant loss was not different across four UI/Creat groups (<50, 50–149, 150–250, >250 µg/g). The incidence of pre-eclampsia, non-proteinuric gestational hypertension, gestational diabetes, glycosuria, anaemia, post-partum haemorrhage, preterm delivery, mode of delivery, being small for gestational age, and large for gestational age did not differ significantly among UI/Creat groups, nor were there any significant differences in the median UI/Creat. We conclude that maternal iodine status was not associated with adverse pregnancy outcomes in a mildly-to-moderately iodine-deficient pregnant population. However, in view of the low number of women with pregnancy/infant loss in our study, further research is required.
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Affiliation(s)
- Barbara Torlinska
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Sarah C Bath
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK.
| | - Aisha Janjua
- Birmingham Heartlands Hospital, Birmingham B9 5SS, UK.
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
| | - Kristien Boelaert
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK.
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Edgbaston, Birmingham B15 2TH, UK.
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.
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64
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O'Kane SM, Pourshahidi LK, Mulhern MS, Weir RR, Hill S, O'Reilly J, Kmiotek D, Deitrich C, Mackle EM, Fitzgerald E, Lowis C, Johnston M, Strain JJ, Yeates AJ. The Effect of Processing and Seasonality on the Iodine and Selenium Concentration of Cow's Milk Produced in Northern Ireland (NI): Implications for Population Dietary Intake. Nutrients 2018; 10:E287. [PMID: 29494493 PMCID: PMC5872705 DOI: 10.3390/nu10030287] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/22/2018] [Accepted: 02/25/2018] [Indexed: 01/07/2023] Open
Abstract
Cow's milk is the most important dietary source of iodine in the UK and Ireland, and also contributes to dietary selenium intakes. The aim of this study was to investigate the effect of season, milk fat class (whole; semi-skimmed; skimmed) and pasteurisation on iodine and selenium concentrations in Northern Ireland (NI) milk, and to estimate the contribution of this milk to consumer iodine and selenium intakes. Milk samples (unpasteurised, whole, semi-skimmed and skimmed) were collected weekly from two large NI creameries between May 2013 and April 2014 and were analysed by inductively coupled plasma-mass spectrometry (ICP-MS). Using milk consumption data from the National Diet and Nutrition Survey (NDNS) Rolling Programme, the contribution of milk (at iodine and selenium concentrations measured in the present study) to UK dietary intakes was estimated. The mean ± standard deviation (SD) iodine concentration of milk was 475.9 ± 63.5 µg/kg and the mean selenium concentration of milk was 17.8 ± 2.7 µg/kg. Season had an important determining effect on the iodine, but not the selenium, content of cow's milk, where iodine concentrations were highest in milk produced in spring compared to autumn months (534.3 ± 53.7 vs. 433.6 ± 57.8 µg/kg, respectively; p = 0.001). The measured iodine and selenium concentrations of NI milk were higher than those listed in current UK Food Composition Databases (Food Standards Agency (FSA) (2002); FSA (2015)). The dietary modelling analysis confirmed that milk makes an important contribution to iodine and selenium intakes. This contribution may be higher than previously estimated if iodine and selenium (+25.0 and +1.1 µg/day respectively) concentrations measured in the present study were replicable across the UK at the current level of milk consumption. Iodine intakes were theoretically shown to vary by season concurrent with the seasonal variation in NI milk iodine concentrations. Routine monitoring of milk iodine concentrations is required and efforts should be made to understand reasons for fluctuations in milk iodine concentrations, in order to realise the nutritional impact to consumers.
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Affiliation(s)
- S Maria O'Kane
- Nutrition Innovation Centre for Food and Health (NICHE), University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
| | - L Kirsty Pourshahidi
- Nutrition Innovation Centre for Food and Health (NICHE), University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
| | - Maria S Mulhern
- Nutrition Innovation Centre for Food and Health (NICHE), University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
| | - Ruth R Weir
- Nutrition Innovation Centre for Food and Health (NICHE), University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
| | - Sarah Hill
- LGC, Queens Road, Teddington, Middlesex TW11 0LY, UK.
| | | | - Diana Kmiotek
- LGC, Queens Road, Teddington, Middlesex TW11 0LY, UK.
| | | | - Emer M Mackle
- Nutrition Innovation Centre for Food and Health (NICHE), University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
| | - Edel Fitzgerald
- Nutrition Innovation Centre for Food and Health (NICHE), University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
| | - Carole Lowis
- The Dairy Council for Northern Ireland, Edgewater Road, Belfast BT3 9JQ, UK.
| | - Mike Johnston
- The Dairy Council for Northern Ireland, Edgewater Road, Belfast BT3 9JQ, UK.
| | - J J Strain
- Nutrition Innovation Centre for Food and Health (NICHE), University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
| | - Alison J Yeates
- Nutrition Innovation Centre for Food and Health (NICHE), University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
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65
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O'Kane SM, Pourshahidi LK, Mulhern MS, Strain JJ, Mackle EM, Koca D, Schomburg L, Hill S, O'Reilly J, Kmiotek D, Deitrich C, Bath SC, Yeates AJ. Cow Milk Consumption Increases Iodine Status in Women of Childbearing Age in a Randomized Controlled Trial. J Nutr 2018; 148:401-408. [PMID: 29546298 DOI: 10.1093/jn/nxx043] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/13/2017] [Indexed: 01/30/2023] Open
Abstract
Background Recent evidence has highlighted the prevalence of mild-to-moderate iodine deficiency in women of childbearing age and pregnant women, with important public health ramifications due to the role of iodine, which is required for thyroid hormone production, in neurodevelopment. Cow milk contributes the greatest amount to iodine intakes in several countries. Objective The objective of this study was to investigate the effect of increased cow milk consumption on iodine status, thyroid hormone concentrations, and selenium status. Methods A 12-wk randomized controlled trial was conducted in 78 low-moderate milk-consuming (<250 mL/d) healthy women (aged 18-45 y). The intervention group was asked to consume 3 L semiskimmed milk/wk, whereas the control group continued their usual milk consumption (baseline median: 140 mL/d; IQR: 40-240 mL/d). At baseline and weeks 6 and 12, participants provided a spot urine sample [urinary iodine concentration (UIC), creatinine] and a fasting blood sample (thyroid hormone concentrations, serum total selenium, selenoprotein P). Results At baseline, the median (IQR) UIC of all participants was 78.5 µg/L (39.1-126.1 µg/L). Changes in the median UIC from baseline to week 6 (35.4 compared with 0.6 µg/L; P = 0.014) and week 12 (51.6 compared with -3.8 µg/L; P = 0.045) were significantly greater in the intervention group compared with the control group. However, despite being higher within the intervention group at weeks 6 and 12, the change in the iodine:creatinine ratio from baseline was not significantly different between groups at either week 6 (P = 0.637) or week 12 (P = 0.178). There were no significant differences in thyroid hormone concentrations or selenium status between groups at any time point. Conclusions The present study shows that the consumption of additional cow milk can significantly increase UIC in women of childbearing age. These results suggest that cow milk is a potentially important dietary source of iodine in this population group. This trial was registered at www.clinicaltrials.gov as NCT02767167.
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Affiliation(s)
- S Maria O'Kane
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, County Londonderry, United Kingdom
| | - L Kirsty Pourshahidi
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, County Londonderry, United Kingdom
| | - Maria S Mulhern
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, County Londonderry, United Kingdom
| | - J J Strain
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, County Londonderry, United Kingdom
| | - Emer M Mackle
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, County Londonderry, United Kingdom
| | - Duygu Koca
- Charité-Universitätsmedizin Berlin, Institute for Experimental Endocrinology, Berlin, Germany
| | - Lutz Schomburg
- Charité-Universitätsmedizin Berlin, Institute for Experimental Endocrinology, Berlin, Germany
| | - Sarah Hill
- LGC, Teddington, Middlesex, United Kingdom
| | | | | | | | - Sarah C Bath
- Department of Nutritional Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, United Kingdom
| | - Alison J Yeates
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, County Londonderry, United Kingdom
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66
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Chambers L. Are plant-based milk alternatives putting people at risk of low iodine intake? NUTR BULL 2018. [DOI: 10.1111/nbu.12305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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67
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Bath SC, Rayman MP. Has the UK really become iodine sufficient? Lancet Diabetes Endocrinol 2018; 6:89-90. [PMID: 28462870 DOI: 10.1016/s2213-8587(17)30133-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 03/25/2017] [Accepted: 03/29/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Sarah C Bath
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Margaret P Rayman
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.
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68
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Impact of the food matrix on iodine bioavailability. Proc Nutr Soc 2018. [DOI: 10.1017/s0029665118001441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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69
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Fish and seafood products as a source of iodine in the UK and reasons for consumers' low intake. Proc Nutr Soc 2018. [DOI: 10.1017/s0029665118001842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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70
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Review: Dairy foods, red meat and processed meat in the diet: implications for health at key life stages. Animal 2018; 12:1709-1721. [DOI: 10.1017/s1751731118000642] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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71
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Ingoe L, Phipps N, Armstrong G, Rajagopal A, Kamali F, Razvi S. Prevalence of treated hypothyroidism in the community: Analysis from general practices in North-East England with implications for the United Kingdom. Clin Endocrinol (Oxf) 2017; 87:860-864. [PMID: 28782887 DOI: 10.1111/cen.13440] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/20/2017] [Accepted: 07/29/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Hypothyroidism is more frequently diagnosed in women and older individuals. It has been suggested that the prevalence of hypothyroidism and the number of prescriptions for thyroid hormones are increasing. However, despite hypothyroidism being a common medical condition, contemporary data on prevalence, particularly across the various age groups, is limited. DESIGN Information regarding number of individuals diagnosed with treated hypothyroidism (defined as patients prescribed levothyroxine) across ten General Practices (total population of 66 843) in the North-East of England in 2016 was obtained in an anonymized manner. Total as well as age group-specific point prevalence rates were calculated. In addition, corresponding population data for the United Kingdom were acquired, and national total and age-specific hypothyroidism prevalence rates were estimated. RESULTS The overall prevalence of hypothyroidism in this community sample was 4.5% (n = 3004). Prevalence increased across the age groups from 0.1% in children aged 0-10 years to 15.1% in those aged more than 90 years. After adjusting for demographic differences between the North-East England and UK populations, it is estimated that the total UK-wide prevalence of hypothyroidism in 2016 is 3.6%; affecting more than 2.3 million individuals including nearly 800 000 individuals aged >70 years. CONCLUSIONS Hypothyroidism affects millions of individuals in the UK and is currently a prevalent diagnosis in more than 1 in 10 individuals aged above 70 years. As the population ages this number is likely to increase. The clinical and economic effects of current management strategies for hypothyroidism, particularly in the older population, need to be evaluated.
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Affiliation(s)
- Lorna Ingoe
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Norah Phipps
- Hadrian Primary Care Alliance, West Northumberland, UK
| | | | | | | | - Salman Razvi
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
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72
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Chen C, Xu H, Chen Y, Chen Y, Li Q, Hu J, Liang W, Cheng J, Xia F, Wang C, Han B, Zheng Y, Jiang B, Wang N, Lu Y. Iodized Salt Intake and Its Association with Urinary Iodine, Thyroid Peroxidase Antibodies, and Thyroglobulin Antibodies Among Urban Chinese. Thyroid 2017; 27:1566-1573. [PMID: 29092685 DOI: 10.1089/thy.2017.0385] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Whether iodized salt increases the risk of thyroid disease has been strongly debated in China, especially in the urban areas of coastal regions, in recent years. This study aimed to investigate the status of iodized salt in terms of urinary and serum iodine concentration in urban coastal areas, and to explore further whether consumption of iodized salt or non-iodized salt is associated with autoimmune thyroid disease (AITD). METHODS The data source was SPECT-China, a cross-sectional study in East China. A total of 1678 subjects were enrolled from 12 communities in downtown Shanghai. The type of salt consumed, the urinary iodine concentration (UIC), serum iodine, thyroid peroxidase antibodies (TPOAb), and thyroglobulin antibodies (TgAb) levels were obtained. AITD was defined as serum TPOAb and/or TgAb >60 kIU/L (TPO/TgAb [+]). RESULTS The prevalence of AITD was 10.5% in men and 21.4% in women. The median UIC and serum iodine concentration were 106.4 μg/L and 60.9 μg/L, respectively. Among all the subjects, 46.4% consumed non-iodized salt; the prevalence of iodine deficiency among those subjects was significantly higher than that of the subjects who consumed iodized salt (54.2% vs. 40.1%; p < 0.001). Consumption of non-iodized salt was positively associated with AITD in all participants (odds ratio [OR] = 1.49 [confidence interval (CI) 1.15-1.95]; p = 0.003) and in women (OR = 1.63 [CI 1.20-2.21]; p < 0.01) after multivariable adjustment. Additionally, the association between low UIC and AITD was observed among all subjects (OR = 1.50 [CI 1.10-2.05]; p = 0.01) and in women (OR = 1.45 [CI 1.02-2.07]; p = 0.038). CONCLUSIONS In coastal areas, which are believed to be rich in iodine, consuming non-iodized salt still led to lower UIC levels and a higher prevalence of iodine deficiency. The consumption of non-iodized salt and low UICs might be a risk factor for AITD, especially for women, which should be further confirmed by longitudinal studies.
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Affiliation(s)
- Chi Chen
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Hao Xu
- 2 Shanghai Changning Center for Disease Control and Prevention , Shanghai, China
| | - Yi Chen
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Yingchao Chen
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Qin Li
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Jie Hu
- 2 Shanghai Changning Center for Disease Control and Prevention , Shanghai, China
| | - Weijiu Liang
- 2 Shanghai Changning Center for Disease Control and Prevention , Shanghai, China
| | - Jing Cheng
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Fangzhen Xia
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Chiyu Wang
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Bing Han
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Yanjun Zheng
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Boren Jiang
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Ningjian Wang
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Yingli Lu
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
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73
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Eaton JC, Iannotti LL. Genome-nutrition divergence: evolving understanding of the malnutrition spectrum. Nutr Rev 2017; 75:934-950. [PMID: 29112753 DOI: 10.1093/nutrit/nux055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Humans adapted over a period of 2.3 million years to a diet high in quality and diversity. Genome-nutrition divergence describes the misalignment between modern global diets and the genome formed through evolution. A survey of hominin diets over time shows that humans have thrived on a broad range of foods. Earlier diets were highly diverse and nutrient dense, in contrast to modern food systems in which monotonous diets of staple cereals and ultraprocessed foods play a more prominent role. Applying the lens of genome-nutrition divergence to malnutrition reveals shared risk factors for undernutrition and overnutrition at nutrient, food, and environmental levels. Mechanisms for food system shifts, such as crop-neutral agricultural policy, agroecology, and social policy, are explored as a means to realign modern diets with the nutritional patterns to which humans may be better adapted to thrive.
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Affiliation(s)
- Jacob C Eaton
- Institute for Public Health, Brown School, Washington University, St Louis, Missouri, USA
| | - Lora L Iannotti
- Institute for Public Health, Brown School, Washington University, St Louis, Missouri, USA
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74
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Mehran L, Yarahmadi S, Khalili D, Nazeri P, Delshad H, Abdollahi Z, Azhang N, Azizi F. The Impact of Iodine Status on the Recall Rate of the Screening Program for Congenital Hypothyroidism: Findings from Two National Studies in Iran. Nutrients 2017; 9:E1194. [PMID: 29084139 PMCID: PMC5707666 DOI: 10.3390/nu9111194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/14/2017] [Accepted: 10/18/2017] [Indexed: 01/01/2023] Open
Abstract
Back ground: Iodine deficiency is one of the important factors in increasing the recall rate in congenital hypothyroidism (CH) screening programs. The present study assessed whether the iodine status of the general population may predict the recall rate or vice versa. METHODS In the current national study, among 1,382,229 live births delivered between March 2010 and March 2011, 1,288,237 neonates were screened for detecting CH by TSH (thyroid stimulating hormone) measurement via heel prick sampling. Simultaneously, a total of 11,280 school-aged children, aged 7-8 years, were selected using random multi-cluster sampling for measurement of urinary iodine. RESULTS A negative correlation was found between median urinary iodine (MUI) and the recall rate (r = -0.33, p = 0.03). No correlation was found between MUIC (median urinary iodine concentration) and the incidence rate of CH. Linear regression analysis showed a 0.1% increase in the recall rate for a one unit decrease in MUIC (β = -0.11, 95% CI: -0.2, -0.1, p = 0.03). MUIC, at a cut-off point of 144.7 µg/L, was predictive for a recall rate < 3% (p = 0.05). CONCLUSION Frequencies of TSH ≥ 5 mU/L may be a more sensitive indicator for iodine status during pregnancy rather than in the general population. As higher recall rates reflect inadequate iodine nutrition, sufficient iodine supplementation is needed to reduce the recall rate in such communities.
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Affiliation(s)
- Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 1985717413, Tehran, Iran.
| | - Shahin Yarahmadi
- Endocrinology and Metabolic Office, Center for Disease Control, Ministry of Health and Medical Education, 1419943471,Tehran, Iran.
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences & Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 1985717413, Tehran, Iran.
| | - Pantea Nazeri
- Family Health Institute, Breastfeeding Research Center, Tehran University of Medical Sciences,1419943471, Tehran, Iran.
| | - Hossein Delshad
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 1985717413, Tehran, Iran.
| | - Zahra Abdollahi
- Nutrition Office, Iran Ministry of Health, Treatment and Medical Education, 1419943471, Tehran, Iran.
| | - Nasrin Azhang
- Endocrinology and Metabolic Office, Center for Disease Control, Ministry of Health and Medical Education, 1419943471,Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 1985717413, Tehran, Iran.
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Bath SC, Hill S, Infante HG, Elghul S, Nezianya CJ, Rayman MP. Iodine concentration of milk-alternative drinks available in the UK in comparison with cows' milk. Br J Nutr 2017; 118:525-532. [PMID: 28946925 PMCID: PMC5650045 DOI: 10.1017/s0007114517002136] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Iodine deficiency is present in certain groups of the UK population, notably in pregnant women; this is of concern as iodine is required for fetal brain development. UK milk is rich in iodine and is the principal dietary iodine source. UK sales of milk-alternative drinks are increasing but data are lacking on their iodine content. As consumers may replace iodine-rich milk with milk-alternative drinks, we aimed to measure the iodine concentration of those available in the UK. Using inductively coupled plasma-MS, we determined the iodine concentration of seven types of milk-alternative drink (soya, almond, coconut, oat, rice, hazelnut and hemp) by analysing forty-seven products purchased in November/December 2015. For comparison, winter samples of conventional (n 5) and organic (n 5) cows' milk were included. The median iodine concentration of all of the unfortified milk-alternative drinks (n 44) was low, at 7·3 μg/kg, just 1·7 % of our value for winter conventional cows' milk (median 438 μg/kg). One brand (not the market leader), fortified its soya, oat and rice drinks with iodine and those drinks had a higher iodine concentration than unfortified drinks, at 280, 287 and 266 μg/kg, respectively. The iodine concentration of organic milk (median 324 μg/kg) was lower than that of conventional milk. Although many milk-alternative drinks are fortified with Ca, at the time of this study, just three of forty-seven drinks were fortified with iodine. Individuals who consume milk-alternative drinks that are not fortified with iodine in place of cows' milk may be at risk of iodine deficiency unless they consume alternative dietary iodine sources.
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Affiliation(s)
- Sarah C Bath
- 1Department of Nutritional Sciences, Faculty of Health and Medical Sciences,University of Surrey,Guildford,Surrey GU2 7XH,UK
| | - Sarah Hill
- 2LGC Limited,Queens Road,Teddington,Middlesex TW11 0LY,UK
| | | | - Sarah Elghul
- 1Department of Nutritional Sciences, Faculty of Health and Medical Sciences,University of Surrey,Guildford,Surrey GU2 7XH,UK
| | - Carolina J Nezianya
- 1Department of Nutritional Sciences, Faculty of Health and Medical Sciences,University of Surrey,Guildford,Surrey GU2 7XH,UK
| | - Margaret P Rayman
- 1Department of Nutritional Sciences, Faculty of Health and Medical Sciences,University of Surrey,Guildford,Surrey GU2 7XH,UK
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76
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A Paleolithic-type diet results in iodine deficiency: a 2-year randomized trial in postmenopausal obese women. Eur J Clin Nutr 2017; 72:124-129. [PMID: 28901333 DOI: 10.1038/ejcn.2017.134] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/28/2017] [Accepted: 07/18/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Different diets are used for weight loss. A Paleolithic-type diet (PD) has beneficial metabolic effects, but two of the largest iodine sources, table salt and dairy products, are excluded. The objectives of this study were to compare 24-h urinary iodine concentration (24-UIC) in subjects on PD with 24-UIC in subjects on a diet according to the Nordic Nutrition Recommendations (NNR) and to study if PD results in a higher risk of developing iodine deficiency (ID), than NNR diet. SUBJECTS/METHODS A 2-year prospective randomized trial in a tertiary referral center where healthy postmenopausal overweight or obese women were randomized to either PD (n=35) or NNR diet (n=35). Dietary iodine intake, 24-UIC, 24-h urinary iodine excretion (24-UIE), free thyroxin (FT4), free triiodothyronine (FT3) and thyrotropin (TSH) were measured at baseline, 6 and 24 months. Completeness of urine sampling was monitored by para-aminobenzoic acid and salt intake by urinary sodium. RESULTS At baseline, median 24-UIC (71.0 μg/l) and 24-UIE (134.0 μg/d) were similar in the PD and NNR groups. After 6 months, 24-UIC had decreased to 36.0 μg/l (P=0.001) and 24-UIE to 77.0 μg/d (P=0.001) in the PD group; in the NNR group, levels were unaltered. FT4, TSH and FT3 were similar in both groups, except for FT3 at 6 months being lower in PD than in NNR group. CONCLUSIONS A PD results in a higher risk of developing ID, than a diet according to the NNR. Therefore, we suggest iodine supplementation should be considered when on a PD.
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77
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Breakfast consumption and nutrient intakes in 4-18-year-olds: UK National Diet and Nutrition Survey Rolling Programme (2008-2012). Br J Nutr 2017; 118:280-290. [PMID: 28814349 DOI: 10.1017/s0007114517001714] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although breakfast consumption is widely considered to be an important component of a healthy lifestyle, few UK studies have examined differences in nutrient intakes between breakfast consumers and breakfast skippers among children and adolescents. We investigated associations between breakfast skipping in 4-18-year-olds and their nutrient intakes using data from the UK's National Diet and Nutrition Survey Rolling Programme. Dietary data were derived from 4-d estimated food diaries of 802 children aged 4-10 years and 884 children aged 11-18 years (1686 in total). Daily nutrient intakes of children with different breakfast habits were compared by one-way ANCOVA adjusting for relevant covariates (sex, age, ethnicity, equivalised household income and BMI). Within-person analysis was carried out on children with an irregular breakfast habit (n 879) comparing nutrient intakes on breakfast days with those on non-breakfast days using repeated measures ANCOVA. We observed that the overall nutritional profile of the children in terms of fibre and micronutrient intake was superior in frequent breakfast consumers (micronutrients: folate, Ca, Fe and I (P<0·01)) and, for the 4-10 years age group, on breakfast days (micronutrients: folate, vitamin C, Ca and I (P<0·01)). Also, significantly higher proportions of breakfast-consuming children met their reference nutrient intakes of folate, vitamin C, Ca, Fe and I compared with breakfast skippers (χ 2 analysis, P<0·001). Our study adds to the body of data linking breakfast consumption with higher quality dietary intake in school-age children, supporting the promotion of breakfast as an important element of a healthy dietary pattern in children.
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78
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Pires AM, Félix S, Sousa ACC. Assessment of iodine importance and needs for supplementation in school-aged children in Portugal. BMC Nutr 2017; 3:64. [PMID: 32153844 PMCID: PMC7050902 DOI: 10.1186/s40795-017-0175-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 06/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Micronutrients are essential for child proper growth and development. Nutritional deficiencies of these elements have increasingly been a concern in Europe, as they are often related to the cognitive potential and physical lifelong consequences. However, being an essential trace element for thyroid function, iodine intake in the desired quantities becomes also very important for neurodevelopment, including for school-aged children. Therefore, the aim of this paper is to highlight the need for wider dissemination of the physiological importance of iodine among health professionals and the general population as well as the knowledge of iodine needs and possible supplementation within families with school-aged children. METHODS The present study is an observational, descriptive, cross-sectional evaluation of knowledge and perceptions of iodine physiological importance. An evaluation survey has been carried out based on knowledge of iodine needs and possible supplementation within families with school-aged children. It has been target at mothers with school-age children under 18 years old with residence in Portugal. Data are represented as frequency and percentages and association between variables was measured. RESULTS The internet survey has been answered by around 691 mothers, corresponding to 811 children data validated; 47% (n = 381) girls and 53% (n = 430) boys. Mother's knowledge about iodine and the importance for the improvement of learning capacity is not independent of having health study/work area (χ2 at the 0.05 level). Nevertheless, it can be observed a slight association between mothers who agree with iodine supplementation and those who effectively supplement their child (χ2 9.315; Φ 0.116). Although use of iodized kitchen salt certainly changes the balance from sub-optimal to adequate iodine nutrition, only 8.8% (n = 61) reported using iodized salt. However, 87.6% (n = 605) assumed salt iodization importance without information. CONCLUSIONS We believe that the findings of this survey have great public health importance for Portugal. While many countries have mandatory iodizes salt programmes, in Portugal iodine supplementation is not a current practice. Therefore, we suggest an urgent evaluation of iodine in Portugal, namely for school-aged children, where iodine deficiencies are critical, as well as a systematic information dissemination as a form of publicizing iodine supplementation needs.
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Affiliation(s)
- Ana M. Pires
- Universidade Atlântica – Centro de Estudos, Sociedade, Organizações e Bem-Estar (CESOB), Oeiras, Portugal
- Faculdade de Ciências da Universidade de Lisboa – Centre for Ecology, Evolution and Environmental Changes (Ce3C), Lisbon, Portugal
| | - Sandra Félix
- Universidade Atlântica – Centro de Estudos, Sociedade, Organizações e Bem-Estar (CESOB), Oeiras, Portugal
| | - Ana C. C. Sousa
- Universidade Atlântica – Centro de Estudos, Sociedade, Organizações e Bem-Estar (CESOB), Oeiras, Portugal
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79
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Arbesú Fernández E, Serrano Peraza MH, Eguia Angeles HA, Sotelo García CO, Saint Jean CH, Musa Martín NI. Urinary iodine levels and dairy consumption in pre-school children in Southwest Asturias (Spain). ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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80
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Stevenson MC, Drake C, Givens DI. Further studies on the iodine concentration of conventional, organic and UHT semi-skimmed milk at retail in the UK. Food Chem 2017; 239:551-555. [PMID: 28873603 DOI: 10.1016/j.foodchem.2017.06.135] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/17/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
Milk is the largest source of iodine in UK diets and earlier studies showed organic summer and winter milk to be significantly lower in iodine than conventional milk. One study also showed UHT milk to have lower iodine concentration. The study on winter and UHT milk was small and accordingly a new study is reported here involving conventional, organic and UHT semi-skimmed milk from four supermarkets over a six-month period in summer and winter in two regions of the UK. The results showed organic milk to be 44% lower in iodine than conventional milk (427 vs. 241µg/L, P<0.001) and UHT milk was 27% lower in iodine than conventional milk (427 vs. 314µg/L, P<0.001) although the differences tended to be less in the summer. The results indicate that replacement of conventional milk by organic or UHT milk will increase the risk of sub-optimal iodine status especially for pregnant/lactating women.
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Affiliation(s)
- Melissa C Stevenson
- Institute for Food, Nutrition and Health, University of Reading, Earley Gate, Reading RG6 6AR, UK.
| | - Chris Drake
- Institute for Food, Nutrition and Health, University of Reading, Earley Gate, Reading RG6 6AR, UK; Hypha Discovery Ltd, Russell Building, Brunel Science Park, Uxbridge, Middlesex UB8 3PQ, UK.
| | - D Ian Givens
- Institute for Food, Nutrition and Health, University of Reading, Earley Gate, Reading RG6 6AR, UK.
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81
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Puncher M, Zhang W, Harrison JD, Wakeford R. Assessing the reliability of dose coefficients for exposure to radioiodine by members of the public, accounting for dosimetric and risk model uncertainties. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2017; 37:506-526. [PMID: 28586312 DOI: 10.1088/1361-6498/aa6a68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Assessments of risk to a specific population group resulting from internal exposure to a particular radionuclide can be used to assess the reliability of the appropriate International Commission on Radiological Protection (ICRP) dose coefficients used as a radiation protection device for the specified exposure pathway. An estimate of the uncertainty on the associated risk is important for informing judgments on reliability; a derived uncertainty factor, UF, is an estimate of the 95% probable geometric difference between the best risk estimate and the nominal risk and is a useful tool for making this assessment. This paper describes the application of parameter uncertainty analysis to quantify uncertainties resulting from internal exposures to radioiodine by members of the public, specifically 1, 10 and 20-year old females from the population of England and Wales. Best estimates of thyroid cancer incidence risk (lifetime attributable risk) are calculated for ingestion or inhalation of 129I and 131I, accounting for uncertainties in biokinetic model and cancer risk model parameter values. These estimates are compared with the equivalent ICRP derived nominal age-, sex- and population-averaged estimates of excess thyroid cancer incidence to obtain UFs. Derived UF values for ingestion or inhalation of 131I for 1 year, 10-year and 20-year olds are around 28, 12 and 6, respectively, when compared with ICRP Publication 103 nominal values, and 9, 7 and 14, respectively, when compared with ICRP Publication 60 values. Broadly similar results were obtained for 129I. The uncertainties on risk estimates are largely determined by uncertainties on risk model parameters rather than uncertainties on biokinetic model parameters. An examination of the sensitivity of the results to the risk models and populations used in the calculations show variations in the central estimates of risk of a factor of around 2-3. It is assumed that the direct proportionality of excess thyroid cancer risk and dose observed at low to moderate acute doses and incorporated in the risk models also applies to very small doses received at very low dose rates; the uncertainty in this assumption is considerable, but largely unquantifiable. The UF values illustrate the need for an informed approach to the use of ICRP dose and risk coefficients.
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Affiliation(s)
- M Puncher
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Didcot, OX11 0RQ, United Kingdom
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Costa Leite J, Keating E, Pestana D, Cruz Fernandes V, Maia ML, Norberto S, Pinto E, Moreira-Rosário A, Sintra D, Moreira B, Costa A, Silva S, Costa V, Martins I, Castro Mendes F, Queirós P, Peixoto B, Carlos Caldas J, Guerra A, Fontoura M, Leal S, Moreira R, Palmares Carvalho I, Matias Lima R, Martins C, Delerue-Matos C, Almeida A, Azevedo L, Calhau C. Iodine Status and Iodised Salt Consumption in Portuguese School-Aged Children: The Iogeneration Study. Nutrients 2017; 9:E458. [PMID: 28475154 PMCID: PMC5452188 DOI: 10.3390/nu9050458] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/26/2017] [Accepted: 04/28/2017] [Indexed: 11/17/2022] Open
Abstract
The World Health Organization promotes salt iodisation to control iodine deficiency. In Portugal, the use of iodised salt in school canteens has been mandatory since 2013. The present study aimed to evaluate iodine status in school-aged children (6-12 years) and to monitor the use of iodised salt in school canteens. A total of 2018 participants were randomly selected to participate in a cross-sectional survey in northern Portugal. Children's urine and salt samples from households and school canteens were collected. A lifestyle questionnaire was completed by parents to assess children's eating frequency of iodine food sources. Urinary iodine concentration (UIC) was measured by inductively coupled plasma-mass spectrometry. The median UIC was 129 µg/L which indicates the adequacy of iodine status and 32% of the children had UIC < 100 µg/L. No school canteen implemented the iodised salt policy and only 2% of the households were using iodised salt. Lower consumption of milk, but not fish, was associated with a higher risk of iodine deficiency. Estimation of sodium intake from spot urine samples could be an opportunity for adequate monitoring of population means. Implementation of iodine deficiency control policies should include a monitoring program aligned with the commitment of reducing the population salt intake.
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Affiliation(s)
- João Costa Leite
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- Department of Biomedicine-Biochemistry Unit, Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal.
| | - Elisa Keating
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- Department of Biomedicine-Biochemistry Unit, Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal.
| | - Diogo Pestana
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- Department of Biomedicine-Biochemistry Unit, Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal.
- Nutrition & Metabolism, NOVA Medical School|Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal.
| | - Virgínia Cruz Fernandes
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- Department of Biomedicine-Biochemistry Unit, Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal.
- LAQV/REQUIMTE-Instituto Superior de Engenharia, Instituto Politécnico do Porto, 4249-015 Porto, Portugal.
| | - Maria Luz Maia
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- Department of Biomedicine-Biochemistry Unit, Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal.
| | - Sónia Norberto
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- Department of Biomedicine-Biochemistry Unit, Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal.
| | - Edgar Pinto
- LAQV/REQUIMTE-Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4249-015 Porto, Portugal.
| | - André Moreira-Rosário
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- Department of Biomedicine-Biochemistry Unit, Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal.
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal.
| | - Diana Sintra
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
| | - Bárbara Moreira
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
| | - Ana Costa
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
| | - Sofia Silva
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
| | - Vera Costa
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
| | - Inês Martins
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
| | | | - Pedro Queirós
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
| | - Bruno Peixoto
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies, 4585-116 Gandra, Portugal.
| | - José Carlos Caldas
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies, 4585-116 Gandra, Portugal.
| | - António Guerra
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- Division of Paediatric Nutrition, Department of Paediatrics, Integrated Paediatric Hospital, Centro Hospitalar São João, Porto. Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal.
| | - Manuel Fontoura
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- Division of Paediatric Endocrinology, Department of Paediatrics, Integrated Paediatric Hospital, Centro Hospitalar São João, Porto. Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal.
| | - Sandra Leal
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies, 4585-116 Gandra, Portugal.
- Department of Biomedicine-Anatomy Unit, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal.
| | - Roxana Moreira
- CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies, 4585-116 Gandra, Portugal.
| | - Irene Palmares Carvalho
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal.
| | - Rui Matias Lima
- Directorate-General of Education, 1049-005 Lisbon, Portugal.
| | - Catia Martins
- Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), NO-7491 Trondheim, Norway.
| | - Cristina Delerue-Matos
- LAQV/REQUIMTE-Instituto Superior de Engenharia, Instituto Politécnico do Porto, 4249-015 Porto, Portugal.
| | - Agostinho Almeida
- LAQV/REQUIMTE-Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4249-015 Porto, Portugal.
| | - Luís Azevedo
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal.
| | - Conceição Calhau
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal.
- Department of Biomedicine-Biochemistry Unit, Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal.
- Nutrition & Metabolism, NOVA Medical School|Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal.
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Bath SC, Pop VJM, Furmidge-Owen VL, Broeren MAC, Rayman MP. Thyroglobulin as a Functional Biomarker of Iodine Status in a Cohort Study of Pregnant Women in the United Kingdom. Thyroid 2017; 27:426-433. [PMID: 27762729 PMCID: PMC5337401 DOI: 10.1089/thy.2016.0322] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Though iodine deficiency in pregnancy is a matter of public-health concern, a functional measure of iodine status is lacking. The thyroid-specific protein thyroglobulin (Tg), which reflects thyroid size, has shown promise as a functional measure in studies of children and adults, but data in pregnancy are sparse. In a cohort of mildly to moderately iodine-deficient pregnant women, this study aimed to explore whether serum Tg is a sensitive functional biomarker of iodine status and to examine longitudinal change in Tg with gestational age. METHOD A total of 230 pregnant women were recruited at an antenatal clinic at 12 weeks of gestation to the Selenium in PRegnancy INTervention study, in Oxford, United Kingdom. Repeated measures of urinary iodine-to-creatinine ratio, serum thyrotropin (TSH), and Tg at 12, 20, and 35 weeks of gestation were made. Women were dichotomized by their iodine-to-creatinine ratio (<150 or ≥150 μg/g) to group them broadly as iodine deficient or iodine sufficient. Women with thyroid antibodies were excluded; data and samples were available for 191 women. RESULTS Median Tg concentrations were 21, 19, and 23 μg/L in the first, second, and third trimesters, respectively. In a linear mixed model, controlling for confounders, Tg was higher in the <150 μg/g group than it was in the ≥150 μg/g group (p < 0.001) but there was no difference in TSH (p = 0.27). Gestational week modified the effect of iodine status on TSH (p = 0.01) and Tg (p = 0.012); Tg did not increase with gestational week in the ≥150 μg/g group, but it did in the <150 μg/g group, and TSH increased more steeply in the <150 μg/g group. CONCLUSIONS Low iodine status (<150 μg/g) in pregnancy is associated with higher serum Tg, suggesting that the thyroid is hyperstimulated by iodine deficiency, which causes it to enlarge. Tg is a more sensitive biomarker of iodine status in pregnancy than is TSH.
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Affiliation(s)
- Sarah C Bath
- 1 Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey , Guildford, United Kingdom
| | - Victor J M Pop
- 2 Department of Primary Care, University of Tilburg , Tilburg, The Netherlands
| | - Victoria L Furmidge-Owen
- 1 Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey , Guildford, United Kingdom
- 3 Danone Nutricia Early Life Nutrition , Trowbridge, United Kingdom
| | - Maarten A C Broeren
- 4 Department of Clinical Chemistry, Máxima Medical Center , Veldhoven, The Netherlands
| | - Margaret P Rayman
- 1 Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey , Guildford, United Kingdom
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84
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Knight BA, Shields BM, He X, Pearce EN, Braverman LE, Sturley R, Vaidya B. Iodine deficiency amongst pregnant women in South-West England. Clin Endocrinol (Oxf) 2017; 86:451-455. [PMID: 27805280 DOI: 10.1111/cen.13268] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/21/2016] [Accepted: 10/27/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Iodine deficiency in pregnancy may impair foetal neurological development. The UK population is generally thought to be iodine sufficient; however, recent studies have questioned this assumption. Our study aimed to explore the prevalence of iodine deficiency in a cohort of pregnant mothers from South-West England. METHODS Urine samples were obtained from 308 women participating in a study of breech presentation in late pregnancy. They had no known thyroid disease and a singleton pregnancy at 36-38 weeks' gestation. Samples were analysed for urinary iodine concentrations (UIC). Baseline data included age, parity, smoking status, ethnicity, body mass index (BMI) at booking, prenatal vitamin use and a dietary questionnaire. There was no difference in median UIC between women with (n = 156) or without (n = 152) a breech presentation (P = 0·3), so subsequent analyses were carried out as a combined group. RESULTS Participants had a mean (SD) age 31(5) years, median (IQR) BMI 24·4 (22·0, 28·3) kg/m2 ; 42% were primiparous, 10% smoked during pregnancy, and 35% took iodine-containing vitamins. Ninety-six per cent were Caucasian. Median (IQR) UIC was 88·0 (54·3, 157·5) μg/l, which is consistent with iodine deficiency by WHO criteria. A total of 224/308 (73%) of women had UIC values <150 μg/l. Increasing milk intake was associated with higher UIC (P = 0·02). There was no difference in median (IQR) UIC between those women who took iodine-containing vitamins (n = 108) and those who did not (n = 200): 88 (54, 168) vs 88 (54, 150) μg/l, P = 0·7. CONCLUSION Iodine deficiency in pregnancy is common in South-West England. Measures to develop optimum prevention and treatment strategies are urgently needed.
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Affiliation(s)
- Bridget A Knight
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, University of Exeter, Exeter, UK
- Research & Development Department, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Beverley M Shields
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Xuemei He
- Section of Endocrinology, Diabetes & Nutrition, Boston University School of Medicine, Boston, MA, USA
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes & Nutrition, Boston University School of Medicine, Boston, MA, USA
| | - Lewis E Braverman
- Section of Endocrinology, Diabetes & Nutrition, Boston University School of Medicine, Boston, MA, USA
| | - Rachel Sturley
- Centre for Women's Health, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
- University of Exeter Medical School, Exeter, UK
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85
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De Leo S, Pearce EN, Braverman LE. Iodine Supplementation in Women During Preconception, Pregnancy, and Lactation: Current Clinical Practice by U.S. Obstetricians and Midwives. Thyroid 2017; 27:434-439. [PMID: 27784201 DOI: 10.1089/thy.2016.0227] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Iodine deficiency is a major public-health problem throughout the world, especially for pregnant women, and it is considered the most common cause of preventable intellectual impairment. In the United States, iodine status in pregnant women is considered mildly deficient. Therefore, the Endocrine Society, the American Thyroid Association, the Teratology Society, and the American Academy of Pediatrics recommend that women receive prenatal vitamins containing 150 μg of iodine daily during preconception, pregnancy, and lactation. The objectives of this study were to evaluate awareness of iodine nutrition among obstetricians and midwives in the United States, and to document current clinical practice regarding recommendations for iodine supplementation for women during preconception, pregnancy, and lactation. METHODS All midwife members of the American College of Nurse-Midwives (ACNM) and all obstetrician members of the American Medical Association (AMA) were invited to participate in a web-based survey. RESULTS A total of 199 midwives and 277 obstetricians participated in the survey. One third of both obstetricians and midwives considered iodine status in U.S. pregnant women to be deficient. Although almost all obstetricians and midwives would recommend prenatal multivitamins, most reported rarely or never recommending iodine-containing multivitamins for women planning pregnancy (68.7% and 70.2%, respectively), pregnant women (66% and 67.1%), or lactating women (68.7% and 71.7%). Of the respondents who did report prescribing iodine-containing supplements, 85% recommended supplementation during the first trimester and 75-80% during the second and third trimesters. However, of those who did recommend iodine supplementation, only 45% would prescribe the recommended 150 μg of iodine daily during pregnancy. Overall, 75% of U.S. obstetricians and midwives do not recommend or would recommend an inadequate amount of iodine during preconception, pregnancy, and lactation. CONCLUSIONS Despite the important consequences of iodine deficiency for pregnant women and the recommendations of many medical societies, the majority of U.S. obstetricians and midwives who participated in this survey do not recommend iodine-containing vitamins in women planning pregnancy, during pregnancy, and during lactation.
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Affiliation(s)
- Simone De Leo
- 1 Endocrine Unit, Fondazione IRCCS Cà Granda , Milan, Italy
- 2 Department of Clinical Sciences and Community Health, University of Milan , Milan, Italy
- 3 Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine , Boston, Massachusetts
| | - Elizabeth N Pearce
- 3 Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine , Boston, Massachusetts
| | - Lewis E Braverman
- 3 Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine , Boston, Massachusetts
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Abstract
AbstractI is an important mineral for health, required for the production of key thyroid hormones, which are essential for cellular metabolism, growth and physical development. Hence, adequate I is crucial at all stages of life, but imperative during pregnancy for fetal brain development and during a child’s early life for neurodevelopment. Within Ireland, limited information exists on population I intakes and status. Therefore, the purposes of the present analysis were to estimate dietary I intakes and to analyse urinary iodine (UI) status using the cross-sectional National Adult Nutrition Survey 2008–2010 and the most recent Irish Total Diet Study. Median I intakes in the total population (n1106) were adequate with only 26 % of the population being classified as below the estimated average requirement (EAR). Milk consumption was the major source of I in the diet, contributing 45 % to total intake. Likewise, median UI concentrations (107 µg/l) indicated ‘optimal’ I nutrition according to the WHO cut-off points. In our cohort, 77 % of women of childbearing age (18–50 years) did not meet the EAR recommendation set for pregnant women. Although I is deemed to be sufficient in the majority of adult populations resident in Ireland, any changes to the current dairy practices could significantly impact intake and status. Continued monitoring should be of priority to ensure that all subgroups of the population are I sufficient.
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87
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Santos JEC, Freitas M, Fonseca CP, Castilho P, Carreira IM, Rombeau JL, Branco MC. Iodine deficiency a persisting problem: assessment of iodine nutrition and evaluation of thyroid nodular pathology in Portugal. J Endocrinol Invest 2017; 40:185-191. [PMID: 27619914 DOI: 10.1007/s40618-016-0545-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 09/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The goal of eliminating iodine deficiency (ID) by the year 2000 has still not been achieved in several countries. More than 2 billion people worldwide (over 260 million school age children) remain ID. In Europe, there are still countries, such as Portugal, without national general population data on iodine nutrition (IN). This study aims at evaluating combined complementary data of the IN of the general population through urinary iodine concentration (UIC) and the thyroid histology profile from the inland region of Beira Interior (BI), in Portugal. METHODS UIC from a population sample of 214 volunteers (131 females and 83 males), with ages ranging from 8 to 97 years (mean 51.5 years ± SD 20.74 years), from BI was determined; the thyroid histology pattern in BI (6-year period) was evaluated; and the iodine content of the largest surface water reservoir of BI, never previously reported, was measured. RESULTS Median UIC of 62.6 μg/L was measured. Over 92 % of the population had UIC less than 100 μg/L. From 279 histology reports evaluated, the incidence of the different types of thyroid nodular pathology in BI was established. There were 60 histologic diagnoses of malignancy. The observed ratio of papillary to follicular carcinoma relatively close to 1 and the fairly high percentage of anaplastic carcinomas are characteristic of ID areas. CONCLUSIONS The findings of this first general population study on IN from the inland region of BI, Portugal, document significant ID. This problem, with its serious public health implications, could be corrected by having affordable iodised salt widely and generally available and by promoting a proactive population attitude generated by ample public information and educational programs as to the negative consequences of ID.
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Affiliation(s)
- J E C Santos
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
- CICS-UBI Health Sciences Research Centre, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
- Centro Hospitalar Cova da Beira, Covilhã, Portugal.
| | - M Freitas
- Department of Biostatistics, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - C P Fonseca
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- CICS-UBI Health Sciences Research Centre, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - P Castilho
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- CICS-UBI Health Sciences Research Centre, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - I M Carreira
- CIMAGO - Centre of Investigation in Environment, Genetics and Oncobiology, Coimbra, Portugal
- Laboratory of Cytogenetics and Genomics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J L Rombeau
- Emeritus Professor of Surgery, Perleman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M C Branco
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- CICS-UBI Health Sciences Research Centre, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- Centro Hospitalar Cova da Beira, Covilhã, Portugal
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88
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Peckham S, Lowery D, Spencer S. Fluoride levels in drinking water and hypothyroidism: Response to Grimes and Newton et al. J Epidemiol Community Health 2017; 71:313-314. [PMID: 28093449 DOI: 10.1136/jech-2016-208632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S Peckham
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - D Lowery
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - S Spencer
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
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89
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Del C Valdés Hernández M, Kyle J, Allan J, Allerhand M, Clark H, Muñoz Manieg S, Royle NA, Gow AJ, Pattie A, Corley J, Bastin ME, Starr JM, Wardlaw JM, Deary IJ, Combet E. Dietary Iodine Exposure and Brain Structures and Cognition in Older People. Exploratory Analysis in the Lothian Birth Cohort 1936. J Nutr Health Aging 2017; 21:971-979. [PMID: 29083437 DOI: 10.1007/s12603-017-0954-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Iodine deficiency is one of the three key micronutrient deficiencies highlighted as major public health issues by the World Health Organisation. Iodine deficiency is known to cause brain structural alterations likely to affect cognition. However, it is not known whether or how different (lifelong) levels of exposure to dietary iodine influences brain health and cognitive functions. METHODS From 1091 participants initially enrolled in The Lothian Birth Cohort Study 1936, we obtained whole diet data from 882. Three years later, from 866 participants (mean age 72 yrs, SD±0.8), we obtained cognitive information and ventricular, hippocampal and normal and abnormal tissue volumes from brain structural magnetic resonance imaging scans (n=700). We studied the brain structure and cognitive abilities of iodine-rich food avoiders/low consumers versus those with a high intake in iodine-rich foods (namely dairy and fish). RESULTS We identified individuals (n=189) with contrasting diets, i) belonging to the lowest quintiles for dairy and fish consumption, ii) milk avoiders, iii) belonging to the middle quintiles for dairy and fish consumption, and iv) belonging to the middle quintiles for dairy and fish consumption. Iodine intake was secured mostly though the diet (n=10 supplement users) and was sufficient for most (75.1%, median 193 µg/day). In individuals from these groups, brain lateral ventricular volume was positively associated with fat, energy and protein intake. The associations between iodine intake and brain ventricular volume and between consumption of fish products (including fish cakes and fish-containing pasties) and white matter hyperintensities (p=0.03) the latest being compounded by sodium, proteins and saturated fats, disappeared after type 1 error correction. CONCLUSION In this large Scottish older cohort, the proportion of individuals reporting extreme (low vs. high)/medium iodine consumption is small. In these individuals, low iodine-rich food intake was associated with increased brain volume shrinkage, raising an important hypothesis worth being explored for designing appropriate guidelines.
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Affiliation(s)
- M Del C Valdés Hernández
- Dr. Maria C. Valdés Hernández, Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Chancellor's Building, Edinburgh, EH16 4SB, UK. Telephone:+44-131-4659527, Fax: +44-131-3325150, E-mail:
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90
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Sarfo-Kantanka O, Sarfo FS, Ansah EO, Kyei I. Spectrum of Endocrine Disorders in Central Ghana. Int J Endocrinol 2017; 2017:5470731. [PMID: 28326101 PMCID: PMC5343284 DOI: 10.1155/2017/5470731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/25/2016] [Accepted: 11/27/2016] [Indexed: 12/24/2022] Open
Abstract
Background. Although an increasing burden of endocrine disorders is recorded worldwide, the greatest increase is occurring in developing countries. However, the spectrum of these disorders is not well described in most developing countries. Objective. The objective of this study was to profile the frequency of endocrine disorders and their basic demographic characteristics in an endocrine outpatient clinic in Kumasi, central Ghana. Methods. A retrospective review was conducted on endocrine disorders seen over a five-year period between January 2011 and December 2015 at the outpatient endocrine clinic of Komfo Anokye Teaching Hospital. All medical records of patients seen at the endocrine clinic were reviewed by endocrinologists and all endocrinological diagnoses were classified according to ICD-10. Results. 3070 adults enrolled for care in the endocrine outpatient service between 2011 and 2015. This comprised 2056 females and 1014 males (female : male ratio of 2.0 : 1.0) with an overall median age of 54 (IQR, 41-64) years. The commonest primary endocrine disorders seen were diabetes, thyroid, and adrenal disorders at frequencies of 79.1%, 13.1%, and 2.2%, respectively. Conclusions. Type 2 diabetes and thyroid disorders represent by far the two commonest disorders seen at the endocrine clinic. The increased frequency and wide spectrum of endocrine disorders suggest the need for well-trained endocrinologists to improve the health of the population.
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Affiliation(s)
| | - Fred Stephen Sarfo
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
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93
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Iodine knowledge is positively associated with dietary iodine intake among women of childbearing age in the UK and Ireland. Br J Nutr 2016; 116:1728-1735. [PMID: 27855727 DOI: 10.1017/s0007114516003925] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Adequate I intake is important before conception and during pregnancy for optimal infant neurodevelopment. Recent studies have highlighted the prevalence of I deficiency in the UK and Ireland. It is possible that optimal I intake may be impeded by a poor knowledge of I nutrition. This study aimed to investigate I knowledge among women of childbearing age in the UK and Ireland and to determine whether a relationship exists between I knowledge and dietary I intake. Females (aged 18-45 years) were invited to complete an online questionnaire, which assessed knowledge of I and estimated dietary I intake using a FFQ. A total of 520 females of childbearing age completed the study. I knowledge was poor; only one-third (32 %) of the participants correctly identified pregnancy as the most important stage of the lifecycle for I, and 41 % of participants could not correctly identify any health problem related to I deficiency. The median daily I intake was estimated as 152 µg/d. Almost half (46 %) of the participants failed to meet dietary recommendations (140 µg/d) for I. A higher dietary I intake was positively associated with greater I knowledge (r 0·107; P=0·016). This study suggests that knowledge of I nutrition is low among women of childbearing age, and those with a greater knowledge of I nutrition had a higher dietary I intake. Initiatives to educate women of childbearing age on the importance of I nutrition should be considered as part of a larger public health strategy to address I deficiency.
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94
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Affiliation(s)
- M. Reid
- School of Life Sciences; University of Hull; Hull UK
| | - R. Hammersley
- School of Life Sciences; University of Hull; Hull UK
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95
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Boelaert K. WOMEN IN CANCER PROFILE: From bedside to bench and back: my journey in thyroid disease. Endocr Relat Cancer 2016; 23:P9-P13. [PMID: 27633515 DOI: 10.1530/erc-16-0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Kristien Boelaert
- Reader in EndocrinologyInstitute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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96
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Kurku H, Gencer A, Pirgon O, Buyukinan M, Aslan N. Increased oxidative stress parameters in children with moderate iodine deficiency. J Pediatr Endocrinol Metab 2016; 29:1159-1164. [PMID: 27710914 DOI: 10.1515/jpem-2016-0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/29/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND Iodine is a part of thyroid hormones and has been reported to act directly as an antioxidant or induce indirectly antioxidant enzymes. This study aimed to assess the urinary iodine concentration and its relationship between the antioxidant and oxidative stress capacity in healthy school-aged children. METHODS In total, 196 students from five primary schools, randomly selected between 9 and 12 years (mean age: 10.2±1.2 years), were enrolled in the study. Urinary iodine levels were measured by spectrophotometry with the Sandell-Kolthoff reaction. Total antioxidant status (TAS) and total oxidant status (TOS) were analysed from urine samples. The ratio of TOS to TAS was regarded as an oxidative stress index (OSI), an indicator of the degree of oxidative status. RESULTS Fifty-four percentage (107) of the children had iodine deficiency (ID) and the majority of them (30%) had mild ID. There was no severe-ID child in the population (<20 μg/L). Urine TAS levels were significantly lower in the moderate-ID group than in the mild-ID group (6.5±4.1 vs. 11.3±4.1 mmol, p<0.001) and the iodine-sufficient group (11.0±5.3 μmol, p<0.001). TOS levels and OSI were found higher in the moderate-ID group than in the mild-ID group (4.8±2.1 vs. 3.7±2.1 μmol, p<0.001) and the iodine-sufficient group (4.8±2.1 vs. 3.4±2.5 mmol, p<0.001). In the moderate-ID group, low urine iodine levels exhibited significant negative correlations with OSI (r=-0.660) and TOS (r=-0.248) and a positive correlation with TAS (r=0.475). CONCLUSIONS We found that children with moderate ID were exposed to more oxidative burden than children with mild ID or iodine sufficiency. Increased systemic oxidative stress induced by moderate ID could cause development of ID-related complications and diseases. Iodine supplementation could have a beneficial role in the prevention of oxidative stress.
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97
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Bath SC, Combet E, Scully P, Zimmermann MB, Hampshire-Jones KHC, Rayman MP. A multi-centre pilot study of iodine status in UK schoolchildren, aged 8-10 years. Eur J Nutr 2016; 55:2001-9. [PMID: 26276556 PMCID: PMC5009164 DOI: 10.1007/s00394-015-1014-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 08/05/2015] [Indexed: 11/04/2022]
Abstract
PURPOSE Iodine, as an essential constituent of thyroid hormones, is required for brain development. Iodine status is low in some UK population groups, notably in teenage girls, women of childbearing age and pregnant women. We aimed to assess iodine status of UK schoolchildren as there are no data on children below 14 years of age. METHODS Children (boys and girls) aged 8-10 years were recruited to a cross-sectional study from schools in three areas of the UK (Omagh, Northern Ireland; Glasgow, Scotland, and Guildford, South-East England). Spot urine samples, for measurement of urinary iodine concentration, were collected in the winter months (November 2012 to March 2013) and in the summer, in Omagh only (September 2013). A food frequency questionnaire was completed. RESULTS A total of 168 schoolchildren provided 165 urine samples. The median urinary iodine concentration was 161 µg/L in winter samples (n = 134) and 127 µg/L in summer samples (n = 31). The median urinary iodine concentration for the whole group was 144 µg/L, weighted to account for the unequal proportion of samples from the two seasons. The children are classified as iodine-sufficient by WHO criteria (100-199 µg/L), even in the summer. Milk intake was positively associated with iodine status. CONCLUSIONS This pilot study suggests that iodine deficiency is unlikely to be a problem in UK children aged 8-10 years. This could be a result of higher intake of milk, the principal UK dietary iodine source, in this age group than in teenagers and adults. Further assessment of iodine status in a representative sample of UK schoolchildren is required.
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Affiliation(s)
- Sarah C. Bath
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH UK
| | - Emilie Combet
- Human Nutrition, School of Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, G31 2ER UK
| | - Patrick Scully
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH UK
| | - Michael B. Zimmermann
- Human Nutrition Laboratory, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Katharine H. C. Hampshire-Jones
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH UK
| | - Margaret P. Rayman
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH UK
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98
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Peters C, Brooke I, Heales S, Ifederu A, Langham S, Hindmarsh P, Cole TJ. Defining the Newborn Blood Spot Screening Reference Interval for TSH: Impact of Ethnicity. J Clin Endocrinol Metab 2016; 101:3445-9. [PMID: 27399348 PMCID: PMC5010572 DOI: 10.1210/jc.2016-1822] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/29/2016] [Indexed: 12/21/2022]
Abstract
CONTEXT There is variability in the congenital hypothyroidism (CH) newborn screening TSH cutoff across the United Kingdom. OBJECTIVE To determine the influences of year, gender, and ethnicity on screening variability and examine whether there is an optimal operational TSH cutoff. DESIGN AND SETTING Single center, retrospective population study using blood spot TSH cards received by the Great Ormond Street Hospital Screening Laboratory between 2006 and 2012. PATIENTS A total of 824 588 newborn screening blood spot TSH cards. INTERVENTION Blood spot TSH results were recorded with demographic data including the Ethnic Category Code. MAIN OUTCOME MEASURES The proportions of samples exceeding different TSH cutoffs, ranked by ethnicity. RESULTS The proportion of samples exceeding the TSH cutoff increased over time, with the cutoff at 4 mU/L, but not at 6 mU/L. There was a consistent trend with ethnicity, irrespective of cutoff, with the odds ratio of exceeding the TSH cutoff lowest (∼1.0) in White babies, higher in Pakistani and Bangladeshi (>2.0), and highest in Chinese (>3.5). CONCLUSIONS The blood spot TSH screening data demonstrate a clear ranking according to ethnicity for differences in mean TSH. This suggests that there may be ethnic differences in thyroid physiology. Ethnic diversity within populations needs to be considered when establishing and interpreting screening TSH cutoffs.
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Affiliation(s)
- Catherine Peters
- Department of Endocrinology (C.P., S.L., P.H.), and Chemical Pathology, Laboratory Medicine (I.B., S.H., A.I.), Great Ormond Street Hospital, London WC1N 3JH, United Kingdom; and Population, Policy, and Practice Programme (T.J.C.), UCL Institute of Health, London WC1N 1EH, United Kingdom
| | - Ivan Brooke
- Department of Endocrinology (C.P., S.L., P.H.), and Chemical Pathology, Laboratory Medicine (I.B., S.H., A.I.), Great Ormond Street Hospital, London WC1N 3JH, United Kingdom; and Population, Policy, and Practice Programme (T.J.C.), UCL Institute of Health, London WC1N 1EH, United Kingdom
| | - Simon Heales
- Department of Endocrinology (C.P., S.L., P.H.), and Chemical Pathology, Laboratory Medicine (I.B., S.H., A.I.), Great Ormond Street Hospital, London WC1N 3JH, United Kingdom; and Population, Policy, and Practice Programme (T.J.C.), UCL Institute of Health, London WC1N 1EH, United Kingdom
| | - Adeboye Ifederu
- Department of Endocrinology (C.P., S.L., P.H.), and Chemical Pathology, Laboratory Medicine (I.B., S.H., A.I.), Great Ormond Street Hospital, London WC1N 3JH, United Kingdom; and Population, Policy, and Practice Programme (T.J.C.), UCL Institute of Health, London WC1N 1EH, United Kingdom
| | - Shirley Langham
- Department of Endocrinology (C.P., S.L., P.H.), and Chemical Pathology, Laboratory Medicine (I.B., S.H., A.I.), Great Ormond Street Hospital, London WC1N 3JH, United Kingdom; and Population, Policy, and Practice Programme (T.J.C.), UCL Institute of Health, London WC1N 1EH, United Kingdom
| | - Peter Hindmarsh
- Department of Endocrinology (C.P., S.L., P.H.), and Chemical Pathology, Laboratory Medicine (I.B., S.H., A.I.), Great Ormond Street Hospital, London WC1N 3JH, United Kingdom; and Population, Policy, and Practice Programme (T.J.C.), UCL Institute of Health, London WC1N 1EH, United Kingdom
| | - Tim J Cole
- Department of Endocrinology (C.P., S.L., P.H.), and Chemical Pathology, Laboratory Medicine (I.B., S.H., A.I.), Great Ormond Street Hospital, London WC1N 3JH, United Kingdom; and Population, Policy, and Practice Programme (T.J.C.), UCL Institute of Health, London WC1N 1EH, United Kingdom
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Abstract
BACKGROUND Iodine is necessary for the production of thyroid hormones and is acquired through the diet. Cow's milk is a primary source of iodine in the U.S. diet. The objective of this study was to measure the iodine content in a variety of milk alternatives to determine whether milk alternatives contain iodine levels comparable to that of cow's milk. METHODS Iodine levels from 30 different brands of milk alternatives from 16 different companies were measured by the spectrophotometric method of the Sandell-Kolthoff reaction. RESULTS The 30 brands of milk alternatives contained an average of 3.1 ± 2.5 μg/250 mL (∼8 oz. or one cup, serving size) of iodine or 12.3 ± 10.1 μg/L (∼24 oz. or four cups, daily recommended serving for adequate calcium intake) of iodine. CONCLUSIONS These results indicate that milk alternatives contain far less iodine than cow's milk. Individuals with restricted dairy product consumption are at risk for inadequate dietary iodine intake.
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Affiliation(s)
- Wendy Ma
- 1 Department of Biological Sciences, Wellesley College , Wellesley, Massachusetts
| | - Xuemei He
- 2 Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine , Boston, Massachusetts
| | - Lewis Braverman
- 2 Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine , Boston, Massachusetts
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100
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Pearce EN, Lazarus JH, Moreno-Reyes R, Zimmermann MB. Consequences of iodine deficiency and excess in pregnant women: an overview of current knowns and unknowns. Am J Clin Nutr 2016; 104 Suppl 3:918S-23S. [PMID: 27534632 PMCID: PMC5004501 DOI: 10.3945/ajcn.115.110429] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Severe iodine deficiency during development results in maternal and fetal hypothyroidism and associated serious adverse health effects, including cretinism and growth retardation. Universal salt iodization is the first-line strategy for the elimination of severe iodine deficiency. Iodine supplementation is recommended for vulnerable groups in severely iodine-deficient regions where salt iodization is infeasible or insufficient. A recent clinical trial has informed best practices for iodine supplementation of severely iodine-deficient lactating mothers. Because of successful programs of universal salt iodization in formerly severely iodine-deficient regions around the world, public health concern has shifted toward mild to moderate iodine deficiency, which remains prevalent in many regions, especially among pregnant women. Observational studies have shown associations between both mild maternal iodine deficiency and mild maternal thyroid hypofunction and decreased child cognition. Iodine supplementation has been shown to improve indexes of maternal thyroid function, even in marginally iodine-deficient areas. However, no data are yet available from randomized controlled trials in regions of mild to moderate iodine insufficiency on the relation between maternal iodine supplementation and neurobehavioral development in the offspring; thus, the long-term benefits and safety of such supplementation are uncertain. Although it is clear that excessive iodine intake can cause alterations in thyroid function in susceptible individuals, safe upper limits for iodine intake in pregnancy have not been well defined. Well-designed, prospective, randomized controlled trials that examine the effects of iodine supplementation on maternal thyroid function and infant neurobehavioral development in mildly to moderately iodine-deficient pregnant women are urgently needed. In addition, clinical data on the effects of iodine excess in pregnant and lactating women are needed to inform current recommendations for safe upper limits on chronic iodine ingestion in general and on iodine supplementation in particular.
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Affiliation(s)
- Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA;
| | - John H Lazarus
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Rodrigo Moreno-Reyes
- Department of Nuclear Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; and
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
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