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Lukindo T, Masumo R, Hancy A, John SE, Paulo HA, Sanga A, Noor R, Lankoande F, Towo E, Leyna GH, Bridge G, Bedi R. Factors associated with inadequate urinary iodine concentration among pregnant women in Mbeya region Tanzania. F1000Res 2024; 10:858. [PMID: 39211896 PMCID: PMC11358688 DOI: 10.12688/f1000research.55269.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
Background Insufficient and above WHO-recommended levels of iodine intake during pregnancy can lead to serious health outcomes. This study aimed to assess median urine iodine concentration and its associated risk factors among pregnant women in the Mbeya region, Tanzania. Method A cross sectional survey involving 420 pregnant women (n=420) aged 15-49, registered in Reproductive and Child Health Clinics was conducted. Socio-demographic and dietary factors were assessed by structured questionnaire and the urine samples were analyzed using the ammonium persulfate digestion method. Results Median urinary iodine concentration (mUIC) was 279.4μg/L and it ranged from 26.1 to 1915μg/L. Insufficient mUIC (below 150μg/L) was observed in 17.14% of participants, sufficient mUIC was 24.29% and 58.57% had mUIC above the recommended level (>250μg/L). Sample women who reported consuming fish in the last 24 hours had an increased risk of insufficient mUIC [Adjusted OR= 2.60 (95%CI 1.31-5.15)] while the risk was lower for those who attended at least primary education [AOR= 0.29 (CI 0.08-0.99)]. Further, sample women resident in Mbarali district, in the oldest age group (35-49) and having a higher socio-economic status were associated with an increased risk of having MUIC above recommended level [AOR=4.09 (CI 1.85-9.010], [AOR=2.51 (CI 0.99-6.330] and, [AOR=2.08 (CI 0.91-4.71) respectively. Conclusion This study demonstrated a significant association between geographical, age and socio-economic factors and median urine iodine concentration above the WHO-recommended level. Further, this study found association between inadequate iodine in diet and insufficient median urine iodine concentration. Therefore, educational programs on iodine intake should be strengthened.
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Affiliation(s)
- Tedson Lukindo
- Tanzania Food and Nutrition Centre, 22 Barack Obama Drive, Dar es Salaam, P.O. Box 977, Tanzania
| | - Ray Masumo
- Tanzania Food and Nutrition Centre, 22 Barack Obama Drive, Dar es Salaam, P.O. Box 977, Tanzania
| | - Adam Hancy
- Tanzania Food and Nutrition Centre, 22 Barack Obama Drive, Dar es Salaam, P.O. Box 977, Tanzania
| | - Sauli E. John
- Tanzania Food and Nutrition Centre, 22 Barack Obama Drive, Dar es Salaam, P.O. Box 977, Tanzania
| | - Heavenlight A. Paulo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, MUHAS, P.O. Box 65001, Tanzania
| | - Abraham Sanga
- The United Nations Children's Fund (UNICEF), The United Nations Children's Fund (UNICEF), Dar es Salaam, Tanzania, P.O. Box 4076, Tanzania
| | - Ramadhan Noor
- The United Nations Children's Fund (UNICEF), The United Nations Children's Fund (UNICEF), Dar es Salaam, Tanzania, P.O. Box 4076, Tanzania
| | - Fatoumata Lankoande
- The United Nations Children's Fund (UNICEF), The United Nations Children's Fund (UNICEF), Dar es Salaam, Tanzania, P.O. Box 4076, Tanzania
| | - Elifatio Towo
- Tanzania Food and Nutrition Centre, 22 Barack Obama Drive, Dar es Salaam, P.O. Box 977, Tanzania
| | - Germana H. Leyna
- Tanzania Food and Nutrition Centre, 22 Barack Obama Drive, Dar es Salaam, P.O. Box 977, Tanzania
| | - Gemma Bridge
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Garrod Building, Turner Street, Whitechapel,, London, E1 2AD, UK
- Global Child Dental Fund (GCD fund), King's College London, Norfolk Building, Room G03-G03A, The Global Child Dental Fund, Surrey Street, London, WC2R 2ND, UK
| | - Raman Bedi
- King's College London, Norfolk Building, Room G03-G03A, Surrey Street, London, WC2R 2ND, UK
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Gong B, Wang C, Yang W, Shan Z. Changing trends in the global, regional, and national burden of iodine deficiency among adolescents and young adults: population-based study. Eur J Pediatr 2024; 183:2855-2863. [PMID: 38592486 DOI: 10.1007/s00431-024-05545-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
Iodine is a micronutrient required for the production of thyroid hormones, which regulate metabolism, growth, and neurodevelopment. Iodine deficiency among adolescents and young adults is a major global health issue. We analyzed data from the Global Burden of Disease 2019 database to calculate the prevalence, incidence, and disability-adjusted life-year (DALY) rates of iodine deficiency among adolescents and young adults. We explored the specific year with the most substantial changes in the trends of iodine deficiency among adolescents with annual percentage change (APC) by Joinpoint Regression analysis. Descriptive analyses were conducted to characterize the iodine deficiency burden according to age, sex, location, and sociodemographic index (SDI) quintiles. All measures are listed with 95% uncertainty intervals (UIs), and all rates are reported per 100,000 individuals. From 1990 to 2019, the iodine deficiency prevalence rate among adolescents decreased from 3082.43 (95% uncertainty interval [UI], 2473.01-3855.86) to 2190.84 (95% [UI], 1729.18-2776.16) per 100,000 population, with an AAPC of -1.15 (95% confidence interval [CI], -1.29 to -1.02). Regarding the SDI in 2019, the highest prevalence and DALY rates of iodine deficiency were reported in low-SDI countries. In 1990, Southeast Asia had the highest prevalence and DALYs rates for iodine deficiency among adolescents, while in 2019, Africa had the highest prevalence rate (3330.12). CONCLUSION Globally, the iodine deficiency burden among adolescents has substantially decreased since 1990; however, low-SDI countries still bear a great burden. Implementation measures and monitoring systems should be strengthened to reduce the iodine deficiency burden, especially among adolescents. WHAT IS KNOWN • Iodine deficiency can cause severe or irreversible developmental disorders, particularly in adolescents and young adults. • Universal Salt Iodization was implemented for ensuring appropriate iodine intake. WHAT IS NEW • We found substantial declines in the prevalence rates of iodine deficiency among adolescents during the past three decades. Globally, the disability-adjusted life-year rate of iodine deficiency among adolescents decreased from 56.17 in 1990 to 35.38 in 2019. • Iodine deficiency among adolescents in low- sociodemographic index countries still bear a great burden.
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Affiliation(s)
- Boshen Gong
- Department of Endocrinology and Metabolism, Institute of Endocrinology, National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, China Medical University, No. 155, Nanjing Bei Street, Shenyang, Liaoning Province, P. R. China, 110001
| | - Chuyuan Wang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, China Medical University, No. 155, Nanjing Bei Street, Shenyang, Liaoning Province, P. R. China, 110001
| | - Wanyu Yang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, China Medical University, No. 155, Nanjing Bei Street, Shenyang, Liaoning Province, P. R. China, 110001
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, China Medical University, No. 155, Nanjing Bei Street, Shenyang, Liaoning Province, P. R. China, 110001.
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Candido AC, Vieira AA, de Souza Ferreira E, Moreira TR, do Carmo Castro Franceschini S, Cotta RMM. Prevalence of Excessive Iodine Intake in Pregnancy and Its Health Consequences: Systematic Review and Meta-analysis. Biol Trace Elem Res 2023; 201:2784-2794. [PMID: 36018544 DOI: 10.1007/s12011-022-03401-5] [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: 06/13/2022] [Accepted: 08/22/2022] [Indexed: 11/02/2022]
Abstract
The objective was to estimate the prevalence of excessive iodine intake in pregnant women and to investigate the consequences for maternal-fetal health. The systematic review was based on PRISMA. The search was conducted in September 2021 in LILACS, PubMed/MEDLINE, Science Direct, and SCOPUS databases. Observational studies that assessed excessive nutritional iodine status in pregnancy diagnosed by urinary iodine concentration and associated it with biomarkers of thyroid health function were included. Study selection, data extraction, and risk of biased evaluation were performed independently. Meta-analysis was calculated using a fixed and random effect model, and heterogeneity was assessed by the chi-square test. Meta-regressions were performed to identify the causes of heterogeneity using the Knapp and Hartung test. Nine studies were included in the systematic review, and eight in the meta-analysis. The prevalence of excessive iodine intake in 10,736 pregnant women in different regions of the world was 52%. The main implications for pregnant women were hypothyroxinemia, hypothyroidism, and hyperthyroidism. For the newborn, macrosomia and thyroid dysfunction. In addition, drinking water with high iodine intake contributed to excessive iodine intake. Therefore, the prevalence of iodine excess was 52%, with high heterogeneity among studies, explained by trimester of gestation and FT4 level; therefore, the farther the trimester of gestation and the lower the FT4, the higher the prevalence of iodine excess. PROSPERO Registration: CRD420206467 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206467 ).
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Affiliation(s)
- Aline Carare Candido
- Department of Nutrition and Health, Ed. Centro de Ciências Biológicas II, Universidade Federal de Viçosa, Peter Henry Rolfs Avenue, w/o. Campus Universitário, Viçosa, Minas Gerais, 36570.900, Brazil.
| | - Almir Antônio Vieira
- Department of Agricultural Engineering, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Emily de Souza Ferreira
- Department of Nutrition and Health, Ed. Centro de Ciências Biológicas II, Universidade Federal de Viçosa, Peter Henry Rolfs Avenue, w/o. Campus Universitário, Viçosa, Minas Gerais, 36570.900, Brazil
| | - Tiago Ricardo Moreira
- Department of Medicine and Nursing, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
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Doggui R, McCormick BJ, Caulfield LE, Schulze KJ, Murray-Kolb LE. Adequacy of Iodine Status and Associations with Gut Health: A Prospective Cohort Study among Infants in 8 Low- and Middle-Income Countries. J Nutr 2023; 153:828-838. [PMID: 36797135 DOI: 10.1016/j.tjnut.2022.11.027] [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: 06/18/2022] [Revised: 10/25/2022] [Accepted: 11/15/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Environmental enteric dysfunction increases the likelihood of micronutrient deficiencies among infants, but few studies have assessed the potential impact of gut health on urinary iodine concentration (UIC) among this vulnerable group. OBJECTIVES We describe the trends of iodine status among infants from 6 to 24 mo old and examine the associations between intestinal permeability, inflammation, and UIC from 6 to 15 mo of age. METHODS Data from 1557 children enrolled in this birth cohort study conducted in 8 sites were included in these analyses. UIC was measured at 6, 15, and 24 mo of age by using the Sandell-Kolthoff technique. Gut inflammation and permeability were assessed using the concentrations of fecal neopterin (NEO), myeloperoxidase (MPO) and alpha-1-antitrypsin (AAT), and lactulose-mannitol ratio (LM). A multinomial regression analysis was used to assess the classified UIC (deficiency or excess). Linear mixed regression was used to test the effect of interactions among biomarkers on logUIC. RESULTS All studied populations had adequate (≥100 μg/L) to excess (≥371 μg/L) median UIC at 6 mo. Between 6 and 24 mo, 5 sites displayed a significant decline in the infant's median UIC. However, median UIC remained within the optimal range. An increase of NEO and MPO concentrations by +1 unit in ln scale reduced the risk of low UIC by 0.87 (95% CI: 0.78-0.97) and 0.86 (95% CI: 0.77-0.95), respectively. AAT moderated the association between NEO and UIC (P < 0.0001). The shape of this association appears to be asymmetric and in a reverse J-shape, with a higher UIC observed at both lower NEO and AAT concentrations. CONCLUSIONS Excess UIC was frequent at 6 mo and tended to normalize at 24 mo. Aspects of gut inflammation and increased permeability appear to reduce the prevalence of low UIC in children aged 6 to 15 mo. Programs addressing iodine-related health should consider the role of gut permeability in vulnerable individuals.
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Affiliation(s)
- Radhouene Doggui
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.
| | | | - Laura E Caulfield
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kerry J Schulze
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA; Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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Azeez TA, Lamidi AO, Osin IO. A systematic review and meta-analysis of the etiology and treatment patterns of thyrotoxicosis in Africa. Expert Rev Endocrinol Metab 2022; 17:563-572. [PMID: 36267032 DOI: 10.1080/17446651.2022.2136165] [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: 06/23/2022] [Accepted: 10/11/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Thyrotoxicosis is one of the most common endocrine disorders seen in clinical practice. This study aims to determine the etiologies and treatment modalities of thyrotoxicosis in Africa. AREAS COVERED The study design is a systematic review with a meta-analysis. Medical databases and the gray literature were systematically searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies done in Africa on the etiology and treatment of thyrotoxicosis were selected. EXPERT OPINION In Africa, it is still believed that autoimmune diseases, generally, are not as common as what is seen in the western world. The frequency of Graves' disease is reportedly lower in Africa. The treatment of thyrotoxicosis depends on the cause. Therefore, it is of substantial importance to establish the etiology following the diagnosis of the clinical syndrome.
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Nista F, Bagnasco M, Gatto F, Albertelli M, Vera L, Boschetti M, Musso N, Ferone D. The effect of sodium restriction on iodine prophylaxis: a review. J Endocrinol Invest 2022; 45:1121-1138. [PMID: 35079975 DOI: 10.1007/s40618-022-01749-y] [Citation(s) in RCA: 3] [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] [Received: 12/20/2021] [Accepted: 01/16/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Sodium is essential to life. However, its dietary excess is detrimental to the cardiovascular system, and sodium restriction is a crucial step in cardiovascular prevention. Iodine deficiency has been fought worldwide for decades, and substantial success has been achieved introducing the use of iodine-enriched salt. Nevertheless, areas of iodine deficiency persist around the world, both in developing and industrialized countries, and a major concern affecting dietary sodium reduction programs is represented by a possible iodine intake deficiency. There are substantial differences in the source of alimentary iodine among countries, such as iodized salt added, household tap water, seafood, or salt employed in packaged food. It is clear that a sodium-restricted diet can induce differences in terms of iodine intake, depending on the country considered. Moreover, iodine status has undergone relevant changes in many countries in the last years. METHODS Systematic review of literature evidence about the possible effects of sodium restriction on population iodine status. RESULTS To date, the available results are conflicting, depending on country, salt iodization policy, as well as time frame of data collection. However, to ensure an optimal iodine supply by salt fortification, without exceeding the current recommendation by World Health Organization for salt intake, seems to be an achievable goal. CONCLUSION A balanced approach may be obtained by an adequate iodine concentration in fortified salt and by promoting the availability of iodized salt for household consumption and food industry use. In this scenario, updated prospective studies are strongly needed.
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Affiliation(s)
- F Nista
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - M Bagnasco
- Department of Internal Medicine and Medical Specialties, President-elect of the Italian Thyroid Association, University of Genoa, Genoa, Italy
| | - F Gatto
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy.
| | - M Albertelli
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - L Vera
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - M Boschetti
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - N Musso
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - D Ferone
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
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Assessment of the Impact of Salt Iodisation Programmes on Urinary Iodine Concentrations and Goitre Rates: A Systematic Review. J Nutr Metab 2021; 2021:9971092. [PMID: 34188956 PMCID: PMC8192202 DOI: 10.1155/2021/9971092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Two main strategies are currently recommended for the prevention and control of iodine deficiency in the world: implementation of universal salt iodisation programmes and permanent monitoring of iodine consumption by the population. Although iodine intake and coverage iodised salt have increased in the world population, iodine deficiency disorders (IDDs) may still be a public health problem in a few countries or communities. Objective To assess the impact of salt iodisation programmes on urinary iodine concentrations and goitre rates in the world population. Methodology. A systematic review based on the PRISMA method. We obtained articles from Scopus, Science Direct, MEDLINE databases, and other sources between March and April 2020, without limitation of dates. "Iodisation" AND "urinary iodine concentrations" AND "goitre" in English, Portuguese, and Spanish without filters and clinical trial, case-control, and cross-sectional studies were included in this review. Results Of 479 abstracts, twenty-three were eligible. Coverage on iodised salt was in the range of 16 to 98%, and 11 studies had been sufficient, whilst eight studies had adequate iodine concentration in salt and three excess. 81.8% of studies that had an adequate median of UIC had a good impact in their respective salt iodisation programmes. Conclusion After 18 years of salt iodisation programme implementation in the 13 countries, the majority achieved sustaining elimination of IDD whilst all had adequate median UIC; however, more detailed studies are still needed to confirm that all communities are equally protected of IDD.
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