A „silent” jódprofilaxis csak részben korrigálja a jódhiányt: a magyar történet (1970–2020)

2020 ◽  
Vol 161 (50) ◽  
pp. 2107-2116
Author(s):  
Ferenc Péter

Összefoglaló. A szerző a bevezetőben emlékeztet a több mint 50 évvel korábbi publikációjára (Orv Hetil. 1968; 109: 360–363) és annak utóéletére: az 1970-es években megállt a jódprevenció fejlődése. Ezt követően ismerteti az utóbbi 50 év jódellátottságra vonatkozó fontosabb hazai eredményeit. A számszerű adatok szerint az iskolás gyermekek, várandós anyák, idősek és újszülöttek jódellátottságára, valamint az anyatej jódtartalmára vonatkozó sorozatvizsgálatok az ezredforduló előtt egybehangzóan enyhe, illetve mérsékelt jódhiányra utaltak. Az utóbbi két évtizedben egyre többször váltak adekváttá az ugyanezen kategóriák jódellátottságát jelző eredmények. A szabályozatlan jódozottsó-forgalom (fakultatív jódprevenció) ellenére, valószínűleg a sikeres felvilágosítási kampányok miatt, a lakosság jódellátottsága határozottan javult. Ezt a szituációt nevezik „silent” profilaxisnak. Ezzel a módszerrel nem lehet a jódhiányt teljesen felszámolni. A legnagyobb kockázatot a várandós anyák (közel felének!) hiányos jódpótlása jelenti az utódok agyfejlődésének veszélyeztetése miatt. A befejezésben az EUthyroid Consortium „Krakkói kiáltvány”-ának (2018) rövid ismertetése tartalmazza a teendőket. A kötelező jódprevencióhoz a nem jódozott sót ki kell váltani jódozott sóval szinte minden élelmiszerben. A graviditás alatt megnövekedett igényt az élelmiszerekben lévő jód gyakran nem fedezi, ilyenkor több jódpótlásra van szükség. Az egészségügyi szerveknek meg kell valósítaniuk a jóddúsító program összehangolt, rendszeres monitorozását és kiértékelését a lakosság optimális jódellátottságának biztosításához. Orv Hetil. 2020; 161(50): 2107–2116. Summary. In the introduction, the author reminds the readers of his publication presented more than 50 years ago in the same journal („Data to the present state of the goiter problem in Hungary”, 1968) and of its afterlife: the development of iodine prevention stopped in the 1970s. Then the major Hungarian results are reviewed related to the iodine supply gained in the latter 50 years. Numerical data are presented showing mild or moderate iodine deficiency according to the results of a range of screening studies among schoolchildren, pregnant women, elderly people and newborns as well as by iodine content of breast milk before the millennium. In the same categories, the data indicating the level of iodine supply became increasingly adequate in the recent two decades. The iodine supply of the people improved markedly, in spite of unregulated iodized salt trade (facultative prevention), presumably because of the successful public-information campaigns. This situation is called “silent” prophylaxis. The total eradication of iodine deficiency is impossible with this method. The highest risk is the deficient iodine supply of pregnant women (almost the half!) due to the endangerment of the offspring’s brain development. In the end, a brief review of the Krakow Declaration on Iodine of the EUthyroid Consortium comprises the round of the duties. To the mandatory iodine prevention, iodized salt should replace non-iodized salt in nearly all food productions. During pregnancy, the increased need for iodine is frequently not covered by food sources, more iodine supplement is needed. Health authorities should perform harmonized monitoring and evaluation of fortification programs at regular intervals to ensure optimal iodine supply to the population. Orv Hetil. 2020; 161(50): 2107–2116.

2021 ◽  
Vol 54 (1) ◽  
pp. 21-33
Author(s):  
IT Matasar ◽  
VI Kravchenko ◽  
LM Petryschenko ◽  
VI Vodopianov

Aim. Study of iodine supply in different segments of the population throughout Ukraine, establishment of the morbidity level caused by iodine deficiency, analysis of preventive measures and their effectiveness and development of adequate ways of mass, group and individual prophylaxis of iodine deficiency in the body, which will reduce morbidity in areas of endemic iodine deficiency. The article considers the most important results of long-term epidemiological studies of iodine supply in different categories of the population of almost all regions of Ukraine. Significant volume of work was performed with the support of the Ministry of Healthcare of Ukraine, UNICEF Ukrainian office, and the CDC in Atlanta (USA), which for more than 19 years has provided external quality control of the study of iodine status of the population of Ukraine. The data on iodine content in food and biological fluids of the population affected by the Chernobyl accident are given and the dependence of the irradiation dose of the thyroid on the body supply with stable iodine and on the optimization of the latter after the adoption of the State Programme for Iodine Deficiency Prevention for 2002–2005 is shown. The effectiveness of mass iodine prophylaxis by using universally iodized table salt is emphasized. The article presents data on suggested and implemented ways of mass, group and individual iodine prophylaxis, studies of their effectiveness and shows the positive dynamics of changes in providing the population with dietary iodine. The need for constant consumption of food products with sufficient iodine content, including iodized salt, is proven. Significant changes in the prevalence and incidence of thyroid pathology, socio-ecological and medical benefits of prevention of iodine-dependent disorders are described. The article was prepared as a scientific information material for family doctors, endocrinologists, obstetricians and gynaecologists, hygienists, the public, the Ministry of Healthcare of Ukraine in connection with the need for a legislative solution to the prevention of iodine-dependent disorders in Ukraine. Materials and Methods. To study the problem and assess the state of iodine deficiency in Ukraine the criteria recommended by the WHO and the United Nations Children’s Fund (UNICEF) were applied for the first time, a method for determining the iodine content in the body was developed and implemented, which allowed to join the international “Equip” system of iodine supply control in the world and in Ukraine. This made it possible to move from indirect to direct methods of determining the intake of iodine in the body. Conclusions. A detailed study of iodine supply in different segments of the population of Ukraine proved the negative effects of iodine deficiency on health; in particular, it was found that the overall decrease in productivity of the generation of children in iodine deficiency populations is 5%. Measures to eliminate iodine-dependent disorder among the population of Ukraine have been developed and implemented. The development and production of iodized food salt, adequate to the needs of the population, has been carried out. The result of these measures, developed and implemented to eliminate iodine-dependent disorders and to improve the nation’s intelligence, is, according to the official data, the improvement of iodine supply of the population, significant reduction in the number of thyroid disorders, especially among those affected with 131I, which, even just because of this indicator, has significant social-economic effect. Key Words: Chernobyl accident, iodine deficiency, iodized salt, population, prevention, regions.


2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
David Larbi Simpong ◽  
Yaw Asante Awuku ◽  
Kenneth Kwame Kye-Amoah ◽  
Martin Tangnaa Morna ◽  
Prince Adoba ◽  
...  

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.


Author(s):  
Surekha A. Tayade ◽  
Shakuntala Chhabra

Background: There is an increased demand for iodine and thyroid hormones, in pregnancy starting from the early weeks of pregnancy suggesting that there may be a need for additional supplements of iodine in high risk population to prevent iodine deficiency and its associated disorders. Hence this study was undertaken to determine the iodine status and its determinants in a subpopulation of pregnant women from a rural area of Central India.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables, use of iodized salt, iodine rich food and goitrogens as part of diet and other determinants. Spot urine samples were obtained, and assessment of urine iodine concentration was done by using Sandell-Kolthoff reaction.Results: Among 250 pregnant women of first trimester, iodine deficiency (ID) was present in 11.8 %, of which 59.25% had mild deficiency, 33.33% moderate deficiency and 7.4% severe deficiency. More women with iodine deficiency were of higher age, had less formal education and belonged to lower middle and lower economic class. Higher number of women with iodine deficiency had family history of thyroid disorders compared to iodine sufficient (18.51% versus 5.58%), more iodine deficient commonly had goitrogens (cabbage, cauliflower, radish, sweet potato, soya etc) as part of their meals (77.77% versus 68.60%), lesser women with ID ate iodine rich food (fish, milk yoghurt, bread) (18.51% versus 68.60%) and fewer of them used iodized salt during food preparation (25.92% versus 69.95%) compared to iodine sufficient, with a significant difference.Conclusions: Iodine deficiency is prevalent in pregnant women in this geographic region of central India. Age, low socioeconomic status, lack of education, family history, low intake of iodized salt and iodine rich food and more consumption of goitrogenic food as part of diet are risk factors. Appropriate health education, promoting use of iodized salt, quality assurance of universal salt iodization by household survey and screening in high risk group is suggested.


2019 ◽  
Vol 59 (6) ◽  
pp. 2535-2545 ◽  
Author(s):  
Sofia Manousou ◽  
Maria Andersson ◽  
Robert Eggertsen ◽  
Sandra Hunziker ◽  
Lena Hulthén ◽  
...  

Abstract Purpose Voluntary salt iodization at 50 mg/kg salt ensures adequate iodine nutrition in Swedish school-aged children, but iodine status in pregnant women is uncertain. Methods We conducted a cross-sectional national study of 743 pregnant women, at median gestational age of 23 weeks (IQR 9, 38), recruited from maternal health care centers. We measured: urinary iodine concentration (UIC) and urinary creatinine concentration in spot urine samples; thyroglobulin (Tg), thyroid-stimulating hormone (TSH), and total thyroxine (tT4) on dried blood spots (DBS); and thyreoperoxidase antibodies in serum samples. Data on dietary supplement use were obtained, and women were classified as supplement users (consuming multivitamins containing ≥ 150 µg iodine/day) and non-supplement users (no supplements or < 150 µg iodine/day from supplements). Results Overall median UIC [bootstrapped 95% confidence interval (CI)] was 101 µg/L (95, 108; n = 737): 149 µg/L (132, 164) in supplement users (n = 253) and 85 µg/L (79, 92) in non-supplement users (n = 440) (p < 0.001). Overall geometric mean DBS-Tg (95% CI) was 22.1 μg/L (20.8, 23.5; n = 675) and the prevalence of elevated DBS-Tg was 19%. DBS-Tg was lower in supplement users (n = 229) than in non-supplement users (n = 405) (19.1 vs 24.4 μg/L, p < 0.001). DBS-TSH, DBS-tT4, and S-TPOab positivity did not differ between the two groups. Conclusions Pregnant women in Sweden have inadequate iodine nutrition. Women not taking iodine supplements containing ≥ 150 µg iodine/day are affected by mild iodine deficiency and are at higher risk for increased thyroid activity, while maintaining euthyroidism. Iodine intake should be improved in women both before and after conception by promotion of iodized salt instead of non-iodized salt. We urge regular monitoring of iodine status in the general Swedish population, as well as in risk groups.


2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Prince Kubi Appiah ◽  
Clement Tiimim Yanbom ◽  
Martin Amogre Ayanore ◽  
Alex Bapula

Background. Iodine deficiency is a global public health concern as it leads to inadequate production of thyroid hormone in the body, causing too many destructive consequences on the roles and functions of different human organs and muscles including brain growth and can manifest into many damaging effects such as intestinal cerebral impedance, cancer of intestine, breast disorders, and physical deformities like goitre and cretinism to one’s body. Despite all these negative effects, there are several important public health programs including universal salt iodization (USI) to improve on households’ iodine intake, notwithstanding this, countless families are still eating foods containing less iodine or no iodine at all. Hence, this study examined the intake of iodized salt after years of universal salt iodization and the knowledge on iodized salt among households in the Sissala East Municipality. Method. A descriptive cross-sectional study was adopted to collect data for the study. Data were collected from women in charge of household meal preparation using a semistructured questionnaire and rapid field iodine test kits. The Statistical Package for Social Sciences (SPSS) version 20 was used for the data analysis and presented in tables and graphs. p value <0.05 was considered as statistically significant. Findings. Only 41.4% of the households have good knowledge on benefits of iodized salt and dangers associated with iodine deficiency. It was realized that the health workers (46.6%) and television were the main sources of information on iodized salt. Household salt usage with adequate (>15 ppm) levels of iodine was 44.0%; however 85.9% of the salts were stored in covered containers. The study showed significant associations between knowledge on iodized salt and educational level (p≤0.001), occupation (p=0.043), religion (p=0.027), and ethnic lineage (p=0.046). Also, the use of iodized salt showed associations with the educational level (p≤0.001), occupation (p=0.003), religion (p=0.042), and knowledge on iodized salt (p≤0.001). Conclusions. Only about 4 in 10 households were consuming salt with adequate iodine, and this coverage is very low compared with the 90% or more coverage recommended by WHO/UNICEF/ICCIDD. Having secondary and tertiary education and having good knowledge of iodized salt has a great influence on the use of iodized salt; however, with this low level of knowledge of importance of iodized salt among women responsible for house food preparations, there is the need for health professionals to intensify education and promotion on iodized salt in the area and to monitor and verify iodine content of salts produced and sold in the market all times, as the source of the salt might have contributed to the low levels of iodine in the household salt.


2020 ◽  
Vol 11 ◽  
Author(s):  
Tal Schiller ◽  
Arnon Agmon ◽  
Viviana Ostrovsky ◽  
Gabi Shefer ◽  
Hilla Knobler ◽  
...  

IntroductionAn Israeli national survey found that 85% of pregnant women had urinary iodine content (UIC) levels below the adequacy range (&lt;150 µg/L). Widespread desalinated water usage and no national fortification plan are possible causes. Studies assessing relationships between iodine status and maternal and neonatal thyroid function provided varying results. Our aims were to determine whether iodine deficiency was associated with altered maternal or neonatal thyroid function and the factors leading to iodine deficiency.MethodsA cross-sectional study including 100 healthy women without prior thyroid disease, in their first trimester of a singleton pregnancy were recruited from an HMO clinic in central Israel. The women were followed from their first trimester. All women completed a 24-h dietary recall and life habits questionnaires. We tested for UIC, maternal and neonatal thyroid function, maternal autoantibodies, and neonatal outcomes.ResultsMedian UIC in our cohort was 49 µg/L [25%–75% interquartile range (IQR) 16-91.5 µg/L], with 84% below adequacy range. No correlation was found between iodine deficiency and maternal or neonatal thyroid function which remained within normal ranges. Antibody status did not differ, but thyroglobulin levels were significantly higher in iodine insufficient subjects. UIC was higher in women consuming an iodine containing supplement. There was no association between UIC and dietary iodine content or water source.ConclusionsModerate iodine deficiency is common in our healthy pregnant women population. Our data imply that moderate iodine deficiency in pregnancy seem sufficient to maintain normal maternal and neonatal thyroid function.


2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Haji Kedir ◽  
Yemane Berhane ◽  
Alemayehu Worku

Background.Iodine deficiency in pregnancy is a worldwide problem. This study aimed to assess prevalence and predictors of subclinical iodine deficiency among pregnant women in Haramaya district, eastern Ethiopia.Methods.A cross-sectional, community-based study was conducted on 435 pregnant women existing in ten randomly selected rural kebeles (kebele is the smallest administrative unit in Ethiopia). Data on the study subjects’ background characteristics, dietary habits, and gynecological/obstetric histories were collected via a structured questionnaire. UIC of <150 μg/L defined subclinical iodine deficiency. Data were analyzed by Stata 11. A multivariable logistic regression was used to identify the predictors of subclinical iodine deficiency.Results.The median urinary iodine concentration (MUIC) was 58.1 μg/L and 82.8% of the women who had subclinical iodine deficiency. The risk of subclinical iodine deficiency was reduced by the use of iodized salt (AOR = 0.13) and by intake of milk twice a month or more (AOR = 0.50), but it was increased by maternal illiteracy (AOR = 3.52).Conclusion.Iodine nutritional status of the pregnant women was poor. This shows that women and their children are exposed to iodine deficiency and its adverse effects. Thus, they need urgent supplementation with iodine and improved access to and intake of iodized salt and milk during pregnancy.


Author(s):  
Md Sujan Hossen ◽  
Md Nazrul Islam Khan

Aims: Iodine deficiency disorders are one of the major public health concerns in Bangladesh. Regular consumption of iodized salt can help combat these disorders. The aims of this study were to determine the content of iodine in edible packaged salt and to assess iodized salt related knowledge and storage practices in Dhaka City, Bangladesh. Study Design: The study was an experimental cross-sectional study. Place and Duration of Study: The present study was conducted from June 2019 to July 2019 in Dhaka City, Bangladesh. A total of 120 households were selected for interview and packaged salt sample collection. The chemical analysis was done in the Food Analysis Laboratory of Institute of Nutrition and Food Science, University of Dhaka. Methodology: A closed-ended questionnaire was used for collection of information. Iodometric titration method was used to determine the content of iodine in packaged salt samples. Results: The mean (±SD) iodine content in the salt samples was 31.469 (±10.196) ppm. More than 90% salt samples were adequately iodized. Twenty five percent of the respondents know that consumption of iodized salt helps prevent goiter. Only 10.8% of the respondents know that iodine content decreases if iodized salt is stored close to fire. About 87% of them store salt away from fire. Conclusion: Along with consuming packaged iodized salt, householders should be educated about iodized salt related knowledge and storage practices to control iodine deficiency disorders.


2020 ◽  
Author(s):  
Zhengyuan Wang ◽  
Yiwen Wu ◽  
Zehuan Shi ◽  
Jun Song ◽  
Guoquan Wang ◽  
...  

Abstract Background: China’s universal salt-iodization program has all but eliminated iodine deficiency disorders. Concern has shifted to mild iodine deficiency. Our study examined factors with the potential to predict mild iodine deficiency in pregnant women. Methods: A total of 2 400 pregnant women were enrolled using a multistage, stratified, random-sampling method. Data were collected through face-to-face interviews, a standardized questionnaire, an iodine-related knowledge questionnaire, urine samples, and household cooking salt samples. Results: The median urinary iodine concentration (MUIC) was 148.0 μg/L for all participants, and 155.0 μg/L, 151.0 μg/L, and 139.6 μg/L in the first, second, and third trimesters, respectively. The third trimester’s MUIC was significantly lower than that of the first trimester, and the usage rates of iodized salt and qualified-iodized salt were 71.5% and 59.4%, respectively. Iodine-related knowledge was significantly different between the high and low UIC groups. Participants’ MUIC increased significantly with increases in iodine-related knowledge. The third trimester was a significant risk factor for high UIC, whereas abundant iodine-related knowledge, study the dietary knowledge urgently, and consumption of iodine-rich food within 48 hours of a urine iodine test were significant protective factors for high UIC (P<0.05). Conclusions: Iodine levels are adequate among pregnant women in Shanghai during the first and second trimesters, but insufficient in the third trimester. The use of iodized cooking salt does not determine the iodine status of pregnant women. Abundant iodine-related knowledge is important for pregnant women in the third trimester to maintain adequate urinary iodine.


2020 ◽  
Vol 26 (2) ◽  
pp. 63-69
Author(s):  
Scrinic Olesea ◽  
Delia Corina Elena ◽  
Toma Geanina Mirela ◽  
Circo Eduard

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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