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Nazeri P, Pearce EN, Farrokhzad N, Baghalha F, Shariat M, Azizi F. Do Postpartum Maternal Iodine Status or Supplementation Affect Thyroid Function After Delivery? A Systematic Review and Meta-Analysis. Biol Trace Elem Res 2024; 202:3425-3441. [PMID: 37966688 DOI: 10.1007/s12011-023-03934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023]
Abstract
The aim of this systematic review and meta-analysis was, for the first time, to explore whether postpartum maternal iodine status or supplementation is associated with thyroid function after delivery. The MEDLINE/PubMed, Web of Science, Embase, and Scopus were searched up to December 2021 to identify relevant studies. The pooled mean thyroid stimulating hormone (TSH), free thyroxine (fT4), and thyroxine (T4) concentrations and 95% confidence intervals (CIs) were estimated based on maternal urinary iodine concentration (UIC) (< 50, 50-100, 100-200, and > 200 µg/L) or breast milk iodine concentration (BMIC) (< 100 µg/L vs. ≥ 100 µg/L) during postpartum. A fixed/random effects model was used based on the absence/presence of heterogeneity, respectively. The study is registered with PROSPERO, number CRD42022336145. A total of 2175 studies were identified, of which 18 were eligible for the meta-analysis. The pooled values for TSH, fT4, and T4 concentrations in all subgroups were within the normal range; however, except for TSH, comparing the 95% CI showed no statistically significant difference among different subgroups. The pooled mean for TSH concentration in women with UIC > 200 µg/L was 2.23 mIU/L, whereas the corresponding values in women with UIC < 50, 50-100 and 100-200 µg/L were 0.56, 0.56 and 0.95 mIU/L, respectively. Thyroid hormones in women with BMIC < 100 µg/L and ≥ 100 µg/L were within the normal range. Iodine supplementation during postpartum was not associated with any differences in thyroid parameters, compared to non-supplemented women. In conclusion, iodine status or supplementation had no effect on thyroid hormones in postpartum women.
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Affiliation(s)
- Pantea Nazeri
- Breastfeeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes and Nutrition, Boston University Chobanian & Avedisian School of Medicine, Boston, USA.
| | - Nahid Farrokhzad
- Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Baghalha
- Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mamak Shariat
- Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Bath SC. Thyroid function and iodine intake: global recommendations and relevant dietary trends. Nat Rev Endocrinol 2024; 20:474-486. [PMID: 38693274 DOI: 10.1038/s41574-024-00983-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 05/03/2024]
Abstract
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.
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Affiliation(s)
- Sarah C Bath
- Department of Nutrition, Food and Exercise Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
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Zheng C, Yin Z, Zhan B, Xu W, Ma ZF. Pregnant women at risk for iodine deficiency but adequate iodine intake in school-aged children of Zhejiang Province, China. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2024; 46:204. [PMID: 38695896 PMCID: PMC11065927 DOI: 10.1007/s10653-024-01934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/21/2024] [Indexed: 05/05/2024]
Abstract
The median urinary iodine concentration (UIC) of school-aged children has been commonly used as a surrogate to assess iodine status of a population including pregnant women. However, pregnant women have higher iodine requirements than children due to increased production of thyroid hormones. The aim of the study was to evaluate the iodine status of pregnant women and children as well as their household salt iodine concentration (SIC) in Quzhou, Zhejiang Province, China. Eligible pregnant women and children from all six counties of Quzhou in 2021 were recruited into the study. They were asked to complete a socio-demographic questionnaire and provide both a spot urine and a household table salt sample for the determination of UIC and SIC. A total of 629 pregnant women (mean age and gestation weeks of 29.6 years and 21.6 weeks, respectively) and 1273 school-aged children (mean age of 9 years and 49.8% of them were females) were included in the study. The overall median UIC of pregnant women and children in our sample was 127 (82, 193) μg/L and 222 (147, 327) μg/L, respectively, indicating sufficient iodine status in children but a risk of mild-to-moderate iodine deficiency in pregnant women. Distribution of iodine nutrition in children varied significantly according to their sex and age (P < 0.05). The rate of adequately household iodised salt samples (18-33 mg/kg) provided by pregnant women and children was 92.4% and 90.6%, respectively. In conclusion, our results indicated a risk of insufficient iodine status in pregnant population of China, but iodine sufficiency in school-aged children. Our data also suggested that median UIC of children may not be used as a surrogate to assess iodine status in pregnant women.
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Affiliation(s)
- Canjie Zheng
- Quzhou Center for Disease Control and Prevention, 154 Xi'an Road, Quzhou, 324000, Zhejiang Province, China
| | - Zhiying Yin
- Quzhou Center for Disease Control and Prevention, 154 Xi'an Road, Quzhou, 324000, Zhejiang Province, China
| | - Bingdong Zhan
- Quzhou Center for Disease Control and Prevention, 154 Xi'an Road, Quzhou, 324000, Zhejiang Province, China
| | - Wenjie Xu
- Quzhou Center for Disease Control and Prevention, 154 Xi'an Road, Quzhou, 324000, Zhejiang Province, China
| | - Zheng Feei Ma
- Centre for Public Health and Wellbeing, School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK.
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Fischer L, Andersson M, Braegger C, Herter-Aeberli I. Iodine intake in the Swiss population 100 years after the introduction of iodised salt: a cross-sectional national study in children and pregnant women. Eur J Nutr 2024; 63:573-587. [PMID: 38141138 PMCID: PMC10899291 DOI: 10.1007/s00394-023-03287-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE The Swiss voluntary salt iodisation programme has successfully prevented iodine deficiency for 100 years, but dietary habits are changing and today only one-third of processed foods contain iodised salt. We aimed to monitor the current iodine status in children and pregnant women. METHODS We conducted a nationwide cross-sectional study in children (6-12 years) and pregnant women and measured the urinary iodine concentration (UIC) in spot urine samples. We estimated the iodine intake using UIC and urinary creatinine concentration (UCC) and determined the prevalence of intakes below the average requirement (AR) using the SPADE method. We measured dried blood spot (DBS) thyroglobulin (Tg), TSH and total T4 in pregnant women. RESULTS The median UIC was 127 μg/L (bootstrapped 95% CI 119, 140, n = 362) in children and 97 μg/L (bootstrapped 95% CI 90, 106, n = 473) in pregnant women. The estimated prevalence of inadequate iodine intake (< 65 μg/day) was 5.4% (bootstrapped 95% CI 0.0, 14.6) in children. Half (47%) of the women consumed iodine-containing multivitamin and mineral supplements (≥ 150 μg/day). Compared to non-users, users had higher median UIC (129 vs. 81 μg/L, P < 0.001), lower prevalence of inadequacy (< 160 μg/day; 0.2 vs. 31%) and lower DBS-Tg (23 vs. 29 μg/L, P < 0.001). All women were euthyroid. CONCLUSIONS The Swiss diet and current salt fortification provides adequate iodine intake in children, but not in all pregnant women. Iodine supplements cover the dietary gap in pregnancy but are not universally consumed. Therefore, improved use of iodised salt in processed foods is desired to ensure adequate iodine intake in all population groups. This trial was registered at clinicaltrials.gov as NCT04524013.
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Affiliation(s)
- Lena Fischer
- Nutrition Research Unit, Children's Research Centre, University Children's Hospital Zurich - Eleonore Foundation, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
- Laboratory of Nutrition and Metabolic Epigenetics, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.
| | - Maria Andersson
- Nutrition Research Unit, Children's Research Centre, University Children's Hospital Zurich - Eleonore Foundation, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Christian Braegger
- Nutrition Research Unit, Children's Research Centre, University Children's Hospital Zurich - Eleonore Foundation, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Isabelle Herter-Aeberli
- Laboratory of Nutrition and Metabolic Epigenetics, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
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Gunnarsdóttir I, Brantsæter AL. Iodine: a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2023; 67:10369. [PMID: 38187800 PMCID: PMC10770700 DOI: 10.29219/fnr.v67.10369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/27/2022] [Accepted: 11/10/2023] [Indexed: 01/09/2024] Open
Abstract
Iodine is essential for the synthesis of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). As in many other parts of the world, insufficient iodine intake and consequently insufficient iodine status is a public health challenge in the Nordic and Baltic countries. The main dietary sources of iodine in the Nordic and Baltic countries include cow's milk, saltwater fish, eggs, products containing iodised salt, and iodised table salt. Only Denmark (DK), Finland (FI) and Sweden (SE) have implemented mandatory (DK) or voluntary (SE, FI) salt iodisation. New data, as well as recent studies from the Nordic and Baltic countries, strengthen the evidence that the main health challenges related to insufficient iodine intake remain thyroid function and thyroid disease, mental development, and cognitive function. Excessive intakes can also cause hyperthyroidism, autoimmune thyroid disease, and thyroid cancer.
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Affiliation(s)
- Ingibjörg Gunnarsdóttir
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
- Unit for Nutrition Research, Landspitali National University Hospital, Reykjavik, Iceland
| | - Anne Lise Brantsæter
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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Knowles J, Codling K, Houston R, Gorstein J. Introduction to the programme guidance for the use of iodised salt in processed foods and its pilot implementation, strengthening strategies to improve iodine status. PLoS One 2023; 18:e0274301. [PMID: 37824480 PMCID: PMC10569583 DOI: 10.1371/journal.pone.0274301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Efforts to achieve optimal iodine intake through salt iodisation have focussed primarily on iodisation of household salt. However, there is strong evidence that in most regions of the world, industrially processed foods and condiments are an increasingly important source of dietary salt. In this context The Iodine Global Network (IGN) and partners developed programme guidance to help national programme managers assess the potential contribution of widely consumed industrially processed foods and condiments to iodine intake. The programme guidance additionally aimed to facilitate better understanding of iodised salt use by the processed food industry, review existing salt iodisation legislation for inclusion of food industry salt, and investigate how regulatory monitoring of food industry practices could be strengthened if needed. To evaluate the utility of the guidance in practice and identify areas where it could be improved, the IGN requested expressions of interest to pilot test implementation. Five pilots were implemented in Kenya, North Macedonia, The Republic of Moldova, Sri Lanka and Thailand, with remote technical support from IGN. The pilots demonstrated how evidence from implementation could be used to strengthen existing salt iodisation initiatives. In particular, how modelling existing processed food intake data enhanced understanding of potential or actual iodised salt intake and provided an evidence base for strategic change, as well as encouraging alignment with salt reduction programmes. In summary, the guidance provided a useful framework for national teams to conduct a relatively rapid assessment of the existing programme for achieving optimal iodine nutrition and opportunities to strengthen it. National teams involved with the pilot implementation were highly engaged and motivated by the outcomes. The pilot implementation process resulted in the development of strategic recommendations nationally and provided invaluable feedback to IGN on the utility of the guidance, facilitating development of an improved version.
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Affiliation(s)
| | | | | | - Jonathan Gorstein
- Iodine Global Network, Ontario, Canada
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
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Filipan D, Vidranski V, Bosak Butković M, Blažeković I, Romić M, Mihaljević I, Bogović Crnčić T, Kusić Z, Šamija I, Fröbe A, Jukić T. Recent data on iodine intake in Croatian schoolchildren: results of 2014-2019 survey. Eur J Clin Nutr 2023; 77:959-965. [PMID: 37414967 DOI: 10.1038/s41430-023-01301-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 06/04/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Both insufficient and excessive iodine intake can lead to a broad range of disorders. A cross-sectional survey was conducted to assess iodine status in schoolchildren from Croatia. DESIGN 957 healthy 6 to 12-year-olds were enrolled (381 from northwestern region, 190 from eastern region, 215 from north Adriatic, and 171 from central Dalmatia region). Urinary iodine concentration (UIC) was measured in spot urine samples. Thyroid volume (Tvol) was recorded by ultrasound device. Standard anthropometric measures were taken, and body surface area (BSA) was determined. Tvol medians were calculated as a function of age, sex and BSA and compared with reference values. RESULTS Total sample size included 490 boys and 467 girls. Overall median UIC was 250.68 µg/L, with statistically significant variance in geographical regions (median UIC was 244.71 µg/L in northwestern, 208.02 µg/L in eastern, 216.07 µg/L in north Adriatic and 366.43 µg/L in central Dalmatia region). There were 10.08% of samples with UIC < 100 mcg/L while 38.24% of samples had UIC > 300 mcg/L. Age-matched Tvol medians in schoolchildren from all regions of Croatia were at the upper limits of reference values, but in north Adriatic and central Dalmatia exceeded the 97th percentile. BSA-matched Tvol was within the reference range in all regions. CONCLUSIONS Our results demonstrate sufficient (more than adequate) iodine intake in schoolchildren of Croatia, and excessive iodine intake in central Dalmatia region. Total thyroid volumes in schoolchildren of Croatia were within the normal range, however borderline enlarged age-matched thyroid glands were observed in coastal areas.
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Affiliation(s)
- Dorotea Filipan
- University Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Valentina Vidranski
- University Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marija Bosak Butković
- University Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ivan Blažeković
- University Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Matija Romić
- University Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ivan Mihaljević
- Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Osijek, Croatia
- Clinical Institute of Nuclear Medicine and Radiation Protection, University Hospital Osijek, Osijek, Croatia
| | - Tatjana Bogović Crnčić
- Clinical Department of Nuclear Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
- University of Rijeka, Faculty of Medicine, Rijeka, Croatia
| | - Zvonko Kusić
- Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Ivan Šamija
- University Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Fröbe
- University Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomislav Jukić
- University Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
- Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Osijek, Croatia.
- School of Medicine, University of Zagreb, Zagreb, Croatia.
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Spina V, Baldini E, Cardarelli S, Oliva C, Venarubea S, Faraoni F, Pastore G, Tittoni R, Musella A, Squarcella A, Lori E, Renzi E, Feroci R, Mastrodonato F, Ciferri F, Virili C, Centanni M, Fabiani C, Rago R, Schiavi MC, Palazzetti P, D'Armiento E, Cantisani V, Sorrenti S, Ulisse S. Iodized Salt May Not Be Sufficient to Guarantee an Adequate Iodine Intake in Pregnant Women. Nutrients 2023; 15:4182. [PMID: 37836466 PMCID: PMC10574232 DOI: 10.3390/nu15194182] [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: 09/01/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Adequate iodine intake is of crucial importance in pregnancy to meet the thyroid hormone needs of both mother and fetus. In the present study, undertaken as a part of the surveillance actions following the introduction in Italy of a national salt iodination program in 2005, the iodine intake was investigated in 123 pregnant women and 49 control women living in the same area of central Italy. All the participants were screened for urinary iodine concentration (UIC), serum level of thyrotropin, free-thyroxine, free-triiodothyronine, and thyroid volume. Moreover, they were provided with a questionnaire on the use of iodine-containing salt or supplements. Control women had a median UIC of 102 µg/L, consistent with an iodine sufficiency, while in pregnant women the median UIC value was 108 µg/L, lower than the endorsed UIC of 150 µg/L. In addition, pregnant women showed a significantly increased median thyroid volume compared to controls. Interestingly, the median UIC did not differ between pregnant women not using iodine-containing salt or supplements and those regularly consuming iodized salt alone, while pregnant women with a daily intake of iodine-containing supplements had an adequate median UIC (168 µg/L). In conclusion, the data reported here showed that pregnant women and their fetuses are still exposed to the detrimental effects of iodine deficiency and that the consumption of iodine-containing supplements should be recommended in pregnancy.
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Affiliation(s)
- Vincenzo Spina
- Mother and Infant Department Unit, ASL-Rieti, 02100 Rieti, Italy
| | - Enke Baldini
- Department of Surgery, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Silvia Cardarelli
- Department of Surgery, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Cosimo Oliva
- Obstetrics and Gynaecology Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Stefano Venarubea
- Clinical Pathology Laboratory Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Franca Faraoni
- Pediatrics and Neonatology Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Giovanni Pastore
- Obstetrics and Gynaecology Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Rachele Tittoni
- Obstetrics and Gynaecology Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Angela Musella
- Obstetrics and Gynaecology Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Antonia Squarcella
- Obstetrics and Gynaecology Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Eleonora Lori
- Department of Surgery, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Elisabetta Renzi
- Mother and Infant Department Unit, ASL-Rieti, 02100 Rieti, Italy
| | - Roberta Feroci
- Mother and Infant Department Unit, ASL-Rieti, 02100 Rieti, Italy
| | | | - Fabiola Ciferri
- Mother and Infant Department Unit, ASL-Rieti, 02100 Rieti, Italy
| | - Camilla Virili
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, 04100 Latina, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, 04100 Latina, Italy
| | - Cristina Fabiani
- Mother and Infant Department, "Sandro Pertini" Hospital, 00157 Rome, Italy
| | - Rocco Rago
- Mother and Infant Department, "Sandro Pertini" Hospital, 00157 Rome, Italy
| | | | | | - Eleonora D'Armiento
- Department of Internal Medicine and and Medical Specialties, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Vito Cantisani
- Department of Radiological and Oncological Sciences and Pathological Anatomy, "Sapienza" University of Rome, 00185 Rome, Italy
- Teleradiology Complex Unit, ASL-Rieti, 02100 Rieti, Italy
| | | | - Salvatore Ulisse
- Department of Surgery, "Sapienza" University of Rome, 00185 Rome, Italy
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Groufh-Jacobsen S, Abel MH, Brantsæter AL, Andersson M, Meyer HE, Henjum S. National monitoring of iodine, sodium, and vitamin D status in toddlers and women of childbearing age - results and lessons learned from a pilot study in Norway. Food Nutr Res 2023; 67:9088. [PMID: 37691743 PMCID: PMC10492227 DOI: 10.29219/fnr.v67.9088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 09/12/2023] Open
Abstract
Background Norway is lacking a population-based national monitoring program for iodine, sodium, and vitamin D status. Objective The aim of this study was to pilot-test a study design for collecting biological samples from a country-representative sample of 2-year-old children and their mothers and to report results for iodine, salt, and vitamin D at baseline, before initiation of salt iodization in Norway. Design In a cross-sectional study, we recruited 2-year-old children and their mothers during the routine 2-year check-up through 38 randomly selected health clinics in 2021. Spot urine samples were analyzed for iodine, creatinine, and sodium, and dried blood spots from the mothers were analyzed for thyroglobulin (Tg) and 25-hydroxyvitamin D (25(OH)D). Results We aimed at including 400 mother-child pairs but recruited only 55 pairs. Major challenges were closed health clinics due to the COVID-19 pandemic, lack of motivation of the health personnel to prioritize recruiting, missing information about non-participation, and high workload for participants. The median urinary iodine concentration (UIC) was 123 (95% CI: 76, 228) µg/L in the toddlers and 83 (95% CI: 72, 99) µg/L in the mothers. The median urinary sodium concentration (UNaC) was 62 (95% CI: 37, 91) mmol/L in the toddlers and 93 (95% CI: 77, 107) mmol/L in the mothers. Of the mothers, 18% had levels of 25(OH)D <50 nmol/L (suboptimal status). Discussion and conclusion Lessons learned from the pilot study will be used to design a national monitoring program for toddlers and women of childbearing age in Norway. The results indicate that 2-year-old children and women of childbearing age in Norway may have inadequate iodine intakes at the group level, while for vitamin D, most of the mothers had adequate status.
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Affiliation(s)
- Synne Groufh-Jacobsen
- Department of Nutrition and Public Health, Faculty of Health and Sport Science, University of Agder, Kristiansand, Norway
| | - Marianne Hope Abel
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Lise Brantsæter
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria Andersson
- Nutrition Research Unit, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Haakon E. Meyer
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Sigrun Henjum
- Department of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
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10
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Nie J, Zhu Y, Wang C, Lin Q, Tayier R, Cai Z, Ma P, Zhang L. Relationship between iodine knowledge and dietary iodine intake in pregnant and lactating women: a cross-sectional study. Public Health Nutr 2023; 26:1436-1450. [PMID: 36946300 PMCID: PMC10346033 DOI: 10.1017/s1368980023000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/04/2023] [Accepted: 02/24/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This study assessed the iodine knowledge of pregnant and lactating women and the relationship to dietary iodine intake and iodine status. The factors influencing iodine intake were analysed. DESIGN Basic information and iodine knowledge were collected via a questionnaire. A FFQ assessed dietary iodine intake. The urinary iodine concentration (UIC) was measured using the arsenic-cerium catalytic spectrophotometric determination of iodine in urine (WS/T 107 -2016). SETTING A cross-sectional study involving pregnant and lactating women in Xinjiang, China was conducted. PARTICIPANTS A total of 1181 pregnant women and 504 lactating women were enrolled in the study. RESULTS The median UIC for pregnant and lactating women was 179·27 and 192·81 µg/l, respectively, and the dietary iodine intake was 407·16 and 356·89 µg/d, respectively. Of the pregnant and lactating women, 73·4 % and 82·5 % had medium iodine knowledge, respectively. In pregnant women, iodine knowledge and dietary iodine intake were positively correlated. High iodine knowledge and iodine education were shown to be protective factors for excessive iodine intake in pregnant women. CONCLUSION This study demonstrated that the iodine nutritional status of women in Xinjiang was appropriate, and iodine knowledge was at a medium level, but there was confusion about iodine nutrition. Public education is needed to improve iodine knowledge and active iodine supplementation awareness among these populations of women.
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Affiliation(s)
- Jiaoyang Nie
- School of Public Health, Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Yuming Zhu
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Chenchen Wang
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Qin Lin
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Rishalaiti Tayier
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Zhuoxuan Cai
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Pinjiang Ma
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Ling Zhang
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
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11
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Jaisamrarn U, Esteban-Habana MA, Padolina CS, Decena DCD, Dee MT, Damodaran P, Bhaskaran V, Garg V, Dorado E, Hu H. Vitamins and minerals, education, and self-care need during preconception to 1000 days of life in Southeast Asia: An expert panel opinion. SAGE Open Med 2023; 11:20503121231173377. [PMID: 37223672 PMCID: PMC10201185 DOI: 10.1177/20503121231173377] [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: 01/26/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
Addressing maternal malnutrition and its drivers is paramount in Southeast Asia. This article summarizes the key clinical learnings and evidence-based opinions from the experts to understand the need for vitamins and minerals supplementation, education, and self-care from preconception to the first 1000 days of life, which warranted further attention since COVID-19 pandemic. Evidence describing the importance of vitamins and minerals during preconception, pregnancy, and lactation stages was identified using literature databases. A pre-meeting survey was conducted to determine the current practices and challenges in Southeast Asia. Based on the literature review and clinical experience, experts defined the topics, and an online meeting was held on 13th July 2021. During the meeting, nine experts from Southeast Asia provided evidence-based opinion on the vitamins and minerals supplementation, education, and self-care need during preconception, pregnancy, and lactation stages. The expert opinions underpin maternal malnutrition as a prevalent issue and discuss appropriate interventions and prevention strategies for women in Southeast Asia. The recent pandemic further impacted nutrition status, pregnancy, and neonatal health outcomes. The expert panel emphasized a need to improve existing inadequacies in education, self-care, and social support, and discussed the role of policymakers in addressing the barriers to dietary changes. As inadequacies in regular vitamins and minerals supplementation, education, and self-care for women of reproductive age implicate maternal and child health outcomes, there is an urgent need for addressing malnutrition concerns in this population. Thus, a strong partnership between policymakers, healthcare professionals, and other relevant sectors is required.
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Affiliation(s)
- Unnop Jaisamrarn
- Faculty of Medicine, Chulalongkorn
University, Bangkok, Thailand
| | | | - Christia S Padolina
- University of the East Ramon Magsaysay
Memorial Medical Center, Quezon City, Philippines
| | | | - Marlyn T Dee
- UST Faculty of Medicine and Surgery,
Manila, Philippines
| | - Premitha Damodaran
- Pantai Hospital Kuala Lumpur, Wilayah
Persekutuan Kuala Lumpur, Malaysia
| | | | - Vandana Garg
- Haleon (formerly GSK Consumer
Healthcare), Singapore, Singapore
| | - Egbert Dorado
- Haleon (formerly GSK Consumer
Healthcare), Singapore, Singapore
| | - Henglong Hu
- Haleon (formerly GSK Consumer
Healthcare), Singapore, Singapore
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12
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Iodine Availability through Iodized Salt in Portugal: 2010–2021 Sales Evolution and Distribution. Nutrients 2023; 15:nu15061324. [PMID: 36986054 PMCID: PMC10056069 DOI: 10.3390/nu15061324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/17/2023] [Accepted: 03/04/2023] [Indexed: 03/10/2023] Open
Abstract
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.
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13
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Improving Iodine Intake in Rural Haiti through Social Enterprise: A Cross-Sectional Study in the Central Plateau. Nutrients 2023; 15:nu15051092. [PMID: 36904092 PMCID: PMC10005509 DOI: 10.3390/nu15051092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Iodine intake in Haiti has increased in recent years thanks to the "Bon Sel" social enterprise approach to salt fortification and distribution by the market segment. However, it was uncertain whether this salt reached remote communities. This cross-sectional study aimed to assess the iodine status of school-age children (SAC) and women of reproductive age (WRA) in a remote region of the Central Plateau. A total of 400 children (9-13 years) and 322 women (18-44 years) were recruited through schools and churches, respectively. Urinary iodine (UIC) and urinary creatinine (UCC) concentrations were measured in spot samples, and thyroglobulin (Tg) on dried blood spots. Their iodine intake was estimated, and dietary information collected. The median (IQR) UIC in SAC was 130 µg/L (79-204, n = 399), and in WRA, 115 µg/L (73-173, n = 322). The median (IQR) Tg in SAC was 19.7 µg/L (14.0-27.6, n = 370), and in WRA, 12.2 µg/L (7.9-19.0, n = 183); 10% of SAC had Tg > 40 µg/L. Estimated iodine intake was 77 µg/day and 202 µg/day in SAC and WRA, respectively. Iodized table salt was rarely consumed, though bouillon was used daily; this is hypothesized to be a major contributor to dietary iodine intake. Iodine intake in this remote region seems to have improved considerably since the 2018 national survey, though SAC remain at risk. These results point to the potential effectiveness of using social business principles to deliver humanitarian solutions.
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Optimizing Growth: The Case for Iodine. Nutrients 2023; 15:nu15040814. [PMID: 36839172 PMCID: PMC9959690 DOI: 10.3390/nu15040814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/29/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Iodine is an essential micronutrient and component of thyroid hormone. An adequate dietary iodine intake is critical to maintain and promote normal growth and development, especially during vulnerable life stages such as pregnancy and early infancy. The role of iodine in cognitive development is supported by numerous interventional and observational studies, and when iodine intake is too low, somatic growth is also impaired. This can be clearly seen in cases of untreated congenital hypothyroidism related to severe iodine deficiency, which is characterized, in part, by a short stature. Nevertheless, the impact of a less severe iodine deficiency on growth, whether in utero or postnatal, is unclear. Robust studies examining the relationship between iodine and growth are rarely feasible, including the aspect of examining the effect of a single micronutrient on a process that is reliant on multiple nutrients for optimal success. Conversely, excessive iodine intake can affect thyroid function and the secretion of optimal thyroid hormone levels; however, whether this affects growth has not been examined. This narrative review outlines the mechanisms by which iodine contributes to the growth process from conception onwards, supported by evidence from human studies. It emphasizes the need for adequate iodine public health policies and their robust monitoring and surveillance, to ensure coverage for all population groups, particularly those at life stages vulnerable for growth. Finally, it summarizes the other micronutrients important to consider alongside iodine when seeking to assess the impact of iodine on somatic growth.
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15
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Sprayed microcapsules of minerals for fortified food. J Funct Foods 2023. [DOI: 10.1016/j.jff.2023.105401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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16
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Azevedo FM, Machamba AAL, Candido AC, Pinto CA, Lopes SO, Macedo MDS, Ribeiro SAV, Priore SE, Franceschini SDCC. Correlation Between Drinking Water and Iodine Status: a Systematic Review and Meta-analysis. Biol Trace Elem Res 2023; 201:129-138. [PMID: 35075595 DOI: 10.1007/s12011-022-03127-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/19/2022] [Indexed: 01/11/2023]
Abstract
Iodine is a micronutrient essential for maintaining normal body functioning, and the consumption depends on the distribution in the environment, and insufficient or excessive intake results in thyroid dysfunction. The purpose of this review was to evaluate the correlation between iodine concentration in drinking water and the iodine status of the population. The systematic review was conducted following the PRISMA guidelines and was registered at the International Prospective Register of Ongoing Systematic Reviews (CRD42019128308). A literature search was conducted using MEDLINE/PUBMED (National Library of Medicine), LILACS (Latin-American and Caribbean Literature on Health Sciences), and Cochrane Library, June 2021. The quality of the studies was assessed by a checklist for cross-sectional studies developed by Joanna Briggs Institute. The initial search identified 121 articles, out of which ten were included in this systematic review, and five were included in the meta-analysis. Among the articles listed, six adopted cutoff points to classify the iodine content in the drinking water. The study identified median iodine concentration in drinking water from 2.2 to 617.8 μg/L and the correlation between iodine concentration in drinking water and urinary iodine concentration was 0.92, according to meta-analysis. Furthermore, the iodine status was correlated to the iodine content in water. The determination of a cutoff point can contribute to the implementation of iodine consumption control measures.
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Affiliation(s)
- Francilene Maria Azevedo
- Departamento de Nutrição E Saúde, Universidade Federal de Viçosa (UFV), Ed. Centro de Ciências Biológicas II Avenida Peter Henry Rolfs, s/n, Campus Universitário, Viçosa, MG, 36570-900, Brazil.
| | - Almeida Abudo Leite Machamba
- Departamento de Nutrição E Saúde, Universidade Federal de Viçosa (UFV), Ed. Centro de Ciências Biológicas II Avenida Peter Henry Rolfs, s/n, Campus Universitário, Viçosa, MG, 36570-900, Brazil
| | - Aline Carare Candido
- Departamento de Nutrição E Saúde, Universidade Federal de Viçosa (UFV), Ed. Centro de Ciências Biológicas II Avenida Peter Henry Rolfs, s/n, Campus Universitário, Viçosa, MG, 36570-900, Brazil
| | - Carina Aparecida Pinto
- Departamento de Nutrição E Saúde, Universidade Federal de Viçosa (UFV), Ed. Centro de Ciências Biológicas II Avenida Peter Henry Rolfs, s/n, Campus Universitário, Viçosa, MG, 36570-900, Brazil
| | - Sílvia Oliveira Lopes
- Departamento de Nutrição E Saúde, Universidade Federal de Viçosa (UFV), Ed. Centro de Ciências Biológicas II Avenida Peter Henry Rolfs, s/n, Campus Universitário, Viçosa, MG, 36570-900, Brazil
| | - Mariana de Souza Macedo
- Departamento de Nutrição E Saúde, Universidade Federal de Viçosa (UFV), Ed. Centro de Ciências Biológicas II Avenida Peter Henry Rolfs, s/n, Campus Universitário, Viçosa, MG, 36570-900, Brazil
| | - Sarah Aparecida Vieira Ribeiro
- Departamento de Nutrição E Saúde, Universidade Federal de Viçosa (UFV), Ed. Centro de Ciências Biológicas II Avenida Peter Henry Rolfs, s/n, Campus Universitário, Viçosa, MG, 36570-900, Brazil
| | - Silvia Eloiza Priore
- Departamento de Nutrição E Saúde, Universidade Federal de Viçosa (UFV), Ed. Centro de Ciências Biológicas II Avenida Peter Henry Rolfs, s/n, Campus Universitário, Viçosa, MG, 36570-900, Brazil
| | - Sylvia do Carmo Castro Franceschini
- Departamento de Nutrição E Saúde, Universidade Federal de Viçosa (UFV), Ed. Centro de Ciências Biológicas II Avenida Peter Henry Rolfs, s/n, Campus Universitário, Viçosa, MG, 36570-900, Brazil
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17
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Zhang X, Zhang F, Li Q, Feng C, Teng W. Iodine nutrition and papillary thyroid cancer. Front Nutr 2022; 9:1022650. [PMID: 36337631 PMCID: PMC9631789 DOI: 10.3389/fnut.2022.1022650] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/30/2022] [Indexed: 09/19/2023] Open
Abstract
Thyroid cancer (TC) is the most frequent endocrine malignancy. The incidence of TC, especially papillary thyroid carcinoma (PTC), has continued to rise all over the world during the past few years, for reasons that are not entirely clear. Though the phenomenon of overdiagnosis is occurring, it is not the sole driver of the substantial increase in incidence. Lifestyle, environmental factors, or complications are considered to be potential risk factors. Among these factors, iodine is a micronutrient that is vital to thyroid function. The effect of iodine intake on PTC has been controversial for many years and the epidemiological or experimental studies provided diametrically opposite conclusions. Combining all these studies, we found that iodine nutrition may affect the overall prevalence, distribution of the histological types, and clinicopathological aggressiveness of TC, especially PTC. However, the available evidence is poor due to the impact of various internal and external related factors. Therefore, this article sums up available results from both epidemiological and experimental studies, future studies are also warranted to expound on the relationship between overall PTC prevalence and iodine intake.
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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.
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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:
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19
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Nista F, Bagnasco M, Gatto F, Albertelli M, Vera L, Boschetti M, Musso N, Ferone D. The effect of sodium restriction on iodine prophylaxis: a review. J Endocrinol Invest 2022; 45:1121-1138. [PMID: 35079975 DOI: 10.1007/s40618-022-01749-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/16/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Sodium is essential to life. However, its dietary excess is detrimental to the cardiovascular system, and sodium restriction is a crucial step in cardiovascular prevention. Iodine deficiency has been fought worldwide for decades, and substantial success has been achieved introducing the use of iodine-enriched salt. Nevertheless, areas of iodine deficiency persist around the world, both in developing and industrialized countries, and a major concern affecting dietary sodium reduction programs is represented by a possible iodine intake deficiency. There are substantial differences in the source of alimentary iodine among countries, such as iodized salt added, household tap water, seafood, or salt employed in packaged food. It is clear that a sodium-restricted diet can induce differences in terms of iodine intake, depending on the country considered. Moreover, iodine status has undergone relevant changes in many countries in the last years. METHODS Systematic review of literature evidence about the possible effects of sodium restriction on population iodine status. RESULTS To date, the available results are conflicting, depending on country, salt iodization policy, as well as time frame of data collection. However, to ensure an optimal iodine supply by salt fortification, without exceeding the current recommendation by World Health Organization for salt intake, seems to be an achievable goal. CONCLUSION A balanced approach may be obtained by an adequate iodine concentration in fortified salt and by promoting the availability of iodized salt for household consumption and food industry use. In this scenario, updated prospective studies are strongly needed.
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Affiliation(s)
- F Nista
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - M Bagnasco
- Department of Internal Medicine and Medical Specialties, President-elect of the Italian Thyroid Association, University of Genoa, Genoa, Italy
| | - F Gatto
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy.
| | - M Albertelli
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - L Vera
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - M Boschetti
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - N Musso
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - D Ferone
- Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
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20
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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.
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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
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21
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Turck D, Bohn T, Castenmiller J, de Henauw S, Hirsch-Ernst KI, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Peláez C, Pentieva K, Thies F, Tsabouri S, Vinceti M, Bresson JL, Siani A. Scientific advice related to nutrient profiling for the development of harmonised mandatory front-of-pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. EFSA J 2022; 20:e07259. [PMID: 35464873 PMCID: PMC9016720 DOI: 10.2903/j.efsa.2022.7259] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver scientific advice related to nutrient profiling for the development of harmonised mandatory front‐of‐pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. This Opinion is based on systematic reviews and meta‐analyses of human studies on nutritionally adequate diets, data from the Global Burden of Disease framework, clinical practice guidelines, previous EFSA opinions and the priorities set by EU Member States in the context of their Food‐Based Dietary Guidelines and associated nutrient/food intake recommendations. Relevant publications were retrieved through comprehensive searches in PubMed. The nutrients included in the assessment are those likely to be consumed in excess or in inadequate amounts in a majority of European countries. Food groups with important roles in European diets have been considered. The Panel concludes that dietary intakes of saturated fatty acids (SFA), sodium and added/free sugars are above, and intakes of dietary fibre and potassium below, current dietary recommendations in a majority of European populations. As excess intakes of SFAs, sodium and added/free sugars and inadequate intakes of dietary fibre and potassium are associated with adverse health effects, they could be included in nutrient profiling models. Energy could be included because a reduction in energy intake is of public health importance for European populations. In food group/category‐based nutrient profiling models, total fat could replace energy in most food groups owing to its high‐energy density, while the energy density of food groups with low or no fat content may be well accounted for by the inclusion of (added/free) sugars. Some nutrients may be included in nutrient profiling models for reasons other than their public health importance, e.g. as a proxy for other nutrients of public health importance, or to allow for a better discrimination of foods within the same food category.
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22
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Liu Z, Lin Y, Wu J, Chen D, Wu X, Lan Y, Chen Z. Is the urinary iodine/creatinine ratio applicable to assess short term individual iodine status in Chinese adults? Comparison of iodine estimates from 24-h urine and timed-spot urine samples in different periods of the day. Nutr Metab (Lond) 2022; 19:27. [PMID: 35392953 PMCID: PMC8991982 DOI: 10.1186/s12986-022-00656-6] [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: 10/01/2021] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Urinary iodine concentration (UIC) is routinely used to evaluate the population iodine status while the uniform method for the individual level assessment is uncertain. Objectives To explore the 24-h urinary iodine excretion (UIE) in five different periods of the day and the corresponding prediction equations respect by the use of creatinine-corrected UIC. Methods We collected 24-h, spot and fasting urine in five periods of the day to estimate 24-h UIE by the six different prediction equations. We compared the estimated creatinine-corrected UIC to the collected 24-h UIE and identified the most suitable equations in each period of the day. Results Among the six different prediction equations, the equation of Kawasaki T was the best to estimate the 24-h UIE by fasting urine among Chinese adults. Among the five periods of time, the equation of Knudsen N was the best to estimate the 24-h UIE in the non-morning period. Conclusion Urinary iodine status at the individual level could be estimated by different creatinine-based equations at different periods of the day.
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Affiliation(s)
- Zhuan Liu
- The Department of Endemic Diseases, Fujian Center for Disease Control and Prevention Fujian, No. 386 Chong'an Road, Fuzhou, 350012, Fujian, People's Republic of China.,The Department of Disease Control and Prevention, The First Hospital of Quanzhou Affiliated to Fujian Medical University, No.248-252, Dongjie Road, Quanzhou, 362000, Fujian, People's Republic of China
| | - Yixuan Lin
- School of Public Health, Fujian Medical University, University of New Area, No.1 Xueyuan Road, Fuzhou, 350122, Fujian, People's Republic of China
| | - Jiani Wu
- The Department of Endemic Diseases, Fujian Center for Disease Control and Prevention Fujian, No. 386 Chong'an Road, Fuzhou, 350012, Fujian, People's Republic of China
| | - Diqun Chen
- The Department of Endemic Diseases, Fujian Center for Disease Control and Prevention Fujian, No. 386 Chong'an Road, Fuzhou, 350012, Fujian, People's Republic of China
| | - Xiaoyan Wu
- The Department of Endemic Diseases, Fujian Center for Disease Control and Prevention Fujian, No. 386 Chong'an Road, Fuzhou, 350012, Fujian, People's Republic of China
| | - Ying Lan
- The Department of Endemic Diseases, Fujian Center for Disease Control and Prevention Fujian, No. 386 Chong'an Road, Fuzhou, 350012, Fujian, People's Republic of China
| | - Zhihui Chen
- The Department of Endemic Diseases, Fujian Center for Disease Control and Prevention Fujian, No. 386 Chong'an Road, Fuzhou, 350012, Fujian, People's Republic of China. .,School of Public Health, Fujian Medical University, University of New Area, No.1 Xueyuan Road, Fuzhou, 350122, Fujian, People's Republic of China.
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Milevska-Kostova N, Karanfilski B, Knowles J, Codling K, Lazarus JH. Modelling the contribution of iodised salt in industrially processed foods to iodine intake in Macedonia. PLoS One 2022; 17:e0263225. [PMID: 35089975 PMCID: PMC8797217 DOI: 10.1371/journal.pone.0263225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/14/2022] [Indexed: 11/19/2022] Open
Abstract
Evidence from the 1950s showed that Macedonia was iodine deficient. After the introduction of mandatory universal salt iodisation, the country saw a steady increase in iodine intake and decline in goitre prevalence, earning iodine-deficiency free status in 2003. Iodine status assessments in 2007 and 2016 showed adequate iodine intake among school age children (median urinary iodine concentration of 241 μg/L and 236 μg/L respectively). Macedonia participated in piloting the Iodine Global Network Programme Guidance on the use of iodised salt in industrially processed foods to better understand potential iodised salt intake from processed foods. One objective of implementation was to identify the need, opportunities, and required actions to strengthen the processed food component of the national salt iodisation policy. Data from the 2017 Household Consumption and Expenditure Survey (HCES) was used to determine household salt consumption, to identify widely-consumed, salt-containing industrially processed foods, and estimate typical daily intake of these foods. Their estimated contribution to iodine intake was estimated based on their salt content and the percentage of food industry salt that is iodised. Although the study has limitations, including a relatively small selection of foods, the results indicate potential iodine intake from iodised household salt and iodised salt in the selected foods of nearly 300% of the Estimated Average Requirement and over 220% of the Recommended Nutrient Intake for adults. This was approximately 50% of the tolerable safe Upper Level for iodine intake. The study confirmed high daily salt intake (11.2 grams from household salt only). Successful salt reduction would be expected to reduce iodine intake, however, modelling with 10% and 30% reduction implied this is unlikely to put any population group at risk of deficiency. It is recommended that implementation of salt iodisation and salt reduction policies are harmonized, alongside continued regular iodine status monitoring for different population groups.
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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.
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Melero V, Runkle I, Garcia de la Torre N, De Miguel P, Valerio J, del Valle L, Barabash A, Sanabria C, Moraga I, Familiar C, Durán A, Torrejón MJ, Diaz JA, Cuesta M, Ruiz JG, Jiménez I, Pazos M, Herraiz MA, Izquierdo N, Pérez N, Matia P, Perez-Ferre N, Marcuello C, Rubio MA, Calle-Pascual AL. The Consumption of Food-Based Iodine in the Immediate Pre-Pregnancy Period in Madrid Is Insufficient. San Carlos and Pregnancy Cohort Study. Nutrients 2021; 13:nu13124458. [PMID: 34960010 PMCID: PMC8707458 DOI: 10.3390/nu13124458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/12/2021] [Accepted: 12/12/2021] [Indexed: 12/01/2022] Open
Abstract
A pre-gestational thyroid reserve of iodine is crucial to guarantee the increased demand for thyroid hormone production of early pregnancy. An iodine intake ≥150 µg/day is currently recommended. The objective of this study was to assess average pre-gestational food-based iodine consumption in pregnant women at their first prenatal visit (<12 gestational weeks), and its association with adverse materno-fetal events (history of miscarriages, early fetal losses, Gestational Diabetes, prematurity, caesarean sections, and new-borns large/small for gestational age). Between 2015–2017, 2523 normoglycemic women out of 3026 eligible had data in the modified Diabetes Nutrition and Complication Trial (DNCT) questionnaire permitting assessment of pre-gestational food-based iodine consumption, and were included in this study. Daily food-based iodine intake was 123 ± 48 µg, with 1922 (76.1%) not reaching 150 µg/day. Attaining this amount was associated with consuming 8 weekly servings of vegetables (3.84; 3.16–4.65), 1 of shellfish (8.72; 6.96–10.93) and/or 2 daily dairy products (6.43; 5.27–7.86). Women who reached a pre-gestational intake ≥150 µg had lower rates of hypothyroxinemia (104 (17.3%)/384 (21.4%); p = 0.026), a lower miscarriage rate, and a decrease in the composite of materno-fetal adverse events (0.81; 0.67–0.98). Reaching the recommended iodine pre-pregnancy intake with foods could benefit the progression of pregnancy.
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Affiliation(s)
- Verónica Melero
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
| | - Nuria Garcia de la Torre
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Paz De Miguel
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Johanna Valerio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
| | - Laura del Valle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
| | - Ana Barabash
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Concepción Sanabria
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
| | - Inmaculada Moraga
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
| | - Cristina Familiar
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
| | - Alejandra Durán
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Maria Jose Torrejón
- Clinical Laboratory Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain;
| | - Jose Angel Diaz
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Martin Cuesta
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
| | - Jorge Grabiel Ruiz
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
| | - Inés Jiménez
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
| | - Mario Pazos
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
| | - Miguel Angel Herraiz
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (M.A.H.); (N.I.); (N.P.)
| | - Nuria Izquierdo
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (M.A.H.); (N.I.); (N.P.)
| | - Noelia Pérez
- Gynecology and Obstetrics Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (M.A.H.); (N.I.); (N.P.)
| | - Pilar Matia
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Natalia Perez-Ferre
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Clara Marcuello
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Miguel Angel Rubio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Alfonso Luis Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (V.M.); (I.R.); (N.G.d.l.T.); (P.D.M.); (J.V.); (L.d.V.); (A.B.); (C.S.); (I.M.); (C.F.); (A.D.); (J.A.D.); (M.C.); (J.G.R.); (I.J.); (M.P.); (P.M.); (N.P.-F.); (C.M.); (M.A.R.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
- Medicina II Department, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Correspondence:
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de Oliveira Campos R, Lima SCR, de Souza Braga Filho J, de Jesus JS, Anunciação SM, Martins GF, de Jesus LM, Dos Anjos Santana A, de Oliveira Souza VC, Júnior FB, Ramos HE. Association of Salt Iodization and Urine Iodine Concentration in Schoolchildren from Public Schools in Northeast of Brazil. Biol Trace Elem Res 2021; 199:4423-4429. [PMID: 33595754 DOI: 10.1007/s12011-020-02571-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
Iodine deficiency (ID) is recognized as a leading risk factor for child development. Universal salt iodization (USI) is an effective and well-established intervention strategy for the prevention of iodine deficiency disorders (IDD). To evaluate the levels of iodine in household salt samples and the urinary iodine concentration (UIC) in schoolchildren aged 6 to 14 years in public schools in Bahia, Brazil. A cross-sectional study was conducted with 1231 students (6 to 14 years old) from 17 public schools in Bahia. The iodine concentration was evaluated in salt and UIC samples. The adapted Sandell-Kolthoff reaction was used to determine urinary iodine levels. A spectrophotometer (UV-Vis) was used to examine the reduction of ceric ammonium sulfate. A standard iodine solution using a potassium iodate was used to extrapolate the iodine concentrations. The total of 665 salt samples had a median iodine concentration of 24 mg/kg (25th-75th percentile 17.0 to 28.5 mg/kg). The largest proportion (79.6%) of salt samples had iodine concentration in the recommended range, 17.6% of the samples presented iodine at a salt concentration below the established level (<15 mg/kg) and a small proportion was above it (2.8%). The general mean urinary iodine concentration (MUIC) was 217.53 ± 28.30 μg/L and median was 205.50 μg/L. The students evaluated and the salt samples analyzed showed satisfactory results, as recommended by Brazilian legislation and nutritional recommendations of the World Health Organization (WHO).
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Affiliation(s)
- Renata de Oliveira Campos
- Health and Science Center, Federal University of Bahia Reconcavo, BA, Santo Antonio de Jesus, Brazil
- Postgraduate Program in Interactive Processes of Organs and Systems, Health & Science Institute, Federal University of Bahia, Salvador, BA, Brazil
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Sara Cristina Rebouças Lima
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Jair de Souza Braga Filho
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Joice Santos de Jesus
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Sara Moreira Anunciação
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
- Health & Science Center, Federal University Recôncavo da Bahia, Santo Antonio de Jesus, Bahia, Brazil
| | - Gabriela Flor Martins
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Lorena Maia de Jesus
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Aline Dos Anjos Santana
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Vanessa Cristina de Oliveira Souza
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering of University of São Paulo, Pirassununga, São Paulo, Brazil
| | - Fernando Barbosa Júnior
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto of University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Helton Estrela Ramos
- Postgraduate Program in Interactive Processes of Organs and Systems, Health & Science Institute, Federal University of Bahia, Salvador, BA, Brazil.
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil.
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Tachibana M, Miyoshi Y, Fukui M, Onuma S, Fukuoka T, Satomura Y, Yasuda K, Kimura T, Bessho K, Ozono K. Urinary iodine and thyroglobulin are useful markers in infants suspected of congenital hypothyroidism based on newborn screening. J Pediatr Endocrinol Metab 2021; 34:1411-1418. [PMID: 34388329 DOI: 10.1515/jpem-2021-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Iodine deficiency and excess both cause thyroid dysfunction. Few data describe the relationship between iodine status and outcomes of congenital hypothyroidism (CH) in iodine-sufficient areas. We investigated urinary iodine (UI) concentration and its relationship with the clinical course of CH. METHODS We reviewed and retrospectively analyzed patients with positive newborn screening (NBS) for CH from January 2012 to June 2019 in Japan, obtaining UI and UI-urine creatinine ratio (UI/Cr), serum TSH, free T4, free T3 and thyroglobulin (Tg) at the first visit, TSH at NBS, levothyroxine (LT4) dose, and subsequent doses. A UI value of 100-299 μg/L was considered adequate. RESULTS Forty-eight patients were included. Median UI and UI/Cr were 325 μg/L and 3,930 µg/gCr, respectively. UI was high (≥300 μg/L) in 26 (54%) and low (≤99 μg/L) in 11 (23%). LT4 was administered to 34 patients. Iodine status was not related to the need for treatment. We found a U-shaped relationship between Tg and UI/Cr. Patients with high Tg (≥400 ng/mL) and abnormal UI levels required significantly lower LT4 doses (≤20 µg/day) at three years of age. Even if they showed severe hypothyroidism initially, they did not need subsequent dose increments. CONCLUSIONS Abnormal UI levels with Tg elevation were associated with lower LT4 dose requirements. The evaluation of iodine status and Tg concentrations were considered useful in patients suspected of CH.
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Affiliation(s)
- Makiko Tachibana
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoko Miyoshi
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Health and Nutrition, Faculty of Health and Nutrition, Osaka Shoin Women's University, Osaka, Japan
| | - Miho Fukui
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinsuke Onuma
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoya Fukuoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshinori Satomura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kie Yasuda
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Kimura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiko Bessho
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
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Age-related Changes in Computed Tomography Density of Thyroid Gland in Children. J Comput Assist Tomogr 2021; 46:145-149. [DOI: 10.1097/rct.0000000000001241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zimmermann MB, Andersson M. GLOBAL ENDOCRINOLOGY: Global perspectives in endocrinology: coverage of iodized salt programs and iodine status in 2020. Eur J Endocrinol 2021; 185:R13-R21. [PMID: 33989173 PMCID: PMC8240726 DOI: 10.1530/eje-21-0171] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/14/2021] [Indexed: 12/18/2022]
Abstract
Iodine deficiency has multiple adverse effects on growth and development. Diets in many countries cannot provide adequate iodine without iodine fortification of salt. In 2020, 124 countries have legislation for mandatory salt iodization and 21 have legislation allowing voluntary iodization. As a result, 88% of the global population uses iodized salt. For population surveys, the urinary iodine concentration (UIC) should be measured and expressed as the median, in μg/L. The quality of available survey data is high: UIC surveys have been done in 152 out of 194 countries in the past 15 years; in 132 countries, the studies were nationally representative. The number of countries with adequate iodine intake has nearly doubled from 67 in 2003 to 118 in 2020. However, 21 countries remain deficient, while 13 countries have excessive intakes, either due to excess groundwater iodine, or over-iodized salt. Iodine programs are reaching the poorest of the poor: of the 15 poorest countries in the world, 10 are iodine sufficient and only 3 (Burundi, Mozambique and Madagascar) remain mild-to-moderately deficient. Nigeria and India have unstable food systems and millions of malnourished children, but both are iodine-sufficient and population coverage with iodized salt is a remarkable 93% in both. Once entrenched, iodine programs are often surprisingly durable even during national crises, for example, war-torn Afghanistan and Yemen are iodine-sufficient. However, the equity of iodized salt programs within countries remains an important issue. In summary, continued support of iodine programs is needed to sustain these remarkable global achievements, and to reach the remaining iodine-deficient countries.
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Affiliation(s)
- Michael B Zimmermann
- Department of Health Sciences and Technology, Human Nutrition Laboratory, ETH Zürich, Zürich, Switzerland
- Iodine Global Network, Ottawa, Ontario, Canada
| | - Maria Andersson
- Iodine Global Network, Ottawa, Ontario, Canada
- Nutrition Research Unit, University Children’s Hospital Zürich, Zürich, Switzerland
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Prpić M, Franceschi M, Vidranski V, Andersson M, Zimmermann MB, Hunziker S, Milošević M, Kusić Z, Jukić T. IODINE STATUS AND THYROID FUNCTION IN LACTATING WOMEN AND INFANTS - A SURVEY IN THE ZAGREB AREA, CROATIA. Acta Clin Croat 2021; 60:259-267. [PMID: 34744276 PMCID: PMC8564841 DOI: 10.20471/acc.2021.60.02.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/24/2019] [Indexed: 11/24/2022] Open
Abstract
Lactating women (LW) and infants have high dietary iodine requirements and are at risk of iodine deficiency. The aim of the study was to assess iodine status and thyroid function in LW and their breastfed infants in Zagreb, Croatia. The study included 133 LW and breastfed infant pairs. Urinary iodine concentration (UIC) and thyroid function parameters were measured in all subjects. In LW, breast milk iodine concentration (BMIC) was measured and iodine and salt rich food frequency questionnaire data were collected. Results of analysis indicated that 99.2% of the LW used iodized salt in household and 20.4% used iodine-containing vitamin and mineral supplements. Median (IQR) UIC was 75 µg/L (19.0-180.5 µg/L) in LW and 234 µg/L (151.0-367.5 µg/L) in infants, whereas BMIC was 121 µg/kg (87.8-170.8 µg/kg). Multivariate regression analysis revealed BMIC to be a significant predictor of infant UIC (p<0.001). Positive correlation was recorded between LW and infant thyroid function. This was the first study in Croatia demonstrating BMIC to be a reliable biomarker of iodine status during lactation and predicting iodine intake in breastfed infants. The study confirmed that mandatory salt iodization in Croatia ensured sufficient dietary iodine for LW and optimal iodine intake for breastfed infants via breast milk.
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Affiliation(s)
| | - Maja Franceschi
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Valentina Vidranski
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Maria Andersson
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Michael B Zimmermann
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Sandra Hunziker
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Milan Milošević
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Zvonko Kusić
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Tomislav Jukić
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
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Xu T, Ren Z, Li S, Tan L, Zhang W. The relationship of different levels of high iodine and goiter in school children: a meta-analysis. Nutr Metab (Lond) 2021; 18:46. [PMID: 33941207 PMCID: PMC8094504 DOI: 10.1186/s12986-021-00563-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/12/2021] [Indexed: 11/11/2022] Open
Abstract
Background Over the past decade, the phenomenon of high urine iodine (HUI) and high water iodine (HWI) has become more common. But the risk of goiter caused by different levels of HUI and HWI remains unclear. Objectives To explore the risk of goiter development caused by HUI and HWI, and compare the risk of goiter development from different levels of high iodine. Methods The Medline, Cochrane library, Embase, China National Knowledge Infrastructure and Wan fang databases were searched for relevant population-based studies investigating the link between high iodine levels and goiter development in mainland China. Three reviewers extracted data from the included studies independently, assessing the prevalence of goiter development due to high iodine. Results Taking 100 μg/L ≤ UIC < 300 μg/L (UIC = urinary iodine concentration) as the reference group, the odds ratio (OR) regarding high iodine levels and goiter formation was 1.74 (95% CI 1.50, 2.01, P < 0.001), if the water iodine concentration (WIC) was greater than 100 μg/L, the OR between goiter development and WIC was 4.74 (95% CI 1.15, 19.46, P = 0.001). The Linear trend analysis of HUI and goiter showed that the prevalence of goiter increased with the increase of UIC (χ2 = 734.605, P < 0.001). Conclusions When the UIC ≥ 300 μg/L or the WIC ≥ 100 μg/L, the risk of goiter will increase. The higher the UIC, the greater the risk of goiter development. In order to improve the public thyroid health, we should adhere to the monitoring of urinary iodine and water iodine, and keep them at an appropriate level. Trial registration PROSPEROCR, CRD42020197620. Registered 8 August 2020, https://www.crd.york.ac.uk/PROSPERO/.
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Affiliation(s)
- Tingting Xu
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Heping District, No. 22, Qixiangtai Road, Tianjin, China
| | - Zhiyuan Ren
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Heping District, No. 22, Qixiangtai Road, Tianjin, China
| | - Shaohan Li
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Heping District, No. 22, Qixiangtai Road, Tianjin, China
| | - Long Tan
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Heping District, No. 22, Qixiangtai Road, Tianjin, China.
| | - Wanqi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Heping District, No. 22, Qixiangtai Road, Tianjin, China
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Zhang Y, Chen L, Cao S, Tian X, Hu S, Mi X, Wu Y. Iodine enrichment and the underlying mechanism in deep groundwater in the Cangzhou Region, North China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:10552-10563. [PMID: 33099732 DOI: 10.1007/s11356-020-11159-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
The lack of information on the origin and behavior of iodine in deep groundwater restricts the development and use of groundwater resources. To address this issue, the Cangzhou region in the eastern North China Plain (NCP) was selected for a case study. In total, 296 deep groundwater samples were collected, their iodine concentrations were determined, and the distribution characteristics of iodine concentrations were analyzed. Iodine concentrations ranged from < 0.002 to 1.22 mg/L, with a mean of 0.19 mg/L; 42% of the samples had high iodine concentrations. The levels were higher in the east than in the west, and most of the samples with high iodine concentrations were obtained from sites east of the boundary between the Cangxian uplift and the Huanghua depression. The weathering and dissolution of iodine-bearing minerals and the leaching of marine sediments can facilitate iodine enrichment. In the Cangxian uplift, iodine was mainly a result of the conversion of organic iodine, while in the Huanghua depression, iodine enrichment was a factor of the conversion of IO3-. Overall, the main factors for the enrichment of iodine are the sedimentary environmental and the hydrodynamic conditions. Our results provide a theoretical basis to understand the occurrence of high iodine concentrations in deep groundwater.
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Affiliation(s)
- Yuanjing Zhang
- School of Chemistry and Chemical Engineering, Northwestern Polytechnical University, Xi'an, 710072, Shaanxi Province, China
- The Institute of Hydrogeology and Environmental Geology, CAGS, Shijiazhuang, 050061, Hebei Province, China
| | - Lining Chen
- The Institute of Hydrogeology and Environmental Geology, CAGS, Shijiazhuang, 050061, Hebei Province, China
| | - Shengwei Cao
- The Institute of Hydrogeology and Environmental Geology, CAGS, Shijiazhuang, 050061, Hebei Province, China
| | - Xia Tian
- The Institute of Hydrogeology and Environmental Geology, CAGS, Shijiazhuang, 050061, Hebei Province, China
| | - Sihai Hu
- School of Chemistry and Chemical Engineering, Northwestern Polytechnical University, Xi'an, 710072, Shaanxi Province, China.
| | - Xiaohui Mi
- School of Chemistry and Chemical Engineering, Northwestern Polytechnical University, Xi'an, 710072, Shaanxi Province, China
| | - Yaoguo Wu
- School of Chemistry and Chemical Engineering, Northwestern Polytechnical University, Xi'an, 710072, Shaanxi Province, China.
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The diets of children: Overview of available data for children and adolescents. GLOBAL FOOD SECURITY 2020. [DOI: 10.1016/j.gfs.2020.100442] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Li X, Cao X, Li J, Xu J, Ma W, Wang H, Wang J, Zhang Y. Effects of high potassium iodate intake on iodine metabolism and antioxidant capacity in rats. J Trace Elem Med Biol 2020; 62:126575. [PMID: 32580100 DOI: 10.1016/j.jtemb.2020.126575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND KIO3 and KI are the most common salt iodization agents. Coincidentally, iodine exists naturally in high-iodine drinking water in the form of iodide (I-) or iodate (IO3-). As an oxidizing substance, IO3- should be reduced to I- before it can be effectively used by the thyroid. However, there is a lack of systematic studies on the metabolic process of high dose KIO3in vivo. METHODS The iodine metabolism processes in the thyroid and serum of rats after high KIO3 intake were determined using high-performance liquid chromatography-inductively coupled plasma-mass spectrometry (HPLC/ICP-MS) and arsenic cerium catalytic spectrophotometry. The changes of redox activity in the serum, thyroid, liver, and kidneys were observed by detecting total antioxidative activity (TAA). RESULTS High doses of IO3- were completely reduced to I-in vivo within 0.5 h. The level of organic bound iodine in the serum was stable, while the organic bound iodine in the thyroid increased to a plateau after intake of high-dose KIO3. The levels of total iodine and I- in serum and thyroid increased quickly, then all decreased after reaching the maximum absorption peak, and I- had two absorption peaks in serum. The thyroid blocking dose of I- was 0.5 mg/kg in rat. Additionally, high KIO3 intake did not influence the TAA in serum and other tissues. CONCLUSION The body is able to reduce and utilize high doses of KIO3 ingested through the digestive tract. The metabolism of high KIO3in vivo is characterized by two absorption process of I- in serum and the thyroid blocking effect. Moreover, a single intake of high-dose KIO3 does not affect TAA in vivo. The results suggest that such excess IO3- may have be reduced in the digestive tract before I- enters the blood.
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Affiliation(s)
- Xiuwei Li
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing 100050, China
| | - Xiaoxiao Cao
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing 100050, China.
| | - Junyan Li
- Animal Laboratory, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing 100050, China
| | - Jing Xu
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing 100050, China
| | - Wei Ma
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing 100050, China
| | - Haiyan Wang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing 100050, China
| | - Jianqiang Wang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing 100050, China
| | - Ying Zhang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing 100050, China
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Kusrini I, Farebrother J, Mulyantoro DK. Adequately iodized salt is an important strategy to prevent iodine insufficiency in pregnant women living in Central Java, Indonesia. PLoS One 2020; 15:e0242575. [PMID: 33211758 PMCID: PMC7676736 DOI: 10.1371/journal.pone.0242575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/04/2020] [Indexed: 12/24/2022] Open
Abstract
Iodine is an essential micronutrient for cognitive development and growth. Optimal intakes are critical during pregnancy. We report the iodine status and thyroid function of pregnant women living in areas previously affected by severe iodine deficiency and in longstanding iodine sufficient areas in Java, Indonesia. This cross-sectional study was conducted in Magelang, Java, from July to November 2015, in four sub-districts; two previously affected by severe iodine deficiency (area 1) and two that were iodine-sufficient (area 2). Iodine intake was estimated using median urinary iodine concentration in spot samples and mean urinary iodine excretion in 3 x 24-hour samples, thyroid hormones (thyroid-stimulating hormone and free thyroxine) were measured in venous blood samples, and iodine content of household salt samples was estimated by titration. We recruited a total of 244 pregnant women, 123 in area 1 and 121 in area 2. Urinary iodine results suggested adequate habitual iodine intakes in both areas (median urinary iodine concentration in area 1: 222 μg/l (interquartile range 189, 276 μg/l), area 2: 264 μg/l (interquartile range 172, 284 μg/l), however, the risk of inadequate intakes increased with advancing trimester (Odds Ratio = 2.59 (95% CI 1.19-5.67) and 3.85 (95% CI 1.64-9.02) at second and third trimesters, respectively). Estimated prevalence of thyroid function disorders was generally low. Salt was iodized to approximately 40 ppm and foods rich in native iodine did not contribute significantly to dietary intakes. Adequately iodized salt continues to prevent iodine insufficiency in pregnant women living in areas previously affected by severe iodine deficiency in Java, Indonesia. Monitoring and surveillance, particularly in vulnerable groups, should be emphasized to ensure iodine sufficiency prevails.
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Affiliation(s)
- Ina Kusrini
- Health Research and Development Magelang, Indonesia Ministry of Health, Magelang, Indonesia
| | - Jessica Farebrother
- Department of Women and Children’s Health, King’s College London, London, United Kingdom
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland
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Iodine status of pregnant women with obesity from inner city populations in the United Kingdom. Eur J Clin Nutr 2020; 75:801-808. [PMID: 33184453 DOI: 10.1038/s41430-020-00796-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/14/2020] [Accepted: 10/26/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Iodine is essential for foetal neurodevelopment and growth. Requirements increase in pregnancy to support increased thyroid hormone synthesis for maternal and foetal requirements, and for foetal transfer. Iodine deficiency in pregnancy is widely reported, and obesity has been associated with sub-optimal thyroid function. We evaluated iodine status and its relation with birthweight in a secondary analysis of pregnant women with obesity from multi-ethnic inner-city settings who participated in the UK Pregnancies Better Eating and Activity trial (UPBEAT). SUBJECTS/METHODS Iodine and creatinine concentrations were evaluated in spot urine samples in the second (15+0-18+6 weeks, n = 954) trimester of pregnancy. We assessed iodine status as urinary iodine concentration (UIC) and urinary iodine-to-creatinine ratio (UI/Cr) and applied WHO/UNICEF/IGN population threshold of median UIC > 150 µg/L for iodine sufficiency. Relationships between iodine status and birthweight were determined using linear and logistic regression with appropriate adjustment, including for maternal BMI and gestational age. RESULTS Median (IQR) UIC and UI/Cr in the second trimester of pregnancy were 147 µg/L (99-257) and 97 µg/g (59-165), respectively. An UI/Cr <150 μg/g was observed in 70% of women. Compared to women with UI/Cr >150 µg/g, there was a trend for women with UI/Cr <150 µg/g to deliver infants with a lower birthweight (β = -60.0 g; 95% CI -120.9 to -1.01, P = 0.05). CONCLUSIONS Iodine status of pregnant women with obesity from this cohort of UK women was suboptimal. Lower iodine status was associated with lower birthweight.
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Eriksen KG, Andersson M, Hunziker S, Zimmermann MB, Moore SE. Effects of an Iodine-Containing Prenatal Multiple Micronutrient on Maternal and Infant Iodine Status and Thyroid Function: A Randomized Trial in The Gambia. Thyroid 2020; 30:1355-1365. [PMID: 32183608 PMCID: PMC7482118 DOI: 10.1089/thy.2019.0789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Iodine supplementation is recommended to pregnant women in iodine-deficient populations, but the impact in moderate iodine deficiency is uncertain. We assessed the effect of an iodine-containing prenatal multiple micronutrient (MMN) supplement in a rural Gambian population at risk of moderate iodine deficiency. Materials and Methods: This study uses data and samples collected as a part of the randomized controlled trial Early Nutrition and Immune Development (ENID; ISRCTN49285450) conducted in Keneba, The Gambia. Pregnant women (<20 weeks gestation) were randomized to either a daily supplement of MMNs containing 300 μg of iodine or an iron and folic acid (FeFol) supplement. Randomization was double blinded (participants and investigators). The coprimary outcomes were maternal urinary iodine concentration (UIC) and serum thyroglobulin (Tg), assessed at baseline and at 30 weeks' gestation. Secondary outcomes were maternal serum thyrotropin (TSH), total triiodothyronine (TT3), total thyroxine (TT4) (assessed at baseline and at 30 weeks' gestation), breast milk iodine concentration (BMIC) (assessed at 8, 12, and 24 weeks postpartum), infant serum Tg (assessed at birth [cord], 12, and 24 weeks postpartum), and serum TSH (assessed at birth [cord]). The effect of supplementation was evaluated using mixed effects models. Results: A total of 875 pregnant women were enrolled between April 2010 and February 2015. In this secondary analysis, we included women from the MMN (n = 219) and FeFol (n = 219) arm of the ENID trial. At baseline, median (interquartile range or IQR) maternal UIC and Tg was 51 μg/L (33-82) and 22 μg/L (12-39), respectively, indicating moderate iodine deficiency. Maternal MMN supplement increased maternal UIC (p < 0.001), decreased maternal Tg (p < 0.001), and cord blood Tg (p < 0.001) compared with FeFol. Maternal thyroid function tests (TSH, TT3, TT4, and TT3/TT4 ratio) and BMIC did not differ according to maternal supplement group over the course of the study. Median (IQR) BMIC, maternal UIC, and infant Tg in the MMN group were 51 μg/L (35-72), 39 μg/L (25-64), and 87 μg/L (59-127), respectively, at 12 weeks postpartum, and did not differ between supplement groups. Conclusions: Supplementing moderately iodine-deficient women during pregnancy improved maternal iodine status and reduced Tg concentration. However, the effects were not attained postpartum and maternal and infant iodine nutrition remained inadequate during the first six months after birth. Consideration should be given to ensuring adequate maternal status through pregnancy and lactation in populations with moderate deficiency.
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Affiliation(s)
- Kamilla G. Eriksen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Address correspondence to: Kamilla G. Eriksen, PhD, Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg, Copenhagen, Denmark
| | - Maria Andersson
- Division of Gastroenterology and Nutrition, Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Sandra Hunziker
- 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
| | - Sophie E. Moore
- Department of Women and Children's Health, King's College London, London, United Kingdom
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Zou Y, Wang D, Cheng X, Ma C, Lin S, Hu Y, Yu S, Xia L, Li H, Yin Y, Liu H, Zhang D, Zhang K, Lian X, Xu T, Qiu L. Reference Intervals for Thyroid-Associated Hormones and the Prevalence of Thyroid Diseases in the Chinese Population. Ann Lab Med 2020; 41:77-85. [PMID: 32829582 PMCID: PMC7443523 DOI: 10.3343/alm.2021.41.1.77] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/23/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thyroid diseases are highly prevalent worldwide, but their diagnosis remains a challenge. We established reference intervals (RIs) for thyroid-associated hormones and evaluated the prevalence of thyroid diseases in China. METHODS After excluding outliers based on the results of ultrasound screening, thyroid antibody tests, and the Tukey method, the medical records of 20,303 euthyroid adults, who visited the Department of Health Care at Peking Union Medical College Hospital from January 2014 to December 2018, were analyzed. Thyroid-associated hormones were measured by the Siemens Advia Centaur XP analyzer. The RIs for thyroid-associated hormones were calculated according to the CLSI C28-A3 guidelines, and were compared with the RIs provided by Siemens. The prevalence of thyroid diseases over the five years was evaluated and compared using the chi-square test. RESULTS The RIs for thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total thyroxine (TT4), and total triiodothyronine (TT3) were 0.71-4.92 mIU/L, 12.2-20.1 pmol/L, 3.9-6.0 pmol/L, 65.6-135.1 nmol/L, and 1.2-2.2 nmol/L, respectively. The RIs of all hormones except TT4 differed significantly between males and females. The RIs of TSH increased with increasing age. The prevalence of overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism was 0.5% and 0.8%, 0.2% and 0.6%, 3.8% and 6.1%, and 3.3% and 4.7% in males and females, respectively, which differed from those provided by Siemens. CONCLUSIONS Sex-specific RIs were established for thyroid-associated hormones, and the prevalence of thyroid diseases was determined in the Chinese population.
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Affiliation(s)
- Yutong Zou
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Danchen Wang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Xinqi Cheng
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Chaochao Ma
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Songbai Lin
- Department of Health Care, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Yingying Hu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Songlin Yu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Liangyu Xia
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Honglei Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Yicong Yin
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Huaicheng Liu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Dianxi Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Kui Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Xiaolan Lian
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Tengda Xu
- Department of Health Care, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
| | - Ling Qiu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & China Academy of Medical Science, Beijing, China
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Current iodine nutrition status in Poland (2017): is the Polish model of obligatory iodine prophylaxis able to eliminate iodine deficiency in the population? Public Health Nutr 2020; 23:2467-2477. [PMID: 32476639 DOI: 10.1017/s1368980020000403] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The monitoring of the populations' iodine status is an essential part of successful programmes of iodine deficiency elimination. The current study aimed at the evaluation of current iodine nutrition in school children, pregnant and lactating women as a marker of the effectiveness and sustainability of mandatory iodine prophylaxis in Poland. DESIGN The following iodine nutrition indicators were used: urinary iodine concentration (UIC) (all participants) and serum thyroglobulin (pregnant and lactating women). SETTING The study was conducted in 2017 within the National Health Programme in five regions of Poland. PARTICIPANTS The research included 300 pregnant women, 100 lactating women and 1000 school children (aged 6-12 years). RESULTS In pregnant women, median UIC was 111·6 µg/l; there was no significant difference in median UIC according to the region of residence. In 8 % of pregnant women, thyroglobulin level was >40 ng/ml (median thyroglobulin 13·3 ng/ml). In lactating women, median UIC was 68·0 µg/l. A significant inter-regional difference was noted (P = 0·0143). In 18 % of breastfeeding women, thyroglobulin level was >40 ng/ml (median thyroglobulin 18·5 ng/ml). According to the WHO criteria, the investigated sample of pregnant and lactating women was iodine-deficient. Median UIC in school children was 119·8 µg/l (with significant inter-regional variation; P = 0·0000), which is consistent with iodine sufficiency. Ninety-four children (9·4 %) had UIC < 50 µg/l. CONCLUSIONS Mandatory iodisation of household salt in Poland has led to a sustainable optimisation of iodine status in the general population. However, it has failed to assure adequate iodine nutrition during pregnancy and lactation.
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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.
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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
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Rosen SR, Ovadia YS, Anteby EY, Fytlovich S, Aharoni D, Zamir D, Gefel D, Shenhav S. Low intake of iodized salt and iodine containing supplements among pregnant women with apparently insufficient iodine status - time to change policy? Isr J Health Policy Res 2020; 9:9. [PMID: 32223752 PMCID: PMC7104484 DOI: 10.1186/s13584-020-00367-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/18/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Iodine is an essential nutrient for human health throughout the life cycle, especially during early stages of intrauterine life and infancy, to ensure adequate neurocognitive development. The growing global reliance on desalinated iodine-diluted water raises the specter of increased iodine deficiency in several regions. The case of Israel may be instructive for exploring the link between iodine status and habitual iodine intake in the setting of extensive national reliance on desalinated water. The aim of this study was to explore the relationship between iodine intake, including iodized salt and iodine-containing supplements intake, and iodine status among pregnant women residing in a sub-district of Israel that is highly reliant on desalinated iodine-diluted water. METHODS A total of 134 consecutive pregnant women were recruited on a voluntary basis from the obstetrics department of the Barzilai University Medical Center during 2018. Blood was drawn from participants to determine levels of serum thyrotropin (TSH), thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and thyroglobulin (Tg). An iodine food frequency questionnaire (sIFFQ) was used to assess iodine intake from food, IS and ICS. A questionnaire was used to collect data on demographic and health characteristics. RESULTS A total of 105 pregnant women without known or reported thyroid disease were included in the study. Elevated Tg values (≥ 13 μg/L), were found among 67% of participants, indicating insufficient iodine status. The estimated iodine intake (median, mean ± SD 189, 187 ± 106 μg/d by sIFFQ) was lower than the levels recommended by the World Health Organization and the Institute of Medicine (250 vs. 220 μg/day respectively). The prevalence of iodized salt intake and iodine containing supplement intake were 4 and 52% (respectively). Values of Tg > 13 μg/L were inversely associated with compliance with World Health Organization and Institute of Medicine recommendations. CONCLUSIONS While the Israeli Ministry of Health has recommended the intake of iodized salt and iodine containing supplements, this is apparently insufficient for achieving optimal iodine status among Israeli pregnant women. The evidence of highly prevalent probable iodine deficiency in a sample of pregnant women suggests an urgent need for a national policy of iodized salt regulation, as well as guidelines to promote iodine containing supplements and adherence to them by caregivers. In addition, studies similar to this one should be undertaken in additional countries reliant on desalinated iodine-diluted water to further assess the impact of desalinization on maternal iodine status.
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Affiliation(s)
- Shani R Rosen
- School of Nutritional Science; Institute of Biochemistry, Food Science and Nutrition; Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, 76100, Rehovot, Israel.
- Obstetrics and Gynecology Department, "Barzilai" University Medical Center Ashkelon, Ashkelon, Israel.
| | - Yaniv S Ovadia
- Obstetrics and Gynecology Department, "Barzilai" University Medical Center Ashkelon, Ashkelon, Israel
- Foreign studies department; Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eyal Y Anteby
- Obstetrics and Gynecology Department, "Barzilai" University Medical Center Ashkelon, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Ashkelon, Israel
| | - Shlomo Fytlovich
- Laboratory of Clinical Biochemistry, Barzilai University Medical Center Ashkelon, Ashkelon, Israel
| | - Dorit Aharoni
- Laboratory of Clinical Biochemistry, Barzilai University Medical Center Ashkelon, Ashkelon, Israel
| | - Doron Zamir
- Faculty of Health Sciences, Ben-Gurion University of Negev, Ashkelon, Israel
- Internal Medicine Department, Barzilai University Medical Center Ashkelon, Ashkelon, Israel
| | - Dov Gefel
- School of Nutritional Science; Institute of Biochemistry, Food Science and Nutrition; Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, 76100, Rehovot, Israel
| | - Simon Shenhav
- Obstetrics and Gynecology Department, "Barzilai" University Medical Center Ashkelon, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Ashkelon, Israel
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Abstract
Iodine deficiency during pregnancy is an important global public health issue and the leading preventable cause of neurodevelopmental impairments worldwide. The effects of severe iodine deficiency during pregnancy, including adverse obstetric outcomes and decreased child intelligence quotient, have been clearly established. However, the effects of mild-to-moderate deficiency remain less well understood. Pregnant and lactating women have higher iodine requirements than other adults; intakes of 220 to 250 µg/d in pregnancy and 250 to 290 µg/d in lactation. In this article, we describe iodine metabolism, iodine requirements in pregnancy and lactation, the effects of both iodine deficiency and excessive iodine intakes in pregnancy, and the efficacy of iodine supplementation.
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Cakmak I, Marzorati M, Van den Abbeele P, Hora K, Holwerda HT, Yazici MA, Savasli E, Neri J, Du Laing G. Fate and Bioaccessibility of Iodine in Food Prepared from Agronomically Biofortified Wheat and Rice and Impact of Cofertilization with Zinc and Selenium. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2020; 68:1525-1535. [PMID: 31942799 DOI: 10.1021/acs.jafc.9b05912] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Enrichment of food crops with iodine is an option to alleviate dietary deficiencies. Therefore, foliar iodine fertilizer was applied on wheat and rice, in the presence and absence of the other micronutrients zinc and selenium. This treatment increased the concentration of iodine, as well as zinc and selenium, in the staple grains. Subsequently, potential iodine losses during preparation of foodstuffs with the enriched grains were studied. Oven-heating did not affect the iodine content in bread. Extraction of bran from flour lowered the iodine in white bread compared to wholegrain bread, but it was still markedly higher compared to the control. During subsequent in vitro gastrointestinal digestion, a higher percentage of iodine was released from foods based on extracted flour (82-92%) compared to wholegrain foods (50-76%). The foliar fertilization of wheat was found to be adequate to alleviate iodine deficiency in a population with a moderate to high intake of bread.
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Affiliation(s)
- Ismail Cakmak
- Faculty of Engineering & Natural Sciences , Sabanci University , 34956 Istanbul , Turkey
| | - Massimo Marzorati
- ProDigest BVBA , 9052 Gent , Belgium
- Center of Microbial Ecology and Technology, Faculty of Bioscience Engineering , Ghent University , 9000 Gent , Belgium
| | | | - Katja Hora
- SQM International N.V. , 2030 Antwerpen , Belgium
| | | | - Mustafa Atilla Yazici
- Faculty of Engineering & Natural Sciences , Sabanci University , 34956 Istanbul , Turkey
| | - Erdinc Savasli
- Transitional Zone Agricultural Research Institute , 26002 Eskisehir , Turkey
| | - Joachim Neri
- Laboratory of Analytical Chemistry and Applied Ecochemistry, Faculty of Bioscience Engineering , Ghent University , B-9000 Gent , Belgium
| | - Gijs Du Laing
- Laboratory of Analytical Chemistry and Applied Ecochemistry, Faculty of Bioscience Engineering , Ghent University , B-9000 Gent , Belgium
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Manousou S, Andersson M, Eggertsen R, Hunziker S, Hulthén L, Nyström HF. Iodine deficiency in pregnant women in Sweden: a national cross-sectional study. Eur J Nutr 2019; 59:2535-2545. [PMID: 31616973 PMCID: PMC7413865 DOI: 10.1007/s00394-019-02102-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/26/2019] [Indexed: 01/20/2023]
Abstract
Purpose Voluntary salt iodization at 50 mg/kg salt ensures adequate iodine nutrition in Swedish school-aged children, but iodine status in pregnant women is uncertain. Methods We conducted a cross-sectional national study of 743 pregnant women, at median gestational age of 23 weeks (IQR 9, 38), recruited from maternal health care centers. We measured: urinary iodine concentration (UIC) and urinary creatinine concentration in spot urine samples; thyroglobulin (Tg), thyroid-stimulating hormone (TSH), and total thyroxine (tT4) on dried blood spots (DBS); and thyreoperoxidase antibodies in serum samples. Data on dietary supplement use were obtained, and women were classified as supplement users (consuming multivitamins containing ≥ 150 µg iodine/day) and non-supplement users (no supplements or < 150 µg iodine/day from supplements). Results Overall median UIC [bootstrapped 95% confidence interval (CI)] was 101 µg/L (95, 108; n = 737): 149 µg/L (132, 164) in supplement users (n = 253) and 85 µg/L (79, 92) in non-supplement users (n = 440) (p < 0.001). Overall geometric mean DBS-Tg (95% CI) was 22.1 μg/L (20.8, 23.5; n = 675) and the prevalence of elevated DBS-Tg was 19%. DBS-Tg was lower in supplement users (n = 229) than in non-supplement users (n = 405) (19.1 vs 24.4 μg/L, p < 0.001). DBS-TSH, DBS-tT4, and S-TPOab positivity did not differ between the two groups. Conclusions Pregnant women in Sweden have inadequate iodine nutrition. Women not taking iodine supplements containing ≥ 150 µg iodine/day are affected by mild iodine deficiency and are at higher risk for increased thyroid activity, while maintaining euthyroidism. Iodine intake should be improved in women both before and after conception by promotion of iodized salt instead of non-iodized salt. We urge regular monitoring of iodine status in the general Swedish population, as well as in risk groups.
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Affiliation(s)
- Sofia Manousou
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. .,Frölunda Specialist Hospital, Marconigatan 31, 42144, Västra Frölunda, Sweden.
| | - Maria Andersson
- Division of Gastroenterology and Nutrition, University Children's Hospital Zurich, Eleonore Foundation, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Iodine Global Network, Ottawa, ON, Canada
| | - Robert Eggertsen
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Mölnlycke Health Care Centre, Ekdalavägen 2, 43530, Mölnlycke, Sweden
| | - Sandra Hunziker
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland
| | - Lena Hulthén
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 13, 40530, Gothenburg, Sweden
| | - Helena Filipsson Nyström
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Endocrinology, Sahlgrenska University Hospital, Gröna Stråket 8, 41345, Gothenburg, Sweden
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Gebreegziabher T, Woltamo T, Thomas DG, Kennedy TS, Stoecker BJ. Iodine supplementation of lactating women and assessment of infant visual information processing and maternal and infant thyroid function: A randomized trial. PLoS One 2019; 14:e0223348. [PMID: 31589645 PMCID: PMC6779247 DOI: 10.1371/journal.pone.0223348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022] Open
Abstract
Iodine deficiency is one of the major causes of brain damage in childhood. However, iodine supplementation during early pregnancy and lactation can prevent the ill effects of iodine deficiency. This study evaluated maternal and infant thyroid function and infant visual information processing (VIP) in the context of maternal iodine supplementation. A community-based, randomized, supplementation trial was conducted. Mother infant dyads (n = 106) were enrolled within the first 10 days after delivery to participate in this study. Mothers were randomly assigned either to receive a potassium iodide capsule (225 μg iodine) daily for 26 weeks or iodized salt weekly for 26 weeks. Maternal thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH), thyroglobulin (Tg), urinary iodine concentration (UIC), breast milk iodine concentration (BMIC) and infant T4, TSH, UIC and VIP were measured as outcome variables. At baseline, neither mothers nor infants in the two groups were significantly different in any of the biomarkers or anthropometric measurements. Maternal TSH and goiter prevalence significantly decreased following iodine supplementation. The percentage of infants who preferentially remembered the familiar face was 26% in the capsule and 51% in the I-salt groups. Infant sex, length for age Z score, BMIC, maternal education and household food security were strong predictors of novelty quotient. In conclusion supplementation daily for six months with an iodine capsule or the use of appropriately iodized salt for an equivalent time was sufficient to reduce goiter and TSH in lactating women. Higher BMIC and LAZ as well as better household food security, maternal education, and male sex predicted higher novelty quotient scores in the VIP paradigm.
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Affiliation(s)
- Tafere Gebreegziabher
- Department of Health Sciences, Central Washington University, Ellensburg, WA, United States of America
| | - Tesfaye Woltamo
- School of Environment, Gender, and Development Studies, Hawassa University, Hawassa, Ethiopia
| | - David G. Thomas
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States of America
| | - Tay S. Kennedy
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States of America
| | - Barbara J. Stoecker
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States of America
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Iodine-fortified toddler milk improves dietary iodine intakes and iodine status in toddlers: a randomised controlled trial. Eur J Nutr 2019; 59:909-919. [PMID: 30929067 DOI: 10.1007/s00394-019-01950-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE We aimed to evaluate the effectiveness of consuming iodine-fortified toddler milk for improving dietary iodine intakes and biochemical iodine status in toddlers. METHODS In a 20-week parallel randomised controlled trial, healthy 12-20-month-old children were assigned to: Fortified Milk [n = 45; iodine-fortified (21.1 µg iodine/100 g prepared drink) cow's milk], or Non-Fortified Milk (n = 90; non-fortified cow's milk). Food and nutrient intakes were assessed with 3-day weighed food records at baseline, and weeks 4 and 20. Urinary iodine concentration (UIC) was measured at baseline and 20 weeks. RESULTS At baseline, toddlers' median milk intake was 429 g/day. There was no evidence that milk intakes changed within or between the groups during the intervention. Toddlers' baseline geometric mean iodine intake was 46.9 µg/day, and the median UIC of 43 µg/L in the Fortified Milk group and 55 µg/L in the Non-Fortified Milk group indicated moderate and mild iodine deficiency, respectively, with this difference due to chance. During the intervention, iodine intakes increased by 136% (p < 0.001) and UIC increased by 85 µg/L (p < 0.001) in the Fortified Milk group compared to the Non-Fortified Milk group. The 20-week median UIC was 91 µg/L in the Fortified Milk group and 49 µg/L in the Non-Fortified Milk group. CONCLUSIONS Consumption of ≈ 1.7 cups of iodine-fortified toddler milk per day for 20 weeks can increase dietary iodine intakes and UIC in healthy iodine-deficient toddlers. This strategy alone is unlikely to provide sufficient intake to ensure adequate iodine status in toddlers at risk of mild-to-moderate iodine deficiency.
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Farebrother J, Zimmermann MB, Andersson M. Excess iodine intake: sources, assessment, and effects on thyroid function. Ann N Y Acad Sci 2019; 1446:44-65. [PMID: 30891786 DOI: 10.1111/nyas.14041] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/30/2019] [Accepted: 02/02/2019] [Indexed: 12/15/2022]
Abstract
Iodine is essential for thyroid hormone synthesis. High iodine intakes are well tolerated by most healthy individuals, but in some people, excess iodine intakes may precipitate hyperthyroidism, hypothyroidism, goiter, and/or thyroid autoimmunity. Individuals with preexisting thyroid disease or those previously exposed to iodine deficiency may be more susceptible to thyroid disorders due to an increase in iodine intake, in some cases at intakes only slightly above physiological needs. Thyroid dysfunction due to excess iodine intake is usually mild and transient, but iodine-induced hyperthyroidism can be life-threatening in some individuals. At the population level, excess iodine intakes may arise from consumption of overiodized salt, drinking water, animal milk rich in iodine, certain seaweeds, iodine-containing dietary supplements, and from a combination of these sources. The median urinary iodine concentration (UIC) of a population reflects the total iodine intake from all sources and can accurately identify populations with excessive iodine intakes. Our review describes the association between excess iodine intake and thyroid function. We outline potential sources of excess iodine intake and the physiological responses and consequences of excess iodine intakes. We provide guidance on choice of biomarkers to assess iodine intake, with an emphasis on the UIC and thyroglobulin.
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Affiliation(s)
- Jessica Farebrother
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland.,Department of Women and Children's Health, King's College London, London, UK
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland.,Iodine Global Network, Ottawa, Ontario, Canada
| | - Maria Andersson
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland.,Iodine Global Network, Ottawa, Ontario, Canada.,Division of Gastroenterology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland
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Effectiveness of increased salt iodine concentration on iodine status: trend analysis of cross-sectional national studies in Switzerland. Eur J Nutr 2019; 59:581-593. [PMID: 30843107 DOI: 10.1007/s00394-019-01927-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/06/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE Despite longstanding voluntary salt iodisation in Switzerland, data suggest inadequate iodine intake in vulnerable population groups. In response, the salt iodine concentration was increased from 20 to 25 mg/kg and we assessed the impact on iodine status. METHODS We conducted a cross-sectional national study in school-age children (n = 731), women of reproductive age (n = 353) and pregnant women (n = 363). We measured urinary iodine concentration (UIC) and urinary sodium concentration (UNaC) in spot urine samples. The current median UIC was compared with national data from 1999, 2004 and 2009. We measured TSH, total T4 and thyroglobulin (Tg) on dried blood spot samples collected in women. RESULTS The median UIC (bootstrapped 95% CI) was 137 µg/L (131, 143 µg/L) in school children, 88 µg/L (72, 103 µg/L) in women of reproductive age and 140 µg/L (124, 159 µg/L) in pregnant women. Compared to 2009, the median UIC increased modestly in school children (P < 0.001), but did not significantly change in pregnant women (P = 0.417). Estimated sodium intake exceeded the recommendations in all population groups. The prevalence of thyroid disorders in women was low, but Tg was elevated in 13% of the pregnant women. CONCLUSION Iodine intake is overall adequate in Swiss school-age children, but only borderline sufficient in pregnant and non-pregnant women, despite high salt intakes and satisfactory household coverage with iodized salt. Our findings suggest increasing the concentration of iodine in salt may not improve iodine intakes in women if iodised salt is not widely used in processed foods. REGISTRATION This trial was registered at clinicaltrials.gov as NCT02312466.
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Farebrother J, Zimmermann MB, Assey V, Castro MC, Cherkaoui M, Fingerhut R, Jia Q, Jukic T, Makokha A, San Luis TO, Wegmüller R, Andersson M. Thyroglobulin Is Markedly Elevated in 6- to 24-Month-Old Infants at Both Low and High Iodine Intakes and Suggests a Narrow Optimal Iodine Intake Range. Thyroid 2019; 29:268-277. [PMID: 30648484 DOI: 10.1089/thy.2018.0321] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND In areas with incomplete salt iodization coverage, infants and children aged 6-24 months weaning from breast milk and receiving complementary foods are at risk of iodine deficiency. However, few data exist on the risk of excessive iodine intake in this age group. Thyroglobulin (Tg) is a sensitive marker of iodine intake in school-age children and adults and may be used to estimate the optimal iodine intake range in infancy. The aim of this study was to assess the association of low and high iodine intakes with Tg and thyroid function in weaning infants. METHODS This multicenter cross-sectional study recruited infants aged 6-24 months (n = 1543; Mage = 12.2 ± 4.6 months) receiving breast milk with complementary foods, from seven countries in areas with previously documented deficient, sufficient, or excessive iodine intake in schoolchildren or pregnant women. Urinary iodine concentration (UIC) and Tg, total thyroxine, and thyrotropin were measured using dried blood spot testing. RESULTS Median UIC ranged from 48 μg/L (interquartile range 31-79 μg/L) to 552 μg/L (interquartile range 272-987 μg/L) across the study sites. Median Tg using dried blood spot testing was high (>50 μg/L) at estimated habitual iodine intakes <50 μg/day and >230 μg/day. Prevalence of overt thyroid disorders was low (<3%). Yet, subclinical hyperthyroidism was observed in the countries with the lowest iodine intake. CONCLUSIONS Tg is a sensitive biomarker of iodine intake in 6- to 24-month-old infants and follows a U-shaped relationship with iodine intake, suggesting a relatively narrow optimal intake range. Infants with low iodine intake may be at increased risk of subclinical thyroid dysfunction. In population monitoring of iodine deficiency or excess, assessment of iodine status using UIC and Tg may be valuable in this young age group.
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Affiliation(s)
- Jessica Farebrother
- 1 Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland
| | - Michael B Zimmermann
- 1 Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland
- 2 Iodine Global Network, Ottawa, Ottawa, Canada
| | - Vincent Assey
- 2 Iodine Global Network, Ottawa, Ottawa, Canada
- 3 Nutrition Services Section, Preventive Services Department; Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | | | - Mohamed Cherkaoui
- 5 Faculté des Sciences Semlalia, Université Caddi Ayyed, Marrakech, Morocco
| | - Ralph Fingerhut
- 6 Swiss Newborn Screening Laboratory and Children's Research Center; University Children's Hospital Zurich, Zurich, Switzerland
| | - Qingzhen Jia
- 7 Shanxi Institute for Prevention and Treatment of Endemic Disease, Linfen, P.R. China
| | - Tomislav Jukic
- 8 Department of Nuclear Medicine and Oncology, Sestre Milosrdnice University Hospital Center and School of Medicine, University of Zagreb, Zagreb, Croatia
- 9 Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Osijek, Croatia
| | - Anselimo Makokha
- 10 Department of Food Science, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Theofilo O San Luis
- 2 Iodine Global Network, Ottawa, Ottawa, Canada
- 11 St Luke's Medical Center, Quezon City, Manila, The Philippines
| | - Rita Wegmüller
- 12 Medical Research Council The Gambia, Keneba, The Gambia
| | - Maria Andersson
- 1 Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland
- 2 Iodine Global Network, Ottawa, Ottawa, Canada
- 13 Division of Gastroenterology and Nutrition; University Children's Hospital Zurich, Zurich, Switzerland
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Pearce EN. Iodine nutrition: recent research and unanswered questions. Eur J Clin Nutr 2018; 72:1226-1228. [PMID: 30185854 DOI: 10.1038/s41430-018-0226-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, 720 Harrison Ave, Suite 8100, Boston, MA, 02118, USA.
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