Iodized Salt Intake Research Articles

Iodine deficiency hypothyroidism in children in recent years: a re-emerging issue?

Iodine nutrition is a growing issue within the USA due to newer trends of non-iodized salts. There are no recent reviews looking at the current state of iodine deficiency-induced hypothyroidism in children in the USA. We performed a retrospective chart review at our tertiary pediatric endocrine clinic; four met the diagnostic criteria for iodine deficiency defined by a low urine iodine level. We further characterized severity of disease, risk factors, goiter, thyroid labs and antibodies. All cases had significant goiter and were diagnosed within the last 2 years. One case had iodine deficiency due to no iodized salt intake along with concurrent diagnosis of developmental delay and multiple food allergies, while others involved the use of non-iodized salts. Two cases had iodine deficiency along with autoimmunity. It is critical to obtain a dietary history for all patients who present with goiter and/or hypothyroidism. There may be a need to consider reevaluating current preventative measures for iodine deficiency, especially for certain vulnerable populations such as children who do not consume iodized salt. In recent decades, iodine nutrition has become a growing concern due to changing dietary patterns and food manufacturing practices. A dietary history is crucial to obtain in children presenting with hypothyroidism and goiter, especially in children with restrictive diets due to behavioral concerns, developmental delays, or multiple food allergies. Of the 12 different types of salts commercially available, only table salt contains iodine in an appropriate amount; thus, individuals using specialty salts can develop mild to moderate iodine deficiency-related thyroid disease.

Individual- and community-level factors associated with the presence of adequate iodized salt in households in Bangladesh: a multilevel modelling approach.

The aim of this study is to estimate the factors at both the individual and community levels related to the adequacy of iodized salt in households in Bangladesh. For this study we utilized the 2019 Multiple Indicator Cluster Survey data. A total of 61242 households were chosen as samples from Bangladesh. In our study of socio-economic disparities, we applied a concentration indexing method. To identify the factors associated with the adequacy of iodine in salt at both the individual and community levels, we employed multilevel logistic regression. Aside from the multilevel regression used in the study, we also applied spatial analysis. The results indicated that the prevalence of iodine adequacy in household salt was found to be 57.8% (95% confidence interval 57.4 to 58.2). Rural areas have a higher concentration of iodine than urban areas. According to the multilevel model, younger women (adjusted odds ratio [aOR] 0.70), Muslim women (aOR 0.89), illiterate women (aOR 0.80) and those from poor households (aOR 0.33) were found to be less likely to consume iodine in concentrated salt compared with their counterparts. Disabled women and those with low media exposure have a lower likelihood of iodine adequacy in salt compared to their reference group. Furthermore, households in urban areas exhibited higher odds of having iodine adequacy in salt compared with households in rural areas. Barisal, Chattogram, Dhaka, Khulna, Mymensingh, Rajshahi and Rangpur Divisions have lower iodine adequacy in salt compared with Sylhet Division. The findings reveal that religion, physical disability and exposure to media exert an equal influence on the presence of iodized salt intake. Moreover, women's age, wealth status, education level and the educational background of the household head positively contribute to the adequacy of iodine in household salt. In light of these results, policymakers are advised to prioritize efforts aimed at enhancing iodine concentration, with a particular focus on mass media advertising, especially in rural areas (excluding Sylhet Division).

How did we eliminate the hazards of water-borne excessive iodine in northern China?

Drinking water is the main cause of iodine excess among Chinese residents and we have found that water iodine concentration (WIC) reduction was the effective intervening measure. In this study, to eliminate the hazards of water-borne excessive iodine, we firstly investigated the WIC of villages in Tianjin in 2017 to determine the distribution range. Secondly, the risk characterization of excessive iodine on residents in 6∼< 9 years old, 9∼< 12 years old, 12∼< 15 years old, 15∼< 18 years old and adults were evaluated, and the safe upper limit of WIC was determined. Finally, WIC was investigated again after the completion of WIC reduction in water-borne excessive-iodine villages in 2020, and the differences in urinary iodine concentration (UIC) and thyroid volume (Tvol) of children aged 8–10 years before and after WIC reduction were analyzed. The WIC of 2459 villages surveyed was 22.30 (8.60–58.80) μg/L and the maximum was 514 μg/L. There were 422 villages with WIC > 100 μg/L. Under the conditions of non-iodized salt intake, recommended amount of iodized salt intake and actual amount intake, the maximum of excessive iodine exposure hazard quotient (HQ) were the highest in the age group of 6∼< 9 years, which were 2.300, 2.663 and 2.771, the safe upper WIC limits were 223 μg/L, 142 μg/L and 118 μg/L and villages with HQ> 1 accounted for 4.14%, 6.09% and 6.88% of all villages, respectively. After the WIC reduction, the WIC of the former water-borne iodine-excess villages decreased to < 100 μg/L, and the UIC and Tvol of children decreased (both P < 0.001) and was within normal range. Determining the distribution range of water-borne iodine-excess areas, exploring appropriate intervening measure, carrying out risk assessment, determining the WIC safe upper limit, intervening and evaluating the intervention effect can be the process to eliminate the hazards of water-borne excessive iodine.

Introduction to the programme guidance for the use of iodised salt in processed foods and its pilot implementation, strengthening strategies to improve iodine status.

Efforts to achieve optimal iodine intake through salt iodisation have focussed primarily on iodisation of household salt. However, there is strong evidence that in most regions of the world, industrially processed foods and condiments are an increasingly important source of dietary salt. In this context The Iodine Global Network (IGN) and partners developed programme guidance to help national programme managers assess the potential contribution of widely consumed industrially processed foods and condiments to iodine intake. The programme guidance additionally aimed to facilitate better understanding of iodised salt use by the processed food industry, review existing salt iodisation legislation for inclusion of food industry salt, and investigate how regulatory monitoring of food industry practices could be strengthened if needed. To evaluate the utility of the guidance in practice and identify areas where it could be improved, the IGN requested expressions of interest to pilot test implementation. Five pilots were implemented in Kenya, North Macedonia, The Republic of Moldova, Sri Lanka and Thailand, with remote technical support from IGN. The pilots demonstrated how evidence from implementation could be used to strengthen existing salt iodisation initiatives. In particular, how modelling existing processed food intake data enhanced understanding of potential or actual iodised salt intake and provided an evidence base for strategic change, as well as encouraging alignment with salt reduction programmes. In summary, the guidance provided a useful framework for national teams to conduct a relatively rapid assessment of the existing programme for achieving optimal iodine nutrition and opportunities to strengthen it. National teams involved with the pilot implementation were highly engaged and motivated by the outcomes. The pilot implementation process resulted in the development of strategic recommendations nationally and provided invaluable feedback to IGN on the utility of the guidance, facilitating development of an improved version.

Association between Iodized Salt Intake and Cognitive Function in Older Adults in China.

To investigate the association between iodized salt intake and cognitive function in older adults. A cross-sectional study. Individuals from the Zhejiang Major Public Health Surveillance Program (ZPHS). Data of 10,217 participants (including 4,680 coastal residents and 5,537 inland residents) aged ≥ 60 years were analyzed. Salt intake was evaluated using a questionnaire, and participants were stratified into the following three groups: iodized salt, non-iodized salt, and mixed salt. Cognitive function was assessed through the Mini-Mental State Examination and defined using education-specific cut-off points. Logistic regression models controlling for an extensive range of potential confounders were generated to examine the association between salt intake and cognitive function among all participants. Data from 10,217 participants with a 16.1% prevalence of cognitive impairment were analyzed. Compared with non-iodized salt intake, consumption of iodized salt was inversely associated with cognitive impairment (odds ratio [OR], 0.410; 95% confidence interval [CI], 0.351-0.480; P < 0.001) in all participants after multivariable adjustment. An association between iodized salt intake and cognitive impairment was observed in coastal (OR, 0.441; 95% CI, 0.340-0.572; P < 0.001) and inland residents (OR, 0.569; 95% CI, 0.439-0.738; P < 0.001). Despite the insufficient sample size, the results for individuals consuming mixed salt suggested an inverse association between mixed salt intake and cognitive impairment among coastal residents (OR, 0.598; 95% CI, 0.405-0.885; P = 0.010) after multivariable adjustment. Our results indicate that iodized salt intake may reduce the risk of cognitive impairment in older adults living in coastal or inland areas, and the protective effect of iodized salt intake is greater in coastal areas than in inland areas.

An assessment of Individual, community and state-level factors associated with inadequate iodised salt consumption among pregnant and lactating women in Nigeria

BackgroundIodine deficiency is the most common cause of thyroid disease, and in its severe form can result in cretinism; the impairment of the brain development of a child. Pregnant and breastfeeding women’s daily iodine requirement is elevated due to physiological changes in iodine metabolism, requiring up to double the iodine intake of other women. Although Nigeria was the first African country to be declared iodine sufficient in 2007, recent evidence has shown that only about seven in ten households consume salt with adequate iodine content (≥ 15 ppm), with variation across states. The study aimed to assess the Individual- and household-, community- and state-level factors associated with inadequate iodised salt consumption among pregnant women and breastfeeding mothers in Nigeria.MethodsThis study utilised the Multiple Indicator Cluster Survey to assess factors associated with inadequate iodised salt consumption among 4911 pregnant women and breastfeeding mothers in Nigeria. The descriptive analysis was presented using frequencies and percentages. The prevalence of adequate and inadequate iodised salt consumption with their 95% confidence interval were computed. Several multi-level mixed effect log-binomial logistic regressions were used to explore the factors associated with inadequate iodised salt consumption. The Loglikelihood, Akaike Information Criterion and Bayesian Information Criterion were used to assess the goodness of fit of the models. All analyses were adjusted for the complex survey design and analysed using Stata 15.0 at p < 0.05.ResultsThe prevalence of inadequate iodised salt consumption among pregnant and breastfeeding mothers was 35.2% (95% CI: 33.1–37.5). Inadequate consumption of iodised salt was highest among pregnant and breastfeeding women aged 45–49 years (48.2%; 95%CI: 37.8–58.8), as well as those with non-formal education (52.7%; 95%CI: 47.7–57.6) and no education (34.6%; 95%CI: 31.3–38.1). Our findings revealed that pregnant and breastfeeding women living in the poorer, middle, richer and richest quintiles were 32%, 47%, 35% and 62% less likely to consume salt with inadequate iodine compared to those in the poorest households. Those with non-formal education were 1.8 times (95%CI: 1.36–2.42) more likely to consume salt with deficient iodine than those without education. Pregnant and breastfeeding mothers residing in moderately and most deprived communities were 3.5 (95%CI: 2.57–4.73) and 4.7 times (95%CI: 3.38–6.55) more likely to consume salt with inadequate iodine than those from least deprived communities. Women in the Northwestern region and those from the Southwestern region were 4.0 and 3.5 times, respectively, more likely to consume salt with inadequate iodine compared to pregnant and breastfeeding women residing in the North-Central region.ConclusionsThe study has shown that inadequate consumption of iodised salt dominates among older pregnant and breastfeeding women. Also, women with non-formal education have higher prospects of consuming salt with lesser iodine. There is a need to enhance women’s economic opportunities and empowerment as well as sensitisation on their nutritional requirements during pregnancy and breastfeeding. Both formal and non-formal educational initiatives on nutrition are extremely important and should be prioritised by the Nigerian government in its efforts to encourage the consumption of iodised salt among pregnant and lactating mothers. Additionally, health promotion interventions that seek to advocate iodised salt intake must be prioritised by the actors in the health sector.

Prevalence of Iodized Salt Intake and Iodine Deficiency Disorders Status of Pregnant Women Visiting Bishoftu Hospital and Health Center for Antenatal Care

Iodine is an essential mineral for normal thyroid function, mammary gland development, and fetal and infant neurological growth. It is a trace element essential to human and animal health, and present in uneven and mostly insufficient quantities in the environment around the globe. Iodine deficiency disorders are among the major public health problems of the world, particularly in pregnant women of developing countries. In Ethiopia about 15.4% of households consume sufficient iodized salt. This study was designed to assess iodized salt intake and assess iodine nutrition status, to evaluate knowledge, attitudes and practice of iodine nutrition and to asses goiter rate of pregnant women attending Bishoftu clinic for antenatal care in Bishoftu town. The study participants (n=208) was randomly selected. Data over socio-demographic, and knowledge, attitude and practice about iodized salt was collected by interview. Goiter was assessed by palpation and graded according to the WHO guideline. In addition, spot urine sample was collected and the level of urinary iodine was determined following the Sandell-Kolthoff reaction. Iodine level in salt samples was determined by following iodometric titration methods. The prevalence of goiter was 8.7% (Grade 1 = 7.7% and Grade 2 = 1%). The median urinary iodine concentration was 194.3μg/l. The consumption of adequately iodized salt was 89%. This study was indicated as there was no problem of iodine deficiency in the study area.

Modelling the contribution of iodised salt in industrially processed foods to iodine intake in Macedonia.

Evidence from the 1950s showed that Macedonia was iodine deficient. After the introduction of mandatory universal salt iodisation, the country saw a steady increase in iodine intake and decline in goitre prevalence, earning iodine-deficiency free status in 2003. Iodine status assessments in 2007 and 2016 showed adequate iodine intake among school age children (median urinary iodine concentration of 241 μg/L and 236 μg/L respectively). Macedonia participated in piloting the Iodine Global Network Programme Guidance on the use of iodised salt in industrially processed foods to better understand potential iodised salt intake from processed foods. One objective of implementation was to identify the need, opportunities, and required actions to strengthen the processed food component of the national salt iodisation policy. Data from the 2017 Household Consumption and Expenditure Survey (HCES) was used to determine household salt consumption, to identify widely-consumed, salt-containing industrially processed foods, and estimate typical daily intake of these foods. Their estimated contribution to iodine intake was estimated based on their salt content and the percentage of food industry salt that is iodised. Although the study has limitations, including a relatively small selection of foods, the results indicate potential iodine intake from iodised household salt and iodised salt in the selected foods of nearly 300% of the Estimated Average Requirement and over 220% of the Recommended Nutrient Intake for adults. This was approximately 50% of the tolerable safe Upper Level for iodine intake. The study confirmed high daily salt intake (11.2 grams from household salt only). Successful salt reduction would be expected to reduce iodine intake, however, modelling with 10% and 30% reduction implied this is unlikely to put any population group at risk of deficiency. It is recommended that implementation of salt iodisation and salt reduction policies are harmonized, alongside continued regular iodine status monitoring for different population groups.

Estimated contribution of most commonly consumed industrialized processed foods to salt intake and iodine intakes in Sri Lanka.

In Sri Lanka dietary patterns are shifting towards increased consumption of industrially processed foods (IPF). This study aimed to estimate the contribution of IPF to salt and iodine intake and assess the possible impact of salt reduction on iodized salt intake. The assessment was conducted using guidance published by the Iodine Global Network. National nutrition and household income expenditure surveys were used to estimate adult per capita consumption of household salt and commonly consumed salt-containing IPF. Industry and laboratory data were used to quantify salt content of IPF. Modelling estimated the potential and current iodine intake from consumption of household salt and using iodized salt in the identified IPF. Estimates were adjusted to investigate the likely impact on iodine intake of achieving 30% salt reduction. IPF included were bread, dried fish and biscuits, with daily per capita consumption of 32g, 10g and 7g respectively. Daily intake of household salt was estimated to be 8.5g. Potential average national daily iodine intake if all salt in these products was iodized was 166μg. Estimated current daily iodine intake, based on iodization of 78% of household salt and dried fish being made with non-iodized salt, was 111μg nationally, ranging from 90 to 145μg provincially. Estimated potential and current iodine intakes were above the estimated average requirement of 95μg iodine for adults, however, current intake was below the recommended nutrient intake of 150μg. If the 30% salt reduction target is achieved, estimated current iodine intake from household salt, bread and biscuits could decrease to 78μg. The assessment together with data for iodine status suggest that current iodine intake of adults in Sri Lanka is adequate. Recommendations to sustain with reduced salt intake are to strengthen monitoring of population iodine status and of food industry use of iodized salt, and to adjust the salt iodine levels if needed.

Analysis of the correlation between high iodized salt intake and the risk of thyroid nodules: a large retrospective study

BackgroundCurrently, whether daily excess iodized salt intake increases the risk of thyroid nodules and even thyroid cancer remains controversial. Our research group aimed to provide a theoretical basis for the clinical guidance of daily iodized salt intake and the prevention of thyroid nodules through a retrospective analysis of the correlation between daily iodized salt intake and the risk of thyroid nodules and thyroid cancer in Hunan, China.MethodsThis study retrospectively analyzed the data of subjects who underwent a physical examination at the Health Management Center, Third Xiangya Hospital of Central South University, between January 1, 2017, and December 31, 2019. Subjects enrolled in this study underwent thyroid ultrasonography and tests to urine routines and liver and kidney function, and all subjects completed a questionnaire survey. The daily iodized salt intake of the study subjects was estimated based on spot urine methods (Tanaka). A multivariate logistic regression model was used to analyze the relationship between daily iodized salt intake and thyroid nodules and thyroid cancer.ResultsAmong the 51,637 subjects included in this study, the prevalence of thyroid nodules was 40.25%, and the prevalence of thyroid cancer was 0.76%; among all enrolled subjects, only 3.59% had a daily iodized salt intake less than 5 g. In addition, we found that a daily intake of more than 5 g of iodized salt was not only an independent risk factor for the occurrence of thyroid nodules (odds ratio (OR): 2.08, 95% confidence interval (CI): 1.86–2.31, p < 0.001) but also an independent risk factor for the occurrence of thyroid cancer (OR: 5.81, 95% CI: 1.44–23.42, p = 0.012). A pooled analysis showed a significantly higher risk of thyroid nodules in subjects aged > 60 years with a daily iodized salt intake of more than 5 g compared to subjects aged < 60 years with a daily iodized salt intake of no more than 5 g (OR: 4.88, 95% CI: 4.29–5.54, p < 0.001); the risk of thyroid cancer was not significantly different between subjects aged > 60 years with a daily iodized salt intake of more than 5 g and those aged < 60 years with a daily iodized salt intake of no more than 5 g (OR: 2.15, 95% CI: 0.52–8.95, p = 0.281). The risk of thyroid nodules was not increased in physically active subjects with a daily iodized salt intake of more than 5 g compared to physically inactive subjects with a daily iodized salt intake of no more than 5 g (OR: 1.12, 95% CI: 0.97–1.28, p = 0.111). The same protective effect of physical activity was observed for thyroid cancer in subjects whose daily iodized salt intake exceeded 5 g. The risk of thyroid nodules was reduced for subjects with an education level of postgraduate and above, even when the daily iodized salt intake exceeded 5 g, compared to those with high school education and below and a daily iodized salt intake of no more than 5 g (OR: 0.79, 95% CI: 0.66–0.93, p = 0.005); however, a protective effect of education level on the occurrence of thyroid cancer was not observed. Independent risk factors affecting daily iodized salt intake greater than 5 g included age, triglycerides, family history of tumors, physical activity, and marital status.ConclusionsDaily intake of more than 5 g of iodized salt increased the risk of thyroid nodules and thyroid cancer, while increased physical activity and education level reduced the risk of thyroid nodules and thyroid cancer caused by iodized salt intake.

Iodine monitoring models contribute to avoid adverse birth outcomes related more than adequate iodine intake

BackgroundIodine plays an important role in pregnancy. How to maintain adequate iodine intake amongst pregnant women in each trimester of pregnancy to prevent adverse birth outcomes in central China is a challenge for clinical practice.Methods870 pregnant women and their infants were enrolled in the study. Urinary iodine concentration (UIC) was measured using an inductively coupled plasma mass spectrometry (ICP-MS). Maternal and newborn information were obtained during follow-up. Multinomial logistic regression models were established.ResultsMedian UIC of pregnant women was 172 ± 135 μg/L which is currently considered to be sufficient. Multivitamin supplements containing iodine, iodized salt intake and frequent milk intake were significantly associated with higher UIC. Multivariate logistic regression analysis showed that multivitamin supplements containing iodine and milk consumption were risk factors for more than adequate iodine (UIC ≥ 250 μg/L). Iodine-rich diet was significantly related to heavier birthweight, larger head circumference and longer femur length of the newborns while more than adequate iodine intake (UIC ≥ 250 μg/L) was a risk factor for macrosomia. Logistic regression models based on potential risk factors involving iodine containing supplements and iodine-rich diet were established to predict and screen pregnant women with high risk of more than adequate iodine intake among local pregnant women in different trimesters and guide them to supplement iodine reasonably to prevent the risk.ConclusionsMultivitamin supplements containing iodine and milk consumption were risk factors for maternal UIC ≥ 250 μg/L which was a risk factor for macrosomia. Iodine monitoring models were established to provide guidance for pregnant women to reduce the risk of more than adequate iodine intake, thereby contributing to reduce the risk of having a macrosomia.

Assessment of Dietary Pattern of People Living in a Rural Area of Bihar

Introduction: There is a trend of declining cereal intake particularly coarse cereals and really low increase of consumption of other food items within the rural diet, which has often been explained as an expected outcome of economic growth Aims &amp; Objectives: 1). To observe the dietary pattern of different food items and their timely consumption. 2). To assess the consumption and practices of daily food items used in kitchen. Methodology: It was a cross-sectional study done in Nathnagar areas (Bihar) in the month of March, 2017 with the help of pre-tested semi structured questionnaire amongst the rural population. Total 154 subjects were interviewed in one-month period. Result: maximum participants 51 (33.11%) belong to 22-27 years of age group and majority of the population were literate. It was also found that 127 (82.46%) of participants consume green vegetables daily and daily consumption of beverages such as tea and coffee were seen common to 152 (98.7%) participants. Iodized Salt intake consumption was seen in majority 151 (98%). Washing practices of cereals, at least two times a day was seen in 94 (61%) participant and it was also observed that 123 (79.87%) participants practiced washing of vegetables before cutting. Conclusion: Most of them where vegetarian by diet. As of education part all most all the participants were from the literate groups which depicts a good overview of society regarding studies. Many of them were aware of their consumption of food and its pattern, still few were lagging. Overall, everyone had different pattern of food habit and it shows that much work has to be done in the field of health dimension with the help of education and motivation and through implementation of healthy life style behaviour in terms of nutrition and its monitoring from time to time.

The Status and Knowledge of Iodine among Pregnant Women in Shanghai.

Iodine plays an important role in thyroid function. However, in daily practices, people lack the related details including the knowledge concerned iodine usage, attitudes towards it, and practice among pregnant women. The aim of the present study is to assess the iodine status of pregnant women in Shanghai, and their knowledge regarding iodine, with the goal of investigating the relationship between iodine and thyroid function during pregnancy. This is a cross-sectional study. We recruited 3 groups of participants including 145 pregnant women (12-16weeks gestation), 101 pregnant women (24-28weeks gestation), and 108 pregnant women (34-38weeks gestation). Iodine status and dietary intake were calculated from 24-h urinary iodine concentration (UIC). Knowledge regarding iodine was collected through a questionnaire. We additionally examined TSH, FT3, FT4, and TPOAb of the participants. The median of UIC of the 354 pregnant women was 119.2μg/L, and 68.9% had urinary iodine levels below 150μg/L. The proportion of daily iodized salt consumption in pregnant women was only 78.0%. The median UIC of the pregnant women who had consumed iodized salt was significantly higher than that of the pregnant women without iodized salt intake (Z = - 5.087, P < 0.001). Pregnant women in weeks 34-38 with a high level of knowledge had significantly lower TSH levels than those with low knowledge level (P = 0.046). Among the 349 pregnant women, few were aware of the harm to the fetus (8.3%). Significant differences were found in the scores for the knowledge level of women with different educational levels (Z = - 5.413, P < 0.001). Pregnant women in Shanghai have mild iodine deficiency. Approaches to improve iodine status among pregnant women in Shanghai include raising their awareness of iodine intake and changing their dietary habits. Otherwise, the risk of iodine deficiency in pregnant women may continue to increase.

Change over time in the iodine nutritional status of pregnant women from the Pamplona healthcare region

IntroductionAdequate iodine intake is essential during pregnancy. A previous study of pregnant women from the Pamplona healthcare region showed mild iodine deficiency (mean urinary iodine level, 125mcg/L). This study was intended to ascertain the iodine intake of pregnant women in our region and to analyze the change over time in their iodine nutritional status. MethodsAn observational study of 400 women in their first trimester of pregnancy. An iodine intake questionnaire was administered. To assess iodine status, urinary iodine concentration (UIC) was measured in a simple urine sample, and serum thyroglobulin levels were determined. In addition, thyroid volume was measured by cervical ultrasound examination. ResultsIodized salt was used by 70.5% of all participants (55.3% since the pre-gestational period) and 98.5% of them received iodine-containing supplements (mean dose, 202.6±30.1mcg/day). Mean urinary iodine concentration was 242mcg/L (138.5–415.5mcg/L) and the mean serum thyroglobulin level was 12.3mcg/L (8.3–9mcg/L). Iodized salt intake was associated with higher UICs and lower thyroid volume. No differences were found in any of the tested parameters regarding the intake of dairy products, fish, or eggs. ConclusionsIodine intake by pregnant women in Pamplona has increased due to a greater use of iodized salt and to higher doses of iodine supplements. As a result of this, an adequate iodine status has been achieved in the last decade.

Effect of nutrition education on iodine deficiency disorders and iodized salt intake in south west Ethiopian women: a cluster randomized controlled trial

BackgroundAlthough iodine nutrition status is improving globally, the progress is not uniform throughout the world due to several factors. Among these, poor knowledge, negative attitude and improper practice of iodized salt are the main risk factors for poor iodine nutrition in Ethiopia. This study was aimed to assess the effect of nutrition education intervention on knowledge, attitude and practice (KAP) of iodine deficiency and iodized salt utilization.MethodsA cluster randomized controlled trial was carried out among 652 women of reproductive age group in southwest Ethiopia. A total of 24 clusters were selected and randomized in to an intervention and control villages. Women in the intervention village received iodine nutrition related education for 6 months; while those in the control village did not receive any education. Baseline and endline data were collected from both groups. Generalized Estimating Equations (GEE) was used to determine the effect of intervention.ResultsA total of 647 (99.2%) participants were successfully involved in the study. In the intervention group the median attendance was 10 out of 12 sessions. Women in the intervention group had shown statistically significant change in knowledge, attitude and practice scores as compared to control one. In multivariable GEE linear model, after adjusting for other background characteristics, the mean difference (95% CI) scores were 8.81 (8.46, 9.16) for knowledge, 3.35 (3.17, 3.54) for attitude and 2.90 (2.74, 3.05) for practice in the intervention arm.ConclusionsWell designed and community-based iodine nutrition education is an effective strategy to improve the KAP of iodine deficiency disorders and iodized salt utilization.Trial registration PACTR201809544276357 (Retrospectively registered on 14, Sept. 2018).https://www.pactr.org.

Evolución del estado de nutrición de yodo en gestantes del area sanitaria de Pamplona

IntroductionAdequate iodine intake is essential during pregnancy. A previous study of pregnant women from the Pamplona healthcare region showed mild iodine deficiency (mean urinary iodine level, 125 mcg/L). This study was intended to ascertain the iodine intake of pregnant women in our region and to analyze the change over time in their iodine nutritional status. MethodsAn observational study of 400 women in their first trimester of pregnancy. An iodine intake questionnaire was administered. To assess iodine status, urinary iodine concentration (UIC) was measured in a simple urine sample, and serum thyroglobulin levels were determined. In addition, thyroid volume was measured by cervical ultrasound examination. ResultsIodized salt was used by 70.5% of all participants (55.3% since the pre-gestational period) and 98.5% of them received iodine-containing supplements (mean dose, 202.6±30.1 mcg/day). Mean urinary iodine concentration was 242 mcg/L (138.5-415.5 mcg/L) and the mean serum thyroglobulin level was 12.3 mcg/L (8.3-9 mcg/L). Iodized salt intake was associated with higher UICs and lower thyroid volume. No differences were found in any of the tested parameters regarding the intake of dairy products, fish, or eggs. ConclusionsIodine intake by pregnant women in Pamplona has increased due to a greater use of iodized salt and to higher doses of iodine supplements. As a result of this, an adequate iodine status has been achieved in the last decade.

Low intake of iodized salt and iodine containing supplements among pregnant women with apparently insufficient iodine status - time to change policy?

BackgroundIodine is an essential nutrient for human health throughout the life cycle, especially during early stages of intrauterine life and infancy, to ensure adequate neurocognitive development. The growing global reliance on desalinated iodine-diluted water raises the specter of increased iodine deficiency in several regions. The case of Israel may be instructive for exploring the link between iodine status and habitual iodine intake in the setting of extensive national reliance on desalinated water. The aim of this study was to explore the relationship between iodine intake, including iodized salt and iodine-containing supplements intake, and iodine status among pregnant women residing in a sub-district of Israel that is highly reliant on desalinated iodine-diluted water.MethodsA total of 134 consecutive pregnant women were recruited on a voluntary basis from the obstetrics department of the Barzilai University Medical Center during 2018. Blood was drawn from participants to determine levels of serum thyrotropin (TSH), thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and thyroglobulin (Tg). An iodine food frequency questionnaire (sIFFQ) was used to assess iodine intake from food, IS and ICS. A questionnaire was used to collect data on demographic and health characteristics.ResultsA total of 105 pregnant women without known or reported thyroid disease were included in the study. Elevated Tg values (≥ 13 μg/L), were found among 67% of participants, indicating insufficient iodine status. The estimated iodine intake (median, mean ± SD 189, 187 ± 106 μg/d by sIFFQ) was lower than the levels recommended by the World Health Organization and the Institute of Medicine (250 vs. 220 μg/day respectively). The prevalence of iodized salt intake and iodine containing supplement intake were 4 and 52% (respectively). Values of Tg > 13 μg/L were inversely associated with compliance with World Health Organization and Institute of Medicine recommendations.ConclusionsWhile the Israeli Ministry of Health has recommended the intake of iodized salt and iodine containing supplements, this is apparently insufficient for achieving optimal iodine status among Israeli pregnant women. The evidence of highly prevalent probable iodine deficiency in a sample of pregnant women suggests an urgent need for a national policy of iodized salt regulation, as well as guidelines to promote iodine containing supplements and adherence to them by caregivers. In addition, studies similar to this one should be undertaken in additional countries reliant on desalinated iodine-diluted water to further assess the impact of desalinization on maternal iodine status.

A Review of Published Literature Regarding Health Issues of Coastal Communities in Sabah, Malaysia.

Several of the coastal zones in Sabah, Malaysia, are isolated and inaccessible. This study aimed to review the published literature on the health status of the coastal communities in Sabah. The following four main health issues were found: (i) malaria, (ii) tuberculosis (TB), (iii) seafood poisoning, and (iv) antenatal problems. Factors associated with the risk of acquiring malarial infection in the studied coastal area were advanced age, male sex, farming as an occupation, history of travel outside the village, and rainy seasons. TB infection was primarily observed in adult men. Seafood poisoning was significantly common in Sabah. Studies have reported that tetrodotoxin and paralytic shellfish poisoning were commonly reported (30–60 cases annually). Several pregnant women in the coastal community had insufficient knowledge of the national antenatal care programme. Nonetheless, 99% of them received antenatal care at public healthcare facilities with 92% of them undergoing safe delivery. Nevertheless, a majority of the pregnant women had iodine deficiency due to low iodised salt intake. Findings from this review highlighted that the coastal communities in Sabah are experiencing significant health problems. Specific attention is required to significantly enhance the health and well-being of the individuals living in the coastal communities in Sabah.

Pregnant Women's Iodine Status and Their Knowledge, Attitude, and Practice towards Iodized Salt in Esfarayen and Jajrom Cities in 2016-2017

Background: Evaluation of status of iodine during pregnancy is crucial. Therefore, this study was conducted to investigate it in pregnant women and to evaluate their knowledge, attitude, and practice toward consuming iodized salt. Methods: In a cross-sectional study, 150 pregnant women were selected by census method based on the inclusion criteria. The participants' status of iodine was measured by measuring their urinary iodine concentration. Furthermore, the women's knowledge, attitude, and practice were investigated regarding iodized salt intake by a valid questionnaire. Results: Median concentrations of the urinary iodine in total population and Esfarayen people 139.05 (92.0-216.5) and 131.19 (211.43-86.43) μg/l, respectively which were lower than the World Health Organization recommendations (150-249 μg/l), while it was within the recommended range in Jajrom people 176.12 (101.76-248.62) μg/l. Although most people in the total population and Esfarayen people had moderate level of knowledge, attitude, and practice, most mothers in Jajrom had good knowledge and attitude scores along with moderate scores of practices. A significant direct correlation was found between attitude level and urinary iodine concentration (P = 0.043, r = 0.17). Conclusions: In total population, the median urinary iodine concentration was lower than the recommended level. Furthermore, knowledge, attitude, and practice of most people were at the moderate level.

Pre-pregnancy iodized salt improved children's cognitive development in randomized trial in Ethiopia.

The overarching Ethiopia project examined the effects of early market introduction of iodized salt on the growth and mental development of young children. Sixty districts were randomly assigned to intervention (early market access to iodized salt) or control (later access through market forces), and one community per district was randomly chosen as the sampling unit. For this project, 22 of the districts were included. The participants were 1,220 pregnant women who conceived after the intervention began. When their children were 2 to 13 months old, field staff collected information on household sociodemographic status and iodized salt intake, child stimulation, maternal depression symptoms, children's diet, anthropometry, urinary iodine concentration (UIC), hemoglobin, and mental development scores (Bayley III scales). Fewer mothers prepartum (28% vs. 41%, p < .05) and their children (13% vs. 20%, p < .05) were iodine deficient (UIC <50 μg/L) in the intervention compared with the control group. The intervention children had higher cognitive scores (33.3 ± 0.3 vs. 32.6 ± 0.3; Δ = 0.6; 95% CI [0.0, 1.3]; d = 0.17; p = .01; 4 IQ points) than their controls. The other Bayley subscale scores did not differ from control children. The intervention group had a higher child stimulation (22.7 ± 0.2 vs. 22.1 ± 0.2; Δ = 0.5; 95% CI [0.02, 0.89]; d = 0.17; p = .01) but not growth indicators (weight‐for‐age z score, length‐for‐age z score, and weight‐for‐length z score: −1.1 ± 0.1 vs. −1.1 ± 0.1, −1.7 ± 0.1 vs. −1.7 ± 0.1; −0.2 ± 0.1 vs. −0.1 ± 0.1, respectively, all p > .05) compared with their controls. Iodized salt intake improved iodine status of both pregnant women and their children and also child cognitive development.