Iodine Status and Iodised Salt Consumption in Portuguese School-Aged Children: The Iogeneration Study

Associations among environmental exposure to trace elements and biomarkers of early kidney damage in the pediatric population

BACKGROUND

In kidney damage, molecular changes can be used as early damage kidney biomarkers, such as Kidney Injury Molecule-1 and Neutrophil gelatinase-associated lipocalin. These biomarkers are associated with toxic metal exposure or disturbed homeostasis of trace elements, which might lead to serious health hazards. This study aimed to evaluate the relationship between exposure to trace elements and early damage kidney biomarkers in a pediatric population.

METHODS

In Tlaxcala, a cross-sectional study was conducted on 914 healthy individuals. The participants underwent a medical review and a socio-environmental questionnaire. Five early damage kidney biomarkers were determined in the urine with Luminex, and molybdenum, copper, selenium, nickel, and iodine were measured with ICP-Mass.

RESULTS

The eGFR showed a median of 103.75 mL/min/1.73 m2. The median levels for molybdenum, copper, selenium, nickel, and iodine were 24.73 ng/mL, 73.35 ng/mL, 4.78 ng/mL, 83.68 ng/mL, and 361.83 ng/mL, respectively. Except for molybdenum and nickel, the other trace elements had significant associations with the eGFR and the early kidney damage biomarkers. Additionally, we report the association of different exposure scenarios with renal parameters.

DISCUSSION

and Conclusions. Among the explored metals, exposure to Cu and iodine impairs renal function. In contrast, Se may manifest as a beneficial metal. Interactions of Mo-Se and Mo-Iodine seem to alter the expression of NGAL; Mo-Cu for CLU; Mo-Cu, Mo-Se, and Mo-iodine for Cys-C and a-1MG; and Mo-Cu and Mo-iodine for KIM-1; were noticed. Our study could suggest that trace element interactions were associated with early kidney damage biomarkers.

Prevalence of iodine deficiency and associated factors among school-age children in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Currently, iodine deficiency has become a significant burden globally; where 2 billion people and 29.8% of school-age children are iodine deficient. It is a leading cause of preventable brain damage among children, resulting in impaired cognitive and motor development. Even though salt iodization was started to be implemented to alleviate this burden in Ethiopia, primary studies assessing iodine deficiency in the country show highly variable findings, and no systematic review was conducted to determine the pooled prevalence of the problem which makes it difficult to assess the effect of the intervention as well as to design appropriate and timely measures. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of iodine deficiency and the common factors affecting its occurrence among school-age children in Ethiopia.

METHOD

To obtain the eligible studies, databases (EMBASE, Scopus, Hinari, and PubMed), websites (Google and Google Scholar), and references of the eligible studies were searched systematically. Data were extracted using an Excel spreadsheet and analyzed using the STATA 17 version. The I2 test was used to assess heterogeneity between the studies. A DerSimonian and Laird random-effects model was used to estimate the pooled prevalence and pooled odds ratio. A funnel plot and Egger's test were used to detect publication bias.

RESULT

A total of 15 eligible studies, representing 15,611 school-age children, were included in the systematic review and meta-analysis. The pooled prevalence of iodine deficiency among school-age children in Ethiopia was found to be 58% (95%CI 44.00-77.00), while the highest prevalence was recorded in the Oromia Region, which was 64% (95% CI 49-79). Goitrogenic food consumption (adjusted odds ratio (AOR) 2.93, 95% CI 1.60-5.35) and being female (adjusted odds ratio (AOR) 1.87, 95% CI 1.43-2.44) showed a significant association with the prevalence of iodine deficiency.

CONCLUSION

Iodine deficiency among school-age children in Ethiopia was noticeably high. Goitrogenic food consumption and the sex of the child were determinant factors for the occurrence of iodine deficiency among the children. Therefore, appropriate advice should be given to households to limit goitrogenic foods in the diet of their children by giving due attention to their female children.

Adequate iodine nutrition and higher salt intake in Chinese adults aged 18-59 years recommended by international organizations

Iodine deficiency and excessive salt intake have adverse health effects. This study evaluated the iodine level and salt intake in Chinese adults aged 18-59 years after implementing the salt reduction program and compared with both the World Health Organization (WHO) and Chinese recommendations. Adults aged 18-59 years were randomly selected using multi-stage stratified random sampling in coastal urban area (CUA), non-coastal urban area (Non-CUA), coastal rural area (CRA), and non-coastal rural area (Non-CRA) of Fujian Province, China. Iodine, sodium, and creatinine concentrations in spot urine samples were measured. Knudsen equation was used to determine 24-h urinary iodine and sodium excretion. The median urinary iodine concentration (mUIC) and urinary sodium concentration (mUNaC) among adults (n = 3513) were 132.0 μg/L and 4.0 g/d, respectively. The mUIC and median daily iodine intake in CUA, Non-CUA, CRA and Non-CRA were 112.1, 127.5, 128.5, 167.5 μg/L and 189.6, 182.5, 199.4, 236.0 μg/d, respectively. The mUNaC and median daily salt intake (mDSI) in these four areas were 2.4, 2.8, 2.9, 2.9 g/L and 9.8, 10.4, 10.4, 10.6 g/d, respectively. The mUIC and DII of residents were higher in the Non-CRA than in the other three areas (P < 0.05). The UNaC and DSI of residents were lower in the CUA than in the other three areas (P < 0.05). The logistic regression demonstrated that the people living in CUA and Non-CUA consumed less salt compared with those in Non-CRA. Except for Non-CUA, the DII was lower (< 150 μg/d) among women of childbearing age in the low-salt intake group (< 5 g/d) compared with the high-salt intake group (≥ 5 g/d) (P < 0.05). Iodine nutrition in Chinese adults aged 18-59 years was sufficient, but the salt intake was substantially higher than the WHO and Chinese recommendations. Further policy implementation is needed to reduce salt intake and improve the monitoring of iodine levels in Chinese adults, especially in women of childbearing age.

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.

Trace Elements in Portuguese Children: Urinary Levels and Exposure Predictors

Exposure to environmental chemicals during developmental stages can result in several adverse outcomes. In this study, the exposure of Portuguese children to Cu, Co, I, Mo, Mn, Ni, As, Sb, Cd, Pb, Sn and Tl was evaluated through the analysis of first morning urine through ICP-MS. Furthermore, we attempted to determine possible exposure predictors. The study sample consisted of 54% girls and 46% boys, with a median age of 10 years; 61% were overweight/obese and were put on a nutritionally oriented diet. For I, half of the population was probably in deficiency status. The median urinary concentrations (μg/L) were Cu 21.9, Mo 54.6, Co 0.76, Mn 2.1, Ni 4.74, As 37.9, Sb 0.09, Cd 0.29, Pb 0.94, Sn 0.45, Tl 0.39 and I 125.5. The region was a significant predictor for Cu, Co, Ni, As and Tl. Children living in an urban area had higher urinary levels, except for Co and Ni. Age was a significant predictor for Cu, I, Mo, Mn, Ni, Sb, Cd and Sn with urinary levels of these elements decreasing with age. No sex-related differences were observed. Diet and weight group were predictors for urinary Cu, Mn, Ni, Sb and As. Significant differences were observed between the diet/weight groups for Cu, Ni, Sb and As, with the healthy diet group presenting higher values.

Iodine intake assessment in the staff of a Porto region university (Portugal): the iMC Salt trial

PURPOSE

Iodine deficiency disorder (IDD) is an ongoing worldwide recognized problem with over two billion individuals having insufficient iodine intake. School-aged children and pregnant women are often target groups for epidemiological studies, but there is a lack of knowledge on the general adult population. The aim of this study was to assess the iodine status among a Portuguese public university staff as a proxy for the adult working population.

METHODS

The population study covered 103 adults within the iMC Salt randomized clinical trial, aged 24-69 years. Urinary iodine concentration was measured spectrophotometrically using the Sandell-Kolthoff reaction. Iodine food intake was assessed using a 24-h dietary recall. The contribution of discretionary salt to the iodine daily intake was assessed through 24-h urinary sodium excretion (UIE) and potentiometric iodine determination of household salt.

RESULTS

The mean urine volume in 24 h was 1.5 L. The median daily iodine intake estimated from 24-h UIE was 113 µg/day, being lower among women (p < 0.05). Only 22% of participants showed iodine intake above the WHO-recommended cutoff (150 µg/day). The median daily iodine intake estimated from the 24-h dietary recall was 58 µg/day (51 and 68 µg/day in women and men, respectively). Dairy, including yoghurt and milk products, were the primary dietary iodine source (55%). Iodine intake estimated from 24-h UIE and 24-h dietary recall was moderately correlated (Spearman rank correlation coefficient r = 0.34, p < 0.05). The average iodine concentration in household salt was 14 mg I/kg, with 45% of the samples below the minimum threshold preconized by WHO (15 mg I/kg). The contribution of discretionary salt to the daily iodine intake was around 38%.

CONCLUSION

This study contributes new knowledge about iodine status in Portuguese working adults. The results revealed moderate iodine deficiency, particularly in women. Public health strategies and monitoring programs are needed to ensure iodine adequacy in all population groups.

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

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

Association between Elevated Iodine Intake and IQ among School Children in Portugal

The goal of this work was to examine whether elevated iodine intake was associated with adverse effects on IQ among school-age children in Portugal. In a representative sample of children from the north of the country, IQ percentiles by age (assessed with Raven’s Colored Progressive Matrices) were dichotomized to <50 (“below-average” IQs) and ≥50. Morning urine iodine concentrations, corrected for creatinine, were dichotomized to <250 µg/g and ≥250 µg/g, according to the European Commission/Scientific Committee on Food’s tolerable upper level of daily iodine intake for young children. Data were examined with Chi-square tests, logistic regression, and GLM univariate analysis. The sample (N = 1965) was classified as generally iodine-adequate (median urinary iodine concentration = 129 µg/L; median iodine-to-creatinine ratio = 126 µg/g) according to the WHO’s criteria. A greater proportion of children in the ≥250 µg/g group had below-average IQs, compared to children with less than 250 µg/g (p = 0.037), despite a sizable (though non-significant) proportion of children in the less-than-250 µg/g group also presenting below-average IQs, at the bottom of the iodine distribution (<50 µg/g). The proportion of below-average IQs increased with increasingly elevated iodine concentrations (p = 0.047). The association remained significant after the adjustment for confounders, with the elevated iodine group showing increased odds of having below-average IQs when compared with the non-elevated iodine group (OR 1.55; 95% CI 1.11−2.17; p = 0.011). Consistently, the former group presented a lower mean IQ than the latter (p = 0.006). High iodine intake was associated with lower IQs even in a population classified as iodine-adequate. These results bear on child cognition and on initiatives involving iodine supplementation.

Noncompliance to iodine supplementation recommendation is a risk factor for iodine insufficiency in Portuguese pregnant women: results from the IoMum cohort

PURPOSE

After a recommendation for iodine supplementation in pregnancy has been issued in 2013 in Portugal, there were no studies covering iodine status in pregnancy in the country. The aim of this study was to assess iodine status in pregnant women in Porto region and its association with iodine supplementation.

METHODS

A cross-sectional study was conducted at Centro Hospitalar Universitário São João, Porto, from April 2018 to April 2019. Pregnant women attending the 1st trimester ultrasound scan were invited to participate. Exclusion criteria were levothyroxine use, gestational age < 10 and ≥ 14 weeks, non-evolutive pregnancy at recruitment and non-signing of informed consent. Urinary iodine concentration (UIC) was measured in random spot urine by inductively coupled plasma-mass spectrometry.

RESULTS

Median UIC was 104 μg/L (IQR 62-189) in the overall population (n = 481) of which 19% had UIC < 50 µg/L. Forty three percent (n = 206) were not taking an iodine-containing supplement (ICS) and median UIC values were 146 µg/L (IQR 81-260) and 74 µg/L (IQR 42-113) in ICS users and non-users, respectively (p < 0.001). Not using an ICS was an independent risk factor for iodine insufficiency [adjusted OR (95% CI) = 6.00 (2.74, 13.16); p < 0.001]. Iodised salt use was associated with increased median iodine-to-creatinine ratio (p < 0.014).

CONCLUSIONS

A low compliance to iodine supplementation recommendation in pregnancy accounted for a mild-to-moderately iodine deficiency. Our results evidence the need to support iodine supplementation among pregnant women in countries with low household coverage of iodised salt. Trial registration number NCT04010708, registered on the 8th July 2019.

Increasing Seaweed Consumption in the Netherlands and Portugal and the Consequences for the Intake of Iodine, Sodium, and Exposure to Chemical Contaminants: A Risk-Benefit Study

Background: Seaweed has a high potential for nourishing the future planet. However, besides being beneficial, it also contains adverse components; this poses the question whether consumption of seaweed foods overall contributes beneficially or detrimentally to human health, and hence if their consumption should be promoted or restricted. Methods: This study evaluated the impact of substituting regular foods with seaweed foods in the diet, both in terms of nutritional quality (via iodine and sodium) and food safety (via arsenic, cadmium, lead, and mercury). Food consumption data from the Netherlands and Portugal (adults aged >18 years) were used, in which 10% of the amounts of pasta, bacon, and lettuce consumed were replaced by seaweed-derived products made from kelp (Saccharina latissima). Using Monte Carlo Risk Assessment software (MCRA), long-term nutrient intake and exposure to contaminants were assessed. The results obtained for the Netherlands and Portugal were compared with data from Japan, a country that has a high natural consumption of seaweed. Results: This low-tier risk-benefit study reveals that an increased seaweed consumption (as assessed by the 10% replacement with seaweed products) has no consequences in terms of intake of sodium and exposure to cadmium, lead, and mercury, and the associated (absence of) adverse health aspects. The alternative scenario almost doubled the mean iodine intake in the Netherlands (to 300 μg/day) and Portugal (to 208 μg/day) and increased the average exposure to arsenic levels in the Netherlands (to 1.02 μg/kg bw/day) and Portugal (to 1.67 μg/kg bw/day). Conclusion: The intake of iodine and exposure to arsenic in the Netherland and Portugal were certainly higher due to the modeled increase of seaweed foods. If seaweed consumption increases close to the 10% substitution, the public health consequences thereof may trigger further research.

Iodine supplementation: compliance and association with adverse obstetric and neonatal outcomes

OBJECTIVES

Over 1.9 billion people worldwide are living in areas estimated to be iodine insufficient. Strategies for iodine supplementation include campaigns targeting vulnerable groups, such as women in pre-conception, pregnancy and lactation. Portuguese women of childbearing age and pregnant women were shown to be mildly-to-moderately iodine deficient. As a response, in 2013, the National Health Authority (NHA) issued a recommendation that all women considering pregnancy, pregnant or breastfeeding, take a daily supplement of 150-200 μg iodine. This study explored how the iodine supplementation recommendation has been fulfilled among pregnant and lactating women in Portugal, and whether the reported iodine supplements intake impacted on adverse obstetric and neonatal outcomes.

DESIGN AND METHODS

Observational retrospective study on pregnant women who delivered or had a fetal loss in the Braga Hospital and had their pregnancies followed in Family Health Units.

RESULTS

The use of iodine supplements increased from 25% before the recommendation to 81% after the recommendation. This was mostly due to an increase in the use of supplements containing iodine only. Iodine supplementation was protective for the number of adverse obstetric outcomes (odds ratio (OR) = 0.791, P = 0.018) and for neonatal morbidities (OR = 0.528, P = 0.024) after controlling for relevant confounding variables.

CONCLUSION

The recommendation seems to have succeeded in implementing iodine supplementation during pregnancy. National prospective studies are now needed to evaluate the impact of iodine supplementation on maternal thyroid homeostasis and offspring psychomotor development and on whether the time of the beginning of iodine supplementation (how early during preconception or pregnancy) is relevant to consider.

Association of Salt Iodization and Urine Iodine Concentration in Schoolchildren from Public Schools in Northeast of Brazil

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).

Urinary minerals excretion among primary schoolchildren in Dubai-United Arab Emirates

Introduction

Urinary excretion of calcium (Ca), magnesium (Mg), phosphorus (P), iodine and fluoride is used to assess their statuses and/or the existence of metabolic abnormalities. In the United Arab Emirates (UAE), the urinary concentration of these minerals among children have not been documented.

Materials and methods

A cross-sectional study, including 593 subjects (232 boys and 361 girls), was conducted among healthy 6 to 11-year-old Emirati children living in Dubai. Non-fasting morning urine samples and anthropometrical measurements were collected and analyzed. Results were expressed as per mg of creatinine (Cr).

Results

On average, estimated Cr excretion was 17.88±3.12 mg/kg/d. Mean urinary Ca/Cr, Mg/Cr and P/Cr excretions were 0.08±0.07 mg/mg, 0.09±0.04 mg/mg, and 0.57±0.26 mg/mg respectively. Urinary excretion of Ca, Mg and P were found to decrease as age increased. Urinary excretion and predicted intake of fluoride were lower than 0.05 mg/kg body weight per day. Surprisingly, more than 50% of the children were found to have urinary iodine excretion level above adequate.

Conclusion

The Emirati schoolchildren had comparable levels of urinary Ca, Mg and P excretion to other countries. The 95% percentile allows the use of the current data as a reference value for the detection of mineral abnormalities. Fluoride excretion implies that Emirati children are at low risk of fluorosis. The level of urinary iodine excretion is slightly higher than recommended and requires close monitoring of the process of salt iodization to avoid the harmful impact of iodine overconsumption.

Assessment of the Impact of Salt Iodisation Programmes on Urinary Iodine Concentrations and Goitre Rates: A Systematic Review

Introduction

Two main strategies are currently recommended for the prevention and control of iodine deficiency in the world: implementation of universal salt iodisation programmes and permanent monitoring of iodine consumption by the population. Although iodine intake and coverage iodised salt have increased in the world population, iodine deficiency disorders (IDDs) may still be a public health problem in a few countries or communities.

Objective

To assess the impact of salt iodisation programmes on urinary iodine concentrations and goitre rates in the world population. Methodology. A systematic review based on the PRISMA method. We obtained articles from Scopus, Science Direct, MEDLINE databases, and other sources between March and April 2020, without limitation of dates. "Iodisation" AND "urinary iodine concentrations" AND "goitre" in English, Portuguese, and Spanish without filters and clinical trial, case-control, and cross-sectional studies were included in this review.

Results

Of 479 abstracts, twenty-three were eligible. Coverage on iodised salt was in the range of 16 to 98%, and 11 studies had been sufficient, whilst eight studies had adequate iodine concentration in salt and three excess. 81.8% of studies that had an adequate median of UIC had a good impact in their respective salt iodisation programmes.

Conclusion

After 18 years of salt iodisation programme implementation in the 13 countries, the majority achieved sustaining elimination of IDD whilst all had adequate median UIC; however, more detailed studies are still needed to confirm that all communities are equally protected of IDD.

Relationship between salt consumption and iodine intake in a pediatric population

PURPOSE

The World Health Organization recommends reduction of salt intake to < 5 g/day and the use of iodized salt to prevent iodine deficiency states. A high prevalence of excess salt consumption and an inadequate iodine intake has been previously shown in an Italian pediatric population. It was appropriate, therefore, to analyse in the same population the relationship occurring between salt consumption and iodine intake.

METHODS

The study population was made of 1270 children and adolescents. Estimates of salt consumption and iodine intake were obtained by measuring 24 h urinary sodium and iodine excretion.

RESULTS

The iodine intake increased gradually across quartiles of salt consumption independently of sex, age and body weight (p < 0.001). Median iodine intake met the European Food Safety Authority adequacy level only in teenagers in the highest quartile of salt consumption (salt intake > 10.2 g/day). We estimated that approximately 65-73% of the total iodine intake was derived from food and 27-35% from iodized salt and that iodized salt made actually only 20% of the total salt intake.

CONCLUSION

In this pediatric population, in face of an elevated average salt consumption, the use of iodized salt was still insufficient to ensure an adequate iodine intake, in particular among teenagers. In the perspective of a progressive reduction of total salt intake, the health institutions should continue to support iodoprophylaxis, in the context of the national strategies for salt reduction. In order for these policies to be successful, in addition to educational campaigns, it is needed that the prescriptions contained in the current legislation on iodoprophylaxis are made compelling through specific enforcement measures for all the involved stakeholders.

Multi-Step Subcritical Water Extracts of Fucus vesiculosus L. and Codium tomentosum Stackhouse: Composition, Health-Benefits and Safety

Mental health and active aging are two of the main concerns in the 21st century. To search for new neuroprotective compounds, extracts of Codium tomentosum Stackhouse and Fucus vesiculosus L. were obtained through multi-step (four step) subcritical water extraction using a temperature gradient. The safety assessment of the extracts was performed by screening pharmaceutical compounds and pesticides by UHPLC-MS/MS, and iodine and arsenic levels by ICP-MS. Although the extracts were free of pharmaceutical compounds and pesticides, the presence of arsenic and high iodine contents were found in the first two extraction steps. Thus, the health-benefits were only evaluated for the fractions obtained in steps 3 and 4 from the extraction process. These fractions were tested against five brain enzymes implicated in Alzheimer’s, Parkinson’s, and major depression etiology as well as against reactive oxygen and nitrogen species, having been observed a strong enzyme inhibition and radical scavenging activities for the step 4 fractions from both seaweed species. Regarding the variation of the chemical composition during the extraction, step 1 fractions were the richest in phenolic compounds. With the increase in temperature, Maillard reaction, caramelization and thermo-oxidation occurred, and the resulting products positively affected the antioxidant capacity and the neuroprotective effects.

A scoping review of research on policies to address child undernutrition in the Millennium Development Goals era

OBJECTIVE

The breadth of research on the impact of nutrition-specific policies to address child undernutrition is not well documented. This review maps the evidence base and identifies gaps on such policies.

DESIGN

We systematically searched Medline, Embase, PAIS Index for public policy, Scopus and Web of Science databases to identify eligible studies. Key study characteristics, including research design, type of policy, time span of policy before impact assessment, child age at outcome assessment and types of outcomes assessed, were abstracted in duplicate.

SETTING

Low-, middle- and high-income countries.

PARTICIPANTS

Studies were eligible for inclusion if they aimed to assess the impact of population-level nutrition-specific policies on undernutrition among children under 10 years of age.

RESULTS

Of the 5646 abstracts screened, eighty-three studies were included. A range of policies to address child undernutrition were evaluated; the majority were related to micronutrient fortification. Most studies were observational, reported on mandatory regional or sub-national polices, were conducted in high-income countries and evaluated policies within 1 year of implementation. A narrow set of health outcomes were evaluated, most commonly iodine deficiency disorders and neural tube defects.

CONCLUSIONS

Nutrition policies were commonly associated with improved child nutritional status and health. However, this evidence is primarily based on limited settings and on a limited number of outcomes. Further research is needed to assess the longer-term impact of a broader range of nutrition policies on child health, particularly in low- and middle-income countries.

Iodine knowledge is associated with iodine status in Portuguese pregnant women: results from the IoMum cohort study

Lack of knowledge about iodine has been suggested as a risk factor for iodine deficiency in pregnant women, but no studies have addressed this issue in Portugal. So, the aim of this study was to investigate iodine knowledge among Portuguese pregnant women and its association with iodine status. IoMum, a prospective observational study, included 485 pregnant women recruited at Centro Hospitalar e Universitário de S. João, Porto, between the 10th and 13th gestational weeks. Partial scores for knowledge on iodine importance, on iodine food sources or on iodised salt were obtained through the application of a structured questionnaire. Then, a total iodine knowledge score was calculated and grouped into low, medium and high knowledge categories. Urinary iodine concentration (UIC) was measured in spot urine samples by inductively coupled plasma MS. Of the pregnant women, 54 % correctly recognised iodine as important to neurocognitive development, 32 % were unable to identify any iodine-rich food and 71 % presented lack of knowledge regarding iodised salt. Of the women, 61 % had a medium total score of iodine knowledge. Knowledge on iodine importance during pregnancy was positively associated with iodine supplementation and also with UIC. Nevertheless, median UIC in women who correctly recognised the importance of iodine was below the cut-off for adequacy in pregnancy (150 µg/l). In conclusion, knowledge on iodine importance is positively associated with iodine status. Despite this, recognising iodine importance during pregnancy may not be sufficient to ensure iodine adequacy. Literacy-promoting actions are urgently needed to improve iodine status in pregnancy.

The association of milk and dairy consumption with iodine status in pregnant women in Oporto region

The role of milk and dairy products in supplying iodine to pregnant women is unknown in Portugal. The aim of this study was to evaluate the association between milk and dairy product consumption and the iodine status of pregnant women in the IoMum cohort of the Oporto region. Pregnant women were recruited between 10 and 13 weeks of gestation, when they provided a spot urine sample and information on lifestyle and intake of iodine-rich foods. Urinary iodine concentration (UIC) was determined by inductively coupled plasma MS. A total of 468 pregnant women (269 iodine supplement users and 199 non-supplement users) were considered eligible for analysis. Milk (but not yogurt or cheese) intake was positively associated with UIC, in the whole population (P = 0·02) and in the non-supplement users (P = 0·002), but not in the supplement users (P = 0·29). In non-supplement users, adjusted multinomial logistic regression analysis showed that milk consumption <3 times/month was associated with a five times increased risk of having UIC < 50 µg/l when compared with milk consumption ≥2 times/d (OR 5·4; 95 % CI 1·55, 18·78; P = 0·008). The highest UIC was observed in supplement users who reported consuming milk once per d (160 µg/l). Milk, but not yogurt or cheese, was positively associated with iodine status of pregnant women. Despite the observed positive association, daily milk consumption may not be sufficient to ensure adequate iodine intake in this population.

Iodine Status and Discretionary Choices Consumption Among Primary School Children, Kinondoni Tanzania

BACKGROUND

Tanzania is one of the countries where excessive iodine intake has been reported, to intervene, the identification of possible causes is required. This study aimed to assess iodine status and determine the critical contributors to excessive iodine intakes in schoolchildren aged 8-14 years.

MATERIALS AND METHODS

A total of 288 school children were randomly selected in this school-based cross-sectional study in Kinondoni municipality, Tanzania. Household salt samples were analyzed using iodine rapid field test kit while that was collected from retailers/wholesalers by iodometric titration. Spot urine samples were collected and analyzed for iodine levels using a modified microplate method following the Sandell-Kolthoff reaction. A lifestyle questionnaire was administered to schoolchildren to assess their eating frequency of discretionary foods and salts.

RESULTS

The mean salt iodine content was 53.94 ± 13.02, and over 90% of household salt was iodized. Median urinary iodine concentration (UIC) was 401 µg/L indicating excessive iodine intake, and one-third of the children had UIC >500 µg/L. Nearly all school children consume discretionary choices as snacks or part of a meal. Potato chips and fried cassava were the top two discretionary choices consumed with discretionary salt use (67.3%). Potato chips (adjusted odds ratio [AOR=9.04, 95% CI: 3.61-22.63]), fried cassava (AOR=11.08, 95% CI: 3.45-35.54) and groundnuts consumption for 4-7 days/week (AOR = 0.30 95% CI: 0.09-1.0) were significantly associated with iodine intake.

CONCLUSION AND RECOMMENDATION

The evidence of excessive iodine intakes observed in previous studies and in this study should alert the policymakers to consider adjustment of the amount of iodine added to salt along with the obligation of reducing discretionary foods and salt intake.

Development of New Canned Chub Mackerel Products Incorporating Edible Seaweeds-Influence on the Minerals and Trace Elements Composition

This study aimed to develop new canned chub mackerel products incorporating edible seaweeds (Ascophyllum nodosum, Fucus spiralis, Saccorhiza polyschides, Chondrus crispus, Porphyra sp. and Ulva sp.) harvested in the Portuguese North-Central coast, with simultaneous sensory improvement and minerals enrichment. Two processes were compared, namely the addition of seaweeds in i) the canning step and ii) in the brining step (as the replacement for salt). The concentrations of four macrominerals (Na, K, Ca and Mg), chloride, and twelve trace elements (Co, Cu, Fe, I, Li, Mn, Mo, Rb, Se, Sr, V and Zn) were determined by high-resolution continuum source flame atomic absorption spectrometry (HR-CS-FAAS) and inductively coupled plasma mass spectrometry (ICP-MS), respectively. Results showed that canned chub mackerel incorporating C. crispus and F. spiralis was found to be the preferred sensory option, also exhibiting contents enriched with Cl, Co, Cu, Fe, I, Li, Mg, Mn, Mo, Na, Rb, Se, and Sr. This effect was more pronounced when both seaweed species were added to replace the salt added in the brining step.

Validez y limitaciones de los métodos para medir la ingesta y la eliminación de sal

La hipertensión arterial (HTA) es el principal factor de riesgo cardiovascular modificable. La HTA se puede relacionar con el consumo elevado de sal. Para medir la ingesta no todas las encuestas de alimentación son comparables y válidas. El procedimiento de referencia para valorar la ingesta de sal consiste en medir la excreción urinaria de sodio en orina recolectada durante 24 h, aunque se han propuesto métodos alternativos, como las recolecciones de muestras de orina puntuales y cronometradas. En esta revisión analizamos qué instrumentos permiten valorar la ingesta de sal y cuáles de ellos han aportado una mayor validez y fiabilidad a través de los estudios de concordancia con la eliminación de sodio en orina. Las encuestas actuales de consumo de alimentos son inadecuados debido a su amplia variabilidad y relativamente baja correlación con la eliminación de sodio en orina de 24 h. Su principal limitación es la necesidad de validación en diferentes grupos poblacionales. En Atención Primaria se debería valorar la ingesta de sal mediante la utilización de cuestionarios de frecuencia de consumo que recojan alimentos con elevado contenido en sal, el consumo de platos preelaborados y preguntas que cuantifiquen la adición de sal en la preparación de alimentos o en la mesa. Para la validación de estos cuestionarios debe emplearse como gold standard la eliminación de sodio en orina de 24 h ajustada según el aclaramiento de creatinina.

Assessment of Iodine Nutritional Status of School-Age Children in Kolkata District of West Bengal State in Post-Iodation Scenario

To evaluate the state of iodine nutrition in post-iodation scenario, 3500 children were examined clinically for endemic goitre. Iodine and thiocyanate were measured in 240 urine samples; iodine content in 210 salt samples was measured. Total goitre prevalence was 6.1%. Median urinary iodine level was 21.80 µg/dl, and mean (±SD) urinary thiocyanate was 0.89 ± 0.49 mg/dl. Iodine content of only 11.9% salt samples was below recommended level of 15 ppm, 25.2% was between 15 and 30 ppm and 62.9% was >30 ppm. Iodine deficiency disorders are thus clinically mild public health problem of the studied population; however, they have no biochemical iodine deficiency. Studied population found exposed to thiocyanate load that might be the possible cause for persistence of endemic goitre. People of Kolkata should be advised to eat commonly consumed goitrogenic foods after boiling and decanting the water. Periodical monitoring and evaluation of iodine status should be mandatory.

Iodine Status in Filipino Women of Childbearing Age

BACKGROUND

Iodine deficiency (ID) has become a concern not only among pregnant women, but in women of childbearing age as well. In fact, a recent report suggested that women with moderate to severe ID may experience a significantly longer time to conceive. This study aimed to investigate iodine status in Filipino women of childbearing age.

METHODS

The iodine status of 6,194 Filipino women aged 15 to 45 years old was assessed through urinary iodine analysis. A casual spot urine sample was collected from women in households participating in the eighth National Nutrition Survey conducted by the Food and Nutrition Research Institute. The sample was analyzed using ammonium persulfate digestion followed by the Sandell-Kolthoff colorimetric reaction. A median urinary iodine concentration (UIC) of less than 100 μg/L was used to define ID.

RESULTS

The median UIC was 123 μg/L, indicative of adequate iodine nutrition; however, 21.5% of participants had a UIC below 50 μg/L. The median UIC of women who lived in urban areas (142 μg/L), belonged to the middle to richest class (>124 μg/L), had reached a college education (136 μg/L), and used iodized salt (15 ppm and above; 148 to 179 μg/L) reflected adequate iodine nutrition. ID was found to have been eliminated in the regions of Central Luzon, Eastern Visayas, Calabarzon, Mimaropa, and the National Capital, while mild ID was identified in Western Visayas, Southern and Western Mindanao, and in the Autonomous Region in Muslim Mindanao.

CONCLUSION

Pockets of ID among women of childbearing age exist in the Philippines. Proper information through education and the use of adequately iodized salt are key measures for improving the iodine status of the studied population.

Can non-fortified marine salt cover human needs for iodine?

Iodine deficiency remains a worldwide problem with two billion individuals having insufficient iodine intake. Universal salt iodisation was declared by UNICEF and WHO as a safe, cost-effective, and sustainable way to tackle iodine deficiency. In Portugal, the few studies available unravel an iodine status below the WHO guidelines for pregnant women and school-aged children. In the present study, the iodine levels of household salt consumed in Portugal was assessed, for the first time. Non-iodised (median 14 ppm) and fortified (median 48 ppm) marine salt samples showed iodine levels lower than the minimum and above the maximum threshold recommended by non-mandatory Portuguese law and WHO recommendations, respectively. This study calls attention to the fact that marine salt per se, in spite of containing a natural high amount of iodine, requires further fortification in order to be used as an effective tool to deal with iodine insufficiency.

Iodine status in Norwegian preschool children and associations with dietary iodine sources: the FINS-KIDS study

Purpose

Iodine is an essential trace element necessary for thyroid hormone synthesis. Iodine deficiency is a continuing public health problem despite international efforts to eliminate it. Studies on iodine status in preschoolers are scarce. Thus, the aims of the current study were to determine the iodine status and to investigate possible associations between urinary iodine concentration (UIC) and estimated 24 h iodine extraction (UIE) and iodine-rich foods.

Methods

Data are cross-sectional baseline data, obtained from the two-armed randomized controlled dietary trial “Fish Intervention Studies-KIDS” (FINS-KIDS) conducted in Bergen, Norway. UIC was determined by inductively coupled plasma-mass spectrometry in spot urine samples. Inadequate UIC was defined as median < 100 µg/L, and low estimated 24 h UIE as < 65 µg/day. Habitual dietary intake was assessed by a short food frequency questionnaire. Logistic regression models were used to investigate possible associations between UIC and estimated 24 h UIE and iodine-rich dietary sources including seafood, dairy products and eggs. Iodine/creatinine ratio (I/Cr) was also estimated.

Results

Urinary spot samples were obtained from 220 children. The median (interquartile range) UIC and estimated 24 h UIE was 132 (96) µg/L, and 65 (55) µg/day, respectively. The majority of children had an estimated I/Cr ratio within 100–199 µg/g. Intake of sweet milk < 2 times/day versus ≥ 2 times/day was associated with UIC < 100 µg/L (OR 2.17, 95% CI 1.07–4.38, p = 0.031). Intake of dairy products (OR 3.59, 95% CI 1.13–11.43, p = 0.031) and sweet milk (OR 2.77, 95% CI 1.37–5.61, p = 0.005) < 2 times/day versus ≥ 2 times day was associated with estimated 24 h UIE < 65 µg/day.

Conclusions

The preschoolers had adequate iodine status. Low intake of sweet milk and dairy products were associated with low iodine status.

Inadequate Iodine Intake in Population Groups Defined by Age, Life Stage and Vegetarian Dietary Practice in a Norwegian Convenience Sample

Inadequate iodine intake has been identified in populations considered iodine replete for decades. The objective of the current study is to evaluate urinary iodine concentration (UIC) and the probability of adequate iodine intake in subgroups of the Norwegian population defined by age, life stage and vegetarian dietary practice. In a cross-sectional survey, we assessed the probability of adequate iodine intake by two 24-h food diaries and UIC from two fasting morning spot urine samples in 276 participants. The participants included children (n = 47), adolescents (n = 46), adults (n = 71), the elderly (n = 23), pregnant women (n = 45), ovo-lacto vegetarians (n = 25), and vegans (n = 19). In all participants combined, the median (95% CI) UIC was 101 (90, 110) µg/L, median (25th, 75th percentile) calculated iodine intake was 112 (77, 175) µg/day and median (25th, 75th percentile) estimated usual iodine intake was 101 (75, 150) µg/day. According to WHOs criteria for evaluation of median UIC, iodine intake was inadequate in the elderly, pregnant women, vegans and non-pregnant women of childbearing age. Children had the highest (82%) and vegans the lowest (14%) probability of adequate iodine intake according to reported food and supplement intakes. This study confirms the need for monitoring iodine intake and status in nationally representative study samples in Norway.

Development of Databases on Iodine in Foods and Dietary Supplements

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