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Can desalinated seawater contribute to iodine-deficiency disorders? An observation and hypothesis. Public Health Nutr 2016; 19:2808-17. [PMID: 27149907 DOI: 10.1017/s1368980016000951] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Over 300 million people rely on desalinated seawater and the numbers are growing. Desalination removes iodine from water and could increase the risk of iodine-deficiency disorders (IDD). The present study assessed the relationship between iodine intake and thyroid function in an area reliant on desalination. DESIGN A case-control study was performed between March 2012 and March 2014. Thyroid function was rigorously assessed by clinical examination, ultrasound and blood tests, including serum thyroglobulin (Tg) and autoimmune antibodies. Iodine intake and the contribution made by unfiltered tap water were estimated by FFQ. The contribution of drinking-water to iodine intake was modelled using three iodine concentrations: likely, worst-case and best-case scenario. SETTING The setting for the study was a hospital located on the southern Israeli Mediterranean coast. SUBJECTS Adult volunteers (n 102), 21-80 years old, prospectively recruited. RESULTS After screening, seventy-four participants met the inclusion criteria. Thirty-seven were euthyroid controls. Among those with thyroid dysfunction, twenty-nine were classified with non-autoimmune thyroid disease (NATD) after excluding eight cases with autoimmunity. Seventy per cent of all participants had iodine intake below the Estimated Average Requirement (EAR) of 95 µg/d. Participants with NATD were significantly more likely to have probable IDD with intake below the EAR (OR=5·2; 95 % CI 1·8, 15·2) and abnormal serum Tg>40 ng/ml (OR=5·8; 95 % CI 1·6, 20·8). CONCLUSIONS Evidence of prevalent probable IDD in a population reliant on desalinated seawater supports the urgent need to probe the impact of desalinated water on thyroid health in Israel and elsewhere.
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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)]. An Pediatr (Barc) 2016; 87:18-25. [PMID: 27139366 DOI: 10.1016/j.anpedi.2016.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/16/2016] [Accepted: 03/17/2016] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION For decades dairy products have been a major source of iodine for decades. The purpose of this study was to determine the iodine nutritional status and its relationship with dairy consumption in pre-schooler children between 2 to 5 years old in a rural area with 27,847 inhabitants. PATIENTS AND METHODS It was planned to study 200 participants, selected by random sampling, proportional to the size of the municipality, age, and sex. Parents provided urine samples to analyse urinary iodine, as well as the nutritional information through an interview. A glass of milk or a slice of cheese was considered as a ration, and a portion of other milk derivatives were considered as half rations. The nutritional status of iodine was interpreted with the median (P[percentile]50) of the urinary iodine levels, and iodine intake was estimated using the mean of ration/day of milk and dairy products, fish, and eggs. RESULTS Of the total of 198 subjects that took part, 193 provide urine specimens for the determination of iodine levels. The mean dairy ration/day was 3.8 (SD:1.4). More than two-thirds (69.9%) drank ≥ 2 glasses of milk/day, and 88.1% consumed a dairy ration of another dairy product. The median urinary iodine level was 184 μg/l, but was dependent on glasses of milk/day (282.5 μg/l ≥ 4 glasses) and/or the type of milk (233.0 μg/l in semi-skimmed). An intake of 115.1 μg/day to 170.2 μg/day of iodine was estimated, and that milk was the food which provided more iodine (89.9 μg/day). CONCLUSIONS Iodine intake was adequate, although higher than necessary when four or more glasses of milk were consumed, and/or when the milk was skimmed. The consumption of dairy products should be monitored to prevent both excessive and deficient intake of iodine.
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Affiliation(s)
- Esther Arbesú Fernández
- Área Sanitaria 2 del Servicio de Salud del Principado de Asturias (SESPA), Hospital Carmen y Severo Ochoa, Cangas del Narcea, Asturias, España.
| | - M Haydee Serrano Peraza
- Área Sanitaria 2 del Servicio de Salud del Principado de Asturias (SESPA), Centro de Salud de Cangas del Narcea, Asturias, España
| | - Hans Abdón Eguia Angeles
- Área Sanitaria 2 del Servicio de Salud del Principado de Asturias (SESPA), Centro de Salud de Cangas del Narcea, Asturias, España
| | - César Oliver Sotelo García
- Área Sanitaria 2 del Servicio de Salud del Principado de Asturias (SESPA), Centro de Salud de Cangas del Narcea, Asturias, España
| | - Claude Henrry Saint Jean
- Área Sanitaria 2 del Servicio de Salud del Principado de Asturias (SESPA), Centro de Salud de Cangas del Narcea, Asturias, España
| | - Nache Ismael Musa Martín
- Área Sanitaria 2 del Servicio de Salud del Principado de Asturias (SESPA), Centro de Salud de Cangas del Narcea, Asturias, España
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253
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Impact of prenatal exposure to cadmium on cognitive development at preschool age and the importance of selenium and iodine. Eur J Epidemiol 2016; 31:1123-1134. [PMID: 27147065 PMCID: PMC5206289 DOI: 10.1007/s10654-016-0151-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 04/23/2016] [Indexed: 01/14/2023]
Abstract
The evidence regarding a potential link of low-to-moderate iodine deficiency, selenium status, and cadmium exposure during pregnancy with neurodevelopment is either contradicting or limited. We aimed to assess the prenatal impact of cadmium, selenium, and iodine on children’s neurodevelopment at 4 years of age. The study included 575 mother–child pairs from the prospective “Rhea” cohort on Crete, Greece. Exposure to cadmium, selenium and iodine was assessed by concentrations in the mother’s urine during pregnancy (median 13 weeks), measured by ICPMS. The McCarthy Scales of Children’s Abilities was used to assess children’s general cognitive score and seven different sub-scales. In multivariable-adjusted regression analysis, elevated urinary cadmium concentrations (≥0.8 µg/L) were inversely associated with children’s general cognitive score [mean change: −6.1 points (95 % CI −12; −0.33) per doubling of urinary cadmium; corresponding to ~0.4 SD]. Stratifying by smoking status (p for interaction 0.014), the association was restricted to smokers. Urinary selenium was positively associated with children’s general cognitive score [mean change: 2.2 points (95 % CI −0.38; 4.8) per doubling of urinary selenium; ~0.1 SD], although the association was not statistically significant. Urinary iodine (median 172 µg/L) was not associated with children’s general cognitive score. In conclusion, elevated cadmium exposure in pregnancy of smoking women was inversely associated with the children’s cognitive function at pre-school age. The results indicate that cadmium may adversely affect neurodevelopment at doses commonly found in smokers, or that there is an interaction with other toxicants in tobacco smoke. Additionally, possible residual confounding cannot be ruled out.
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254
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Laillou A, Sophonneary P, Kuong K, Hong R, Un S, Chamnan C, Poirot E, Berger J, Wieringa F. Low Urinary Iodine Concentration among Mothers and Children in Cambodia. Nutrients 2016; 8:172. [PMID: 27058551 PMCID: PMC4848647 DOI: 10.3390/nu8040172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/29/2016] [Accepted: 03/09/2016] [Indexed: 12/02/2022] Open
Abstract
A 2014 national assessment of salt iodization coverage in Cambodia found that 62% of samples were non-iodized, suggesting a significant decline in daily iodine intakes. The Cambodian Micronutrient Survey conducted in 2014 (CMNS-2014) permitted obtaining national data on urinary iodine concentrations (UIC) to assess iodine status and whether iodized salt use had an impact. Urine samples were collected from mothers (n = 736) and children (n = 950). The median UIC was 63 µg/L and 72 µg/L in mothers and children respectively. More than 60% of mothers and their children had a UIC < 100 µg/L, thereby indicating a serious public health problem. Iodine status was significantly lower among mothers and children living in rural areas, belonging to the poorest socioeconomic category, or living in a household not using iodized salt. The limited enforcement of the legislation for iodized salt has resulted in a major decrease in the prevalence of iodized salt, which in turn has compromised iodine status in Cambodia. It is essential for the government to enhance enforcement of the iodized salt legislation, and implement short term strategies, such as iodine supplementation, to prevent an increase of severe complications due to iodine deficiency in the Cambodian population.
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Affiliation(s)
- Arnaud Laillou
- United Nations Children's Fund (UNICEF), Maternal, Newborn and Child Health and Nutrition section, no11 street 75, Phnom Penh 12202, Cambodia.
| | - Prak Sophonneary
- National Nutrition Program, Maternal and Child Health Center, No 31A, Rue de France (St. 47), Phnom Penh 12202, Cambodia.
| | - Khov Kuong
- Department of Fisheries Post-Harvest Technologies and Quality Control (DFPTQ), Fisheries Administration, Ministry of Agriculture Fisheries and Forestry, 186 Preah Norodom Boulevard, Phnom Penh 12000, Cambodia.
| | - Rathavuth Hong
- ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA.
| | - Samoeurn Un
- United Nations Children's Fund (UNICEF), Maternal, Newborn and Child Health and Nutrition section, no11 street 75, Phnom Penh 12202, Cambodia.
| | - Chhoun Chamnan
- Department of Fisheries Post-Harvest Technologies and Quality Control (DFPTQ), Fisheries Administration, Ministry of Agriculture Fisheries and Forestry, 186 Preah Norodom Boulevard, Phnom Penh 12000, Cambodia.
| | - Etienne Poirot
- United Nations Children's Fund (UNICEF), Maternal, Newborn and Child Health and Nutrition section, no11 street 75, Phnom Penh 12202, Cambodia.
| | - Jacques Berger
- Institute of Research for Development (IRD), UMR Nutripass IRD-UM2-UM1, Montpellier 3400, France.
| | - Frank Wieringa
- Institute of Research for Development (IRD), UMR Nutripass IRD-UM2-UM1, Montpellier 3400, France.
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255
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Błażewicz A, Makarewicz A, Korona-Glowniak I, Dolliver W, Kocjan R. Iodine in autism spectrum disorders. J Trace Elem Med Biol 2016; 34:32-7. [PMID: 26854242 DOI: 10.1016/j.jtemb.2015.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 11/29/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of our study was to assess the iodine status of Polish boys with severe autism compared to their healthy peers and evaluate the relationship between urinary iodine, thyroid hormones, body mass index and Autism Spectrum Disorder (ASD) symptomatology. SUBJECTS AND METHODS Tests were performed in 40 boys with ASD and 40 healthy boys, aged 2-17 from the same geographic region in Poland. Urinary iodine (UI), free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), BMI, and individual symptoms measured by the Childhood Autism Rating Scale (CARS) were correlated. Validated ion chromatography method with pulsed amperometric detection was applied for the determination of urinary iodine after optimized alkaline digestion in a closed system assisted with microwaves. RESULTS 19 out of 40 children with ASD had mild to moderate iodine deficiency. Statistically significant lower levels of UI, fT3 and fT4 and higher levels of TSH were found in the autistic group when compared with the control group. Concentration of iodine in urine was negatively associated with clinician's general impression for children between 11 and 17 years. Emotional response, adaptation to environmental change, near receptor responsiveness, verbal communication, activity level, and intellectual functioning are more associated with UI than other symptoms listed in CARS. CONCLUSION The severity of certain symptoms in autism is associated with iodine status in maturing boys. Thyroid hormones were within normal reference ranges in both groups while urinary iodine was significantly lower in autistic boys suggesting that further studies into the nonhormonal role of iodine in autism are required.
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Affiliation(s)
- Anna Błażewicz
- Department of Analytical Chemistry, Medical University of Lublin, Poland.
| | - Agata Makarewicz
- Department of Psychiatry, Psychotherapy and Early Intervention, Independent Public Hospital No 1, Medical University of Lublin, Poland
| | | | - Wojciech Dolliver
- Department of Analytical Chemistry, Medical University of Lublin, Poland
| | - Ryszard Kocjan
- Department of Analytical Chemistry, Medical University of Lublin, Poland
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256
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Rohner F, Wirth JP, Woodruff BA, Chiwile F, Yankson H, Sesay F, Koroma AS, Petry N, Pyne-Bailey S, Dominguez E, Kupka R, Hodges MH, de Onis M. Iodine Status of Women of Reproductive Age in Sierra Leone and Its Association with Household Coverage with Adequately Iodized Salt. Nutrients 2016; 8:74. [PMID: 26848685 PMCID: PMC4772038 DOI: 10.3390/nu8020074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/08/2016] [Accepted: 01/18/2016] [Indexed: 11/16/2022] Open
Abstract
Salt iodization programs are a public health success in tackling iodine deficiency. Yet, a large proportion of the world's population remains at risk for iodine deficiency. In a nationally representative cross-sectional survey in Sierra Leone, household salt samples and women's urine samples were quantitatively analyzed for iodine content. Salt was collected from 1123 households, and urine samples from 817 non-pregnant and 154 pregnant women. Household coverage with adequately iodized salt (≥15 mg/kg iodine) was 80.7%. The median urinary iodine concentration (UIC) of pregnant women was 175.8 µg/L and of non-pregnant women 190.8 µg/L. Women living in households with adequately iodized salt had higher median UIC (for pregnant women: 180.6 µg/L vs. 100.8 µg/L, respectively, p < 0.05; and for non-pregnant women: 211.3 µg/L vs. 97.8 µg/L, p < 0.001). Differences in UIC by residence, region, household wealth, and women's education were much smaller in women living in households with adequately iodized salt than in households without. Despite the high household coverage of iodized salt in Sierra Leone, it is important to reach the 20% of households not consuming adequately iodized salt. Salt iodization has the potential for increasing equity in iodine status even with the persistence of other risk factors for deficiency.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Elisa Dominguez
- World Health Organization West Africa, Ouagadougou, Burkina Faso.
| | | | | | - Mercedes de Onis
- World Health Organization Headquarters, 1211 Geneva, Switzerland.
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257
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Bjergved L, Carlé A, Jørgensen T, Perrild H, Laurberg P, Krejbjerg A, Ovesen L, Bülow Pedersen I, Rasmussen LB, Knudsen N. Parity and 11-Year Serum Thyrotropin and Thyroid Autoantibody Change: A Longitudinal Population-Based Study. Thyroid 2016; 26:203-11. [PMID: 26711373 DOI: 10.1089/thy.2014.0279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND A role for female reproductive factors in the pathogenesis of thyroid autoimmunity has been suggested. This study investigated the prospective association between parity, abortion, use of oral contraceptive pill (OCP), and use of hormone replacement therapy (HRT), and 11-year change in serum thyrotropin (TSH), as well as change in thyroid peroxidase autoantibody (TPOAb) status. METHODS A random sample of 4649 people aged 18-65 years participated in a population-based study in the period 1997-1998. In the study presented here, 1749 non-pregnant women with no history of thyroid disease were included who participated in the 11-year follow-up examination in the period 2008-2010. Gynecological exposures were reported in a self-administered questionnaire at baseline and follow-up. TSH and TPOAb were measured at baseline and follow-up. Increased TPOAb status during follow-up was defined as a TPOAb below the assay cutoff (<30 kIU/L) at baseline and a TPOAb ≥30 kIU/L at follow-up. Multiple linear regression models were used, adjusted for age, smoking status, and urinary iodine excretion. RESULTS An inverse association was found between the number of years on HRT and the risk (odds ratio) of increased TPOAb status during follow-up (0.735 [confidence interval 0.558-0.968], p = 0.03). However, this association was not statistically significant when applying the Bonferroni adjusted significance level. The remaining reproductive factors showed no statistically significant association with risk of increased TPOAb during follow-up. Furthermore, parity, abortions, use of OCP, HRT use, age at menarche, and being pre- or postmenopausal were not significantly associated with 11-year TSH change. CONCLUSIONS No statistically significant association was found between the studied female reproductive measures and 11-year risk of TSH or TPO change. A possible protective role for HRT in the etiology of thyroid autoimmunity, however, deserves further research.
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Affiliation(s)
- Lena Bjergved
- 1 Research Centre for Prevention and Health , The Capital Region of Denmark, Glostrup, Denmark
- 2 Department of Endocrinology, Bispebjerg University Hospital , Copenhagen, Denmark
| | - Allan Carlé
- 3 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
| | - Torben Jørgensen
- 1 Research Centre for Prevention and Health , The Capital Region of Denmark, Glostrup, Denmark
- 4 Faculty of Health Sciences, University of Copenhagen , Copenhagen, Denmark
- 5 Faculty of Medicine, Aalborg University , Aalborg, Denmark
| | - Hans Perrild
- 2 Department of Endocrinology, Bispebjerg University Hospital , Copenhagen, Denmark
| | - Peter Laurberg
- 3 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
- 5 Faculty of Medicine, Aalborg University , Aalborg, Denmark
| | - Anne Krejbjerg
- 3 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
| | - Lars Ovesen
- 6 Department of Gastroenterology, Slagelse Hospital , Slagelse, Denmark
| | - Inge Bülow Pedersen
- 3 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
| | - Lone Banke Rasmussen
- 7 Department of Nutrition, National Food Institute, Technical University of Denmark , Søborg, Denmark
| | - Nils Knudsen
- 2 Department of Endocrinology, Bispebjerg University Hospital , Copenhagen, Denmark
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258
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Völzke H, Caron P, Dahl L, de Castro JJ, Erlund I, Gaberšček S, Gunnarsdottir I, Hubalewska-Dydejczyk A, Ittermann T, Ivanova L, Karanfilski B, Khattak RM, Kusić Z, Laurberg P, Lazarus JH, Markou KB, Moreno-Reyes R, Nagy EV, Peeters RP, Pīrāgs V, Podoba J, Rayman MP, Rochau U, Siebert U, Smyth PP, Thuesen BH, Troen A, Vila L, Vitti P, Zamrazil V, Zimmermann MB. Ensuring Effective Prevention of Iodine Deficiency Disorders. Thyroid 2016; 26:189-96. [PMID: 26700864 DOI: 10.1089/thy.2015.0543] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Programs initiated to prevent iodine deficiency disorders (IDD) may not remain effective due to changes in government policies, commercial factors, and human behavior that may affect the efficacy of IDD prevention programs in unpredictable directions. Monitoring and outcome studies are needed to optimize the effectiveness of IDD prevention. SUMMARY Although the need for monitoring is compelling, the current reality in Europe is less than optimal. Regular and systematic monitoring surveys have only been established in a few countries, and comparability across the studies is hampered by the lack of centralized standardization procedures. In addition, data on outcomes and the cost of achieving them are needed in order to provide evidence of the beneficial effects of IDD prevention in countries with mild iodine deficiency. CONCLUSION Monitoring studies can be optimized by including centralized standardization procedures that improve the comparison between studies. No study of iodine consumption can replace the direct measurement of health outcomes and the evaluation of the costs and benefits of the program. It is particularly important that health economic evaluation should be conducted in mildly iodine-deficient areas and that it should include populations from regions with different environmental, ethnic, and cultural backgrounds.
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Affiliation(s)
- Henry Völzke
- 1 Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
| | - Philippe Caron
- 2 Department of Endocrinology, Centre Hospitalier Universitaire de Larrey , Toulouse, France
| | - Lisbeth Dahl
- 3 Human Studies, National Institute of Nutrition and Seafood Research , Bergen, Norway
| | - João J de Castro
- 4 Department of Endocrinology, Hospital das Forças Armadas , Lisbon, Portugal
| | - Iris Erlund
- 5 Disease Risk Unit, National Institute for Health and Welfare , Helsinki, Finland
| | - Simona Gaberšček
- 6 Department of Nuclear Medicine, University Medical Centre , Ljubljana, Slovenia
| | - Ingibjörg Gunnarsdottir
- 7 Unit for Nutrition Research, University of Iceland and Landspitali National University Hospital , Reykjavik, Iceland
| | | | - Till Ittermann
- 1 Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
| | - Ludmila Ivanova
- 9 Faculty of Medicine, Sofia University Sv. Kliment Ohridski , Sofia, Bulgaria
| | - Borislav Karanfilski
- 10 Centre for Regional Policy Research and Cooperation "Studiorum," Skopje, Macedonia
| | - Rehman M Khattak
- 1 Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
| | - Zvonko Kusić
- 11 University of Zagreb, School of Medicine, Department of Oncology and Nuclear Medicine, University Hospital Centre Sestre Milosrdnice , Zagreb, Croatia
| | - Peter Laurberg
- 12 Departments of Endocrinology and Clinical Medicine, Aalborg University Hospital and Aalborg University , Aalborg, Denmark
| | - John H Lazarus
- 13 Institute of Molecular Medicine, Cardiff University , Cardiff, United Kingdom
| | - Kostas B Markou
- 14 Department of Endocrinology, Institute University of Patras Medical School , Patras, Greece
| | - Rodrigo Moreno-Reyes
- 15 Nuclear Medicine Department, Erasme Hospital, Université Libre de Bruxelles , Brussels, Belgium
| | - Endre V Nagy
- 16 Division of Endocrinology, University of Debrecen , Debrecen, Hungary
| | - Robin P Peeters
- 17 Department of Internal Medicine, Rotterdam Thyroid Center , Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Valdis Pīrāgs
- 18 Department of Internal Medicine, University of Latvia , Riga, Latvia
| | - Ján Podoba
- 19 Department of Endocrinology, Slovakian Medical University , Bratislava, Slovakia
| | - Margaret P Rayman
- 20 Department of Nutritional Sciences, Faculty Health and Medical Sciences, University of Surrey , Guildford, United Kingdom
| | - Ursula Rochau
- 21 Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Science , Medical Informatics and Technology, Hall, Austria
| | - Uwe Siebert
- 21 Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Science , Medical Informatics and Technology, Hall, Austria
| | - Peter P Smyth
- 22 National University of Ireland, Galway and Centre for Public Health, Queen's University , Belfast, North Ireland
| | - Betina H Thuesen
- 23 Research Centre for Prevention and Health , The Capital Region of Denmark, Rigshospitalet, Glostrup, Denmark
| | - Aron Troen
- 24 Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem , Jerusalem, Israel
| | - Lluís Vila
- 25 Department of Endocrinology and Nutrition, Hospital de Sant Joan Despi Moisès Broggi , Barcelona, Spain
| | - Paolo Vitti
- 26 Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | | | - Michael B Zimmermann
- 28 Swiss Federal Institute of Technology , Zürich Department of Health Sciences and Technology, Zürich, Switzerland
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Huang L, Crino M, Wu JHY, Woodward M, Barzi F, Land MA, McLean R, Webster J, Enkhtungalag B, Neal B. Mean population salt intake estimated from 24-h urine samples and spot urine samples: a systematic review and meta-analysis. Int J Epidemiol 2016; 45:239-50. [DOI: 10.1093/ije/dyv313] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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260
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Chen W, Wu Y, Lin L, Tan L, Shen J, Pearce EN, Guo X, Wang W, Bian J, Jiang W, Zhang W. 24-Hour Urine Samples Are More Reproducible Than Spot Urine Samples for Evaluation of Iodine Status in School-Age Children. J Nutr 2016; 146:142-6. [PMID: 26609173 DOI: 10.3945/jn.115.215806] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/28/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Variation in different urinary measurements for evaluation of iodine status is of concern to clinicians and researchers. OBJECTIVE This study evaluated variations between urine iodine concentration (UIC), spot and 24-h urine sample creatinine concentrations, and 24-h urine iodine excretion (24-h UIE) in repeated samples from school-age children. METHODS Urine samples (24 h and morning spot) were collected on 2 occasions from 981 children in Ningjin and Lingxian counties, China. Samples from Ningjin were collected in October and November 2013, and samples from Lingxian were collected in April and May 2014. Morning spot urine iodine concentration (MUIC), morning spot urine creatinine, 24-h UIC, and 24-h urine creatinine were measured in all samples. The 24-h UIE was calculated by multiplying the 24-h UIC by the 24-h urine volume. RESULTS In Ningjin County, the 24-h UIC and 24-h UIE did not differ between repeated collections [192 and 172 μg/L, respectively, for 24-h UIC (P = 0.08); 123 and 120 μg/L, respectively, for 24-h UIE (P = 0.56)], whereas the MUIC was lower in November 2013 than in October 2013 (170 and 190 μg/L, respectively; P = 0.034). In Lingxian County, no significant differences were observed in 24-h UIC between the repeated collections (230 and 218 μg/L, respectively; P = 0.79), whereas the 24-h UIE and MUIC were higher in the samples collected in May 2014 than in April 2014 [161 and 155 μg/L, respectively, for 24-h UIE (P = 0.002); 244 and 203 μg/L, respectively, for MUIC (P < 0.001)]. When data from both counties were combined, no difference was observed between repeated 24-h UIC (214 compared with 196 μg/L; P = 0.17) and 24-h UIE (143 compared with 143 μg/d; P = 0.06), but MUICs were lower in the first collection than in the second collection (199 and 207 μg/L, respectively; P = 0.002). The κ values were >0.4 for 24-h UIC and mean UIE, whereas relatively low κ values were observed for MUIC and mean UIE. CONCLUSION The 24-h UIC was more accurate and reproducible than the MUIC in evaluating iodine status in a large-scale population study of school-age children.
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Affiliation(s)
- Wen Chen
- The Department of Nutrition and Food Hygiene, School of Public Health
| | - Yalan Wu
- The Department of Nutrition and Food Hygiene, School of Public Health
| | - Laixiang Lin
- Tianjin Institution of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Long Tan
- The Department of Nutrition and Food Hygiene, School of Public Health
| | - Jun Shen
- The Department of Nutrition and Food Hygiene, School of Public Health
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA; and
| | - Xiaohui Guo
- The Department of Nutrition and Food Hygiene, School of Public Health
| | - Wei Wang
- The Department of Nutrition and Food Hygiene, School of Public Health
| | - Jianchao Bian
- The Shandong Institute for Endemic Disease Control and Research, Shangdong Province, China
| | - Wen Jiang
- The Shandong Institute for Endemic Disease Control and Research, Shangdong Province, China
| | - Wanqi Zhang
- The Department of Nutrition and Food Hygiene, School of Public Health,
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Flores-Rebollar A. Regarding the Article: Does Iodine Excess Lead to Hypothyroidism? Evidence from a Case-Control Study in India. Arch Med Res 2015; 46:660-1. [PMID: 26696551 DOI: 10.1016/j.arcmed.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/01/2015] [Indexed: 11/30/2022]
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Abstract
I is essential for thyroid hormone synthesis and neurological development. Various changes occur in thyroid hormone metabolism during pregnancy and I requirements increase significantly. The purpose of this study was to investigate I status among pregnant women in Trabzon, formerly a severely I-deficient area but shown to have become I sufficient following mandatory iodisation of table salt based on monitoring studies among school-age children (SAC) in the area. A total of 864 healthy pregnant women with a median age of 28 (25th-75th percentile 17-47) years participated in the study. None of them were using I-containing supplement. All of them were screened for use of iodised salt, obstetric history, thyroid function tests and urinary I concentrations (UIC), and thyroid ultrasonography was performed. Median UIC was 102 (25th-75th percentile=62-143) μg/l. Median UIC of the patients according to trimesters were 122 µg/l at the 1st, 97 µg/l at the 2nd and 87 µg/l at the 3rd trimester. UIC in the 1st trimester was higher compared with the 2nd and 3rd trimesters (P<0·017). Nodules were present in 17·7% of women (n 153). The rate of iodised salt usage among pregnant women was 90·7%. Our study demonstrates that, although the I status among SAC has been rectified, I deficiency (ID) is still prevalent among pregnant women. Current knowledge is in favour of I supplementation in this group. Until the effects of maternal I supplementation in mild ID have been clarified by large-scale prospective controlled trials, pregnant women living in borderline defficient and I-sufficient areas, such as Trabzon city, should receive 100-200 µg/d of I-containing supplements in addition to iodised salt.
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Abstract
PURPOSE OF REVIEW The aim of this work is to review the recent findings on iodine nutrition in adults with intestinal failure. RECENT FINDINGS Patients with intestinal failure who require long-term parenteral nutrition are potentially at risk for trace element deficiencies. It was considered that iodine deficiency was unlikely to occur in adults on parenteral nutrition, even if iodine is not added to parenteral nutrition, because of iodine absorption from iodine-containing antiseptics, to presence of iodine as contaminant in parenteral nutrition products and to absorption of dietary iodine, in patients eating and having a functioning duodenum. It is believed that thyroidal iodine could support thyroid function for several months during total parenteral nutrition. Clinical Nutrition Societies do not have uniform opinion about the need to supplement iodine routinely in parenteral nutrition in adults. Although very few studies have addressed this topic, inadequate iodine supply in long-term parenteral nutrition in young adults, and the increased risk of iodine deficiency in adults on long-term parenteral nutrition have recently been reported. SUMMARY There is some evidence that adults with intestinal failure on long-term parenteral nutrition may be at risk of iodine deficiency. Studies carried out in large cohorts of patients are required to better define iodine requirements in long-term parenteral nutrition.
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Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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265
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Wang P, Sun H, Shang L, Zhang Q, He Y, Chen Z, Zhou Y, Zhang J, Wang Q, Zhao J, Shen H. Low Goiter Rate Associated with Small Average Thyroid Volume in Schoolchildren after the Elimination of Iodine Deficiency Disorders. PLoS One 2015; 10:e0141552. [PMID: 26513146 PMCID: PMC4626397 DOI: 10.1371/journal.pone.0141552] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 10/09/2015] [Indexed: 12/02/2022] Open
Abstract
Background After the implementation of the universal salt iodization (USI) program in 1996, seven cross-sectional school-based surveys have been conducted to monitor iodine deficiency disorders (IDD) among children in eastern China. Objectives This study aimed to examine the correlation of total goiter rate (TGR) with average thyroid volume (Tvol) and urinary iodine concentration (UIC) in Jiangsu province after IDD elimination. Design Probability-proportional-to-size sampling was applied to select 1,200 children aged 8–10 years old in 30 clusters for each survey in 1995, 1997, 1999, 2001, 2002, 2005, 2009 and 2011. We measured Tvol using ultrasonography in 8,314 children and measured UIC (4,767 subjects) and salt iodine (10,184 samples) using methods recommended by the World Health Organization. Tvol was used to calculate TGR based on the reference criteria specified for sex and body surface area (BSA). Results TGR decreased from 55.2% in 1997 to 1.0% in 2009, and geometric means of Tvol decreased from 3.63 mL to 1.33 mL, along with the UIC increasing from 83 μg/L in 1995 to 407 μg/L in 1999, then decreasing to 243 μg/L in 2005, and then increasing to 345 μg/L in 2011. In the low goiter population (TGR < 3.9%), TGR was positively associated with average Tvol (r = 0.99); UIC showed a non-linear association with average Tvol, and UIC > 300 μg/L was associated with a smaller average Tvol in children. Conclusions After IDD elimination in Jiangsu province in 2001, lower TGR was associated with smaller average Tvol. Average Tvol was more sensitive than TGR in detecting the fluctuation of UIC. A UIC of 300 μg/L may be defined as a critical value for population level iodine status monitoring.
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Affiliation(s)
- Peihua Wang
- Department of Epidemiology and Statistics, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Environmental and Endemic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hong Sun
- Department of Environmental and Endemic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Li Shang
- Department of Environmental and Endemic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Qinglan Zhang
- Department of Environmental and Endemic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yingxia He
- Department of Environmental and Endemic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Zhigao Chen
- Department of Environmental and Endemic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yonglin Zhou
- Department of Environmental and Endemic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jingjing Zhang
- Department of Environmental and Endemic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Qingqing Wang
- Department of Environmental and Endemic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jinkou Zhao
- Department of Environmental and Endemic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hongbing Shen
- Department of Epidemiology and Statistics, School of Public Health, Nanjing Medical University, Nanjing, China
- * E-mail:
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266
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Watts MJ, Joy EJM, Young SD, Broadley MR, Chilimba ADC, Gibson RS, Siyame EWP, Kalimbira AA, Chilima B, Ander EL. Iodine source apportionment in the Malawian diet. Sci Rep 2015; 5:15251. [PMID: 26503697 PMCID: PMC4621511 DOI: 10.1038/srep15251] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/04/2015] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to characterise nutritional-I status in Malawi. Dietary-I intakes were assessed using new datasets of crop, fish, salt and water-I concentrations, while I status was assessed for 60 women living on each of calcareous and non-calcareous soils as defined by urinary iodine concentration (UIC). Iodine concentration in staple foods was low, with median concentrations of 0.01 mg kg−1 in maize grain, 0.008 mg kg−1 in roots and tubers, but 0.155 mg kg−1 in leafy vegetables. Freshwater fish is a good source of dietary-I with a median concentration of 0.51 mg kg−1. Mean Malawian dietary-Iodine intake from food, excluding salt, was just 7.8 μg d−1 compared to an adult requirement of 150 μg d−1. Despite low dietary-I intake from food, median UICs were 203 μg L−1 with only 12% defined as I deficient whilst 21% exhibited excessive I intake. Iodised salt is likely to be the main source of dietary I intake in Malawi; thus, I nutrition mainly depends on the usage and concentration of I in iodised salt. Drinking water could be a significant source of I in some areas, providing up to 108 μg d−1 based on consumption of 2 L d−1.
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Affiliation(s)
- M J Watts
- Inorganic Geochemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, NG12 5GG, UK
| | - E J M Joy
- Inorganic Geochemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, NG12 5GG, UK.,School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK
| | - S D Young
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK
| | - M R Broadley
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK
| | - A D C Chilimba
- Ministry of Agriculture, Irrigation and Water Development, Lunyangwa Research Station, PO Box 59, Malawi
| | - R S Gibson
- University of Otago, PO Box 56, Dunedin, New Zealand
| | - E W P Siyame
- Department of Home Economics and Human Nutrition, Bunda College, Lilongwe University of Agriculture and Natural Resources, PO Box 219, Lilongwe, Malawi
| | - A A Kalimbira
- Department of Home Economics and Human Nutrition, Bunda College, Lilongwe University of Agriculture and Natural Resources, PO Box 219, Lilongwe, Malawi
| | - B Chilima
- Community Health Sciences Unit, Ministry of Health, Private Bag 65, Lilongwe, Malawi
| | - E L Ander
- Inorganic Geochemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, NG12 5GG, UK
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267
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de Farias CR, Cardoso BR, de Oliveira GMB, de Mello Guazzelli IC, Catarino RM, Chammas MC, Cozzolino SMF, Knobel M. A randomized-controlled, double-blind study of the impact of selenium supplementation on thyroid autoimmunity and inflammation with focus on the GPx1 genotypes. J Endocrinol Invest 2015; 38:1065-74. [PMID: 25894865 DOI: 10.1007/s40618-015-0285-8] [Citation(s) in RCA: 24] [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] [Received: 01/20/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To analyze the impact of selenium supplementation on serum antiTPO levels and thyroid echogenicity in patients with CAT, evaluating the response in subgroups with different GPx1 genotypes. METHODS CAT patients (n = 55) with positive antiTPO were randomized to selenomethionine (SeMet) 200 μg daily (n = 28) or placebo (n = 27) for 3 months. Assessments included GPx1 genotyping at baseline and serum levels of plasma selenium, erythrocyte GPx1 activity, antiTPO and thyroid echogenicity at baseline, and 3 and 6 months. RESULTS In the SeMet group, the increase in plasma levels of selenium and erythrocyte GPx1 activity was similar among patients with different GPx1 genotypes. In the overall cohort, patients randomized to SeMet showed a 5 % decrease in antiTPO levels at 3 months (p = non-significant) and 20 % at 6 months (p < 0.001 versus 3 months). In contrast, patients in the placebo group did not show significant changes in antiTPO levels at any time point. Subgroup analysis showed that patients with different GPx1 genotypes presented comparable responses in antiTPO levels and echogenicity index to SeMet. CONCLUSIONS Selenium supplementation decreased serum antiTPO levels in CAT patients, with similar response among patients with different GPx1 genotypes.
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Affiliation(s)
- C R de Farias
- Thyroid Unit and Laboratory of Cellular and Molecular Biology (LIM-25), Division of Endocrinology and Metabolism, University of São Paulo Medical School, Hospital das Clínicas, Av. Dr. Enéas de Carvalho Aguiar, 155, 8th floor, bl 3, PAMB, São Paulo, SP, 05403-900, Brazil.
| | - B R Cardoso
- Department of Food and Experimental Nutrition, Faculty of Pharmaceutical Science, University of São Paulo, Av. Prof. Lineu Prestes 580, bl 14, Cidade Universitária, São Paulo, SP, 05508-000, Brazil.
| | - G M B de Oliveira
- Ultrasound Unit, Department of Radiology, University of São Paulo Medical School, Hospital das Clínicas, Av Dr Enéas de Carvalho Aguiar, 255, 3rd floor, Unit 013, São Paulo, SP, 05403-900, Brazil.
| | - I C de Mello Guazzelli
- Laboratory of Cellular and Molecular Endocrinology, LIM-25, Division of Endocrinology and Metabolism, University of São Paulo Medical School, Av. Dr. Arnaldo 455, 4th floor, Units 4305/4307, São Paulo, SP, 01246-903, Brazil.
| | - R M Catarino
- Hematology and Biochemistry, Center of Pathology, Adolpho Lutz Institute, Av. Dr. Arnaldo 351, 7th floor, São Paulo, SP, 01246-000, Brazil.
| | - M C Chammas
- Ultrasound Unit, Department of Radiology, University of São Paulo Medical School, Hospital das Clínicas, Av. Dr. Enéas de Carvalho Aguiar, 255, 3rd floor, Unit 013, São Paulo, SP, 05403-010, Brazil.
| | - S M F Cozzolino
- Department of Food and Experimental Nutrition, Faculty of Pharmaceutical Science, University of São Paulo, Av. Prof. Lineu Prestes 580, bl 14, Cidade Universitária, São Paulo, SP, 05508-000, Brazil.
| | - M Knobel
- Thyroid Unit and Laboratory of Cellular and Molecular Biology (LIM-25), Division of Endocrinology and Metabolism, University of São Paulo Medical School, Hospital das Clínicas, Av. Dr. Enéas de Carvalho Aguiar, 155, 8th floor, bl 3, PAMB, São Paulo, SP, 05403-900, Brazil.
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268
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Cao X, Ma W, Liu L, Xu J, Wang H, Li X, Wang J, Zhang J, Wang Z, Gu Y. Analysis of potassium iodate reduction in tissue homogenates using high performance liquid chromatography-inductively coupled plasma-mass spectrometry. J Trace Elem Med Biol 2015; 32:1-6. [PMID: 26302905 DOI: 10.1016/j.jtemb.2015.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/26/2015] [Accepted: 04/27/2015] [Indexed: 12/15/2022]
Abstract
Potassium iodate (KIO3) and potassium iodide (KI) are the major salt iodization agents used worldwide. Unlike iodide (I(-)), iodate (IO3(-)) should be reduced to I(-) before it can be effectively used by the thyroid. In this study, we developed a new method for analyzing IO3(-) and I(-) in tissue homogenates using high performance liquid chromatography coupled to inductively coupled plasma mass spectrometry (HPLC-ICP-MS). We further applied the method to demonstrate the KIO3 reduction process by tissues in vitro. The effects of KIO3 on the total antioxidative activity (TAA) and reduced nicotinamide adenine dinucleotide phosphate (NADPH) were also investigated here. Finally, we found that IO3(-) can be reduced to I(-) by tissue homogenates and IO3(-) irreversibly decreases the antioxidant capability of tissues. Our studies suggest that KIO3 might have a big effect on the redox balance of tissue and would further result in oxidative stress of organisms.
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Affiliation(s)
- Xiaoxiao Cao
- National Reference Laboratory for IDD, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Wei Ma
- National Reference Laboratory for IDD, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Liejun Liu
- National Reference Laboratory for IDD, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Jing Xu
- National Reference Laboratory for IDD, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Haiyan Wang
- National Reference Laboratory for IDD, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Xiuwei Li
- National Reference Laboratory for IDD, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Jiangqing Wang
- National Reference Laboratory for IDD, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Jianhua Zhang
- National Reference Laboratory for IDD, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Zexi Wang
- National Reference Laboratory for IDD, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Yunyou Gu
- National Reference Laboratory for IDD, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China.
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Drozd VM, Saenko VA, Brenner AV, Drozdovitch V, Pashkevich VI, Kudelsky AV, Demidchik YE, Branovan I, Shiglik N, Rogounovitch TI, Yamashita S, Biko J, Reiners C. Major Factors Affecting Incidence of Childhood Thyroid Cancer in Belarus after the Chernobyl Accident: Do Nitrates in Drinking Water Play a Role? PLoS One 2015; 10:e0137226. [PMID: 26397978 PMCID: PMC4580601 DOI: 10.1371/journal.pone.0137226] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/14/2015] [Indexed: 11/21/2022] Open
Abstract
One of the major health consequences of the Chernobyl Nuclear Power Plant accident in 1986 was a dramatic increase in incidence of thyroid cancer among those who were aged less than 18 years at the time of the accident. This increase has been directly linked in several analytic epidemiological studies to iodine-131 (131I) thyroid doses received from the accident. However, there remains limited understanding of factors that modify the 131I-related risk. Focusing on post-Chernobyl pediatric thyroid cancer in Belarus, we reviewed evidence of the effects of radiation, thyroid screening, and iodine deficiency on regional differences in incidence rates of thyroid cancer. We also reviewed current evidence on content of nitrate in groundwater and thyroid cancer risk drawing attention to high levels of nitrates in open well water in several contaminated regions of Belarus, i.e. Gomel and Brest, related to the usage of nitrogen fertilizers. In this hypothesis generating study, based on ecological data and biological plausibility, we suggest that nitrate pollution may modify the radiation-related risk of thyroid cancer contributing to regional differences in rates of pediatric thyroid cancer in Belarus. Analytic epidemiological studies designed to evaluate joint effect of nitrate content in groundwater and radiation present a promising avenue of research and may provide useful insights into etiology of thyroid cancer.
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Affiliation(s)
- Valentina M. Drozd
- The International fund “Help for patients with radiation-induced thyroid cancer “Arnica”, Minsk, Belarus
- Department of Endocrinology, Belarusian Medical Academy for Postgraduate Education, Minsk, Belarus
| | - Vladimir A. Saenko
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Sakamoto, Nagasaki, Japan
| | - Alina V. Brenner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, United States Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, United States Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Vasilii I. Pashkevich
- Laboratory of Hydrogeology and Hydroecology, Institute for Nature Management of the National Academy of Sciences, Minsk, Belarus
| | - Anatoliy V. Kudelsky
- Laboratory of Hydrogeology and Hydroecology, Institute for Nature Management of the National Academy of Sciences, Minsk, Belarus
| | - Yuri E. Demidchik
- Department of Oncology, Belarusian Medical Academy for Postgraduate Education, Minsk, Belarus
| | - Igor Branovan
- Project Chernobyl, Brooklyn, New York, United States of America
| | - Nikolay Shiglik
- Project Chernobyl, Brooklyn, New York, United States of America
| | - Tatiana I. Rogounovitch
- Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University, Sakamoto, Nagasaki, Japan
| | - Shunichi Yamashita
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Sakamoto, Nagasaki, Japan
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Sakamoto, Nagasaki, Japan
| | - Johannes Biko
- The International fund “Help for patients with radiation-induced thyroid cancer “Arnica”, Minsk, Belarus
- Clinic and Polyclinic of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany
| | - Christoph Reiners
- The International fund “Help for patients with radiation-induced thyroid cancer “Arnica”, Minsk, Belarus
- Clinic and Polyclinic of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany
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270
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Shakya PR, Gelal B, Lal Das BK, Lamsal M, Pokharel PK, Nepal AK, Brodie DA, Sah GS, Baral N. Urinary iodine excretion and thyroid function status in school age children of hilly and plain regions of Eastern Nepal. BMC Res Notes 2015; 8:374. [PMID: 26306673 PMCID: PMC4548539 DOI: 10.1186/s13104-015-1359-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 08/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iodine deficiency is a major public health problem in many developing countries including Nepal. The present study was designed to investigate the urinary iodine excretion (UIE), thyroid function status and household salt iodine content (SIC) in school-aged children (SAC) and to establish the relationships between these factors. METHODS A community-based cross sectional study was conducted in selected schools of two districts, Tehrathum and Morang, lying in the hill and plain region of eastern Nepal respectively. A total of 640 SAC, (Tehrathum n = 274 and Morang n = 366) aged 6-11 years, were assessed for UIE and household SIC. Among the 640 children, 155 consented to blood samples (Tehrathum n = 78 and Morang n = 77) to test for serum thyroglobulin (Tg), thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4). UIE was measured by ammonium persulfate digestion method. SIC was measured by iodometric titration method and Tg, TSH, fT4 and fT3 were measured by immunoassay based kit method. RESULTS In Tehrathum and Morang, 9.5 and 7.7% of SAC had UIE values of UIE <100 µg/L while 59.5 and 41% had iodine nutrition values of >299 µg/L, with median UIE of 345.65 and 270.36 µg/L respectively. The overall medians were as follows, Tg 14.29 µg/L, fT3 3.94 pmol/L, fT4 16.25 pmol/L and TSH 3.61 mIU/L. There was a negative correlation between UIE and Tg (r = -0.236, p = 0.003) and a positive correlation between UIE and SIC (r = 0.349, p < 0.0001). We found 19.5%, n = 15 and 16.7%, n = 13 subclinical hypothyroid cases in Morang and Tehrathum respectively. Iodometric titration showed only 6.4% (n = 41) of the samples had household SIC <15 ppm. Multivariate analysis revealed that use of packaged salt by SAC of Tehrathum district correlated with higher UIE values. CONCLUSIONS Our focused data suggests that collaborative universal salt iodization (USI) programs are improving the health of children in the Tehrathum and Morang districts of Nepal. We also found that excessive iodine in a large portion of the study groups is a substantial concern and iodine intervention programs need to deal with both deficient and excessive iodine scenarios that can both be present simultaneously in study populations.
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Affiliation(s)
- Prem Raj Shakya
- Department of Biochemistry, School of Medicine, Patan Academy of Health Sciences, Lagankhel-5, PO Box: 26500, Lalitpur, Nepal.
| | - Basanta Gelal
- Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Binod Kumar Lal Das
- Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Madhab Lamsal
- Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Paras Kumar Pokharel
- Department of Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Ashwini Kumar Nepal
- Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - David A Brodie
- Department of Biochemistry, Faculty of Society and Health, Bucks New University, High Wycombe, Buckinghamshire, UK.
| | - Gauri Shankar Sah
- Department of Paediatrics and Adolescent Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Nirmal Baral
- Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
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271
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Tang KT, Wang FF, Pan WH, Lin JD, Won GS, Chau WK, Lin HD, Hsieh YT. Iodine status of adults in Taiwan 2005-2008, 5 years after the cessation of mandatory salt iodization. J Formos Med Assoc 2015; 115:645-51. [PMID: 26272351 DOI: 10.1016/j.jfma.2015.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 06/26/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/PURPOSE Iodine deficiency causes a broad spectrum of disorders across all ages. Mandatory salt iodization in Taiwan successfully reduced the goiter rate from 21.6% to 4.3% in schoolchildren surveyed in 1971. The program continued until 2003 when salt iodization was changed from mandatory to voluntary. The purpose of this study was to investigate the iodine status of Taiwanese individuals after the change in the iodine policy. METHODS Urinary iodine (UI) was measured in samples from adults in the Nutrition and Health Survey in Taiwan 2005-2008. RESULTS The median UI level was 100 μg/L, and the percentage of populations with UI levels below 100 μg/L and 50 μg/L was 50.1% and 15.1%, respectively, indicating that the iodine status was borderline adequate. Men had a higher UI level than women (102 μg/L vs. 98 μg/L, p = 0.003), and older individuals (age > 60 years) had a lower UI level than younger people, particularly in women. The iodine status of the population < 50 years was sufficient, but it was insufficient in older groups. Mild iodine insufficiency was noted in all areas of Taiwan except the Southern area and Penghu islands, with the lowest UI level of 79 μg/L in the Mountain area. Although the UI level of women of childbearing age (19-44 years) was 103 μg/L, there may be a risk of iodine deficiency during pregnancy. CONCLUSION The iodine nutrition of the Taiwanese population in 2005-2008 was borderline adequate, with insufficiency in some subgroups. Further monitoring of the iodine status is necessary.
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Affiliation(s)
- Kam-Tsun Tang
- Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Fan-Fen Wang
- Department of Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan
| | - Wen-Harn Pan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Jiunn-Diann Lin
- Division of Endocrinology and Metabolism, Shuang Ho Hospital, Taipei, Taiwan
| | - Ging-Shing Won
- Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wing-Keung Chau
- Division of Hematology and Oncology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hong-Da Lin
- Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yao-Te Hsieh
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
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272
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Lazarus JH. The importance of iodine in public health. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2015; 37:605-618. [PMID: 25663362 DOI: 10.1007/s10653-015-9681-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/24/2015] [Indexed: 06/04/2023]
Abstract
Iodine (I) deficiency has been known for more than a century and is known to cause cretinism at the extreme end of the spectrum but also, importantly, impaired development and neurocognition in areas of mild deficiency. The WHO has indicated that median urinary iodine of 100-199 μg/l in a population is regarded as indicative of an adequate iodine intake. The understanding of the spectrum of iodine deficiency disorders led to the formation of The International Council for the Control of Iodine Deficiency Disorders which has promulgated the use of household iodized salt and the use of such salt in food processing and manufacture. Iodine deficiency is particularly important in pregnancy as the fetus relies on maternal thyroxine (T4) exclusively during the first 14 weeks and also throughout gestation. As this hormone is critical to brain and nervous system maturation, low maternal T4 results in low child intelligence quotient. The recommendation for I intake in pregnancy is 250 μg/day to prevent fetal and child brain function impairment. During the past 25 years, the number of countries with I deficiency has reduced to 32; these still include many European developed countries. Sustainability of adequate iodine status must be achieved by continuous monitoring and where this has not been performed I deficiency has often recurred. More randomized controlled trials of iodine supplementation in pregnancy are required in mild iodine-deficient areas to inform public health strategy and subsequent government action on suitable provision of iodine to the population at risk.
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Affiliation(s)
- John H Lazarus
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff University, Cardiff, UK,
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273
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274
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Urinary 24-h creatinine excretion in adults and its use as a simple tool for the estimation of daily urinary analyte excretion from analyte/creatinine ratios in populations. Eur J Clin Nutr 2015. [PMID: 26220572 DOI: 10.1038/ejcn.2015.121] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND/OBJECTIVES The assessment of urinary excretion of specific nutrients (e.g. iodine, sodium) is frequently used to monitor a population's nutrient status. However, when only spot urines are available, always a risk of hydration-status-dependent dilution effects and related misinterpretations exists. The aim of the present study was to establish mean values of 24-h creatinine excretion widely applicable for an appropriate estimation of 24-h excretion rates of analytes from spot urines in adults. SUBJECTS/METHODS Twenty-four-hour creatinine excretion from the formerly representative cross-sectional German VERA Study (n=1463, 20-79 years old) was analysed. Linear regression analysis was performed to identify the most important influencing factors of creatinine excretion. In a subsample of the German DONALD Study (n=176, 20-29 years old), the applicability of the 24-h creatinine excretion values of VERA for the estimation of 24-h sodium and iodine excretion from urinary concentration measurements was tested. RESULTS In the VERA Study, mean 24-h creatinine excretion was 15.4 mmol per day in men and 11.1 mmol per day in women, significantly dependent on sex, age, body weight and body mass index. Based on the established 24-h creatinine excretion values, mean 24-h iodine and sodium excretions could be estimated from respective analyte/creatinine concentrations, with average deviations <10% compared with the actual 24-h means. CONCLUSIONS The present mean values of 24-h creatinine excretion are suggested as a useful tool to derive realistic hydration-status-independent average 24-h excretion rates from urinary analyte/creatinine ratios. We propose to apply these creatinine reference means routinely in biomarker-based studies aiming at characterizing the nutrient or metabolite status of adult populations by simply measuring metabolite/creatinine ratios in spot urines.
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275
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Nepal AK, Suwal R, Gautam S, Shah GS, Baral N, Andersson M, Zimmermann MB. Subclinical Hypothyroidism and Elevated Thyroglobulin in Infants with Chronic Excess Iodine Intake. Thyroid 2015; 25:851-9. [PMID: 25950720 DOI: 10.1089/thy.2015.0153] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Acute iodine excess in newborns can cause hypothyroidism, but there are limited data on the effects of iodine excess on thyroid function in older infants. The aim of this study was to measure the effects of chronic excess iodine intake on thyroid function in 6-24-month-old infants. METHODS In this cross-sectional study, infants (n=696) in eastern Nepal were studied. Spot urine samples, venous blood samples, and household salt samples were collected, and urinary iodine concentration (UIC), serum free thyroxine (fT4), thyrotropin (TSH), thyroglobulin (Tg), and titrated household salt iodine concentration (SIC) were measured. Daily iodine intake was calculated from UIC based on estimates of urine volume at this age. RESULTS Median (25th-75th percentile) household SIC was 89 (70-149) ppm, while national legislation stipulates a fortification level of 50 ppm. Median UIC was 407 (312-491) μg/L; 76% of infants had a UIC >300 μg/L, suggesting iodine excess. Calculated mean iodine intake in 12-24-month-old infants was 220 μg/day, exceeding the recommended safe upper limit for iodine at this age (200 μg/day). Among the infants, 15.8% had an elevated Tg, 7.4% had subclinical hypothyroidism, but <1% had overt hypothyroidism. UIC was not a significant predictor of thyroid function, thyroid hormones, or Tg. CONCLUSION In 6-24-month-old infants exposed to excessive iodine intake, ∼7% have subclinical hypothyroidism but <1% have overt hypothyroidism. These findings suggest the thyroid in late infancy is already able to adapt to high iodine intakes and, in most cases, maintain euthyroidism.
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Affiliation(s)
- Ashwini Kumar Nepal
- 1 Department of Biochemistry, B.P. Koirala Institute of Health Sciences , Dharan, Nepal
| | - Ranjan Suwal
- 1 Department of Biochemistry, B.P. Koirala Institute of Health Sciences , Dharan, Nepal
| | - Sharad Gautam
- 1 Department of Biochemistry, B.P. Koirala Institute of Health Sciences , Dharan, Nepal
| | - Gauri Shankar Shah
- 2 Department of Pediatric and Adolescent Medicine, B.P. Koirala Institute of Health Sciences , Dharan, Nepal
| | - Nirmal Baral
- 1 Department of Biochemistry, B.P. Koirala Institute of Health Sciences , Dharan, Nepal
| | - Maria Andersson
- 3 Human Nutrition Laboratory, Institute of Food Nutrition and Health, Swiss Federal Institute of Technology (ETH) , Zurich, Switzerland
| | - Michael Bruce Zimmermann
- 3 Human Nutrition Laboratory, Institute of Food Nutrition and Health, Swiss Federal Institute of Technology (ETH) , Zurich, Switzerland
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276
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De-Regil LM, Harding KB, Peña-Rosas JP, Webster AC. Iodine supplementation for women during the preconception, pregnancy and postpartum period. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011761] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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277
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Zimmermann MB, Galetti V. Iodine intake as a risk factor for thyroid cancer: a comprehensive review of animal and human studies. Thyroid Res 2015; 8:8. [PMID: 26146517 PMCID: PMC4490680 DOI: 10.1186/s13044-015-0020-8] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 11/29/2022] Open
Abstract
Thyroid cancer (TC) is the most common endocrine malignancy and in most countries, incidence rates are increasing. Although differences in population iodine intake are a determinant of benign thyroid disorders, the role of iodine intake in TC remains uncertain. We review the evidence linking iodine intake and TC from animal studies, ecological studies of iodine intake and differentiated and undifferentiated TC, iodine intake and mortality from TC and occult TC at autopsy, as well as the case–control and cohort studies of TC and intake of seafood and milk products. We perform a new meta-analysis of pooled measures of effect from case–control studies of total iodine intake and TC. Finally, we examine the post-Chernobyl studies linking iodine status and risk of TC after radiation exposure. The available evidence suggests iodine deficiency is a risk factor for TC, particularly for follicular TC and possibly, for anaplastic TC. This conclusion is based on: a) consistent data showing an increase in TC (mainly follicular) in iodine deficient animals; b) a plausible mechanism (chronic TSH stimulation induced by iodine deficiency); c) consistent data from before and after studies of iodine prophylaxis showing a decrease in follicular TC and anaplastic TC; d) the indirect association between changes in iodine intake and TC mortality in the decade from 2000 to 2010; e) the autopsy studies of occult TC showing higher microcarcinoma rates with lower iodine intakes; and f) the case control studies suggesting lower risk of TC with higher total iodine intakes.
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Affiliation(s)
- Michael B Zimmermann
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zürich, Schmelzbergstrasse 7, LFV D21, CH-8092 Zürich, Switzerland
| | - Valeria Galetti
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zürich, Schmelzbergstrasse 7, LFV E14, CH-8092 Zürich, Switzerland
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278
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Dietary ratio of animal:plant protein is associated with 24-h urinary iodine excretion in healthy school children. Br J Nutr 2015; 114:24-33. [PMID: 26059089 DOI: 10.1017/s0007114515001567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED Adequate dietary iodine intake in children is essential for optimal physical and neurological development. Whether lower dietary animal food and salt intake may adversely affect iodine status is under discussion. We examined the association between dietary animal:plant protein ratio with 24-h urinary iodine excretion (24-h UI, μg/d), and whether this is modified by salt intake. A 24-h UI was measured in 1959 24-h urine samples from 516 6- to 12-year-old participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study. Parallel 3 d weighed food records were used to estimate dietary intakes. Protein sources were classified as dairy, animal and plant. A repeated-measures regression model (PROC MIXED) was used to analyse the effect of animal:plant protein ratios on 24-h UI. ANIMAL plant protein ratios ranged from 0.5 (95 % CI 0.4, 0.6) to 1.6 (95 % CI 1.4, 1.9) (lowest and highest quartile). After adjustment for total energy intake, main dietary iodine sources (dairy and salt intake), and further covariates, the inter-individual variation in animal:plant protein ratio was significantly associated with variation in 24-h UI. One unit higher animal:plant protein ratio predicted 6 μg/d higher 24-h UI (P= 0.002) in boys and 5 μg/d (P= 0.03) in girls. This relationship was partially mediated by a higher salt intake at higher animal:plant protein ratios. These results suggest that lower consumption of animal protein is associated with a small decline in iodine excretion, partially mediated by decreased salt intake. Because limited salt and increased intake of plant-based foods are part of a preferable healthy food pattern, effective nutrition political strategies will be required in the future to ensure appropriate iodine nutrition in adherent populations.
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279
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Johner SA, Thamm M, Schmitz R, Remer T. Examination of iodine status in the German population: an example for methodological pitfalls of the current approach of iodine status assessment. Eur J Nutr 2015; 55:1275-82. [PMID: 26031434 DOI: 10.1007/s00394-015-0941-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/22/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Preliminary iodine concentration (UIC) measurements in spot urines of the representative German adult study DEGS indicated a severe worsening of iodine status compared to previous results in German children (KiGGS study). Therefore, we aimed to evaluate adult iodine status in detail and to investigate the impact of hydration status on UIC. METHODS UIC and creatinine concentrations were measured in 6978 spot urines from the German nationwide DEGS study (2008-2011). Twenty-four-hour iodine excretions (24-h UIE) were estimated by relating iodine/creatinine ratios to age- and sex-specific 24-h creatinine reference values. Urine osmolality was measured in two subsamples of spot urines (n = 100 each) to determine the impact of hydration status on UIC. RESULTS In DEGS, median UIC was 69 µg/L in men and 54 µg/L in women, lying clearly below the WHO cutoff for iodine sufficiency (100 µg/L). Estimated median 24-h UIE was 113 µg/day, accompanied by 32 % of DEGS adults, lying below the estimated average requirement (EAR) for iodine. Comparative analysis with the KiGGS data (>14,000 spot urines of children; median UIC 117 µg/L) revealed a comparable percentage <EAR (33 %). In two DEGS subsamples with significantly different UIC but similar median 24-h UIE, osmolality was twofold higher in the high- versus the low-UIC group. CONCLUSION Over 30 % of participants in the two German surveys had an estimated iodine intake less than the respective age-group-specific EAR. Our data strongly suggest that even in large surveys, hydration status can considerably interfere with the epidemiological iodine assessment parameter UIC. The present data can serve as an example how to evaluate population-based spot urine data on a 24-h basis, independent of hydration status.
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Affiliation(s)
- S A Johner
- IEL-Nutritional Epidemiology, DONALD Study Centre at the Research Institute of Child Nutrition, University of Bonn, Dortmund, Germany
| | - M Thamm
- Central Epidemiology Laboratory, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - R Schmitz
- Health of Children and Adolescents, Prevention Concepts, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - T Remer
- IEL-Nutritional Epidemiology, DONALD Study Centre at the Research Institute of Child Nutrition, University of Bonn, Dortmund, Germany.
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280
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Bath SC, Furmidge-Owen VL, Redman CW, Rayman MP. Gestational changes in iodine status in a cohort study of pregnant women from the United Kingdom: season as an effect modifier. Am J Clin Nutr 2015; 101:1180-7. [PMID: 25948667 PMCID: PMC4441812 DOI: 10.3945/ajcn.114.105536] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/31/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Iodine is required throughout pregnancy for thyroid hormone production, which is essential for fetal brain development. Studies of iodine status in pregnant women from the United Kingdom (UK) have focused on early gestation (<16 wk). Data on the effect of advancing gestation on urinary iodine excretion are conflicting, with suggestions of both an increase and a decrease. OBJECTIVES The aims were to evaluate iodine status in a cohort of UK pregnant women and to explore how it changes throughout gestation. DESIGN We used samples and data from 230 UK pregnant women who were recruited to the Selenium in PRegnancy INTervention study. Iodine concentration was measured in spot-urine samples that were collected at ∼12, 20, and 35 wk of gestation; creatinine concentration was also measured to correct for urine dilution. A linear mixed model was used to explore the effect of gestational week on iodine-to-creatinine ratio, with change in season, body mass index, daily milk intake, and maternal age controlled for. RESULTS The median urinary iodine concentration from urine samples collected at all time points (n = 662) was 56.8 μg/L, and the iodine-to-creatinine ratio was 116 μg/g, thus classifying this cohort as mildly-to-moderately iodine deficient. The median iodine-to-creatinine ratios at 12, 20, and 35 wk were 102.5, 120.0, and 126.0 μg/g, respectively. Only 3% of women were taking iodine-containing prenatal supplements. The iodine-to-creatinine ratio increased with advancing gestation, and there was a significant interaction between gestational week and season (P = 0.026). For a 1-wk increase in gestation, the iodine-to-creatinine ratio increased by a factor of 1.05 (95% CI: 1.02, 1.08) in winter and by a factor of 1.04 (95% CI: 1.00, 1.08) in summer. CONCLUSIONS This group of UK pregnant women was mildly-to-moderately iodine deficient at all trimesters, which is of public health concern. The finding that the iodine-to-creatinine ratio increased over the course of gestation may not be generalizable to populations with different iodine status from ours and merits further investigation. This trial was registered at www.isrctn.com as ISRCTN37927591.
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Affiliation(s)
- Sarah C Bath
- From the University of Surrey, Guildford, United Kingdom (SCB, VF-O, and MPR); Danone Nutricia Early Life Nutrition, Trowbridge, United Kingdom (VF-O); and the Nuffield Department of Obstetrics and Gynecology, University of Oxford, Oxford, United Kingdom (CWGR)
| | - Victoria L Furmidge-Owen
- From the University of Surrey, Guildford, United Kingdom (SCB, VF-O, and MPR); Danone Nutricia Early Life Nutrition, Trowbridge, United Kingdom (VF-O); and the Nuffield Department of Obstetrics and Gynecology, University of Oxford, Oxford, United Kingdom (CWGR)
| | - Christopher Wg Redman
- From the University of Surrey, Guildford, United Kingdom (SCB, VF-O, and MPR); Danone Nutricia Early Life Nutrition, Trowbridge, United Kingdom (VF-O); and the Nuffield Department of Obstetrics and Gynecology, University of Oxford, Oxford, United Kingdom (CWGR)
| | - Margaret P Rayman
- From the University of Surrey, Guildford, United Kingdom (SCB, VF-O, and MPR); Danone Nutricia Early Life Nutrition, Trowbridge, United Kingdom (VF-O); and the Nuffield Department of Obstetrics and Gynecology, University of Oxford, Oxford, United Kingdom (CWGR).
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281
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Padovani RP, Maciel RM, Kasamatsu TS, Freitas BC, Marone MM, Camacho CP, Biscolla RPM. Assessment of the Effect of Two Distinct Restricted Iodine Diet Durations on Urinary Iodine Levels (Collected over 24 h or as a Single-Spot Urinary Sample) and Na(+)/I(-) Symporter Expression. Eur Thyroid J 2015; 4:99-105. [PMID: 26279995 PMCID: PMC4521067 DOI: 10.1159/000433426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 05/18/2015] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION A restricted iodine diet (RID) may be recommended for depletion of the whole-body iodine pool in patients with differentiated thyroid cancer referred for radioiodine treatment or a whole-body scan. Evaluation of the iodine pool is possible through urinary iodide (UI) measurements, which can be collected in 24-hour (24U) or spot urinary (sU) samples. However, the minimum period required for an RID to lower the iodine pool, the measurement of iodine in sU samples as a iodine pool marker, and the influence of the iodine pool on Na(+)/I(-) symporter (NIS) expression are debatable in the literature. OBJECTIVES To compare the effects of 15- and 30-day RID on UI measurements in 24U and sU samples and the impact of RID on NIS expression. METHODS Thyroidectomized patients went on a 15- or 30-day RID and collected 24U and sU samples before and after the RID. Twenty healthy individuals were evaluated for mRNA NIS expression before and after the RID. RESULTS Of 306 patients, only 125 properly complied with both the RID and 24U collection. We observed a correlation between sU and 24U UI before the RID (n = 306, ρ = 0.47, p < 0.001), after a 15-day RID (n = 79, ρ = 0.49, p < 0.001), and after a 30-day RID (n = 46, ρ = 0.73, p < 0.001). There was a significant decrease in UI after the RID. The median UI measurement was 275 μg/l at baseline and 99 and 80 μg/l after a 15- and 30-day RID, respectively. There was a significant increase in NIS expression after a 15-day RID. CONCLUSIONS A 15-day RID is sufficient to deplete the iodine pool. sU can replace 24U UI as a marker for assessing the iodine pool. NIS expression was increased after a 15-day RID.
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Affiliation(s)
- Rosália P. Padovani
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
- Department of Nuclear Medicine, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Rui M.B. Maciel
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
- *Prof. Rui M.B. Maciel, MD, PhD, Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 669, 11th floor, São Paulo, SP 04039-033 (Brazil), E-Mail
| | - Teresa S. Kasamatsu
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Beatriz C.G. Freitas
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Marilia M.S. Marone
- Department of Nuclear Medicine, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Cleber P. Camacho
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Rosa Paula M. Biscolla
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
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282
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Montenegro-Bethancourt G, Johner SA, Stehle P, Neubert A, Remer T. Iodine status assessment in children: spot urine iodine concentration reasonably reflects true twenty-four-hour iodine excretion only when scaled to creatinine. Thyroid 2015; 25:688-97. [PMID: 25781006 DOI: 10.1089/thy.2015.0006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Currently, the measurement of urinary iodine concentration (UIC, μg/L) is the recommended parameter to assess iodine status, however, the dependency of UIC on urine volume may limit its use as an accurate parameter for monitoring iodine status in populations. Therefore, our objective was to compare two approaches for the assessment of urinary iodine excretion in spot urine samples: UIC (μg/L) and a creatinine-scaled estimate of 24-hour iodine excretion (est24h-UIEcrea [μg/d]) against actually measured 24-hour urinary iodine excretion rates (24h-UIE, μg/d). METHODS Urinary iodine and creatinine were measured both in 24-hour urine samples and parallel collected spot urine samples from 180 healthy participants of the DONALD Study, aged 6-18 years. 24h-UIE was used as quasi-reference for actual iodine status. Published 24-hour creatinine reference values served to calculate est24h-UIEcrea. Correlation analysis, cross-classifications, and Bland-Altman plots were used to evaluate agreement between the different assessment approaches. RESULTS Correlation coefficients of 24h-UIE with UIC (r=0.12, r=0.22; p=n.s.) were substantially weaker than with est24h-UIEcrea (r=0.41, r=0.47; p<0.001) in the 6-12 year old and 13-18 year old groups, respectively. Cross-classification into opposite quartiles by UIC was 7% (6-12 year old group) and 15% (13-18 year old group) versus 5% and 3% by est24h-UIEcrea, respectively. Bland-Altman plots indicated greater deviation from 24h-UIE for the UIC versus the est24h-UIEcrea approach. CONCLUSION Our findings in children and adolescents clearly show a better comparability of real 24h-UIE with est24h-UIEcrea than with UIC. Whenever highest possible validity is required for iodine status assessment from spot urine sampling, the determination of est24h-UIEcrea appears to be the more accurate monitoring approach.
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Affiliation(s)
- Gabriela Montenegro-Bethancourt
- 1Institute of Nutrition and Food Sciences-Nutritional Epidemiology, University of Bonn, Bonn, Germany; DONALD Study at the Research Institute of Child Nutrition, Dortmund, Germany
| | - Simone Anja Johner
- 1Institute of Nutrition and Food Sciences-Nutritional Epidemiology, University of Bonn, Bonn, Germany; DONALD Study at the Research Institute of Child Nutrition, Dortmund, Germany
| | - Peter Stehle
- 2Institute of Nutrition and Food Sciences-Department of Nutritional Physiology, University of Bonn, Bonn, Germany
| | - Annette Neubert
- 3Research Institute of Child Nutrition, Dortmund, Germany (former affiliation as PhD student)
| | - Thomas Remer
- 1Institute of Nutrition and Food Sciences-Nutritional Epidemiology, University of Bonn, Bonn, Germany; DONALD Study at the Research Institute of Child Nutrition, Dortmund, Germany
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283
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Edmonds JC, McLean RM, Williams SM, Skeaff SA. Urinary iodine concentration of New Zealand adults improves with mandatory fortification of bread with iodised salt but not to predicted levels. Eur J Nutr 2015; 55:1201-12. [PMID: 26018655 DOI: 10.1007/s00394-015-0933-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 05/16/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To measure the iodine status and iodine intake of New Zealand adults 18-64 years of age following mandatory fortification of bread with iodine. METHODS A cross-sectional survey of NZ adults living in Dunedin and Wellington during February-November 2012. Three hundred and one men and women aged 18-64 years randomly selected from the New Zealand Electoral Roll completed a 24-h urine collection, a demographic and iodine-specific food frequency questionnaire (FFQ), and had height and weight measured. Urine collections were analysed for iodine and reported as median urinary iodine concentration (UIC) µg/L and median urinary iodine excretion (UIE) µg/day. The FFQ was used to estimate iodine intake with and without discretionary iodised salt use. RESULTS The median UIC for all adults was 73 µg/L, indicative of mild iodine deficiency. The mean urinary volume was 2.0 L. As an estimate of iodine intake, the median UIE was 127 µg/day. Estimated iodine intake, using the FFQ which included discretionary iodised salt use, was 132 µg/day. Iodine intakes were associated with UIC (P = 0.040) and UIE (P = 0.003), but not with bread iodine intake and iodised salt use. CONCLUSION Using the WHO/UNICEF/ICCIDD target for iodine sufficiency (a UIC of >100 µg/L) based on school-aged children with a mean urinary volume of 1.0 L, the iodine status of NZ adults does not reach adequate levels (73 µg/L). A more realistic parameter in a population with a higher urinary volume excretion (2.0 L) is the UIE. A median UIE of 127 µg/day suggests that the iodine status of NZ adults is now likely to be adequate.
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Affiliation(s)
- Julia C Edmonds
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Rachael M McLean
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand.,Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Sheila M Williams
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Sheila A Skeaff
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand.
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Abstract
Iodine deficiency early in life impairs cognition and growth, but iodine status is also a key determinant of thyroid disorders in adults. Severe iodine deficiency causes goitre and hypothyroidism because, despite an increase in thyroid activity to maximise iodine uptake and recycling in this setting, iodine concentrations are still too low to enable production of thyroid hormone. In mild-to-moderate iodine deficiency, increased thyroid activity can compensate for low iodine intake and maintain euthyroidism in most individuals, but at a price: chronic thyroid stimulation results in an increase in the prevalence of toxic nodular goitre and hyperthyroidism in populations. This high prevalence of nodular autonomy usually results in a further increase in the prevalence of hyperthyroidism if iodine intake is subsequently increased by salt iodisation. However, this increase is transient because iodine sufficiency normalises thyroid activity which, in the long term, reduces nodular autonomy. Increased iodine intake in an iodine-deficient population is associated with a small increase in the prevalence of subclinical hypothyroidism and thyroid autoimmunity; whether these increases are also transient is unclear. Variations in population iodine intake do not affect risk for Graves' disease or thyroid cancer, but correction of iodine deficiency might shift thyroid cancer subtypes toward less malignant forms. Thus, optimisation of population iodine intake is an important component of preventive health care to reduce the prevalence of thyroid disorders.
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Affiliation(s)
- Michael B Zimmermann
- Human Nutrition Laboratory, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland.
| | - Kristien Boelaert
- Centre for Endocrinology, Diabetes & Metabolism, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
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285
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Development and validation of an iodine-specific FFQ to estimate iodine intake in Australian pregnant women. Br J Nutr 2015; 113:944-52. [PMID: 25744430 DOI: 10.1017/s0007114515000197] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Adequate iodine is important during pregnancy to ensure optimal growth and development of the offspring. We validated an iodine-specific FFQ (I-FFQ) for use in Australian pregnant women. A forty-four-item I-FFQ was developed to assess iodine intake from food and was administered to 122 pregnant women at 28 weeks gestation. Iodine supplement use was captured separately at 28 weeks gestation. Correlation between iodine intake from food estimated using the I-FFQ and a 4 d weighed food record as well as correlation between total iodine intake and 24 h urinary iodine excretion (UIE), 24 h urinary iodine concentration (UIC), spot UIC and thyroid function were assessed at 28 weeks gestation. A moderate correlation between the two dietary methods was shown (r 0·349, P< 0·001), and it was strengthened with the addition of iodine supplements (r 0·876, P<0·001). There was a fair agreement (k= 0·28, P<0·001) between the two dietary measures in the classification of women as receiving adequate (≥160 μg/d) or inadequate (<160 μg/d) iodine intake from food, but the limits of agreement from the Bland-Altman plot were large. Total iodine intake was associated with 24 h UIE (β = 0·488, P<0·001) but not with spot UIC. Iodine intake from food using the I-FFQ was assessed at study entry (<20 weeks gestation) in addition to 28 weeks gestation, and there was a strong correlation in iodine intake at the two time points (r 0·622, P<0·001), which indicated good reproducibility. In conclusion, the I-FFQ provides a valid tool for estimating iodine intake in pregnant women and can be used to screen women who are at risk of inadequate intake.
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286
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Watutantrige Fernando S, Cavedon E, Nacamulli D, Pozza D, Ermolao A, Zaccaria M, Girelli ME, Bertazza L, Barollo S, Mian C. Iodine status from childhood to adulthood in females living in North-East Italy: Iodine deficiency is still an issue. Eur J Nutr 2015; 55:335-40. [PMID: 25663610 DOI: 10.1007/s00394-015-0853-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 01/31/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE This survey aimed to assess iodine status in a female population at different ages, also investigating their eating habits. METHODS We measured urinary iodine concentrations (UIC) in: 634 females at puberty and 361 fertile women in 246 of whom were considered also their children (134 daughters and 120 sons). All subjects completed a food frequency questionnaire. RESULTS Median UIC decreased from childhood to adulthood (median UIC 107, 77 and 55 μg/l in the young girls, females at puberty and fertile women, respectively). Though using iodized salt improved iodine status in all groups, a significantly higher UIC was only noted in females at puberty. Milk consumption significantly increased UIC at all ages. In mother-child (both daughters and sons) pairs, the children's median UIC was nearly twice as high as their mothers' (UIC 115 vs. 57 μg/l). Milk consumption varied significantly: 56% of the mothers and 76% of their children drank milk regularly. The children (both daughters and sons) and mothers who drank milk had UIC ≥100 μg/l in 59 and 34% of cases, respectively, among the pairs who did not drink milk, 44% of the children and 19% of the mothers had UIC ≥100 μg/l. On statistical regression, 3.6% of the variability in the children's UIC depended on that of their mothers. CONCLUSIONS Dietary iodine status declines from childhood to adulthood in females due to different eating habits. A mild iodine deficiency emerged in women of child-bearing age that could have consequences during pregnancy and lactation.
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Affiliation(s)
- Sara Watutantrige Fernando
- Endocrinology Unit, Department of Medicine-DIMED, University of Padua, Via Ospedale n.105, 35128, Padua, Italy.
| | - Elisabetta Cavedon
- Endocrinology Unit, Department of Medicine-DIMED, University of Padua, Via Ospedale n.105, 35128, Padua, Italy.
| | - Davide Nacamulli
- Endocrinology Unit, Department of Medicine-DIMED, University of Padua, Via Ospedale n.105, 35128, Padua, Italy.
| | - Dina Pozza
- Endocrinology Unit, Department of Medicine-DIMED, University of Padua, Via Ospedale n.105, 35128, Padua, Italy.
| | - Andrea Ermolao
- Sports Medicine Division, Department of Medicine-DIMED, University of Padua, Padua, Italy.
| | - Marco Zaccaria
- Sports Medicine Division, Department of Medicine-DIMED, University of Padua, Padua, Italy.
| | - Maria Elisa Girelli
- Endocrinology Unit, Department of Medicine-DIMED, University of Padua, Via Ospedale n.105, 35128, Padua, Italy.
| | - Loris Bertazza
- Endocrinology Unit, Department of Medicine-DIMED, University of Padua, Via Ospedale n.105, 35128, Padua, Italy.
| | - Susi Barollo
- Endocrinology Unit, Department of Medicine-DIMED, University of Padua, Via Ospedale n.105, 35128, Padua, Italy.
| | - Caterina Mian
- Endocrinology Unit, Department of Medicine-DIMED, University of Padua, Via Ospedale n.105, 35128, Padua, Italy.
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287
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Campos RDO, Barreto IDS, Maia LRDJ, Rebouças SCL, Cerqueira TLDO, Oliveira CA, Santos CADST, Mendes CMC, Teixeira LSG, Ramos HE. Iodine nutritional status in Brazil: a meta-analysis of all studies performed in the country pinpoints to an insufficient evaluation and heterogeneity. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 59:13-22. [DOI: 10.1590/2359-3997000000004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/12/2014] [Indexed: 11/21/2022]
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288
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Ovadia YS, Gefel D, Turkot S, Aharoni D, Fytlovich S, Troen AM. Elevated Serum Thyroglobulin and Low Iodine Intake Are Associated with Nontoxic Nodular Goiter among Adults Living near the Eastern Mediterranean Coast. J Thyroid Res 2014; 2014:913672. [PMID: 25610705 PMCID: PMC4279788 DOI: 10.1155/2014/913672] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 12/11/2022] Open
Abstract
Background. Information about iodine intake is crucial for preventing thyroid diseases. Inadequate iodine intake can lead to thyroid diseases, including nontoxic nodular goiter (NNG). Objective. To estimate iodine intake and explore its correlation with thyroid diseases among Israeli adults living near the Mediterranean coast, where iodine-depleted desalinated water has become a major source of drinking water. Methods. Cross-sectional study of patients attending Barzilai Medical Center Ashkelon. Participants, who were classified as either NNG (n = 17), hypothyroidism (n = 14), or control (n = 31), provided serum thyroglobulin (Tg) and completed a semiquantitative iodine food frequency questionnaire. Results. Elevated serum Tg values (Tg > 60 ng/mL) were significantly more prevalent in the NNG group than in the other groups (29% versus 7% and 0% for hypothyroidism and controls, resp., P < 0.05). Mean estimated iodine intake was significantly lower in the NNG group (65 ± 30 μg/d) than in controls (115 ± 60 μg/d) (P < 0.05) with intermediate intake in the hypothyroid group (73 ± 38 μg/d). Conclusions. Elevated serum Tg values and low dietary iodine intake are associated with NNG among adult patients in Ashkelon District, Israel. Larger studies are needed in order to expand on these important initial findings.
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Affiliation(s)
- Yaniv S. Ovadia
- Department of Internal Medicine “C”, Barzilai Medical Center Ashkelon, Hahistadrout Street 2, 7830604 Ashkelon, Israel
- Nutrition and Brain Health Laboratory, School of Nutritional Sciences, Institute of Biochemistry, Food Science and Nutrition, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, 76100 Rehovot, Israel
| | - Dov Gefel
- Department of Internal Medicine “C”, Barzilai Medical Center Ashkelon, Hahistadrout Street 2, 7830604 Ashkelon, Israel
- Nutrition and Brain Health Laboratory, School of Nutritional Sciences, Institute of Biochemistry, Food Science and Nutrition, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, 76100 Rehovot, Israel
| | - Svetlana Turkot
- Endocrinology Clinic, Barzilai Medical Center Ashkelon, Hahistadrout Street 2, 7830604 Ashkelon, Israel
| | - Dorit Aharoni
- Laboratory of Clinical Biochemistry, Barzilai Medical Center Ashkelon, Hahistadrout Street 2, 7830604 Ashkelon, Israel
| | - Shlomo Fytlovich
- Laboratory of Clinical Biochemistry, Barzilai Medical Center Ashkelon, Hahistadrout Street 2, 7830604 Ashkelon, Israel
| | - Aron M. Troen
- Nutrition and Brain Health Laboratory, School of Nutritional Sciences, Institute of Biochemistry, Food Science and Nutrition, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, 76100 Rehovot, Israel
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289
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Ersoy B, Özhan B, Kiremitçi S, Rubio-Cabezas O, Ellard S. Primary hypothyroidism: an unusual manifestation of Wolcott-Rallison syndrome. Eur J Pediatr 2014; 173:1565-8. [PMID: 23933668 DOI: 10.1007/s00431-013-2110-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/16/2013] [Indexed: 11/26/2022]
Abstract
Wolcott-Rallison syndrome has been reported to be associated with early-onset diabetes, epiphyseal dysplasia, hepatic and renal dysfunction, mental retardation, severe growth retardation, neutropenia, exocrine pancreatic dysfunction, and central hypothyroidism. We report on primary hypothyroidism, which has not been previously described, of a patient with Wolcott-Rallison syndrome due to novel mutation (W521X), who showed improved growth after thyroid hormone treatment.
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Affiliation(s)
- Betül Ersoy
- Division of Pediatric Endocrinology and Metabolism, School of Medicine, Celal Bayar University, Manisa, 45000, Turkey
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290
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Bath SC, Sleeth ML, McKenna M, Walter A, Taylor A, Rayman MP. Iodine intake and status of UK women of childbearing age recruited at the University of Surrey in the winter. Br J Nutr 2014; 112:1715-23. [PMID: 25274294 PMCID: PMC4340577 DOI: 10.1017/s0007114514002797] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As intra-thyroidal iodine stores should be maximised before conception to facilitate the increased thyroid hormone production during pregnancy, women who are planning to become pregnant should ideally consume 150 μg iodine/d (US RDA). As few UK data exist for this population group, a cross-sectional study was carried out at the University of Surrey to assess the iodine intake and status of women of childbearing age. Total iodine excretion was measured from 24 h urine samples in fifty-seven women; iodine intake was estimated by assuming that 90 % of ingested iodine was excreted. The average iodine intake was also estimated from 48 h food diaries that the participants completed. The median urinary iodine concentration value (63·1 μg/l) indicated the group to be mildly iodine deficient by WHO criteria. By contrast, the median 24 h urinary iodine excretion value (149·8 μg/24 h) indicated a relatively low risk of iodine deficiency. The median estimated iodine intake, extrapolated from urinary excretion, was 167 μg/d, whereas it was lower, at 123 μg/d, when estimated from the 48 h food diaries. Iodine intake estimated from the food diaries and 24 h urinary iodine excretion were strongly correlated (r 0·75, P< 0·001). The intake of milk, eggs and dairy products was positively associated with iodine status. The iodine status of this UK cohort is probably a best-case scenario as the women were mostly nutrition students and were recruited in the winter when milk-iodine content is at its highest; further study in more representative cohorts of UK women is required. The present study highlights the need for revised cut-off values for iodine deficiency that are method- and age group-specific.
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Affiliation(s)
- Sarah C Bath
- Department of Nutritional Sciences,Faculty of Health and Medical Sciences, University of Surrey,Guildford,SurreyGU2 7XH,UK
| | - Michelle L Sleeth
- Department of Nutritional Sciences,Faculty of Health and Medical Sciences, University of Surrey,Guildford,SurreyGU2 7XH,UK
| | - Marianne McKenna
- Department of Nutritional Sciences,Faculty of Health and Medical Sciences, University of Surrey,Guildford,SurreyGU2 7XH,UK
| | - Alan Walter
- Department of Nutritional Sciences,Faculty of Health and Medical Sciences, University of Surrey,Guildford,SurreyGU2 7XH,UK
| | - Andrew Taylor
- Department of Nutritional Sciences,Faculty of Health and Medical Sciences, University of Surrey,Guildford,SurreyGU2 7XH,UK
| | - Margaret P Rayman
- Department of Nutritional Sciences,Faculty of Health and Medical Sciences, University of Surrey,Guildford,SurreyGU2 7XH,UK
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291
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Iodine excretion has decreased in Denmark between 2004 and 2010--the importance of iodine content in milk. Br J Nutr 2014; 112:1993-2001. [PMID: 25354521 DOI: 10.1017/s0007114514003225] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Fortification with the essential trace element iodine is widespread worldwide. In the present study, results on iodine excretion and intake of iodine-rich foods from a cross-sectional study carried out in 2004-5, 4 to 5 years after the implementation of mandatory iodine fortification, were compared with data in a study carried out in 2008-10. The 2008-10 study was a follow-up of a cross-sectional study carried out before iodine fortification was implemented. Participants in the cross-sectional studies were randomly selected. Both studies were carried out in the cities of Aalborg and Copenhagen in Denmark. The median urinary iodine concentration decreased in women from 97 μg/l (n 2862) to 78 μg/l (n 2041) (P< 0.001). The decrease persisted after adjustment for age, city and education, and if expressed as estimated 24 h iodine excretion. The prevalence of users of iodine containing dietary supplements increased from 29.4 to 37.3 % (P< 0.001). The total fluid intake increased in women (P< 0.001), but the intake of other iodine-rich foods did not change. The median urinary iodine concentration did not change in men (114 μg/l (n 708) and 107 μg/l (n 424), respectively), while the total fluid intake decreased (P= 0.001). Iodine content was measured in milk sampled in 2000-1 and in 2013. The iodine content was lower in 2013 (12 (sd 3) μg/100 g) compared with that in 2000-1 (16 (sd 6) μg/100 g) (P< 0.001). In conclusion, iodine excretion in women has decreased below the recommended level. The reason might probably, at least partly, be a decreased content of iodine in milk.
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292
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Kim BK, Jeong JY, Seok KH, Lee AS, Oak CH, Kim GC, Jeong CK, Choi SI, Afidchao PM, Choi YS. Current iodine nutrition status and awareness of iodine deficiency in tuguegarao, Philippines. Int J Endocrinol 2014; 2014:210528. [PMID: 25374598 PMCID: PMC4211171 DOI: 10.1155/2014/210528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/10/2014] [Accepted: 09/12/2014] [Indexed: 11/17/2022] Open
Abstract
The Philippines is one of the countries where adequate iodine status has been achieved. However, iodine deficiency still remains an important public health problem in this country. In this study, we evaluated iodine nutrition status and investigated an awareness status of iodine deficiency targeting high school students of Tuguegarao, Philippines. A total of 260 students provided samples for urinary iodine analysis, among which 146 students completed thyroid volume measurement by ultrasonography and answering the questionnaires. The median urinary iodine level was 355.3 µg/L and only 3.8% of the students were in the range of iodine deficiency status according to the ICCIDD criteria. Although 62.3% of students answered that they can list problems resulting from iodine deficiency, a majority of students (70.5%) were unable to identify problems other than goiter. They did not appreciate that adequate iodine levels are important during pregnancy and for development of children. 33.6% of students answered that they did not use iodized salt and the biggest reason was that they did not find it necessary. Based on these results, we suggest that a future strategy should be focused on vulnerable groups to completely eliminate iodine deficiency, including women at their reproductive ages and during pregnancy.
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Affiliation(s)
- Bu Kyung Kim
- Department of Internal Medicine, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 602-703, Republic of Korea
| | - Jee-Yeong Jeong
- Department of Biochemistry, Kosin University College of Medicine, Busan 602-703, Republic of Korea
- Cancer Research Institute, Kosin University College of Medicine, Busan 602-703, Republic of Korea
| | - Kwang-Hyuk Seok
- Department of Microbiology, Kosin University College of Medicine, Busan 602-703, Republic of Korea
| | - Andrew S. Lee
- Department of Microbiology, Kosin University College of Medicine, Busan 602-703, Republic of Korea
- Institute for International Healthcare Cooperation, Kosin University College of Medicine, Busan 602-703, Republic of Korea
| | - Chul Ho Oak
- Department of Internal Medicine, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 602-703, Republic of Korea
- Institute for International Healthcare Cooperation, Kosin University College of Medicine, Busan 602-703, Republic of Korea
| | - Ghi Chan Kim
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan 602-703, Republic of Korea
| | - Chae-Kyeong Jeong
- Department of Chemistry, Boston College, Chestnut Hill, MA 02467, USA
| | - Sung In Choi
- Department of Food Science and Nutrition, Pusan National University, Busan 609-838, Republic of Korea
| | - Pablo M. Afidchao
- Department of Pharmacology and Biochemistry, Cagayan State University, College of Medicine, 3500 Tuguegarao, Philippines
| | - Young Sik Choi
- Department of Internal Medicine, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 602-703, Republic of Korea
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293
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Daily iodine intake and the impact of salt reduction on iodine prophylaxis in the Italian population. Eur J Clin Nutr 2014; 69:211-5. [PMID: 25293434 DOI: 10.1038/ejcn.2014.206] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/11/2014] [Accepted: 07/23/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Salt iodization is one of the preferred strategies to eradicate iodine-deficiency disorders worldwide. The aim of this study was (i) to estimate the daily iodine intake in the Italian population, (ii) to verify whether the recently recommended salt intake of 5 g/day in adults and less in children may be sufficient to achieve the adequate daily iodine intake, (iii) to estimate the contribution of iodine-enriched vegetables to the total daily iodine intake. SUBJECTS/METHODS The content of iodine has been evaluated in 288 food samples highly representative of Italian eating habits. The contribution of foods and iodized salt to the total daily iodine intake was estimated in adults, adolescents, and children on the basis of available nationwide data of food consumption. RESULTS The total daily iodine intake owing to food and uniodized salt consumption resulted lower than the daily requirement in all age groups. With a daily consumption of 5 g of salt iodized at 30 mg/kg, the estimated daily iodine intake resulted within the range of optimal iodine intake in all age groups. In children the recommended iodine intake is achieved with a daily consumption of 3 g of iodized salt. Moreover, the daily iodine intake significantly increased in all age groups if the consumption of iodine-enriched vegetables was considered in substitution of non iodine-enriched ones. CONCLUSIONS Our study suggests that the recommended quantities of salt, if iodized at 30 mg/kg, are sufficient to achieve the adequate daily iodine intake both in adults and children.
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294
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Nutrición de yodo en mujeres embarazadas del área de Oviedo. ¿Es necesaria la suplementación con yodo? ACTA ACUST UNITED AC 2014; 61:404-9. [DOI: 10.1016/j.endonu.2014.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/14/2014] [Accepted: 02/23/2014] [Indexed: 11/18/2022]
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295
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Prevalence of iodine inadequacy in Switzerland assessed by the estimated average requirement cut-point method in relation to the impact of iodized salt. Public Health Nutr 2014; 18:1333-42. [PMID: 25231207 DOI: 10.1017/s1368980014002018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess the iodine status of Swiss population groups and to evaluate the influence of iodized salt as a vector for iodine fortification. DESIGN The relationship between 24 h urinary iodine and Na excretions was assessed in the general population after correcting for confounders. Single-day intakes were estimated assuming that 92 % of dietary iodine was excreted in 24 h urine. Usual intake distributions were derived for male and female population groups after adjustment for within-subject variability. The estimated average requirement (EAR) cut-point method was applied as guidance to assess the inadequacy of the iodine supply. SETTING Public health strategies to reduce the dietary salt intake in the general population may affect its iodine supply. SUBJECTS The study population (1481 volunteers, aged ≥15 years) was randomly selected from three different linguistic regions of Switzerland. RESULTS The 24 h urine samples from 1420 participants were determined to be properly collected. Mean iodine intakes obtained for men (n 705) and women (n 715) were 179 (sd 68.1) µg/d and 138 (sd 57.8) µg/d, respectively. Urinary Na and Ca, and BMI were significantly and positively associated with higher iodine intake, as were men and non-smokers. Fifty-four per cent of the total iodine intake originated from iodized salt. The prevalence of inadequate iodine intake as estimated by the EAR cut-point method was 2 % for men and 14 % for women. CONCLUSIONS The estimated prevalence of inadequate iodine intake was within the optimal target range of 2-3 % for men, but not for women.
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296
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Salam RA, Das JK, Bhutta ZA. Multiple micronutrient supplementation during pregnancy and lactation in low-to-middle-income developing country settings: impact on pregnancy outcomes. ANNALS OF NUTRITION AND METABOLISM 2014; 65:4-12. [PMID: 25227399 DOI: 10.1159/000365792] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Malnutrition, including micronutrient deficiencies, remains one of the major public health challenges, particularly in low-to-middle-income countries. Micronutrient deficiencies affect people of all ages, but its effects appear more devastating in pregnant women and children. Poor maternal nutrition contributes to at least 20% of maternal deaths and increases the probability of poor pregnancy outcomes including intrauterine growth restriction, resulting in low birth weight, stunting, wasting and mortality. Key Messages: Several strategies have been employed to provide pregnant women with micronutrients. These strategies include education, dietary modification, food provision, agricultural interventions, supplementation and fortification either alone or in combination. Micronutrient supplementation is the most widely practiced intervention to prevent and manage single or multiple micronutrient deficiencies. Micronutrient supplementation either alone or in combination has shown to be effective in improving maternal, birth and child outcomes. CONCLUSIONS There is a need to focus on maternal micronutrient status as a continuum from the periconceptional period throughout pregnancy to lactation. Given the wide prevalence of multiple micronutrient deficiencies in low-to-middle-income countries, the challenge is to implement intervention strategies that combine appropriate maternal and child health interventions with micronutrient interventions.
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Affiliation(s)
- Rehana A Salam
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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297
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Rydbeck F, Rahman A, Grandér M, Ekström EC, Vahter M, Kippler M. Maternal urinary iodine concentration up to 1.0 mg/L is positively associated with birth weight, length, and head circumference of male offspring. J Nutr 2014; 144:1438-44. [PMID: 25031330 DOI: 10.3945/jn.114.193029] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Adequate iodine status in early life is crucial for neurodevelopment. However, little is known about the effects of maternal iodine status during pregnancy on fetal growth. The present study investigated the potential impact of maternal iodine status during pregnancy on offspring birth size. This large prospective cohort study was nested in a Bangladeshi population-based randomized supplementation trial in pregnant women [MINIMat (Maternal and Infant Nutrition Interventions in Matlab)]. Urine samples obtained at 8 wk of gestation from 1617 women were analyzed for iodine and other elements, such as arsenic and cadmium, using inductively coupled plasma mass spectrometry. Anthropometric measurements at birth included weight, length, and head and chest circumference. Maternal urinary iodine concentrations (UICs) ranged from 0.020 to 10 mg/L, with a median of 0.30 mg/L. Below ∼1.0 mg/L, UIC was significantly positively associated with birth weight and length. Birth weight and length increased by 9.3 g (95% CI: 2.9, 16) and 0.042 cm (95% CI: 0.0066, 0.076), respectively, for each 0.1-mg/L increase in maternal UIC. No associations were observed between UIC and head or chest circumference. When we stratified the analyses by newborn sex, the positive associations between maternal UIC (<1 mg/L) and measurements of size at birth were restricted to boys, with no evidence in girls. Among boys, the mean weight, length, and head circumference increased by 70 g (P = 0.019), 0.41 cm (P = 0.013), and 0.28 cm (P = 0.031) for every 0.5-mg/L increase in maternal UIC. Maternal iodine status was positively associated with weight, length, and head circumference in boys up to ∼1 mg/L, which is well above the recommended maximum concentration of 0.5 mg/L. The associations leveled off at UIC ≥ 1 mg/L. Our findings support previous conclusions that the advantages of correcting potential iodine deficiency outweigh the risks of excess exposure.
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Affiliation(s)
- Filip Rydbeck
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anisur Rahman
- Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; and
| | - Margaretha Grandér
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Eva-Charlotte Ekström
- Department of Women's and Children's Health, International Maternal and Child Health, University Hospital, Uppsala, Sweden
| | - Marie Vahter
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden;
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298
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Guidetti M, Agostini F, Lapenna G, Pazzeschi C, Soverini V, Petitto R, Pironi L. Iodine nutrition in adults on long-term home parenteral nutrition. Nutrition 2014; 30:1050-4. [DOI: 10.1016/j.nut.2014.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 10/25/2013] [Accepted: 03/13/2014] [Indexed: 01/28/2023]
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299
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Gutiérrez-Repiso C, Colomo N, Rojo-Martinez G, Valdés S, Tapia MJ, Esteva I, Ruiz de Adana MS, Rubio-Martin E, Lago-Sampedro A, Santiago P, Velasco I, Garcia-Fuentes E, Moreno JC, Soriguer F. Evolution of urinary iodine excretion over eleven years in an adult population. Clin Nutr 2014; 34:712-8. [PMID: 25155806 DOI: 10.1016/j.clnu.2014.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 08/04/2014] [Accepted: 08/04/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Few prospective cohort studies have evaluated dietary iodine intake and urinary iodine concentrations in the general adult population. We assess the evolution of urinary iodine excretion and factors that may influence it in an adult population followed for 11 years. METHODS A population-based cohort study was undertaken in Pizarra (Spain). In the three study phases (baseline (n = 886), and 6 (n = 788) and 11 years later (n = 501)), participants underwent an interview and a standardized clinical examination that included a food questionnaire, and thyroid hormone and urinary iodine determinations. Subjects with thyroid dysfunction, palpable goiter or urinary iodine excretion >400 μg/L were excluded. RESULTS Urinary iodine increased over the years (100.6 ± 70.0 μg/L at baseline vs. 125.4 ± 95.2 μg/L at 6 years and 141.6 ± 81.4 μg/L at 11 years; p < 0.0001). Urinary iodine was significantly higher in subjects who reported iodized salt consumption and in subjects with a higher intake of dairy products (p < 0.05). Consumption of iodized salt (Risk ratio (RR) = 1.23, 95% CI [1.01-2.05]) and dairy products (RR = 2.07, 95% CI [1.01-4.23]), and a baseline urinary iodine concentration ≥100 μg/L (RR = 1.26, 95% CI [1.04-1.53]) were significantly associated with urinary iodine concentrations ≥100 μg/L at 11 years. There is no correlation between thyroid function (TSH, free triiodothyronine or free thyroxine levels) and urinary iodine concentrations in conditions of iodine sufficiency. CONCLUSIONS The increase in urinary iodine concentrations over eleven years is associated with an increase in iodized salt intake and with the dairy products intake, and possibly with a higher iodine content of dairy products. However, individual variability in urinary iodine excretion was not fully explained by dietary iodine intake alone; previous urinary iodine concentrations were also important.
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Affiliation(s)
- Carolina Gutiérrez-Repiso
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos IIII, Málaga, Spain
| | - Natalia Colomo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos IIII, Málaga, Spain
| | - Gemma Rojo-Martinez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos IIII, Málaga, Spain; CIBER de Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Málaga, Spain
| | - Sergio Valdés
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos IIII, Málaga, Spain; CIBER de Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Málaga, Spain
| | - Maria J Tapia
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain
| | - Isabel Esteva
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos IIII, Málaga, Spain; CIBER de Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Málaga, Spain
| | - Maria S Ruiz de Adana
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos IIII, Málaga, Spain; CIBER de Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Málaga, Spain
| | - Elehazara Rubio-Martin
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos IIII, Málaga, Spain
| | - Ana Lago-Sampedro
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos IIII, Málaga, Spain
| | - Piedad Santiago
- Endocrinology and Nutrition Department, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Ines Velasco
- Unidad de Gestión Clínica Materno-Infantil, Hospital de Riotinto, Huelva, Spain
| | - Eduardo Garcia-Fuentes
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos IIII, Málaga, Spain.
| | - Jose C Moreno
- Molecular Thyroid Laboratory, INGEMM-Institute for Medical and Molecular Genetics, La Paz University Hospital, Madrid, Spain
| | - Federico Soriguer
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos IIII, Málaga, Spain; CIBER de Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Málaga, Spain
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Fiore E, Tonacchera M, Vitti P. Influence of iodization programmes on the epidemiology of nodular goitre. Best Pract Res Clin Endocrinol Metab 2014; 28:577-88. [PMID: 25047207 DOI: 10.1016/j.beem.2014.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Iodine is essential for the synthesis of thyroid hormones. Iodine deficiency can affect human health in different ways, and is commonly referred to as iodine deficiency disorders (IDD). These range from defective development of the central nervous system during the fetal-neonatal life, to goitre in the adult. Only a few countries were completely iodine sufficient before 1990. Since then, a major effort has been made to introduce salt iodization to ensure sufficient intake of iodine in deficient areas. Iodine prophylaxis has been shown to exert a pivotal role in abating goitre and other iodine-deficiency disorders, and has also been shown to modulate the pattern of thyroid diseases. An increased frequency of thyroid autoimmunity and of hypothyroidism has been observed after introducing iodization programmes. Nevertheless, available evidence clearly confirms that the benefits of correcting iodine deficiency, consisting mainly of reducing nodular goitre and non-autoimmune hyperthyroidism, far outweigh the risks of iodine supplementation.
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Affiliation(s)
- Emilio Fiore
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy.
| | - Massimo Tonacchera
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy.
| | - Paolo Vitti
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy.
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