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He J, Huang L, Liu C, Mo Z, Su D, Gu S, Guo F, Wang Y, Chen Z, Wang X, Zhang R, Lou X, Mao G. Dietary Iodine Intake and Sources among Residents in Zhejiang Province 10 Years after Reducing Iodine Concentration in Iodized Salt. Nutrients 2024; 16:2153. [PMID: 38999900 PMCID: PMC11243422 DOI: 10.3390/nu16132153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
We aimed to assess dietary iodine intake and sources in Zhejiang Province a decade after a reduction in iodine concentration in iodized salt. Three-day 24 h dietary recall and household weighing were used, complemented by "Chinese Food Composition" data. Household water and salt samples were collected from 5890 residents and analyzed. Differences in iodized salt consumption rates were observed across the following regions: inland (84.20%), subcoastal (67.80%), and coastal (37.00%) areas. The median (P25, P75) iodine concentration in water and diet were 2.2 (0.9, 4.0) μg/L and 142.05 (58.94, 237.11) μg/d, respectively, with significant regional differences in dietary concentration (inland [185.61 μg/d], subcoastal [153.42 μg/d], and coastal [75.66 μg/d]). Males (149.99 μg/d) and iodized salt consumers (191.98 μg/d) had a significantly higher dietary iodine intake than their counterparts. Regions were ranked as follows based on the proportions of individuals meeting the recommended dietary iodine intake: inland (69.40%), subcoastal (56.50%), and coastal (34.10%) areas. Dietary sources included salt (48.54%), other foods (32.06%), drinking water (8.84%), laver (4.82%), kelp (3.02%), and other seafood (2.32%). The qualified iodized salt consumption rate was significantly lower than the national standard. Zhejiang Province should continue implementing measures to control iodine deficiency through salt iodization, education efforts, and increasing the qualified iodized salt consumption rate.
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Affiliation(s)
- Jiaxin He
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Lichun Huang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Chenyang Liu
- School of Public Health, Zhejiang University, Hangzhou 310058, China
| | - Zhe Mo
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Danting Su
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Simeng Gu
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Fanjia Guo
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Yuanyang Wang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Zhijian Chen
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Xiaofeng Wang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Ronghua Zhang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Xiaoming Lou
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Guangming Mao
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
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Christensen C, Matthiessen J, Fagt S, Biltoft-Jensen A. Dietary supplements increase the risk of excessive micronutrient intakes in Danish children. Eur J Nutr 2023; 62:2449-2462. [PMID: 37127694 PMCID: PMC10421806 DOI: 10.1007/s00394-023-03153-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/13/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE Dietary supplement use is common in Northern Europe. Many dietary supplements contain 100% of nutrient reference values (NRV) of micronutrients. This study investigates the contribution of dietary supplements to micronutrient intake, the prevalence of excess intake of micronutrients, and parental characteristics of dietary supplement use in Danish children. METHODS Data on 499 4-10-year-old children from the Danish National Survey of Diet and Physical Activity 2011-2013 were analysed using non-parametric statistics to compare micronutrient intake from the diet and dietary supplements to the reference intake (RI), and to the tolerable Upper Intake Level (UL) for users and non-users of dietary supplements. Furthermore, characteristics of the parents of users and non-users of dietary supplements were examined by logistic regression analysis. RESULTS Sixty-four percent of the children were dietary supplement users. Multivitamin-mineral supplements were the most frequently used type of supplement (60%). Children of never-smokers were more likely to use supplements than children of smokers. Users had significantly higher total intakes of 15 micronutrients compared to non-users. Intakes of vitamin A, zinc, and iodine from the diet alone exceeded ULs in 12-30% of the children. Use of dietary supplements gave rise to 21-73% of children in exceedance of the aforementioned three ULs as well as the UL for iron (6-45%). CONCLUSION Dietary supplement use was common among 4-10-year-old Danish children and resulted in a considerable proportion of users exceeding the ULs for vitamin A, zinc, iodine, and iron. The long-term health consequences of exceeding these ULs for children are unknown.
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Affiliation(s)
- Camilla Christensen
- Research Group for Nutrition, Sustainability and Health Promotion, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark.
| | - Jeppe Matthiessen
- Research Group for Nutrition, Sustainability and Health Promotion, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Sisse Fagt
- Research Group for Nutrition, Sustainability and Health Promotion, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anja Biltoft-Jensen
- Research Group for Nutrition, Sustainability and Health Promotion, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
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Knøsgaard L, Andersen S, Hansen AB, Sørensen A, Vestergaard P, Andersen SL. Iodine status in Danish pregnant women after an increase in iodine fortification. Clin Endocrinol (Oxf) 2023; 98:407-414. [PMID: 35788951 DOI: 10.1111/cen.14797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/16/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Iodine fortification programmes are implemented in many countries and often associated with an increase in population iodine intake. However, the initial attempt may not be sufficient and in Denmark the level of iodine added to salt was increased in 2019. Sparse evidence is available on the impact of such modification in iodine fortification. The aim of this study was to evaluate iodine status in Danish pregnant women in 2021 after this increase in iodine fortification and compare to iodine status in 2012. DESIGN Cross-sectional study. PATIENTS Pregnant women in the North Denmark Region referred for routine obstetric ultrasound in 2021. MEASUREMENTS Participants filled out a questionnaire and delivered a spot urine. Median urinary iodine concentration (UIC) was calculated and assessed according to the recommended range in pregnancy (150-249 µg/L). RESULTS Altogether 147 pregnant women were included and 88% used iodine-containing supplements. Median UIC was overall 77 µg/L [95% confidence interval (CI): 61-96 µg/L], which was lower than in 2012 (101 µg/L [95% CI: 89-111 µg/L]) (p < 0.001). Considering sources of iodine intake in pregnancy, lower daily intake of dairy products (p = 0.008) and bread (p < 0.001) and a lower content of iodine in the supplement used (p < 0.001) was seen in 2021 compared to 2012. CONCLUSION Despite an increase in iodine fortification and frequent use of iodine-containing supplements, iodine status in pregnant women in the North Denmark Region was insufficient. Results call for continued monitoring and attention to ensure adequate iodine status during pregnancy in Denmark.
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Affiliation(s)
- Louise Knøsgaard
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Stig Andersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Annebirthe Bo Hansen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Sørensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
| | - Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Jakobsen LS, Nielsen JO, Paulsen SE, Outzen M, Linneberg A, Møllehave LT, Christensen T, Ravn-Haren G. Risk–Benefit Assessment of an Increase in the Iodine Fortification Level of Foods in Denmark—A Pilot Study. Foods 2022; 11:foods11091281. [PMID: 35564002 PMCID: PMC9104615 DOI: 10.3390/foods11091281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Iodine deficiency is one of the most common nutritional disorders worldwide. In Denmark, the mandatory iodine fortification of salt of 13 ppm was introduced in 2000 to eradicate mild to moderate iodine deficiency and the fortification level was increased to 20 ppm in 2019. However, the optimal iodine intake is a narrow interval, and the risk of disease increases with intakes both below and above this interval. In this study, we quantified the risk–benefit balance in the Danish adult population by increasing the mandatory fortification level. We applied a risk–benefit assessment approach in which population-level iodine intakes before and after the increase in fortification were integrated with epidemiological evidence of the association between iodine nutrition status and risk of relevant diseases to estimate the number of cases caused or prevented and estimated health impact in terms of disability-adjusted life years (DALY). We estimated an overall beneficial health impact and prevention of 34.9 (95% UI: −51.6; −21.7) DALY per 100,000 adults in the population annually with the increase in fortification level. Prevention of low IQ in children due to maternal iodine deficiency was the primary contributor to overall health gain. The gain in healthy life years comes at the expense of extra cases of goiter due to iodine excess. Due to lack of data, hypo- and hyperthyroidism related to iodine status were not included. Neither were children as a population group. Because of this, as well as uncertainties inherent in the model and data used, results should be interpreted with caution. We argue that nation-specific, quantitative assessments of the public health impact of fortification programs provide transparent, evidence-based decision support. Future research should aim to enable the inclusion of all relevant health effects as well as children in the assessment.
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Affiliation(s)
- Lea Sletting Jakobsen
- National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark; (J.O.N.); (S.E.P.); (M.O.); (T.C.); (G.R.-H.)
- Correspondence:
| | - Josefine Ostenfeld Nielsen
- National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark; (J.O.N.); (S.E.P.); (M.O.); (T.C.); (G.R.-H.)
| | - Sophie Egesø Paulsen
- National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark; (J.O.N.); (S.E.P.); (M.O.); (T.C.); (G.R.-H.)
| | - Malene Outzen
- National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark; (J.O.N.); (S.E.P.); (M.O.); (T.C.); (G.R.-H.)
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (A.L.); (L.T.M.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Line Tang Møllehave
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (A.L.); (L.T.M.)
| | - Tue Christensen
- National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark; (J.O.N.); (S.E.P.); (M.O.); (T.C.); (G.R.-H.)
| | - Gitte Ravn-Haren
- National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark; (J.O.N.); (S.E.P.); (M.O.); (T.C.); (G.R.-H.)
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