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Wan S, Jin B, Ren B, Boah M, Shen H. Relationship between mild iodine deficiency in pregnant women and thyroid function: A meta-analysis. J Trace Elem Med Biol 2023; 78:127197. [PMID: 37209527 DOI: 10.1016/j.jtemb.2023.127197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Pregnant women are among the key groups in iodine nutrition evaluation. The purpose of the present study was to summarize the evidence supporting the relationship between mild iodine deficiency (UIC: 100-150 μg/L) in pregnant women and levels of thyroid function tests. METHODS This review follows the guidelines for systematic reviews (PRISMA 2020). Three electronic databases (PubMed, Medline, and Embase) were searched for relevant publications in English on the association between mild iodine deficiency in pregnant women and thyroid function. Articles published in Chinese were searched in China's electronic databases (CNKI, WanFang, CBM, and WeiPu). Pooled effects were presented as standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) using fixed or random effect models, respectively. This meta-analysis was registered at www.crd.york.ac.uk/prospero as CRD42019128120. RESULTS We summarized the results from 7 articles with 8261 participants. The overall pooled results showed that the levels of FT3, FT4, and abnormal TgAb (the antibody levels exceeded the upper limit of the reference range) were significantly increased in pregnant women with mild iodine deficiency compared to pregnant women with adequate iodine status (FT3: SMD=0.854, 95% CI: 0.188, 1.520; FT4: SMD=0.550, 95% CI: 0.050, 1.051; TgAb: OR=1.292, 95% CI: 1.095; 1.524). Subgroup analysis was carried out on the sample size, ethnicity, country, and gestation of FT3, FT4, and TSH, but no plausible factor was found. Egger's tests indicated no publication bias.The increase in FT3 and FT4, as well as TgAb levels, in pregnant women is associated with mild iodine deficiency. CONCLUSION Mild iodine deficiency is associated with an increase in FT3,FT4 and TgAb levels in pregnant women. Mild iodine deficiency may increase the risk of thyroid dysfunction in pregnant women.
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Affiliation(s)
- Siyuan Wan
- Department of Preventive Medicine, Qiqihar Medical University, Qiqihar, Heilongjiang, China.
| | - Baiming Jin
- Department of Preventive Medicine, Qiqihar Medical University, Qiqihar, Heilongjiang, China
| | - Bingxuan Ren
- Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China
| | - Michael Boah
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Hongmei Shen
- Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China.
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Matta Coelho C, Guimarães J, Bracchi I, Xavier Moreira N, Pinheiro C, Ferreira P, Pestana D, Barreiros Mota I, Cortez A, Prucha C, Martins C, Pinto E, Almeida A, Delerue-Matos C, Dias CC, Moreira-Rosário A, Ribeiro de Azevedo LF, Cruz Fernandes V, Ramalho C, Calhau C, Brantsæter AL, Costa Leite J, Keating E. Noncompliance to iodine supplementation recommendation is a risk factor for iodine insufficiency in Portuguese pregnant women: results from the IoMum cohort. J Endocrinol Invest 2022; 45:1865-1874. [PMID: 35635644 DOI: 10.1007/s40618-022-01813-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE After a recommendation for iodine supplementation in pregnancy has been issued in 2013 in Portugal, there were no studies covering iodine status in pregnancy in the country. The aim of this study was to assess iodine status in pregnant women in Porto region and its association with iodine supplementation. METHODS A cross-sectional study was conducted at Centro Hospitalar Universitário São João, Porto, from April 2018 to April 2019. Pregnant women attending the 1st trimester ultrasound scan were invited to participate. Exclusion criteria were levothyroxine use, gestational age < 10 and ≥ 14 weeks, non-evolutive pregnancy at recruitment and non-signing of informed consent. Urinary iodine concentration (UIC) was measured in random spot urine by inductively coupled plasma-mass spectrometry. RESULTS Median UIC was 104 μg/L (IQR 62-189) in the overall population (n = 481) of which 19% had UIC < 50 µg/L. Forty three percent (n = 206) were not taking an iodine-containing supplement (ICS) and median UIC values were 146 µg/L (IQR 81-260) and 74 µg/L (IQR 42-113) in ICS users and non-users, respectively (p < 0.001). Not using an ICS was an independent risk factor for iodine insufficiency [adjusted OR (95% CI) = 6.00 (2.74, 13.16); p < 0.001]. Iodised salt use was associated with increased median iodine-to-creatinine ratio (p < 0.014). CONCLUSIONS A low compliance to iodine supplementation recommendation in pregnancy accounted for a mild-to-moderately iodine deficiency. Our results evidence the need to support iodine supplementation among pregnant women in countries with low household coverage of iodised salt. Trial registration number NCT04010708, registered on the 8th July 2019.
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Affiliation(s)
- C Matta Coelho
- CINTESIS@RISE, Department Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - J Guimarães
- CINTESIS@RISE, Department Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - I Bracchi
- CINTESIS@RISE, Department Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - N Xavier Moreira
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
- Fluminense Federal University, Niterói, Rio de Janeiro, Brasil
| | - C Pinheiro
- CINTESIS@RISE, Department Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - P Ferreira
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - D Pestana
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School│FCM, Universidade Nova de Lisboa, Porto, Portugal
| | - I Barreiros Mota
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School│FCM, Universidade Nova de Lisboa, Porto, Portugal
| | - A Cortez
- Medicina Laboratorial Dr. Carlos Torres, Porto, Portugal
| | - C Prucha
- Department of Obstetrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - C Martins
- Department of Obstetrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - E Pinto
- REQUIMTE//LAQV, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Department of Environmental Health, School of Health, P.Porto, Porto, Portugal
| | - A Almeida
- REQUIMTE//LAQV, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - C Delerue-Matos
- REQUIMTE/LAQV, Instituto Superior de Engenharia, Politécnico do Porto, Porto, Portugal
| | - C C Dias
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Moreira-Rosário
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School│FCM, Universidade Nova de Lisboa, Porto, Portugal
| | - L F Ribeiro de Azevedo
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - V Cruz Fernandes
- REQUIMTE/LAQV, Instituto Superior de Engenharia, Politécnico do Porto, Porto, Portugal
| | - C Ramalho
- Department of Obstetrics, Centro Hospitalar Universitário S. João, Porto, Portugal
- Department of Ginecology-Obstetrics and Pediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, i3S, Universidade Do Porto, Porto, Portugal
| | - C Calhau
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School│FCM, Universidade Nova de Lisboa, Porto, Portugal
| | - A-L Brantsæter
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - J Costa Leite
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
| | - E Keating
- CINTESIS@RISE, Department Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal.
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The Impact of Iodine Concentration Disorders on Health and Cancer. Nutrients 2022; 14:nu14112209. [PMID: 35684009 PMCID: PMC9182735 DOI: 10.3390/nu14112209] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 01/27/2023] Open
Abstract
Iodine deficiency is an ongoing problem. The implementation of salt iodization has significantly reduced the effects of iodine deficiency worldwide in recent years, and the remaining iodine deficiency is mild to moderate. Iodine is an essential substrate for the synthesis of thyroid hormones in the thyroid gland. It can also act as an antioxidant, as well as an anti-proliferative and pro-apoptotic factor. Pregnant women, breastfeeding women, and children are particularly affected by iodine deficiency. It leads to thyroid diseases and metabolic and developmental disorders, as well as cancer. However, an excessive iodine intake may, similarly to iodine deficiency, lead to the development of goiter, and toxic amounts of iodine can lead to thyroiditis, hyperthyroidism, and hypothyroidism, and even to the development of papillary thyroid cancer. Correcting iodine deficiency potentially reduces the chance of developing malignancies. Additional research is needed to better understand both the effect of iodine on carcinogenesis and the clinical outcome of iodine deficiency compensation on cancer patients' prognosis. The upcoming public health challenge appears to be reducing salt consumption, which could result in a lower iodine intake. Thus, an iodine enrichment vehicle other than salt could be considered if salt iodine levels are not increased to compensate, and urine iodine levels should be monitored more frequently.
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Fiorini G, Cerri C, Magri F, Chiovato L, Croce L, Rigamonti AE, Sartorio A, Cella SG. Risk factors, awareness of disease and use of medications in a deprived population: differences between indigent natives and undocumented migrants in Italy. J Public Health (Oxf) 2021; 43:302-307. [PMID: 31705141 DOI: 10.1093/pubmed/fdz123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/25/2019] [Accepted: 09/02/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Undocumented migrants experience many health problems; a comparison with a suitable control group of natives living in the same socio-economic conditions is still lacking. METHODS Demographic data and data on risk factors, chronic conditions and dietary habits were obtained for 6933 adults (2950 Italians and 3983 undocumented migrants) receiving medical assistance from 40 non-governmental organizations all over the country. RESULTS Attributed to the fact that these were unselected groups, differences were found in their demographic features, the main ones being their marital status (singles: 50.5% among Italians and 42.8% among migrants; P < 0.001). Smokers were more frequent among Italians (45.3% versus 42.7% P = 0.03); the same happened with hypertension (40.5% versus 34.5% P < 0.001). Migrants were more often overweight (44.1% versus 40.5% P < 0.001) and reporting a chronic condition (20.2% versus 14.4% P < 0.001). Among those on medications (n = 1354), Italians were fewer (n = 425) and on different medications. Differences emerged also in dietary habits. CONCLUSIONS Differences in health conditions exist between native-borns and undocumented migrants, not because of a bias related to socio-economic conditions. Further studies are needed to design sustainable health policies and tailored prevention plans.
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Affiliation(s)
| | - Cesare Cerri
- Department of Medicine and Surgery, University of Bicocca, 20100 Milano, Italy
| | - Flavia Magri
- Department of Internal Medicine and Medical Therapy, University of Pavia, Internal Medicine and Endocrinology, ICS Maugeri, 27100 Pavia, Italy
| | - Luca Chiovato
- Department of Internal Medicine and Medical Therapy, University of Pavia, Internal Medicine and Endocrinology, ICS Maugeri, 27100 Pavia, Italy
| | - Laura Croce
- Department of Internal Medicine and Medical Therapy, University of Pavia, Internal Medicine and Endocrinology, ICS Maugeri, 27100 Pavia, Italy
| | - Antonello E Rigamonti
- Department of Clinical Sciences and Community Health (Pharmacology), University of Milan, 20129 Milan, Italy
| | - Alessandro Sartorio
- Auxo-Endocrinological Department, IRCCS Istituto Auxologico Italiano, 20100 Milan and Verbania, Italy
| | - Silvano G Cella
- Department of Clinical Sciences and Community Health (Pharmacology), University of Milan, 20129 Milan, Italy.,Osservatorio Povertà Sanitaria, Banco Farmaceutico Onlus, 20100 Milan, Italy
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Refaat B, Azzeh F. Factors Associated with Thyroid Disorders and Iodine Adequacy in Pregnant Saudi Women. Biol Trace Elem Res 2021; 199:1715-1728. [PMID: 32710351 DOI: 10.1007/s12011-020-02301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
Little is known about iodine adequacy and gestational thyroid disorders (GTDs) in Saudi Arabia. This study measured the rates of GTDs and iodine adequacy in 810 healthy Saudi women. Concentrations of serum thyroid hormones and 24-h urine iodine (24-h UIC), and GTDs were diagnosed according to the American Thyroid Association guidelines. Dietary and socioeconomic data to determine factors associated with GTDs and iodine insufficiency were collected. GTDs were detected in 265 women (32.7%) as follows: subclinical (SCH; 20.2%) and overt (OH; 5.8%) hypothyroidism, isolated hypothyroxinemia (ISH; 4.7%) and hyperthyroidism (2%). The SCH (109.2 μg/L; IQR: 77.2-149.7), OH (95.3 μg/L; IQR: 74.3-130.5) and ISH (107.3 μg/L; IQR: 65.5-133.1) groups had median 24-h UIC below the WHO recommended limit, whereas the euthyroid (191.4 μg/L; IQR: 170.03-219.8) and hyperthyroid (159.5 μg/L; IQR: 152.9-238.3) groups were iodine sufficient. Numbers of pregnancies, less education, not consuming iodized salt and not using iodine supplements increased risk of hypothyroidism and ISH. Contrariwise, interval ≥ 3 years from last pregnancy and higher 24-h UIC decreased odds of hypothyroidism and ISH. Moreover, dairy products and egg consumption were markedly lower in all GTD groups. Dairy products and seafood consumption correlated independently with 24-h UIC of the study participants, whereas consuming yogurt, eggs, redfish and shellfish protected against GTDs. In conclusion, GTDs appear to be prevalent in pregnant Saudi women and the hypothyroid and hypothyroxinemia groups had iodine insufficiency. However, consuming iodized salt, iodine supplements, dairy products, seafoods and eggs may protect against GTDs.
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Affiliation(s)
- Bassem Refaat
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, PO Box 7607, Makkah, Saudi Arabia
| | - Firas Azzeh
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, PO Box 7607, Holy Makkah, Saudi Arabia.
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Current Pharmacological Treatment of Type 2 Diabetes Mellitus in Undocumented Migrants: Is It Appropriate for the Phenotype of the Disease? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218169. [PMID: 33167380 PMCID: PMC7663831 DOI: 10.3390/ijerph17218169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/22/2022]
Abstract
Type 2 diabetes is increasingly recognized as a spectrum of metabolic disorders sharing chronic hyperglycaemia. In Europe, the continually growing number of migrants from developing countries could affect diabetes phenotypes. We evaluated a population of 426 Italians and 412 undocumented migrants. Using 17 variables (with the exclusion of ethnic origin) we performed a multiple component analysis to detect potential clusters, independently from ethnicity. We also compared the two groups to evaluate potential ethnicity associated differences. We found five clusters of patients with different disease phenotypes. Comparing Italians with undocumented migrants, we noted that the first had more often cardiovascular risk factors and neurologic involvement, while the latter had a higher frequency of diabetic ulcers and renal involvement. Metformin was used in a comparable percentage of patients in all clusters, but other antidiabetic treatments showed some differences. Italians were more often on insulin, due to a larger use of long acting insulin, and received a larger number of oral antidiabetics in combination. Pharmacological treatment of comorbidities showed some differences too. We suggest that type 2 diabetes should be considered as a spectrum of diseases with different phenotypes also in heterogeneous populations, and that this is not due only to ethnic differences.
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Caputo M, Pecere A, Sarro A, Mele C, Ucciero A, Pagano L, Prodam F, Aimaretti G, Marzullo P, Barone-Adesi F. Incidence and prevalence of hyperthyroidism: a population-based study in the Piedmont Region, Italy. Endocrine 2020; 69:107-112. [PMID: 32056093 DOI: 10.1007/s12020-020-02222-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/04/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Unrecognized and untreated hyperthyroidism leads to serious clinical complications with adverse outcomes for patients and increasing costs for the health care system. Hence, adequate knowledge of the epidemiological features of such condition is desirable to plan effective interventions. The aim of our study was to estimate incidence and prevalence of hyperthyroidism in the mildly iodine-deficient Italian Region of Piedmont. METHODS A retrospective cohort study was conducted using Administrative Health Databases of the Piedmont Region, Italy (2012-2018). Hyperthyroidism cases were defined as the subjects who had at least one of the following claims: (i) hospital discharge records with hyperthyroidism diagnosis code; (ii) exemption from co-payment for hyperthyroidism; (iii) prescription of one of the following medications: methimazole, propylthiouracil, or potassium perchlorate. RESULTS The overall prevalence was 756 per 100,000 inhabitants [95% CI 748-764], and the overall incidence was 81 per 100,000-person year [95% CI 80-82]. The prevalence and incidence increased with age and were two-fold higher among women than men. Women also showed two distinct peaks in incidence at the age of 30 and 50; after the age of 60, the trend became similar between sexes. With regard to the geographic distribution, an increasing gradient of incidence was observed from the northern to the south-western areas of the Region. CONCLUSION This is the first Italian study based on health databases to estimate the incidence and prevalence of hyperthyroidism in the general population. This approach can represent an inexpensive and simple method to monitor patterns of hyperthyroidism in iodine-deficient areas.
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Affiliation(s)
- Marina Caputo
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
| | - Alessandro Pecere
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Andrea Sarro
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Chiara Mele
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Andrealuna Ucciero
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Loredana Pagano
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Flavia Prodam
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Gianluca Aimaretti
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Paolo Marzullo
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Division of General Medicine, I.R.C.C.S. Istituto Auxologico Italiano, Ospedale San Giuseppe Verbania, Verbania, Italy
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Azzeh F, Refaat B. Iodine adequacy in reproductive age and pregnant women living in the Western region of Saudi Arabia. BMC Pregnancy Childbirth 2020; 20:370. [PMID: 32571259 PMCID: PMC7310473 DOI: 10.1186/s12884-020-03057-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 06/16/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the serious maternal and foetal complications associated with iodine deficiency during pregnancy, surveys related to pregnant women in the Kingdom of Saudi Arabia (KSA) are lacking. This study, therefore, measured urine iodine concentrations (UIC) alongside the potential socioeconomic factors contributing towards iodine inadequacy in reproductive age and pregnant Saudi women from the Western province of KSA. METHODS Spot urine samples were collected from 1222 pregnant and 400 age-matched non-pregnant/non-lactating reproductive age women. The socioeconomic characteristics were obtained through a structured questionnaire. The WHO criteria for iodine sufficiency in non-pregnant (100-199 μg/L) and pregnant (150-249 μg/L) women were applied. RESULTS The median UIC in the non-pregnant women (101.64 μg/L; IQR: 69.83-143.55) was at the lowermost WHO recommended cut-off, whereas the pregnant group was iodine deficient (112.99 μg/L; IQR: 81.01-185.57). Moreover, the median UIC was below adequacy across the different trimesters. The use of non-iodised salt significantly increased the risk of iodine deficiency in the non-pregnant (OR = 2.052; 95%CI: 1.118-3.766) and pregnant women (OR = 3.813; 95%CI: 1.992-7.297), whereas taking iodine supplements significantly lowered the risk in both groups (OR = 0.364; 95%CI: 0.172-0.771 and OR = 0.002; 95%CI: 0.001-0.005, respectively). Passive smoking was also an independent risk factor for iodine deficiency in the non-pregnant (OR = 1.818; 95%CI: 1.097-3.014) and pregnant (OR = 1.653; 95%CI: 1.043-2.618) groups. Additionally, BMI correlated independently and significantly with median UIC in the non-pregnant and pregnant populations. However, multiparity (OR = 3.091; 95%CI: 1.707-5.598) and earning below the minimum wage (2.520; 95%CI: 1.038-6.119) significantly increased the risk of iodine deficiency only in the non-pregnant women. CONCLUSIONS This study is the first to show borderline iodine sufficiency in reproductive age Saudi women from the Western province, whereas mild iodine deficiency was observed in the pregnant population and could represent a serious public health problem. This study also advocates the necessity to establish routine iodine dietary advice services by the health authorities to foster adequate iodine intake in pregnant women to avoid the perilous consequences of iodine deficiency on maternal-foetal health.
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Affiliation(s)
- Firas Azzeh
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, PO Box 7607, Makkah, Saudi Arabia
| | - Bassem Refaat
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, Holy Makkah, PO Box 7607, Makkah, Saudi Arabia.
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Conte L, Comina M, Monti E, Sidoti M, Vannozzi O, Di Ciolo L, Lillo F, Giusti M. Urinary Iodine Concentration in a Cohort of Adult Outpatients with Thyroid Diseases in Liguria 14 Years after the Law on Salt Iodization. Nutrients 2019; 12:nu12010011. [PMID: 31861566 PMCID: PMC7019929 DOI: 10.3390/nu12010011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 12/17/2022] Open
Abstract
Italy is considered a mildly iodine-deficient country. The aim of this study was to evaluate the iodine status of a cohort of adults living in Liguria after the 2005 salt iodization program. We searched all medical records of patients examined in two endocrine outpatient clinics in Genoa and Savona for data on urinary iodine. Subjects were under evaluation for thyroid diseases. Information on the type of salt used was found in few clinical records. Iodized salt use was reported in 29%, 20%, and 13% of records of people living in Genoa districts, the Savona district and nearby districts, respectively. The average urinary iodine concentration was 112.9 ± 62.3 µg/L (n = 415, median 101.0 µg/L). Non-significant differences (p > 0.05) were found between subjects with (median 103.5 µg/L) and without (median 97.5 µg/L) a thyroid gland, between the periods 2009–2013 (median 105.0 µg/L) and 2014–2018 (median 97.5 µg/L), and between Genoa (median 94.0 µg/L), Savona (median 105.0 µg/L) and the other districts (median 114.5 µg/L). No correlation with age, body mass index, creatinine, free thyroxine, thyroglobulin, levo-thyroxine dosage, or thyroid volume was observed. These data suggest a borderline status of iodine sufficiency in this cohort.
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Affiliation(s)
- Lucia Conte
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (L.C.); (M.C.)
- Endocrine Unit, San Martino Polyclinic Hospital, 16132 Genoa, Italy;
| | - Martina Comina
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (L.C.); (M.C.)
- Endocrine Unit, San Martino Polyclinic Hospital, 16132 Genoa, Italy;
| | - Eleonora Monti
- Endocrine Unit, San Martino Polyclinic Hospital, 16132 Genoa, Italy;
| | - Marilena Sidoti
- Endocrine Ambulatory, Centro Diagnostico Priamar, 17100 Savona, Italy;
| | - Ornella Vannozzi
- Laboratory Unit, San Martino Polyclinic Hospital, 16132 Genoa, Italy;
| | - Lucia Di Ciolo
- Nuclear Medicine Unit, Santa Corona Hospital, Pietra Ligure, 17027 Savona, Italy;
| | - Flavia Lillo
- Laboratory Unit, Azienda Sanitaria Locale 2 of Liguria, 17100 Savona, Italy;
| | - Massimo Giusti
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (L.C.); (M.C.)
- Endocrine Unit, San Martino Polyclinic Hospital, 16132 Genoa, Italy;
- Endocrine Ambulatory, Centro Diagnostico Priamar, 17100 Savona, Italy;
- Correspondence:
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Abstract
Hypothyroidism affects up to 5% of the general population, with a further estimated 5% being undiagnosed. Over 99% of affected patients suffer from primary hypothyroidism. Worldwide, environmental iodine deficiency is the most common cause of all thyroid disorders, including hypothyroidism, but in areas of iodine sufficiency, Hashimoto’s disease (chronic autoimmune thyroiditis) is the most common cause of thyroid failure. Hypothyroidism is diagnosed biochemically, being overt primary hypothyroidism defined as serum thyroid-stimulating hormone (TSH) concentrations above and thyroxine concentrations below the normal reference range. Symptoms of hypothyroidism are non-specific and include mild to moderate weight gain, fatigue, poor concentration, depression, and menstrual irregularities, while the consequences of untreated or under-treated hypothyroidism include cardiovascular disease and increased mortality. Levothyroxine has long been the main tool for treating hypothyroidism and is one of the world’s most widely prescribed medicines. In adults with overt hypothyroidism, levothyroxine is usually prescribed at a starting dose of 1.6 µg/kg/day, which is then titrated to achieve optimal TSH levels (0.4–4.0 mIU/L), according to the therapeutic target. We here summarise the history of levothyroxine and discuss future issues regarding the optimal treatment of hypothyroidism. Because nearly one-third of patients with treated hypothyroidism still exhibit symptoms, it is important that levothyroxine is used more appropriately to achieve maximum benefit for patients. In order to ensure this, further research should include more accurate assessments of the true prevalence of hypothyroidism in the community, optimisation of the levothyroxine substitution dose, proper duration of treatment, and identification of patients who may benefit from combination therapy with levothyroxine plus levotriiodothyronine. Funding: Merck. Plain Language Summary: Plain language summary available for this article. Hypothyroidism is one of the most common diseases worldwide, and levothyroxine is the usual medication prescribed to manage it. Hypothyroidism occurs when the thyroid gland, located in the neck, does not produce enough thyroid hormone for the body’s requirements. This can result in heart disease, infertility, and poor brain development in children. People with hypothyroidism may have changes in body weight, and feel tired, weak or unhappy, all of which can reduce their quality of life. In underdeveloped parts of the world, the main reason why people develop hypothyroidism is that they not getting enough iodine from food. Thus, many countries try to increase iodine intake by adding iodine to salt. In areas of the world where people ingest enough iodine, the most common cause of hypothyroidism is Hashimoto’s disease. This is an autoimmune disease in which the person’s immune system produces cells and antibodies that attack the thyroid gland. Most people with hypothyroidism will need to take levothyroxine for a long time, perhaps even for the rest of their lives. Levothyroxine replaces the person’s levels of thyroid hormone and makes them feel better, but the dose often needs to be adjusted for the best effect. In addition, many people with hypothyroidism do not know they have it. Research is ongoing to ensure that more people with hypothyroidism are diagnosed and are given effective treatment, and to work out the best way to use levothyroxine so that patients get the best results.
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Affiliation(s)
- Luca Chiovato
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
| | - Flavia Magri
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Allan Carlé
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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