The impact of iodised salt or iodine supplements on iodine status during pregnancy, lactation and infancy

Objectives: Monitoring of iodine status during pregnancy, lactation and infancy is difficult as there are no established reference criteria for urinary iodine concentration (UI) for these groups; so it is uncertain whether iodized salt programs meet the needs of these life stages. Design and Subjects: The method used in this paper was: 1) to estimate the median UI concentration that reflects adequate iodine intake during these life stages; and 2) to use these estimates in a review of the literature to assess whether salt iodisation can control iodine deficiency in pregnant and lactating women, and their infants. Results: For pregnancy, recommended mean daily iodine intakes of 220-250 μg were estimated to correspond to a median UI concentration of about 150 μg l−1, and larger surveys from the iodine sufficient countries have reported a median UI in pregnant women ≥140 μg l−1. Iodine supplementation in pregnant women who are mild-to-moderately iodine deficient is beneficial, but there is no clear affect on maternal or newborn thyroid hormone levels. In countries where the iodine intake is sufficient, most mothers have median breast milk iodine concentration (BMIC) greater than the concentration (100-120 μg l−1) required to meet an infant's needs. The median UI concentration during infancy that indicates optimal iodine nutrition is estimated to be ≥100 μg l−1. In iodine-sufficient countries, the median UI concentration in infants ranges from 90-170 μg l−1, suggesting adequate iodine intake in infancy. Conclusions: These findings suggest pregnant and lactating women and their infants in countries with successful sustained iodised salt programs have adequate iodine statu

Symposium on ‘Geographical and geological influences on nutrition' Iodine deficiency in industrialised countries: Conference on ‘Over- and undernutrition: challenges and approaches'

Iodine deficiency is not only a problem in developing regions; it also affects many industrialised countries. Globally, two billion individuals have an insufficient iodine intake, and approximately 50% of continental Europe remains mildly iodine deficient. Iodine intakes in other industrialised countries, including the USA and Australia, have fallen in recent years. Iodine deficiency has reappeared in Australia, as a result of declining iodine residues in milk products because of decreased iodophor use by the dairy industry. In the USA, although the general population is iodine sufficient, it is uncertain whether iodine intakes are adequate in pregnancy, which has led to calls for iodine supplementation. The few available data suggest that pregnant women in the Republic of Ireland and the UK are now mildly iodine deficient, possibly as a result of reduced use of iodophors by the dairy industry, as observed in Australia. Representative data on iodine status in children and pregnant women in the UK are urgently needed to inform health policy. In most industrialised countries the best strategy to control iodine deficiency is carefully-monitored salt iodisation. However, because approximately 90% of salt consumption in industrialised countries is from purchased processed foods, the iodisation of household salt only will not supply adequate iodine. Thus, in order to successfully control iodine deficiency in industrialised countries it is critical that the food industry use iodised salt. The current push to reduce salt consumption to prevent chronic diseases and the policy of salt iodisation to eliminate iodine deficiency do not conflict; iodisation methods can fortify salt to provide recommended iodine intakes even if per capita salt intakes are reduced to <5 g/

Iodine status of pregnant Haitian-American women

Iodine is an essential element for the production of thyroid hormone, which is required for fetal cognitive development during pregnancy. Changes in maternal metabolism and physiology increase iodine requirements, and even mild iodine deficiency may lead to adverse effects on fetal neurodevelopment. While overall iodine intake in the United States is considered to be sufficient, there have been recent concerns about mild deficiency among women of childbearing years. Potentially exacerbating this issue amongst Haitian-American women is the known occurrence of iodine deficiency in Haiti. Attempts to supplement iodized salt by UNICEF have been unsuccessful due to Haiti's current political climate. Haitian immigrant women living in the United States may be at particular risk for iodine deficiency during pregnancy due to their unique dietary patterns. We conducted a cross-sectional study of 21 pregnant Haitian women living in the Boston area in order to determine if they are ingesting adequate dietary iodine. Our subjects included women with singleton pregnancies, who were not taking any thyroid hormone or anti-thyroid medication, and who were recruited at the Antenatal Clinic at Boston Medical Center. We obtained spot urine iodine concentrations, as well as information pertaining to iodine-containing prenatal vitamin use. To date, this has been the only such study carried out in this particularly vulnerable ethnic group and this study provides information of public health importance

Distinguished Scientist Lecture Series Program 1991-1992

Distinguished Scientist Lecture Series Brochure 1991-1992, published by the Bard Centerhttps://digitalcommons.bard.edu/dsls_1991_1992/1005/thumbnail.jp

Optimal assessment and quantification of iodine nutrition in pregnancy and lactation : laboratory and clinical methods, controversies and future directions

Iodine intake must be boosted during pregnancy to meet the demands for increased production and placental transfer of thyroid hormone essential for optimal foetal development. Failure to meet this challenge results in irreversible brain damage, manifested in severity from neurological cretinism to minor or subtle deficits of intelligence and behavioural disorders. Attention is now being focused on explaining observational studies of an association between insufficient iodine intake during pregnancy and mild degrees of intellectual impairment in the offspring and confirming a cause and effect relationship with impaired maternal thyroid function. The current qualitative categorisation of iodine deficiency into mild, moderate and severe by the measurement of the median urinary iodine concentration (MUIC) in a population of school-age children, as a proxy measure of dietary iodine intake, is inappropriate for defining the degree or severity of gestational iodine deficiency and needs to be replaced. This review examines progress in analytical techniques for the measurement of urinary iodine concentration and the application of this technology to epidemiological studies of iodine deficiency with a focus on gestational iodine deficiency. We recommend that more precise definitions and measurements of gestational iodine deficiency, beyond a spot UIC, need to be developed. We review the evidence for hypothyroxinaemia as the cause of intrauterine foetal brain damage in gestational iodine deficiency and discuss the many unanswered questions, from which we propose that further clinical studies need to be designed to address the pathogenesis of neurodevelopmental impairments in the foetus and infant. Agreement on the testing instruments and standardization of processes and procedures for Intelligence Quotient (IQ) and psychomotor tests needs to be reached by investigators, so that valid comparisons can be made among studies of gestational iodine deficiency and neurocognitive outcomes. Finally, the timing, safety and the efficacy of prophylactic iodine supplementation for pregnant and lactating women needs to be established and confirmation that excess intake of iodine during pregnancy is to be avoided

Assessment of iodine nutrition in populations: past, present, and future

Iodine status has been historically assessed by palpation of the thyroid and reported as goiter rates. Goiter is a functional biomarker that can be applied to both individuals and populations, but it is subjective. Iodine status is now assessed using an objective biomarker of exposure, i.e., urinary iodine concentrations (UICs) in spot samples and comparison of the median UIC to UIC cut-offs to categorize population status. This has improved standardization, but inappropriate use of the crude proportion of UICs below the cut-off level of 100 µg/L to estimate the number of iodine-deficient children has led to an overestimation of the prevalence of iodine deficiency. In this review, a new approach is proposed in which UIC data are extrapolated to iodine intakes, adjusted for intraindividual variation, and then interpreted using the estimated average requirement cut-point model. This may allow national programs to define the prevalence of iodine deficiency in the population and to quantify the necessary increase in iodine intakes to ensure sufficiency. In addition, thyroglobulin can be measured on dried blood spots to provide an additional sensitive functional biomarker of iodine statu

PERLUKAH WANITA HAMIL MENDAPAT SUPLEMENTASI IODIUM ?

ABSTRAK Perlindungan wanita hamil dari kekurangan iodium merupakan salah satu kebijakan perbaikan gizi di Indonesia. Kekurangan iodium pada wanita hamil selain berdampak buruk pada ibu juga mempengaruhi pertumbuhan dan perkembangan janin terutama organ otak. Di Indonesia saat ini, sumber utama asupan iodium berasal dari konsumsi ikan laut dan garam konsumsi beriodium. Akan tetapi tidak semua wanita hamil dapat dengan mudah mendapatkan iodium yang cukup selama kehamilannya. Data proporsi penduduk Indonesia yang mengonsumsi ikan laut sebesar 42,6% dengan rerata konsumsi ikan laut per orang per hari sebesar 25,5 gram. Garam beriodium sesuai SNI mensyaratkan mengandung 30 ppm iodium (KIO3). Dengan perkiraan konsumsi garam beriodium 10 gram per orang per hari, wanita hamil hanya mendapatkan 178 µg iodium dari kebutuhan yang dianjurkan sebesar 250 µg per hari. Bukti empiris menunjukkan bahwa rata – rata konsumsi garam di Indonesia sekitar 5 – 8 gram per orang per hari sehingga asupan iodium harian wanita hamil semakin jauh berkurang dari kebutuhan. Keadaan ini diperberat dengan cakupan rumah tangga mengonsumsi garam beriodium cukup mengandung iodium selama lebih dari 3 dekade hanya berkisar 60% sampai &lt;80%. Hasil Riskesdas 2013 menunjukkan proporsi rumah tangga mengonsumsi garam beriodium cukup berdasarkan hasil tes cepat sebesar 77,1% (target &gt;90%). Sedangkan indikator kecukupan asupan iodium menunjukkan bahwa median ekskresi iodium urin (EIU) wanita hamil di perkotaan dan perdesaan di Indonesia 163 µg/L (adekuat 150 – 249 µg/L), mendekati batas batas bawah (marjinal). Oleh karena itu, suplementasi iodium pada wanita hamil sebagai alternatif sementara untuk memenuhi kebutuhan iodium wanita hamil perlu dipertimbangkan untuk menggunakan dosis harian 150 µg per hari

Effects of Iodine Intake on Human Health

Iodine, a key component of thyroid hormones, is considered an essential micronutrient for proper health at all life stages. Indeed, an inadequate dietary intake of iodine is responsible for several functional and developmental abnormalities. The most serious consequences of iodine deficiency include hypothyroidism, early abortion, low birth weight, preterm delivery, neurocognitive impairment, and mental retardation. On the other hand, the consequences of mild-to-moderate iodine deficiency, such as goiter, are less well understood but represent an important priority for research and public health practice. Over the last several decades, many countries across the globe have introduced mandatory salt iodization programs, which have dramatically reduced the number of iodine-deficient countries. However, despite substantial progress worldwide, mild-to-moderate deficiency is still prevalent even in many developed countries. Thus, the ongoing monitoring of the population iodine status remains crucially important, and attention may need to be paid to vulnerable life stage groups