Current iodine status in Japan: A cross-sectional nationwide survey of schoolchildren, 2014–2019

Context Japan has been regarded as a long-standing iodine sufficient country without iodine fortification; however, data on nationwide iodine status is lacking. Objective This study aimed to characterize the iodine status in Japan. Methods From 2014 through 2019 a nationwide school-based survey was conducted across all districts in Japan. Urinary iodine concentration (UIC), creatinine (Cr) concentration and anthropometry were assessed in healthy school-aged children (SAC) aged 6 to 12 years. Their iodine status is regarded as generally representative of the nation's iodine status. Results A total of 32,025 children participated. The overall median UIC was 269 μg/L which was within the WHO’s adequacy range. There was a regional difference in UIC values within 14 regions, and the lowest and highest median UIC were found in Tanegashima Island (209 μg/L) and Nakashibetsu, Hokkaido (1,071 μg/L), respectively. The median UIC ≥ 300 μg/L was observed in 12 out of 46 regions. By using estimated 24-h urinary iodine excretion (UIE), the prevalence of SAC exceeding the upper tolerable limit of iodine for Japanese children was from 5.2 to 13.7%. The UIC values did not change with age, BSA and BMI percentile, while the Cr concentration simultaneously increased suggesting the effect of urinary creatinine on UI/Cr and estimated 24-h UIE values. Conclusions The iodine intake of Japanese people is adequate, but in some areas it is excessive. The incidence and prevalence of thyroid disorders associated with iodine intake should be obtained especially in the areas where high amounts of iodine are consumed.

Nutritional iodine status and obesity

Iodine is an essential component of the thyroid hormones, thyroxine and triiodothyronine. Its availability strictly depends on iodine content of foods, which may vary from very low to very high. Inadequate iodine intake (deficiency or excess) may affect thyroid function resulting in hypothyroidism or hyperthyroidism. Based on median urinary iodine concentrations, epidemiological criteria have been established for the categorization and monitoring of nutritional iodine status of a population (or subgroups of populations). Additional methods for iodine intake assessment include measurement of thyroid size (by thyroid palpation or ultrasonography) and of biochemical parameters, such as neonatal thyroid stimulating hormone, thyroglobulin and thyroid hormones.Recent studies carried out in overweight/obese children and adults provide evidence that body mass index (BMI) may significantly influence the above indicators, thus theoretically affecting the epidemiological evaluation of nutritional iodine status in populations.In this short review, we analyze current knowledge on the effects of overweight and obesity on indicators of adequacy and monitoring of iodine status, namely urinary iodine excretion and thyroid volume and echogenicity.Data on urinary iodine excretion in overweight/obese children are divergent, as both increased and reduced levels have been reported in overweight/obese children compared to normal-weight controls.Whether gastrointestinal surgery may affect iodine absorption and lead to iodine deficiency in patients undergoing bariatric surgery has been evaluated in a limited number of studies, which excluded iodine deficiency, thus suggesting that supplements usually recommended after bariatric surgery do not need to include iodine.Albeit limited, evidence on thyroid volume and obesity is consistent with a direct relationship between thyroid volume and BMI, irrespective of nutritional iodine status. Finally, a higher frequency of thyroid hypoechoic pattern has been described in overweight/obese children. This finding has been recently related to an increased adipocyte infiltration and thyroid parenchyma imbibition mediated by inflammatory cytokines and should be considered when the frequency of thyroid hypoechoic pattern is used as non-invasive marker to indirectly assess thyroid autoimmunity in monitoring Universal Salt Iodization programs. Further studies, specifically addressing the role of schoolchildren body mass index as a factor potentially influencing iodine intake indicators are needed.

Nationwide Representative Survey of Dietary Iodine Intake and Urinary Excretion in Postpartum Korean Women

Iodine is an essential component of thyroid hormones, but excessive iodine intake can lead to thyroid dysfunction. Traditionally, Korean mothers consume brown seaweed soup (miyeokguk), a high source of iodine, after childbirth. There is controversy regarding the effects of excessive postpartum iodine intake on the health of mothers and infants. Thus far, there have been no nationwide large-scale surveys regarding the status of iodine intake among postpartum women in Korea. Therefore, we conducted a nationwide survey of postpartum dietary iodine intake among Korean women. In total, 1054 Korean women aged ≥19 years, at less than 8 weeks postpartum, participated in this survey. Dietary data were collected using self-reported 2-day dietary records, along with before-and-after meal photos. To evaluate the correlation between dietary iodine and urinary iodine excretion (UIE), spot urine, and 24 h urine samples were collected from 98 and 29 participants, respectively. The mean daily iodine intake among all participants was 2945.6 μg, and it gradually decreased over time after childbirth. Dietary iodine intake was significantly correlated with 24 h UIE (r = 0.396, p < 0.05) and spot urine UIE (r = 0.312, p < 0.05). Follow-up studies are required to examine the influence of excessive postpartum iodine intake on thyroid health in mothers and their infants.

Is the urinary iodine/Creatinine ratio applicable to assess individual iodine status in Chinese adults? Comparison of iodine estimates from 24-hour urine and timed-spot urine samples in different periods of the day

Background: Urinary iodine concentration (UIC) is routinely used to evaluate the population iodine status while the uniform method for the individual level assessment is uncertain. Objectives : To explore the 24-hour urinary iodine excretion (UIE) in five different periods of the day and the corresponding prediction equations respect by the use of creatinine-corrected UIC. Methods: We collected 24-hour, spot and fasting urine in five periods of the day to estimate 24-hour UIE by the six different prediction equations. We compared the estimated creatinine-corrected UIC to the collected 24-hour UIE and identified the most suitable equations in each period of the day. Results: Among the six different prediction equations, the equation of Kawasaki T was the best to estimate the 24-hour UIE by fasting urine among Chinese adults. Among the five periods of time, the equation of Knudsen N was the best to estimate the 24-hour UIE except the morning period. Conclusion: Urinary iodine status at the individual level could be estimated by different creatinine-based equations at different periods of the day.

Use of Salivary Iodine Concentrations to Estimate the Iodine Status of Adults in Clinical Practice

ABSTRACT Background Measurement of the 24-h urinary iodine concentration or urinary iodine excretion (UIE) is the gold standard to determine iodine status; however, this method is inconvenient. The use of salivary iodine could be a possible alternative since salivary glands express the sodium-iodine symporter. Objectives We aimed to establish the correlation between the salivary iodine secretion and UIE, to evaluate the clinical applicability of the iodine saliva measurement. Methods We collected 24-h urine and saliva samples from 40 participants ≥18 y: 20 healthy volunteers with no specific diet (group 1), 10 patients with differentiated thyroid cancer with a low dietary intake (&lt;50 μg/d, group 2), and 10 patients with a high iodine status as the result of the use of amiodarone (group 3). Urinary and salivary iodine were measured using a validated inductively coupled plasma MS method. To correct for differences in water content, the salivary iodine concentration (SIC) was corrected for salivary protein and urea concentrations (SI/SP and SI/SU, respectively). The intra- and inter-individual CVs were calculated, and the Kruskal-Wallis test and Spearman's correlation were used. Results The intra-individual CVs for SIC, SI/SP, and SI/SU were 63.8%, 37.7%, and 26.9%, respectively. The inter-individual CVs for SIC, SI/SP, and SI/SU were 77.5%, 41.6% and 47.0%, respectively. We found significant differences (P &lt; 0.01) in urinary and salivary iodine concentrations between all groups [the 24-h UIE values were 176 μg/d (IQR, 96.1–213 μg/d), 26.0 μg/d (IQR, 22.0–37.0 μg/d), and 10.0*103 μg/d (IQR, 7.57*103–11.4*103 μg/d) in groups 1–3, respectively; the SIC values were 136 μg/L (IQR, 86.3–308 μg/L), 71.5 μg/L (IQR, 29.5–94.5 μg/L), and 14.3*103 μg/L (IQR, 10.6*103–25.6*103 μg/L) in groups 1–3, respectively]. Correlations between the 24-h UIE and SIC, SI/SP, and SI/SU values were strong (ρ = 0.80, ρ = 0.90, and ρ = 0.86, respectively; P &lt; 0.01). Conclusions Strong correlations were found between salivary and urinary iodine in adults with different daily iodine intakes. A salivary iodine measurement can be performed to assess the total iodine body pool, with the recommendation to correct for salivary protein or urea.

Low iodine diet of four days is sufficient preparation for 131I therapy in differentiated thyroid cancer patients

Context No consensus exists about the optimal duration of the low iodine diet (LID) in preparation of 131I therapy in differentiated thyroid cancer (DTC) patients. Objective This work aimed to investigate if a LID of four days is enough to achieve adequate iodine depletion in preparation for 131I therapy. In addition, the nutritional status of the LID was evaluated. Methods In this prospective study, 65 DTC patients treated in two University Medical Centers were included between 2018 and 2021. The patients collected 24-h urine on day four and seven of the LID and kept a food diary before and during the LID. The primary outcome was the difference between the 24-h urinary iodine excretion (UIE) on both days. Results The median 24-h UIE on day four and day seven of the LID were not significantly different (36.1[IQR 25.4 – 51.2]mcg and 36.5[IQR 23.9 – 47.7]mcg, respectively, P=0.43). On day four of the LID, 72.1% of the DTC patients were adequately prepared (24-h UIE&lt;50 mcg), and 82.0% of the DTC patients on day seven(P=0.18). Compared to the self-reported regular diet, DTC patients showed a significantly(P&lt;0.01) lower percentage of nutrient intake (calories, protein, calcium, iodine, and water) during the LID. Conclusions The 24-h UIE on day four of the LID did not differ from day seven, and therefore shortening the LID from seven to four days seems justified to prepare DTC patients for 131I therapy in areas with sufficient iodine intake and may be beneficial to maintain a sufficient nutritional intake during DTC treatment.

Evaluation of iodine nutritional status during pregnancy by estimated 24-hour urinary iodine excretion: population variation range and individual accuracy

Objective: To explore the accuracy of estimated 24-hour urinary iodine excretion(24hUIEest) in assessing iodine nutritional status. Design: Fasting venous blood, 24-hour and spot urine samples were collected during the day. The urinary iodine concentration (UIC) and urinary creatinine concentration (UCrC) were measured, and the urinary iodine-to-creatinine ratio (UI/Cr), 24hUIEest, and 24-hour urinary iodine excretion(24hUIE) were calculated. At the population level, correlation and consistency between UIC, UI/Cr, 24hUIEest and 24hUIE were assessed using correlation analysis and Bland-Altman plots. At the individual level, ROC curves were used to analyse the accuracy of the above indicators for evaluating insufficient and excessive iodine intake. The reference interval of 24hUIEest was established based on percentile values. Setting: Indicator can accurately evaluate individual iodine nutrition during pregnancy remains controversial. Participants: Pregnant women (n=788). Results: Using 24hUIE as standard, the correlation coefficients of 24hUIEest from different periods of the day ranged from 0.409 to 0.531, and the relative average differences ranged from 4.4% to 10.9%. For diagnosis of insufficient iodine intake, the area under the ROC curve of 24hUIEest was 0.754, sensitivity and specificity were 79.6% and 65.4%, respectively. For diagnosis of excessive iodine intake, the area of 24hUIEest was 0.771, sensitivity and specificity were 66.7% and 82.0%, respectively. The reference interval of 24hUIEest was 58.43-597.65μg. Conclusions: 24hUIEest can better indicate iodine nutritional status at a relatively large sample size in a given population of pregnant women. It can be used for early screening at the individual level to obtain more lead time for pregnant women.

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 Iodine Deficiency among School-Going Children of Age Group 6 to 12 Years in Kachchh District, Gujarat State: Cross-Sectional Hospital-Based Study

Aim Iodine deficiency disorder (IDD) is the cause of preventable brain damage, mental retardation, and stunted growth and development in children. This study aimed to detect the prevalence of IDD in Kachchh district, Gujarat, by testing urinary iodine excretion levels and iodine intake of salts in school-going children. Methods A cross-sectional study was conducted and the level of iodine deficiency was assessed in 223 school children of both sexes, aged 6 to 12 years from four talukas, that is, subdivisions, of the Kachchh district by estimating urinary iodine using Sandell–Kolthoff reaction along with iodine content in edible salt samples by MBI kit (STK-Spot testing kit, MBI Kits International, Chennai, TN, India). Results The median urinary iodine level was found to be 194 μg/L, indicating no biochemical iodine deficiency in the region. In the study areas, 1% of the population showed a level of urinary iodine excretion < 50 μg/L. About 83% salt samples had iodine level more than 15 ppm and the iodine content in salt samples less than 15 ppm was only about 17%, indicating the salt samples at households contain iodine in adequate level. Conclusion There is a need of periodic surveys to assess the change in magnitude of IDD with respect to impact of iodized salt intervention.Furthermore, to strengthen National Iodine Deficiency Disorders Control Program, factors should be identified. There is also a need to prevent and reimpose the ban on the sale of noniodized salts in Gujarat.