In: Woodside , J V & Mullan , K R 2020 , ' Iodine status in UK–An accidental public health triumph gone sour ' , Clinical Endocrinology . https://doi.org/10.1111/cen.14368
The improvement in iodine status among the UK population from the 1930s onwards has been described as an 'accidental public health triumph' despite the lack of any iodine fortification program. However, iodine deficiency in the UK has re-emerged in vulnerable groups and is likely due to a combination of changing farming practices, dietary preferences and public health priorities. The UK is now among only a minority of European countries with no legislative framework for iodine fortification. The experience of folic acid fortification and the 28-year delay in its implementation lays bare the political difficulties of introducing any fortification program in the UK. If iodine fortification is not an imminent possibility, then it is important to explore other options: how to change farming practice especially on organic farms; encourage dairy intake; protect and expand our public health programs of milk provision for vulnerable groups and embark on education programs for women of childbearing potential and healthcare professionals. This review explores how the UK may have arrived at this juncture and how the iodine status of the nation may be improved at this time of major political and public health upheaval.
In: Ittermann , T , Albrecht , D , Arohonka , P , Bílek , R , Dahl , L , Castro , J J , Filipsson Nyström , H , Gaberšček , S , Garcia-Fuentes , E , Gheorghiu , M , Hubalewska-Dydejczyk , A , Hunziker , S , Jukic , T , Karanfilski , B , Koskinen , S , Kusic , Z , Majstorov , V , Makris , K , Markou , K , Meisinger , C , Milevska Kostova , N , Mullan , K R , Nagy , E V , Pīrāgs , V , Rojo-Martinez , G , Samardzic , M , Saranac , L , Strele , I , Top , I , Thamm , M , Trofimiuk-Müldner , M , Unal , B , Valsta , L , Vila , L , Vitti , P , Winter , B , Woodside , J , Zaletel , K , Zamrazil , V , Zimmermann , M , Erlund , I & Völzke , H 2020 , ' Standardized Map of Iodine Status in Europe ' , Thyroid : official journal of the American Thyroid Association . https://doi.org/10.1089/thy.2019.0353
Background Knowledge about the population's iodine status is important, because it allows adjustment of iodine supply and prevention of iodine deficiency. The validity and comparability of iodine related population studies can be improved by standardization, which was one of the goals of the EUthyroid project. The aim of this study was to establish the first standardized map of iodine status in Europe by using standardized UIC data. Methods We established a gold-standard laboratory in Helsinki measuring UIC by inductively-coupled plasma-mass spectrometry. A total of 40 studies from 23 European countries provided 75 urine samples covering the whole range of concentrations. Conversion formulas for UIC derived from the gold-standard values were established by linear regression models and were used to post-harmonize the studies by standardizing the UIC data of the individual studies. Results In comparison to the EUthyroid gold-standard, mean UIC measurements were higher in 11 laboratories and lower in 10 laboratories. The mean differences ranged from -36.6% to 49.5%. Of the 40 post-harmonized studies providing data for the standardization, 16 were conducted in schoolchildren, 13 in adults and 11 in pregnant women. Median standardized UIC was < 100 µg/L in 1 out of 16 (6.3%) studies in schoolchildren, while in adults 7 out of 13 (53.8%) studies had a median standardized UIC < 100 µg/L. Seven out of 11 (63.6%) studies in pregnant women revealed a median UIC < 150 µg/L. Conclusions We demonstrated that iodine deficiency is still present in Europe, using standardized data from a large number of studies. Adults and pregnant women, particularly, are at risk for iodine deficiency, which calls for action. For instance, a more uniform European legislation on iodine fortification is warranted to ensure that non-iodized salt is replaced by iodized salt more often. In addition, further efforts should be put on harmonizing iodine related studies and iodine measurements to improve the validity and comparability of results.