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Momentti AC, de Souza Macedo M, de Sousa Silva AF, de Oliveira Souza VC, Júnior FB, do Carmo Castro Franceschini S, Navarro AM. Household Salt Storage and Seasoning Consumption Are Predictors of Insufficient Iodine Status Among Pregnant Women in Southeastern Brazil. Biol Trace Elem Res 2023; 201:5529-5539. [PMID: 36884126 PMCID: PMC9993368 DOI: 10.1007/s12011-023-03615-1] [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: 06/02/2022] [Accepted: 02/25/2023] [Indexed: 03/09/2023]
Abstract
Iodine deficiency in pregnancy may lead to adverse maternal and fetal outcomes, including impaired child development. Sociodemographic factors and different dietary habits may be related to iodine status in pregnant women. The aim of this study was to evaluate the iodine status and its predictors among pregnant women in a city of Southeastern Brazil. This cross-sectional study was conducted with 266 pregnant women receiving prenatal care in 8 primary health care units. Sociodemographic, obstetric and health, habits of acquisition, storage and consumption of iodized salt, and dietary iodine intake data were collected through a questionnaire. The iodine content was evaluated in urinary iodine concentration (UIC), household salt and seasonings, and drinking water samples. Pregnant women were categorized into three groups according to the UIC, determined by iodine coupled plasma-mass spectrometry (ICP-MS): insufficient (< 150 μg/L), adequate (150-249 μg/L), and more than adequate iodine nutrition (≥ 250 μg/L). The median (p25-p75) UIC was 180.2 μg/L (112.8-262.7). It was found 38% and 27.8% of insufficient and more than adequate iodine nutrition, respectively. Number of gestations, KI content of supplement, alcohol consumption, salt storage, and frequency of using industrialized seasoning were associated to iodine status. Alcohol consumption (OR = 6.59; 95%CI 1.24-34.87), pack the salt in opened container (OR = 0.22; 95%CI 0.08-0.57), and use industrialized seasoning weekly (OR = 3.68; 95% CI 1.12-12.11) were predictors of iodine insufficiency. The pregnant women evaluated have adequate iodine nutrition. Household salt storage and seasoning consumption were risk factors for insufficient iodine status.
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Affiliation(s)
- Ana Carolina Momentti
- Nutrition and Metabolism Program, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Mariana de Souza Macedo
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
| | - Ana Flávia de Sousa Silva
- Nutrition and Metabolism Program, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Vanessa Cristina de Oliveira Souza
- Department of Clinical, Toxicological and Bromatological Analysis, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fernando Barbosa Júnior
- Department of Clinical, Toxicological and Bromatological Analysis, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Anderson Marliere Navarro
- Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Galvao S, Bensenor IM, Blaha MJ, Jones S, Toth PP, Santos RD, Bittencourt M, Lotufo PA, Teixeira PDFDS. GlycA as a Novel Biomarker of Systemic Inflammation in Hypothyroidism. Thyroid 2023; 33:1171-1181. [PMID: 37534852 DOI: 10.1089/thy.2023.0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Background: GlycA is a novel glycoprotein biomarker of systemic inflammation and cardiovascular risk. Our objective was to assess the levels of GlycA in individuals with hypothyroidism. We also explored whether levothyroxine (LT4)-treated patients had different levels of GlycA, with attention to thyrotropin (TSH) levels. Methods: We performed a cross-sectional analysis, using baseline data from the ELSA-Brasil cohort study. We included only participants with serum TSH and GlycA levels measurements, using magnetic resonance spectroscopy (n = 4745). We excluded individuals with endogenous hyperthyroidism and those using drugs impacting thyroid function. Participants not taking LT4 and whose serum TSH was 0.4-4.0 mIU/L were classified as euthyroid (EU) and those with elevated TSH as undiagnosed hypothyroidism (UH). For those on LT4 (n = 345), adequacy of treatment was defined as TSH within the reference range. Those with TSH <0.4 mIU/L were considered over-treated (OT), and those >4.0 mIU/L, under-treated (UT). Both (UT+OT) were considered inadequately treated (IT). Group comparisons were performed by Kruskal-Wallis, adjusted Chi-square, and the post hoc Dunn test. Additional subgroup analysis were performed in patients with circulating thyroperoxidase antibodies (TPO-Ab+). Respective multivariable analyses were performed to evaluate the relationship between thyroid-related variables and GlycA levels (Generalized Linear Model), as well as an abnormal GlycA (>400 μmol/L; Logistic Binary Regression). Results: The prevalence rate of UH was 9.8% (467/4745) and, among those on LT4, only 61.7% (213/345) were adequately treated (AT). GlycA levels were higher in IT in comparison to EU (429 vs. 410 μmol/L, p < 0.01) but did not differ between UH (413 μmol/L) and euthyroidism. However, the subgroup analysis of those TPO-Ab+ showed that not only those with IT, but also those with UH, had higher levels of GlycA in comparison to euthyroidism (423 and 424 vs. 402 μmol/L, p = 0.04). This association between higher levels of GlycA and IT was maintained even in multivariable analysis (odds ratio 1.53, confidence interval 1.03 to 2.31) Lower levels of GlycA were detected in AT (405 μmol/L,) compared with OT (432 μmol/L, 0.04) and UT (423 μmol/L, p = 0.02). Conclusions: Patients with IT, both OT and UT, had higher GlycA levels, which may be associated with low-grade systemic inflammation and, possibly, increased cardiovascular risk.
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Affiliation(s)
- Sarah Galvao
- Post-Graduate Program in Endocrinology, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiological Research, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, USA
| | - Steven Jones
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, USA
| | - Peter P Toth
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Preventive Cardiology, CGH Medical Center, Sterling, Illinois, USA
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Marcio Bittencourt
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Monteiro MC, Assayag G, Botler R, Bergamin A, Conceição FL, Silva de Morais N, Seixas RPD, Berbara TMBL, Schtscherbyna A, Corcino CM, Saraiva DA, Vaisman M, Teixeira PFS. Thyroid Volume in Pregnancy is Associated with Parity, Gestational Age, and Body Mass Index in an Iodine-sufficient Area. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e557-e561. [PMID: 37944921 PMCID: PMC10635786 DOI: 10.1055/s-0043-1776028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/01/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE We compared thyroid volume (TV) and presence of nodular goiter (NG) in pregnant vs. non-pregnant women in an iodine-sufficient area. We also evaluated the relationship between gestational age, parity, and TV in the pregnant women group, and determined the 2.5th and 97.5th percentiles of normal TV in pregnancy. METHODS This cross-sectional study included 299 healthy women (216 pregnant) without previous thyroid diseases. Thyroid ultrasounds were performed and compared between pregnant and non-pregnant women. The range of normal distribution of TV (2.5th and 97.5th percentiles) in pregnancy was determined after excluding individuals with positive thyroid antibodies, NG, and/or abnormal serum thyrotropin (TSH) or free thyroxine (FT4). RESULTS Thyroid volume was larger among pregnant compared to non-pregnant women (8.6 vs 6.1 cm3; p < 0.001) and was positively correlated with gestational age (rs = 0.221; p = 0.001), body mass index (BMI, rs 0.165; p = 0.002), and FT4 levels (rs 0.118 p = 0.021). Nodular goiter frequency did not differ between the two groups. There was a negative correlation between TV and TSH (rs -0.13; p = 0.014). Thyroid volume was lower among primiparous compared to multiparous patients (7.8 vs 8.9; p < 0.001) and was positively correlated with parity (rs 0.161; p = 0.016). The 2.5th and 97.5th percentiles of TV were 4.23 and 16.47 cm3, respectively. CONCLUSION Thyroid volume was higher in pregnant compared to non-pregnant women and was positively related to parity, BMI, and gestational age in a normal iodine status population. Pregnancy did not interfere with the development of NG.
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Affiliation(s)
- Mariana Couto Monteiro
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Gabriela Assayag
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ricardo Botler
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Anice Bergamin
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Flávia Lúcia Conceição
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Nathalie Silva de Morais
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Annie Schtscherbyna
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Carolina Martins Corcino
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Débora Ayres Saraiva
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Mário Vaisman
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Silva DLF, Crispim SP, Almeida CCB, Schrubbe V, Azevedo FM, de Faria FR, Pizato N, Pereira RJ, Macedo MDS, Franceschini SDCC. Improving Pregnant Women's Iodine Intake Estimates and Its Prevalence of Inadequacy through the Use of Salt and Seasoning Covariates. Nutrients 2023; 15:nu15040846. [PMID: 36839203 PMCID: PMC9966772 DOI: 10.3390/nu15040846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
(1) Measuring usual iodine intake is a complex task due to the food consumption variability and its natural concentration in food. Therefore, the use of covariates to adjust statistical methods to estimate usual intake could improve the estimates obtained through dietary surveys. This study aims to evaluate the influence of salt and seasoning usage covariates on the estimates of usual iodine intake and the prevalence of its inadequacy. (2) A cross-sectional study was conducted with Brazilian pregnant women's food consumption data obtained with 24-h recall (n = 2247). The usual iodine intake was adjusted for intraindividual variability, supplement use, temporal effects, data collection methods, and sociodemographic characteristics with the tool UCD/NCI SIMPLE in the SAS software. Then, salt and seasoning usage covariates were used to adjust the distribution. The harmonized intake reference values for populations were used to assess intake adequacy. (3) The adjustments for salt and seasoning usage yielded a higher mean of usual iodine intakes. The only exception was the adjustment for the "habit of adding salt to meals after preparing/cooking", which produced a lower mean of usual intake and increased the prevalence of insufficient intake. (4) Salt and seasoning usage covariates affect the estimates evaluated. However, more studies are necessary to evaluate the influence observed.
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Affiliation(s)
- Débora L. F. Silva
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa 36570-900, Minas Gerais, Brazil
- Correspondence: ; Tel.: +55-41-9-9845-9490
| | - Sandra P. Crispim
- Departamento de Nutrição, Universidade Federal do Paraná, Curitiba 80210-170, Paraná, Brazil
| | - Claudia C. B. Almeida
- Departamento de Nutrição, Universidade Federal do Paraná, Curitiba 80210-170, Paraná, Brazil
| | - Vanessa Schrubbe
- Departamento de Nutrição, Universidade Federal do Paraná, Curitiba 80210-170, Paraná, Brazil
| | - Francilene M. Azevedo
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa 36570-900, Minas Gerais, Brazil
| | - Franciane R. de Faria
- Faculdade de Ciências da Saúde, Universidade Federal de Rondonópolis, Rondonópolis 78736-900, Mato Grosso, Brazil
| | - Nathalia Pizato
- Departamento de Nutrição, Universidade de Brasília, Brasília 70970-000, Distrito Federal, Brazil
| | - Renata J. Pereira
- Curso de Graduação em Nutrição, Universidade Federal do Tocantins, Palmas 77001-090, Tocantins, Brazil
| | - Mariana de S. Macedo
- Departamento de Nutrição, Universidade Federal do Vale do Jequitinhonha e Mucuri, Diamantina 39100-000, Minas Gerais, Brazil
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Iodine Concentration in Brazilian Drinking Water and Its Possible Contribution to Iodine Intake for Different Physiological Groups. J Nutr Metab 2022; 2022:7542632. [PMID: 36590239 PMCID: PMC9797305 DOI: 10.1155/2022/7542632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/06/2022] [Accepted: 10/22/2022] [Indexed: 12/24/2022] Open
Abstract
Objective The objective is to analyze the concentration of iodine in Brazilian drinking water and its possible contribution to iodine intake for different groups. Methods Water samples collected from primary healthcare units in eight locations distributed across all five macroregions of Brazil were analyzed. The quantification of iodine in the water samples was done by spectrophotometry (leuco crystal violet method). To classify the degree of iodine concentration, the recommendation of the Ministry of Health (China) was followed since Brazil lacks a classification standard. To verify the possible contribution of drinking water to iodine intake for different groups, the recommended water intake for each group according to the United States Institute of Medicine (2004) was considered. The percentage of iodine in drinking water and its contribution to iodine intake for different physiological groups were calculated based on the estimated average requirement (EAR) of iodine. A descriptive statistical analysis was performed using SPSS version 21.0 and Statistical Analysis Systems (SAS) version 9.2. Results Significant differences were found between the maximum and minimum concentrations of iodine in water samples from the same location. In Pinhais (south region), the difference was 44.32 μg· L-1; in Viçosa (southeast region), it was 27.86 μg·L-1; in Rondonópolis (midwest region), it was 12.66 μg·L-1; in São Luís (northeast region), it was 11.82 μg·L-1; in Brasilian Federal District (midwest region), it was 10.98 μg·L-1; in Macaé (southeast region), it was 10.14 μg· L-1; in Palmas (north region), it was 4.22 μg·L-1; and in Vitória (southeast region), it was 1.69 μg·L-1. The maximum concentrations of iodine found in the drinking water of Pinhais and Viçosa can contribute more than 70.0% and 50.0%, respectively, to daily iodine intake for all groups. Conclusion Monitoring the concentration of iodine in drinking water from different locations in each city or Federal District is a preventive measure against inadequate iodine intake and possible adverse changes in population health.
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Scherr NCG, Nogueira AI, Rajão KMAB, Leite HV. Nutritional Status of Iodine in a Group of Pregnant Women from the State of Minas Gerais Correlated with Neonatal Thyroid Function. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:909-914. [PMID: 36446557 PMCID: PMC9708397 DOI: 10.1055/s-0042-1756147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To evaluate the iodine sufficiency of pregnant women assisted in a University Hospital of Minas Gerais, and to correlate the urinary concentrations of maternal iodine with the fetal thyroid hormone levels at birth. METHODS Urinary iodine concentrations from 30 pregnant women with a singleton pregnancy and gestational age lower than 20 weeks were analyzed. Occasional samples of the mothers' urine were collected for the urinary iodine concentration dosage, and these were correlated with the newborns' thyroid-stimulating hormone (TSH) levels. RESULTS The median iodine urinary concentration of this study's pregnant women population was 216.73 mcg/l, which is proper for the group, following the World Health Organization (WHO). No cases of neonatal hypothyroidism were reported in the study, which corroborates the iodine sufficiency in this population sample. CONCLUSION This study shows that despite the increased demand for iodine from pregnant women and the Brazilian Health Regulatory Agency (ANVISA) recommendation of 2013 for reduction of salt iodization levels, the population of pregnant women attended in the prenatal ambulatory of normal risk from the Federal University of Minas Gerais is considered sufficient in iodine. As a higher sample is necessary for the confirmation of these findings, it is too early to recommend the universal supplementation of iodine for Brazilian pregnant women, and more studies must be carried out, considering that iodine supplementation for pregnant women in an area of iodine sufficiency is associated to the risks of the fetus's excessive exposure to iodine.
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Affiliation(s)
- Natália Campos Gonçalves Scherr
- Departamento de Ginecologia e Obstetrícia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil,Address for correspondence Natália Campos Gonçalves Scherr, MSc Av. Prof. Alfredo Balena, Universidade Federal de Minas Gerais190, 30130-100, Belo Horizonte, MGBrazil
| | | | | | - Henrique Vitor Leite
- Departamento de Ginecologia e Obstetrícia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Prevalence of insufficient iodine intake in pregnancy worldwide: a systematic review and meta-analysis. Eur J Clin Nutr 2022; 76:703-715. [PMID: 34545212 DOI: 10.1038/s41430-021-01006-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 08/04/2021] [Accepted: 09/03/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES Iodine deficiency in pregnant women is related to impaired foetal growth and development. The objective of this study was to estimate the prevalence of insufficient iodine intake in pregnant women from different regions of the world. SUBJECTS/METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, five electronic databases and Google Scholar grey literature were searched until 10 April 2021. Two reviewers independently conducted article selection, data extraction, and assessment of the risk of bias. Meta-analyses with random effects, subgroup analyses, and meta-regressions were performed. RESULTS In total, 4639 observational articles were found, with 61 eligible for inclusion. The population consisted of 163,021 pregnant women adults and adolescents, and the overall prevalence of insufficient iodine intake was 53% (95% confidence interval [CI]: 47-60; I2 = 99.8%). Pregnant women who live in insufficient iodine status country had a higher prevalence (86%; 95% CI: 78-93; I² =97.0%) of inadequate iodine nutritional status than to those living in country considered sufficient (51%; 95% IC: 45-57; I² = 99.8%). CONCLUSION Despite the progress in iodine fortification policies and periodic monitoring of the iodine nutritional status of the population worldwide, salt iodination alone may not be sufficient to provide adequate iodine status to pregnant women. Thus, other actions may be necessary to improve the nutritional clinical care of pregnant group.
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Candido AC, Ribeiro SAV, Macedo MDS, Fontes EAF, Souza ECGD, Lopes Duarte MS, Priore SE, Peluzio MDCG, Milagres RCRDM, Franceschini SDCC. Is Dietary Iodine Intake Excessive According to the Theoretical Model of Healthy Dietary Intake Pattern in Pregnant Women and Schoolchildren: Water, Salt, or Food? Front Nutr 2021; 8:770798. [PMID: 34957182 PMCID: PMC8707515 DOI: 10.3389/fnut.2021.770798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: Iodine deficiency during pregnancy can cause hypothyroidism and goiter; in schoolchildren, it can cause reduced intelligence quotient. In excess, iodine can cause thyroiditis, goiter, and Hashimoto's hypothyroidism. Currently, schoolchildren and pregnant women are classified as risk groups for excessive iodine intake and iodine deficiency, respectively. Thus, determining iodine from all sources of consumption is important for intervention planning. Objective: To construct a theoretical model for the iodine intake of schoolchildren and pregnant women of a city in the Zona da Mata Mineira region, considering a healthy diet, salt consumption and water intake. Methodology: The dietary iodine intake of pregnant women was analyzed based on a dietary iodine table compiled from an international database. A dietary plan was prepared following the Brazilian Food Guide. Iodine concentration of different salt brands sold in local establishments was checked, and drinking water samples from healthcare facilities were analyzed. A descriptive and exploratory statistical analysis was performed and the results were presented in absolute and relative frequencies, and measures of central tendency and dispersion. Results: According to the proposed diet, pregnant women and schoolchildren would have a daily intake of 71.6 μg and 71 μg, respectively. Thirteen salt brands were evaluated, 69.2% complied with the legislation and the mean iodine content was 29.88 mg. The mean concentration of iodine in water was 25 μg iodine/liter and 14 μg iodine/liter, respectively, in summer and autumn. Considering the intake of food, salt, and drinking water according to the proposed dietary plan, the daily intake for pregnant women would be 279.5 and 253.5 μg for schoolchildren. Conclusion: The daily iodine intake of schoolchildren and pregnant women according to this theoretical model was excessive, considering a healthy dietary pattern. This theoretical model can guide actions and public policies aimed at targeting all forms of iodine intake.
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Affiliation(s)
- Aline Carare Candido
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
| | | | - Mariana de Souza Macedo
- Programa de Pós-Graduação em Ciência da Nutrição, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | | | | | | | - Silvia Eloiza Priore
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
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Silva de Morais N, Ayres Saraiva D, Corcino C, Berbara T, Schtscherbyna A, Moreira K, Vaisman M, Alexander EK, Teixeira P. Consequences of Iodine Deficiency and Excess in Pregnancy and Neonatal Outcomes: A Prospective Cohort Study in Rio de Janeiro, Brazil. Thyroid 2020; 30:1792-1801. [PMID: 32364020 DOI: 10.1089/thy.2019.0462] [Citation(s) in RCA: 6] [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: 02/06/2023]
Abstract
Background: Insufficient or excessive iodine intake during gestation may compromise adaptive mechanisms in maternal thyroid function and lead to adverse pregnancy outcomes. In this context, we aimed to study the effects of maternal iodine status in the first and third trimesters of gestation on obstetric and neonatal outcomes in an iodine-sufficient population in Rio de Janeiro, Brazil. Methods: A total of 214 pregnant women in the first trimester of gestation were enrolled and prospectively followed until delivery between 2014 and 2017. All participants were ≥18 and ≤35 years, had a spontaneous single pregnancy, and had no history of thyroid or other chronic diseases, nor were they taking iodine-containing supplements at enrollment. In the first trimester, we obtained clinical information and determined thyroid function and the urinary iodine concentration (UIC) of the participants. Thyroid function and UIC were reassessed in the third trimester. Iodine status was determined by the median of UIC obtained from six urine spot samples by the inductively coupled plasma mass spectrometry method. Pregnancy and neonatal outcomes and delivery information were obtained from medical records. Results: The median UIC in the whole population was 219.7 μg/L. The prevalence of UIC <150 μg/L was 17.2%, and 38.7% had UIC ≥250 μg/L. Gestational diabetes (GDM) was higher in the group with UIC 250-499 μg/L (n = 77) compared with the group with UIC 150-249 μg/L (n = 94) (20.3% vs. 9.7%, p < 0.05). Ultimately, UIC ≥250 μg/L was an independent risk factors for GDM (relative risk [RR] = 2.9 [confidence interval, CI = 1.1-7.46], p = 0.027) and hypertensive disorders of pregnancy (HDP) (RR = 4.6 [CI = 1.1-18.0], p = 0.029). Among 196 live-born newborns, lower birth length was observed in infants whose mothers had UIC <150μg/L (n = 37) in the first trimester compared with those with UIC 150-249 μg/L (n = 86) (median interquartile range: 48.0 [2.2] vs. 49.0 [4.0] cm, p = 0.01). Maternal UIC <150 μg/L was negatively associated with birth length of newborns (Exp (B) = 0.33 [CI = 0.1-0.9], p = 0.03). Conclusions: In a population whose median iodine intake is sufficient, extensive individual variation occurs. Such abnormalities are associated with increased GDM and HDP when UIC is ≥250 μg/L, and lower infant birth length when UIC is <150 μg/L.
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Affiliation(s)
- Nathalie Silva de Morais
- Endocrinology Post-graduation Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Thyroid Section, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Débora Ayres Saraiva
- Endocrinology Post-graduation Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carolina Corcino
- Endocrinology Post-graduation Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tatiana Berbara
- Endocrinology Post-graduation Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Annie Schtscherbyna
- Endocrinology Post-graduation Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Karina Moreira
- Endocrinology Post-graduation Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mario Vaisman
- Endocrinology Post-graduation Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Erik K Alexander
- Thyroid Section, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrícia Teixeira
- Endocrinology Post-graduation Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Guo W, Wang W, Jin Y, Chen W, Chen L, Lin L, Cheng Y, Cui T, Chen Y, Pan Z, Shen J, Tan L, Gao M, Zhang Y, Zhang W. Trimester-Specific Thyroid Function in Pregnant Women with Different Iodine Statuses. ANNALS OF NUTRITION AND METABOLISM 2020; 76:165-174. [PMID: 32726788 DOI: 10.1159/000506276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/25/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To explore trimester-specific thyroid function changes under different iodine statuses throughout pregnancy. METHODS A cross-sectional study was conducted to assess the pregnancy iodine status, and 2,378 healthy pregnant women covering all 3 trimesters were recruited. Urinary iodine concentration (UIC) was measured by collecting spot urine samples. Blood samples were collected to evaluate thyroid function. Thyroid B-ultrasonography was conducted to measure the thyroid volume (Tvol). RESULTS The median UIC was 168 μg/L (111-263 μg/L). The UIC, free triiodothyronine (FT3), and free thyroxine (FT4) were significantly decreased as the pregnancy progressed (p < 0.001, p for trend <0.001), while Tvol increased (p < 0.001, p for trend <0.001). Thyrotropin (TSH) was significantly different between the 3 trimesters and showed an upward trend (p < 0.001), but the p for trend was not significant (p for trend = 0.88). After stratification by UIC, there were no significant differences in serum TSH, FT4, or FT3 level between UIC groups. Tvol was significantly higher in the UIC ≥500 μg/L group in the first trimester (β: 2.41, 95% CI: 1.09-3.72, p <0.001), as well as in the 250 ≤ UIC < 500 μg/L group (β: 1.65, 95% CI: 0.61-2.70, p < 0.001) and UIC ≥500 μg/L group (β: 3.35, 95% CI: 1.96-4.74, p < 0.001) in the third trimester. CONCLUSIONS No difference was observed in TSH, FT3, or FT4 among the different iodine status groups throughout pregnancy. Tvol increased as the pregnancy progressed, and it was especially higher in the UIC ≥500 μg/L group in the first and third trimesters.
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Affiliation(s)
- Wenxing Guo
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wei Wang
- The Department of Health Services and Management, School of Management, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ya Jin
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wen Chen
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Lu Chen
- Shandong Institute of Geophysical & Geochemical Exploration, Shandong, China
| | - Laixiang Lin
- Tianjin Institution of Endocrinology, Tianjin, China
| | - Yuangui Cheng
- Gaoqing Center for Disease Control and Prevention, Shandong, China
| | - Tingkai Cui
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yanting Chen
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ziyun Pan
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jun Shen
- Department of Sanitary Chemistry, Tianjin Medical University, Tianjin, China
| | - Long Tan
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Min Gao
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yixin Zhang
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wanqi Zhang
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China, .,Key Laboratory of Environment, Nutrition and Population Health of Tianjin, Tianjin, China, .,Key Laboratory of Hormones and Development (Ministry of Health), Tianjin, China,
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Berbara TMBL, Morais NSD, Saraiva DA, Corcino CM, Schtscherbyna A, Moreira KL, Teixeira PDFDS, Vaisman M. Selective case finding versus universal screening for detecting hypothyroidism in the first trimester of pregnancy: a comparative evaluation of a group of pregnant women from Rio de Janeiro. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:159-164. [PMID: 32236307 PMCID: PMC10118952 DOI: 10.20945/2359-3997000000209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 09/13/2019] [Indexed: 11/23/2022]
Abstract
Objective Maternal hypothyroidism during pregnancy may lead to adverse outcomes. Recently published guidelines by the American Thyroid Association (ATA) do not advocate for universal screening but recommend a case-finding approach in high-risk pregnant women. The present study aims to evaluate the accuracy of this approach in identifying women with thyroid dysfunction during early pregnancy. Subjects and methods This is a multiple-center, cross-sectional study. Three hundred and one pregnant women were enrolled. Anamnesis and a physical examination were performed to detect which women fulfilled the criteria to undergo laboratory screening of thyroid dysfunction, according to the ATA's 2017 guidelines. The Zulewski's validated clinical score was applied to assess signs and symptoms of hypothyroidism. Serum levels of thyrotropin (TSH), free thyroxine (FT4), anti-thyroperoxidase (TPO-Ab), and anti-thyroglobulin (Tg-Ab) antibodies were determined. Results Two hundred and thirty one women (78%) were classified as high risk, and 65 (22%) were classified as low risk for thyroid dysfunction. Regarding the clinical score, 75 patients (31.2%) presented mild symptoms that were compatible with SCH, of which 22 (7.4%) had symptoms as the only risk factor for thyroid disease. 17 patients (5.7%) had SCH, of which 10 (58.8%) belonged to the high-risk group, and 7 (41.2%) belonged to the low-risk group. OH was found in 4 patients (1.4%): 3 (75%) in the high-risk group and 1 (25%) in the low-risk group. Conclusions The ATA's proposed screening criteria were not accurate in the diagnosis of thyroid dysfunction in pregnancy. Testing only the high-risk pregnant women would miss approximately 40% of all hypothyroid patients.
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Affiliation(s)
| | - Nathalie Silva de Morais
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Débora Ayres Saraiva
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Carolina Martins Corcino
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Annie Schtscherbyna
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Karina Lúcia Moreira
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Mario Vaisman
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Measurement of Iodine in Consumed Salts at the Distribution Level and Assessing Post-Training Attitude Status in Providers in Qom. PAJOUHAN SCIENTIFIC JOURNAL 2019. [DOI: 10.52547/psj.17.3.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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13
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Variation of iodine status during pregnancy and its associations with thyroid function in women from Rio de Janeiro, Brazil. Public Health Nutr 2019; 22:1232-1240. [PMID: 30846017 DOI: 10.1017/s1368980019000399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess iodine status and its effects on maternal thyroid function throughout pregnancy. DESIGN In the present prospective cohort study, three urinary samples were requested for urinary iodine concentration (UIC) determinations in both the first and third gestational trimesters. Serum thyrotropin (TSH) and free thyroxine (FT4) were analysed in both trimesters and thyroid antibodies were assessed once. SETTING Rio de Janeiro, Brazil.ParticipantsFirst-trimester pregnant women (n 243), of whom 100 were re-evaluated during the third trimester. RESULTS Iodine sufficiency was found in the studied population (median UIC=216·7 µg/l). The first- and third-trimester median UIC was 221·0 and 208·0 µg/l, respectively. TSH levels (mean (sd)) were higher in the third trimester (1·08 (0·67) v. 1·67 (0·86) mIU/l; P<0·001), while FT4 levels decreased significantly (1·18 (0·16) v. 0·88 (0·12) ng/dl; P<0·001), regardless the presence of iodine deficiency (UIC<150 µg/l) or circulating thyroid antibodies. UIC correlated (β; 95% CI) independently and negatively with age (-0·43; -0·71, -0·17) and positively with multiparity (0·15; 0·02, 0·28) and BMI (0·25; 0·00, 0·50). Furthermore, median UIC per pregnant woman tended to correlate positively with TSH (0·07; -0·01, 0·14). Women with median UIC≥250 µg/l and at least one sample ≥500 µg/l throughout pregnancy had a higher risk of subclinical hypothyroidism (OR=6·6; 95% CI 1·2, 37·4). CONCLUSIONS In this cohort with adequate iodine status during pregnancy, excessive UIC was associated with an increased risk of subclinical hypothyroidism.
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Sgarbi JA. Region-specific reference intervals for TSH in pregnancy: time for changes in Brazil. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:383-385. [PMID: 30304101 PMCID: PMC10118735 DOI: 10.20945/2359-3997000000067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 11/23/2022]
Affiliation(s)
- José Augusto Sgarbi
- Unidade de Tireoide, Divisão de Endocrinología e Metabolismo, Departamento de Medicina, Faculdade de Medicina de Marília, Marília, SP, Brasil
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