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Alimardani B, Hashemipour M, Hovsepian S, Mozafarian N, Khoshhali M, Kelishadi R. Association between maternal and cord blood thyroid hormones, and urine iodine concentration with fetal growth. J Pediatr Endocrinol Metab 2024; 37:516-524. [PMID: 38685764 DOI: 10.1515/jpem-2023-0570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES We planned to evaluate the association of fetal and maternal thyroid hormones and maternal iodine status with neonates' anthropometric parameters. METHODS In this cross-sectional study, levels of thyrotropin were measured in maternal serum in the first trimester of pregnancy, and thyrotropin (TSH) and free thyroxin (fT4) were measured in cord blood serum samples at birth. Urinary iodine concentration (UIC) levels in random urine samples of mothers were measured in the third trimester of pregnancy. The relationship between UIC and thyroid hormone levels of mothers with neonates' anthropometric birth parameters of neonates was evaluated. RESULTS One hundred eighty-eight mother-newborn pairs completed the study. Mean (SD) of cord blood TSH (CB-TSH), cord blood-free thyroxin (CB-FT4) values, and maternal TSH (M-TSH) levels were 8.8 (7.3) mIU/L, 1.01 (0.2) ng/dL, and 2.2 (0.9) mIU/L, respectively. After adjusting for confounders, there was a positive significant association between female neonate length and maternal TSH and log log-transformed CB TSH (LN_CB-TSH) (p<0.05). Median UIC (Q1-Q3) was 157 (53-241) μg/L, and there was no association between birth weight, birth length, and head circumferences of neonates and mothers' UIC (p>0.05). CONCLUSIONS We found a positive correlation between maternal TSH in the first trimester of pregnancy and the birth length of newborns, and a negative correlation was observed between CB-TSH and birth length in girls, but it did not provide conclusive evidence for the relationship between maternal and neonatal thyroid hormone levels and birth weight. There was no association between maternal UIC levels in the third trimester and birth anthropometric parameters.
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Affiliation(s)
- Bita Alimardani
- 48455 Metabolic Liver Diseases Research Center, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Mahin Hashemipour
- 48455 Metabolic Liver Diseases Research Center, Isfahan University of Medical Sciences , Isfahan, Iran
- 48455 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Silva Hovsepian
- 48455 Metabolic Liver Diseases Research Center, Isfahan University of Medical Sciences , Isfahan, Iran
- 48455 Imam Hossein Children's Hospital, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Nafiseh Mozafarian
- 48455 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Mehri Khoshhali
- 48455 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Roya Kelishadi
- 48455 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences , Isfahan, Iran
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Bath SC. Thyroid function and iodine intake: global recommendations and relevant dietary trends. Nat Rev Endocrinol 2024:10.1038/s41574-024-00983-z. [PMID: 38693274 DOI: 10.1038/s41574-024-00983-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 05/03/2024]
Abstract
Iodine is a micronutrient that is essential for thyroid hormone production. Adequate iodine intake is especially important during pregnancy and early life, when brain development is dependent on thyroid hormones. Iodine intake recommendations vary around the world, but most recommendations generally reflect the increased requirements during pregnancy and lactation, although adequate iodine intake before pregnancy is also important. Tremendous progress has been made in improving iodine intake across the world over the past 30 years, mainly through salt-iodization programmes. However, in countries without strong iodine fortification programmes, and with shifts in dietary patterns, a need has arisen for health organizations, governments and clinicians to ensure that adequate iodine is consumed by everyone in the population. For example, in countries in which adequate iodine intake depends on individual food choice, particularly of iodine-rich milk and dairy products, intake can be highly variable and is also vulnerable to changing dietary patterns. In this Review, iodine is considered in the wider context of the increasing prevalence of overweight and obesity, the dietary trends for salt restriction for cardiovascular health and the increasing uptake of plant-based diets.
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Affiliation(s)
- Sarah C Bath
- Department of Nutrition, Food and Exercise Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
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Chen D, Ye Y, Lan Y, He M, Wu J, Wang L, Chen Z. Adequate iodine nutrition and higher salt intake in Chinese adults aged 18-59 years recommended by international organizations. Sci Rep 2024; 14:6993. [PMID: 38523151 PMCID: PMC10961319 DOI: 10.1038/s41598-024-57892-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 03/22/2024] [Indexed: 03/26/2024] Open
Abstract
Iodine deficiency and excessive salt intake have adverse health effects. This study evaluated the iodine level and salt intake in Chinese adults aged 18-59 years after implementing the salt reduction program and compared with both the World Health Organization (WHO) and Chinese recommendations. Adults aged 18-59 years were randomly selected using multi-stage stratified random sampling in coastal urban area (CUA), non-coastal urban area (Non-CUA), coastal rural area (CRA), and non-coastal rural area (Non-CRA) of Fujian Province, China. Iodine, sodium, and creatinine concentrations in spot urine samples were measured. Knudsen equation was used to determine 24-h urinary iodine and sodium excretion. The median urinary iodine concentration (mUIC) and urinary sodium concentration (mUNaC) among adults (n = 3513) were 132.0 μg/L and 4.0 g/d, respectively. The mUIC and median daily iodine intake in CUA, Non-CUA, CRA and Non-CRA were 112.1, 127.5, 128.5, 167.5 μg/L and 189.6, 182.5, 199.4, 236.0 μg/d, respectively. The mUNaC and median daily salt intake (mDSI) in these four areas were 2.4, 2.8, 2.9, 2.9 g/L and 9.8, 10.4, 10.4, 10.6 g/d, respectively. The mUIC and DII of residents were higher in the Non-CRA than in the other three areas (P < 0.05). The UNaC and DSI of residents were lower in the CUA than in the other three areas (P < 0.05). The logistic regression demonstrated that the people living in CUA and Non-CUA consumed less salt compared with those in Non-CRA. Except for Non-CUA, the DII was lower (< 150 μg/d) among women of childbearing age in the low-salt intake group (< 5 g/d) compared with the high-salt intake group (≥ 5 g/d) (P < 0.05). Iodine nutrition in Chinese adults aged 18-59 years was sufficient, but the salt intake was substantially higher than the WHO and Chinese recommendations. Further policy implementation is needed to reduce salt intake and improve the monitoring of iodine levels in Chinese adults, especially in women of childbearing age.
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Affiliation(s)
- Diqun Chen
- Institute for Endemic and Chronic Non-Communicable Diseases, Fujian Center for Disease Control and Prevention, Fuzhou, 350012, Fujian, China
- School of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Ying Ye
- Institute for Endemic and Chronic Non-Communicable Diseases, Fujian Center for Disease Control and Prevention, Fuzhou, 350012, Fujian, China
- School of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Ying Lan
- Institute for Endemic and Chronic Non-Communicable Diseases, Fujian Center for Disease Control and Prevention, Fuzhou, 350012, Fujian, China
| | - Meng He
- Institute for Endemic and Chronic Non-Communicable Diseases, Fujian Center for Disease Control and Prevention, Fuzhou, 350012, Fujian, China
| | - Jiani Wu
- Institute for Endemic and Chronic Non-Communicable Diseases, Fujian Center for Disease Control and Prevention, Fuzhou, 350012, Fujian, China
| | - Lijin Wang
- Institute for Endemic and Chronic Non-Communicable Diseases, Fujian Center for Disease Control and Prevention, Fuzhou, 350012, Fujian, China
| | - Zhihui Chen
- Institute for Endemic and Chronic Non-Communicable Diseases, Fujian Center for Disease Control and Prevention, Fuzhou, 350012, Fujian, China.
- School of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian, China.
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Genc M, Yildirim A, Yildirim N. Comparison of body iodine pool assessment methods before radioiodine therapy. Rev Esp Med Nucl Imagen Mol 2024; 43:107-112. [PMID: 38331249 DOI: 10.1016/j.remnie.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION AND OBJECTIVES Radioactive iodine therapy (RAIT) is recommended to reduce the risk of recurrence and metastasis in patients with intermediate-high risk differentiated thyroid cancer (DTC). In preparation for RAIT, stimulation of thyroid-stimulating hormone and reduction of body iodine pool are important for treatment success. For this purpose, patients are asked to reduce their iodine intake before RAIT, and the body iodine pool can be evaluated by measuring iodine excretion in urine before treatment. The aim of our study is to compare the methods used to measure the body iodine pool in the evaluation of the restricted iodine diet (RID) effectiveness applied in the RAIT preparation. PATIENTS AND METHODS Eighty DTC patients discontinued levothyroxine three weeks before RAIT and followed up with a RID two weeks before treatment. After two weeks of RID, all patients collected their 24-h urine the day before the RAIT date. Patients completed 24-h urine samples on the morning of the RAIT date and also provided a spot urine sample. The estimated 24-h creatinine excretion of the patients was calculated. Estimated 24-h urinary iodine excretion (UIE) was calculated using the spot urine iodine/creatinine (I/C) ratio of the patients. 24-h UIE, iodine concentration in spot urine, I/C ratios in spot urine and estimated 24-h UIE of the patients were analyzed by comparing with each other. RESULTS In 99% of the patients, RID efficiency was sufficient according to 24-h UIE before RAIT. The mean 24-h UIE was 48.81 micrograms/day (mcg/day) in 24-h urine samples taken from the patients to evaluate the body iodine pool. The patients' iodine concentrations in spot urine, I/C ratios in spot urine, and estimated 24-h UIE were all statistically significantly lower than actual 24-h UIE, which was the reference method (p: 0.026 vs <0.001 vs 0.041). Moderate positive correlation between 24-h UIE and iodine concentration in spot urine (r: 0.440), I/C ratio in spot urine (r: 0.493), and estimated 24-h UIE (r: 0.560) found. The strongest correlation was obtained with the estimated 24-h UIE. CONCLUSION The estimated 24-h UIE obtained by using the I/C ratio in spot urine can be used practically and safely as an alternative to UIE in 24-h urine, which is the gold standard method for evaluating body iodine pool.
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Affiliation(s)
- Mustafa Genc
- Sivas Numune Hospital, Department of Nuclear Medicine, Sivas, Turkey.
| | - Aslihan Yildirim
- Ankara City Hospital, Department of Nuclear Medicine, Ankara, Turkey
| | - Nilufer Yildirim
- Ankara City Hospital, Department of Nuclear Medicine, Ankara, Turkey; Ankara Yildirim Beyazit University, Department of Nuclear Medicine, Ankara, Turkey
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Světnička M, Heniková M, Selinger E, Ouřadová A, Potočková J, Kuhn T, Gojda J, El-Lababidi E. Prevalence of iodine deficiency among vegan compared to vegetarian and omnivore children in the Czech Republic: cross-sectional study. Eur J Clin Nutr 2023; 77:1061-1070. [PMID: 37488261 PMCID: PMC10630131 DOI: 10.1038/s41430-023-01312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The intake and homeostasis of iodine, an essential micronutrient that plays a vital role in thyroid physiology, is of particular concern with the increasing popularity of vegetarian (VG) and vegan (VN) diets. Children on these restrictive diets may be at risk of possible adverse effects on growth and development, but there is currently a lack of recent epidemiological studies on this topic. METHODS We gathered clinical, anthropometric, and blood/urine data on iodine status and thyroid function from children aged 0-18 years who followed either a VG diet (n = 91), VN diet (n = 75), or omnivore diet (OM, n = 52). Cross-sectional comparison of the groups and linear regression was used. Stratified analyses were performed based on age (according to WHO): 0-5 years and 6-18 years. RESULTS Our study revealed no significant differences in levels of thyroid-stimulating hormone (TSH), triiodothyronine (fT3), thyroglobulin (TG) or anti-thyroid peroxidase antibody (ATPOc) between the VG, VN, and OM groups. However, thyroxine (fT4) levels were found to be higher in the VN group compared to the OM group (15.00 ± 1.73 vs. 16.17 ± 1.82 pmol/l, p < 0.001). The presence of anti-thyroglobulin antibodies (AhTGc) was notably more common in the VG (18.2%)/VN (35.0%) groups than in the OM group (2.1%) (p < 0.001). Regarding iodine status, the concentration of iodine in spot urine (UIC) was found to be highest in the OM group (197.28 ± 105.35 vs. VG: 177.95 ± 155.88 vs. VN: 162.97 ± 164.51 µg/l, p < 0.001). Notably, the lowest (5.99 µg/l) and highest (991.80 µg/l) levels were measured in the VN group. Of the participants, 31 VN, 31 VG and 10 OM children met the criteria for iodine deficiency (i.e., UIC < 100 µg/l). We found that children with regular iodine supplementation had higher UIC (p < 0.001). Importantly, the median UIC was above 100 µg/l in all three groups, through the recommended intake (RDI) of iodine was rarely met throughout the groups. CONCLUSION We have observed a trend to lower UIC values in VN as compared to OM. This trend is also reflected in the median UIC values, even though the median UIC values were above the WHO cut-off (e.g., 100 µg/l) for iodine deficiency in all dietary groups. These results suggest that VN and VG children may be more at higher risk of iodine deficiency, this theory is also supported by higher prevalence of AhTGc positivity. Further research is needed to investigate the long-term impact of these dietary patterns on iodine status and thyroid function in children. Given our findings, it may also be necessary to consider new guidelines for supplementing children following VG and VN diets to ensure their iodine needs are met.
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Affiliation(s)
- Martin Světnička
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic.
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
- Department of Paediatrics, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Marina Heniková
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eliška Selinger
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
- The National Institute of Public Health, Centre for Public Health Promotion, Prague, Czech Republic
| | - Anna Ouřadová
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jana Potočková
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tilman Kuhn
- The Institute for Global Food Security, Queen's University Belfast, Belfast, Northern Ireland, UK
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg, Germany
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
- Medical University of Vienna, Centre for Public Health, Vienna, Austria
| | - Jan Gojda
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eva El-Lababidi
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Paediatrics, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Eriksson J, Barregard L, Sallsten G, Berlinger B, Weinbruch S, Manousou S, Ellingsen DG, Nyström HF. Urinary iodine excretion and optimal time point for sampling when estimating 24-h urinary iodine. Br J Nutr 2023; 130:1289-1297. [PMID: 36744548 PMCID: PMC10511680 DOI: 10.1017/s0007114523000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/10/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
Iodine deficiency may cause thyroid dysfunction. The iodine intake in a population is measured by urinary iodine concentration (UIC) in spot samples or 24-h urinary iodine excretion (24UIE). 24UIE is considered the gold standard and may be estimated using an equation including UIC, urinary creatinine concentration, sex and age (e24UIE). The aims of this study were to evaluate the preferable timing of UIC when using this equation and assess the variability of UIE. Sixty healthy non-smoking women (n 31) and men (n 29) were included in Gothenburg, Sweden. Twelve urine samples were collected at six fixed times on two separate days. Variability was calculated for UIC, 24UIE, e24UIE, iodine excretion per hour (iHr) and UIC adjusted for creatinine and specific gravity. Median 24UIE was 156 µg/24 h and the median UIC (all spot samples) was 104 µg/l. UIC (P < 0·001), 24UIE (P = 0·001) and e24UIE (P < 0·001) were significantly higher in men. e24UIE was relatively similar to 24UIE. However, when e24UIE was calculated from UIC in the first void, it was about 15 % lower than 24UIE (P < 0·001). iHr was lowest in the morning and highest in the afternoon. Median iHr was higher in men (7·4 v. 5·3 µg/h, P < 0·001). The variability of UIE was higher within individuals than between individuals. This study suggests that most time points for estimation of individual 24UIE are appropriate, but they should preferably not be collected in the first void.
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Affiliation(s)
- Janna Eriksson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Praktikertjänst AB, Skövde, 54130, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Balazs Berlinger
- National Institute of Occupational Health, Oslo, Norway
- Department of Animal Hygiene, Herd Health and Mobile Clinic, University of Veterinary Medicine, Budapest, Hungary
| | - Stephan Weinbruch
- National Institute of Occupational Health, Oslo, Norway
- Institute of Applied Geosciences, Darmstadt Technical University, Darmstadt, Germany
| | - Sofia Manousou
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Frölunda Specialist Hospital, Västra Frölunda, Sweden
| | | | - Helena Filipsson Nyström
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg’s Centre for Molecular and Translational Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Zhao FF, Wang XL, Lei YT, Li HQ, Li ZM, Hao XX, Ma WW, Wu YH, Wang SY. A systematic review: on the mercaptoacid metabolites of acrylamide, N-acetyl-S-(2-carbamoylethyl)-L-cysteine. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:88350-88365. [PMID: 37458885 DOI: 10.1007/s11356-023-28714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 07/06/2023] [Indexed: 08/11/2023]
Abstract
Acrylamide is widely found in a variety of fried foods and cigarettes and is not only neurotoxic and carcinogenic, but also has many potential toxic effects. The current assessment of acrylamide intake through dietary questionnaires is confounded by a variety of factors, which poses limitations to safety assessment. In this review, we focus on the levels of AAMA, the urinary metabolite of acrylamide in humans, and its association with other diseases, and discuss the current research gaps in AAMA and the future needs. We reviewed a total of 25 studies from eight countries. In the general population, urinary AAMA levels were higher in smokers than in non-smokers, and higher in children than in adults; the highest levels of AAMA were found in the population from Spain, compared with the general population from other countries. In addition, AAMA is associated with several diseases, especially cardiovascular system diseases. Therefore, AAMA, as a biomarker of internal human exposure, can reflect acrylamide intake in the short term, which is of great significance for tracing acrylamide-containing foods and setting the allowable intake of acrylamide in foods.
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Affiliation(s)
- Fang-Fang Zhao
- Department of Occupational Health, Public Health College, Harbin Medical University, 157 Baojian Road, Nan gang District, Harbin, 150086, People's Republic of China
| | - Xiao-Li Wang
- Department of Occupational Health, Public Health College, Harbin Medical University, 157 Baojian Road, Nan gang District, Harbin, 150086, People's Republic of China
| | - Ya-Ting Lei
- Department of Occupational Health, Public Health College, Harbin Medical University, 157 Baojian Road, Nan gang District, Harbin, 150086, People's Republic of China
| | - Hong-Qiu Li
- Department of Occupational Health, Public Health College, Harbin Medical University, 157 Baojian Road, Nan gang District, Harbin, 150086, People's Republic of China
| | - Zhi-Ming Li
- Department of Occupational Health, Public Health College, Harbin Medical University, 157 Baojian Road, Nan gang District, Harbin, 150086, People's Republic of China
| | - Xiao-Xiao Hao
- Department of Occupational Health, Public Health College, Harbin Medical University, 157 Baojian Road, Nan gang District, Harbin, 150086, People's Republic of China
| | - Wei-Wei Ma
- Harbin Railway Center for Disease Control and Prevention, Harbin, People's Republic of China
| | - Yong-Hui Wu
- Department of Occupational Health, Public Health College, Harbin Medical University, 157 Baojian Road, Nan gang District, Harbin, 150086, People's Republic of China
| | - Sheng-Yuan Wang
- Department of Occupational Health, Public Health College, Harbin Medical University, 157 Baojian Road, Nan gang District, Harbin, 150086, People's Republic of China.
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8
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Dineva M, Rayman MP, Levie D, Hunziker S, Guxens M, Peeters RP, Murcia M, Rebagliato M, Irizar A, Jimeno-Romero A, Sunyer J, Korevaar TIM, Bath SC. Exploration of thyroglobulin as a biomarker of iodine status in iodine-sufficient and mildly iodine-deficient pregnant women. Eur J Nutr 2023:10.1007/s00394-023-03131-x. [PMID: 36973522 DOI: 10.1007/s00394-023-03131-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Urinary iodine-to-creatinine ratio (UI/Creat) reflects recent iodine intake but has limitations for assessing habitual intake. Thyroglobulin (Tg) concentration, which increases with thyroid size, appears to be an indicator of longer-term iodine status in children and adults, however, less is known in pregnancy. This study investigated the determinants of serum-Tg in pregnancy and its use as an iodine-status biomarker in settings of iodine-sufficiency and mild-to-moderate deficiency. METHODS Stored blood samples and existing data from pregnant women from the Netherlands-based Generation R (iodine-sufficient) and the Spain-based INMA (mildly-to-moderately iodine-deficient) cohorts were used. Serum-Tg and iodine status (as spot-urine UI/Creat) were measured at median 13 gestational weeks. Using regression models, maternal socio-demographics, diet and iodine-supplement use were investigated as determinants of serum-Tg, as well as the association between UI/Creat and serum-Tg. RESULTS Median serum-Tg was 11.1 ng/ml in Generation R (n = 3548) and 11.5 ng/ml in INMA (n = 1168). When using 150 µg/g threshold for iodine deficiency, serum-Tg was higher in women with UI/Creat < 150 vs ≥ 150 µg/g (Generation R, 12.0 vs 10.4 ng/ml, P = 0.010; INMA, 12.8 vs 10.4 ng/ml, P < 0.001); after confounder adjustment, serum-Tg was still higher when UI/Creat < 150 µg/g (regression coefficients: Generation R, B = 0.111, P = 0.050; INMA, B = 0.157, P = 0.010). Iodine-supplement use and milk intake were negatively associated with serum-Tg, whereas smoking was positively associated. CONCLUSION The association between iodine status and serum-Tg was stronger in the iodine-deficient cohort, than in the iodine-sufficient cohort. Serum-Tg might be a complementary (to UI/Creat) biomarker of iodine status in pregnancy but further evidence is needed.
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Affiliation(s)
- Mariana Dineva
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Margaret P Rayman
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Deborah Levie
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Sandra Hunziker
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
| | - Mònica Guxens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Robin P Peeters
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Mario Murcia
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Análisis de Sistemas de Información Sanitaria, Conselleria de Sanitat, Generalitat Valenciana, Valencia, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Marisa Rebagliato
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Predepartamental Unit of Medicine, University Jaume I, Castelló, Spain
| | - Amaia Irizar
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- BIODONOSTIA Health Research Institute, Donostia‑San Sebastián, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Alba Jimeno-Romero
- BIODONOSTIA Health Research Institute, Donostia‑San Sebastián, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Parc Salut Mar-IMIM, Barcelona, Spain
| | - Tim I M Korevaar
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Sarah C Bath
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.
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9
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Infant iodine status and associations with maternal iodine nutrition, breast-feeding status and thyroid function. Br J Nutr 2023; 129:854-863. [PMID: 35535981 PMCID: PMC9975782 DOI: 10.1017/s0007114522001465] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Adequate iodine nutrition during infancy is required for normal thyroid function and, subsequently, brain development. However, data on infant iodine status in the first year of life are scarce. This study aimed to describe infant iodine status and further explore its associations with maternal iodine nutrition, breast-feeding status and thyroid function. In this cohort study, 113 infants were followed up at ages 3, 6 and 11 months in Norway. Infant and maternal urinary iodine concentration (UIC), maternal iodine intake, breast milk iodine concentration (BMIC), breast-feeding status and infant thyroid function tests were measured. The median infant UIC was 82 µg/l at the age of 3 months and below the WHO cut-off of 100 µg/l. Infant UIC was adequate later in infancy (median 110 µg/l at ages 6 and 11 months). Infant UIC was associated positively with maternal UIC (β = 0·33, 95 % CI (0·12, 0·54)), maternal iodine intake (β = 0·30, 95 % CI (0·18, 0·42)) and BMIC (β = 0·46, 95 % CI (0·13, 0·79)). Breastfed infants had lower median UIC compared with formula-fed infants at ages 3 months (76 v. 190 µg/l) and 6 months (105 v. 315 µg/l). Neither infant UIC nor BMIC were associated with infant thyroid function tests. In conclusion, breastfed infants in Norway are at risk of insufficient iodine intake during the first months of life. Maternal iodine nutrition is important for providing sufficient iodine intake in infants, and awareness of promoting adequate iodine nutrition for lactating women should be prioritised.
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10
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Cannas A, Rayman MP, Kolokotroni O, Bath SC. Iodine status of pregnant women from the Republic of Cyprus. Br J Nutr 2023; 129:126-134. [PMID: 35236523 PMCID: PMC9816652 DOI: 10.1017/s0007114522000617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/08/2022] [Accepted: 02/18/2022] [Indexed: 01/21/2023]
Abstract
Iodine supply is crucial during pregnancy to ensure that the proper thyroid function of mother and baby support fetal brain development. Little is known about iodine status or its dietary determinants in pregnant women in the Republic of Cyprus. We therefore recruited 128 pregnant women at their first-trimester ultrasound scan to a cross-sectional study. We collected spot-urine samples for the measurement of urinary iodine concentration (UIC, µg/l) and creatinine concentration (Creat, g/l), the latter of which allows us to correct for urine dilution and to compute the iodine-to-creatinine ratio (UI/Creat). Women completed a FFQ and a general questionnaire. We used a General Linear model to explore associations between maternal and dietary characteristics with UI/Creat. The median UIC (105 µg/l) indicated iodine deficiency according to the WHO criterion (threshold for adequacy = 150 µg/l), and the UI/Creat was also low at 107 µg/g. Only 32 % (n 45) of women reported the use of iodine-containing supplements; users had a higher UI/Creat than non-users (131 µg/g v. 118 µg/g), though this difference was NS in the adjusted analysis (P = 0·37). Of the dietary components, only egg intake was significantly associated with a higher UI/Creat in adjusted analyses (P = 0·018); there was no significant association with milk, dairy products or fish intake. Our results suggest that pregnant women in Cyprus have inadequate iodine status and are at risk of mild-to-moderate iodine deficiency. Further research on dietary sources in this population is required.
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Affiliation(s)
- Andrea Cannas
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Margaret P. Rayman
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Ourania Kolokotroni
- Department of Primary Care and Population Health, University of Nicosia, Medical School, Nicosia, 1700, Cyprus
| | - Sarah C. Bath
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
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11
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Association between Elevated Iodine Intake and IQ among School Children in Portugal. Nutrients 2022; 14:nu14214493. [PMID: 36364754 PMCID: PMC9657725 DOI: 10.3390/nu14214493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/05/2022] [Accepted: 10/18/2022] [Indexed: 11/23/2022] Open
Abstract
The goal of this work was to examine whether elevated iodine intake was associated with adverse effects on IQ among school-age children in Portugal. In a representative sample of children from the north of the country, IQ percentiles by age (assessed with Raven’s Colored Progressive Matrices) were dichotomized to <50 (“below-average” IQs) and ≥50. Morning urine iodine concentrations, corrected for creatinine, were dichotomized to <250 µg/g and ≥250 µg/g, according to the European Commission/Scientific Committee on Food’s tolerable upper level of daily iodine intake for young children. Data were examined with Chi-square tests, logistic regression, and GLM univariate analysis. The sample (N = 1965) was classified as generally iodine-adequate (median urinary iodine concentration = 129 µg/L; median iodine-to-creatinine ratio = 126 µg/g) according to the WHO’s criteria. A greater proportion of children in the ≥250 µg/g group had below-average IQs, compared to children with less than 250 µg/g (p = 0.037), despite a sizable (though non-significant) proportion of children in the less-than-250 µg/g group also presenting below-average IQs, at the bottom of the iodine distribution (<50 µg/g). The proportion of below-average IQs increased with increasingly elevated iodine concentrations (p = 0.047). The association remained significant after the adjustment for confounders, with the elevated iodine group showing increased odds of having below-average IQs when compared with the non-elevated iodine group (OR 1.55; 95% CI 1.11−2.17; p = 0.011). Consistently, the former group presented a lower mean IQ than the latter (p = 0.006). High iodine intake was associated with lower IQs even in a population classified as iodine-adequate. These results bear on child cognition and on initiatives involving iodine supplementation.
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12
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Pieters TT, Veldhuis WB, Moeskops P, de Vos BD, Verhaar MC, Haitjema S, Huitema ADR, Rookmaaker MB. Deep learning body-composition analysis of clinically acquired CT-scans estimates creatinine excretion with high accuracy in patients and healthy individuals. Sci Rep 2022; 12:9013. [PMID: 35637278 PMCID: PMC9151677 DOI: 10.1038/s41598-022-13145-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/20/2022] [Indexed: 11/14/2022] Open
Abstract
Assessment of daily creatinine production and excretion plays a crucial role in the estimation of renal function. Creatinine excretion is estimated by creatinine excretion equations and implicitly in eGFR equations like MDRD and CKD-EPI. These equations are however unreliable in patients with aberrant body composition. In this study we developed and validated equations estimating creatinine production using deep learning body-composition analysis of clinically acquired CT-scans. We retrospectively included patients in our center that received any CT-scan including the abdomen and had a 24-h urine collection within 2 weeks of the scan (n = 636). To validate the equations in healthy individuals, we included a kidney donor dataset (n = 287). We used a deep learning algorithm to segment muscle and fat at the 3rd lumbar vertebra, calculate surface areas and extract radiomics parameters. Two equations for CT-based estimate of RenAl FuncTion (CRAFT 1 including CT parameters, age, weight, and stature and CRAFT 2 excluding weight and stature) were developed and compared to the Cockcroft-Gault and the Ix equations. CRAFT1 and CRAFT 2 were both unbiased (MPE = 0.18 and 0.16 mmol/day, respectively) and accurate (RMSE = 2.68 and 2.78 mmol/day, respectively) in the patient dataset and were more accurate than the Ix (RMSE = 3.46 mmol/day) and Cockcroft-Gault equation (RMSE = 3.52 mmol/day). In healthy kidney donors, CRAFT 1 and CRAFT 2 remained unbiased (MPE = − 0.71 and − 0.73 mmol/day respectively) and accurate (RMSE = 1.86 and 1.97 mmol/day, respectively). Deep learning-based extraction of body-composition parameters from abdominal CT-scans can be used to reliably estimate creatinine production in both patients as well as healthy individuals. The presented algorithm can improve the estimation of renal function in patients who have recently had a CT scan. The proposed methods provide an improved estimation of renal function that is fully automatic and can be readily implemented in routine clinical practice.
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13
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The Impact of Iodine Concentration Disorders on Health and Cancer. Nutrients 2022; 14:nu14112209. [PMID: 35684009 PMCID: PMC9182735 DOI: 10.3390/nu14112209] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 01/27/2023] Open
Abstract
Iodine deficiency is an ongoing problem. The implementation of salt iodization has significantly reduced the effects of iodine deficiency worldwide in recent years, and the remaining iodine deficiency is mild to moderate. Iodine is an essential substrate for the synthesis of thyroid hormones in the thyroid gland. It can also act as an antioxidant, as well as an anti-proliferative and pro-apoptotic factor. Pregnant women, breastfeeding women, and children are particularly affected by iodine deficiency. It leads to thyroid diseases and metabolic and developmental disorders, as well as cancer. However, an excessive iodine intake may, similarly to iodine deficiency, lead to the development of goiter, and toxic amounts of iodine can lead to thyroiditis, hyperthyroidism, and hypothyroidism, and even to the development of papillary thyroid cancer. Correcting iodine deficiency potentially reduces the chance of developing malignancies. Additional research is needed to better understand both the effect of iodine on carcinogenesis and the clinical outcome of iodine deficiency compensation on cancer patients' prognosis. The upcoming public health challenge appears to be reducing salt consumption, which could result in a lower iodine intake. Thus, an iodine enrichment vehicle other than salt could be considered if salt iodine levels are not increased to compensate, and urine iodine levels should be monitored more frequently.
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14
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Fuse Y, Tsukada N, Urakawa Y, Yokoyama J, Matsuzaki M, Shishiba Y, Irie M. Studies on urinary excretion and variability of dietary iodine in healthy Japanese adults. Endocr J 2022; 69:427-440. [PMID: 34789603 DOI: 10.1507/endocrj.ej21-0486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The daily consumption of iodine in Japan is higher than in most countries, and there are few reports on iodine metabolism and variance of habitual iodine ingestion in an iodine-sufficient area. To elucidate the patterns of short-term urinary iodine excretion (UIE) and long-term variability of habitual iodine intake, the urinary iodine excretion process after a high dietary iodine load of 3 mg was observed in eight Japanese adults under strict supervision with complete urine collections for three days. In addition, estimated UIE and dietary iodine intake (DII) were assessed in 24 university students using repeated spot urine samples of ten consecutive days and a food frequency questionnaire in each of the four seasons. Approximately 50, 75 and 90% of orally ingested iodine was excreted into the urine at 8, 13 and 22 hours after ingestion, respectively. Almost an equal amount of ingested iodine in meals was cleared within 33.5 h after eating with a maximum excretion rate at 3-4 h. There was a high fluctuation in the UIE and DII in the university students. The intra- and inter-individual crude coefficients of variation were 123 or 294.7% for UIE, and 58.3 or 88.7% for DII, respectively, indicating a higher variance of habitual iodine intake than in other countries. The frequency of occurrence for UIE above 3 mg was every 43 days. Rapid renal clearance of iodine and high variability as well as low frequency of dietary iodine intake might prevent people from being exposed to an excess iodine intake over the long term in Japan.
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Affiliation(s)
- Yozen Fuse
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
| | - Nobu Tsukada
- Kagawa Nutrition University, Institute of Nutrition Sciences, Saitama 350-0288, Japan
| | | | | | | | - Yoshimasa Shishiba
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
| | - Minoru Irie
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
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15
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Fuse Y, Ito Y, Shishiba Y, Irie M. Current Iodine Status in Japan: A Cross-sectional Nationwide Survey of Schoolchildren, 2014-2019. J Clin Endocrinol Metab 2022; 107:e2065-e2079. [PMID: 34935958 DOI: 10.1210/clinem/dgab919] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Japan has been regarded as a long-standing iodine-sufficient country without iodine fortification; however, data on nationwide iodine status are lacking. OBJECTIVE This study aimed to characterize the iodine status in Japan. METHODS From 2014 through 2019, a nationwide school-based survey was conducted across all districts in Japan. Urinary iodine concentration (UIC), creatinine (Cr) concentration, and anthropometry were assessed in healthy school-aged children (SAC) aged 6 to 12 years. Their iodine status is regarded as generally representative of the nation's iodine status. RESULTS A total of 32 025 children participated. The overall median UIC was 269 μg/L, which was within the World Health Organization's adequacy range. There was a regional difference in UIC values within 14 regions, and the lowest and highest median UICs were found in Tanegashima Island (209 μg/L) and Nakashibetsu, Hokkaido (1071 μg/L), respectively. The median UIC ≥ 300 μg/L was observed in 12 of 46 regions. By using estimated 24-hour urinary iodine excretion (UIE), the prevalence of SAC exceeding the upper tolerable limit of iodine for Japanese children was from 5.2% to 13.7%. The UIC values did not change with age, body surface area and body mass index percentile, whereas the Cr concentration simultaneously increased suggesting the effect of urinary creatinine on UI/Cr and estimated 24-hour UIE values. CONCLUSIONS The iodine intake of Japanese people is adequate, but in some areas it is excessive. The incidence and prevalence of thyroid disorders associated with iodine intake should be obtained, especially in the areas where high amounts of iodine are consumed.
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Affiliation(s)
- Yozen Fuse
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
| | - Yoshiya Ito
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
- Division of Clinical Medicine, Japanese Red Cross Hokkaido College of Nursing, Kitami, Hokkaido 090-0011, Japan
| | - Yoshimasa Shishiba
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
| | - Minoru Irie
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
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16
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Liu Z, Lin Y, Wu J, Chen D, Wu X, Lan Y, Chen Z. Is the urinary iodine/creatinine ratio applicable to assess short term individual iodine status in Chinese adults? Comparison of iodine estimates from 24-h urine and timed-spot urine samples in different periods of the day. Nutr Metab (Lond) 2022; 19:27. [PMID: 35392953 PMCID: PMC8991982 DOI: 10.1186/s12986-022-00656-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Urinary iodine concentration (UIC) is routinely used to evaluate the population iodine status while the uniform method for the individual level assessment is uncertain. Objectives To explore the 24-h urinary iodine excretion (UIE) in five different periods of the day and the corresponding prediction equations respect by the use of creatinine-corrected UIC. Methods We collected 24-h, spot and fasting urine in five periods of the day to estimate 24-h UIE by the six different prediction equations. We compared the estimated creatinine-corrected UIC to the collected 24-h UIE and identified the most suitable equations in each period of the day. Results Among the six different prediction equations, the equation of Kawasaki T was the best to estimate the 24-h UIE by fasting urine among Chinese adults. Among the five periods of time, the equation of Knudsen N was the best to estimate the 24-h UIE in the non-morning period. Conclusion Urinary iodine status at the individual level could be estimated by different creatinine-based equations at different periods of the day.
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Affiliation(s)
- Zhuan Liu
- The Department of Endemic Diseases, Fujian Center for Disease Control and Prevention Fujian, No. 386 Chong'an Road, Fuzhou, 350012, Fujian, People's Republic of China.,The Department of Disease Control and Prevention, The First Hospital of Quanzhou Affiliated to Fujian Medical University, No.248-252, Dongjie Road, Quanzhou, 362000, Fujian, People's Republic of China
| | - Yixuan Lin
- School of Public Health, Fujian Medical University, University of New Area, No.1 Xueyuan Road, Fuzhou, 350122, Fujian, People's Republic of China
| | - Jiani Wu
- The Department of Endemic Diseases, Fujian Center for Disease Control and Prevention Fujian, No. 386 Chong'an Road, Fuzhou, 350012, Fujian, People's Republic of China
| | - Diqun Chen
- The Department of Endemic Diseases, Fujian Center for Disease Control and Prevention Fujian, No. 386 Chong'an Road, Fuzhou, 350012, Fujian, People's Republic of China
| | - Xiaoyan Wu
- The Department of Endemic Diseases, Fujian Center for Disease Control and Prevention Fujian, No. 386 Chong'an Road, Fuzhou, 350012, Fujian, People's Republic of China
| | - Ying Lan
- The Department of Endemic Diseases, Fujian Center for Disease Control and Prevention Fujian, No. 386 Chong'an Road, Fuzhou, 350012, Fujian, People's Republic of China
| | - Zhihui Chen
- The Department of Endemic Diseases, Fujian Center for Disease Control and Prevention Fujian, No. 386 Chong'an Road, Fuzhou, 350012, Fujian, People's Republic of China. .,School of Public Health, Fujian Medical University, University of New Area, No.1 Xueyuan Road, Fuzhou, 350122, Fujian, People's Republic of China.
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Wang T, Liu Y, Kong Q, Cao X, Liu Y, Xia S, Zheng T, Yu L. Effect of Moderate-to-Severe Iodine Deficiency in Early Pregnancy on Subclinical Hypothyroidism: A Longitudinal Study in an Iodine-Sufficient Region in China. Front Nutr 2022; 9:839651. [PMID: 35433796 PMCID: PMC9011046 DOI: 10.3389/fnut.2022.839651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate iodine status among pregnant women in an iodine-sufficient region in China after the implementation of revised universal salt iodization (USI) standards in 2012 and assess the association between urinary iodine concentrations (UIC) in early pregnancy and the incidence of subclinical hypothyroidism (SCH) in euthyroid women negative for antithyroid Ab during different trimesters.MethodsWe measured the iodine status of 1,264 pregnant women, and performed follow-up assessment of thyroid function at 20 and 30 weeks of gestation among a cohort of 250 euthyroid women. We assessed the association of UIC in the 1st trimester with the incidence of SCH in subsequent trimesters. UIC and serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) were measured.ResultsThe median UIC was 135.95 μg/L among 1,264 women. Serum FT4 level was significantly higher in the group of UIC 150 to 249 μg/L compared with other UIC groups (P < 0.001). TSH was significantly higher in the UIC more than or equal to 250 μg/L group than the UIC 150 to 249 g/L group (P = 0.043). Of the 250 euthyroid women negative for antithyroid Ab (TSH value of 2.5–3.55 mU/L) in the 1st trimester, pregnant women with UIC lower than 100 μg/L in the 1st trimester exhibited a significantly increased risk of SCH (odds ratio [OR] = 2.47; 95% confidence interval [CI] = 1.22–5.71; P = 0.012, according to the Chinese Medical Association criteria; OR = 5.22, 95% CI = 1.73–6.09, P = 0.004, according to ATA criteria) during the latter half of pregnancy compared with the UIC 150 to 249 μg/L group.ConclusionModerate-to-severe iodine deficiency (UIC lower than 100 μg/L) in the 1st trimester was associated with a significantly higher risk of SCH during the 2nd or 3rd trimesters among euthyroid pregnant women who had negative for antithyroid Ab. Women with SCH during pregnancy require regular UIC tests to maintain appropriate iodine status.
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Affiliation(s)
- Taotao Wang
- Department of Endocrinology and Clinical Nutrition, Affiliated Hospital of Jiangsu University, Zhenjiang, China
- *Correspondence: Taotao Wang
| | - Yanqiu Liu
- Department of Obstetrics, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Qianqian Kong
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Xiaoxia Cao
- Department of Obstetrics, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yuzhou Liu
- Department of Obstetrics, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Song Xia
- Department of Endocrinology and Clinical Nutrition, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Tingting Zheng
- Department of Nuclear Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Li Yu
- Department of Endocrinology and Clinical Nutrition, Affiliated Hospital of Jiangsu University, Zhenjiang, China
- Li Yu
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18
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Fuse Y, Ito Y, Tsukada N, Shishiba Y, Irie M. Iodine intake in healthy Japanese aged from 6 to 70 years residing in the same district. Endocr J 2022; 69:253-262. [PMID: 34602518 DOI: 10.1507/endocrj.ej21-0479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Iodine is an essential component of thyroid hormones and a dietary micronutrient for humans, and adequate iodine intake is necessary to maintain thyroid function. A population's iodine intake and nutritional status are assessed based on urinary iodine excretion. There are few studies on iodine nutritional status for all age groups residing in the same area in Japan. Between 2010 and 2017, a total of 769 healthy subjects aged 6.4-73 years in three sites in Yokohama City, were enrolled in the survey. The urinary iodine concentration (UIC), iodine to creatinine (Cr) ratio (UI/Cr) and estimated 24-h urinary iodine excretion (UIE) in single spot urine samples were measured, and habitual dietary iodine intake was assessed by food frequency questionnaires. The estimated 24-h UIE was calculated using individual predicted 24-h creatinine excretion by the validated equations developed for healthy Japanese children and adults which vary by age, gender and anthropometry. The median UIC for all participants was 219 μg/L, suggesting adequate iodine intake for this population. There was an increasing trend in median UI/Cr and estimated 24-h UIE by age. A significant correlation between UIC and UI/Cr (r = 0.6378), UIC and estimated 24-h UIE (r = 0.6804), and UI/Cr and estimated 24-h UIE (r = 0.5756) were observed. These estimates can be feasible, convenient and alternative methods to 24-h urine collection in order to assess iodine status in some populations such as ethnically or racially homogeneous and well-nourished people. Additional studies are required to validate these findings.
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Affiliation(s)
- Yozen Fuse
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
| | - Yoshiya Ito
- Division of Clinical Medicine, Japanese Red Cross Hokkaido College of Nursing, Kitami 090-0011, Japan
| | - Nobu Tsukada
- Kagawa Nutrition University, Institute of Nutrition Sciences, Sakado 350-0288, Japan
| | - Yoshimasa Shishiba
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
| | - Minoru Irie
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
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Sorrenti S, Baldini E, Pironi D, Lauro A, D’Orazi V, Tartaglia F, Tripodi D, Lori E, Gagliardi F, Praticò M, Illuminati G, D’Andrea V, Palumbo P, Ulisse S. Iodine: Its Role in Thyroid Hormone Biosynthesis and Beyond. Nutrients 2021; 13:nu13124469. [PMID: 34960019 PMCID: PMC8709459 DOI: 10.3390/nu13124469] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
The present review deals with the functional roles of iodine and its metabolism. The main biological function of iodine concerns its role in the biosynthesis of thyroid hormones (THs) by the thyroid gland. In addition, however, further biological roles of iodine have emerged. Precisely, due to its significant action as scavenger of reactive oxygen species (ROS), iodine is thought to represent one of the oldest antioxidants in living organisms. Moreover, iodine oxidation to hypoiodite (IO−) has been shown to possess strong bactericidal as well as antiviral and antifungal activity. Finally, and importantly, iodine has been demonstrated to exert antineoplastic effects in human cancer cell lines. Thus, iodine, through the action of different tissue-specific peroxidases, may serve different evolutionarily conserved physiological functions that, beyond TH biosynthesis, encompass antioxidant activity and defense against pathogens and cancer progression.
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20
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Lee H, Paeng JC, Choi H, Cho SW, Park YJ, Park DJ, Lee YA, Chung JK, Kang KW, Cheon GJ. Effect of TSH stimulation protocols on adequacy of low-iodine diet for radioiodine administration. PLoS One 2021; 16:e0256727. [PMID: 34492048 PMCID: PMC8423307 DOI: 10.1371/journal.pone.0256727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/13/2021] [Indexed: 11/19/2022] Open
Abstract
Low-iodine diet (LID) is a crucial preparation for radioactive iodine (RAI) treatment or scan in thyroid cancer. The aim of this study is to analyze the influence of thyroid stimulating hormone (TSH) stimulation protocols and other clinical factors on LID adequacy. Thyroid cancer patients who underwent LID for RAI scan or treatment were retrospectively analyzed. Patients were guided to have LID for 2 weeks before RAI administration and urine iodine/creatinine ratio (UICR, μg/g Cr) was measured. TSH stimulation was conducted using either thyroid hormone withdrawal (THW) or recombinant human TSH (rhTSH) injection. Adequacy of LID was classified by UICR as ‘excellent (< 50)’, ‘adequate (50–100)’, ‘inadequate (101–250)’ and ‘poor (> 250)’. A total of 1715 UICR measurements from 1054 patients were analyzed. UICR was significantly higher in case of rhTSH use than THW (72.4 ± 48.1 vs. 29.9 ± 45.8 μg/g Cr, P < 0.001). In patients who underwent LID twice using both TSH stimulation protocols alternately, UICR was higher in case of rhTSH than THW regardless of the order of method. Among clinical factors, female, old-age, and the first LID were significant factors to show higher UICR. Although the adequacy of LID was ‘adequate’ or ‘excellent’ in most patients, multivariate analysis demonstrated that THW method, male, young age, and prior LID-experience were significant determinants for achieving ‘excellent’ adequacy of LID. In conclusion, UICR was higher and the proportion of ‘excellent’ LID adequacy was lower with rhTSH than with THW. UICR was higher also in women, old-age, and LID-naïve patients. Further researches are required to suggest effective methods to reduce body iodine pool in case of rhTSH use and to validate the efficacy of such methods on outcomes of RAI treatment.
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Affiliation(s)
- Hwanhee Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Republic of Korea
| | - June-Key Chung
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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21
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Evaluation of iodine nutritional status during pregnancy by estimated 24-h urinary iodine excretion: population variation range and individual accuracy. Public Health Nutr 2021; 25:237-247. [PMID: 34380579 PMCID: PMC8883787 DOI: 10.1017/s1368980021003335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: To explore the accuracy of estimated 24-h urinary iodine excretion (24-h UIEest) in assessing iodine nutritional status. Design: Fasting venous blood, 24-h and spot urine samples were collected during the day. The urinary iodine concentration (UIC) and urinary creatinine concentration (UCrC) were measured, and the urinary iodine-to-creatinine ratio (UI/Cr), 24-h UIEest, and 24-h urinary iodine excretion (24-h UIE) were calculated. At the population level, correlation and consistency between UIC, UI/Cr, 24-h UIEest and 24-h UIE were assessed using correlation analysis and Bland–Altman plots. At the individual level, receiver operating characteristic (ROC) curves were used to analyse the accuracy of the above indicators for evaluating insufficient and excessive iodine intake. The reference interval of 24-h UIEest was established based on percentile values. Setting: Indicator can accurately evaluate individual iodine nutrition during pregnancy remains controversial. Participants: Pregnant women (n 788). Results: Using 24-h UIE as standard, the correlation coefficients of 24-h UIEest from different periods of the day ranged from 0·409 to 0·531, and the relative average differences ranged from 4·4 % to 10·9 %. For diagnosis of insufficient iodine intake, the area under the ROC curve of 24-h UIEest was 0·754, sensitivity and specificity were 79·6 % and 65·4 %, respectively. For diagnosis of excessive iodine intake, the area of 24-h UIEest was 0·771, sensitivity and specificity were 66·7 % and 82·0 %, respectively. The reference interval of 24-h UIEest was 58·43–597·65 μg. Conclusions: Twenty-four-hour UIEest can better indicate iodine nutritional status at a relatively large sample size in a given population of pregnant women. It can be used for early screening at the individual level to obtain more lead time for pregnant women.
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22
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Kim K, Cho SW, Park YJ, Lee KE, Lee DW, Park SK. Association between Iodine Intake, Thyroid Function, and Papillary Thyroid Cancer: A Case-Control Study. Endocrinol Metab (Seoul) 2021; 36:790-799. [PMID: 34376043 PMCID: PMC8419609 DOI: 10.3803/enm.2021.1034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/02/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study aimed to assess the effects of iodine intake, thyroid function, and their combined effect on the risk of papillary thyroid cancer (PTC) and papillary thyroid microcarcinoma (PTMC). METHODS A case-control study was conducted including 500 community-based controls who had undergone a health check-up, and 446 overall PTC cases (209 PTC and 237 PTMC) from the Thyroid Cancer Longitudinal Study. Urinary iodine concentration (UIC), was used as an indicator of iodine intake, and serum for thyroid function. The risk of PTC and PTMC was estimated using unconditional logistic regression. RESULTS Excessive iodine intake (UIC ≥220 μg/gCr) was associated with both PTC (odds ratio [OR], 18.13 95% confidence interval [CI], 8.87 to 37.04) and PTMC (OR, 8.02; 95% CI, 4.64 to 13.87), compared to adequate iodine intake (UIC, 85 to 219 μg/gCr). Free thyroxine (T4) levels ≥1.25 ng/dL were associated with PTC (OR, 1.97; 95% CI, 1.36 to 2.87) and PTMC (OR, 2.98; 95% CI, 2.01 to 4.41), compared to free T4 levels of 0.7 to 1.24 ng/dL. Individuals with excessive iodine intake and high free T4 levels had a greatly increased OR of PTC (OR, 43.48; 95% CI, 12.63 to 149.62), and PTMC (OR, 26.96; 95% CI, 10.26 to 70.89), compared to individuals with adequate iodine intake and low free T4 levels. CONCLUSION Excessive iodine intake using creatinine-adjusted UIC and high free T4 levels may have a synergistic effect on PTC and PTMC. Considering both iodine intake and thyroid function is important to assess PTC and PTMC risk.
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Affiliation(s)
- Kyungsik Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Biomedical Science, Seoul National University Graduate School, Seoul,
Korea
- Cancer Research Institute, Seoul National University, Seoul,
Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul,
Korea
| | - Kyu Eun Lee
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
- Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul,
Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul,
Korea
| | - Dong-Wook Lee
- Department of Family Medicine, Dongguk University College of Medicine, Gyeongju,
Korea
| | - Sue K. Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul,
Korea
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23
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Næss S, Markhus MW, Strand TA, Kjellevold M, Dahl L, Stokland AEM, Nedrebø BG, Aakre I. Iodine Nutrition and Iodine Supplement Initiation in Association with Thyroid Function in Mildly-to-Moderately Iodine-Deficient Pregnant and Postpartum Women. J Nutr 2021; 151:3187-3196. [PMID: 34255063 PMCID: PMC8485914 DOI: 10.1093/jn/nxab224] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/18/2021] [Accepted: 06/15/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Whereas the adverse effects of severe iodine deficiency during pregnancy are well documented, the effects of mild-to-moderate deficiency are not well established. OBJECTIVES We aimed to explore whether iodine nutrition and timing of iodine supplement initiation are associated with thyroid function in pregnant and postpartum women. METHODS In this cohort study, 137 pregnant women were enrolled and followed up at gestational weeks (GWs) 18 and 36, and 3 and 6 mo postpartum. Thyroid function tests [thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4)], urinary iodine and creatinine concentration (UIC:Cr), and iodine intake (including iodine supplement use) were measured at each time point. The associations between thyroid hormone concentrations and UIC:Cr, iodine intakes, and iodine supplement use were estimated using multiple generalized estimating equation models. RESULTS The median UIC at GW18 was 94 μg/L, indicating mild-to-moderate iodine deficiency. UIC:Cr (β; 95% CI) per 100 μg/g was negatively associated with fT3 (-0.191; -0.331, -0.051) and fT4 (-0.756; -1.372, -0.141) concentrations. Iodine intake (β; 95% CI) per 100 μg/d was positively associated with TSH (0.099; 0.022, 0.177), and negatively associated with fT3 (-0.084; -0.0141, -0.027) and fT4 (-0.390; -0.599, -0.182) concentrations. Compared with no use of supplement, those initiating an iodine-containing supplement prepregnancy and continuing through pregnancy had lower TSH (estimated means) (1.35 compared with 1.68 mIU/L, P = 0.021), and higher fT3 (4.48 compared with 4.28 pmol/L, P = 0.035) and fT4 (15.2 compared with 14.4 pmol/L, P = 0.024) concentrations. CONCLUSIONS Lower iodine availability during pregnancy and postpartum was associated with lower TSH, and higher fT3 and fT4 concentrations. The use of an iodine-containing supplement that was initiated prepregnancy and continuing through pregnancy was associated with lower TSH, and higher fT3 and fT4 concentrations, which may suggest improved thyroid function. These findings support the notion that optimization of iodine intake should start before pregnancy.This trial was registered at clinicaltrials.gov as NCT02610959.
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Affiliation(s)
| | - Maria W Markhus
- Seafood, Nutrition and Environmental State, Institute of Marine Research, Bergen, Norway
| | - Tor A Strand
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway,Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | - Marian Kjellevold
- Seafood, Nutrition and Environmental State, Institute of Marine Research, Bergen, Norway
| | - Lisbeth Dahl
- Seafood, Nutrition and Environmental State, Institute of Marine Research, Bergen, Norway
| | - Ann-Elin M Stokland
- Department of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Bjørn G Nedrebø
- Department of Internal Medicine, Haugesund Hospital, Haugesund, Norway,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Inger Aakre
- Seafood, Nutrition and Environmental State, Institute of Marine Research, Bergen, Norway
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24
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Zeng Z, Li K, Wang X, Ouyang S, Zhang Z, Liu Z, Sun J, Ye X, Kang W, Yu J. Low urinary iodine is a protective factor of central lymph node metastasis in papillary thyroid cancer: a cross-sectional study. World J Surg Oncol 2021; 19:208. [PMID: 34253203 PMCID: PMC8276512 DOI: 10.1186/s12957-021-02302-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background An abrupt increase of thyroid cancer has been witnessed paralleling the supplemented iodine intake in formerly iodine-deficient countries. And increased iodine intake has been linked to the rising incidence rate of papillary thyroid cancer (PTC). However, the correlation between iodine and clinicopathological features of PTC has not been well-characterized. This study aimed to investigate the associations between iodine intake and the clinicopathological features of PTC patients. Methods Three hundred and fifty-nine PTC patients who received surgical treatment in Peking Union Medical College Hospital from May 2015 to November 2020 were retrospectively reviewed. The associations between urinary iodine (UI), urinary iodine/creatinine ratio (UI/U-Cr), and the clinicopathological features of PTC were analyzed. Univariate and multivariate analysis were performed to investigate the relationship between UI level and central lymph node metastasis (CLNM). Results There were no significant differences in UI in different groups according to the variables studied, except that patients with CLNM had higher UI level than CLNM(−) patients. No associations were found between UI/U-Cr and clinicopathological features except variant subtypes (classic/follicular). After dividing patients into high-iodine group and low-iodine group, more patients were found to have CLNM in the high-iodine group (p = 0.02). In addition, younger age, larger tumor size, and classic variant were positively correlated with CLNM (p < 0.05). Univariate analysis showed that insufficient iodine intake (≤ 99 μg/L) was associated with decreased CLNM risk in PTC. And after defining insufficient iodine intake as ≤ 109 μg/L and above requirements as ≥ 190 μg/L, multivariate analysis showed that lower iodine was associated with CLNM in total population of PTC (OR 0.53, 95% CI 0.31–0.91) and in PTC < 1 cm (papillary thyroid microcarcinoma, PTMC) (OR 0.43, 95% CI 0.21–0.87). Conclusions Low iodine was a protective factor for CLNM in papillary thyroid cancer, particularly in those < 1 cm. These results indicated that iodine may not only be an initiator of tumorigenesis, but also a promoter of the development of PTC. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02302-6.
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Affiliation(s)
- Ziyang Zeng
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Kang Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianze Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Siwen Ouyang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Zimu Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Zhen Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Juan Sun
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
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25
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Jiang Y, Jin J, Fan J, Huang C, Jia Q, Tan J, He X, Zheng X, Zhao Y, Zhang Q, Meng Z, Wang Y. Urinary iodine concentration and radioactive iodine therapeutic response in patients with differentiated thyroid cancer. Biomark Med 2021; 15:879-890. [PMID: 34241549 DOI: 10.2217/bmm-2020-0745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Urinary iodine concentration (UIC) may assess radioactive iodine ablation. Materials & methods: According the 2015 American Thyroid Association guidelines, patients were categorized into low- to intermediate-risk or high-risk groups. The iodine concentration in the morning urine specimens was measured by the ceric ion-arsenious acid method. Results: In the low- to intermediate-risk group (113 cases), nonexcellent response (non-ER) was associated with higher UIC, higher UIC subgroups (p < 0.05), higher pre-ablative stimulated thyroglobulin levels (p < 0.01). In the high-risk group (68 cases), the non-ER rate was higher in the higher pre-ablative stimulated thyroglobulin group (p < 0.01), but not significantly different between the UIC and UIC subgroups (p > 0.05). Conclusion: The non-ER rate was related to UIC in the low- to intermediate-risk group; however, UIC did not affect the non-ER rate in the high-risk group.
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Affiliation(s)
- Yuyan Jiang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Jiahui Jin
- Tianjin University of Traditional Chinese Medicine, Jian Kang Chan Ye Yuan, Tianjin, PR China
| | - Jingzheng Fan
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Chao Huang
- Hull York Medical School, University of Hull, Hull, UK
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Xianghui He
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Xiangqian Zheng
- Department of Thyroid & Neck Tumor, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention & Therapy of Tianjin City, Tianjin, PR China
| | - Yue Zhao
- Department of Health Management, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Qing Zhang
- Department of Health Management, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Yan Wang
- Tianjin University of Traditional Chinese Medicine, Jian Kang Chan Ye Yuan, Tianjin, PR China
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26
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Mulder TA, Korevaar TIM, Peeters RP, van Herwaarden AE, de Rijke YB, White T, Tiemeier H. Urinary Iodine Concentrations in Pregnant Women and Offspring Brain Morphology. Thyroid 2021; 31:964-972. [PMID: 33267727 DOI: 10.1089/thy.2020.0582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Severe maternal iodine deficiency during pregnancy leads to marked intellectual disability in the offspring. Although recent studies showed that even mild-to-moderate maternal iodine deficiency is associated with lower intelligence quotient and attention deficit hyperactivity disorder in offspring, the underlying neurobiological mechanism of these associations remains unknown. The aim of this study was to investigate the association of maternal iodine excretion during pregnancy with offspring brain morphology during pre-adolescence. Methods: This study was embedded within Generation R, a prospective population-based birth cohort in Rotterdam, the Netherlands. We included 990 mother-child pairs with data on urinary iodine concentration (UIC) and creatinine during pregnancy. The UIC was assessed at <18 and/or 18-25 weeks of gestation and offspring brain imaging data were acquired with magnetic resonance imaging (MRI) at age 10 years. We used linear regression to study the association of the iodine-to-creatinine ratio (UI/Creat) with offspring brain MRI outcomes. Results: Maternal UI/Creat during pregnancy was not consistently associated with offspring brain morphology. A low UI/Creat (<150 μg/g) during pregnancy was nominally associated with smaller total gray matter volume, but this did not survive correction for multiple testing. Also, we could not identify a linear association between continuous iodine excretion and offspring brain morphology. Instead, our results suggest a curvilinear association between UI/Creat and brain morphology. In sensitivity analyses using the World Health Organization categorization for UIC values, both low and high UI/Creat were associated with smaller total gray matter volume. Conclusions: The current study provides some but no conclusive evidence for an association of maternal iodine excretion during pregnancy with offspring brain morphology. Our results suggest that the exact definition of the reference group is important because of potential non-linear associations, which could be leveraged in future studies.
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Affiliation(s)
- Tessa A Mulder
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tim I M Korevaar
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Antonius E van Herwaarden
- Department of Laboratory Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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27
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Threapleton DE, Snart CJP, Keeble C, Waterman AH, Taylor E, Mason D, Reid S, Azad R, Hill LJB, Meadows S, McKillion A, Alwan NA, Cade JE, Simpson NAB, Stewart PM, Zimmermann M, Wright J, Waiblinger D, Mon-Williams M, Hardie LJ, Greenwood DC. Maternal iodine status in a multi-ethnic UK birth cohort: Associations with child cognitive and educational development. Paediatr Perinat Epidemiol 2021; 35:236-246. [PMID: 32870514 DOI: 10.1111/ppe.12719] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/17/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Maternal iodine requirements increase during pregnancy to supply thyroid hormones critical for fetal neurodevelopment. Iodine insufficiency may result in poorer cognitive or child educational outcomes but current evidence is sparse and inconsistent. OBJECTIVES To quantify the association between maternal iodine status and child educational outcomes. METHODS Urinary iodine concentrations (UIC) and iodine/creatinine ratios (I:Cr) were measured in 6971 mothers at 26-28 weeks' gestation participating in the Born in Bradford cohort. Maternal iodine status was examined in relation to child school achievement (early years foundation stage (EYFS), phonics, and Key Stage 1 (KS1)), other learning outcomes, social and behavioural difficulties, and sensorimotor control in 5745 children aged 4-7 years. RESULTS Median (interquartile range) UIC was 76 µg/L (46, 120), and I:Cr was 83 µg/g (59, 121). Overall, there was no strong or consistent evidence to support associations between UIC or I:Cr and neurodevelopmental outcomes. For instance, predicted EYFS and phonics scores (primary outcomes) at the 25th vs 75th I:Cr percentiles (99% confidence intervals) were similar, with no evidence of associations: EYFS scores were 32 (99% CI 31, 33) and 33 (99% CI 32, 34), and phonics scores were 34 (99% CI 33, 35) and 35 (99% CI 34, 36), respectively. CONCLUSIONS In the largest single study of its kind, there was little evidence of detrimental neurodevelopmental outcomes in children born to pregnant women with iodine insufficiency as defined by World Health Organization-outlined thresholds. Alternative functional biomarkers for iodine status in pregnancy and focused assessment of other health outcomes may provide additional insight.
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Affiliation(s)
- Diane E Threapleton
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Charles J P Snart
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Claire Keeble
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | | | - Elizabeth Taylor
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Dan Mason
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Stephen Reid
- Earth Surface Science Institute, School of Earth and Environment, University of Leeds, Leeds, UK
| | - Rafaq Azad
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Liam J B Hill
- School of Psychology, University of Leeds, Leeds, UK
| | - Sarah Meadows
- Elsie Widdowson Laboratory, University of Cambridge, Cambridge, UK.,NIHR Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Amanda McKillion
- Elsie Widdowson Laboratory, University of Cambridge, Cambridge, UK.,NIHR Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Nisreen A Alwan
- Faculty of Medicine, School of Primary Care and Population Sciences, Southampton General Hospital, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science & Nutrition, University of Leeds, Leeds, UK
| | - Nigel A B Simpson
- Division of Women's and Children's Health, School of Medicine, University of Leeds, Leeds, UK
| | - Paul M Stewart
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Michael Zimmermann
- Laboratory for Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zürich, Switzerland
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Dagmar Waiblinger
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Laura J Hardie
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Darren C Greenwood
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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28
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Manousou S, Eggertsen R, Hulthén L, Filipsson Nyström H. A randomized, double-blind study of iodine supplementation during pregnancy in Sweden: pilot evaluation of maternal iodine status and thyroid function. Eur J Nutr 2021; 60:3411-3422. [PMID: 33620551 PMCID: PMC8354996 DOI: 10.1007/s00394-021-02515-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/05/2021] [Indexed: 12/01/2022]
Abstract
Purpose Pregnant women in Sweden are mildly iodine deficient. We investigated the effect of daily iodine supplementation on the iodine and thyroid status of pregnant women. Methods In this pilot, randomized, double-blind trial, 200 thyroid-healthy pregnant women were recruited at mean (standard deviation) pregnancy week 8.85 (1.62) and assigned (1:1) to daily intake of a multivitamin tablet with or without 150 μg of iodine. Urine and serum samples were collected at baseline and once during the second and third trimesters. Urinary iodine concentration (UIC), serum thyroglobulin (Tg), thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibodies (TPOabs) were analyzed. Neonatal TSH data were collected. UIC and Tg were also analyzed in a group of 89 thyroid-healthy non-pregnant women of reproductive age (WRA). Results At baseline, the intervention and the control groups had similar median UIC (interquartile range (IQR)): 110 μg/L (74–119) and 111 μg/L (66–168), respectively. The intervention group reached iodine sufficiency with median UIC (IQR) 139 μg/L (89–234) and 136 μg/L (91–211) in the second and third trimester, respectively, without significant difference from the lower limit of the recommended range, i.e. 150–250 μg/L (p = 0.42 and p = 0.87, respectively). The intervention group had higher median UIC and lower median Tg compared to the control group during the second (p < 0.001 and p = 0.019, respectively) and third trimester (p < 0.001 and p = 0.003, respectively), whereas thyroid hormones, serum TPOabs, and neonatal TSH were similar. The WRA group presented median UIC (IQR) 65 μg/L (30–98) and median Tg (IQR) 18 μg/L (13–27).
Conclusion A daily supplement containing 150 μg of iodine to a group of pregnant women with mild iodine deficiency improved the iodine status from mild ID to iodine sufficiency. This improvement seems to have had a positive impact on maternal thyroglobulin. This study is now under extension to investigate the children’s neuropsychological development.
Trial registration ClinicalTrials.gov Identifier NCT02378246, May 3, 2015, retrospectively registered.
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Affiliation(s)
- Sofia Manousou
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. .,Frölunda Specialist Hospital, Marconigatan 31, 42144, Västra Frölunda, Sweden.
| | - Robert Eggertsen
- School of Public Health and Community Medicine/General Medicine, R and D Centre Gothenburg and Södra Bohuslän, University of Gothenburg, Göteborg, Sweden
| | - Lena Hulthén
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Helena Filipsson Nyström
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden.,Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden
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The association of milk and dairy consumption with iodine status in pregnant women in Oporto region. Br J Nutr 2021; 126:1314-1322. [DOI: 10.1017/s000711452100009x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe role of milk and dairy products in supplying iodine to pregnant women is unknown in Portugal. The aim of this study was to evaluate the association between milk and dairy product consumption and the iodine status of pregnant women in the IoMum cohort of the Oporto region. Pregnant women were recruited between 10 and 13 weeks of gestation, when they provided a spot urine sample and information on lifestyle and intake of iodine-rich foods. Urinary iodine concentration (UIC) was determined by inductively coupled plasma MS. A total of 468 pregnant women (269 iodine supplement users and 199 non-supplement users) were considered eligible for analysis. Milk (but not yogurt or cheese) intake was positively associated with UIC, in the whole population (P = 0·02) and in the non-supplement users (P = 0·002), but not in the supplement users (P = 0·29). In non-supplement users, adjusted multinomial logistic regression analysis showed that milk consumption <3 times/month was associated with a five times increased risk of having UIC < 50 µg/l when compared with milk consumption ≥2 times/d (OR 5·4; 95 % CI 1·55, 18·78; P = 0·008). The highest UIC was observed in supplement users who reported consuming milk once per d (160 µg/l). Milk, but not yogurt or cheese, was positively associated with iodine status of pregnant women. Despite the observed positive association, daily milk consumption may not be sufficient to ensure adequate iodine intake in this population.
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Threapleton DE, Waiblinger D, Snart CJ, Taylor E, Keeble C, Ashraf S, Bi S, Ajjan R, Azad R, Hancock N, Mason D, Reid S, Cromie KJ, Alwan NA, Zimmermann M, Stewart PM, Simpson NA, Wright J, Cade JE, Hardie LJ, Greenwood DC. Prenatal and Postpartum Maternal Iodide Intake from Diet and Supplements, Urinary Iodine and Thyroid Hormone Concentrations in a Region of the United Kingdom with Mild-to-Moderate Iodine Deficiency. Nutrients 2021; 13:nu13010230. [PMID: 33466826 PMCID: PMC7830764 DOI: 10.3390/nu13010230] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 11/25/2022] Open
Abstract
Iodine is essential for normal thyroid function, supporting healthy fetal and child development. Iodine requirements increase in pregnancy, but many women in regions without salt iodization have insufficient intakes. We explored associations between iodide intake and urinary iodine concentration (UIC), urinary iodine/creatinine ratio (I/Cr), thyroid stimulating hormone, thyroglobulin, free triiodothyronine, free thyroxine and palpable goiter in a region of mild-to-moderate iodine insufficiency. A total of 246 pregnant women aged 18–40 in Bradford, UK, joined the Health and Iodine in Babies (Hiba) study. They provided detailed information on diet and supplement use, urine and serum samples and were assessed for goiter at around 12, 26 and 36 weeks’ gestation, and 6, 18 and 30 weeks postpartum. Dietary iodide intake from food and drink was estimated using six 24 h recalls. During pregnancy, median (IQR) dietary iodide intake was 101 µg/day (54, 142), with 42% from dairy and 9% from white fish. Including supplements, intake was 143 µg/day (94, 196), with 49% < UK reference nutrient intake (140 µg/day). Women with Pakistani heritage had 129 µg/day (87, 190) median total intake. Total intake during pregnancy was associated with 4% (95% CI: 1%, 7%) higher UIC, 5% (3%, 7%) higher I/Cr, 4% (2%, 6%) lower thyroglobulin and 21% (9%, 32%) lower odds of palpable goiter per 50 µg/day. This cohort consumed less iodide in pregnancy than UK and World Health Organization dietary recommendations. UIC, I/Cr and thyroglobulin were associated with intake. Higher intake was associated with fewer goiters. Because dairy was the dominant source of iodide, women following plant-based or low-dairy diets may be at particular risk of iodine insufficiency.
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Affiliation(s)
- Diane E. Threapleton
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (D.E.T.); (C.J.P.S.); (E.T.); (C.K.); (R.A.); (K.J.C.); (L.J.H.)
| | - Dagmar Waiblinger
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ, UK; (D.W.); (S.A.); (S.B.); (R.A.); (D.M.); (J.W.)
| | - Charles J.P. Snart
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (D.E.T.); (C.J.P.S.); (E.T.); (C.K.); (R.A.); (K.J.C.); (L.J.H.)
| | - Elizabeth Taylor
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (D.E.T.); (C.J.P.S.); (E.T.); (C.K.); (R.A.); (K.J.C.); (L.J.H.)
| | - Claire Keeble
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (D.E.T.); (C.J.P.S.); (E.T.); (C.K.); (R.A.); (K.J.C.); (L.J.H.)
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9JT, UK
| | - Samina Ashraf
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ, UK; (D.W.); (S.A.); (S.B.); (R.A.); (D.M.); (J.W.)
| | - Shazia Bi
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ, UK; (D.W.); (S.A.); (S.B.); (R.A.); (D.M.); (J.W.)
| | - Ramzi Ajjan
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (D.E.T.); (C.J.P.S.); (E.T.); (C.K.); (R.A.); (K.J.C.); (L.J.H.)
| | - Rafaq Azad
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ, UK; (D.W.); (S.A.); (S.B.); (R.A.); (D.M.); (J.W.)
| | - Neil Hancock
- Nutritional Epidemiology Group, School of Food Science & Nutrition, University of Leeds, Leeds LS2 9JT, UK; (N.H.); (J.E.C.)
| | - Dan Mason
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ, UK; (D.W.); (S.A.); (S.B.); (R.A.); (D.M.); (J.W.)
| | - Stephen Reid
- Earth Surface Science Institute, School of Earth and Environment, University of Leeds, Leeds LS2 9JT, UK;
| | - Kirsten J. Cromie
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (D.E.T.); (C.J.P.S.); (E.T.); (C.K.); (R.A.); (K.J.C.); (L.J.H.)
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9JT, UK
| | - Nisreen A. Alwan
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Michael Zimmermann
- Laboratory for Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, 8092 Zurich, Switzerland;
| | - Paul M. Stewart
- Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK;
| | - Nigel A.B. Simpson
- Division of Women’s and Children’s Health, School of Medicine, University of Leeds, Leeds LS2 9JT, UK;
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ, UK; (D.W.); (S.A.); (S.B.); (R.A.); (D.M.); (J.W.)
| | - Janet E. Cade
- Nutritional Epidemiology Group, School of Food Science & Nutrition, University of Leeds, Leeds LS2 9JT, UK; (N.H.); (J.E.C.)
| | - Laura J. Hardie
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (D.E.T.); (C.J.P.S.); (E.T.); (C.K.); (R.A.); (K.J.C.); (L.J.H.)
| | - Darren C. Greenwood
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (D.E.T.); (C.J.P.S.); (E.T.); (C.K.); (R.A.); (K.J.C.); (L.J.H.)
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9JT, UK
- Correspondence: ; Tel.: +44-(0)11-3343-1813
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Luo J, Li C, Zhang X, Shan Z, Teng W. Reference Intervals of the Ratio of Urine Iodine to Creatinine in Pregnant Women in an Iodine-Replete Area of China. Biol Trace Elem Res 2021; 199:62-69. [PMID: 32249377 DOI: 10.1007/s12011-020-02133-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/25/2020] [Indexed: 11/28/2022]
Abstract
The assessment method of iodine nutrition for pregnant women lacks strong evidence-based medicine. The prevalence of iodine deficiency in pregnant women may be overestimated using urinary iodine concentration (UIC). The reference intervals of UIC-to-urinary creatinine concentration ratio (UIC/UCr) were established using a self-sequential longitudinal study of pregnant women with singleton gestation who were recruited using the criteria of the National Academy of Clinical Biochemistry in Dandong City, which is a long-term iodine-replete area. Nine thousand one hundred sixty-four pregnant women in the first trimester from Dalian City, Dandong City, and Shenyang City were included to verify our proposed reference intervals. UIC and concentrations of urinary creatinine, serum iodine, TSH, FT4, TPOAb, and TgAb were measured. The reference intervals of UIC/UCr were 38.63-489.46 μg/g for the first trimester, 58.48-644.03 μg/g for the second trimester, and 56.27-644.93 μg/g for the third trimester. The prevalence of iodine deficiency was 49.50% using UIC as the indicator (< 150 μg/L), while the prevalence was 3.28% using UIC/UCr (< 38.63 μg/g). The prevalence of iodine excess was 3.21% using UIC as the indicator (> 500 μg/L) while the prevalence was 1.45% using UIC/UCr (> 489.46 μg/g). The highest prevalence of overt hypothyroidism and positive thyroid antibodies was in the group with UIC/UCr < 38.63 μg/g. In contrast to the place of residence and age, BMI was an influencing factor for UIC/UCr. The reference intervals of UIC/UCr were established. UIC/UCr may eliminate the effect of urine volume and reflect the actual prevalence of iodine deficiency in pregnant women.
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Affiliation(s)
- Jingyi Luo
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Chenyan Li
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Xiaomei Zhang
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 100000, People's Republic of China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China
| | - Weiping Teng
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, People's Republic of China.
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Manousou S, Augustin H, Eggertsen R, Hulthén L, Filipsson Nyström H. Inadequate iodine intake in lactating women in Sweden: A pilot 1-year, prospective, observational study. Acta Obstet Gynecol Scand 2021; 100:48-57. [PMID: 32880886 PMCID: PMC7756844 DOI: 10.1111/aogs.13986] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/12/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Breastfed infants depend on breast-milk iodine for growth and brain development, as iodine is a trace element important for thyroid hormone production. Iodine need is higher during lactation; hence, mothers and children are at risk of iodine deficiency. We aimed to explore maternal iodine and thyroidal status during lactation. MATERIAL AND METHODS Pregnant women were recruited in Gothenburg, southwest Sweden. Maternal urine and serum were collected at pregnancy week 35-37 (n = 84) and 0.5, 4, and 12 months postpartum. Seventy mothers provided breast milk at 0.5 months. RESULTS Median (interquartile range) breast-milk iodine concentration was 90 (66-116) μg/L. About 58% had breast-milk iodine concentration <100 μg/L. Iodine supplement users (n = 13) had higher breast-milk iodine concentration than non-users (n = 49) (140 μg/L vs 71 μg/L, P = .001). Exclusively breastfeeding women at 4 months postpartum (n = 57) had lower median urinary iodine concentration (85 μg/L vs 133 μg/L, P = .004) and higher thyroglobulin serum concentration (22.3 μg/L vs 11.8 μg/L, P = .032) than non-exclusively breastfeeding women (n = 25). Concentrations of thyroid hormones were unaffected. CONCLUSIONS This pilot study suggests that lactating women in southwest Sweden present mildly inadequate iodine intake, mainly among non-iodine supplement users and exclusively breastfeeding mothers. Studies on the coverage of the iodine fortification program in breastfeeding women are warranted.
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Affiliation(s)
- Sofia Manousou
- Institute of MedicineSahlgrenska AcademyUniversity of GothenburgSahlgrenska University HospitalGothenburgSweden
- Frölunda Specialist HospitalVästra FrölundaSweden
| | - Hanna Augustin
- Institute of MedicineSahlgrenska AcademyUniversity of GothenburgSahlgrenska University HospitalGothenburgSweden
- Department of Internal Medicine and Clinical NutritionSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Robert Eggertsen
- Institute of MedicineSahlgrenska AcademyUniversity of GothenburgSahlgrenska University HospitalGothenburgSweden
- School of Public Health and Community MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Lena Hulthén
- Institute of MedicineSahlgrenska AcademyUniversity of GothenburgSahlgrenska University HospitalGothenburgSweden
- Department of Internal Medicine and Clinical NutritionSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Helena Filipsson Nyström
- Institute of MedicineSahlgrenska AcademyUniversity of GothenburgSahlgrenska University HospitalGothenburgSweden
- Department of EndocrinologySahlgrenska University HospitalGothenburgSweden
- The Wallenberg Center for Molecular and Translational MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Cromie KJ, Threapleton DE, Snart CJP, Taylor E, Mason D, Wright B, Kelly B, Reid S, Azad R, Keeble C, Waterman AH, Meadows S, McKillion A, Alwan NA, Cade JE, Simpson NAB, Stewart PM, Zimmermann M, Wright J, Waiblinger D, Mon-Williams M, Hardie LJ, Greenwood DC. Maternal iodine status in a multi-ethnic UK birth cohort: associations with autism spectrum disorder. BMC Pediatr 2020; 20:544. [PMID: 33276760 PMCID: PMC7718710 DOI: 10.1186/s12887-020-02440-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/22/2020] [Indexed: 11/27/2022] Open
Abstract
Background Maternal iodine requirements increase during pregnancy to supply thyroid hormones essential for fetal brain development. Maternal iodine deficiency can lead to hypothyroxinemia, a reduced fetal supply of thyroid hormones which, in the first trimester, has been linked to an increased risk of autism spectrum disorder (ASD) in the child. No study to date has explored the direct link between maternal iodine deficiency and diagnosis of ASD in offspring. Methods Urinary iodine concentrations (UIC) and iodine/creatinine ratios (I:Cr) were measured in 6955 mothers at 26–28 weeks gestation participating in the Born in Bradford (BiB) cohort. Maternal iodine status was examined in relation to the probability of a Read (CTV3) code for autism being present in a child’s primary care records through a series of logistic regression models with restricted cubic splines. Results Median (inter-quartile range) UIC was 76 μg/L (46, 120) and I:Cr was 83 μg/g (59, 121) indicating a deficient population according to WHO guidelines. Ninety two children (1·3%) in our cohort had received a diagnosis of ASD by the census date. Overall, there was no evidence to support an association between I:Cr or UIC and ASD risk in children aged 8–12 years (p = 0·3). Conclusions There was no evidence of an increased clinical ASD risk in children born to mothers with mild-to-moderate iodine deficiency at 26 weeks gestation. Alternative functional biomarkers of exposure and a wider range of conditions may provide further insight.
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Affiliation(s)
- Kirsten Jade Cromie
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Diane Erin Threapleton
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Charles Jonathan Peter Snart
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Elizabeth Taylor
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Dan Mason
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Barry Wright
- The Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK
| | - Brian Kelly
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Stephen Reid
- Earth Surface Science Institute, School of Earth and Environment, University of Leeds, Leeds, LS2 9JT, UK
| | - Rafaq Azad
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Claire Keeble
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Sarah Meadows
- Elsie Widdowson Laboratory, Cambridge, CB1 9NL, UK NIHR Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Clifford Allbutt Building, Hills Road, Cambridge, CB2 0AH, UK
| | - Amanda McKillion
- Elsie Widdowson Laboratory, Cambridge, CB1 9NL, UK NIHR Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Clifford Allbutt Building, Hills Road, Cambridge, CB2 0AH, UK
| | - Nisreen A Alwan
- School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janet Elizabeth Cade
- Nutritional Epidemiology Group, School of Food Science & Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Nigel A B Simpson
- Division of Women's and Children's Health, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Paul M Stewart
- Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Michael Zimmermann
- Laboratory for Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, 8092, Zürich, Switzerland
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Dagmar Waiblinger
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | | | - Laura J Hardie
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Darren Charles Greenwood
- Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK. .,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.
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Iodine status of pregnant women with obesity from inner city populations in the United Kingdom. Eur J Clin Nutr 2020; 75:801-808. [PMID: 33184453 DOI: 10.1038/s41430-020-00796-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/14/2020] [Accepted: 10/26/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Iodine is essential for foetal neurodevelopment and growth. Requirements increase in pregnancy to support increased thyroid hormone synthesis for maternal and foetal requirements, and for foetal transfer. Iodine deficiency in pregnancy is widely reported, and obesity has been associated with sub-optimal thyroid function. We evaluated iodine status and its relation with birthweight in a secondary analysis of pregnant women with obesity from multi-ethnic inner-city settings who participated in the UK Pregnancies Better Eating and Activity trial (UPBEAT). SUBJECTS/METHODS Iodine and creatinine concentrations were evaluated in spot urine samples in the second (15+0-18+6 weeks, n = 954) trimester of pregnancy. We assessed iodine status as urinary iodine concentration (UIC) and urinary iodine-to-creatinine ratio (UI/Cr) and applied WHO/UNICEF/IGN population threshold of median UIC > 150 µg/L for iodine sufficiency. Relationships between iodine status and birthweight were determined using linear and logistic regression with appropriate adjustment, including for maternal BMI and gestational age. RESULTS Median (IQR) UIC and UI/Cr in the second trimester of pregnancy were 147 µg/L (99-257) and 97 µg/g (59-165), respectively. An UI/Cr <150 μg/g was observed in 70% of women. Compared to women with UI/Cr >150 µg/g, there was a trend for women with UI/Cr <150 µg/g to deliver infants with a lower birthweight (β = -60.0 g; 95% CI -120.9 to -1.01, P = 0.05). CONCLUSIONS Iodine status of pregnant women with obesity from this cohort of UK women was suboptimal. Lower iodine status was associated with lower birthweight.
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Pediatric differentiated thyroid carcinoma: An update from the APSA Cancer Committee. J Pediatr Surg 2020; 55:2273-2283. [PMID: 32553450 DOI: 10.1016/j.jpedsurg.2020.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/04/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Differentiated thyroid carcinomas (DTCs) are rare in young children but represent almost 10% of all malignancies diagnosed in older adolescents. METHODS This article reviews the recent literature describing surgical therapeutic approaches to pediatric DTC, associated complications, and long-term recurrence and survival outcomes. RESULTS Similar to adult thyroid cancers, pediatric DTCs are more common in females and are associated with thyroid nodules, family history of thyroid cancer, radiation exposure, iodine deficiency, autoimmune thyroid disease, and genetic syndromes. Management of thyroid cancers in children involves ultrasound imaging, fine needle aspiration, and surgical resection with treatment decisions based on clinical and radiological features, cytology and risk assessment. CONCLUSIONS Total thyroidectomy and compartment based resection of clinically involved lymph node basins form the cornerstone of treatment of DTC. There is an evolving literature regarding the use of molecular genetics to inform treatment strategies and the use of targeted therapies to treat iodine refractory and surgically unresectable progressive disease. TYPE OF STUDY Summary review. LEVEL OF EVIDENCE This is a review article of previously published Level 1-5 articles that includes expert opinion (Level 5).
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Beckford K, Grimes CA, Margerison C, Riddell LJ, Skeaff SA, West ML, Nowson CA. A systematic review and meta-analysis of 24-h urinary output of children and adolescents: impact on the assessment of iodine status using urinary biomarkers. Eur J Nutr 2020; 59:3113-3131. [PMID: 31784814 PMCID: PMC7501103 DOI: 10.1007/s00394-019-02151-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/18/2019] [Indexed: 11/04/2022]
Abstract
PURPOSE Urinary iodine concentration (UIC (μg/ml) from spot urine samples collected from school-aged children is used to determine the iodine status of populations. Some studies further extrapolate UIC to represent daily iodine intake, based on the assumption that children pass approximately 1 L urine over 24-h, but this has never been assessed in population studies. Therefore, the present review aimed to collate and produce an estimate of the average 24-h urine volume of children and adolescents (> 1 year and < 19 years) from published studies. METHODS EBSCOHOST and EMBASE databases were searched to identify studies which reported the mean 24-h urinary volume of healthy children (> 1 year and < 19 years). The overall mean (95% CI) estimate of 24-h urine volume was determined using a random effects model, broken down by age group. RESULTS Of the 44 studies identified, a meta-analysis of 27 studies, with at least one criterion for assessing the completeness of urine collections, indicated that the mean urine volume of 2-19 year olds was 773 (654, 893) (95% CI) mL/24-h. When broken down by age group, mean (95% CI) 24-h urine volume was 531 mL/day (454, 607) for 2-5 year olds, 771 mL/day (734, 808) for 6-12 year olds, and 1067 mL/day (855, 1279) for 13-19 year olds. CONCLUSIONS These results demonstrate that the average urine volume of children aged 2-12 years is less than 1 L, therefore, misclassification of iodine intakes may occur when urine volumes fall below or above 1 L. Future studies utilizing spot urine samples to assess iodine status should consider this when extrapolating UIC to represent iodine intakes of a population.
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Affiliation(s)
- Kelsey Beckford
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC, 3220, Australia.
| | - Carley A Grimes
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC, 3220, Australia
| | - Claire Margerison
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC, 3220, Australia
| | - Lynn J Riddell
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC, 3220, Australia
| | - Sheila A Skeaff
- Department of Human Nutrition, University of Otago, 362 Leith St, North Dunedin, Dunedin, 9016, New Zealand
| | - Madeline L West
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC, 3220, Australia
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC, 3220, Australia
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Levie D, Bath SC, Dineva M, Tiemeier H, Rayman MP, Guxens M, Peeters RP, Korevaar TIM. Response to Letter to the Editor: "Association of Maternal Iodine Status With Child IQ: A Meta-Analysis of Individual Participant Data". J Clin Endocrinol Metab 2020; 105:5859532. [PMID: 32556152 DOI: 10.1210/clinem/dgaa365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/05/2020] [Indexed: 02/13/2023]
Affiliation(s)
- Deborah Levie
- The Generation R Study Group, Erasmus University Medical Centre, CA Rotterdam, Netherlands
- Department of Internal Medicine, Academic Center For Thyroid Diseases, Erasmus University Medical Centre, CA Rotterdam, Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, CB Rotterdam, Netherlands
- ISGlobal, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Sarah C Bath
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Mariana Dineva
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, CB Rotterdam, Netherlands
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Margaret P Rayman
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Mònica Guxens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, CB Rotterdam, Netherlands
- ISGlobal, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center For Thyroid Diseases, Erasmus University Medical Centre, CA Rotterdam, Netherlands
| | - Tim I M Korevaar
- The Generation R Study Group, Erasmus University Medical Centre, CA Rotterdam, Netherlands
- Department of Internal Medicine, Academic Center For Thyroid Diseases, Erasmus University Medical Centre, CA Rotterdam, Netherlands
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38
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Snart CJP, Threapleton DE, Keeble C, Taylor E, Waiblinger D, Reid S, Alwan NA, Mason D, Azad R, Cade JE, Simpson NAB, Meadows S, McKillion A, Santorelli G, Waterman AH, Zimmermann M, Stewart PM, Wright J, Mon-Williams M, Greenwood DC, Hardie LJ. Maternal iodine status, intrauterine growth, birth outcomes and congenital anomalies in a UK birth cohort. BMC Med 2020; 18:132. [PMID: 32522280 PMCID: PMC7288513 DOI: 10.1186/s12916-020-01602-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/21/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Severe iodine insufficiency in pregnancy has significant consequences, but there is inadequate evidence to indicate what constitutes mild or moderate insufficiency, in terms of observed detrimental effects on pregnancy or birth outcomes. A limited number of studies have examined iodine status and birth outcomes, finding inconsistent evidence for specific outcomes. METHODS Maternal iodine status was estimated from spot urine samples collected at 26-28 weeks' gestation from 6971 mothers in the Born in Bradford birth cohort. Associations with outcomes were examined for both urinary iodine concentration (UIC) and iodine-to-creatinine ratio (I:Cr). Outcomes assessed included customised birthweight (primary outcome), birthweight, small for gestational age (SGA), low birthweight, head circumference and APGAR score. RESULTS There was a small positive association between I:Cr and birthweight in adjusted analyses. For a typical participant, the predicted birthweight centile at the 25th percentile of I:Cr (59 μg/g) was 2.7 percentage points lower than that at the 75th percentile of I:Cr (121 μg/g) (99% confidence interval (CI) 0.8 to 4.6), birthweight was predicted to be 41 g lower (99% CI 13 to 69) and the predicted probability of SGA was 1.9 percentage points higher (99% CI 0.0 to 3.7). There was no evidence of associations using UIC or other birth outcomes, including stillbirth, preterm birth, ultrasound growth measures or congenital anomalies. CONCLUSION Lower maternal iodine status was associated with lower birthweight and greater probability of SGA. Whilst small, the effect size for lower iodine on birthweight is comparable to environmental tobacco smoke exposure. Iodine insufficiency is avoidable, and strategies to avoid deficiency in women of reproductive age should be considered. TRIAL REGISTRATION ClinicalTrials.gov NCT03552341. Registered on June 11, 2018.
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Affiliation(s)
- Charles Jonathan Peter Snart
- Leeds Institute of Cardiovascular & Metabolic Medicine, LIGHT Laboratories, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Diane Erin Threapleton
- Leeds Institute of Cardiovascular & Metabolic Medicine, LIGHT Laboratories, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Claire Keeble
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK
| | - Elizabeth Taylor
- Leeds Institute of Cardiovascular & Metabolic Medicine, LIGHT Laboratories, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Dagmar Waiblinger
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Stephen Reid
- Earth Surface Science Institute, School of Earth and Environment, University of Leeds, Leeds, LS2 9JT, UK
| | - Nisreen A Alwan
- School of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Dan Mason
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Rafaq Azad
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Janet Elizabeth Cade
- Nutritional Epidemiology Group, School of Food Science & Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Nigel A B Simpson
- Division of Women's and Children's Health, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Sarah Meadows
- Elsie Widdowson Laboratory, University of Cambridge, Cambridge, CB1 9NL, UK.,NIHR Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Clifford Allbutt Building, Hills Road, Cambridge, CB2 0AH, UK
| | - Amanda McKillion
- Elsie Widdowson Laboratory, University of Cambridge, Cambridge, CB1 9NL, UK.,NIHR Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Clifford Allbutt Building, Hills Road, Cambridge, CB2 0AH, UK
| | - Gillian Santorelli
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | | | - Michael Zimmermann
- Laboratory for Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, 8092, Zürich, Switzerland
| | - Paul M Stewart
- Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | | | - Darren Charles Greenwood
- Leeds Institute of Cardiovascular & Metabolic Medicine, LIGHT Laboratories, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK. .,Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK.
| | - Laura J Hardie
- Leeds Institute of Cardiovascular & Metabolic Medicine, LIGHT Laboratories, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK.
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Levie D, Bath SC, Guxens M, Korevaar TIM, Dineva M, Fano E, Ibarluzea JM, Llop S, Murcia M, Rayman MP, Sunyer J, Peeters RP, Tiemeier H. Maternal Iodine Status During Pregnancy Is Not Consistently Associated with Attention-Deficit Hyperactivity Disorder or Autistic Traits in Children. J Nutr 2020; 150:1516-1528. [PMID: 32171006 PMCID: PMC7269752 DOI: 10.1093/jn/nxaa051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/19/2019] [Accepted: 02/13/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Severe iodine deficiency during pregnancy can cause intellectual disability, presumably through inadequate placental transfer of maternal thyroid hormone to the fetus. The association between mild-to-moderate iodine deficiency and child neurodevelopmental problems is not well understood. OBJECTIVES We investigated the association of maternal iodine status during pregnancy with child attention-deficit hyperactivity disorder (ADHD) and autistic traits. METHODS This was a collaborative study of 3 population-based birth cohorts: Generation R (n = 1634), INfancia y Medio Ambiente (n = 1293), and the Avon Longitudinal Study of Parents and Children (n = 2619). Exclusion criteria were multiple fetuses, fertility treatment, thyroid-interfering medication use, and pre-existing thyroid disease. The mean age of assessment in the cohorts was between 4.4 and 7.7 y for ADHD symptoms and 4.5 and 7.6 y for autistic traits. We studied the association of the urinary iodine-to-creatinine ratio (UI/Creat) <150 μg/g-in all mother-child pairs, and in those with a urinary-iodine measurement at ≤18 weeks and ≤14 weeks of gestation-with the risk of ADHD or a high autistic-trait score (≥93rd percentile cutoff), using logistic regression. The cohort-specific effect estimates were combined by random-effects meta-analyses. We also investigated whether UI/Creat modified the associations of maternal free thyroxine (FT4) or thyroid-stimulating hormone concentrations with ADHD or autistic traits. RESULTS UI/Creat <150 μg/g was not associated with ADHD (OR: 1.2; 95% CI: 0.7, 2.2; P = 0.56) or with a high autistic-trait score (OR: 0.8; 95% CI: 0.6, 1.1; P = 0.22). UI/Creat <150 μg/g in early pregnancy (i.e., ≤18 weeks or ≤14 weeks of gestation) was not associated with a higher risk of behavioral problems. The association between a higher FT4 and a greater risk of ADHD (OR: 1.3; 95% CI: 1.0, 1.6; P = 0.017) was not modified by iodine status. CONCLUSIONS There is no consistent evidence to support an association of mild-to-moderate iodine deficiency during pregnancy with child ADHD or autistic traits.
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Affiliation(s)
- Deborah Levie
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, Netherlands,Department of Internal Medicine, Academic Center For Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, Netherlands,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre–Sophia Children's Hospital, Rotterdam, Netherlands,ISGlobal, Barcelona, Spain,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Madrid, Spain
| | - Sarah C Bath
- Department of Nutritional Sciences, University of Surrey, Guildford, United Kingdom
| | - Mònica Guxens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre–Sophia Children's Hospital, Rotterdam, Netherlands,ISGlobal, Barcelona, Spain,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Madrid, Spain
| | - Tim I M Korevaar
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, Netherlands,Department of Internal Medicine, Academic Center For Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Mariana Dineva
- Department of Nutritional Sciences, University of Surrey, Guildford, United Kingdom
| | - Eduardo Fano
- BIODONOSTIA, Health Research Institute, Donostia—San Sebastián, Spain,Faculty of Psychology, University of the Basque Country (UPV/EHU), Donostia—San Sebastián, Spain
| | - Jesús M Ibarluzea
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Madrid, Spain,BIODONOSTIA, Health Research Institute, Donostia—San Sebastián, Spain,Faculty of Psychology, University of the Basque Country (UPV/EHU), Donostia—San Sebastián, Spain,Basque Government Department of Health, Deputy Directorate of Public Health of Gipuzkoa, Donostia—San Sebastián, Spain
| | - Sabrina Llop
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Madrid, Spain,Epidemiology and Environmental Health Joint Research Unit, FISABIO–Jaume I University–University of València, Valencia, Spain
| | - Mario Murcia
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Madrid, Spain,Epidemiology and Environmental Health Joint Research Unit, FISABIO–Jaume I University–University of València, Valencia, Spain
| | - Margaret P Rayman
- Department of Nutritional Sciences, University of Surrey, Guildford, United Kingdom
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Madrid, Spain,Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center For Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre–Sophia Children's Hospital, Rotterdam, Netherlands,Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, MA, USA,Address correspondence to HT (e-mail: )
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40
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Long-term iodine nutrition is associated with longevity in older adults: a 20 years’ follow-up of the Randers–Skagen study. Br J Nutr 2020; 125:260-265. [DOI: 10.1017/s0007114520001592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AbstractIodine intake affects the occurrence of thyroid disorders. However, the association of iodine intake with longevity remains to be described. This led us to perform a 20 years’ follow-up on participants from the Randers–Skagen (RaSk) study. Residents in Randers born in 1920 (n 210) and Skagen born in 1918–1923 (n 218) were included in a clinical study in 1997–1998. Mean iodine content in drinking water was 2 µg/l in Randers and 139 µg/l in Skagen. We collected baseline data through questionnaires, performed physical examinations and measured iodine concentrations in spot urine samples. Income data were retrieved from Danish registries. We performed follow-up on mortality until 31 December 2017 using Danish registries. Complete follow-up data were available on 428 out of 430 of participants (99·5 %). At baseline, the median urinary iodine concentration was 55 µg/l in Randers and 160 µg/l in Skagen residents. Participants were long-term residents with 72·8 and 92·7 % residing for more than 25 years in Randers and Skagen, respectively. Cox regression showed that living in Skagen compared with Randers was associated with a lower hazard ratio (HR) of death in both age- and sex-adjusted analyses (HR 0·60, 95 % CI 0·41, 0·87, P = 0·006), but also after adjustment for age, sex, number of drugs, Charlson co-morbidity index, smoking, alcohol and income (HR 0·60, 95 % CI 0·41, 0·87, P = 0·008). Residing in iodine-replete Skagen was associated with increased longevity. This indicates that long-term residency in an iodine-replete environment may be associated with increased longevity compared with residency in an iodine-deficient environment.
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41
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Watts MJ, Middleton DRS, Marriott A, Humphrey OS, Hamilton E, McCormack V, Menya D, Farebrother J, Osano O. Iodine status in western Kenya: a community-based cross-sectional survey of urinary and drinking water iodine concentrations. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2020; 42:1141-1151. [PMID: 31190125 DOI: 10.1007/s10653-019-00352-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/05/2019] [Indexed: 06/09/2023]
Abstract
Spot urinary iodine concentrations (UIC) are presented for 248 individuals from western Kenya with paired drinking water collected between 2016 and 2018. The median UIC was 271 µg L-1, ranging from 9 to 3146 µg L-1, unadjusted for hydration status/dilution. From these data, 12% were potentially iodine deficient (< 100 µg L-1), whilst 44% were considered to have an excess iodine intake (> 300 µg L-1). The application of hydration status/urinary dilution correction methods was evaluated for UICs, using creatinine, osmolality and specific gravity. The use of specific gravity correction for spot urine samples to account for hydration status/urinary dilution presents a practical approach for studies with limited budgets, rather than relying on unadjusted UICs, 24 h sampling, use of significantly large sample size in a cross-sectional study and other reported measures to smooth out the urinary dilution effect. Urinary corrections did influence boundary assessment for deficiency-sufficiency-excess for this group of participants, ranging from 31 to 44% having excess iodine intake, albeit for a study of this size. However, comparison of the correction methods did highlight that 22% of the variation in UICs was due to urinary dilution, highlighting the need for such correction, although creatinine performed poorly, yet specific gravity as a low-cost method was comparable to osmolality corrections as the often stated 'gold standard' metric for urinary concentration. Paired drinking water samples contained a median iodine concentration of 3.2 µg L-1 (0.2-304.1 µg L-1). A weak correlation was observed between UIC and water-I concentrations (R = 0.11).
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Affiliation(s)
- Michael J Watts
- Inorganic Geochemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, UK.
| | - Daniel R S Middleton
- Inorganic Geochemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, UK
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Andrew Marriott
- Inorganic Geochemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, UK
| | - Olivier S Humphrey
- Inorganic Geochemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, UK
| | - Elliott Hamilton
- Inorganic Geochemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, UK
| | - Valerie McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Diana Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | | | - Odipo Osano
- School of Environmental Sciences, University of Eldoret, Eldoret, Kenya
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42
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Dineva M, Rayman MP, Levie D, Guxens M, Peeters RP, Vioque J, González L, Espada M, Ibarluzea J, Sunyer J, Korevaar TIM, Bath SC. Similarities and differences of dietary and other determinants of iodine status in pregnant women from three European birth cohorts. Eur J Nutr 2020; 59:371-387. [PMID: 30734058 DOI: 10.1007/s00394-019-01913-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/23/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE As a component of thyroid hormones, adequate iodine intake is essential during pregnancy for fetal neurodevelopment. Across Europe, iodine deficiency is common in pregnancy, but data are lacking on the predictors of iodine status at this life stage. We, therefore, aimed to explore determinants of iodine status during pregnancy in three European populations of differing iodine status. METHODS Data were from 6566 pregnant women from three prospective population-based birth cohorts from the United Kingdom (ALSPAC, n = 2852), Spain (INMA, n = 1460), and The Netherlands (Generation R, n = 2254). Urinary iodine-to-creatinine ratio (UI/Creat, µg/g) was measured in spot-urine samples in pregnancy (≤ 18-weeks gestation). Maternal dietary intake, categorised by food groups (g/day), was estimated from food-frequency questionnaires (FFQs). Multivariable regression models used dietary variables (energy-adjusted) and maternal characteristics as predictors of iodine status. RESULTS Median UI/Creat in pregnant women of ALSPAC, INMA, and Generation R was 121, 151, and 210 µg/g, respectively. Maternal age was positively associated with UI/Creat in all cohorts (P < 0.001), while UI/Creat varied by ethnicity only in Generation R (P < 0.05). Of the dietary predictors, intake of milk and dairy products (per 100 g/day) was positively associated with UI/Creat in all cohorts [ALSPAC (B = 3.73, P < 0.0001); INMA (B = 6.92, P = 0.002); Generation R (B = 2.34, P = 0.001)]. Cohort-specific dietary determinants positively associated with UI/Creat included fish and shellfish in ALSPAC and INMA, and eggs and cereal/cereal products in Generation R. CONCLUSIONS The cohort-specific dietary determinants probably reflect not only dietary habits but iodine-fortification policies; hence, public-health interventions to improve iodine intake in pregnancy need to be country-specific.
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Affiliation(s)
- Mariana Dineva
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Margaret P Rayman
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Deborah Levie
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
- ISGlobal, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Mònica Guxens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
- ISGlobal, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Robin P Peeters
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jesus Vioque
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Nutritional Epidemiology Unit, Miguel Hernández University, ISABIAL-FISABIO, Alicante, Spain
| | - Llúcia González
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Predepartamental Unit of Medicine, University Jaume I, Castelló, Spain
| | - Mercedes Espada
- Departamento de Salud del Gobierno Vasco, Public Health Laboratory of Bilbao, Basque Government, Derio, Spain
- BIODONOSTIA Health Research Institute, Donostia-San Sebastián, Spain
| | - Jesús Ibarluzea
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- BIODONOSTIA Health Research Institute, Donostia-San Sebastián, Spain
- Departamento de Salud del Gobierno Vasco, Subdirección de Salud Pública de Guipúzcoa, Donostia-San Sebastián, Spain
- Facultad de Psicología, University of the Basque Country UPV/EHU, Donostia-San Sebastián, Spain
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Tim I M Korevaar
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Sarah C Bath
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.
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Ji C, Bu Y, Tian C, Fan L, Liu S, Liu Y, Sun D. Determination of Reference Intervals of Ratios of Concentrations of Urinary Iodine to Creatinine and Thyroid Hormone Concentrations in Pregnant Women Consuming Adequate Iodine in Harbin, Heilongjiang Province. Biol Trace Elem Res 2020; 193:36-43. [PMID: 30840185 DOI: 10.1007/s12011-019-01689-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Abstract
The objectives of this study were to explore reference intervals of ratios of concentrations of urinary iodine to creatinine (UIC/UCr) in pregnant women, to determine specific reference intervals for thyroid hormone concentrations (FT3, FT4, TSH) in the first trimester of pregnancy, and provide a comprehensive evaluation of iodine nutritional status and thyroid function. Cross-sectional data analysis, including questionnaires and thyroid ultrasonograms, were used to exclude subjects who had a history of thyroid disease, a family history of thyroid disease, or thyroid morphological abnormalities. Tests of thyroid hormone were evaluated together with urinary iodine concentration (UIC), urinary creatinine concentration (UCr), and salt iodine concentration in pregnant women. For the sample of pregnant women eligible for inclusion, the 95% reference intervals of the bilateral limits of UIC/UCr and thyroid hormone concentrations in pregnant women were determined by the percentile method. Pregnant women were recruited in Harbin, Heilongjiang Province, a particular geographical area of China, where iodine nutrition is adequate. The median UIC was 141.47 μg/L, while the median UIC/UCr was 141.12 μg/g. The reference intervals of thyroid hormone concentrations in the first trimester were FT3 3.63-6.12 pmol/L, FT4 11.89-22.91 pmol/L, and TSH 0.013-3.814 mIU/L. The reference intervals of UIC/UCr were 52.47 to 532.09 μg/g (first trimester 47.25-353.91 μg/g, second trimester 57.95-639.08 μg/g, third trimester 46.98-494.73 μg/g).The established UIC/UCr medical reference intervals and thyroid hormone concentration reference intervals may be used for iodine nutritional assessment and thyroid disease screening in pregnant women.
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Affiliation(s)
- Chunlei Ji
- Key Laboratory of Etiology and Epidemiology, National Health and Family Planning Commission, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Ye Bu
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Chunyuan Tian
- Key Laboratory of Etiology and Epidemiology, National Health and Family Planning Commission, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Lijun Fan
- Key Laboratory of Etiology and Epidemiology, National Health and Family Planning Commission, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Shoujun Liu
- Key Laboratory of Etiology and Epidemiology, National Health and Family Planning Commission, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Ying Liu
- Key Laboratory of Etiology and Epidemiology, National Health and Family Planning Commission, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150086, Heilongjiang, China.
| | - Dianjun Sun
- Key Laboratory of Etiology and Epidemiology, National Health and Family Planning Commission, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150086, Heilongjiang, China.
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Levie D, Korevaar TIM, Bath SC, Murcia M, Dineva M, Llop S, Espada M, van Herwaarden AE, de Rijke YB, Ibarluzea JM, Sunyer J, Tiemeier H, Rayman MP, Guxens M, Peeters RP. Association of Maternal Iodine Status With Child IQ: A Meta-Analysis of Individual Participant Data. J Clin Endocrinol Metab 2019; 104:5957-5967. [PMID: 30920622 PMCID: PMC6804415 DOI: 10.1210/jc.2018-02559] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/22/2019] [Indexed: 12/16/2022]
Abstract
CONTEXT Although the consequences of severe iodine deficiency are beyond doubt, the effects of mild to moderate iodine deficiency in pregnancy on child neurodevelopment are less well established. OBJECTIVE To study the association between maternal iodine status during pregnancy and child IQ and identify vulnerable time windows of exposure to suboptimal iodine availability. DESIGN Meta-analysis of individual participant data from three prospective population-based birth cohorts: Generation R (Netherlands), INMA (Spain), and ALSPAC (United Kingdom); pregnant women were enrolled between 2002 and 2006, 2003 and 2008, and 1990 and 1992, respectively. SETTING General community. PARTICIPANTS 6180 mother-child pairs with measures of urinary iodine and creatinine concentrations in pregnancy and child IQ. Exclusion criteria were multiple pregnancies, fertility treatment, medication affecting the thyroid, and preexisting thyroid disease. MAIN OUTCOME MEASURE Child nonverbal and verbal IQ assessed at 1.5 to 8 years of age. RESULTS There was a positive curvilinear association of urinary iodine/creatinine ratio (UI/Creat) with mean verbal IQ only. UI/Creat <150 µg/g was not associated with lower nonverbal IQ (-0.6 point; 95% CI: -1.7 to 0.4 points; P = 0.246) or lower verbal IQ (-0.6 point; 95% CI: -1.3 to 0.1 points; P = 0.082). Stratified analyses showed that the association of UI/Creat with verbal IQ was only present up to 14 weeks of gestation. CONCLUSIONS Fetal brain development is vulnerable to mild to moderate iodine deficiency, particularly in the first trimester. Our results show that potential randomized controlled trials investigating the effect of iodine supplementation in women with mild to moderate iodine deficiency on child neurodevelopment should begin supplementation not later than the first trimester.
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Affiliation(s)
- Deborah Levie
- The Generation R Study Group, Erasmus University Medical Centre, CA Rotterdam, Netherlands
- Department of Internal Medicine, Academic Center For Thyroid Diseases, Erasmus University Medical Centre, CA Rotterdam, Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre–Sophia Children’s Hospital, CB Rotterdam, Netherlands
- ISGlobal, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Tim I M Korevaar
- The Generation R Study Group, Erasmus University Medical Centre, CA Rotterdam, Netherlands
- Department of Internal Medicine, Academic Center For Thyroid Diseases, Erasmus University Medical Centre, CA Rotterdam, Netherlands
| | - Sarah C Bath
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Mario Murcia
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Mariana Dineva
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Sabrina Llop
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Mercedes Espada
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Clinical Chemistry Unit, Public Health Laboratory of Bilbao, Basque Government, Parque Tecnológico de Bizkaia, Derio, Spain
| | - Antonius E van Herwaarden
- Department of Laboratory Medicine, Radboud University Nijmegen Medical Centre, GA Nijmegen, Netherlands
| | - Yolanda B de Rijke
- Department of Internal Medicine, Academic Center For Thyroid Diseases, Erasmus University Medical Centre, CA Rotterdam, Netherlands
- Department of Clinical Chemistry, Erasmus University Medical Centre, CN Rotterdam, Netherlands
| | - Jesús M Ibarluzea
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Sanidad Gobierno Vasco, Subdirección de Salud Pública de Guipúzcoa, Donostia – San Sebastián, Spain
- BIODONOSTIA Health Research Institute, Donostia – San Sebastián, Spain
- Faculty of Psychology, University of the Basque Country UPV/EHU, Donostia – San Sebastián, Spain
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre–Sophia Children’s Hospital, CB Rotterdam, Netherlands
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Margaret P Rayman
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Mònica Guxens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre–Sophia Children’s Hospital, CB Rotterdam, Netherlands
- ISGlobal, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center For Thyroid Diseases, Erasmus University Medical Centre, CA Rotterdam, Netherlands
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Levie D, Derakhshan A, Shu H, Broeren MAC, de Poortere RA, Peeters RP, Bornehag CG, Demeneix B, Korevaar TIM. The Association of Maternal Iodine Status in Early Pregnancy with Thyroid Function in the Swedish Environmental Longitudinal, Mother and Child, Asthma and Allergy Study. Thyroid 2019; 29:1660-1668. [PMID: 31524090 DOI: 10.1089/thy.2019.0164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Severe maternal iodine deficiency can impact fetal brain development through effects on maternal and/or fetal thyroid hormone availability. The effects of mild-to-moderate iodine deficiency on thyroid function are less clear. The aim was to investigate the association of maternal urinary iodine concentration corrected for creatinine (UI/Creat) with thyroid function and autoantibodies in a mild-to-moderate iodine-deficient pregnant population. Methods: This study was embedded within the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study. Clinical reference ranges were determined by the 2.5th and 97.5th population-based percentile cutoffs. The associations of UI/Creat with thyrotropin (TSH), free thyroxine (fT4), free triiodothyronine (fT3), total T4 (TT4), and total T3 (TT3) were studied using multivariable linear regression in thyroid peroxidase antibody (TPOAb)-negative women. The association of UI/Creat with TPOAb and thyroglobulin antibody (TgAb) positivity was analyzed using multivariable logistic regression. Results: Urinary iodine and thyroid function were measured at a median (95% range) gestational age of 10 (6-14) weeks in 2009 women. The median (95% range) UI/Creat was 85 μg/g (36-386) and the UI/Creat was below 150 μg/g in 80.1% of women. Reference ranges did not differ substantially by UI/Creat. A lower UI/Creat was associated with a lower TSH (p = 0.027), a higher TT4 (p = 0.032), and with a corresponding trend toward slightly higher fT4 (p = 0.081), fT3 (p = 0.079), and TT3 (p = 0.10). UI/Creat was not associated with the fT4/fT3 (p = 0.94) or TT4/TT3 ratios (p = 0.63). Women with a UI/Creat of 150-249 μg/g had the lowest prevalence of TPOAb positivity (6.1%), while women with a UI/Creat of <150 μg/g had a higher prevalence (11.0%, odds ratio [OR] confidence interval [95% CI] 1.84 [1.07-3.20], p = 0.029). Women with a UI/Creat ≥500 μg/g showed the highest prevalence and a higher risk of TPOAb positivity, however, only a small proportion of women had such a UI/Creat (12.5%, OR, [95% CI] 2.36 [0.54-10.43], p = 0.26). Conclusions: We could not identify any meaningful differences in thyroid function reference ranges. Lower iodine availability was associated with a slightly lower TSH and a higher TT4. Women with adequate iodine intake had the lowest risk of TPOAb positivity.
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Affiliation(s)
- Deborah Levie
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Arash Derakhshan
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Huan Shu
- Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, Sweden
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Ralph A de Poortere
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Carl-Gustaf Bornehag
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Barbara Demeneix
- UMR 7221, Laboratoire d'Evolution des Régulations Endocriniennes, CNRS/Muséum National d'Histoire Naturelle, Sorbonne Universities, Paris, France
| | - Tim I M Korevaar
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
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46
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Eastman CJ, Ma G, Li M. Optimal Assessment and Quantification of Iodine Nutrition in Pregnancy and Lactation: Laboratory and Clinical Methods, Controversies and Future Directions. Nutrients 2019; 11:E2378. [PMID: 31590373 PMCID: PMC6835375 DOI: 10.3390/nu11102378] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/05/2019] [Accepted: 09/15/2019] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Creswell J Eastman
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia.
- Australian Centre for Control of Iodine Deficiency Disorders (ACCIDD), Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia.
| | - Gary Ma
- Australian Centre for Control of Iodine Deficiency Disorders (ACCIDD), Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia.
- School of Medicine (Pathology), Liverpool Hospital Clinical School, Western Sydney University, Liverpool, Sydney 2170, Australia.
| | - Mu Li
- Australian Centre for Control of Iodine Deficiency Disorders (ACCIDD), Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia.
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia.
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47
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Mullan K, Hamill L, Doolan K, Young I, Smyth P, Flynn A, Walton J, Meharg AA, Carey M, McKernan C, Bell M, Black N, Graham U, McCance D, McHugh C, McMullan P, McQuaid S, O'Loughlin A, Tuthill A, Bath SC, Rayman M, Woodside JV. Iodine status of teenage girls on the island of Ireland. Eur J Nutr 2019; 59:1859-1867. [PMID: 31321499 DOI: 10.1007/s00394-019-02037-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Karen Mullan
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, Ireland.
| | | | | | | | | | | | | | | | | | | | | | | | - Una Graham
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, Ireland
| | - David McCance
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, Ireland
| | | | - Paul McMullan
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, Ireland
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48
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Chung SM, Moon JS, Yoon JS, Won KC, Lee HW. Sex-specific effects of blood cadmium on thyroid hormones and thyroid function status: Korean nationwide cross-sectional study. J Trace Elem Med Biol 2019; 53:55-61. [PMID: 30910207 DOI: 10.1016/j.jtemb.2019.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 01/20/2023]
Abstract
Previous studies on blood cadmium (BCd) and changes in thyroid hormone levels are controversial. We investigated whether thyroid hormone levels and thyroid function status were associated with BCd according to sex in the Korean population. Our study included 1972 participants based on the 2013 Korea National Health and Nutrition Examination Survey (KNHANES) data. Participants whose thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels were altered physiologically or medically were excluded. Changes in TSH, fT4, and anti-thyroid peroxidase antibody (TPOAb) in men and women were analyzed by different characteristics: age, body mass index (BMI), smoking status, drinking status, BCd, and urine iodine-to-creatinine ratio (UI/Cre). Thyroid function status was classified as hypothyroidism, euthyroidism, and hyperthyroidism as defined by TSH and fT4 levels. Among the total participants, there was a negative correlation between BCd and fT4 (r=-0.067, p = 0.003). In men (n = 1057), fT4 levels decreased with increasing BCd quartile (p-for-trend = 0.002). After adjustment for age, BMI, smoking status, UI/Cre, and TPOAb, the association between BCd and hypothyroidism was significant in men (odds ratio = 1.813, p = 0.032) but not in women. These results suggest that cadmium accumulation is closely associated with thyroid dysfunction, and there is a difference in metabolic capacity according to sex.
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Affiliation(s)
- Seung Min Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam College of Medicine, Daegu, Republic of Korea.
| | - Jun Sung Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam College of Medicine, Daegu, Republic of Korea.
| | - Ji Sung Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam College of Medicine, Daegu, Republic of Korea.
| | - Kyu Chang Won
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam College of Medicine, Daegu, Republic of Korea.
| | - Hyoung Woo Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam College of Medicine, Daegu, Republic of Korea.
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49
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Lin YS, Rothen ML, Milgrom P. Pharmacokinetics of Iodine and Fluoride following Application of an Anticaries Varnish in Adults. JDR Clin Trans Res 2019; 3:238-245. [PMID: 30938600 DOI: 10.1177/2380084418771930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Researchers have suggested that combining topical fluoride with an antiseptic to reduce cariogenic bacteria may be more effective than fluoride application alone in preventing dental caries. In previous studies, povidone iodine (PVP-I), a widely used bactericidal antiseptic, and sodium fluoride (NaF), used to foster remineralization of enamel, were applied sequentially topically and shown to be safe and effective. The study aim was to characterize the kinetics of iodine and fluoride following topical application of a single combination PVP-I and NaF anticaries varnish in healthy adults. Sixteen participants (aged 23 to 57 y) participated in a pharmacokinetics study following the application of 0.4 mL varnish containing 10% (w/v) PVP-I and 5% (w/v) NaF. Serum and urine samples were collected at various time points over 24 h following application of varnish. Iodine and fluoride concentrations were analyzed, and for each time point, baseline concentrations were subtracted from observed values. Following varnish application, 2 of 16 participants had nearly undetectable baseline-corrected iodine and fluoride levels, suggesting minimal absorption, lack of release of iodine and fluoride from the varnish, or inconsistent dosing. The average peak concentrations were 57 ± 33 ng/mL iodine and 60 ± 34 ng/mL (0.060 ± 0.034 ppm) fluoride and occurred within 3 h of application. The average elimination half-life was 5.5 ± 1.4 h and 3.1 ± 1.6 h for iodine and fluoride, respectively. Renal clearance of iodine and fluoride was similar to literature values. No adverse events related to the study varnish were observed by the investigative team or reported by the participants. In this study, serum fluoride and iodine transiently increased but were within normal range 24 h after application of the varnish. This study has shown that the combination of PVP-I and NaF in a proposed anticaries varnish was well tolerated. Knowledge Transfer Statement: This clinical study demonstrated that a dental varnish combining 10% (w/v) povidone iodine and 5% (w/v) sodium fluoride is well tolerated. Serum fluoride and iodine transiently increased but were within normal range after 24 h. Further studies should be conducted to assess the efficacy of a combination in preventing dental caries, especially in high-risk populations.
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Affiliation(s)
- Y S Lin
- 1 Department of Pharmaceutics, University of Washington, Seattle, WA, USA
| | - M L Rothen
- 2 Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - P Milgrom
- 2 Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
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50
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Maloney E, Iyer RS, Phillips GS, Menon S, Lee JJ, Callahan MJ. Practical administration of intravenous contrast media in children: screening, prophylaxis, administration and treatment of adverse reactions. Pediatr Radiol 2019; 49:433-447. [PMID: 30923875 DOI: 10.1007/s00247-018-4306-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/14/2018] [Accepted: 11/02/2018] [Indexed: 12/28/2022]
Abstract
Administration of intravenous contrast media to children is a routine practice at many clinical imaging centers, that can involve special considerations. In this paper, we provide practical information to facilitate optimal performance and oversight of this task. We provide targeted screening questions that can help to identify high-risk pediatric patients for both iodine-based and gadolinium-based intravenous contrast media administration. These include children at risk for allergic-like reactions, thyroid dysfunction, contrast-induced nephropathy, and nephrogenic systemic fibrosis. We make recommendations for addressing "yes" responses to screening questions using risk stratification schema that are specific to children. We also present criteria for selecting children for premedication prior to intravenous contrast administration, and suggest pediatric regimens. Additionally, we discuss practical nuances of intravenous contrast media administration to children and provide a quick-reference table of appropriate treatments with pediatric dosages for adverse contrast reactions.
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Affiliation(s)
- Ezekiel Maloney
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Grace S Phillips
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Shina Menon
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - John J Lee
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
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