Iodine nutrition: iodine content of iodized salt in the United States

Iodine and selenium: Dietary sources and nutritional status of the population of the Kurdistan Region in Northern Iraq

AIM

The primary aim of this study was to determine the selenium (Se) and iodine (I) food concentrations and dietary intake of the population living in the Kurdish controlled region of northern Iraq. We also assessed the extent to which iodised salt contributes to dietary iodine intake.

METHODOLOGY

Foods and samples of salt and drinking water were analysed, including 300 crops samples from 40 local farms. The results, supplemented by food composition data, were used to assess dietary Se and I intake for 410 volunteers using a semi-quantitative food questionnaire. To directly investigate the nutritional status of individuals, urine samples were also collected from participants.

RESULTS

Selenium intake was mainly supplied by protein and cereal sources. Calculated median dietary intake of Se was 62.7 µg d-1 (mean = 66.3 µg d-1) with c. 72 % of participants meeting or exceeding dietary reference intake recommendations for age. Median dietary intake of I, excluding salt consumption, was 94.6 µg d-1 (mean 100.2 µg d-1), increasing to 607.2 µg d-1 when salt (of which >90 % was iodized) was included. Salt intake was estimated to be c.13.5 g d-1 (5400 mg Na d-1) which greatly exceeds WHO recommended intake (< 2000 mg d-1 of Na). Urine iodine concentrations indicated that 98 % of school aged children had excessive iodine intake (≥300 µg L-1) and 80-90 % of all study participants had above average or excessive iodine intake (≥200 µg L-1).

CONCLUSIONS

Poultry and rice are the main sources of dietary Se to this population but around a third of children receive an inadequate Se intake. Fresh fruit and vegetables are the main sources of dietary I, but consumption of local foods cannot supply adequate I without iodised salt supplementation. Consumption of iodized salt well above recommended amounts is supplying this population with substantial iodine intake. Interventions to reduce salt intake would help to limit excessive iodine intake whilst also reducing cardio-vascular risks from Na consumption.

Thyroid function and iodine intake: global recommendations and relevant dietary trends

Iodine is a micronutrient that is essential for thyroid hormone production. Adequate iodine intake is especially important during pregnancy and early life, when brain development is dependent on thyroid hormones. Iodine intake recommendations vary around the world, but most recommendations generally reflect the increased requirements during pregnancy and lactation, although adequate iodine intake before pregnancy is also important. Tremendous progress has been made in improving iodine intake across the world over the past 30 years, mainly through salt-iodization programmes. However, in countries without strong iodine fortification programmes, and with shifts in dietary patterns, a need has arisen for health organizations, governments and clinicians to ensure that adequate iodine is consumed by everyone in the population. For example, in countries in which adequate iodine intake depends on individual food choice, particularly of iodine-rich milk and dairy products, intake can be highly variable and is also vulnerable to changing dietary patterns. In this Review, iodine is considered in the wider context of the increasing prevalence of overweight and obesity, the dietary trends for salt restriction for cardiovascular health and the increasing uptake of plant-based diets.

Green strength: The role of micronutrients in plant-based diets for athletic performance enhancement

This review examines the correlation between plant-based diets and athletic performance, with a specific emphasis on the vital aspect of optimizing micronutrients for athletes. In light of the increasing prevalence of plant-based nutrition among athletes due to its perceived advantages in terms of health, ethics, and the environment, this study investigates the ability of these diets to satisfy the demanding nutritional requirements essential for achieving optimal performance and facilitating recovery. The article emphasizes the significance of essential micronutrients such as iron, vitamin B12, calcium, vitamin D, zinc, and omega-3 fatty acids and also addressing the challenges with their absorption and bioavailability from plant sources. The review consolidates existing scientific knowledge to propose strategies for improving micronutrient consumption, comparing the effects of supplements against whole foods, and highlighting the significance of enhancing bioavailability. The proposal supports the implementation of personalized meal planning, with the assistance of sports nutritionists or dietitians, and is substantiated by case studies showcasing the success of plant-based athletes. Future research directions examine the long-term effects of plant-based diets on micronutrient status and athletic performance, as well as developing nutritional trends and technology. The review concludes that plant-based diets can meet athletes' nutritional demands and improve peak performance while aligning with personal and ethical values with strategic planning and professional guidance. This study intends to help athletes, coaches, and nutritionists understand plant-based nutrition for enhanced athletic performance.

Iodine Intake Trends in United States Girls and Women between 2011 and 2020

BACKGROUND

Usual intakes of iodine in United States girls and women, including pregnant and lactating women have not been adequately studied. Adequate intake of iodine is critical for neurodevelopment of girls, thyroid functions, and reproductive health of women.

OBJECTIVES

This study aimed to examine the adequacy and trends of iodine intake of United States girls and women between 2011 and 2020.

METHODS

We mapped the sources of United States girls and women's iodine intake from the 29 food groups between 2011 and 2020 using United States Department of Agriculture's iodine data release 2. The total food intakes from 2 d of dietary recall of the United States National Health and Nutritional Examination Survey and estimated iodine concentrations of the food groups were used to calculate the usual iodine intakes of female participants. Trends of usual intakes, urinary iodine concentrations (UIC), and estimated intake adequacy were calculated.

RESULTS

Median usual intakes of iodine estimated from diet and supplements and UIC of United States girls and nonpregnant, nonlactating women declined between 2011 and 2020 in all 3 age groups: ≤14 y, 15-49 y old, and ≥50 y. Median usual intakes of iodine for pregnant and lactating United States women declined as well. Inadequacy levels of usual iodine intake were 9.9% for nonpregnant, nonlactating women of reproductive age 15-49 y old, 40.3% for lactating, and 10.2% for pregnant women in the 2017-2020 period. Intake insufficiencies estimated from UIC were 48.8%, 63.2%, and 31.3% for nonpregnant, nonlactating women of reproductive age 15-49 y old, pregnant and lactating women, respectively, in the 2017-2020 period. A significant decline in milk consumption might be one of the major contributors to the dietary iodine decline in United States women.

CONCLUSIONS

Iodine intake of United States girls and women were on the decline between 2011 and 2020 and the increased inadequacy of iodine intake deserves public health attention.

Iodine revisited: If and how inorganic iodine species can be measured reliably and what cause their conversions in water?

This study revisited a list of inorganic iodine species on their detections and conversions under different water conditions. Several surprising results were found, e.g., UV-vis spectrophotometry is the only reliable method for I3- and I2 determinations with coexisting I-/IO3-/IO4-, while alkaline eluent of IC and LC columns can convert them into I- completely; IO4- can be converted into IO3- completely in IC columns and partly in LC columns; a small portion of IO3- was reduced to I- in LC columns. To avoid errors, a method for detecting multiple coexisting iodine species is suggested as follows: firstly, detecting I3- and I2 via UV-vis spectrophotometry; then, analyzing IO4- (> 0.2 mg/L) through LC; and lastly, obtaining I- and IO3- concentrations by deducting I- and IO3- measured by IC from the signals derived from I3-/I2/IO4-. As for stability, I- or IO3- alone is stable, but mixing them up generates I2 or H2OI+ under acidic conditions. Although IO4- is stable within pH 4.0-8.0, it becomes H5IO6/H3IO62- in strongly acidic/alkaline solutions. Increasing pH accelerates the conversions of I3- and I2 into I- under basic conditions, whereas dissolved oxygen and dosage exert little effect. Additionally, spiking ICl into water produces I2 and IO3- rather than HIO.

Investigation of the effects of heat and light on iodine content of packaged and open salt brands collected from Jimma town

Iodine deficiency is one of the most common micronutrient deficiencies in developing countries, which leads to iodine deficiency disorders (IDD). To combat iodine deficiency disorders, universal salt iodization is mandatory. However, iodized salt can lose its iodine due to environmental factors such as heat, light, moisture, and so on. Therefore, the aim of this study is to investigate the effects of heat and light on the iodine content of packaged and open salt brands available in Jimma town, Oromia, Ethiopia. An experimental study design was employed to determine the effects of heat and light on the iodine content of salts. A total of six salt samples were collected from retailers selected based on convenience sampling technique. Among six different salt brands, three were packaged salts, and the rest were non-packaged (open) salts. The iodine content of the salt samples was determined by the iodometric titration method, and the effects of heat and light on the concentration of iodine were also investigated. It has been revealed that heat and light decrease the iodine content of salt samples. The findings of this study provide valuable insights into the stability of iodized salt against heat and light. It is also helpful in identifying the right time at which salt should be added while cooking and the appropriate storage conditions for salt in households.

Role of different organic and inorganic amendments in the biofortification of iodine in Coriandrum sativum crop

Iodine deficiency disorder (IDDs) is one of the most prevailing and common health issues in mountainous communities. An effective way to control the prevalence and emergence of IDDs in remote areas is to use iodized salt. However, recent studies indicated that iodized salt is mostly lost during the cooking process. The current study of iodine biofortification differed from the previous studies in two main aspects: it involved exogenous organic iodine (OI), and inorganic iodine such as potassium iodide (KI), added in the amended soils, which previous studies did not consider. Moreover, the translocation, transformation, and distribution of iodine from soil to plants are poorly understood in amended soil. Thus, identifying an effective management option to enhance iodine (I) bioavailability in nutrient-deficient soils is currently a significant challenge. Therefore, a greenhouse study was conducted to investigate the effects of organic and inorganic soil amendments on the uptake of different iodine sources in coriander crops. Results showed that applying an inorganic iodine source significantly enhanced the iodine edible part of the crop compared to the control (p &lt; 0.05). The application of soil amendments relatively improved iodine uptake by the coriander crop compared to the control. The highest iodine was found in crop tissues grown in wood ash-amended soil supplemented with KI (291.97 μg kg−1). The KI uptake was significantly higher than the OI (p &lt; 0.05). Compared to OI, a higher translocation factor (0.96) and distribution coefficient (3.51) were found for plants treated with KI. Thus, this study indicates that a suitable soil amendment can be a better option for iodine biofortification and that it can serve as an alternative to iodized salt in preventing IDDs.

Iodine Availability through Iodized Salt in Portugal: 2010–2021 Sales Evolution and Distribution

Salt iodization programs are considered the most cost-effective measures to ensure adequate iodine intake in iodine-deficient populations. Portuguese women of childbearing age and pregnant women were reported to be iodine-deficient, which led the health authorities, in 2013, to issue a recommendation for iodine supplementation during preconception, pregnancy and lactation. In the same year, iodized salt became mandatory in school canteens. Of note, no regulation or specific programs targeting the general population, or the impact of iodized salt availability in retailers, are known. The present study analyzed iodized salt supermarket sales from 2010 to 2021 from a major retailer, identifying the proportion of iodized salt in total salt sales and its distribution in mainland Portugal. Data on iodine content were collected through the nutritional label information. Of a total of 33 salt products identified, 3 were iodized (9%). From 2010 to 2021, the weighted sales of iodized salt presented a growing tendency, reaching the maximum of 10.9% of total sales (coarse plus fine salt) in 2021. Iodized salt reached a maximum of 11.6% of total coarse salt in 2021, a maximum of 2.4% of the total fine salt in 2018. The overall sales of iodized salt and their contribution to iodine intake are extremely low, prompting additional studies to understand the consumer’s choice and awareness of the benefits of iodized salt.

Iodine status, household salt iodine content, knowledge and practice assessment among pregnant women in Butajira, South Central Ethiopia

BACKGROUND

Iodine is one of the crucial micronutrients needed by the human body, and is vitally important during pregnancy. This study aimed to determine the relationship between the iodine status of pregnant women and their knowledge, and practices regarding iodized salt. All participants were enrolled in the Butajira nutrition, mental health and pregnancy (BUNMAP) cohort, Butajira, Ethiopia in February-May, 2019.

METHODS

In this cross-sectional study, 152 pregnant women without hypertension or known thyroid disease before or during pregnancy were randomly selected from the BUNMAP mother to child cohort (n = 832). Spot urine samples were collected to estimate the level of urinary iodine concentration (UIC). Salt samples were also collected from their homes. The Sandall-Kolthoff (S-K) method was used to measure the level of iodine in the urine samples, and iodometric titration was used to measure the level of iodine in the salt. Data was entered and cleaned using Epi-info version 3.5.3 and then exported to SPSS version 20 for further analysis. Multivariate logistic regression analysis was performed to identify associations in the collected data.

RESULTS

The WHO recommended level of iodine for populations of pregnant women is 150-249 F06Dg/L. The median UIC among pregnant women in this study was 151.2 μg/L [interquartile range (IQR) = 85.5-236.2 F06Dg/L], at the low end of this range. About half (49.65%) of the participants were likely to be iodine deficient. There was a significant association between having a formal job (AOR = 2.56; CI = 1.11-5.96) and iodine sufficiency. Based on a cutoff of >15 ppm (mg/kg), 91.7% (95% CI: 87.2-96.2) of the salts collected from the household had adequate iodine content. The median iodine level of the collected salt samples was 34.9 mg/kg (ppm) (IQR = 24.2-44.6 mg/kg).

CONCLUSIONS

The UNICEF 2018 guidelines for adequate iodine nutrition in pregnant women include both a recommended median range of 150-249 μg/L, and an upper limit of 20% on the fraction of the population with UIC below 50 μg/L. Because our study population's median level is 151.2 μg/L and the percentage of pregnant women with urinary iodine concentration of less than 50 μg/L is 9.7% (14/145), the women received adequate iodine nutrition. The availability of adequately iodized salt in households is more than 90%, as recommended by WHO. In light of previous iodine deficiency in this region of Ethiopia, the salt iodization program promotes the health of babies and mothers.

Association between Iodine Intake, Thyroid Function, and Papillary Thyroid Cancer: A Case-Control Study

BACKGROUND

This study aimed to assess the effects of iodine intake, thyroid function, and their combined effect on the risk of papillary thyroid cancer (PTC) and papillary thyroid microcarcinoma (PTMC).

METHODS

A case-control study was conducted including 500 community-based controls who had undergone a health check-up, and 446 overall PTC cases (209 PTC and 237 PTMC) from the Thyroid Cancer Longitudinal Study. Urinary iodine concentration (UIC), was used as an indicator of iodine intake, and serum for thyroid function. The risk of PTC and PTMC was estimated using unconditional logistic regression.

RESULTS

Excessive iodine intake (UIC ≥220 μg/gCr) was associated with both PTC (odds ratio [OR], 18.13 95% confidence interval [CI], 8.87 to 37.04) and PTMC (OR, 8.02; 95% CI, 4.64 to 13.87), compared to adequate iodine intake (UIC, 85 to 219 μg/gCr). Free thyroxine (T4) levels ≥1.25 ng/dL were associated with PTC (OR, 1.97; 95% CI, 1.36 to 2.87) and PTMC (OR, 2.98; 95% CI, 2.01 to 4.41), compared to free T4 levels of 0.7 to 1.24 ng/dL. Individuals with excessive iodine intake and high free T4 levels had a greatly increased OR of PTC (OR, 43.48; 95% CI, 12.63 to 149.62), and PTMC (OR, 26.96; 95% CI, 10.26 to 70.89), compared to individuals with adequate iodine intake and low free T4 levels.

CONCLUSION

Excessive iodine intake using creatinine-adjusted UIC and high free T4 levels may have a synergistic effect on PTC and PTMC. Considering both iodine intake and thyroid function is important to assess PTC and PTMC risk.

Adequately Iodized Salt Utilization and Associated Factors among Households in Tach Armachio District, Northwest Ethiopia: A Community-Based Cross-Sectional Study

Background

For the synthesis of thyroid hormones, iodine is a crucial trace element. Iodine deficiency disorders affect all groups particularly: pregnant, young women and children. Iodine deficiency disorder has been recognized as a serious public health issue in Ethiopia. Therefore, this study planned to assess iodized salt utilization and associated factors at the household level.

Methods

A community-based cross-sectional study was conducted from January 25 to February 24, 2019, in Tach Armachio district, Northwest Ethiopia. A single population proportion formula was used to calculate the sample size and a total of 555 households were sampled. A multistage sampling technique was conducted to select the household. An iodometric titration method was performed. A structured, pretested, and face-to-face interview questionnaire was used to collect data; then, it was entered in Epi Info 7 and exported to SPSS version 25 for analysis. Bivariable and multivariable analyses were done to identify predictor variables. A 95% confidence interval and adjusted odd ratio were reported. P values less than 0.05 were considered statistically significant in the multivariable analysis.

Results

This study showed that iodized salt was adequately utilized by 61.1% (CI = 57%–65%) of households. Good knowledge of iodine deficiency disorder (AOR = 2.25, 95% CI = (1.44, 3.50)), keeping salt in the kitchen house away from fire (AOR = 5.09, 95% CI = (3.25, 7.98)), buying packed salt [AOR = 1.89, 95% CI = (1.12, 3.19)), keeping salt in a covered container (AOR = 2.18, 95% CI = (1.24, 3.81)), and exposing salt to sunlight (AOR = 0.39, 95% CI = (0.23, 0.65)) were significantly associated.

Conclusion

In the district, adequately iodized salt utilization was low. Therefore, it is necessary to enforce the current law for merchants to sell iodized packed salt and teach the community how to handle it.

Agronomic iodine biofortification of leafy vegetables grown in Vertisols, Oxisols and Alfisols

Iodine deficiency disorders (IDD) in sub-Saharan African countries are related to low dietary I intake and generally combatted through salt iodisation. Agronomic biofortification of food crops may be an alternative approach. This study assessed the effectiveness of I biofortification of green vegetables (Brassica napus L and Amaranthus retroflexus L.) grown in tropical soils with contrasting chemistry and fertility. Application rates of 0, 5 and 10 kg ha^-1 I applied to foliage or soil were assessed. Leaves were harvested fortnightly for ~ 2 months after I application before a second crop was grown to assess the availability of residual soil I. A separate experiment was used to investigate storage of I within the plants. Iodine concentration and uptake in sequential harvests showed a sharp drop within 28 days of I application in all soil types for all I application levels and methods. This rapid decline likely reflects I fixation in the soil. Iodine biofortification increased I uptake and concentration in the vegetables to a level useful for increasing dietary I intake and could be a feasible way to reduce IDD in tropical regions. However, biofortification of green vegetables which are subject to multiple harvests requires repeated I applications.

Inadequate iodine intake in lactating women in Sweden: A pilot 1-year, prospective, observational study

INTRODUCTION

Breastfed infants depend on breast-milk iodine for growth and brain development, as iodine is a trace element important for thyroid hormone production. Iodine need is higher during lactation; hence, mothers and children are at risk of iodine deficiency. We aimed to explore maternal iodine and thyroidal status during lactation.

MATERIAL AND METHODS

Pregnant women were recruited in Gothenburg, southwest Sweden. Maternal urine and serum were collected at pregnancy week 35-37 (n = 84) and 0.5, 4, and 12 months postpartum. Seventy mothers provided breast milk at 0.5 months.

RESULTS

Median (interquartile range) breast-milk iodine concentration was 90 (66-116) μg/L. About 58% had breast-milk iodine concentration <100 μg/L. Iodine supplement users (n = 13) had higher breast-milk iodine concentration than non-users (n = 49) (140 μg/L vs 71 μg/L, P = .001). Exclusively breastfeeding women at 4 months postpartum (n = 57) had lower median urinary iodine concentration (85 μg/L vs 133 μg/L, P = .004) and higher thyroglobulin serum concentration (22.3 μg/L vs 11.8 μg/L, P = .032) than non-exclusively breastfeeding women (n = 25). Concentrations of thyroid hormones were unaffected.

CONCLUSIONS

This pilot study suggests that lactating women in southwest Sweden present mildly inadequate iodine intake, mainly among non-iodine supplement users and exclusively breastfeeding mothers. Studies on the coverage of the iodine fortification program in breastfeeding women are warranted.

Agronomic iodine biofortification of leafy vegetables grown in Vertisols, Oxisols and Alfisols

Iodine deficiency disorders (IDD) in sub-Saharan African countries are related to low dietary I intake and generally combatted through salt iodisation. Agronomic biofortification of food crops may be an alternative approach. This study assessed the effectiveness of I biofortification of green vegetables (Brassica napus L and Amaranthus retroflexus L.) grown in tropical soils with contrasting chemistry and fertility. Application rates of 0, 5 and 10 kg ha^-1 I applied to foliage or soil were assessed. Leaves were harvested fortnightly for ~ 2 months after I application before a second crop was grown to assess the availability of residual soil I. A separate experiment was used to investigate storage of I within the plants. Iodine concentration and uptake in sequential harvests showed a sharp drop within 28 days of I application in all soil types for all I application levels and methods. This rapid decline likely reflects I fixation in the soil. Iodine biofortification increased I uptake and concentration in the vegetables to a level useful for increasing dietary I intake and could be a feasible way to reduce IDD in tropical regions. However, biofortification of green vegetables which are subject to multiple harvests requires repeated I applications.

Risk of Iodine Deficiency in Extremely Low Gestational Age Newborns on Parenteral Nutrition

Iodine is an essential component of thyroid hormones, which play a critical role in neurodevelopment. The iodine status of pregnant women and their newborns is not checked routinely. Extremely Low Gestational Age Newborns do not receive Iodine supplementation while on parenteral nutrition (PN). We measured urine iodine levels and thyroid function tests in 50 mother–infant dyads at birth, at 1 week, 1, 2, 3 months and near discharge. We correlated maternal and neonatal urine iodine levels with thyroid functions and measured iodine levels in milk and PN. In our study, 64% of mothers were iodine deficient at the time of delivery, their free T4 levels were 0.48 (0.41–0.54) ng/dL with normal thyroid-stimulating hormone (TSH). Iodine levels were thirty-fold higher in extremely low gestational age newborns (ELGAN) exposed to iodine comparing to full terms (p < 0.001), but this effect lasted <1 week. At 1 month of age, ELGAN on PN developed iodine deficiency (p = 0.017) and had high thyroglobulin levels of 187 (156–271) ng/mL. Iodine levels improved with enteral feeds by 2 months of age (p = 0.01). Iodine deficiency is prevalent among pregnant women and ELGAN; in particular, those on PN are at risk of hypothyroidism. Iodine supplementation during pregnancy and postnatally should be considered to avoid iodine deficiency.

Vegans, Vegetarians, and Omnivores: How Does Dietary Choice Influence Iodine Intake? A Systematic Review

Vegan and vegetarian diets are becoming increasingly popular. Dietary restrictions may increase the risk of iodine deficiency. This systematic review aims to assess iodine intake and status in adults following a vegan or vegetarian diet in industrialised countries. A systematic review and quality assessment were conducted in the period May 2019-April 2020 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were identified in Ovid MEDLINE, Embase, Web of Science, PubMed, Scopus, and secondary sources. Fifteen articles met inclusion criteria. Participants included 127,094 adults (aged ≥ 18 years). Vegan groups presented the lowest median urinary iodine concentrations, followed by vegetarians, and did not achieve optimal status. The highest iodine intakes were recorded in female vegans (1448.0 ± 3879.0 µg day-1) and the lowest in vegetarians (15.6 ± 21.0 µg day-1). Omnivores recorded the greatest intake in 83% of studies. Seaweed contributed largely to diets of vegans with excessive iodine intake. Vegans appear to have increased risk of low iodine status, deficiency and inadequate intake compared with adults following less restrictive diets. Adults following vegan and vegetarian diets living in countries with a high prevalence of deficiency may be more vulnerable. Therefore, further monitoring of iodine status in industrialised countries and research into improving the iodine intake and status of adults following vegan and vegetarian diets is required.

Large Variability of Iodine Content in Retail Cow's Milk in the U.S

Iodine intake is of contemporary public health interest. The recommended daily iodine intake is 150 µg for most adults, and milk is an important source of iodine in the U.S. diet. Iodine concentration in cow's milk is affected by diet and iodine supplementation levels, milking sanitation practices, and other factors. Current analytical iodine data in U.S. retail milk are crucial for evaluating population-wide health outcomes related to diet. Samples of whole (3.25% fat), 2%, 1%, and skim (0-0.5% fat) milk were procured from 24 supermarkets across the U.S. using a census-based statistical plan. Iodine was analyzed by inductively coupled plasma mass spectrometry, including certified reference materials and control samples to validate results. No difference in iodine content was found between milkfat levels (F3,69 1.033, p = 0.4). Overall mean (SEM) was 85(5.5) µg/serving (240 mL). However, the 95% prediction interval of 39-185 µg/serving for individual samples indicated high variability among individual samples. Given the recommended 150 µg iodine per day for most adults along with the study mean, one milk serving can provide approximately 57% of daily intake. Researchers, health care professionals, and consumers should be aware of iodine variability in milk, while additional research is needed to investigate the impact of iodine variability factors.

Thyroid Function and Nutrient Status in the Athlete

Thyroid disease is common in the general population, especially in women, and also may be prevalent among athletes. Autoimmune disorders are the most common cause of thyroid disorders in countries with iodine-fortification programs; however, thyroid dysfunction can be brought on by nutritional factors, including insufficient energy intake and iodine, selenium, iron, and vitamin D deficiency. Additionally, strenuous exercise may be associated with transient alterations in thyroid hormones. While the development of thyroid related disorders has the potential to impact health and peak performance, typical clinical manifestations are highly variable, lack specificity, and are frequently confused with other health problems. The assessment process should focus on anthropometric changes, biochemical tests (thyroid panel), personal and family history, examination for appropriate signs and symptoms, and diet and environmental assessment that includes adequacy of energy, iodine, iron, selenium, and vitamin D intake/status along with excess stress and exposure to environmental contaminants and dietary goitrogens.

Dietary Relationship with 24 h Urinary Iodine Concentrations of Young Adults in the Mountain West Region of the United States

Background: Iodine deficiency is not seen as a public health concern in the US. However certain subpopulations may be vulnerable due to inadequate dietary sources. The purpose of the present study was to determine the dietary habits that influence iodine status in young adult men and women, and to evaluate the relationship between iodine status and thyroid function. Methods: 111 participants (31.6 ± 0.8 years, 173.2 ± 1.0 cm, 74.9 ± 1.7 kg) provided 24 h urine samples and completed an iodine-specific Food Frequency Questionnaire (FFQ) for assessment of urinary iodine content (UIC) as a marker of iodine status and habitual iodine intake, respectively. Serum Thyroid Stimulating Hormone (TSH) concentration was evaluated as a marker of thyroid function. Spearman correlational and regression analysis were performed to analyze the associations between iodine intake and iodine status, and iodine status and thyroid function. Results: 50.4% of participants had a 24 h UIC < 100 µg/L). Dairy (r = 0.391, p < 0.000) and egg intake (r = 0.192, p = 0.044) were the best predictors of UIC, accounting for 19.7% of the variance (p ≤ 0.0001). There was a significant correlation between UIC and serum TSH (r = 0.194, p < 0.05) but TSH did not vary by iodine status category (F = 1.087, p = 0.372). Discussion: Total dairy and egg intake were the primary predictors of estimated iodine intake, as well as UIC. Iodized salt use was not a significant predictor, raising questions about the reliability of iodized salt recall. These data will be useful in directing public health and clinical assessment efforts in the US and other countries.

Systemic endocrinopathies (thyroid conditions and diabetes): impact on postnatal life of the offspring

Fetal programming may influence childhood and adult life, determining the risk of specific diseases. During earlier stages of pregnancy, the transfer of maternal thyroid hormones to the fetus is vital for adequate neurologic development. The presence of severe maternal thyroid dysfunction, particularly severe iodine deficiency, is devastating, leading to irreversible neurologic sequelae. Moreover, mild maternal thyroid conditions, such as a mild-to-moderate iodine deficiency, may also lead to milder neurologic and behavioral conditions later during the life of the offspring. Maternal dysglycemia due to pregestational or gestational diabetes mellitus is another common situation in which fetal development encounters a hostile environment. Hyperglycemia in utero may trigger metabolic conditions in the offspring, including abnormalities of glucose tolerance and weight excess. Physicians assisting pregnant women have to be aware about these conditions, because they may go unnoticed if not properly screened. Because an early diagnosis and appropriate management may prevent most of the possible negative consequences for the progeny, the prevention, early diagnosis, and proper management of these endocrine conditions should be offered to all women undergoing pregnancy. Here, we comprehensively review the current evidence about the effects of maternal thyroid dysfunction and maternal dysglycemia on the cognitive function and carbohydrate metabolism in the offspring, two prevalent conditions of utmost importance for the child's health and development.

Nutritional status of iodine in children: When appropriateness relies on milk consumption and not adequate coverage of iodized salt in households

BACKGROUND & AIMS

Iodine deficiency inhibits the normal development of human beings and is the leading cause of preventable mental retardation. Our study aims to update the urinary iodine concentrations and the intake of iodized salt in children in Madrid (Spain).

METHODS

A cross-sectional study was designed where 217 children aged 3-14 years old were studied. A nutritional survey including the intake of iodized salt and other iodine-rich foods was performed. In addition, the urinary concentration of iodine was determined in each patient.

RESULTS

Near 60% of the surveyed households routinely used iodized salt. Significant differences in age, sex, country of birth, or country of birth and parents educational levels and iodized salt consumption were not found. The median of the urinary iodine level (120 μg/L; interquartile range 80-184) was significantly higher in boys than girls and more elevated in younger children. Iodized salt and milk consumption significantly increased the concentration of urinary iodine. Children who drank less than two glasses of milk per day and did not consume iodized salt have four times the risk of iodine deficiency compared to children who daily drank at least two glasses of milk and consumed iodized salt (P < 0.001).

CONCLUSIONS

The nutritional level of iodine in the children studied is appropriate despite the low consumption of iodized salt. This is due to the consumption of dairy products and milk. The younger the child, the better his/her iodine nutritional level. Teenagers studied are at higher risk of iodine deficiency.

A Review of Iodine Status of Women of Reproductive Age in the USA

Iodine, an essential micronutrient, is required to produce thyroid hormones. Iodine deficiency disorders (IDD) comprise a range of adverse maternal and fetal outcomes, with the most significant irreversible effect resulting from neurodevelopmental deficits in fetal brain caused by deficient iodine status during early pregnancy. The objective of this scoping review was to summarize the studies that assessed iodine status of women of reproductive age in the USA. A systematic review of literature using the PRISMA Extension for Scoping Reviews (PRISMA-ScR) statement was conducted. PubMed, Medline, CINAHL, EMBASE, EBSCOHost, Cochrane, ERIC, Google Scholar, and Web of Science databases were searched, 1652 records were identified. One thousand six hundred forty-one records that did not satisfy the inclusion/exclusion criteria and quality review were excluded, and 11 peer-reviewed articles were determined to be eligible for this scoping review. Despite the USA being considered iodine sufficient for the general population, the US dietary iodine intakes have decreased drastically since the 1970s, with iodine deficiency reemerging in vulnerable groups such as women of reproductive age. Although data to conduct a scoping review of iodine status among women of reproductive age in the USA was scarce, majority of the articles reviewed demonstrate emergent iodine deficiency in this population of women of reproductive age, indicating alarm for a public health concern needing immediate attention.

Nutraceuticals' Novel Formulations: The Good, the Bad, the Unknown and Patents Involved

Traditional nutraceuticals and cosmeceuticals hold pragmatic nature with respect to their definitions, claims, purposes and marketing strategies. Their definitions are not well established worldwide. They also have different regulatory definitions and registration regulatory processes in different parts of the world. Global prevalence of nutraceuticals and cosmeceuticals is noticeably high with large market share with minimal regulation compared to traditional drugs. The global market is flooded with nutraceuticals and cosmeceuticals claiming to be of natural origin and sold with a therapeutic claim by major online retail stores such as Amazon and eBay. Apart from the traditional formulations, many manufacturers and researchers use novel formulation technologies in nutraceutical and cosmeceutical formulations for different reasons and objectives. Manufacturers tend to differentiate their products with novel formulations to increase market appeal and sales. On the other hand, researchers use novel strategies to enhance nutraceuticals and cosmeceuticals activity and safety. The objective of this review is to assess the current patents and research adopting novel formulation strategies in nutraceuticals and cosmeceuticals. Patents and research papers investigating nutraceutical and cosmeceutical novel formulations were surveyed for the past 15 years. Various nanosystems and advanced biotechnology systems have been introduced to improve the therapeutic efficacy, safety and market appeal of nutraceuticals and cosmeceuticals, including liposomes, polymeric micelles, quantum dots, nanoparticles, and dendrimers. This review provides an overview of nutraceuticals and cosmeceuticals current technologies, highlighting their pros, cons, misconceptions, regulatory definitions and market. This review also aims in separating the science from fiction in the nutraceuticals and cosmeceuticals development, research and marketing.

Iodine status of children and knowledge, attitude, practice of iodised salt use in a remote community in Kerema district, Gulf province, Papua New Guinea

Iodine deficiency is the single most common cause of preventable mental impairment in communities with suboptimal iodine intake. Objective of the present study was to assess in more detail the iodine status and knowledge, attitudes and practice (KAP) relating to use of iodised salt in a remote community in Kotidanga area, Kerema district, Gulf province, Papua New Guinea. This prospective school and community based cross-sectional study was carried out in 2017. Simple random sampling was used to select schools. Multistage sampling was used to randomly select 300 children aged 6 to 12 years, of which 289 consented to participate in the study. A single urine sample was collected from each of the consenting children, as well as a salt sample from their households. Discretionary salt intake was assessed in a sub-sample of the children's households. Salt iodine content and urinary iodine concentration (UIC) were analysed. A semi-structured modified Food and Agriculture Organisation questionnaire was used to assess KAP of three different community groups. Only 64% of households had salt on the day of data collection. Mean iodine content in household salt samples was 29.0 ± 19.1 ppm. Iodine content was below 30.0 ppm in 54.8% and below 15.0 ppm in 31.2% of salt samples. Mean per capita discretionary intake of household salt was 2.9 ± 1.8 g/day. Median UIC was 25.5 μg/L and Interquartile Range was 15.0 to 47.5 μg/L, indicating moderate status iodine nutrition. Median UIC was 34.3 μg/L for children in households with salt, compared to 15.5 μg/L for children in households without salt, indicating severe iodine deficiency in the latter group. The three community groups had limited knowledge about importance of using iodised salt and consequences of iodine deficiency on health outcomes. This remote community has limited access to adequately iodised household salt due to high cost, inappropriate packaging, storage and food preparation, resulting in iodine deficiency. Strategies to increase iodine intake are needed.

Iodine consumption and cognitive performance: Confirmation of adequate consumption

Iodine, a dynamic nutrient present in thyroid hormones, is responsible for regulating thyroid function, supporting a healthy metabolism, and aiding growth and development. Iodine is also essential for brain development during specific time windows influencing neurogenesis, neuronal and glial cell differentiation, myelination, neuronal migration, and synaptogenesis. About 1.5 billion people in 130 countries live in areas at risk of iron deficiencies (IDs). Reduced mental ability due to IDs occurs in almost 300 million people. Ensuring the consumption of minimum recommended daily allowances of iodine remains challenging. The effects of ID disorders range from high mortality of fetuses and children to inhibited mental development (cretinism). Poor socioeconomic development and impaired school performance are also notable. Currently, ID disorders are the single greatest contributor to preventable brain damage in fetuses and infants and arrested psychomotor development in children. Iodized salt may help fulfill iodine requirements. Increases in food salt iodization programs can help overcome ID disorders. Dietary plans can be well adjusted to incorporate iodinated foods. Maternal iodine supplementation for offspring requires adequate attention. Fruits, vegetables, bread, eggs, legumes (beans and peas), nuts, seeds, seafood, lean meats and poultry, and soy products provide small quantities of iodine. Nutrient-dense foods containing essential vitamins and minerals such as iodine may confer positive effects. To some extent, fortified foods and daily dietary supplements can be provided for different nutrients including iodine; otherwise, iodine may be consumed in less than the recommended amounts. This review focuses on aspects of adequate iodine consumption to avoid cognitive impairments.

Tracing the sources of iodine species in a non-saline wastewater

There are two types of wastewater in Hong Kong, non-saline and saline wastewaters. When it comes to disinfection, iodide is an important inorganic ion in concern because it may involve in the formation of iodinated disinfection byproducts, which show significantly higher toxicity than their brominated and chlorinated analogues. In this study, it was found that a non-saline wastewater in Hong Kong contained an unexpected high level of iodine. To trace the iodine sources of this non-saline wastewater, the information of the corresponding area was collected to find the possible iodine sources; then, the water samples from the possible iodine sources were collected; the concentrations of iodine species (iodide, iodate and organic iodine) in these collected water samples were determined; finally, the contribution percentages of iodine species from different sources were calculated. The results revealed that a specific domestic wastewater was the major iodine source, contributing to 68.6% of total iodine, 66.3% of iodide, 57.0% of iodate, and 112% of organic iodine in the non-saline wastewater, while landfill leachate, industrial and hospital wastewaters were the minor iodine sources, contributing to 6.6%, 3.1%, and 3.0% of total iodine in the non-saline wastewater, respectively. Furthermore, it was found that the extensive use of salt might result in high levels of iodine in the domestic wastewater and thus lead to the high level of iodine in the non-saline wastewater.

Iodine Status and Consumption of Key Iodine Sources in the U.S. Population with Special Attention to Reproductive Age Women

We estimated iodine status (median urinary iodine concentration (mUIC (µg/L))) for the US population (6 years and over; n = 4613) and women of reproductive age (WRA) (15⁻44 years; n = 901). We estimated mean intake of key iodine sources by race and Hispanic origin. We present the first national estimates of mUIC for non-Hispanic Asian persons and examine the intake of soy products, a potential source of goitrogens. One-third of National Health and Nutrition Examination Survey (NHANES) participants in 2011⁻2014 provided casual urine samples; UIC was measured in these samples. We assessed dietary intake with one 24-h recall and created food groups using the USDA’s food/beverage coding scheme. For WRA, mUIC was 110 µg/L. For both non-Hispanic white (106 µg/L) and non-Hispanic Asian (81 µg/L) WRA mUIC was significantly lower than mUIC among Hispanic WRA (133 µg/L). Non-Hispanic black WRA had a mUIC of 124 µg/L. Dairy consumption was significantly higher among non-Hispanic white (162 g) compared to non-Hispanic black WRA (113 g). Soy consumption was also higher among non-Hispanic Asian WRA (18 g compared to non-Hispanic black WRA (1 g). Differences in the consumption pattern of key sources of iodine and goitrogens may put subgroups of individuals at risk of mild iodine deficiency. Continued monitoring of iodine status and variations in consumption patterns is needed.

Global epidemiology of hyperthyroidism and hypothyroidism

Thyroid hormones are essential for growth, neuronal development, reproduction and regulation of energy metabolism. Hypothyroidism and hyperthyroidism are common conditions with potentially devastating health consequences that affect all populations worldwide. Iodine nutrition is a key determinant of thyroid disease risk; however, other factors, such as ageing, smoking status, genetic susceptibility, ethnicity, endocrine disruptors and the advent of novel therapeutics, including immune checkpoint inhibitors, also influence thyroid disease epidemiology. In the developed world, the prevalence of undiagnosed thyroid disease is likely falling owing to widespread thyroid function testing and relatively low thresholds for treatment initiation. However, continued vigilance against iodine deficiency remains essential in developed countries, particularly in Europe. In this report, we review the global incidence and prevalence of hyperthyroidism and hypothyroidism, highlighting geographical differences and the effect of environmental factors, such as iodine supplementation, on these data. We also highlight the pressing need for detailed epidemiological surveys of thyroid dysfunction and iodine status in developing countries.

Use of Iodine-Containing Dietary Supplements Remains Low among Women of Reproductive Age in the United States: NHANES 2011-2014

In the United States, the American Thyroid Association recommends that women take a dietary supplement containing 150 &micro;g of iodine 3 months prior to conception and while pregnant and lactating to support fetal growth and neurological development. We used data from the National Health and Nutrition Examination Survey 2011&ndash;2014 to describe the use of dietary supplements with and without iodine in the past 30 days among 2155 non-pregnant, non-lactating (NPNL) women; 122 pregnant women; and 61 lactating women. Among NPNL women, 45.3% (95% Confidence Interval [CI]: 42.0, 48.6) used any dietary supplement and 14.8% (95% CI: 12.7, 16.8) used a dietary supplement with iodine in the past 30 days. Non-Hispanic black and Hispanic women were less likely to use any dietary supplement as well as one with iodine, than non-Hispanic white or non-Hispanic Asian women (p < 0.05). Among pregnant women, 72.2% (95% CI: 65.8, 78.6) used any dietary supplement; however, only 17.8% (95% CI: 11.4, 24.3) used a dietary supplement with iodine. Among lactating women, 75.0% (95% CI: 63.0, 87.0) used a dietary supplement; however, only 19.0% (95% CI: 8.8, 29.2) used a dietary supplement with iodine. Among NPNL women using a supplement with iodine, median daily iodine intake was 75.0 &micro;g. Self-reported data suggests that the use of iodine containing dietary supplements among pregnant and lactating women remains low in contrast with current recommendations.

Development of Databases on Iodine in Foods and Dietary Supplements

Iodine is an essential micronutrient required for normal growth and neurodevelopment; thus, an adequate intake of iodine is particularly important for pregnant and lactating women, and throughout childhood. Low levels of iodine in the soil and groundwater are common in many parts of the world, often leading to diets that are low in iodine. Widespread salt iodization has eradicated severe iodine deficiency, but mild-to-moderate deficiency is still prevalent even in many developed countries. To understand patterns of iodine intake and to develop strategies for improving intake, it is important to characterize all sources of dietary iodine, and national databases on the iodine content of major dietary contributors (including foods, beverages, water, salts, and supplements) provide a key information resource. This paper discusses the importance of well-constructed databases on the iodine content of foods, beverages, and dietary supplements; the availability of iodine databases worldwide; and factors related to variability in iodine content that should be considered when developing such databases. We also describe current efforts in iodine database development in the United States, the use of iodine composition data to develop food fortification policies in New Zealand, and how iodine content databases might be used when considering the iodine intake and status of individuals and populations.

Assessment of iodine importance and needs for supplementation in school-aged children in Portugal

BACKGROUND

Micronutrients are essential for child proper growth and development. Nutritional deficiencies of these elements have increasingly been a concern in Europe, as they are often related to the cognitive potential and physical lifelong consequences. However, being an essential trace element for thyroid function, iodine intake in the desired quantities becomes also very important for neurodevelopment, including for school-aged children. Therefore, the aim of this paper is to highlight the need for wider dissemination of the physiological importance of iodine among health professionals and the general population as well as the knowledge of iodine needs and possible supplementation within families with school-aged children.

METHODS

The present study is an observational, descriptive, cross-sectional evaluation of knowledge and perceptions of iodine physiological importance. An evaluation survey has been carried out based on knowledge of iodine needs and possible supplementation within families with school-aged children. It has been target at mothers with school-age children under 18 years old with residence in Portugal. Data are represented as frequency and percentages and association between variables was measured.

RESULTS

The internet survey has been answered by around 691 mothers, corresponding to 811 children data validated; 47% (n = 381) girls and 53% (n = 430) boys. Mother's knowledge about iodine and the importance for the improvement of learning capacity is not independent of having health study/work area (χ2 at the 0.05 level). Nevertheless, it can be observed a slight association between mothers who agree with iodine supplementation and those who effectively supplement their child (χ2 9.315; Φ 0.116). Although use of iodized kitchen salt certainly changes the balance from sub-optimal to adequate iodine nutrition, only 8.8% (n = 61) reported using iodized salt. However, 87.6% (n = 605) assumed salt iodization importance without information.

CONCLUSIONS

We believe that the findings of this survey have great public health importance for Portugal. While many countries have mandatory iodizes salt programmes, in Portugal iodine supplementation is not a current practice. Therefore, we suggest an urgent evaluation of iodine in Portugal, namely for school-aged children, where iodine deficiencies are critical, as well as a systematic information dissemination as a form of publicizing iodine supplementation needs.

Role of medical resource level in iodine deficiency disorder

BACKGROUND

Iodine deficiency disorders (IDDs) refer to a series of diseases caused by the human body's insufficient iodine intake. Edible salt became iodized in China in 1996, which yielded remarkable results. We have known that IDDs is associated with iodine in the human body, but it is not clear whether IDDs is related to medical resource level.

METHODS

We collected the number of IDDs cases and an index for the level of medical resource from 31 provinces, autonomous regions and municipalities directly under the central government in China. All data came from the China Statistical Yearbook of Health and Family Planning issued in 2013 by the Peking Union Medical College Publishing House. Data standardization and linear regression analysis were used.

RESULTS

The results showed that IDDs correlated with the number of beds in medical and health institutions, number of medical health personnel, number of medical and health institutions, total health expenditure, average health expenditure per capita, medical insurance for urban resident and new rural cooperative medical rural residents (P < 0.01). In a multiple linear regression, IDDs was most significantly associated with the number of beds in hospitals, the number of rural health personnel, the number of basic medical and health institutions and government health expenditure for these institutions.

CONCLUSION

Based on the experimental data, we concluded that IDDs had a positive connection with the medical resource level, and basic and rural areas had a more significant association with IDDs. This analysis provides new and explicit ideas for iodine prevention and control work in China.

Research needs for assessing iodine intake, iodine status, and the effects of maternal iodine supplementation

The Office of Dietary Supplements of the NIH convened 3 workshops on iodine nutrition in Rockville, Maryland, in 2014. The purpose of the current article is to summarize and briefly discuss a list of research and resource needs developed with the input of workshop participants. This list is composed of the basic, clinical, translational, and population studies required for characterizing the benefits and risks of iodine supplementation, along with related data, analyses, evaluations, methods development, and supporting activities. Ancillary studies designed to use the participant, biological sample, and data resources of ongoing and completed studies (including those not originally concerned with iodine) may provide an efficient, cost-effective means to address some of these research and resource needs. In the United States, the foremost question is whether neurobehavioral development in the offspring of mildly to moderately iodine-deficient women is improved by maternal iodine supplementation during pregnancy. It is important to identify the benefits and risks of iodine supplementation in all population subgroups so that supplementation can be targeted, if necessary, to avoid increasing the risk of thyroid dysfunction and related adverse health effects in those with high iodine intakes. Ultimately, there will be a need for well-designed trials and other studies to assess the impact of maternal supplementation on neurodevelopmental outcomes in the offspring. However, 2 basic information gaps loom ahead of such a study: the development of robust, valid, and convenient biomarkers of individual iodine status and the identification of infant and toddler neurobehavioral development endpoints that are sensitive to mild maternal iodine deficiency during pregnancy and its reversal by supplementation.

Iodine in food- and dietary supplement-composition databases

The US Food and Drug Administration (FDA) and the Nutrient Data Laboratory (NDL) of the USDA Agricultural Research Service have worked independently on determining the iodine content of foods and dietary supplements and are now harmonizing their efforts. The objective of the current article is to describe the harmonization plan and the results of initial iodine analyses accomplished under that plan. For many years, the FDA's Total Diet Study (TDS) has measured iodine concentrations in selected foods collected in 4 regions of the country each year. For more than a decade, the NDL has collected and analyzed foods as part of the National Food and Nutrient Analysis Program; iodine analysis is now being added to the program. The NDL recently qualified a commercial laboratory to conduct iodine analysis of foods by an inductively coupled plasma mass spectrometry (ICP-MS) method. Co-analysis of a set of samples by the commercial laboratory using the ICP-MS method and by the FDA laboratory using its standard colorimetric method yielded comparable results. The FDA recently reviewed historical TDS data for trends in the iodine content of selected foods, and the NDL analyzed samples of a limited subset of those foods for iodine. The FDA and the NDL are working to combine their data on iodine in foods and to produce an online database that can be used for estimating iodine intake from foods in the US population. In addition, the NDL continues to analyze dietary supplements for iodine and, in collaboration with the NIH Office of Dietary Supplements, to publish the data online in the Dietary Supplement Ingredient Database. The goal is to provide, through these 2 harmonized databases and the continuing TDS focus on iodine, improved tools for estimating iodine intake in population studies.

Comparison of 2 methods for estimating the prevalences of inadequate and excessive iodine intakes

BACKGROUND

Prevalences of iodine inadequacy and excess are usually evaluated by comparing the population distribution of urinary iodine concentration (UIC) in spot samples with established UIC cutoffs. To our knowledge, until now, dietary intake data have not been assessed for this purpose.

OBJECTIVE

Our objective was to compare 2 methods for evaluating the prevalence of iodine inadequacy and excess in sex- and life stage-specific subgroups of the US population: one that uses UIC cutoffs, and one that uses iodine intake cutoffs.

DESIGN

By using the iodine concentrations of foods measured in the US Food and Drug Administration's Total Diet Study (TDS), dietary intake data from the NHANES 2003-2010, and a file that maps each NHANES food to a TDS food with similar ingredients, we estimated each NHANES participant's iodine intake from each NHANES food as the mean iodine concentration of the corresponding TDS food in samples gathered over the same 2-y period. We calculated prevalences of iodine inadequacy and excess in each sex- and life stage-specific subgroup by both the UIC cutoff method and the iodine intake cutoff method-using the UIC values and dietary intakes reported for NHANES participants who provided both types of data-and compared the prevalences across methods.

RESULTS

We found lower prevalences of iodine inadequacy across all sex- and life stage-specific subgroups with the iodine intake cutoff method than with the UIC cutoff method; for pregnant females, the respective prevalences were 5.0% and 37.9%. For children aged ≤8 y, the prevalence of excessive iodine intake was high by either method.

CONCLUSIONS

The consideration of dietary iodine intake from all sources may provide a more complete understanding of population prevalences of iodine inadequacy and excess and thus better inform dietary guidance than consideration of UIC alone. Methods of adjusting UIC for within-person variation are needed to improve the accuracy of prevalence assessments based on UIC.

In Vivo Evaluation of Transdermal Iodide Microemulsion for Treating Iodine Deficiency Using Sprague Dawley Rats

The objective of this study was to evaluate the transdermal efficiency of iodide microemulsion in treating iodine deficiency using rats as an animal model. Animals were fed either iodine-deficient diet (20 μg/kg iodide) or control diet (200 μg/kg iodide) over a 17-month period. At month 14, iodide microemulsion was applied topically in iodine-deficient group and physiological evaluations of thyroid gland functions were characterized by monitoring the thyroid hormones (T3, T4), thyroid-stimulating hormone (TSH), iodide ion excretion in urine, and the overall rat body weights in both groups. Moreover, morphological evaluations of thyroid gland before and after treatment were performed by ultrasound imaging and through histological assessment. Prior to microemulsion treatment, the levels of T3, T4, and TSH in iodine-deficient group were statistically significant as compared to that in the control group. The levels of T3 and T4 increased while TSH level decreased significantly in iodine-deficient group within the first 4 weeks of treatment. After treatment, iodide concentration in urine increased significantly. There was no statistical difference in weight between the two groups. Ultrasound imaging and histological evaluations showed evidence of hyperplasia in iodine-deficient group. Topical iodide microemulsion has shown a promising potential as a novel delivery system to treat iodine deficiency.

Food Group Intakes as Determinants of Iodine Status among US Adult Population

Adequate intake of iodine is essential for proper thyroid function. Although dietary reference intakes for iodine have been established, iodine intake cannot be estimated due to the lack of data on iodine contents in foods. We aimed to determine if food group intakes can predict iodine status assessed by urinary iodine concentration (UIC) from spot urine samples of 5967 US adults in the National Health and Nutrition Examination Survey (NHANES) 2007–2012. From an in-person 24-h dietary recall, all foods consumed were aggregated into 12 main food groups using the individual food code of the US Department of Agriculture (USDA); dairy products, meat/poultry, fish/seaweed, eggs, legumes/nuts/seeds, breads, other grain products, fruits, vegetables, fats/oils, sugars/sweets, and beverages. Chi-square test, Spearman correlation, and multiple linear regression analyses were conducted to investigate the predictability of food group intakes in iodine status assessed by UIC. From the multiple linear regressions, the consumption of dairy products, eggs, and breads, and iodine-containing supplement use were positively associated with UIC, whereas beverage consumption was negatively associated with UIC. Among various food group intakes, dairy product intake was the most important determinant of iodine status in both US men and women. Subpopulation groups with a high risk of iodine deficiency may need nutritional education regarding the consumption of dairy products, eggs, and breads to maintain an adequate iodine status. Efforts toward a better understanding of iodine content in each food and a continued monitoring of iodine status within US adults are both warranted.

Changes in iodine status among US adults, 2001-2012

Urinary iodine concentrations (UICs) in the US have been reported to be stable since 1988-1994, although those in selected subgroups remained low. We aimed to investigate iodine status among adults (≥20 years) by two different criteria of assessing iodine deficiency in population. Utilizing National Health and Nutrition Examination Surveys 2001-2012, we conducted linear logistic regressions adjusting for covariates. The prevalence of <50 μg/L UIC was higher in women than in men; increased from 11.6% (2001-2004) to 13.2% (2009-2012) at the national level and in young adults, non-Hispanic blacks (NHBs) and non-users of iodine-containing supplements (all, p <0.05); the adjusted odds ratios (95%CI) in young adults (1.54 [1.11-2.15], p = 0.0007) and NHBs (1.70 [1.15-2.52], p = 0.0078). Median UICs confirm women and NHBs being in borderline iodine status. Recognizing the critical consequence of iodine deficiency particularly in women and NHBs, regular monitoring of iodine status is important for public health in the US.

Identification, toxicity and control of iodinated disinfection byproducts in cooking with simulated chlor(am)inated tap water and iodized table salt

Chlorine/chloramine residuals are maintained in drinking water distribution systems to prevent microbial contamination and microorganism regrowth. During household cooking processes (e.g., soup making), the residual chlorine/chloramines in tap water may react with the iodide in iodized table salt to form hypoiodous acid, which could react with remaining natural organic matter in tap water and organic matter in food to generate iodinated disinfection byproducts (I-DBPs). However, I-DBPs formed during cooking with chloraminated/chlorinated tap water are almost completely new to researchers. In this work, by adopting precursor ion scan of m/z 127 using ultra performance liquid chromatography/electrospray ionization-triple quadrupole mass spectrometry, many new polar I-DBPs formed during cooking with chloraminated/chlorinated tap water were detected and proposed with structures, of which 3-iodo-4-hydroxybenzaldehyde, 3-iodo-4-hydroxybenzoic acid, 3-iodo-4-hydroxy-5-methylbenzoic acid, diiodoacetic acid, 3,5-diiodo-4-hydroxybenzaldehyde, 3,5-diiodo-4-hydroxybenzoic acid, 2,6-diiodo-4-nitrophenol, 2,4-diiodo-6-nitrophenol, and 2,4,6-triiodophenol were confirmed with standard compounds. With the aid of ultra fast liquid chromatography/ion trap-time of flight-mass spectrometry, molecular formula identification of five new I-DBPs (C8H5O4I, C7H4NO4I, C8H5O5I, C7H4NO5I, and C8H6O3I2) was achieved. A developmental toxicity with a recently developed sensitive bioassay was conducted for the newly identified I-DBPs, suggesting that phenolic I-DBPs (except for iodinated carboxyphenols) were about 50-200 times more developmentally toxic than aliphatic I-DBPs. The major I-DBPs in a baseline simulated cooking water sample were determined to be from 0.72 to 7.63 μg/L. Polar I-DBPs formed under various disinfection and cooking conditions were compared, and suggestions for controlling their formation were provided.

Specific anion effects in Artemia salina

The specific anion effect on the vitality of Artemia salina was investigated by measuring the Lethal Time LT50 of the crustaceans in the presence of different sodium salts solutions at room temperature and at the same ionic strength as natural seawater. Fluoride, thiocyanate and perchlorate are the most toxic agents, while chloride, bromide and sulfate are well tolerated. The rates of oxygen consumption of brine shrimps were recorded in mixed NaCl+NaF or NaCl+NaSCN solutions as a function of time. The results are discussed in terms of the Hofmeister series, and suggest that, besides the biochemical processes that involve F(-), SCN(-) and ClO4(-), the different physico-chemical properties of the strong kosmotropic and chaotropic anions may contribute in determining their strong toxicity for A. salina.

Iodized salt in Cambodia: trends from 2008 to 2014

Though the consequences of nutritional iodine deficiency have been known for a long time, in Cambodia its elimination has only become a priority in the last 18 years. The Royal Government of Cambodia initiated the National Sub-Committee for Control of Iodine Deficiency Disorders in 1996 to fight this problem. Using three different surveys providing information across all provinces, we examined the compliance of salt iodization in Cambodia over the last 6 years. Salt samples from the 24 provinces were collect at the household level in 2008 (n = 566) and 2011 (n = 1275) and at the market level in 2014 (n = 1862) and analysed through a wavelength spectrophotometer for iodine content. According to the samples collected, the median iodine content significantly dropped from 22 mg/kg (25th/75th percentile: 2/37 mg/kg) in 2011 to 0 mg/kg in 2014 (25th/75th percentile: 0/8.9 mg/kg) (p < 0.001). The proportion of non-iodized salt within our collected salt drastically increased from 22% in 2011 to 62% in 2014 (p < 0.001). Since the international organizations ceased to support the procurement of iodine, the prevalence of salt compliant with the Cambodian declined within our samples. To date, the current levels of iodine added to tested salt are unsatisfactory as 92% of those salts do not meet the government requirements (99.6% of the coarse salt and 82.4% of the fine salt). This inappropriate iodization could illustrate the lack of periodic monitoring and enforcement from government entities. Therefore, government quality inspection should be reinforced to reduce the quantity of salt not meeting the national requirement.

Iodized salt sales in the United States

Iodized salt has been an important source of dietary iodine, a trace element important for regulating human growth, development, and metabolic functions. This analysis identified iodized table salt sales as a percentage of retail salt sales using Nielsen ScanTrack. We identified 1117 salt products, including 701 salt blends and 416 other salt products, 57 of which were iodized. When weighted by sales volume in ounces or per item, 53% contained iodized salt. These findings may provide a baseline for future monitoring of sales of iodized salt.

Managing terrorism or accidental nuclear errors, preparing for iodine-131 emergencies: a comprehensive review

Chernobyl demonstrated that iodine-131 (131I) released in a nuclear accident can cause malignant thyroid nodules to develop in children within a 300 mile radius of the incident. Timely potassium iodide (KI) administration can prevent the development of thyroid cancer and the American Thyroid Association (ATA) and a number of United States governmental agencies recommend KI prophylaxis. Current pre-distribution of KI by the United States government and other governments with nuclear reactors is probably ineffective. Thus we undertook a thorough scientific review, regarding emergency response to 131I exposures. We propose: (1) pre-distribution of KI to at risk populations; (2) prompt administration, within 2 hours of the incident; (3) utilization of a lowest effective KI dose; (4) distribution extension to at least 300 miles from the epicenter of a potential nuclear incident; (5) education of the public about dietary iodide sources; (6) continued post-hoc analysis of the long-term impact of nuclear accidents; and (7) support for global iodine sufficiency programs. Approximately two billion people are at risk for iodine deficiency disorder (IDD), the world's leading cause of preventable brain damage. Iodide deficient individuals are at greater risk of developing thyroid cancer after 131I exposure. There are virtually no studies of KI prophylaxis in infants, children and adolescents, our target population. Because of their sensitivity to these side effects, we have suggested that we should extrapolate from the lowest effective adult dose, 15-30 mg or 1-2 mg per 10 pounds for children. We encourage global health agencies (private and governmental) to consider these critical recommendations.

Consequences of excess iodine

Iodine is a micronutrient that is essential for the production of thyroid hormones. The primary source of iodine is the diet via consumption of foods that have been fortified with iodine, including salt, dairy products and bread, or that are naturally abundant in the micronutrient, such as seafood. Recommended daily iodine intake is 150 µg in adults who are not pregnant or lactating. Ingestion of iodine or exposure above this threshold is generally well-tolerated. However, in certain susceptible individuals, including those with pre-existing thyroid disease, the elderly, fetuses and neonates, or patients with other risk factors, the risk of developing iodine-induced thyroid dysfunction might be increased. Hypothyroidism or hyperthyroidism as a result of supraphysiologic iodine exposure might be either subclinical or overt, and the source of the excess iodine might not be readily apparent.