TSH Mediated the Effect of Iodized Salt on Child Cognition in a Randomized Clinical Trial

Objectives: This study examines the hormonal mediators of the effect of iodized salt in pregnancy on child cognition. Methods: Sixty districts across 6 zones in the Amhara region of Ethiopia were randomly allocated to a control or intervention arm of early market access to iodized salt. Twenty-two villages per arm were randomly selected for this sub-study. A total of 1220 pregnant women who conceived after the intervention began were enrolled and assessed for their iodine and iron status. Data were collected once on the household socio-demographic status and iodized salt use, and maternal urinary iodine during pregnancy. Then, infants’ diet, urinary iodine level, cognitive development (Bayley III), serum hormonal levels, iron status, and inflammation markers were measured between 2 and 13 months of age. Results: The median maternal urinary iodine concentration was adequate and significantly higher in the intervention mothers than that of the controls (163 vs 121 µg/L, P < .0001). Intervention children compared to the control children had lower thyroid-stimulating hormone (TSH) (mean: 2.4 ± 1.0 µIU/mL vs 2.7 ± 1.0 µIU/mL, effect size = 0.18, P < .01) and thyroglobulin (Tg) (41.6 ± 1.0 ng/mL vs 45.1 ± 1.0 ng/mL, effect size = 0.14, P < .05). There was an interaction between the intervention and iron stores such that cognition was higher with iron (effect size = 0.28, 100 vs 94 IQ points). TSH was a partial mediator (12%) of the effect of the intervention on child cognition (Sobel z-score = 2.1 ± 0.06, P < .05). Conclusion: TSH partially mediated the effect of the iodized salt intervention on child cognition.

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Two Sources of Maternal Iodine Intake and Their Effect on Maternal and Infant Iodine Status and Thyroid Function and Infant Information Processing in Southern Ethiopia (P11-007-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-007-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Tafere Gebreegziabher ◽

Barbara Stoecker

Keyword(s):

Information Processing ◽

Thyroid Function ◽

Visual Information ◽

Urinary Iodine ◽

Iodine Concentration ◽

Thyroid Stimulating Hormone ◽

Iodized Salt ◽

Southern Ethiopia ◽

Urinary Iodine Concentration ◽

Iodine Supplementation

Abstract Objectives The objective of this study was to assess the effects of two sources of iodine supplementation on maternal and infant thyroid function and on visual information processing (VIP) of infants in southern Ethiopia Methods A community-based, randomized, supplementation trial was conducted. Mother infant dyads (n = 106) were recruited within the first week after delivery to participate in this study. Mothers were randomly assigned either to receive a potassium iodide capsule (225 µg iodine) daily for 26 weeks or appropriately iodized salt weekly for 26 weeks for household consumption. Maternal thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH), thyroglobulin (Tg), urinary iodine concentration (UIC), breast milk iodine concentration (BMIC) and infant T4, TSH, UIC and VIP were measured as outcome variables. Results At baseline, neither mothers nor infants in the two groups (capsule and iodized salt groups) were significantly different in any of the biomarkers and anthropometry measurements. Maternal TSH and goiter rate significantly decreased following iodine supplementation but T3, T4 and Tg didn't change. Maternal UIC and BMIC and infant UIC were not different among groups. Conclusions A maternal dose of 225 µg iodine daily or adequately iodized salt initiated within a week after delivery decreased goiter and TSH but did not impact infant T4, TSH or VIP. The two treatment groups didn't differ in any of the outcome variables. Funding Sources The study was funded by Nestlé Foundation and Oklahoma State University.

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THE SITUATION OF URINARY IODINE CONCENTRATION (UIC) AMONG SCHOOL AGE CHILDREN, WOMEN AT REPRODUCTIVE AGE AND PREGNANT WOMEN IN INDONESIA: THE ANALYSIS OF RISKESDAS 2013

GIZI INDONESIA ◽

10.36457/gizindo.v39i1.207 ◽

2017 ◽

Vol 39 (1) ◽

pp. 49

Author(s):

Djoko Kartono ◽

Atmarita Atmarita ◽

Abas B Jahari ◽

Soekirman Soekirman ◽

Doddy Izwardy

Keyword(s):

Pregnant Women ◽

Iodine Deficiency ◽

Urinary Iodine ◽

Iodine Concentration ◽

Iodized Salt ◽

Reproductive Age ◽

School Age Children ◽

Urinary Iodine Concentration ◽

Iodine Status ◽

Iodine Level

Iodine Deficiency Disorders (IDD) are the leading cause of goiter, cretinism, developmental delays and other health problems. Iodine deficiency is an important public health issue as it is a preventable cause of intellectual disability. While elimination of iodine deficiency is imperative, it should be noted that excessive intake of iodine can also lead to adverse health effects. This paper analyzed the iodine status using median urinary iodine concentration (MUIC) of school age children (SAC), women of reproductive age (WRA), and pregnant women (PW) who live in the same household from Riskesdas 2013. The total number of households included in the analysis was 13,811 households, from which 6,149 SAC (aged 6 – 12 years), 13,218 WRA (aged 15-49 years), and 578 PW (aged 15-49 years) were enumerated. The national MUIC of SAC, WRA and PWwas in the normal range indicated that the iodine status was adequate using WHO epidemiological criteria. Iodine status in some sub-populations indicated deficiency, however, in terms of geographic characteristics people who live in the urban has better iodine status compared to rural areas. Similarly, populations in richer economic quintiles had better iodine status. Only pregnant women in the 1st and 2nd quintile were deficient. Almost all regions in Indonesia showed the MUIC was in the normal adequate range, except NTT-NTB, Maluku-Papua, and East Java for pregnant women who tend to have lower MUIC (<150 µg/L). The status of iodized salt at the household was detected using both Rapid Test Kit/RTK as well as Titration. The result demonstrated a strong association between salt iodine level and iodine status. The MUIC for all three groups were lower when the iodine level in salt was lower, then increased when the levels of iodine content in salt increased. The iodine status of pregnant women consuming non-iodized salt was inadequate. The detrimental effect of iodine deficiency on the mental and physical development of children as well as on the women of reproductive age has been recognized. Indonesia still needs the salt iodization program to keep the iodine status in the normal range. In particular coverage with adequately iodized salt needs to be improved in order to improve the iodine status of pregnant women. For the prevention of Iodine disorders (insufficient), monitoring should be undertaken in regular basis to assess the MUIC, especially for pregnant women.

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Iron and Iodine Status in Pregnant Women from A Developing Country and Its Relation to Pregnancy Outcomes

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16224414 ◽

2019 ◽

Vol 16 (22) ◽

pp. 4414 ◽

Cited By ~ 4

Author(s):

Sehar Iqbal ◽

Petra Rust ◽

Lisbeth Weitensfelder ◽

Inayat Ali ◽

Michael Kundi ◽

...

Keyword(s):

Pregnant Women ◽

Developing Country ◽

Pregnancy Complications ◽

Iron Status ◽

Urinary Iodine ◽

Iodine Concentration ◽

Thyroid Stimulating Hormone ◽

Urinary Iodine Concentration ◽

Spot Urine ◽

Total Thyroxine

Birth related complications and comorbidities are highly associated with a poor nutritional status of pregnant women, whereas iron and iodine are among especially important trace elements for healthy maternal and fetal outcomes. The study compares the status of iron, iodine, and related functional parameters in pregnant and non-pregnant women from a developing country and associates the data with pregnancy complications. The concentrations of ferritin, hemoglobin (Hb), total triiodothyronine (TT3), total thyroxine (TT4), and thyroid-stimulating hormone (TSH) were determined in the blood serum of 80 pregnant women at the time of delivery and compared with 40 non-pregnant healthy controls. Spot urine samples were taken to evaluate the urinary iodine concentration (UIC). In pregnant women, ferritin, Hb concentrations, and UIC were significantly lower, and TT4 values were significantly higher compared to controls. Higher Hb levels were tendentially associated with a reduced risk for pregnancy complications (OR = 0.747, CI (95%) 0.556–1.004; p = 0.053). Regarding covariates, only previous miscarriages were marginally associated with pregnancy complications. High consumption of dairy products was associated with lower Hb and ferritin values. Our results suggest that pregnant women from a developing country have lower iron status with Hb levels being possibly associated with pregnancy complications.

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High Iodine Deficiency among Pregnant Women in Periurban Ghana: A Hospital-Based Longitudinal Study

Journal of Nutrition and Metabolism ◽

10.1155/2018/9706805 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

David Larbi Simpong ◽

Yaw Asante Awuku ◽

Kenneth Kwame Kye-Amoah ◽

Martin Tangnaa Morna ◽

Prince Adoba ◽

...

Keyword(s):

Longitudinal Study ◽

Pregnant Women ◽

Iodine Deficiency ◽

Urinary Iodine ◽

Clinical Information ◽

Iodine Concentration ◽

Iodized Salt ◽

Urinary Iodine Concentration ◽

Study Cohort ◽

Iodine Sufficiency

Background. Iodine deficiency causes maternal hypothyroidism which can lead to growth, cognitive, and psychomotor deficit in neonates, infants, and children. This study examined the iodine status of pregnant women in a periurban setting in Ghana. Methods. This longitudinal study recruited 125 pregnant women by purposeful convenience sampling from the antenatal clinic of the Sefwi Wiawso municipal hospital in Ghana. Urinary iodine concentration (UIC) was estimated by the ammonium persulfate method at an estimated gestational age (EGA) of 11, 20, and 32 weeks. Demographic information, iodized salt usage, and other clinical information were collected using a questionnaire. Results. The prevalence of iodine deficiency among the pregnant women was 47.2% at EGA 11 and 60.8% at both EGA of 20 and 32, whereas only 0.8% of participants not using iodized salt had iodine sufficiency at EGA 32. 18.4%, 20%, and 24% of participants using iodized salt had iodine sufficiency at EGA 11, 20, and 32, respectively. Conclusion. A high prevalence of iodine deficiency was observed among our study cohort.

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

Nutrients ◽

10.3390/nu12082399 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2399 ◽

Cited By ~ 1

Author(s):

Simona Censi ◽

Jacopo Manso ◽

Susi Barollo ◽

Alberto Mondin ◽

Loris Bertazza ◽

...

Keyword(s):

Dietary Habits ◽

Urinary Iodine ◽

Iodine Concentration ◽

Iodine Intake ◽

Iodized Salt ◽

Urinary Iodine Concentration ◽

Milk Product ◽

Veneto Region ◽

School Students ◽

Iodine Status

Background: Fifteen years after a nationwide voluntary iodine prophylaxis program was introduced, the aims of the present study were: (a) to obtain an up-to-date assessment of dietary iodine intake in the Veneto region, Italy; and (b) to assess dietary and socioeconomic factors that might influence iodine status. Methods: Urinary iodine concentration (UIC) was obtained in 747 school students (median age 13 years; range: 11–16 years). Results: The median UIC was 111 μg/L, with 56% of samples ≥ 100 μg/L, but 26% were < 50 μg/L, more frequently females. Iodized salt was used by 82% of the students. The median UIC was higher among users of iodized salt than among non-users, 117.0 ug/L versus 90 ug/L (p = 0.01). The median UIC was higher in regular consumers of cow’s milk than in occasional consumers, 132.0 μg/L versus 96.0 μg/L (p < 0.01). A regular intake of milk and/or the use of iodized salt sufficed to reach an adequate median UIC, although satisfying only with the combined use. A trend towards higher UIC values emerged in regular consumers of cheese and yogurt. Conclusion: Iodine status has improved (median UIC 111.0 μg/L), but it is still not adequate as 26% had a UIC < 50 μg/L in the resident population of the Veneto region. A more widespread use of iodized salt but also milk and milk product consumption may have been one of the key factors in achieving this partial improvement.

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Factors Associated with Urinary Iodine Concentration among Women of Reproductive Age, 20–49 Years Old, in Tanzania: A Population-Based Cross-Sectional Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa079 ◽

2020 ◽

Vol 4 (5) ◽

Author(s):

Djibril M Ba ◽

Paddy Ssentongo ◽

Muzi Na ◽

Kristen H Kjerulff ◽

Guodong Liu ◽

...

Keyword(s):

Urinary Iodine ◽

Iodine Concentration ◽

Population Based ◽

Cross Sectional Study ◽

Iodized Salt ◽

Reproductive Age ◽

Urinary Iodine Concentration ◽

Women Of Reproductive Age ◽

Cross Sectional ◽

Factors Associated

ABSTRACT Background Universal salt iodization (USI) is the most feasible and cost-effective, and equitable, approach to prevent iodine deficiency. Severe maternal iodine deficiency during pregnancy is associated with serious adverse gestational and birth outcomes. Objectives The aim was to assess iodine status and identify independent factors associated with urinary iodine concentration (UIC) among women of reproductive age in Tanzania. Methods This was a weighted, population-based, cross-sectional study in 2985 women of reproductive age (20–49 y) in Tanzania who participated in the Demographic and Health Surveys in 2015–2016 (DHS 2015–2016) and had measured UIC. Multivariable generalized linear regression was used to identify potential factors that were associated with UIC. Results The median UICs among women consuming inadequately iodized salt (93.6 μg/L; 25th and 75th percentiles: 43.1, 197.9 μg/L) and women in the lowest socioeconomic status (92.3 μg/L; 45.6, 194.4 μg/L) were below the WHO-recommended ranges (≥150 μg/L for pregnant women and ≥100 μg/L for nonpregnant women). The results of multivariable models indicated that pregnant women had 1.21 μg/L lower UIC than nonpregnant women (β = −1.21; 95% CI: −3.42, −0.12), breastfeeding women had 1.02 μg/L lower UIC than nonbreastfeeding women (β = −1.02; 95% CI: −2.25, −0.27), and women with no education had a 1.88 μg/L lower UIC compared with those with secondary/highest education (β = −1.88; 95% CI: −4.58, −0.36). Women consuming inadequately iodized salt had 6.55 μg/L lower UIC than those consuming adequately iodized salt (β = −6.55; 95% CI: −9.24, −4.33). The median UIC varied substantially across geographic zones, ranging from 83.2 μg/L (45.9, 165.3) in the Western region to 347.8 μg/L (185.0, 479.8) in the Eastern region. Conclusions Our findings indicated a great heterogeneity in median UIC across regions of Tanzania among women of reproductive age. Poverty, consuming inadequately iodized salt, and lack of education appeared to be the driving factors for lower UIC in Tanzania.

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Assessment of the iodine nutritional status among Chinese school-aged children

Endocrine Connections ◽

10.1530/ec-19-0568 ◽

2020 ◽

Vol 9 (5) ◽

pp. 379-386

Author(s):

Ning Yao ◽

Chunbei Zhou ◽

Jun Xie ◽

Xinshu Li ◽

Qianru Zhou ◽

...

Keyword(s):

Nutritional Status ◽

Urinary Iodine ◽

Thyroid Volume ◽

Iodine Content ◽

Iodine Concentration ◽

Iodine Intake ◽

Iodized Salt ◽

Urinary Iodine Concentration ◽

School Aged Children ◽

Goiter Prevalence

Objective The remarkable success of iodine deficiency disorders (IDD) elimination in China has been achieved through a mandatory universal salt iodization (USI) program. The study aims to estimate the relationship between urinary iodine concentration (UIC) and iodine content in edible salt to assess the current iodine nutritional status of school aged children. Methods A total of 5565 students from 26 of 39 districts/counties in Chongqing participated in the study, UIC and iodine content in table salt were measured. Thyroid volumes of 3311 students were examined by ultrasound and goiter prevalence was calculated. Results The overall median UIC of students was 222 μg/L (IQR: 150-313 μg/L). Median UIC was significantly different among groups with non-iodized salt (iodine content <5 mg/kg), inadequately iodized salt (between 5 and 21 mg/kg), adequately iodized (between 21 and 39 mg/kg) and excessively iodized (>39 mg/kg) salt (P < 0.01). The total goiter rate was 1.9% (60/3111) and 6.0% (186/3111) according to Chinese national and WHO reference values, respectively. Thyroid volume and goiter prevalence were not different within the three iodine nutritional status groups (insufficient, adequate and excessive, P > 0.05). Conclusions The efficient implementation of current USI program is able to reduce the goiter prevalence in Chongqing as a low incidence of goiter in school aged children is observed in this study. The widened UIC range of 100–299 μg/L indicating sufficient iodine intake is considered safe with a slim chance of causing goiter or thyroid dysfunction. Further researches were needed to evaluate the applicability of WHO reference in goiter diagnose in Chongqing or identifying more accurate criteria of normal thyroid volume of local students in the future.

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Thyroid stimulating hormone isn’t a sensitive indicator of iodine nutritional status in schoolchildren

Revista de Ciências Médicas e Biológicas ◽

10.9771/cmbio.v14i3.14990 ◽

2016 ◽

Vol 14 (3) ◽

pp. 350

Author(s):

Renata De Oliveira Campos ◽

Joaquim Custódio Silva Júnior ◽

Elton Estrela Ramos

Keyword(s):

Public Schools ◽

Nutritional Status ◽

Filter Paper ◽

Urinary Iodine ◽

Iodine Concentration ◽

Thyroid Stimulating Hormone ◽

Urinary Iodine Concentration ◽

Iodine Nutrition ◽

Cross Sectional ◽

Stimulating Hormone

Introduction: iodine deficiency disorders (IDD) are most common cause of preventable brain damage, mental retardation and stunted growth in children worldwide. Several indicators are complementary to urinary iodine concentration (UIC) for assessing iodine nutritional status, as thyroid size, thyroglobulin (Tg) and thyroid stimulating hormone (TSH) concentrations in the blood. Objective: analyze TSH in filter paper blood values and correlate with UIC in schoolchildren from public school at state of Bahia, Brazil. Methodology: cross-sectional study was conducted in 880 schoolchildren aged 6-14 years, randomly selected, of public schools in five cities of four micro-regions of Bahia between October 2013 and September 2014. TSH was analyzed in filter-paper blood and UIC were measured by adapted Sandell-Kolthoff reaction. Results: 880 blood samples on filter-paper were analyzed for TSH. The reference range previously established is 0.72 to 6.0 μUI/mL. Results of this research TSH dosage ranged from 0.24 μIU/L to 7.71 μIU/L, with a mean of 1.01±0.55 μUI/L and median 0.89 μUI/L. Only one child presented TSH greater than 6.0 (7.71 μIU/L); however, results of urinary iodine were consistent with a more than adequate nutrition iodine (243.70μg/L). There’ no correlation between TSH and UIC (r= 0.115; p= 0.002). Conclusion: in the present study, schoolchildren showed low values of TSH, but the mean UIC was indicative of adequate iodine nutrition.

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Armenia's experience in achieving an adequate iodine status of the population

Clinical and experimental thyroidology ◽

10.14341/ket12525 ◽

2021 ◽

Vol 16 (2) ◽

pp. 25-30

Author(s):

Gregory A. Gerasimov ◽

Nicholas Hutchings ◽

Hrayr Aslanyan ◽

Irina Tovmasyan

Keyword(s):

Urinary Iodine ◽

Iodine Concentration ◽

Iodized Salt ◽

Urinary Iodine Concentration ◽

Optimal Range ◽

Neonatal Hypothyroidism ◽

Iodine Status ◽

Iodine Prophylaxis ◽

Health Authorities ◽

Detailed Assessment

Armenia was one of the first post-Soviet countries, that after a relatively short break has restored the production of iodized salt at the beginning of the 2000s, and in 2004 adopted a decree that made the production and import of iodized salt mandatory, as well as its use in the food industry. A 2016 national survey showed high sustainability of the iodine prophylaxis program in Armenia – median urinary iodine concentration (UIC) in schoolchildren and pregnant women (PW) was in the optimal range (242 and 226 μg/l, respectively), and coverage of households with quality iodized salt was 95%. In addition to iodized salt used in households, more than 50% of iodine was consumed with processed foods, primarily bakery products. An essential advantage of the iodine prophylaxis program in Armenia is that it provides adequate iodine status not only for the general population, but also for PW. At the same time about 37% of PW used iodine supplements, which were not necessary. The experience of Armenia shows that the analysis of screening datasets for neonatal hypothyroidism screening makes it possible to efficiently and at minimal cost annually evaluate the iodine status of the population. And if the frequency of TSH levels > 5 mIU/L exceeds 3%, the health authorities should consider this as an alarm and conduct a more detailed assessment to find out the cause of the iodine status insufficiency and take appropriate measures

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Indicators of Iodine Status in Pregnancy and Postpartum in a Group of Pregnant Women from Perimarine Area of Romania

ARS Medica Tomitana ◽

10.2478/arsm-2020-0013 ◽

2020 ◽

Vol 26 (2) ◽

pp. 63-69

Author(s):

Scrinic Olesea ◽

Delia Corina Elena ◽

Toma Geanina Mirela ◽

Circo Eduard

Keyword(s):

Pregnant Women ◽

Iodine Deficiency ◽

Urinary Iodine ◽

Iodine Concentration ◽

Iodine Intake ◽

Iodized Salt ◽

Urinary Iodine Concentration ◽

Urinary Creatinine ◽

Iodine Status ◽

In Pregnancy

Abstract Objective: Assessment of iodine nutritional status in pregnant women in the perimarine area of Romania, a region without iodine deficiency. Adequate iodine intake is the main source for normal thyroid function, ensuring the need for maternal thyroid hormones during pregnancy, but also for the development and growth of children in the fetal and postpartum period. Material and method: Prospective study performed on 74 pregnant women in the first 2 trimesters of pregnancy, originating from the perimarin area. The following indicators of iodine status were analyzed: urinary iodine concentration (UIC), the ratio between urinary iodine concentration and urinary creatinine (UIC/UCr), the prevalence of maternal goiter and the value of neonatal TSH (thyroid stimulating hormone). Results: The mean gestational age was 11 weeks. The ways of iodine intake are: iodized salt - 59.4%, iodized salt and iodine supplements- 23%, only iodine supplements -10.8% and 6.8% consume only non-iodized salt. The median of UIC was 133.03 mcg/l considered insufficient iodine intake (normal in pregnancy UIC >150 mcg/l), but the adjustment of UIC to urinary creatinine reveals a median of 152.83 mcg/g, a value that reflects an adequate iodine intake. The prevalence of goiter was 25.6% characteristic for a moderate iodine deficiency. The prevalence of neonatal TSH >5 mIU/L was registered in 18.8% characteristic of mild iodine deficiency. Conclusions: Monitoring of the iodine nutritional status is recommended for the prevention of disorders due to iodine deficiency under the conditions of universal salt iodization. Perimarine areas considered sufficient in iodine may show variations in iodine status in subpopulations under certain physiological conditions, such as pregnancy. An indicator of iodine status of the population is UIC, but the UIC/UCr ratio may be a more optimal indicator for pregnant women, to avoid possible overestimated results of iodine deficiency in pregnancy.

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