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Wang Z, Li C, Teng Y, Guan Y, Zhang L, Jia X, Cui D, Li J, Guan H. The Effect of Iodine-Containing Vitamin Supplementation During Pregnancy on Thyroid Function in Late Pregnancy and Postpartum Depression in an Iodine-Sufficient Area. Biol Trace Elem Res 2020; 198:1-7. [PMID: 31950399 DOI: 10.1007/s12011-020-02032-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/01/2020] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to investigate the effect of iodine supplementation during pregnancy on thyroid function and also its effect on postpartum depression in an iodine-sufficient area. Healthy pregnant women were divided into three groups: group A (vitamin iodine-150) receiving vitamin containing 150 μg iodine, group B (vitamin iodine-0) receiving vitamin without iodine, and group C (no vitamin) receiving no vitamin. General information was collected by questionnaire and thyroid function was determined in the third trimester of pregnancy. Depression was assessed 1 month postpartum by the Edinburgh postnatal depression scale (EPDS). The results showed that there was no significant difference in thyroid-stimulating hormone (TSH) level among the three groups (P > 0.05). FT4 concentration was significantly lower in group A (n = 234: 10.68 pmol/L) than in group B (n = 220: 11.47 pmol/L) and group C (n = 195: 11.64 pmol/L) (P < 0.05), However, it was still within the normal range. EPDS scores obtained from group B (3.50) and group C (3.00) were similar but markedly lower than group A (5.00) (P < 0.05). Despite the difference in the EPDS score, the prevalence of postpartum depression was not significantly different among the three groups. In conclusion, 150 μg/day iodine supplementation for pregnant women in areas with adequate iodine had little effect on thyroid function in the third trimester, and serum FT4 level could not be increased. Iodine supplementation during pregnancy also had no significant effect on postpartum depression.
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Affiliation(s)
- Zixiao Wang
- Department of Endocrinology and Metabolism and Institute of Endocrinology, The First Hospital of China Medical University, 155 Nanjing Bei Street, Shenyang, 110001, Liaoning, People's Republic of China
| | - Chenyang Li
- Department of Gynaecology and Obstetrics, Shenyang Maternity and Child Health Hospital, Shenyang, 110000, Liaoning, People's Republic of China
| | - Ying Teng
- Department of Gynaecology and Obstetrics, Shenyang Fifth People Hospital, Shenyang, 110023, Liaoning, People's Republic of China
| | - Yunping Guan
- Department of Gynaecology and Obstetrics, Shenyang Maternity and Child Health Hospital, Shenyang, 110000, Liaoning, People's Republic of China
| | - Li Zhang
- Department of Gynaecology and Obstetrics, Shenyang Maternity and Child Health Hospital, Shenyang, 110000, Liaoning, People's Republic of China
| | - Xi Jia
- Department of Gynaecology and Obstetrics, Shenyang Maternity and Child Health Hospital, Shenyang, 110000, Liaoning, People's Republic of China
| | - Dandan Cui
- Department of Gynaecology and Obstetrics, Shenyang Maternity and Child Health Hospital, Shenyang, 110000, Liaoning, People's Republic of China
| | - Jing Li
- Department of Gynaecology and Obstetrics, Shenyang Maternity and Child Health Hospital, Shenyang, 110000, Liaoning, People's Republic of China
| | - Haixia Guan
- Department of Endocrinology and Metabolism and Institute of Endocrinology, The First Hospital of China Medical University, 155 Nanjing Bei Street, Shenyang, 110001, Liaoning, People's Republic of China.
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Introduction of iodised salt benefits infants’ mental development in a community-based cluster-randomised effectiveness trial in Ethiopia. Br J Nutr 2018; 119:801-809. [DOI: 10.1017/s0007114517003658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe effectiveness of salt iodisation in improving the mental development of young children has not been assessed. We implemented a community-based cluster-randomised effectiveness trial in sixty randomly selected districts in the Amhara region of Ethiopia. We randomly allocated each district to treatment and randomly selected one of its villages. In parallel to national salt iodisation efforts, iodised salt was brought early into the markets of the thirty intervention villages before it became widely available in the thirty control villages 4–6 months later. The primary outcome was children’s mental development scores on the Bayley Scales. This was an intention-to-treat analysis using mixed linear models adjusted for covariates and clusters. The trial was registered at ClinicalTrials.gov, NCT013496. We assessed 1835 infants aged 5–11 months at baseline. The same children (85 % of the sample) were re-assessed at 20–29 months when all villages had iodised salt. At endline, urinary iodine concentration was higher in children in the intervention group compared with those in the control group (median 228·0v. 155·1 µg/l,P=0·001). The intervention group had higher scores compared with the control group on the Bayley composite score (raw scores:130·60v. 128·51; standardised scores: 27·8v. 26·9;d=0·13; 95 % CI 0·02, 0·23) and three of the four subscales: cognitive (53·27v. 52·54,d=0·13; 95 % CI 0·03, 0·23), receptive language (20·71v. 20·18,d=0·13; 95 % CI 0·03, 0·24) and fine motor (35·45v. 34·94,d=0·15; 95 % CI 0·04, 0·25). The introduction of iodised salt contributes to children’s higher urinary iodine concentration and mental development.
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Saghazadeh A, Ahangari N, Hendi K, Saleh F, Rezaei N. Status of essential elements in autism spectrum disorder: systematic review and meta-analysis. Rev Neurosci 2017; 28:783-809. [DOI: 10.1515/revneuro-2017-0015] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/16/2017] [Indexed: 12/15/2022]
Abstract
AbstractAutism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder that imposes heavy financial burden on governments and families of affected children. It is considered a multifactorial condition, where trace elements are among environmental factors that may contribute to ASD. Meanwhile, the between-study variance is high. The present systematic review was designed to investigate the difference in trace element measures between patients with ASD and control subjects. Meta-analyses showed that the hair concentrations of chromium (p=0.024), cobalt (p=0.012), iodine (p=0.000), iron (p=0.017), and magnesium (p=0.007) in ASD patients were significantly lower than those of control subjects, while there were higher magnesium levels in the hair of ASD patients compared to that of controls (p=0.010). Patients with ASD had higher blood levels of copper (p=0.000) and lower levels of zinc compared to controls (p=0.021). Further urinary iodine levels in patients with ASD were decreased in comparison with controls (p=0.026). Sensitivity analyses showed that ASD patients in non-Asian but not in Asian countries had lower hair concentrations of chromium compared to controls. Also, such analyses indicated that ASD patients in Asian countries had lower hair zinc concentrations, whereas ASD patients in non-Asian countries had higher hair zinc concentrations in comparison with control subjects. This study found significant differences in the content of trace elements between patients with ASD compared to controls. The findings help highlighting the role of trace elements as environmental factors in the etiology of ASD.
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Affiliation(s)
- Amene Saghazadeh
- Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd., Tehran 14194, Iran
- MetaCognition Interest Group (MCIG), Universal Scientific Education and Research Network (USERN), Tehran 14194, Iran
| | - Narges Ahangari
- NeuroImmunology Research Association (NIRA), Universal Scientific Education and Research Network (USERN), Tehran 14194, Iran
| | - Kasra Hendi
- NeuroImmunology Research Association (NIRA), Universal Scientific Education and Research Network (USERN), Tehran 14194, Iran
| | - Fatemeh Saleh
- NeuroImmunology Research Association (NIRA), Universal Scientific Education and Research Network (USERN), Tehran 14194, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd., Tehran 14194, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran 14194, Iran
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Boston, MA, USA
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Nutrition (Micronutrients) in Child Growth and Development: A Systematic Review on Current Evidence, Recommendations and Opportunities for Further Research. J Dev Behav Pediatr 2017; 38:665-679. [PMID: 28746059 DOI: 10.1097/dbp.0000000000000482] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE An important aspect of malnutrition is deficiency of different micronutrients during pregnancy or early childhood. We systematically reviewed the role of nutrition in child growth (weight or height gain) and development. METHODS A comprehensive literature search was done on PubMed/Cochrane Library browsing through 38,795 abstracts until December 31, 2016 to select systematic reviews/meta-analyses and individual randomized controlled trials (RCTs) of micronutrient supplementation. RESULTS Micronutrients studied included iron, iodine, folate, zinc, calcium, magnesium, selenium, vitamin D, vitamin A, vitamin B complex, and multiple micronutrients. We summarize evidence with details and results of RCTs, highlight strengths/weaknesses, and critically interpret findings. Effects of breastfeeding-promotion, food-supplementation (complementary and school feeding), conditional-cash-transfers, and integrated nutrition/psychosocial interventions are discussed. CONCLUSION Based on this evidence we make policy and programmatic recommendations for supplementation to mothers and children at high-risk of deficiency.
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Harding KB, Peña‐Rosas JP, Webster AC, Yap CMY, Payne BA, Ota E, De‐Regil LM. Iodine supplementation for women during the preconception, pregnancy and postpartum period. Cochrane Database Syst Rev 2017; 3:CD011761. [PMID: 28260263 PMCID: PMC6464647 DOI: 10.1002/14651858.cd011761.pub2] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Iodine is an essential nutrient required for the biosynthesis of thyroid hormones, which are responsible for regulating growth, development and metabolism. Iodine requirements increase substantially during pregnancy and breastfeeding. If requirements are not met during these periods, the production of thyroid hormones may decrease and be inadequate for maternal, fetal and infant needs. The provision of iodine supplements may help meet the increased iodine needs during pregnancy and the postpartum period and prevent or correct iodine deficiency and its consequences. OBJECTIVES To assess the benefits and harms of supplementation with iodine, alone or in combination with other vitamins and minerals, for women in the preconceptional, pregnancy or postpartum period on their and their children's outcomes. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (14 November 2016), and the WHO International Clinical Trials Registry Platform (ICTRP) (17 November 2016), contacted experts in the field and searched the reference lists of retrieved studies and other relevant papers. SELECTION CRITERIA Randomized and quasi-randomized controlled trials with randomisation at either the individual or cluster level comparing injected or oral iodine supplementation (such as tablets, capsules, drops) during preconception, pregnancy or the postpartum period irrespective of iodine compound, dose, frequency or duration. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility, risk of bias, extracted data and conducted checks for accuracy. We used the GRADE approach to assess the quality of the evidence for primary outcomes.We anticipated high heterogeneity among trials, and we pooled trial results using random-effects models and were cautious in our interpretation of the pooled results. MAIN RESULTS We included 14 studies and excluded 48 studies. We identified five ongoing or unpublished studies and two studies are awaiting classification. Eleven trials involving over 2700 women contributed data for the comparisons in this review (in three trials, the primary or secondary outcomes were not reported). Maternal primary outcomesIodine supplementation decreased the likelihood of the adverse effect of postpartum hyperthyroidism by 68% (average risk ratio (RR) 0.32; 95% confidence interval (CI) 0.11 to 0.91, three trials in mild to moderate iodine deficiency settings, 543 women, no statistical heterogeneity, low-quality evidence) and increased the likelihood of the adverse effect of digestive intolerance in pregnancy by 15 times (average RR 15.33; 95% CI 2.07 to 113.70, one trial in a mild-deficiency setting, 76 women, very low-quality evidence).There were no clear differences between groups for hypothyroidism in pregnancy or postpartum (pregnancy: average RR 1.90; 95% CI 0.57 to 6.38, one trial, 365 women, low-quality evidence, and postpartum: average RR 0.44; 95% CI 0.06 to 3.42, three trials, 540 women, no statistical heterogeneity, low-quality evidence), preterm birth (average RR 0.71; 95% CI 0.30 to 1.66, two trials, 376 women, statistical heterogeneity, low-quality evidence) or the maternal adverse effects of elevated thyroid peroxidase antibodies (TPO-ab) in pregnancy or postpartum (average RR 0.95; 95% CI 0.44 to 2.07, one trial, 359 women, low-quality evidence, average RR 1.01; 95% CI 0.78 to 1.30, three trials, 397 women, no statistical heterogeneity, low-quality evidence), or hyperthyroidism in pregnancy (average RR 1.90; 95% CI 0.57 to 6.38, one trial, 365 women, low-quality evidence). All of the trials contributing data to these outcomes took place in settings with mild to moderate iodine deficiency. Infant/child primary outcomesCompared with those who did not receive iodine, those who received iodine supplements had a 34% lower likelihood of perinatal mortality, however this difference was not statistically significant (average RR 0.66; 95% CI 0.42 to 1.03, two trials, 457 assessments, low-quality evidence). All of the perinatal deaths occurred in one trial conducted in a severely iodine-deficient setting. There were no clear differences between groups for low birthweight (average RR 0.56; 95% CI 0.26 to 1.23, two trials, 377 infants, no statistical heterogeneity, low-quality evidence), neonatal hypothyroidism/elevated thyroid-stimulating hormone (TSH) (average RR 0.58; 95% CI 0.11 to 3.12, two trials, 260 infants, very low-quality evidence) or the adverse effect of elevated neonatal thyroid peroxidase antibodies (TPO-ab) (average RR 0.61; 95% CI 0.07 to 5.70, one trial, 108 infants, very low-quality evidence). All of the trials contributing data to these outcomes took place in areas with mild to moderate iodine deficiency. No trials reported on hypothyroidism/elevated TSH or any adverse effect beyond the neonatal period. AUTHORS' CONCLUSIONS There were insufficient data to reach any meaningful conclusions on the benefits and harms of routine iodine supplementation in women before, during or after pregnancy. The available evidence suggested that iodine supplementation decreases the likelihood of postpartum hyperthyroidism and increases the likelihood of the adverse effect of digestive intolerance in pregnancy - both considered potential adverse effects. We considered evidence for these outcomes low or very low quality, however, because of study design limitations and wide confidence intervals. In addition, due to the small number of trials and included women in our meta-analyses, these findings must be interpreted with caution. There were no clear effects on other important maternal or child outcomes though these findings must also be interpreted cautiously due to limited data and low-quality trials. Additionally, almost all of the evidence came from settings with mild or moderate iodine deficiency and therefore may not be applicable to settings with severe deficiency.More high-quality randomised controlled trials are needed on iodine supplementation before, during and after pregnancy on maternal and infant/child outcomes. However, it may be unethical to compare iodine to placebo or no treatment in severe deficiency settings. Trials may also be unfeasible in settings where pregnant and lactating women commonly take prenatal supplements with iodine. Information is needed on optimal timing of initiation as well as supplementation regimen and dose. Future trials should consider the outcomes in this review and follow children beyond the neonatal period. Future trials should employ adequate sample sizes, assess potential adverse effects (including the nature and extent of digestive intolerance), and be reported in a way that allows assessment of risk of bias, full data extraction and analysis by the subgroups specified in this review.
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Affiliation(s)
- Kimberly B Harding
- Micronutrient InitiativeResearch and Evaluation180 Elgin Street, Suite 1000OttawaONCanadaK2P 2K3
| | - Juan Pablo Peña‐Rosas
- World Health OrganizationEvidence and Programme Guidance, Department of Nutrition for Health and Development20 Avenue AppiaGenevaGESwitzerland1211
| | - Angela C Webster
- The University of SydneySydney School of Public HealthEdward Ford Building A27SydneyNSWAustralia2006
| | - Constance MY Yap
- Westmead HospitalDepartment of Diabetes and EndocrinologyCorner Hawkesbury and Darcy RoadsWestmeadNSWAustralia2145
| | - Brian A Payne
- Ministry of Health BarbadosNational Nutrition CenterSt MichaelBarbados
| | - Erika Ota
- St. Luke's International University, Graduate School of Nursing SciencesGlobal Health Nursing10‐1 Akashi‐choChuo‐KuTokyoJapan104‐0044
| | - Luz Maria De‐Regil
- Micronutrient InitiativeResearch and Evaluation180 Elgin Street, Suite 1000OttawaONCanadaK2P 2K3
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Dosiou C, Medici M. MANAGEMENT OF ENDOCRINE DISEASE: Isolated maternal hypothyroxinemia during pregnancy: knowns and unknowns. Eur J Endocrinol 2017; 176:R21-R38. [PMID: 27528503 DOI: 10.1530/eje-16-0354] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/10/2016] [Accepted: 02/15/2016] [Indexed: 12/16/2022]
Abstract
Isolated maternal hypothyroxinemia (IMH) during pregnancy is defined as a low maternal T4 in the absence of TSH elevation. As IMH is common, with a prevalence of 1-2% in iodine-sufficient populations, and early research has suggested adverse effects on fetal neurodevelopment, it has been the focus of many studies in the last decade. In the current review, we first discuss the significance of IMH based on data from animal models and recent discoveries regarding the role of thyroid hormone on neurodevelopment. We address issues surrounding the definition and prevalence of this entity and discuss new insights into the etiologies, clinical consequences and management of IMH. A number of large cohort studies have investigated the effects of IMH on the risk of various pregnancy complications and child neurodevelopment. We review these studies in detail and describe their limitations. We discuss the available research on management of IMH, including two recent randomized controlled trials (RCTs). Finally, we delineate the remaining uncertainties in this field and emphasize the need for a sufficiently powered, placebo-controlled RCT on the treatment of IMH early in the first trimester of pregnancy.
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Affiliation(s)
- Chrysoula Dosiou
- Division of EndocrinologyStanford University School of Medicine, Stanford, California, USA
| | - Marco Medici
- Department of Endocrinology and Rotterdam Thyroid CenterErasmus Medical Center, Rotterdam, The Netherlands
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Grantham-McGregor SM, Fernald LC, Sethuraman K. Effects of Health and Nutrition on Cognitive and Behavioural Development in Children in the First Three Years of Life: Part 2: Infections and Micronutrient Deficiencies: Iodine, Iron, and Zinc. Food Nutr Bull 2016. [DOI: 10.1177/156482659902000108] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The following paper and its accompanying paper (Grantham-McGregor SM, et al. Effects of health and nutrition on cognitive and behavioural development in children in the first three years of life. Part 1: Low birthweight, breastfeeding, and protein-energy malnutrition. Food Nutr Bull 1999;20:53–75) review the literature on the conditions that are prevalent and considered to be likely to affect child development and are therefore of public health importance. the reviews are selective, and we have generally focused on recent work, particularly in areas that remain controversial. the reviews are restricted to nutritional and health insults that are important in the first three years of life. Where possible, we have discussed the better studies. This paper considers the effects of infections and the major micronutrient deficiencies: iodine, iron, and zinc.
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Affiliation(s)
- Sally M. Grantham-McGregor
- Centre for International Child Health, Institute of Child Health, at the University College London Medical School in London
| | - Lia C. Fernald
- Centre for International Child Health, Institute of Child Health, at the University College London Medical School in London
| | - Kavita Sethuraman
- Centre for International Child Health, Institute of Child Health, at the University College London Medical School in London
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Aboud FE, Bougma K, Lemma T, Marquis GS. Evaluation of the effects of iodized salt on the mental development of preschool-aged children: a cluster randomized trial in northern Ethiopia. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27145299 DOI: 10.1111/mcn.12322] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022]
Abstract
A cluster randomized effectiveness trial was used to examine the effects on mental development of introducing iodized salt to children 4 to 6 years of age in Ethiopia, where there were reportedly high levels of iodine deficiency. Sixty district clusters were randomized to receive iodized salt early at their markets with assistance from regular salt distributors or later as introduced by market forces. At pre- and post-iodization, 1602 children were given cognitive/language tests (namely School Readiness, WPPSI verbal reasoning, WPPSI Matrix reasoning), and mothers were interviewed concerning demographics, nutrition and health. Children's weight, height, urine and a blood sample were taken. Analyses of covariance, adjusting for clustering and baseline levels were conducted. Urinary iodine concentrations were significantly higher at endline in the intervention children than controls though both medians were above threshold. Overall, less than 5% were anemic. There were no significant main effect differences between groups on the cognitive/language tests, but there were effect modifiers, namely mother's education, child's sex and diet. For example, the intervention group performed better on the school readiness test than controls if their mothers had attended school, but not otherwise. In conclusion, the data are consistent with negative findings from studies where children 6 to 12 years were supplemented with an iodine capsule, indicating that the benefits of iodine, in salt or capsule form, for brain development may be restricted to children under 3 years. Yet, benefits may be tied to those with more educational resources or may compensate for conditions of disadvantage.
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Affiliation(s)
- Frances E Aboud
- Department of Psychology, McGill University, Montreal, Québec, Canada
| | - Karim Bougma
- School of Dietetics and Human Nutrition, McGill University, Sainte Anne-de-Bellevue, Québec, Canada
| | - Tizita Lemma
- Department of Psychology, Bahir Dar University, Bahir Dar, Ethiopia
| | - Grace S Marquis
- School of Dietetics and Human Nutrition, McGill University, Sainte Anne-de-Bellevue, Québec, Canada
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Golding J, Emmett P, Iles-Caven Y, Steer C, Lingam R. A review of environmental contributions to childhood motor skills. J Child Neurol 2014; 29:1531-47. [PMID: 24170258 PMCID: PMC4004720 DOI: 10.1177/0883073813507483] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although much of children's motor skills have a heredity component, at least half of the variance is likely to be influenced by the environment. It is important to ascertain features of the environment that are responsible so that toxins can be avoided, children at risk can be identified, and beneficial interventions initiated. This review outlines the results of published studies and recommends the areas where further research is required. We found much confusion with little comparability concerning the ages or measures used. Few studies had sufficient power and few allowed for confounders. We found that research to date implicates associations with prenatal drinking ≥4 drinks of alcohol per day; diabetes; taking antidepressant drugs; being deficient in iodine or iron; dietary fish; and postnatal depression. The child appearing to be most at risk was born of low birth weight (but not due to preterm delivery) or with neonatal problems.
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Affiliation(s)
- Jean Golding
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Zhou SJ, Anderson AJ, Gibson RA, Makrides M. Effect of iodine supplementation in pregnancy on child development and other clinical outcomes: a systematic review of randomized controlled trials. Am J Clin Nutr 2013; 98:1241-54. [PMID: 24025628 DOI: 10.3945/ajcn.113.065854] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Routine iodine supplementation during pregnancy is recommended by leading health authorities worldwide, even in countries where the iodine status of the population is sufficient. OBJECTIVES We evaluated the efficacy and safety of iodine supplementation during pregnancy or the periconceptional period on the development and growth of children. Secondary outcomes included pregnancy outcome and thyroid function. DESIGN A systematic review of randomized controlled trials (RCTs) was conducted. PUBMED, MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials databases were searched to identify relevant RCTs. RESULTS Fourteen publications that involved 8 trials met the inclusion criteria. Only 2 included trials reported the growth and development of children and clinical outcomes. Iodine supplementation during pregnancy or the periconceptional period in regions of severe iodine deficiency reduced risk of cretinism, but there were no improvements in childhood intelligence, gross development, growth, or pregnancy outcomes, although there was an improvement in some motor functions. None of the remaining 6 RCTs conducted in regions of mild to moderate iodine deficiency reported childhood development or growth or pregnancy outcomes. Effects of iodine supplementation on the thyroid function of mothers and their children were inconsistent. CONCLUSIONS In this review, we highlight a lack of quality evidence of the effect of prenatal or periconceptional iodine supplementation on growth and cognitive function of children. Although contemporary RCTs of iodine supplementation with outcomes addressing childhood development are indicated, conduct of such RCTs may not be feasible in populations where iodine supplementation in pregnancy is widely practiced.
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Affiliation(s)
- Shao J Zhou
- Women's & Children's Health Research Institute, North Adelaide, Australia (AJA, MM, and SJZ); the School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia (MM); and the FOODplus Research Centre, School of Agriculture, Food and Wine, University of Adelaide, Urrbrae, Australia (AJA, RAG, MM, and SJZ)
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Iodine and mental development of children 5 years old and under: a systematic review and meta-analysis. Nutrients 2013; 5:1384-416. [PMID: 23609774 PMCID: PMC3705354 DOI: 10.3390/nu5041384] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/14/2013] [Accepted: 03/22/2013] [Indexed: 11/17/2022] Open
Abstract
Several reviews and meta-analyses have examined the effects of iodine on mental development. None focused on young children, so they were incomplete in summarizing the effects on this important age group. The current systematic review therefore examined the relationship between iodine and mental development of children 5 years old and under. A systematic review of articles using Medline (1980-November 2011) was carried out. We organized studies according to four designs: (1) randomized controlled trial with iodine supplementation of mothers; (2) non-randomized trial with iodine supplementation of mothers and/or infants; (3) prospective cohort study stratified by pregnant women's iodine status; (4) prospective cohort study stratified by newborn iodine status. Average effect sizes for these four designs were 0.68 (2 RCT studies), 0.46 (8 non-RCT studies), 0.52 (9 cohort stratified by mothers' iodine status), and 0.54 (4 cohort stratified by infants' iodine status). This translates into 6.9 to 10.2 IQ points lower in iodine deficient children compared with iodine replete children. Thus, regardless of study design, iodine deficiency had a substantial impact on mental development. Methodological concerns included weak study designs, the omission of important confounders, small sample sizes, the lack of cluster analyses, and the lack of separate analyses of verbal and non-verbal subtests. Quantifying more precisely the contribution of iodine deficiency to delayed mental development in young children requires more well-designed randomized controlled trials, including ones on the role of iodized salt.
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Prado EL, Alcock KJ, Muadz H, Ullman MT, Shankar AH. Maternal multiple micronutrient supplements and child cognition: a randomized trial in Indonesia. Pediatrics 2012; 130:e536-46. [PMID: 22908103 DOI: 10.1542/peds.2012-0412] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We investigated the relative benefit of maternal multiple micronutrient (MMN) supplementation during pregnancy and until 3 months postpartum compared with iron/folic acid supplementation on child development at preschool age (42 months). METHODS We assessed 487 children of mothers who participated in the Supplementation with Multiple Micronutrients Intervention Trial, a cluster-randomized trial in Indonesia, on tests adapted and validated in the local context measuring motor, language, visual attention/spatial, executive, and socioemotional abilities. Analysis was according to intention to treat. RESULTS In children of undernourished mothers (mid-upper arm circumference <23.5 cm), a significant benefit of MMNs was observed on motor ability (B = 0.39 [95% confidence interval (CI): 0.08-0.70]; P = .015) and visual attention/spatial ability (B = 0.37 [95% CI: 0.11-0.62]; P = .004). In children of anemic mothers (hemoglobin concentration <110 g/L), a significant benefit of MMNs on visual attention/spatial ability (B = 0.24 [95% CI: 0.02-0.46]; P = .030) was also observed. No robust effects of maternal MMN supplementation were found in any developmental domain over all children. CONCLUSIONS When pregnant women are undernourished or anemic, provision of MMN supplements can improve the motor and cognitive abilities of their children up to 3.5 years later, particularly for both motor function and visual attention/spatial ability. Maternal MMN but not iron/folic acid supplementation protected children from the detrimental effects of maternal undernutrition on child motor and cognitive development.
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Melse-Boonstra A, Gowachirapant S, Jaiswal N, Winichagoon P, Srinivasan K, Zimmermann MB. Iodine supplementation in pregnancy and its effect on child cognition. J Trace Elem Med Biol 2012; 26:134-6. [PMID: 22575544 DOI: 10.1016/j.jtemb.2012.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 03/22/2012] [Indexed: 11/25/2022]
Abstract
Maternal hypothyroidism and hypothyroxenemia due to iodine deficiency have been shown to affect development of the newborn negatively. Maternal iodine supplementation may therefore improve cognitive performance of the offspring, even in areas of mild-to-moderate iodine deficiency (ID). Several iodine supplementation studies have been performed in mildly ID pregnant women in Europe. These studies have shown that iodine supplementation increases maternal urinary iodine (UI) excretion and reduces thyroid volume, as well as prevents increases in infant thyroid volume and thyroglobuline. However, randomized controlled studies with long-term outcomes are lacking. Therefore, two trials were started in 2008 in areas of low iodine status; one in Bangalore, India (n=325), and another in Bangkok, Thailand (n=514). Pregnant women were recruited <14 weeks gestational age and randomized to either receive a daily dose of 200 μg I (as KI) or an identical placebo throughout pregnancy. Both trials are ongoing, and women are followed up during pregnancy and at delivery. UI, thyroid hormones, and thyroid size are measured. Birth outcomes are recorded, such as gestational age at delivery, height, weight, and APGAR scores, and cord blood and heel stick blood (<72 h) is collected from the child. Child development is assessed at 6 weeks of age using the Neonatal Behavioral Assessment Scale (NBAS), and at 12 and 24 months of age using the Bayley Scales of Infant Development. The outcomes of these trials will contribute importantly to the evidence base for iodine supplementation of pregnant women living in areas of mild iodine deficiency.
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Affiliation(s)
- Alida Melse-Boonstra
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
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Pharoah POD. Commentary: from iodine deficiency to anomalous fetal development. Int J Epidemiol 2012; 41:593-5. [PMID: 22586137 DOI: 10.1093/ije/dys056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Basic Science and Clinical Evidence Regarding Treatment of Subclinical Hypothyroidism During Pregnancy. Clin Obstet Gynecol 2011; 54:488-92. [DOI: 10.1097/grf.0b013e3182272fca] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Abstract
Although the number of iodine-deficient countries has been reduced by almost 50 % over the last decade, it still remains a frequently misunderstood health problem. The most devastating effects of iodine deficiency occur during fetal development and childhood, periods in which sufficient iodine delivery remains critical. Besides the determination of thyroid size, the concentration of urinary iodine, serum thyroid-stimulating hormone and serum thyroglobulin are useful biomarkers to assess iodine status. Severe iodine deficiency is associated with neurological complications, cretinism, endemic goitre development, hypothyroidism, decreased fertility and increased infant mortality. The recommended iodine supplementation strategies are based on correction of iodine deficiency, close monitoring and evaluation of iodine administration, cooperation of the salt industry, training of local health care professionals and education of the population. Besides the multiple beneficial effects of supplementation, we present in this review a critical look at the possible side effects.
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Perrine CG, Herrick K, Serdula MK, Sullivan KM. Some subgroups of reproductive age women in the United States may be at risk for iodine deficiency. J Nutr 2010; 140:1489-94. [PMID: 20554903 DOI: 10.3945/jn.109.120147] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Consuming an adequate amount of iodine during pregnancy is critical for fetal neurologic development. Even a mild deficiency can impair cognitive ability. Important sources of iodine in the United States include dairy products and iodized salt. Although the U.S. population has traditionally been considered iodine sufficient, median urinary iodine concentrations (UIC) have decreased 50% since the 1970s. We analyzed 2001-2006 NHANES data from urine iodine spot tests for pregnant (n = 326), lactating (n = 53), and nonpregnant, nonlactating (n = 1437) women of reproductive age (15-44 y). We used WHO criteria to define iodine sufficiency (median UIC: 150-249 microg/L among pregnant women; >or=100 microg/L among lactating women; and 100-199 microg/L among nonpregnant, nonlactating women). The iodine status of pregnant women was borderline sufficient (median UIC = 153 microg/L; 95% CI = 105-196), while lactating (115 microg/L; 95% CI = 62-162) and nonpregnant, nonlactating (130 microg/L; 95% CI = 117-140) women were iodine sufficient. Dairy product consumption was an important contributor to iodine status among both pregnant and nonpregnant, nonlactating women, and those who do not consume dairy products may be at risk for iodine deficiency. Although larger samples are needed to confirm these findings, these results raise concerns about the iodine status of pregnant women and women of reproductive age who are not consuming dairy products. Iodine levels among U.S. women should be monitored, particularly among subgroups at risk for iodine deficiency.
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Affiliation(s)
- Cria G Perrine
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Melse-Boonstra A, Jaiswal N. Iodine deficiency in pregnancy, infancy and childhood and its consequences for brain development. Best Pract Res Clin Endocrinol Metab 2010; 24:29-38. [PMID: 20172468 DOI: 10.1016/j.beem.2009.09.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Iodine deficiency during foetal development and early childhood is associated with cognitive impairment. Randomised clinical studies in school-aged children encountered in the literature indicate that cognitive performance can be improved by iodine supplementation, but most studies suffer from methodological constraints. Tests to assess cognitive performance in the domains that are potentially affected by iodine deficiency need to be refined. Maternal iodine supplementation in areas of mild-to-moderate iodine deficiency may improve cognitive performance of the offspring, but randomised controlled studies with long-term outcomes are lacking. Studies in infants or young children have not been conducted. The best indicators for iodine deficiency in children are thyroid-stimulating hormone (TSH) in newborns and thyroglobulin (Tg) in older children. Urinary iodine may also be useful but only at the population level. Adequate salt iodisation will cover the requirements of infants and children as well as pregnant women. However, close monitoring remains essential.
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Affiliation(s)
- Alida Melse-Boonstra
- Division of Human Nutrition, Wageningen University, 6700 EV Wageningen, the Netherlands.
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Influence of Iodine Deficiency and Excess on Thyroid Function Tests. THYROID FUNCTION TESTING 2010. [DOI: 10.1007/978-1-4419-1485-9_3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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20
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Wynn M, Wynn A. ‘No Nation Can Rise Above the Level of its Women’: New Thoughts on Maternal Nutrition the Caroline Walker Lecture 1993. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/13590849509000215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Collins JK, Jupp JJ, Maberly GF, Morris JG, Eastman CJ. An Exploratory Study of the Intellectual Functioning of Neurological and Myxoedematous Cretins in China. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/13668258708998650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Lechtig A, Cornale G, Ugaz ME, Arias L. Decreasing stunting, anemia, and vitamin A deficiency in Peru: results of the Good Start in Life Program. Food Nutr Bull 2009; 30:37-48. [PMID: 19445258 DOI: 10.1177/156482650903000104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The rates of stunting, iron-deficiency anemia, and vitamin A deficiency in Peru are among the highest in South America. There is little scaled-up experience on how to solve these problems countrywide. OBJECTIVE To evaluate the Good Start in Life Program during the period from 2000 to 2004. METHODS Data on weight, height, hemoglobin, serum retinol, urinary iodine, and age were obtained from children under 3 years of age during two transverse surveys in 2000 and 2004. RESULTS In 2004, the program covered 75,000 children, 35,000 mothers, and 1 million inhabitants from 223 poor communities. The rate of stunting decreased from 54.1% to 36.9%, the rate of iron-deficiency anemia decreased from 76.0% to 52.3%, and the rate of vitamin A deficiency decreased from 30.4% to 5.3% (p < .01). The annual cost per child was US$116.50. CONCLUSIONS Adaptations of this participative program could contribute to decreased stunting, iron-deficiency anemia, and vitamin A deficiency at the national scale in Peru and many other countries.
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Affiliation(s)
- Aarón Lechtig
- Agencia Internacional de Seguridad Alimentaria (AISA), Lima, Peru.
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Abstract
2 billion individuals worldwide have insufficient iodine intake, with those in south Asia and sub-Saharan Africa particularly affected. Iodine deficiency has many adverse effects on growth and development. These effects are due to inadequate production of thyroid hormone and are termed iodine-deficiency disorders. Iodine deficiency is the most common cause of preventable mental impairment worldwide. Assessment methods include urinary iodine concentration, goitre, newborn thyroid-stimulating hormone, and blood thyroglobulin. In nearly all countries, the best strategy to control iodine deficiency is iodisation of salt, which is one of the most cost-effective ways to contribute to economic and social development. When iodisation of salt is not possible, iodine supplements can be given to susceptible groups. Introduction of iodised salt to regions of chronic iodine-deficiency disorders might transiently increase the proportion of thyroid disorders, but overall the small risks of iodine excess are far outweighed by the substantial risks of iodine deficiency. International efforts to control iodine-deficiency disorders are slowing, and reaching the third of the worldwide population that remains deficient poses major challenges.
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Affiliation(s)
- Michael B Zimmermann
- Laboratory for Human Nutrition, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland
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Abstract
An inadequate supply of iodine during gestation results in damage to the foetal brain that is irreversible by mid-gestation unless timely interventions can correct the accompanying maternal hypothyroxinemia. Even mild to moderate maternal hypothyroxinemia may result in suboptimal neurodevelopment. This review mainly focuses on iodine and thyroid hormone economy up to mid-gestation, a period during which the mother is the only source for the developing brain of the foetus. The cerebral cortex of the foetus depends on maternal thyroxine (T4) for the production of the 3',3,5-tri-iodothyronine (T3) for nuclear receptor-binding and biological effectiveness. Maternal hypothyroxinemia early in pregnancy is potentially damaging for foetal brain development. Direct evidence has been obtained from experiments on animals: even a relatively mild and transient hypothyroxinemia during corticogenesis, which takes place mostly before mid-gestation in humans, affects the migration of radial neurons, which settle permanently in heterotopic locations within the cortex and hippocampus. Behavioural defects have also been detected. The conceptus imposes important early changes on maternal thyroid hormone economy that practically doubles the amount of T4 secreted something that requires a concordant increase in the availability of iodine, from 150 to 250-300 microg I day- 1. Women who are unable to increase their production of T4 early in pregnancy constitute a population at risk for having children with neurological disabilities. As a mild to moderate iodine deficiency is still the most widespread cause of maternal hypothyroxinemia, the birth of many children with learning disabilities may be prevented by advising women to take iodine supplements as soon as pregnancy starts, or earlier if possible, in order to ensure that their requirements for iodine are met.
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Zimmermann MB. Iodine requirements and the risks and benefits of correcting iodine deficiency in populations. J Trace Elem Med Biol 2008; 22:81-92. [PMID: 18565420 DOI: 10.1016/j.jtemb.2008.03.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 03/05/2008] [Accepted: 03/05/2008] [Indexed: 11/22/2022]
Abstract
Iodine deficiency has multiple adverse effects on growth and development due to inadequate thyroid hormone production that are termed the iodine deficiency disorders (IDD). IDD remains the most common cause of preventable mental impairment worldwide. IDD assessment methods include urinary iodine concentration, goiter, thyroglobulin and newborn thyrotropin. In nearly all iodine-deficient countries, the best strategy to control IDD is salt iodization, one of the most cost-effective ways to contribute to economic and social development. When salt iodization is not possible, iodine supplements can be targeted to vulnerable groups. Introduction of iodized salt to regions of chronic IDD may transiently increase the incidence of thyroid disorders, and programs should include monitoring for both iodine deficiency and excess. Although more data on the epidemiology of thyroid disorders caused by differences in iodine intake are needed, overall, the relatively small risks of iodine excess are far outweighed by the substantial risks of iodine deficiency.
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Simeon DT, Grantham-McGregor SM. Nutritional Deficiencies and Children's Behaviour and Mental Development. Nutr Res Rev 2007; 3:1-24. [DOI: 10.1079/nrr19900004] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Iodine is required for the production of thyroid hormones, which are essential for normal brain development, and the fetus, newborn, and young child are particularly vulnerable to iodine deficiency. The iodine requirement increases during pregnancy and recommended intakes are in the range of 220-250 microg/day. Monitoring iodine status during pregnancy is a challenge. New recommendations from World Health Organization suggest that a median urinary iodine concentration >250 microg/L and <500 microg/L indicates adequate iodine intake in pregnancy. Based on this range, it appears that many pregnant women in Western Europe have inadequate intakes. A recent Swiss study has suggested that thyroid-stimulating hormone concentration in the newborn is a sensitive indicator of mild iodine deficiency in late pregnancy. The potential adverse effects of mild iodine deficiency during pregnancy are uncertain. Controlled trials of iodine supplementation in mildly iodine-deficient pregnant women suggest beneficial effects on maternal and newborn serum thyroglobulin and thyroid volume, but no effects on maternal and newborn total or free thyroid hormone concentrations. There are no long-term data on the effect of iodine supplementation on birth outcomes or infant development. New data from well-controlled studies indicate that iodine repletion in moderately iodine-deficient school-age children has clear benefits: it improves cognitive and motor function; it also increases concentrations of insulin-like growth factor 1 and insulin-like growth factor-binding protein 3, and improves somatic growth.
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Affiliation(s)
- Michael B Zimmermann
- Laboratory for Human Nutrition, Swiss Federal Institute of Technology, Zürich, Switzerland.
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Zimmermann MB, Connolly K, Bozo M, Bridson J, Rohner F, Grimci L. Iodine supplementation improves cognition in iodine-deficient schoolchildren in Albania: a randomized, controlled, double-blind study. Am J Clin Nutr 2006; 83:108-14. [PMID: 16400058 DOI: 10.1093/ajcn/83.1.108] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Iodine is required for the production of thyroid hormones, which are necessary for normal brain development and cognition. Although several randomized trials examined the effect of iodine supplementation on cognitive performance in schoolchildren, the results were equivocal. OBJECTIVE We aimed to ascertain whether providing iodized oil to iodine-deficient children would affect their cognitive and motor performance. DESIGN In a double-blind intervention trial, 10-12-y-old children (n = 310) in primary schools in rural southeastern Albania were randomly assigned to receive 400 mg I (as oral iodized oil) or placebo. We measured urinary iodine (UI), thyroid-stimulating hormone (TSH), and total thyroxine (TT4) concentrations and thyroid gland volume (by ultrasound). The children were given a battery of 7 cognitive and motor tests, which included measures of information processing, working memory, visual problem solving, visual search, and fine motor skills. Thyroid ultrasound and the biochemical and psychological tests were repeated after 24 wk. RESULTS At baseline, the children's median UI concentration was 43 microg/L; 87% were goitrous, and nearly one-third had low concentrations of circulating TT4. Treatment with iodine markedly improved iodine and thyroid status: at 24 wk, median UI in the treated group was 172 microg/L, mean TT4 was approximately 40% higher, and the prevalence of hypothyroxinemia was < 1%. In the placebo group after the intervention, these variables did not differ significantly from baseline. Compared with placebo, iodine treatment significantly improved performance on 4 of 7 tests: rapid target marking, symbol search, rapid object naming, and Raven's Coloured Progressive Matrices (P < 0.0001). CONCLUSION Information processing, fine motor skills, and visual problem solving are improved by iodine repletion in moderately iodine-deficient schoolchildren.
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Affiliation(s)
- Michael B Zimmermann
- Laboratory for Human Nutrition, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland.
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Mason J, Deitchler M, Mathys E, Winichagoon P, Tuazon MA. Lessons from Successful Micronutrient Programs Part III: Program Impact. Food Nutr Bull 2004; 25:53-78. [DOI: 10.1177/156482650402500104] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Micronutrient-deficiency control programs have been greatly extended at the national level in the last 10 to 15 years. However, rigorous evaluations of these are scarce, so that conclusions on impact are tentative and based mainly on indirect evidence. The coverage of vitamin A capsule distribution programs has exceeded 70% in most study countries. In countries implementing national iodized salt programs, the coverage reaches 60% to 90% of households with adequately iodized salt. Of the three micronutrients, coverage of iron tablet supplementation is the least well documented due to inadequate program monitoring systems and population survey data. Supplementation of preschool children 6 to 59 months of age with vitamin A capsules has plausibly contributed to the reduction in clinical vitamin A deficiency and its near-elimination in many countries. The impact of vitamin A capsule supplementation on children's biochemical vitamin A status (serum retinol) in national programs may be less. National data on salt iodization show a consistent relation to reduced prevalence of iodine-deficiency disorder symptoms (goiter); the rates of cretinism and other results of iodine deficiency are almost certainly falling too. The evaluation of the impact of salt iodization programs on biochemical iodine status is limited by a lack of data. Although trials have demonstrated the efficacy of iron supplementation in reducing the prevalence of anemia, the interpretation of national-level data is not so clear. Given the substantial financial and technical commitment required to implement national micronutrient-deficiency control programs, it is vital that investment enable the evaluation of the impact of these programs. It is becoming increasingly important to collect data on subclinical deficiency (e.g., biochemical data) to assess program impact.
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Abstract
This article thoroughly updates the authors' previous review of nutritional assessment and support during pregnancy. After briefly reviewing nutrient metabolism and requirements, the authors discuss the nutritional assessment of the pregnant woman and review the nutritional support principles in hyperemesis gravidarum and other conditions that can compromise the nutritional health of mother or fetus.
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Affiliation(s)
- Elie Hamaoui
- Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA.
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Abstract
Iodine Deficiency Disorders (IDD) reflects the broad manifestations of iodine deficiency including the implications on reproductive functions and lowering of IQ levels in school aged children. Today, IDD is a public health problem in 130 countries and affects 13% of world's population. In India, no state is free from iodine deficiency and 200 million people are 'at risk' of IDD. Daily consumption of salt fortified with iodine is a proven effective strategy and is the measure stressed by the Government of India. The paper describes the major five phases of the IDD Control Programme in India. The paper describes the major five phases of the IDD Control Programme in India since 1962 and synthesizes the spectrum of activities that significantly attributed to the Universal salt Iodisation (USI) efforts launched in 1992. The sustainability of the USI programme is critical since IDD prevalence will rise if programme of salt iodisation weakens. A two pronged strategy needs to be institutionalized for ensuring continued demand for iodised salt, linked to ongoing health, nutrition and education programmes as well as for ensuring supply of quality iodised salt.
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Affiliation(s)
- Sheila C Vir
- UNICEF (India Country Office), Lucknow Field Office
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Huda SN, Grantham-McGregor SM, Tomkins A. Cognitive and motor functions of iodine-deficient but euthyroid children in Bangladesh do not benefit from iodized poppy seed oil (Lipiodol). J Nutr 2001; 131:72-7. [PMID: 11208941 DOI: 10.1093/jn/131.1.72] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Iodine supplementation before pregnancy in iodine-deficient women prevents cretinism and neuromotor deficits in their offspring. It is unclear whether iodine supplementation benefits cognitive function in iodine-deficient school-aged children. We therefore conducted a double-blind, randomized, controlled trial of the effects of iodized poppy seed oil (Lipiodol) on cognitive and motor function and weight gain of iodine-deficient school children. The study was conducted with 305 children in grades 1 and 2 from 10 primary schools in two iodine-deficient areas in Bangladesh. The children were stratified by school and grade and randomly assigned to receive 400 mg of oral Lipiodol or a placebo. All children were given a battery of cognitive and motor function tests and had their weights, serum thyroxine (T4) and thyroid-stimulating hormone (TSH) and urinary iodine levels measured before and 4 mo after the intervention. On enrollment, both groups were moderately iodine deficient (median urinary iodine values: placebo group = 3.3 micromol/L, n = 148; iodine group = 3.1 micromol/L, n = 152; goiter prevalence in both groups >95%). However, their T4 and TSH levels were within the normal range. After 4 mo, there was a significant treatment effect on urinary iodine levels (P < 0.0001), but the levels of the treated group were still below normal (median = 7.9 micromol/L). No significant differences were found in T4 and TSH levels, weight gain, cognitive or motor function. The findings suggest that Lipiodol supplementation in moderately iodine-deficient children with normal T4 levels is unlikely to benefit their cognitive function. However, it remains possible that other iodine preparations may have benefits.
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Affiliation(s)
- S N Huda
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka 1000, Bangladesh
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Grantham-McGregor SM, Walker SP, Chang S. Nutritional deficiencies and later behavioural development. Proc Nutr Soc 2000; 59:47-54. [PMID: 10828173 DOI: 10.1017/s0029665100000069] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The literature on the long-term effects of nutritional deficiencies in early life is reviewed. The severity and duration of the deficiency, the stage of the children's development, the biological condition of the children and the socio-cultural context may all modify the effect. There is substantial evidence that reduced breast-feeding, small-for-gestational-age birth weight, Fe and I deficiency, and protein-energy malnutrition (PEM) are associated with long-term deficits in cognition and school achievement. However, all these conditions are associated with poverty and poor health, which may account for the association. It is difficult to establish that the long-term relationship is causal, as it requires a randomized treatment trial with long-term follow-up. Such studies are only available for I deficiency in utero and early childhood PEM. Results from these studies indicate that I deficiency has a long-term effect and PEM probably has a long-term effect.
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Affiliation(s)
- S M Grantham-McGregor
- Centre for International Child Health, Institute of Child Health, 30 Guilford St, London WCI IEH, UK.
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Abstract
Proper nutrition during pregnancy is critically important to mother and fetus. For most healthy women, the only nutritional intervention required may be adequate iron and folate intake; however, for others, who begin pregnancy in a malnourished state or whose nutritional intake deteriorates during pregnancy, invasive nutritional support, including tube feeding or parenteral nutrition, may be indicated. To guide nutritional therapy and to avoid its potential complications, it is necessary to evaluate the patient's nutritional state. Such evaluation must focus not only on body composition and substrate reserves but also on the patient's changing nutrient requirements and any impediments to the patient's capacity to ingest and assimilate food.
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Affiliation(s)
- E Hamaoui
- Metabolic Support Service, Maimonides Medical Center, Brooklyn, New York, USA
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35
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Van den Broeck J, Eeckels R, Van Loon H, Van Miert M, Vanderschueren-Lodeweyckx M. Growth of children in a iodine-deficient area in northern Zaïre. Ann Hum Biol 1993; 20:183-9. [PMID: 8447661 DOI: 10.1080/03014469300002612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In a case-control study all preschool children of 50 villages in an iodine-deficient area in northern Zaïre were examined for the absence or presence of a goitre. Children with goitre but without obvious signs of cretinism (cases) were maximally matched with a goitre-free child of the same ethnic group, village, sex and age (controls). Anthropometry of cases and controls was compared in order to investigate if endemic goitre is associated with any growth impairment. Surprisingly, between ages 2 and 4 years, children with goitre are taller and heavier, and have a smaller triceps skinfold thickness. Arm circumferences did not differ between cases and controls. Stunting is more prevalent in controls. If manifest cretinism is excluded, goitre is not associated with growth retardation. The higher anthropometric figures in goitrous children remain unexplained. In the absence of any data on the hormonal status of these two groups of children, it can only be surmised that, in iodine-deficient areas, some degree of hypothyroidism negatively influencing growth might be more frequent in non-goitrous children than in goitrous ones.
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37
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Fenzi GF, Giusti LF, Aghini-Lombardi F, Bartalena L, Marcocci C, Santini F, Bargagna S, Brizzolara D, Ferretti G, Falciglia G. Neuropsychological assessment in schoolchildren from an area of moderate iodine deficiency. J Endocrinol Invest 1990; 13:427-31. [PMID: 2380506 DOI: 10.1007/bf03350696] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neuropsychological assessment was carried out in schoolchildren from a montane area of Eastern Tuscany (Tiberina Valley). This area was found to be moderately iodine deficient (mean urinary iodine excretion: 39 micrograms/g creatinine), with a cumulative goiter prevalence of 51.9% in schoolchildren aged 6-14 yr (goiter prevalence in the control iodine-sufficient area: 5.6%). No significant differences in serum TT4, TT3, FT4I, TSH levels between the endemic and control areas were found, whereas serum thyroglobulin values were significantly higher in the iodine-deficient area (61 +/- 8 vs 17 +/- 1 ng/ml, p less than 0.01). No differences were found as to the height, body weight and pubertal development in the two areas. Neuropsychological assessment, performed in a representative sample of 50 schoolchildren from the endemic area and 50 schoolchildren from the control area, matched for age, sex and socioeconomical conditions, failed to show major differences between the two groups in the global neuropsychological performance and cognitive levels. However, minor but significant differences were noted in the information vocabulary and coding subtests, at least in children aged 8. Although familial cultural influences might play a role, it would appear that some marginal impairment, with particular regard to motor-perceptual functions, be present in areas of moderate iodine deficiency.
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Affiliation(s)
- G F Fenzi
- Istituto di Endocrinologia, Universita di Pisa, Italy
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38
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Boyages SC, Maberly GF, Morris J, Eastman CJ, Collins JK, Jupp JJ. Iodine deficiency impairs intellectual and neuromotor development in apparently‐normal persons: A study of rural inhabitants of north‐central China. Med J Aust 1989. [DOI: 10.5694/j.1326-5377.1989.tb136760.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - John Morris
- Westmead HospitalHawkesbury RoadWestmeadNSW2145
| | | | | | - James J. Jupp
- School of Behavioural SciencesMacquarie UniversityNSW2109
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Eastman CJ, Phillips DI. Endemic goitre and iodine deficiency disorders--aetiology, epidemiology and treatment. BAILLIERE'S CLINICAL ENDOCRINOLOGY AND METABOLISM 1988; 2:719-35. [PMID: 3066326 DOI: 10.1016/s0950-351x(88)80062-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Disorders caused by iodine deficiency continue to be a major health problem in many underdeveloped areas of the world. The most significant is the impaired mental and physical development which occurs as a result of iodine deprivation early in life. Individuals in affected communities show a spectrum of abnormalities which can be attributed to two interacting pathological processes. Fetal hypothyroidism in the first and early second trimester predominantly affects the developing nervous system causing deaf-mutism and mental retardation. If hypothyroidism occurs in the early postnatal period the main abnormalities are growth stunting and related somatic abnormalities. Subclinical deficits of intellectual and motor development may also be found in apparently normal individuals living in affected areas. Although dietary iodine deficiency is clearly the major aetiological factor in both endemic goitre and cretinism, cofactors such as goitrogens, other trace element deficiencies and immunological mechanisms may greatly modify the expression of these disorders. Iodine supplementation programmes form the basis of the public health strategy in combatting these disorders. Where the iodization of foodstuffs is not feasible, an alternative is the use of iodine containing oil which can be given orally or intramuscularly to provide a long-lasting supply of iodine.
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Abstract
Global descriptive, epidemiological studies have established the relation of iodine deficiency to endemic cretinism which, in its fully developed form, is characterized by mental deficiency, deaf mutism and spastic diplegia. However, a second less common variant--myxedematous or hypothyroid cretinism--is characterized by severe hypothyroidism with dwarfism. Mixed forms occur. It has been shown that both conditions can be prevented by correction of the iodine deficiency before pregnancy. Cretinism and development--now termed iodine deficiency disorders (IDD). A number of recently developed animal models establish the effect of severe iodine deficiency on brain development. These include the rat, the marmoset monkey and the sheep. These models are all characterized by the production of severe maternal and fetal hypothyroidism which is associated with effects on the maturation of the cerebral cortex and cerebellum. There was a reduced brain weight with a reduced number of cells as indicated by reduced DNA, a greater density of cells in the cerebral cortex and reduced cell acquisition in the cerebellum. Studies of the mechanisms involved have been carried out in the sheep. The findings reveal significant, though less severe, effects of fetal thyroidectomy (late gestation) and a significant effect of maternal thyroidectomy on brain development in mid-gestation. A combination of maternal and fetal thyroidectomy has similar but more severe effects than iodine deficiency. In the light of current knowledge of the embryology of the brain it is suggested that the critical time for the effect of iodine deficiency is the mid-trimester (14-18 weeks) when the neurons of the cerebral cortex and basal ganglia are formed and could be damaged by the effect of iodine deficiency on maternal thyroid function. There is now recent evidence indicating transfer of maternal thyroxine across the placental barrier early in pregnancy. In this way, neurological cretinism might be produced. Impaired fetal thyroid function would follow in the third trimester and augment the effect of reduced maternal thyroid function. Impaired fetal thyroid function alone could produce the hypothyroid form of cretinism. Further experimental studies, particularly into the postnatal period, are required to substantiate these suggestions. Apart from this, further study of the effects of iodine deficiency on brain development at the subcellular and cellular levels are likely to be most productive.
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Affiliation(s)
- B S Hetzel
- CSIRO Division of Human Nutrition, Adelaide, Australia
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Affiliation(s)
- P J Aggett
- Department of Child Health, University of Aberdeen, Foresterhill
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Bongiovanni AM. Congenital hypothyroidism. Dev Med Child Neurol 1985; 27:387-9. [PMID: 4018436 DOI: 10.1111/j.1469-8749.1985.tb04554.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Pharoah PO, Connolly KJ, Ekins RP, Harding AG. Maternal thyroid hormone levels in pregnancy and the subsequent cognitive and motor performance of the children. Clin Endocrinol (Oxf) 1984; 21:265-70. [PMID: 6478630 DOI: 10.1111/j.1365-2265.1984.tb03468.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Serum levels of thyroxine and triiodothyronine during pregnancy were measured in women from a severely iodine deficient region in the highlands of Papua New Guinea. Subsequently the children born to these women were examined when aged 10-12 years and measures made of intellectual ability and motor competence. A significant correlation between these measures in the children and the maternal thyroxine but not maternal triiodothyronine level was observed. It is speculated that maternal thyroxine and not triiodothyronine may be essential for normal neurological maturation of the fetus before the fetal thyroid becomes functional.
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Abstract
Disorders resulting from severe iodine deficiency affect more than 400 million people in Asia alone. These disorders include stillbirths, abortions, and congenital anomalies; endemic cretinism, characterised most commonly by mental deficiency, deaf mutism, and spastic diplegia and lesser degrees of neurological defect related to fetal iodine deficiency; and impaired mental function in children and adults with goitre associated with subnormal concentrations of circulating thyroxine. Use of the term iodine deficiency disorders, instead of "goitre", would help to bridge the serious gap between knowledge and its application. Iodised salt and iodised oil (by injection or by mouth) are suitable for the correction of iodine deficiency on a mass scale. A single dose of iodised oil can correct severe iodine deficiency for 3-5 years. Iodised oil offers a satisfactory immediate measure for primary care services until an iodised salt programme can be implemented. The complete eradication of iodine deficiency is therefore feasible within 5-10 years.
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Larrick JW, Plato CC, Hornabrook RW. Studies of endemic cretinism in Papua New Guinea: digital and palmar dermatoglyphic patterns. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 1983; 61:205-10. [PMID: 6881322 DOI: 10.1002/ajpa.1330610209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We have tested the hypothesis that the abnormal development of the central nervous system seen in endemic cretinism might be accompanied by concurrent abnormal dermatoglyphic patterns. We compared digital and palmar dermatoglyphics of normal individuals and endemic cretins inhabiting the Huon Peninsula of Papua New Guinea. The population sampled from the Irumu River Valley included 118 males and 114 females with 22 male cretins and 23 female cretins. The population sampled from the Wantoat River Valley included 72 males and 38 females with 12 male cretins. No pathognomonic patterns were found that could identify the endemic cretin subpopulation. However, the occurrence of a number of differences between controls and cretins suggests that subtle changes in dermatoglyphic patterns accompany the anomalous development of the CNS secondary to maternal iodine deficiency. We discuss the significance of these findings and compare the dermatoglyphic patterns of normal Irumu and Wantoat natives and 21 other populations of Papua New Guinea.
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Abstract
Serum thyroid hormone levels were measured in women living in an area of severe dietary iodine deficiency in a remote region of Papua New Guinea. Levels of maternal hormone were found to be related to the motor competence of the women's offspring, who were aged between six years and 11 years 10 months at the time of assessment. Motor competence in the children was measured by two tests of manual dexterity which demanded speed and accuracy in performance. A significant correlation was obtained between the children's motor performance and maternal serum thyroxine levels, but not with maternal serum triiodothyronine levels. The implications of the findings for the pathogenesis of some forms of cerebral palsy are considered.
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