Changing Dietary Habits in Veneto Region over Two Decades: Still a Long Road to Go to Reach an Iodine-Sufficient Status

The effects of dietary iodine content, milking system, and farming practices on milk iodine concentration and quality traits

Various management practices can influence milk quality traits in dairy cattle. As an example, an increasing investment in automatic milking system to substitute milking parlors has been observed in the last 2 decades in dairy farms which could have affected certain bulk milk quality traits. What is more, milking practices can also affect certain milk parameters; as an example, teat disinfectants containing I are used in commercial farms where pre- or postdipping is performed, leading to presence of some I in the bulk milk. However, this trace mineral is also supplied in cows' diet to fulfill their nutritional requirements, partly contributing to the milk I final concentration. Therefore, the aim of this study was to evaluate the sources of variation of milk I along with other traditional milk quality traits. A total of 91 dairy farms in northeastern Italy were enrolled in the study. In each farm, diet and bulk milk samples were collected on the same day for chemical analysis. Concentration of I, in particular, was determined in both milk and feed with gold standard. Pearson correlations were calculated among the traits available for milk and diet, and a general linear model was used to test significance of fixed effects (feeding system, milking system, farming system, herd size, herd stage of lactation, and sampling month) on milk quality traits including the I concentration. In the case of milk I, diet I and presence of I-based predipping and postdipping teat disinfect application were also tested as fixed effects. Results showed a positive linear correlation between milk and diet I content (correlation coefficient [r] = 0.78). Although milk I was also positively correlated with lactose content (r = 0.25), dietary I was not correlated with other milk traits. Milk I content was significantly affected by dietary I, I-based predipping teat disinfectant application, and herd composition. Compared with conventional farms, organic farms showed lower protein content and greater somatic cell score (SCS) but similar milk I. Milking system significantly affected only lactose content and SCS of milk. Sampling month was only significant for milk urea nitrogen and herd composition, feeding system, herd size, and herd average days in milk did not modify milk gross composition and SCS. In conclusion, dietary supply of I is the main factor affecting milk I concentration and findings suggest that I level in milk can be naturally improved in dairy cows by modulating the I content in the diet administered. However, further research is needed to evaluate the effect of I-based sanitizers on milk I.

Environmental iodine as a natural iodine intake in humans and environmental pollution index: a scientometric and updated mini review

Although almost a third of the world's population is exposed to iodine deficiency (ID), and supplementation programs such as enriching table salt have been carried out or are being carried out at the global and national level, in many regions of the world, people are facing an increase in iodine intake, which is mainly due to the presence of large amounts of iodine in water, soil, agricultural products, or high consumption of seafood. Published articles were indexed in the Scopus database (from 2000 to 1 April 2023) were reviewed and analyzed by VOSviewer software. The results showed the growing interest of researchers over the last 20 years in environmental iodine intake. The results of this study can have a significant impact on the planning and policy-making of relevant officials and communities to supply the needed iodine.

Assessment of energy dispersive X-ray fluorescence (ED-XRF) for quantification of iodine in non-lyophilized milk

Iodine represents a fundamental element for human health, with particular regard to thyroid function. Dietary intake of milk naturally rich in iodine becomes of primary importance in the prevention of syndromes related to iodine deficiency. The concentration of iodine in milk is characterized by wide variability, mainly related to animal feed and level of mineral supplementation. Therefore, there is interest in the development of fast analytical techniques which are able to predict milk iodine concentration. The aim of the present study was to investigate the effectiveness of energy-dispersive X-ray fluorescence (ED-XRF) for the prediction of iodine in cow milk. Results showed moderate accuracy of the ED-XRF technique, with a coefficient of determination in cross validation of 0.60. This study represents a first contribution towards the possibility to discriminate milk with high or low iodine concentration, as an essential preliminary step for the introduction into the market of naturally fortified milk.

Iodine status and associated dietary factors among preschool children in Shanghai

Children aged 3-6 years undergo a critical stage of growth and development and are irreversibly affected by their iodine status. In order to reveal iodine status in preschool children, we detected iodine concentrations in urine samples from 1382 children aged 3-6 years based on a cross-sectional study. The median urinary iodine concentration (UIC) of children was 193.36 μg/L and was 336.96 μg/g·Cr corrected for creatinine. The study developed a link between dietary habits and iodine status, revealing that regular calcium supplement (OR: 1.79, (95% CI: 1.03, 3.12)) increased deficiency risk, while moderate seafood consumption (OR: 0.60, (95% CI: 0.38, 0.95)) decreased it. Additionally, modest intake of shellfish (OR: 0.58, (95% CI: 0.33, 1.00)), vegetables (OR: 0.61, (95% CI: 0.38, 0.97)), and eggs (OR: 0.53, (95% CI: 0.30, 0.95)) was found to protect against excess iodine. The findings underline the importance of balanced diets and various nutrients' roles in preschoolers' iodine status.

Safety and efficacy of prophylactic treatment for hyperthyroidism induced by iodinated contrast media in a high-risk population

Introduction

The use of iodinated contrast media (ICM) can lead to thyrotoxicosis, especially in patients with risk factors, such as Graves' disease, multinodular goiter, older age, and iodine deficiency. Although hyperthyroidism may have clinically relevant effects, whether high-risk patients should receive prophylactic treatment before they are administered ICM is still debated.

Aim of the study

We aimed to demonstrate the safety and efficacy of prophylactic treatment with sodium perchlorate and/or methimazole to prevent ICM-induced hyperthyroidism (ICMIH) in a population of high-risk cardiac patients. We ran a cost analysis to ascertain the most cost-effective prophylactic treatment protocol. We also aimed to identify possible risk factors for the onset of ICMIH.

Materials and methods

We performed a longitudinal retrospective study on 61 patients admitted to a tertiary-level cardiology unit for diagnostic and/or therapeutic ICM-procedures. We included patients with available records of thyroid function tests performed before and after ICM were administered, who were at high risk of developing ICMIH. Patients were given one of two different prophylactic treatments (methimazole alone or both methimazole and sodium perchlorate) or no prophylactic treatment. The difference between their thyroid function at the baseline and 11-30 days after the ICM-related procedure was considered the principal endpoint.

Results

Twenty-three (38%) of the 61 patients were given a prophylactic treatment. Thyroid function deteriorated after the administration of ICM in 9/61 patients (15%). These cases were associated with higher plasma creatinine levels at admission, higher baseline TSH levels, lower baseline FT4 levels, and no use of prophylactic treatment. The type of prophylaxis provided did not influence any onset of ICMIH. A cost-benefit analysis showed that prophylactic treatment with methimazole alone was less costly per person than the combination protocol. On multivariate analysis, only the use of a prophylactic treatment was independently associated with a reduction in the risk of ICMIH. Patients not given any prophylactic treatment had a nearly five-fold higher relative risk of developing ICMIH.

Conclusion

Prophylactic treatment can prevent the onset of ICMIH in high-risk populations administered ICM. Prophylaxis is safe and effective in this setting, especially in cardiopathic patients. Prophylaxis with methimazole alone seems to be the most cost-effective option.

Invited review: Iodine level in dairy products-A feed-to-fork overview

The theme of iodine in the dairy sector is of particular interest due to the involvement and the interconnection of several stakeholders along the dairy food chain. Iodine plays a fundamental role in animal nutrition and physiology, and in cattle it is an essential micronutrient during lactation and for fetal development and the calf's growth. Its correct use in food supplementation is crucial to guarantee the animal's recommended daily requirement to avoid excess intake and long-term toxicity. Milk iodine is fundamental for public health, being one of the major sources of iodine in Mediterranean and Western diets. Public authorities and the scientific community have made great efforts to address how and to what extent different drivers may affect milk iodine concentration. The scientific literature concurs that the amount of iodine administered through animal feed and mineral supplements is the most important factor affecting its concentration in milk of most common dairy species. Additionally, farming practices related to milking (e.g., use of iodized teat sanitizers), herd management (e.g., pasture vs. confinement), and other environmental factors (e.g., seasonality) have been identified as sources of variation of milk iodine concentration. Overall, the aim of this review is to provide a multilevel overview on the mechanisms that contribute to the iodine concentration of milk and dairy products.

Iodine Deficiency and Iodine Prophylaxis: An Overview and Update

The thyroid gland requires iodine to synthesize thyroid hormones, and iodine deficiency results in the inadequate production of thyroxine and related thyroid, metabolic, developmental, and reproductive disorders. Iodine requirements are higher in infants, children, and during pregnancy and lactation than in adult men and non-pregnant women. Iodine is available in a wide range of foods and water and is susceptible to almost complete gastric and duodenal absorption as an iodide ion. A healthy diet usually provides a daily iodine consumption not exceeding 50% of the recommended intake. Iodine supplementation is usually necessary to prevent iodine deficiency disorders (IDDs), especially in endemic areas. The community-based strategy of iodine fortification in salt has eradicated IDDs, such as endemic goiter and cretinism, in countries providing adequate measures of iodine prophylaxis over several decades in the 20th century. Iodized salt is the cornerstone of iodine prophylaxis in endemic areas, and the continuous monitoring of community iodine intake and its related clinical outcomes is essential. Despite the relevant improvement in clinical outcomes, subclinical iodine deficiency persists even in Western Europe, especially among girls and women, being an issue in certain physiological conditions, such as pregnancy and lactation, and in people consuming unbalanced vegetable-based or salt-restricted diets. Detailed strategies to implement iodine intake (supplementation) could be considered for specific population groups when iodized salt alone is insufficient to provide adequate requirements.

The effect of sodium restriction on iodine prophylaxis: a review

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.

Nutritional Iodine Status in Pregnant Women from Health Area IV in Asturias (Spain): Iodised Salt Is Enough

Background: Iodine deficiency during pregnancy may have adverse effects on the neurodevelopment of the foetus. Recent studies of pregnant women in Asturias (Spain) indicate that nutritional iodine levels are sufficient. The objective of this study was to confirm the appropriate nutritional iodine status and to analyse the influence of the ingestion of iodine on maternal urinary iodine concentration (UIC) and thyroid function. Methods: An observational study was carried out between May and June 2017 on women in the first trimester of pregnancy from Health Area IV in Asturias. The women completed a questionnaire related to their consumption of iodine and samples were taken to analyse UIC and thyroid function. Results: Three hundred and eighteen pregnant women were involved. Of these, 51.10% used iodised salt, 48.90% consumed ≥ 2 servings of dairy products daily and 87.08% took iodine supplements. The median UIC was 171.5 μg/L (116–265 μg/L) and 60.41% of women had UIC ≥ 150 μg/L. Multivariate logistic regression analysis demonstrated that iodised salt had a protective effect on UIC < 150 μg/L (odds ratio (OR) 0.404 (0.237–0.683), p = 0.001), but not iodine supplements (OR 0.512 (0.240–1.085), p = 0.080). The average level of thyroid stimulating hormone (TSH) was 2.26 ± 0.94 mIU/L; 68.40% of pregnant women taking iodine supplements had TSH < 2.5 mIU/L compared to 30.00% of those who were not taking supplements (p = 0.031). Conclusions: The pregnant women in our health area are maintaining appropriate nutritional iodine levels. The consumption of iodised salt protects against iodine deficiency; thus, iodine supplements should be taken on an individualised basis.

Iodine Intake Estimated by 24 h Urine Collection in the Italian Adult Population: 2008-2012 Survey

Monitoring the population iodine status is essential for iodine deficiency eradication. This study assessed the average dietary iodine intake and the iodine status of a random sample of the Italian general adult population. The study population included 2378 adults aged 35–79 years (1229 men and 1149 women) from all 20 Italian regions, participating in the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 2008–2012 (OEC/HES), and were examined for iodine intake in the framework of the MINISAL-GIRCSI Programme. Dietary iodine intake was assessed by the measurement of 24 h urinary iodine excretion. The median daily iodine intake of the whole population was lower (96 µg/d, interquartile range 51–165) than the daily adequate iodine intake according to both EFSA and WHO recommendation (150 µg/d), with a significantly lower value among women (85 µg/d) compared with men (111 µg/d). Iodine intake diminished with age and increased with BMI (body mass index) in male but not in female participants, without achieving the adequate intake in any sex, age, or BMI category. In this random sample of Italian general adult population examined in 2008–2012, iodine intake still remained lower than the recommended values despite the implementation of a strategy of iodoprophylaxis based on salt iodization in 2005. These data represent a valuable reference for future monitoring of iodine status in our country.

Short communication: Iodine content in bovine milk is lowly heritable and shows limited genetic variation

Milk and dairy products are considered important sources of iodine in several countries. Despite this, there is a paucity of studies that have investigated sources of variation of milk iodine, especially on a large scale. So far, it is not clear if milk iodine content could be increased through breeding in dairy cattle. Recently, a mid-infrared spectroscopy prediction model has been developed for an indirect quantification of iodine content in cow milk, as it is a faster and less expensive method that allows the prediction at population level. The model has coefficient of determination and ratio of performance to deviation in external validation of 0.57 and 1.44, respectively, and it was used in the present study to predict the iodine content from historical milk spectral data to investigate phenotypic and genetic aspects in the Italian Holstein cattle. Based on the accuracy of the model, the prediction was interpreted as proxy for the real milk iodine concentration (IOD_P). The data set comprised 33,776 test-day records with IOD_P from 4,072 cows. Data of IOD_P were transformed through natural logarithm to achieve a normal distribution. The effect of parity, lactation stage, and month of sampling were investigated, and genetic parameters were estimated using a test-day repeatability animal model. Milk IOD_P decreased with parities and was the lowest in early lactation. Heritability of IOD_P was low (0.025) and it was positively genetically correlated with milk yield and negatively with fat content. Results suggested that it would be challenging to directly improve this trait through breeding strategies in dairy cattle, because IOD_P is mainly affected by temporary environmental factors and thus, cannot be easily improved through genetics. Although preliminary, findings of this study suggest that it would be more convenient to develop feeding and management strategies to drive milk iodine level than to put efforts and resources into breeding strategies. Further studies should validate IOD_P as an indicator trait of milk iodine content by improving reference data and estimating genetic correlation between predicted and measured values.

Iodine Intake in Norwegian Women and Men: The Population-Based Tromsø Study 2015-2016

Ensuring sufficient iodine intake is a public health priority, but we lack knowledge about the status of iodine in a nationally representative population in Norway. We aimed to assess the current iodine status and intake in a Norwegian adult population. In the population-based Tromsø Study 2015–2016, 493 women and men aged 40–69 years collected 24-h urine samples and 450 participants also completed a food frequency questionnaire (FFQ). The 24-h urinary iodine concentration (UIC) was analyzed using the Sandell–Kolthoff reaction on microplates followed by colorimetric measurement. Iodine intake was estimated from the FFQ using a food and nutrient calculation system at the University of Oslo. The mean urine volume in 24 h was 1.74 L. The median daily iodine intake estimated (UIE) from 24-h UIC was 159 µg/day (133 and 174 µg/day in women and men). The median daily iodine intake estimated from FFQ was 281 µg/day (263 and 318 µg/day in women and men, respectively). Iodine intake estimated from 24-h UIC and FFQ were moderately correlated (Spearman rank correlation coefficient r = 0.39, p < 0.01). The consumption of milk and milk products, fish and fish products, and eggs were positively associated with estimated iodine intake from FFQ. In conclusion, this shows that iodine intake estimated from 24-h UIC describes a mildly iodine deficient female population, while the male population is iodine sufficient. Concurrent use of an extensive FFQ describes both sexes as iodine sufficient. Further studies, applying a dietary assessment method validated for estimating iodine intake and repeated individual urine collections, are required to determine the habitual iodine intake in this population.