1
|
Nicol K, Nugent AP, Woodside JV, Hart KH, Bath SC. The impact of replacing milk with plant-based alternatives on iodine intake: a dietary modelling study. Eur J Nutr 2024; 63:599-611. [PMID: 38212424 PMCID: PMC10899362 DOI: 10.1007/s00394-023-03286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/23/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE Cow's milk is the primary source of iodine in the UK, but consumption of plant-based milk alternatives (PBMA) is increasing and these products are often not fortified with iodine. We evaluated the impact that replacing current milk consumption with PBMA would have on iodine intake. METHODS We used data from the National Diet and Nutrition Survey (2016-2019) for children (1.5-10 years), girls 11-18 years, and women of reproductive age (WRA). We used a dietary modelling approach with scenarios using brand-level iodine-fortification data (0, 13, 22.5, 27.4 and 45 µg/100 mL). Relative to usual diet, we calculated change in iodine intake, and the proportion with intake below the Lower Reference Nutrient Intake (LRNI) or above the upper limit. RESULTS For all groups, replacement with PBMA, either unfortified or fortified at the lowest concentration, resulted in a meaningful decrease in iodine intake, and increased the proportion with intake < LRNI; compared to usual diet, iodine intake reduced by 58% in children 1.5-3 years (127 vs. 53 µg/day) and the proportion with intake < LRNI increased in girls (11-18 years; 20% to 48%) and WRA (13% to 33%) if an unfortified PBMA was used. Replacement of milk with PBMA fortified at 27.4 µg/100 mL had the lowest impact. CONCLUSION Replacing milk with commercially available PBMAs has potential to reduce population iodine intake, depending on the fortification level. PBMAs fortified with ≥ 22.5 and < 45 µg iodine/100 mL would be required to minimize the impact on iodine intake. Research is needed on the impact of total dairy replacement.
Collapse
Affiliation(s)
- Katie Nicol
- Department of Nutrition, Food and Exercise Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Anne P Nugent
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, UK
| | - Jayne V Woodside
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, UK
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - Kathryn H Hart
- Department of Nutrition, Food and Exercise Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Sarah C Bath
- Department of Nutrition, Food and Exercise Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.
| |
Collapse
|
2
|
Huang CJ, Li JZ, Hwu CM, Chen HS, Wang FF, Yeh CC, Yang CC. Iodine Concentration in the Breast Milk and Urine as Biomarkers of Iodine Nutritional Status of Lactating Women and Breastfed Infants in Taiwan. Nutrients 2023; 15:4125. [PMID: 37836409 PMCID: PMC10574722 DOI: 10.3390/nu15194125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Breast milk iodine concentration (BMIC) can be different when median urinary iodine concentration (UIC) is similar. The BMIC, UIC/creatinine (Cr), estimated 24-h urinary iodine excretion (24-h UIE) of lactating women in Taiwan is unknown. This study enrolled lactating women from Taipei Veterans General Hospital (August 2021-February 2023). Each participant provided a random spot urine sample, two breast milk samples, a blood sample, and completed a food frequency questionnaire on the same day. Iodine measurement was performed by inductively coupled plasma mass spectrometry. The median UIC of the enrolled 71 women was 91.1 μg/L, indicating insufficient iodine status; however, the median BMIC was 166.6 μg/L and this suggested that the amount of iodine delivered through breast milk was adequate for the breastfed infants. BMIC was correlated with UIC/Cr and 24-h UIE (both rs = 0.49) but not with UIC (rs = 0.18) or thyroid stimulating hormone (rs = 0.07). Women who did not consume dairy products (adjusted odds ratio: 24.41, 95% confidence interval: 1.26-471.2) and multivitamins (adjusted odds ratio: 8.26, 95% confidence interval: 1.76-38.79) were at increased odds for having lower BMIC. The results suggest that measuring maternal UIC alone may not be sufficient, as BMIC, UIC/Cr, and 24-h UIE are all important biomarkers. Ingestion of dairy products and multivitamins were independently associated with BMIC.
Collapse
Affiliation(s)
- Chun-Jui Huang
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-J.H.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Jia-Zhen Li
- Institute of Food Safety and Health Risk Assessment, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chii-Min Hwu
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-J.H.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Harn-Shen Chen
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-J.H.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Fan-Fen Wang
- Department of Medicine, Yangming Branch, Taipei City Hospital, Taipei 11146, Taiwan
| | - Chang-Ching Yeh
- Department of Obstetrics & Gynecology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Obstetrics & Gynecology, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Nurse-Midwifery and Women Health, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
| | - Chen-Chang Yang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Environmental & Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| |
Collapse
|
3
|
Grossklaus R, Liesenkötter KP, Doubek K, Völzke H, Gaertner R. Iodine Deficiency, Maternal Hypothyroxinemia and Endocrine Disrupters Affecting Fetal Brain Development: A Scoping Review. Nutrients 2023; 15:nu15102249. [PMID: 37242131 DOI: 10.3390/nu15102249] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
This scoping review critically discusses the publications of the last 30 years on the impact of mild to moderate iodine deficiency and the additional impact of endocrine disrupters during pregnancy on embryonal/fetal brain development. An asymptomatic mild to moderate iodine deficiency and/or isolated maternal hypothyroxinemia might affect the development of the embryonal/fetal brain. There is sufficient evidence underlining the importance of an adequate iodine supply for all women of childbearing age in order to prevent negative mental and social consequences for their children. An additional threat to the thyroid hormone system is the ubiquitous exposure to endocrine disrupters, which might exacerbate the effects of iodine deficiency in pregnant women on the neurocognitive development of their offspring. Ensuring adequate iodine intake is therefore essential not only for healthy fetal and neonatal development in general, but it might also extenuate the effects of endocrine disruptors. Individual iodine supplementation of women of childbearing age living in areas with mild to moderate iodine deficiency is mandatory as long as worldwide universal salt iodization does not guarantee an adequate iodine supply. There is an urgent need for detailed strategies to identify and reduce exposure to endocrine disrupters according to the "precautional principle".
Collapse
Affiliation(s)
- Rolf Grossklaus
- Department of Food Safety, Federal Institute for Risk Assessment, D-10589 Berlin, Germany
| | | | - Klaus Doubek
- Professional Association of Gynecologists, D-80337 Munich, Germany
| | - Henry Völzke
- Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, D-17475 Greifswald, Germany
| | - Roland Gaertner
- Medical Clinic IV, University of Munich, D-80336 Munich, Germany
| |
Collapse
|
4
|
Mechanisms of Sodium/Iodide Symporter-Mediated Mammary Gland Iodine Compensation during Lactation. Nutrients 2022; 14:nu14173592. [PMID: 36079849 PMCID: PMC9460413 DOI: 10.3390/nu14173592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
This research aimed to investigate the compensation mechanism of iodine deficiency and excess in the mammary gland during lactation. Female rats were divided into the low iodine group (LI), the normal iodine group (NI), the 10-fold high iodine group (10HI) and the 50-fold high iodine group (50HI). We measured the iodine levels in the urine, blood, milk, and mammary gland. The protein expression of sodium/iodide symporter (NIS), DPAGT1, and valosin-containing protein (VCP) in the mammary gland was also studied. The 24-hour urinary iodine concentration, serum total iodine concentration, serum non-protein-bound iodine concentration, breast milk iodine concentration, and mammary gland iodine content in the 50HI group were significantly higher than those in the NI group (p < 0.05). Compared with the NI group, NIS expression in the 50HI group significantly decreased (p < 0.05). DAPGT1 expression was significantly higher in the LI group than in the NI group (p < 0.05). The expression level of VCP was significantly increased in the 10HI and 50HI groups. In conclusion, milk iodine concentration is positively correlated with iodine intake, and the lactating mammary gland regulates the glycosylation and degradation of NIS by regulating DPAGT1 and VCP, thus regulating milk iodine level. However, the mammary gland has a limited role in compensating for iodine deficiency and excess.
Collapse
|
5
|
Mathiaparanam S, Nori de Macedo A, Mente A, Poirier P, Lear SA, Wielgosz A, Teo KK, Yusuf S, Britz-Mckibbin P. The Prevalence and Risk Factors Associated with Iodine Deficiency in Canadian Adults. Nutrients 2022; 14:nu14132570. [PMID: 35807751 PMCID: PMC9268597 DOI: 10.3390/nu14132570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 02/04/2023] Open
Abstract
Iodine is a trace micronutrient that is critical for normal thyroid function and human health. Inadequate dietary intake is associated with cognitive impairment, infertility, growth retardation and iodine deficiency disorders in affected populations. Herein, we examined the prevalence of iodine deficiency in adults (median age of 61 years) based on the analysis of 24 h urine samples collected from 800 participants in four clinical sites across Canada in the Prospective Urban and Rural Epidemiological (PURE) study. Urinary iodide together with thiocyanate and nitrate were measured using a validated capillary electrophoresis assay. Protective/risk factors associated with iodine deficiency were identified using a binary logistic regression model, whereas daily urinary iodine concentration (24 h UIC, μg/L) and urinary iodine excretion (24 h UIE, μg/day) were compared using complementary statistical methods with covariate adjustments. Overall, our Canadian adult cohort had adequate iodine status as reflected by a median UIC of 111 μg/L with 11.9% of the population <50 μg/L categorized as having moderate to severe iodine deficiency. Iodine adequacy was also evident with a median 24 h UIE of 226 μg/day as a more robust metric of iodine status with an estimated average requirement (EAR) of 7.1% (< 95 μg/day) and a tolerable upper level (UL) of 1.8% (≥1100 μg/day) based on Canadian dietary reference intake values. Participants taking iodine supplements (OR = 0.18; p = 6.35 × 10−5), had greater 24 h urine volume (OR = 0.69; p = 4.07 × 10−4), excreted higher daily urinary sodium (OR = 0.71; p = 3.03 × 10−5), and/or were prescribed thyroxine (OR = 0.33; p = 1.20 × 10−2) had lower risk for iodine deficiency. Self-reported intake of dairy products was most strongly associated with iodine status (r = 0.24; p = 2.38 × 10−9) after excluding for iodine supplementation and T4 use. Participants residing in Quebec City (OR = 2.58; p = 1.74 × 10−4) and Vancouver (OR = 2.54; p = 3.57 × 10−4) were more susceptible to iodine deficiency than Hamilton or Ottawa. Also, greater exposure to abundant iodine uptake inhibitors from tobacco smoking and intake of specific goitrogenic foods corresponded to elevated urinary thiocyanate and nitrate, which were found for residents from Quebec City as compared to other clinical sites. Recent public health policies that advocate for salt restriction and lower dairy intake may inadvertently reduce iodine nutrition of Canadians, and further exacerbate regional variations in iodine deficiency risk.
Collapse
Affiliation(s)
- Stellena Mathiaparanam
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.); (A.N.d.M.)
| | - Adriana Nori de Macedo
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.); (A.N.d.M.)
- Departamento de Química, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Andrew Mente
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada; (A.M.); (K.K.T.); (S.Y.)
| | - Paul Poirier
- Faculté de Pharmacie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, QC G1V 4G5, Canada;
| | - Scott A. Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby and Division of Cardiology, Providence Health Care, Vancouver, BC V5A 1S6, Canada;
| | - Andreas Wielgosz
- University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada;
| | - Koon K. Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada; (A.M.); (K.K.T.); (S.Y.)
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada; (A.M.); (K.K.T.); (S.Y.)
| | - Philip Britz-Mckibbin
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.); (A.N.d.M.)
- Correspondence:
| |
Collapse
|
6
|
Andersson M, Braegger CP. The Role of Iodine for Thyroid Function in Lactating Women and Infants. Endocr Rev 2022; 43:469-506. [PMID: 35552681 PMCID: PMC9113141 DOI: 10.1210/endrev/bnab029] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 12/18/2022]
Abstract
Iodine is a micronutrient needed for the production of thyroid hormones, which regulate metabolism, growth, and development. Iodine deficiency or excess may alter the thyroid hormone synthesis. The potential effects on infant development depend on the degree, timing, and duration of exposure. The iodine requirement is particularly high during infancy because of elevated thyroid hormone turnover. Breastfed infants rely on iodine provided by human milk, but the iodine concentration in breast milk is determined by the maternal iodine intake. Diets in many countries cannot provide sufficient iodine, and deficiency is prevented by iodine fortification of salt. However, the coverage of iodized salt varies between countries. Epidemiological data suggest large differences in the iodine intake in lactating women, infants, and toddlers worldwide, ranging from deficient to excessive intake. In this review, we provide an overview of the current knowledge and recent advances in the understanding of iodine nutrition and its association with thyroid function in lactating women, infants, and toddlers. We discuss risk factors for iodine malnutrition and the impact of targeted intervention strategies on these vulnerable population groups. We highlight the importance of appropriate definitions of optimal iodine nutrition and the need for more data assessing the risk of mild iodine deficiency for thyroid disorders during the first 2 years in life.
Collapse
Affiliation(s)
- Maria Andersson
- Nutrition Research Unit, University Children's Hospital Zurich, CH-8032 Zürich, Switzerland
| | - Christian P Braegger
- Nutrition Research Unit, University Children's Hospital Zurich, CH-8032 Zürich, Switzerland
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW Iodine deficiency is a global concern, and in recent years, there has been a significant improvement in the number of countries identified as being iodine-sufficient. This review considers the best strategies to ensure iodine sufficiency among breastfeeding women and their infants. RECENT FINDINGS Fortification strategies to improve iodine intake have been adequate for school-age children (SAC); however, often, iodine deficiency remains for breastfeeding women and their infants. Daily supplementation with iodine is not an ideal strategy to overcome deficiency. Countries defined as iodine-sufficient, but where pregnant and breastfeeding women have inadequate intake, should consider increasing salt iodine concentration, such that the median urinary iodine concentration of SAC can be up to 299 µg/L. This will ensure adequate intake for mothers and infants, without SAC being at risk thyroid dysfunction. Consensus is required for thresholds for iodine adequacy for breastfeeding women and infants.
Collapse
|
8
|
Abstract
The work reported in this paper addresses the iodine nutritional deficiency that still affects a large number of people. For this purpose, we analyzed the possibility to use, as iodine vehicle, a hard typical ewe cheese, called Canestrato d'Abruzzo, derived from milk of ewes fed with an iodine-fortified diet. Both in the milk and the cheese of these animals, the iodine level was higher than that measured in sheep with a normal diet. An increase in the lactoferrin and iron content was evident in the whey derived from milk of the iodine group. Furthermore, in derived cheese, the caseins seemed more efficiently transformed in small peptides making the product more digestible and, for this reason, particularly suitable for feeding the elderly. In conclusion, the dairy products obtained from ewes fed with iodine diet contain more bioactive compounds so that they represent a useful food to prevent iodine and iron deficiency in lamb and humans.
Collapse
|
9
|
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.
Collapse
|
10
|
Huang CJ, Cheng CP, Lee LH, Chen HS, Hwu CM, Tang KT, Shih CW, Yeh CC, Yang CC, Wang FF. Iodine nutritional status of lactating women in northern Taiwan in 2019. J Chin Med Assoc 2021; 84:400-404. [PMID: 33595993 DOI: 10.1097/jcma.0000000000000505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pregnant and lactating women are vulnerable to iodine deficiency. This study was conducted to evaluate the iodine nutritional status of lactating women in northern Taiwan. METHODS Women recruited from Taipei Veterans General Hospital (TVGH) in 2019 provided a spot urine sample and completed a Food Frequency Questionnaire. The urinary iodine concentration (UIC) was measured by inductively coupled plasma mass spectrometry. RESULTS The overall median UIC in 198 women was 120.4 μg/L, indicating a sufficient iodine status. Univariate analysis revealed a lower median UIC in women of younger age (p = 0.004), who were not taking multivitamins (p = 0.004), not on a postpartum nourishment diet (p = 0.04), and whose infant received more breast milk (p = 0.004). The median UIC was <100 μg/L in the group aged 20 to 29 years (UIC: 74.4 μg/L) and in women whose infants' diet was composed of >50% breast milk (UIC: 86.1 μg/L). A postpartum nourishment diet was followed by 73.7% (n = 146) of the women. Nevertheless, a significant decrease in the intake frequency of iodine-containing foods, including seaweeds (p < 0.001), seafood (p < 0.001), dairy products (p = 0.009), and multivitamins (p < 0.001) was observed compared with the intake noted in a previous survey of pregnant women in TVGH. Following multivariate analysis, only younger age (20-29 vs ≥30 years; odds ratio [OR]: 3.38; 95% confidence interval [CI]: 1.49-7.65), no use of multivitamin (OR: 1.89; 95% CI: 1.03-3.48), and infant diet composition (>50% breast milk vs <50% breast milk; OR: 2.93; 95% CI: 1.37-6.25) were independently associated with UIC < 100 μg/L. CONCLUSION The results suggest that the iodine status in lactating women in northern Taiwan is adequate. However, iodine deficiency may continue to be present in certain subgroups, such as women of younger age and those who do not take multivitamins.
Collapse
Affiliation(s)
- Chun-Jui Huang
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Cheng-Pin Cheng
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Lin-Hsuan Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Food Safety and Health Risk Assessment, School of Pharmaceutical Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Harn-Shen Chen
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chii-Min Hwu
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kam-Tsun Tang
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chiao-Wei Shih
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chang-Ching Yeh
- Department of Obstetrics & Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics & Gynecology, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Nurse-Midwifery and Women Health, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Chen-Chang Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Environmental & Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Fan-Fen Wang
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
11
|
Rodriguez-Diaz E, Pearce EN. Iodine status and supplementation before, during, and after pregnancy. Best Pract Res Clin Endocrinol Metab 2020; 34:101430. [PMID: 32792134 DOI: 10.1016/j.beem.2020.101430] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Iodine intake is essential for the production of thyroid hormone. Iodine deficiency remains a public health problem in many regions around the world. Iodine deficiency can present as a spectrum of disorders depending on the degree of severity. Pregnant and lactating women are particularly vulnerable to iodine deficiency disorders because of their increased iodine requirements. Severe maternal iodine deficiency has been associated with cretinism or impaired neurodevelopment in children as well as obstetric complications. Universal salt iodization has been shown to prevent these disorders in severely iodine deficient areas. Recently, observational studies have demonstrated an association between mild-to-moderate iodine deficiency and poorer cognitive outcomes in children. In this review, we describe the iodine requirements for pregnant and lactating women, how population iodine status can be assessed, the effects of maternal iodine deficiency and excess, and current data regarding efficacy of iodine supplementation for women who are pregnant or lactating.
Collapse
Affiliation(s)
- Eduardo Rodriguez-Diaz
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, 720 Harrison Avenue Suite 8100, Boston, MA 02118, USA.
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, 720 Harrison Avenue Suite 8100, Boston, MA 02118, USA.
| |
Collapse
|
12
|
Delshad H, Azizi F. Iodine nutrition in pregnant and breastfeeding women: sufficiency, deficiency, and supplementation. Hormones (Athens) 2020; 19:179-186. [PMID: 31776808 DOI: 10.1007/s42000-019-00160-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
Iodine is a micronutrient used by the thyroid gland to produce thyroid hormones, which manage different aspects of body metabolism. Humans depend on exogenous sources of iodine to maintain the normal concentration of thyroid hormones. Pregnancy alters iodine turnover and is associated with significant changes in thyroid function. Daily iodine requirement during pregnancy increases to 250 μg, compared with 150 μg for nonpregnant women. According to recent guidelines of scientific organizations, to improve maternal thyroid status and to prevent child neurocognitive defects, all pregnant and breastfeeding women should take 150 μg of iodine supplementation, not only in iodine-deficient regions but also in iodine-sufficient areas. However, some recent studies have confirmed that iodine supplementation of mildly iodine-deficient pregnant women has no clear benefits as concerns maternal thyroid function or child neurodevelopment.
Collapse
Affiliation(s)
- Hossein Delshad
- Micronutrient Research Office, Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak, Parvaneh Avenue No. 24, Research Institute for Endocrine Sciences, Tehran, Islamic Republic of Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| |
Collapse
|
13
|
Chen Y, Gao M, Bai Y, Hao Y, Chen W, Cui T, Guo W, Pan Z, Lin L, Wang C, Shen J, Zhang W. Variation of iodine concentration in breast milk and urine in exclusively breastfeeding women and their infants during the first 24 wk after childbirth. Nutrition 2019; 71:110599. [PMID: 31901706 DOI: 10.1016/j.nut.2019.110599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 09/15/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to observe the variation of iodine concentration in breast milk and urine in exclusively breastfeeding women and their infants during the first 24 wk after childbirth. METHODS In all, 634 exclusively breastfeeding mother-infant pairs were enrolled at hospital and followed at the 1, 4, 8, 12, 16, and 24 wk postpartum. Spot infant urinary iodine concentration (I-UIC), maternal urinary iodine concentration UIC (M-UIC), and breast milk iodine concentration (BMIC) in bilateral breasts were measured. RESULTS During the first 24 wk, the median I-UIC was 216 (139-362) and 122 (68-217) μg/L in lactating mothers, both indicating iodine sufficiency. A strong correlation and no difference were found between BMIC in bilateral breasts. The mean BMIC (M-BMIC) of the two breasts was 165 (112-257) μg/L with a Bland-Altman index of 2.1%. Positive correlations were found between M-BMIC and I-UIC (r = 0.353, P < 0.001), between M-BMIC and M-UIC (r = 0.339, P < 0.001), and between I-UIC and M-UIC (r = 0.222, P < 0.001). M-BMIC was significantly higher than M-UIC (P < 0.001) and lower than I-UIC (P < 0.001). M-BMIC declined from week 1 to week 8 postpartum, both I-UIC and M-UIC dropped from week 1 to week 4 postpartum and stabilized thereafter. CONCLUSION The iodine nutrition in lactating women and infants were adequate during the first 24 wk after childbirth. M-BMIC declined from week 1 to week 8 postpartum. Both I-UIC and M-UIC dropped from week 1 to week 4 postpartum. Further studies are needed to explore a more definitive BMIC and UIC range for an optimal iodine status in lactating women and breastfed infants.
Collapse
Affiliation(s)
- Yanting Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Min Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yanbo Bai
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yunmeng Hao
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wen Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Tingkai Cui
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenxing Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ziyun Pan
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Laixiang Lin
- The Key Laboratory of Hormone and Development (Ministry of Health), Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Chongdan Wang
- Department of Obstetrics and Inpatient, Tanggu Maternity Hospital, Tianjin, China
| | - Jun Shen
- Department of Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, China.
| | - Wanqi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China; The Key Laboratory of Hormone and Development (Ministry of Health), Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China; Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin, China.
| |
Collapse
|
14
|
Vila L, Lucas A, Donnay S, de la Vieja A, Wengrovicz S, Santiago P, Bandrés O, Velasco I, Garcia-Fuentes E, Ares S, Moreno Navarro JC, Espada M, Muñoz A, Galofré JC, Puig-Domingo M. Iodine nutrition status in Spain Needs for the future. ACTA ACUST UNITED AC 2019; 67:61-69. [PMID: 30962160 DOI: 10.1016/j.endinu.2019.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
Although iodine nutrition in Spain has improved in recent years, the problem is not completely resolved. It is necessary that health institutions establish measures to ensure an adequate iodine nutrition of the population, especially among the highest risk groups (children and adolescents, women of childbearing age, pregnant women and nursing mothers). A low salt intake should be advised, but it should be iodized. It is also imperative that food control agencies establish effective control over adequate iodization of salt. Indicators on iodine nutrition should be included in future health surveys. The EUthyroid study and the Krakow Declaration on iodine nutrition provide an opportunity to set up a pan-European plan for the prevention of iodine deficiency that should be considered and used by health authorities.
Collapse
Affiliation(s)
- Lluís Vila
- Servicio de Endocrinología y Nutrición, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, España; Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición.
| | - Anna Lucas
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Servicio de Endocrinología y Nutrición, Hospital Germans Trias i Pujol, Badalona, España
| | - Sergio Donnay
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Servicio de Endocrinología y Nutrición, Fundación Hospital Alcorcón, Madrid, España
| | - Antonio de la Vieja
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Unidad de Tumores Endocrinos. 53.03.020. Instituto de Salud Carlos III-UFIEC, Madrid, España
| | - Silvia Wengrovicz
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Instituto Catalán de Endocrinología, Clínica Tres Torres, Barcelona, España
| | - Piedad Santiago
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Jaén, Jaén, España
| | - Orosia Bandrés
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Sección de Endocrinología y Nutrición, Hospital Royo Villanova, Zaragoza, España
| | - Inés Velasco
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Servicio de Obstetricia y Ginecología, Hospital Riotinto, Riotinto, Huelva, España
| | - Eduardo Garcia-Fuentes
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Unidad de Gestión Clínica de Aparato Digestivo/Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga, España
| | - Susana Ares
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España
| | - José Carlos Moreno Navarro
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Laboratorio de Tiroides Molecular, INGEMM-Instituto de Medicina y Genética Molecular, Hospital Universitario de La Paz, Madrid, España
| | - Mercedes Espada
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Unidad de Bioquímica Clínica, Laboratorio de Salud Pública de Bilbao, Gobierno Vasco, Parque Tecnológico de Bizkaia, Derio, España
| | - Antonio Muñoz
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Centro de Atención Primaria de la Seu d'Urgell, Lleida, España
| | - Juan Carlos Galofré
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Departamento de Endocrinología Clínica, Universidad de Navarra, Pamplona, España
| | - Manel Puig-Domingo
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Servicio de Endocrinología y Nutrición, Hospital Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (IGTP), Badalona, España
| |
Collapse
|
15
|
Prezioso G, Giannini C, Chiarelli F. Effect of Thyroid Hormones on Neurons and Neurodevelopment. Horm Res Paediatr 2019; 90:73-81. [PMID: 30157487 DOI: 10.1159/000492129] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/15/2018] [Indexed: 11/19/2022] Open
Abstract
This review focuses on the current knowledge of the effects of thyroid hormones on central nervous system differentiation and development in animals and the human fetal brain. The outcomes of children with congenital hypothyroidism and of newborns with hypothyroid pregnant mothers are emphasized, focusing on how therapies could affect and especially improve the outcomes.
Collapse
|
16
|
Nazeri P, Tahmasebinejad Z, Mehrabi Y, Hedayati M, Mirmiran P, Azizi F. Lactating Mothers and Infants Residing in an Area with an Effective Salt Iodization Program Have No Need for Iodine Supplements: Results from a Double-Blind, Placebo-Controlled, Randomized Controlled Trial. Thyroid 2018; 28:1547-1558. [PMID: 30272528 DOI: 10.1089/thy.2018.0153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The necessity of iodine supplementation in lactating mothers residing in countries with sustained salt iodization programs for iodine sufficiency of breast-fed infants remains unclear. The aims of this study were to investigate the effect of iodine supplementation on iodine status and growth parameters of lactating mothers and breast-fed infants and to compare these data with that of formula-feeding mothers and their infants during the first year of infancy. METHODS In this multicenter, double-blinded, randomized clinical trial conducted in four healthcare centers in Tehran (Iran), healthy lactating mothers and their term newborns aged 3-5 days were randomly assigned to treatment groups: placebo, 150 μg/day iodine, or 300 μg/day iodine. They were followed up for 12 months. Formula-fed infants aged 30-45 days and their mothers were randomly selected from the same centers. The primary outcomes were maternal and infant urinary iodine concentrations (UICs), breast-milk iodine concentrations (BMICs), and infant growth parameters, measured at 1, 2, 4, 6, 9, and 12 months during routine health visits. The formula-fed group was assessed at 2, 4, 6, 9, and 12 months of age. Analysis was by per protocol principle using mixed-effects models. RESULTS Mother-newborn pairs (n = 180) in treatment groups and partially/exclusively formula-feeding mother-infant pairs (n = 60) participated between October 2014 and January 2016. Median baseline UICs in the treatment groups were 84 μg/L (interquartile range [IQR] 41-143 μg/L) in mothers and 208 μg/L (IQR 91-310 μg/L) in their infants. The values in the formula-fed group were 76 μg/L (IQR 40-144 μg/L) in mothers and 121 μg/L (IQR 66-243 μg/L) in infants. The 300 μg/day iodine group showed significantly higher UICs and BMICs than did the other treatment groups; infant UICs in the 150 μg/day iodine, placebo, and formula-fed groups were similar. Infants in all groups showed iodine sufficiency (median UIC ≥100 μg/L) throughout the study period. Anthropometric measurements were similar between the treatment and formula-fed groups over the study period, except at the last follow-up visit at 12 months. CONCLUSION Supplementation of breast-feeding mothers with either 300 or 150 μg/day iodine improved their iodine status. However, the iodine status of infants in all groups studied indicated iodine sufficiency during the first year of infancy, demonstrating that in countries with effective salt iodization program, iodine supplementation for lactating mothers is unnecessary.
Collapse
Affiliation(s)
- Pantea Nazeri
- 1 Family Health Institute, Breastfeeding Research Center, Tehran University of Medical Sciences , Tehran, Iran
- 2 Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Zhale Tahmasebinejad
- 2 Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Yadollah Mehrabi
- 3 Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Mehdi Hedayati
- 4 Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Parvin Mirmiran
- 2 Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Fereidoun Azizi
- 5 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| |
Collapse
|
17
|
Sicherheit und Risiken vegetarischer und veganer Ernährung in Schwangerschaft, Stillzeit und den ersten Lebensjahren. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0554-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
18
|
Dold S, Zimmermann MB, Jukic T, Kusic Z, Jia Q, Sang Z, Quirino A, San Luis TOL, Fingerhut R, Kupka R, Timmer A, Garrett GS, Andersson M. Universal Salt Iodization Provides Sufficient Dietary Iodine to Achieve Adequate Iodine Nutrition during the First 1000 Days: A Cross-Sectional Multicenter Study. J Nutr 2018; 148:587-598. [PMID: 29659964 DOI: 10.1093/jn/nxy015] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/16/2018] [Indexed: 12/14/2022] Open
Abstract
Background Dietary iodine requirements are high during pregnancy, lactation, and infancy, making women and infants vulnerable to iodine deficiency. Universal salt iodization (USI) has been remarkably successful for preventing iodine deficiency in the general population, but it is uncertain if USI provides adequate iodine intakes during the first 1000 d. Objective We set out to assess if USI provides sufficient dietary iodine to meet the iodine requirements and achieve adequate iodine nutrition in all vulnerable population groups. Methods We conducted an international, cross-sectional, multicenter study in 3 study sites with mandatory USI legislation. We enrolled 5860 participants from 6 population groups (school-age children, nonpregnant nonlactating women of reproductive age, pregnant women, lactating women, 0-6-mo-old infants, and 7-24-mo-old infants) and assessed iodine status [urinary iodine concentration (UIC)] and thyroid function in Linfen, China (n = 2408), Tuguegarao, the Philippines (n = 2512), and Zagreb, Croatia (n = 940). We analyzed the iodine concentration in household salt, breast milk, drinking water, and cow's milk. Results The salt iodine concentration was low (<15 mg/kg) in 2.7%, 33.6%, and 3.1%, adequate (15-40 mg/kg) in 96.3%, 48.4%, and 96.4%, and high (>40 mg/kg) in 1.0%, 18.0%, and 0.5% of household salt samples in Linfen (n = 402), Tuguegarao (n = 1003), and Zagreb (n = 195), respectively. The median UIC showed adequate iodine nutrition in all population groups, except for excessive iodine intake in school-age children in the Philippines and borderline low intake in pregnant women in Croatia. Conclusions Salt iodization at ∼25 mg/kg that covers a high proportion of the total amount of salt consumed supplies sufficient dietary iodine to ensure adequate iodine nutrition in all population groups, although intakes may be borderline low during pregnancy. Large variations in salt iodine concentrations increase the risk for both low and high iodine intakes. Strict monitoring of the national salt iodization program is therefore essential for optimal iodine nutrition. This trial was registered at clinicaltrials.gov as NCT02196337.
Collapse
Affiliation(s)
- Susanne Dold
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich, Switzerland
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich, Switzerland.,Iodine Global Network, Ottawa, Ontario, Canada
| | - Tomislav Jukic
- Department of Nuclear Medicine and Oncology, Sestre Milosrdnice University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia.,Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Osijek, Croatia
| | - Zvonko Kusic
- Department of Nuclear Medicine and Oncology, Sestre Milosrdnice University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia.,Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Qingzhen Jia
- Shanxi Institute for Prevention and Treatment of Endemic Disease, Linfen, China
| | - Zhongna Sang
- Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Antonio Quirino
- Technological Institute of the Philippines, Manila, Philippines
| | | | - Ralph Fingerhut
- Swiss Newborn Screening Laboratory, Division of Metabolism and Children's Research Centre (CRC), University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Arnold Timmer
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Greg S Garrett
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Maria Andersson
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich, Switzerland.,Iodine Global Network, Ottawa, Ontario, Canada
| |
Collapse
|
19
|
Lee SY, McCarthy AM, Stohl H, Ibrahim S, Jeong C, Braverman LE, Ma W, He X, Mestman JH, Schuller KE, Jahreis KA, Pearce EN, Leung AM. Urinary Iodine, Perchlorate, and Thiocyanate Concentrations in U.S. Lactating Women. Thyroid 2017; 27:1574-1581. [PMID: 29130403 PMCID: PMC5734160 DOI: 10.1089/thy.2017.0158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Iodine is an essential micronutrient for thyroid hormone production. Adequate iodine intake and normal thyroid function are important during early development, and breastfed infants rely on maternal iodine excreted in breast milk for their iodine nutrition. The proportion of women in the United States of childbearing age with urinary iodine concentration (UIC) <50 μg/L has been increasing, and a subset of lactating women may have inadequate iodine intake. UIC may also be influenced by environmental exposure to perchlorate and thiocyanate, competitive inhibitors of iodine transport into thyroid, and lactating mammary glands. Data regarding UIC in U.S. lactating women are limited. To adequately assess the iodine sufficiency of lactating women and potential associations with environmental perchlorate and thiocyanate exposure, we conducted a multicenter, cross-sectional study of urinary iodine, perchlorate, and thiocyanate concentrations in healthy U.S. lactating women. METHODS Lactating women ≥18 years of age were recruited from three U.S. geographic regions: California, Massachusetts, and Ohio/Illinois from November 2008 to June 2016. Demographic information and multivitamin supplements use were obtained. Iodine, perchlorate, and thiocyanate levels were measured from spot urine samples. Correlations between urinary iodine, perchlorate, and thiocyanate levels were determined using Spearman's rank correlation. Multivariable regression models were used to assess predictors of urinary iodine, perchlorate, and thiocyanate levels, and UIC <100 μg/L. RESULTS A total of 376 subjects (≥125 from each geographic region) were included in the final analyses [mean (SD) age 31.1 (5.6) years, 37% white, 31% black, and 11% Hispanic]. Seventy-seven percent used multivitamin supplements, 5% reported active cigarette smoking, and 45% were exclusively breastfeeding. Median urinary iodine, perchlorate, and thiocyanate concentrations were 143 μg/L, 3.1 μg/L, and 514 μg/L, respectively. One-third of women had UIC <100 μg/L. Spot urinary iodine, perchlorate, and thiocyanate levels all significantly positively correlated to each other. No significant predictors of UIC, UIC <100 μg/L, or urinary perchlorate levels were identified. Smoking, race/ethnicity, and marital status were significant predictors of urinary thiocyanate levels. CONCLUSION Lactating women in three U.S. geographic regions are iodine sufficient with an overall median UIC of 143 μg/L. Given ubiquitous exposure to perchlorate and thiocyanate, adequate iodine nutrition should be emphasized, along with consideration to decrease these exposures in lactating women to protect developing infants.
Collapse
Affiliation(s)
- Sun Y. Lee
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Alicia M. McCarthy
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Walnut Creek, California
| | - Hindi Stohl
- Department of Obstetrics and Gynecology, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Sherrine Ibrahim
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christina Jeong
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Lewis E. Braverman
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Wendy Ma
- Wellesley College, Wellesley, Massachusetts
| | - Xuemei He
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Jorge H. Mestman
- Department of Medicine and Department of Obstetrics and Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Kristin E. Schuller
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Katherine A. Jahreis
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Elizabeth N. Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Angela M. Leung
- Division of Endocrinology, Diabetes, and Metabolism, UCLA David Geffen School of Medicine, Los Angeles, California
- Division of Endocrinology, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
| |
Collapse
|
20
|
Dold S, Zimmermann MB, Aboussad A, Cherkaoui M, Jia Q, Jukic T, Kusic Z, Quirino A, Sang Z, San Luis TO, Vandea E, Andersson M. Breast Milk Iodine Concentration Is a More Accurate Biomarker of Iodine Status Than Urinary Iodine Concentration in Exclusively Breastfeeding Women. J Nutr 2017; 147:528-537. [PMID: 28228508 DOI: 10.3945/jn.116.242560] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/06/2016] [Accepted: 01/23/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Iodine status in populations is usually assessed by the median urinary iodine concentration (UIC). However, iodine is also excreted in breast milk during lactation; thus, breast milk iodine concentration (BMIC) may be a promising biomarker of iodine nutrition in lactating women. Whether the mammary gland can vary fractional uptake of circulating iodine in response to changes in dietary intake is unclear.Objective: We evaluated UIC and BMIC as biomarkers for iodine status in lactating women with a wide range of iodine intakes.Methods: We recruited 866 pairs of lactating mothers and exclusively breastfed infants from 3 iodine-sufficient study sites: Linfen, China (n = 386); Tuguegarao, Philippines (n = 371); and Zagreb, Croatia (n = 109). We also recruited iodine-deficient lactating women from Amizmiz, Morocco (n = 117). We collected urine and breast milk samples and measured UIC and BMIC.Results: In the 3 iodine-sufficient sites, a pooled regression analysis of the estimated iodine excretion revealed higher fractional iodine excretion in breast milk than in urine at borderline low iodine intakes. In contrast, in the iodine-deficient site in Morocco, a constant proportion (∼33%) of total iodine was excreted into breast milk.Conclusions: In iodine-sufficient populations, when iodine intake in lactating women is low, there is increased partitioning of iodine into breast milk. For this reason, maternal UIC alone may not reflect iodine status, and BMIC should also be measured to assess iodine status in lactating women. Our data suggest a BMIC reference range (2.5th and 97.5th percentiles) of 60-465 μg/kg in exclusively breastfeeding women. This trial was registered at clinicaltrials.gov as NCT02196337.
Collapse
Affiliation(s)
- Susanne Dold
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland;
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.,Iodine Global Network, Ottawa, Canada
| | | | - Mohamed Cherkaoui
- Laboratory of Human Ecology, Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco
| | - Qingzhen Jia
- Shanxi Institute for Prevention and Treatment of Endemic Disease, Linfen, China
| | - Tomislav Jukic
- Department of Nuclear Medicine and Oncology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zvonko Kusic
- Department of Nuclear Medicine and Oncology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Antonio Quirino
- St. Luke's Medical Center, Quezon City, Manila, Philippines; and
| | - Zhongna Sang
- Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | | | - Elena Vandea
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
| | - Maria Andersson
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.,Iodine Global Network, Ottawa, Canada
| |
Collapse
|
21
|
Krylova K, Bilek R, Kulicka J, Dejmek P, Bayer M, Kacerovsky M, Neumann D. Urinary iodine concentrations in mothers and their term newborns in country with sufficient iodine supply. J Matern Fetal Neonatal Med 2016; 30:2633-2639. [DOI: 10.1080/14767058.2016.1260114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Katerina Krylova
- Department of Pediatrics, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Jiri Kulicka
- Department of Informatics, Jan Perner Transport Faculty, University of Pardubice, Pardubice, Czech Republic
| | - Petr Dejmek
- Department of Pediatrics, Charles University in Prague, 3rd Faculty of Medicine, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Milan Bayer
- Department of Pediatrics and Osteocenter, Thomayer Hospital, Prague, Czech Republic
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic
| | - David Neumann
- Department of Pediatrics, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| |
Collapse
|