Recent data on iodine excretion in the urine of adults, adolescents and newborns and on the iodine content of breast milk indicate a high prevalence of iodine deficiency (moderate in many cases and severe in a few) in many European countries. These cases may manifest as subclinical hypothyroidism in neonates and as goitre in adolescents and adults. Lack of iodine causes not only goitre, but also mental deficiency, hearing loss and other neurological impairments, and short stature due to thyroid insufficiency during fetal development and childhood. Although iodinated salt is available theoretically in most countries where it is needed, its quality and share of the market are often unsatisfactory. In many countries where only household salt is iodinated the iodine content has been set too low owing to an overestimation of household salt consumption. Governments are therefore urged to pass legislation and provide means for efficient iodination of salt wherever this is necessary.
Universal salt iodization (USI) was adopted in Madagascar in 1995 within the framework of a worldwide policy to eliminate iodine deficiency disorders. Despite early USI adoption, there are no representative data on the iodine status of the Malagasy population. The aims of this study were to determine the iodine status of the Malagasy population and to assess the use of adequately iodized salt among households. We randomly sampled women of reproductive age (WRA) using a national, two‐stage, stratified cross‐sectional survey in 2014. Casual urine from WRA and salt samples from the household containing WRA were collected to measure urinary iodine concentration (UIC) and to assess household salt iodine content. Data from 1,721 WRA in 1,128 households were collected and analysed. The national median UIC was 46 μg L(−1) (interquartile range [IQR]: 13–98 μg L(−1)), indicating a moderate iodine deficiency. The median UIC was 53 μg L(−1) (IQR: 9–89 μg L(−1)) in pregnant women and 46 μg L(−1) (IQR: 13–98 μg L(−1)) in non‐pregnant women. The national median iodine concentration of household salt was 10 mg kg(−1) (IQR: 6.3–15.8 mg kg(−1)) and 26.2% (95% CI [22.1, 31.0]) of households containing WRA used adequately iodized salt (≥15 mg kg(−1)). Women living in households with adequately iodized salt had higher median UIC (72 vs. 50 μg L(−1)). Iodine status was significantly lower among women from low socio‐economic households. Madagascar's USI program needs to be revitalized. Implementing strategies to provide adequately iodized salt and enhancing iodized salt legislation to prevent severe complications resulting from iodine deficiency in the Malagasy population are essential.
This is the peer reviewed version of the following article: "First national iodine survey in Madagascar demonstrates iodine deficiency", which has been published in final form at https://doi.org/10.1111/mcn.12717. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. ; International audience ; Universal salt iodization (USI) was adopted in Madagascar in 1995 within the framework of a worldwide policy to eliminate iodine deficiency disorders. Despite early USI adoption, there are no representative data on the iodine status of the Malagasy population. The aims of this study were to determine the iodine status of the Malagasy population and to assess the use of adequately iodized salt among households. We randomly sampled women of reproductive age (WRA) using a national, two-stage, stratified cross-sectional survey in 2014. Casual urine from WRA and salt samples from the household containing WRA were collected to measure urinary iodine concentration (UIC) and to assess household salt iodine content. Data from 1721 WRA in 1128 households were collected and analyzed. The national median UIC was 46 μg/L (interquartile range (IQR): 13-98 μg/L), indicating a moderate iodine deficiency. The median UIC was 53 μg/L (IQR: 9-89 μg/L) in pregnant women and 46 μg/L (IQR: 13-98 μg/L) in non-pregnant women. The national median iodine concentration of household salt was 10 mg/kg (IQR: 6.3-15.8 mg/kg) and 26.2% (95% CI: 22.1-31.0%) of households containing WRA used adequately iodized salt (≥15 mg/kg). Women living in households with adequately iodized salt had higher median UIC (72 μg/L vs. 50 μg/L). Iodine status was significantly lower among women from low socio-economic households. Madagascar's USI program needs to be revitalized. Implementing strategies to provide adequately iodized salt and enhancing iodized salt legislation to prevent severe complications resulting from iodine deficiency in the Malagasy population are essential.
This is the peer reviewed version of the following article: "First national iodine survey in Madagascar demonstrates iodine deficiency", which has been published in final form at https://doi.org/10.1111/mcn.12717. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. ; International audience ; Universal salt iodization (USI) was adopted in Madagascar in 1995 within the framework of a worldwide policy to eliminate iodine deficiency disorders. Despite early USI adoption, there are no representative data on the iodine status of the Malagasy population. The aims of this study were to determine the iodine status of the Malagasy population and to assess the use of adequately iodized salt among households. We randomly sampled women of reproductive age (WRA) using a national, two-stage, stratified cross-sectional survey in 2014. Casual urine from WRA and salt samples from the household containing WRA were collected to measure urinary iodine concentration (UIC) and to assess household salt iodine content. Data from 1721 WRA in 1128 households were collected and analyzed. The national median UIC was 46 μg/L (interquartile range (IQR): 13-98 μg/L), indicating a moderate iodine deficiency. The median UIC was 53 μg/L (IQR: 9-89 μg/L) in pregnant women and 46 μg/L (IQR: 13-98 μg/L) in non-pregnant women. The national median iodine concentration of household salt was 10 mg/kg (IQR: 6.3-15.8 mg/kg) and 26.2% (95% CI: 22.1-31.0%) of households containing WRA used adequately iodized salt (≥15 mg/kg). Women living in households with adequately iodized salt had higher median UIC (72 μg/L vs. 50 μg/L). Iodine status was significantly lower among women from low socio-economic households. Madagascar's USI program needs to be revitalized. Implementing strategies to provide adequately iodized salt and enhancing iodized salt legislation to prevent severe complications resulting from iodine deficiency in the Malagasy population are essential.
Abstract Background Iodine deficiency disorders (IDD) and their attendant effects on human development, perinatal mortality and intellectual dysfunction are a major nutrition and public health problem worldwide, with Ethiopia counted among the top iodine-deficient countries. Despite the passing of new legislation in 2011 under the National Nutrition Programme and subsequent increase in the availability of iodized salt, the eradication of IDD in Ethiopia remains a significant challenge. This paper critically reviews the recent published data on iodine-status in Ethiopia as a basis for formulating future research and policy initiatives. Methods We performed a structural search for IDD studies in Ethiopia for all population groups published after the year 2000. Results Twenty four studies reported national and regional data giving a national total goiter rate above 35.8 % in women, with rates close to 60 % in four regional states, and an estimated prevalence of IDD ranging from 0.4 to 66.3 % depending on region. The prevalence of goiter in children was 35 %, but was as high as 71 % in the South Nations Nationalities and Peoples Region. The problem persists despite the widespread availability of iodized salt. Conclusions Eradicating IDD in Ethiopia will require concerted efforts including the close evaluation of intervention programs through regular, nation-wide monitoring of IDD and salt-iodization coverage. Salt iodization became mandatory in Ethiopia in 2011 and despite significant progress, the current level of eradicating IDD could be improved. Prospective and controlled intervention studies to evaluate biomarkers of thyroid function and cognitive outcomes will help to monitor and improve eradication efforts. Ascertaining and improving health and development in the most vulnerable populations of women and children is a priority that may be advanced through a greater investment in outreach and education.
BACKGROUND: Iodine deficiency disorders (IDD) and their attendant effects on human development, perinatal mortality and intellectual dysfunction are a major nutrition and public health problem worldwide, with Ethiopia counted among the top iodine-deficient countries. Despite the passing of new legislation in 2011 under the National Nutrition Programme and subsequent increase in the availability of iodized salt, the eradication of IDD in Ethiopia remains a significant challenge. This paper critically reviews the recent published data on iodine-status in Ethiopia as a basis for formulating future research and policy initiatives. METHODS: We performed a structural search for IDD studies in Ethiopia for all population groups published after the year 2000. RESULTS: Twenty four studies reported national and regional data giving a national total goiter rate above 35.8 % in women, with rates close to 60 % in four regional states, and an estimated prevalence of IDD ranging from 0.4 to 66.3 % depending on region. The prevalence of goiter in children was 35 %, but was as high as 71 % in the South Nations Nationalities and Peoples Region. The problem persists despite the widespread availability of iodized salt. CONCLUSIONS: Eradicating IDD in Ethiopia will require concerted efforts including the close evaluation of intervention programs through regular, nation-wide monitoring of IDD and salt-iodization coverage. Salt iodization became mandatory in Ethiopia in 2011 and despite significant progress, the current level of eradicating IDD could be improved. Prospective and controlled intervention studies to evaluate biomarkers of thyroid function and cognitive outcomes will help to monitor and improve eradication efforts. Ascertaining and improving health and development in the most vulnerable populations of women and children is a priority that may be advanced through a greater investment in outreach and education.
The prevention of iodine deficiency through salt iodization has been recognized as a global success story, and China stands at the forefront of this achievement with one of the most successful programs in the world. High level political commitment, national mandatory legislation, a state-managed edible salt industry and a complex and highly sophisticated surveillance system have facilitated the success of the program. Challenges have arisen however, including: (i) concern that adequate iodine status in pregnant women cannot be achieved without causing above adequate iodine intakes in children; (ii) declining iodine intake as a result of reductions in salt consumption and increased consumption of processed foods, which may not be made with iodized salt; (iii) the existence of areas with high iodine content in the water; and (iv) declines in household use of iodized salt due to concerns about excess iodine intake and thyroid disease. This article reviews the achievements and challenges of the Chinese Iodine Deficiency Disorders (IDD) Elimination Program and reflects on lessons learned and implications for other national salt iodization programs.
Iodine deficiency disorders (IDDs) constitute a significant public health problem globally. In India, the entire population is prone to IDDs due to deficiency of iodine in the soil of the sub-continent and thus both animal and plant source food grown on the iodine-deficient soil. IDDs encompass the spectrum of disability and disease and include goitre, cretinism, hypothyroidism, abortion, stillbirth, brain damage, learning disabilities, mental retardation, psychomotor defects, hearing and speech impairment. Iodine deficiency is known to be the single largest cause of preventable brain damage. IDDs with their causal association with brain development, cognition, and learning disabilities impair the human resource development and progress of the country. The children born in iodine-deficient regions on an average have 13.5 intelligence quotient (IQ) points lesser than children born in iodine-sufficient regions. IDD control programme in India is a public health success story, with 92 per cent of the population consuming iodized salt. The partnership between government agencies, academic institutions, salt industry, development agencies and civil society has been key to achieve this success story. The sustainable elimination of iodine deficiency in India is within reach, what is required is accelerated and coordinated effort by all key stakeholder at national and State level.
Abstract In the absence of a mandatory salt iodisation programme, two nationwide cross-sectional cluster surveys revealed persisting iodine deficiency among Latvian schoolchildren during the spring season and a noteworthy iodine deficiency in pregnant women in Latvia; these deficiencies warrant intervention. The consequences of mild-to-moderate iodine deficiency during pregnancy and lactation can adversely affect foetal brain development. Data from a Latvian population survey revealed the consumption of approximately 100 μg of iodine per day through foods and iodised salt. Therefore, strategies to increase the consumption of iodine-containing products should be implemented, particularly for children. In addition, to meet the increased iodine requirement during pregnancy, pregnant women should take daily supplements containing 150 μg iodine from the earliest time possible. All women of childbearing age should be advised to increase their dietary iodine intake by using iodised table salt and iodine-rich products: seafood, milk and milk products. For women with pre-existing thyroid pathologies, the medical decision should be considered on a case-by-case basis. Urinary iodine concentration monitoring among schoolchildren and pregnant women and neonatal thyrotropin registry analysis every five years would be an appropriate strategy for maintaining iodine intake within the interval that prevents iodine deficiency disorders.
This study, which covered all the ten provinces of Zambia, aimed at assessing the Iodine Deficiency prevalence, and access to adequately iodised salt in the country. It was carried out in 2011 and entailed determining the urinary iodine concentration (UIC) among 1, 283 school children from 30 selected schools and the amount of iodine in 875 salt samples collected from the households of the children. The iodine concentration was also determined in salt samples collected from 365 salt traders near the selected schools. Each of the salt traders was requested to complete a questionnaire. In addition, a questionnaire was administered to 75 teachers from the selected schools. The Urinary Iodine Concentration (UIC) was assayed by the Sandell-Kolthoff reaction, after digesting the urine with Ammonium Persulfate at 100oC. The iodine concentration in the salt was determined using the quantitative titrimetric method. The data for the UIC and salt iodine plus data from questionnaires were analysed using Excel and Statistical Package for Social Sciences version 15 (SPSS 15). The median urinary iodine concentration (MUIC) was 248.5μg/l and the Interquartile Range (IQR) was 145 – 380 μg/L. These results indicated that Iodine Deficiency was not of public health concern among children in Zambia at the time of this study. However, the proportion of households with access to adequately iodised salt (15-40 ppm iodine) was 53%, which is below the recommended target of 90% or more household coverage. Results from questionnaires indicated that the challenges faced by the Zambian Government in attaining Universal Salt Iodisation (USI) include: (i) lack of sustainability of local salt iodisation in local salt producing areas, (ii) weak enforcement of the law on salt iodisation, (iii) poor packaging and storage of salt by traders and households, (iv) limited knowledge of the link between lack of iodine in salt and iodine deficiency, and (v) relatively high cost of imported iodised salt in local salt producing areas.Keywords: Iodized, Salt, Iodine Deficiency, Universal Salt Iodisation, Zambia
On April 18, 2018 the EUthyroid consortium released the Krakow Declaration on Iodine in response to the increasing concern about the deteriorating commitment of policymakers to address public health strategies against iodine deficiency disorders (IDD) in the European populations. Regulators and policymakers should harmonize obligatory Universal Salt Iodization to ensure free trade of fortified foodstuffs in Europe. Similarly, iodized animal feed requires regulatory approval to ensure free trade within the EU. National governments and public health authorities have to perform harmonized monitoring and evaluation of fortification programs at regular intervals to ensure optimal iodine supply to the population. Scientists, together with public health care workers, patient organizations, industry, and the public should support measures necessary to ensure that IDD prevention programs are sustainable, as appropriate within a rapidly changing environment and further social awareness of the issue. The declaration defines measures and responsibilities to optimize IDD prevention.
O iodo é o componente essencial das hormonas tiroideias triiodotironina (T3) e tiroxina (T4). Estas hormonas são fundamentais para o metabolismo celular em todas as células do corpo. Na fase embriológica da vida as hormonas tiroideias são ainda fundamentais para o desenvolvimento normal de todos os órgãos sendo particularmente importantes para o desenvolvimento cerebral. Globalmente o défice de iodo afecta em excesso de 2 biliões de pessoas de pelo menos 130 países, entre as quais se estima que estão 266 milhões de crianças em idade escolar. O défice de iodo está associado com problemas de desenvolvimento cognitivo, comprovados défices nas funções neuropsicointelectuais, comprovados problemas reprodutivos, no desenvolvimento de bócio e de patologia nodular da tiroide bem como um aumento na incidência do cancro da tiroide. Com o défice de iodo ocorre também uma alteração do perfil da patologia do cancro da tiroide com um aumento das incidências relativas dos cancros tiroideus mais agressivos como o cancro tiroideu com predominância do carcinoma folicular da tiroide e um aumento na incidência dos carcinomas anaplásicos. Isto ao contrário dos tumores predominantes em áreas sem défice de iodo, os carcinomas papilares habitualmente de comportamento indolente. Em 1990 numa cimeira nas Nações Unidas em Nova Iorque intitulada "World Summit for Children 1990" que contou com a presença de 71 Chefes de Estado foi assinada por todas as Nações presentes uma série de declarações de intenções para o bem de todas as crianças de todo o mundo entre as quais estava a da eliminação do défice de iodo até ao ano 2000. Para completar a universalidade destas moções elas foram subsequentemente ainda assinadas por mais 88 Governos que não tinham assinado na altura. Passaram-se mais de 25 anos desde essa conferência e a prevalência do défice de iodo continua a um nível superior ao dos 2 mil milhões de pessoas. Isto revela medidas ineficazes tomadas (ou não) por governos que não têm em conta o interesse do Povo. Países como a República Popular da China e a África do Sul são exemplos em que medidas políticas eficazes foram adoptadas para corrigir este problema tendo na China o Congresso do Povo decretado que a iodização do sal era no interesse nacional e no interesse do Povo e como tal os (pequenos) custos da iodização do sal passaram a ser pagos pelo Estado. Para que essa correção deste problema seja possível é necessário que haja a disponibilidade de sal iodado com teor certificado por todo o País e que o mesmo seja a um preço acessível. Estas medidas foram implementadas nos Países mencionados (China e África do Sul), previamente documentados como deficitários de iodo e que após a introdução das medidas corretivas necessárias foram documentados como tendo conseguido eliminar o problema do défice de iodo. Dados epidemiológicos sobre a nutrição de iodo a nível Nacional e Regional são essenciais para o desenvolvimento de estratégias eficazes para a eliminação do problema do défice de iodo. Portugal é reportado nos artigos de revisão sobre o estado da nutrição de iodo no mundo como um dos países de onde não existem dados nacionais populacionais sobre a nutrição de iodo. A nutrição de iodo é hoje em dia avaliada através dos valores da excreção urinária de iodo medidas através do valor da mediana da concentração urinária do iodo (urinary iodine concentration – UIC). Um valor de UIC inferior a 100 μg/L é classificado como deficitário de iodo. Outros estudos referem parâmetros alternativos de prevalência de bócio e de patologia nodular da tiroide e o seu tamanho. O perfil de anatomia patológica das tiroidectomias é também tido como informação complementar com os carcinomas papilares a predominarem em áreas não deficitárias de iodo sobre os carcinomas foliculares com rácios papilares / foliculares (P:F) de 3.4:1 a 6.0:1 reportados nos Estados Unidos da América em áreas que não são deficitárias de iodo. Em contraste em áreas deficitárias de iodo o perfil é alterado observando-se um aumento relativo dos cancros tiroideus mais agressivos com uma maior incidência relativa de carcinomas foliculares com alteração do rácio P:F para cerca de 1 ou 50%) das pessoas tende a comer comida preparada em casa, muitas vezes comum ao resto da família, dada a falta de dados Nacionais da população geral, respeitantes á nutrição de iodo, pode presentemente assumir-se que os dados Nacionais publicados sobre a avaliação da população de grávidas provavelmente serão extrapoláveis para a situação na população geral. Essa inferência de dados prováveis em nada altera a importância e prioridade de ser feito um estudo Nacional documentando a nutrição de iodo na população geral. Como evidência complementar sobre a nutrição de iodo da população da BI foi avaliado o perfil da patologia nodular da tiroide na população da BI, através da anatomia patológica da tiroide da população da Beira Interior reflectida através dos Instituto Português de Oncologia de Coimbra, Porto e Lisboa, respeitantes a doentes com a área de residência oriunda da região da BI, bem como dos Hospitais da Covilhã e do Fundão, num período de 6 anos de Janeiro de 2002 a Dezembro de 2007. Este perfil foi comparado com o perfil de anatomia patológica da cirurgia da tiroide feito no período de 5 anos, Janeiro de 1984 a Dezembro de 1988, na região de Joanesburgo, na África do Sul. Este período corresponde a uma altura anterior á introdução da iodização mandatória de todo o sal para consumo humano, feita em legislação introduzida em 1995. Nessa altura de avaliação, a determinação de UIC ainda não se efetuava. Apesar dos períodos diferentes da colecção dos dados eles correspondem a períodos em que havia défice de iodo. Os perfis de anatomia patológica foram avaliados e comparados estatisticamente analisando as frequências relativas das neoplasias e os dados calculados através do qui-quadrado (G* Power) e do intervalo de confiança a 95% e eram sobreponíveis como é reflectido na Tabela 1. Na África do Sul o défice de iodo está documentado como tendo sido eliminado depois da introdução da iodização obrigatória do Sal. A introdução de uma medida semelhante aliada a campanhas de informação popular acerca das consequências do défice de iodo seriam medidas que teriam a possibilidade de contribuir para a eliminação do défice de iodo em Portugal. Dado que Portugal tem produção comercial de sal essas medidas seriam facilmente implementáveis. Promover a nutrição á base dos produtos do mar, que são naturalmente ricos em iodo, seria uma medida adicional recomendável. Consciencialização da importância eliminação do problema do défice de iodo deverá contribuir para a realização do primeiro estudo nacional que documente a nutrição de iodo na população geral de Portugal. ; Iodine is the essential component of the thyroid hormones T3 and T4, which regulate metabolic processes in most cells and play an important role in the early growth and development of most organs, particularly the brain. Globally iodine deficiency (ID) is the most common preventable cause of brain damage, with more than 2 billion people from 130 countries at risk, (241 million children of school age). It is especially prevalent worldwide in inland continental or mountainous regions, and may be independent of sea proximity. Consequences of ID include variable degrees of intellectual impairment, with demonstrable neuropsychointellectual deficits, compromised reproductive potential, development of goitre, thyroid nodular pathology and an increase in the incidence of thyroid cancer. There is still no general population data on iodine nutrition (IN) from Portugal. This study aims at evaluating the IN of the general population of the inland region of Beira Interior (BI) in Portugal and to compare their parameters with the available IN parameters for the equally high altitude region of Johannesburg (JHB), South Africa prior to legislation enforcing the iodisation of all manufactured food grade salt in 1995. In this thesis after an introductory overview of the historical aspects relating to iodine, ID and the mechanisms for goitre, hyperplasia, nodular and cancer development, the relationship between the environment and ID is analysed together the methods for evaluation of IN. Thyroid nodules, their benign and malignant characteristics on different investigation modalities are discussed, after a preliminary overview of the thyroid anatomy, histology and physiology. The IN of the population of BI was evaluated through combined parameters of the urinary iodine concentration (UIC) of a general population sample of 214 volunteers and the thyroid histology pattern of patients from the study area of BI operated over the 6 year period January 2002 to December 2007. This was compared to the available nutritional parameter of IN in the JHB region before the mandatory salt iodization, the thyroid histology pattern over the 5 years: January 1984 to December 1988. The median UIC from the population of BI revealed significant ID. The thyroid histology patterns were characteristic of ID in both regions with a statistically significant overlap of the results. The adoption of legislation requiring all food grade salt to have a minimum amount of iodine and the promotion of sea based nutrition in a well informed public that could be pro-active in the elimination of ID would be important in achieving this goal.
About one billion people worldwide are at risk for iodine deficiency. Despite existing programs of prophylaxis, the prevention of iodine deficiency is still a challenge throughout the developing world. We studied the efficacy of low doses of iodized oil in an area of severe iodine deficiency in Zaire. ; Clinical Trial ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't ; SCOPUS: cp.j ; info:eu-repo/semantics/published
