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Liu S, Sharp A, Lane S, Villanueva EV, Lu Z, Ma ZF. Low Iodine Nutrition Knowledge in Chinese Breastfeeding Women despite Adequate Iodine Status. Nutrients 2024; 16:491. [PMID: 38398815 PMCID: PMC10891795 DOI: 10.3390/nu16040491] [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: 01/09/2024] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
There has been a scarcity of evidence about iodine nutrition knowledge among women during pregnancy and lactation. The aim of this study was to determine women's iodine knowledge and the relationship between knowledge and iodine status during pregnancy and lactation. Women were recruited from a hospital in the western part of China in the third trimester of pregnancy and followed until the end of the first week of lactation. The women's iodine status was measured by their urinary iodine concentration (UIC) and an iodine-specific, validated food frequency questionnaire (FFQ). Iodine nutrition knowledge was assessed using an iodine nutrition knowledge questionnaire. A total of 200 women (mean age of 29.0 ± 4.2 years) completed the whole study. The majority of the women did not consume enough iodine during both pregnancy and lactation (231.89 vs. 237.26 µg/day). The overall mean iodine knowledge scores in our sample of women during pregnancy and lactation were 4.77 and 4.87, indicating low iodine knowledge. The use of iodized salt and a higher education level were significantly associated with an increased iodine knowledge score. In conclusion, this study reported poor iodine nutrition knowledge in women, highlighting a public health concern. Therefore, the iodine knowledge of women should be improved, possibly via maternal health campaigns to avoid the consequences of iodine deficiency disorders in newborns.
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Affiliation(s)
- Shuchang Liu
- Department of Biological Sciences, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China
- Harris-Wellbeing Research Centre, Faculty of Health & Life Sciences, University of Liverpool, Liverpool L8 7SS, UK
- School of Health and Sport Sciences, Liverpool Hope University, Liverpool L16 9JD, UK
| | - Andrew Sharp
- Harris-Wellbeing Research Centre, Faculty of Health & Life Sciences, University of Liverpool, Liverpool L8 7SS, UK
| | - Steven Lane
- Health Data Science, University of Liverpool, Liverpool L69 3BX, UK
| | - Elmer V. Villanueva
- School of Science, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China
- First Year College, Victoria University, Footscray, VIC 3011, Australia
| | - Zhiliang Lu
- Department of Biological Sciences, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China
| | - Zheng Feei Ma
- School of Science, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China
- Centre for Public Health and Wellbeing, School of Health and Social Wellbeing, College of Health, University of the West of England, Bristol BS16 1QY, UK
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Wei F, Liang C, Lin X. Individualized Program with Iodine Supplementation. Adv Nutr 2024; 15:100167. [PMID: 38184199 PMCID: PMC10877339 DOI: 10.1016/j.advnut.2024.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/08/2024] Open
Affiliation(s)
- Fengqin Wei
- From the Department of Thyroid Breast Surgery, Shanghai East Hospital, School of Medicine, Tongji University School of Medicine, Shanghai, China; Department of Orthopedics, Fujian Provincial 2nd People's Hospital, Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Chunli Liang
- From the Department of Thyroid Breast Surgery, Shanghai East Hospital, School of Medicine, Tongji University School of Medicine, Shanghai, China
| | - Xiaoti Lin
- From the Department of Thyroid Breast Surgery, Shanghai East Hospital, School of Medicine, Tongji University School of Medicine, Shanghai, China.
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Sun H, Zhou Y, Liu J, Wang Y, Wang G. Maternal pre-pregnancy obesity modifies the association between first-trimester thyroid hormone sensitivity and gestational Diabetes Mellitus: a retrospective study from Northern China. Diabetol Metab Syndr 2023; 15:212. [PMID: 37875982 PMCID: PMC10598956 DOI: 10.1186/s13098-023-01188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Contradictory relationships have been observed between thyroid function and gestational diabetes mellitus (GDM). Previous studies have indicated that pre-pregnancy BMI (pBMI) could modify their relationships. Few studies have illustrated the role of thyroid hormone sensitivity on GDM. We aimed to explore the effect of pre-pregnancy obesity on the association between early pregnancy thyroid hormone sensitivity and GDM in euthyroid pregnant women. METHODS This study included 1310 women with singleton gestation. Subjects were classified into pre-pregnancy obese and non-obese subgroups by pBMI levels with a cutoff of 25 kg/m2. Sensitivity to thyroid hormone was evaluated by Thyroid Feedback Quartile-Based Index (TFQI), Chinese-referenced parametric TFQI (PTFQI), TSH Index (TSHI) and Thyrotrophic T4 Resistance Index (TT4RI). The associations between these composite indices and GDM were analyzed using multivariate regression models in the two subgroups, respectively. RESULTS In pre-pregnancy non-obese group, early pregnancy TFQI, PTFQI, TSHI and TT4RI levels were higher in subjects with incident GDM compared to those without GDM (all P < 0.05). By contrast, obese women with GDM exhibited lower levels of those indices (all P < 0.05). The occurrence of GDM were increased with rising TFQI, PTFQI, TSHI and TT4RI quartiles in non-obese women ( all P for trend < 0.05), while exhibited decreased trend across quartiles of those indices in obese women (all P for trend < 0.05). Further logistic analysis indicated contrary relationships between thyroid hormone sensitivity and the occurrence of GDM in the two groups, respectively. The OR of the fourth versus the first quartile of TFQI for GDM was 1.981 (95% CI 1.224, 3.207) in pre-pregnancy non-obese group, while was 0.131 (95% CI 0.036, 0.472) in pre-pregnancy obese group. PTFQI and TSHI yielded similar results. CONCLUSIONS The association between maternal sensitivity to thyroid hormones during early gestation and the occurrence of GDM was modified by pre-pregnancy obesity.
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Affiliation(s)
- Honglin Sun
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yibo Zhou
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Ying Wang
- Physical Examination Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 10020, China.
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
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Nie J, Zhu Y, Wang C, Lin Q, Tayier R, Cai Z, Ma P, Zhang L. Relationship between iodine knowledge and dietary iodine intake in pregnant and lactating women: a cross-sectional study. Public Health Nutr 2023; 26:1436-1450. [PMID: 36946300 PMCID: PMC10346033 DOI: 10.1017/s1368980023000514] [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: 07/15/2022] [Revised: 02/04/2023] [Accepted: 02/24/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This study assessed the iodine knowledge of pregnant and lactating women and the relationship to dietary iodine intake and iodine status. The factors influencing iodine intake were analysed. DESIGN Basic information and iodine knowledge were collected via a questionnaire. A FFQ assessed dietary iodine intake. The urinary iodine concentration (UIC) was measured using the arsenic-cerium catalytic spectrophotometric determination of iodine in urine (WS/T 107 -2016). SETTING A cross-sectional study involving pregnant and lactating women in Xinjiang, China was conducted. PARTICIPANTS A total of 1181 pregnant women and 504 lactating women were enrolled in the study. RESULTS The median UIC for pregnant and lactating women was 179·27 and 192·81 µg/l, respectively, and the dietary iodine intake was 407·16 and 356·89 µg/d, respectively. Of the pregnant and lactating women, 73·4 % and 82·5 % had medium iodine knowledge, respectively. In pregnant women, iodine knowledge and dietary iodine intake were positively correlated. High iodine knowledge and iodine education were shown to be protective factors for excessive iodine intake in pregnant women. CONCLUSION This study demonstrated that the iodine nutritional status of women in Xinjiang was appropriate, and iodine knowledge was at a medium level, but there was confusion about iodine nutrition. Public education is needed to improve iodine knowledge and active iodine supplementation awareness among these populations of women.
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Affiliation(s)
- Jiaoyang Nie
- School of Public Health, Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Yuming Zhu
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Chenchen Wang
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Qin Lin
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Rishalaiti Tayier
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Zhuoxuan Cai
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Pinjiang Ma
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
| | - Ling Zhang
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi830002, People’s Republic of China
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Estimation of appropriate dietary intake of iodine among lactating women in China based on iodine loss in breast milk. Eur J Nutr 2023; 62:739-748. [PMID: 36209299 DOI: 10.1007/s00394-022-02996-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/31/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Data on iodine loss in breast milk, which are critical for establishing the appropriate dietary iodine intake for lactating women, is currently limited. A study was conducted to assess iodine loss in breast milk among Chinese lactating women to estimate the appropriate dietary intake of iodine. METHODS A total of 54 pairs of healthy, lactating women and their infants aged 0-6 months were recruited from Tianjin and Luoyang cities in China. A 4 days infant weighing study was conducted to assess iodine loss in the breast milk of lactating women. Mothers were required to weigh and record their infants' body weights before and after each feeding for a 24 h period from 8:00 am to 8:00 am. During the weighing study, 2812 breast milk samples and 216 24-h urine samples were collected from each lactating mother for four consecutive days. In addition, a 3 days 24 h dietary record, including salt weighing and drinking water samples collecting, was performed by each lactating mother to determine dietary iodine intake during the weighing study. RESULTS The average dietary iodine intake of lactating women was 323 ± 80 μg/d. The median breast milk iodine concentration and 24 h urinary iodine concentration of lactating women were 154 (122-181) and 135 (104-172) μg/L, respectively. The mean volume of breast milk and the mean iodine loss in the breast milk of lactating women were 711 ± 157 mL/d and 112 ± 47 μg/d, respectively. The appropriate dietary intake of iodine among lactating Chinese women is approximately 260 µg/d. CONCLUSIONS Based on the iodine loss in breast milk (110 μg/d) found in this study, and the estimated average requirement of iodine for adults, the appropriate dietary intake of iodine among lactating Chinese women is 260 µg/d, which is higher than the 240 μg/d recommended by the China Nutrition Science Congress in 2013.
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Li A, Hou J, Fu J, Wang Y, Hu Y, Zhuang T, Li M, Song M, Jiang G. Association between serum levels of TSH and free T4 and per- and polyfluoroalkyl compounds concentrations in pregnant women. J Environ Sci (China) 2023; 124:11-18. [PMID: 36182121 DOI: 10.1016/j.jes.2021.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 06/16/2023]
Abstract
Many per- and polyfluoralkyl substances (PFASs) may disrupt maternal thyroid hormone homeostasis in pregnancy. Concerns should be raised regarding the PFASs exposure in pregnant women because thyroid hormones are involved in the early development of the fetus. In this study, we measured the concentrations of 13 PFASs, including five novel short-chain PFASs, in serum from 123 pregnant women in Beijing, China. Linear regression models were used to investigate the association between thyroid-stimulating hormone (TSH) or free thyroxine (FT4) levels and PFASs concentrations under consideration of the impacts of pregnancy-induced physiological factors. We found that perfluorobutanoic acid (PFBA) (β=0.189, 95%CI=-0.039, 0.417, p=0.10) and perfluorodecanoic acid (PFDA) (β=-0.554, 95%CI=-1.16, 0.049, p=0.071) were suggestive of significant association with TSH in thyroid peroxidase antibody (TPOAb) negative women. No association was observed between all PFASs and FT4 levels after controlling for these confounding factors, such as BMI, gestational weight gain and maternal age. These findings suggest that it should pay more attention to the association between thyroid hormone levels and short-chain PFASs concentrations. Future studies could consider a greater sample and the inclusion of other clinical indicators of thyroid function, such as free T3 and total T3.
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Affiliation(s)
- Aijing Li
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Science, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Jianjie Fu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Science, Beijing 100085, China
| | - Yinan Wang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Yifei Hu
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Taifeng Zhuang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Menglong Li
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Maoyong Song
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Science, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Guibin Jiang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Science, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
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Tayier R, Wang C, Ma P, Yuan Y, Zhang Y, Wu S, Zhang L. Iodine Nutritional Status of Pregnant Women After 14 Years of Lipiodol Supplementation: a Cross-Sectional Study in Historically Iodine-Deficient Areas of China. Biol Trace Elem Res 2023; 201:14-22. [PMID: 35322354 DOI: 10.1007/s12011-022-03123-8] [Citation(s) in RCA: 1] [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] [Received: 11/02/2021] [Accepted: 01/17/2022] [Indexed: 01/11/2023]
Abstract
Southern Xinjiang has a history of serious iodine deficiency. Since 2007, pregnant women in this area have taken iodized salt and oral lipiodol preparations to prevent iodine deficiency disorders. However, the current status of iodine nutrition and thyroid function in this population is unknown. A cross-sectional study was conducted on 555 pregnant women from 5 counties (cities) in southern Xinjiang and 429 pregnant women from 3 counties in northern Xinjiang. The participants were given a questionnaire and serum concentrations of free triiodothyronine (FT3), free thyroxine (FT4), thyrotropic stimulating hormone (TSH), thyroglobulin antibody (Tg-Ab), and thyroid peroxidase antibody (TPO-Ab), and the urine iodine concentration (UIC) was measured. The median UIC and interquartile range [M (IQR)] of the 984 pregnant women in the study was 189.38 (143.15, 288.77) μg/L. Positive Tg-Ab and TPO-Ab titers were detected in 6.74% and 9.55%, 8.30% and 9.84%, and 7.39% and 10.55% in T1, T2, and T3, respectively. The incidence of subclinical hypothyroidism, clinical hypothyroidism, and isolated hypothyroxinemia in pregnant women in areas where lipiodol pills were taken was 4.32%, 0%, and 1.44%, respectively, which was significantly lower than those in areas where lipiodol pills were not taken. The median UIC (IQR) of pregnant women in the two regions was 213.80 (130.44, 331.77) μg/L and 168.30 (155.0, 254.8) μg/L, the UIC of pregnant women who took lipiodol pills was higher than in those who did not take lipiodol pills, and the difference was statistically significant (p < 0.05). According to WHO standards, all pregnant women in southern Xinjiang are in a state of adequate iodine nutrition. Taking lipiodol pills has improved the iodine nutrition level of pregnant women in this area. The results of this study did not find that oral lipiodol pills had adverse effects on pregnant women's thyroid function, but it is necessary to further study the effect of oral lipiodol pills on the offspring.
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Affiliation(s)
- Rishalaiti Tayier
- College of Public Health, Xinjiang Medical University, Urumqi, 830011, Xinjiang, People's Republic of China
| | - Chenchen Wang
- Xinjiang Uighur Autonomous Region Centre for Disease Control and Prevention, Urumqi, 830011, People's Republic of China
| | - Pinjiang Ma
- Xinjiang Uighur Autonomous Region Centre for Disease Control and Prevention, Urumqi, 830011, People's Republic of China
| | - Yimu Yuan
- Xinjiang Production and Construction Corps Hospital, Urumqi, 830011, Xinjiang, People's Republic of China
| | - Yuxia Zhang
- Urumqi Maternal and Child Health Hospital, Urumqi, 830011, Xinjiang, People's Republic of China
| | - Shunhua Wu
- Department of Occupational and Environmental Health, School of Public Health, Xinjiang Medical University, Urumqi, 830001, People's Republic of China.
| | - Ling Zhang
- Xinjiang Uighur Autonomous Region Centre for Disease Control and Prevention, Urumqi, 830011, People's Republic of China.
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Sun R, Fan L, Du Y, Liu L, Qian T, Zhao M, Che W, Liu P, Sun D. The relationship between different iodine sources and nutrition in pregnant women and adults. Front Endocrinol (Lausanne) 2022; 13:924990. [PMID: 35983514 PMCID: PMC9379486 DOI: 10.3389/fendo.2022.924990] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022] Open
Abstract
Background Different iodine supplement measures emerge along with the economy development in China. The article objectives are to compare and explore the relationship between iodine sources and nutrition of pregnant women and adults. Methods A total of 2,145 pregnant women and 1,660 adults were investigated by multi-stage random method. Questionnaire was used to collect basic information and the consumption of food, water, and iodine preparations. Household salt and individual urine and blood samples were collected, and thyroid function and morphology of pregnant women were measured. Results The median urinary iodine concentration (MUIC) of pregnant women (164.49 μg/L) was lower than adults (187.30 μg/L, p < 0.05). Iodine supplement with IS (iodized salt) was the main measure for pregnant women and adults, and the difference was mainly on the consumption of iodine preparations between pregnant women (5.19%) and adults (0.85%). Moreover, adults' dietary iodine intake from food (100.6 μg/day), IS (140.8 μg/day), and drinking water (6.0 μg/day) was higher than those of pregnant women (86.5, 107.2, and 3.5 μg/day, respectively). Compared with iodine supplement with IS, ISFP (IS + iodine-rich food + iodine preparations) could reduce the risk of iodine deficiency for pregnant women. The MUICs for pregnant women and adults of iodine supplements with IF (iodine-rich food) and ISF (IS + iodine-rich food) were lower. For pregnant women, thyroid nodule (11.90%) and peroxidase antibody (TPOAb) positive (9.32%) were high prevalent thyroid diseases, and habitation (urban/rural), gestation, annual income, and drinking water type would affect them. Conclusion Pregnant women and adults had adequate iodine nutrition in four provinces. Their iodine supplement measures were different, the consumption of iodine preparations in pregnant women was higher, and their dietary iodine intake was lower than adults. ISFP was an effect measure for pregnant women to supplement iodine.
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Affiliation(s)
- Rong Sun
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Lijun Fan
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
- Key Laboratory of Etiology and Epidemiology, Education Bureau of Heilongjiang Province (23618504) and Ministry of Health, Microelement and Human Health Laboratory of Heilongjiang Province, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Yang Du
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
- Key Laboratory of Etiology and Epidemiology, Education Bureau of Heilongjiang Province (23618504) and Ministry of Health, Microelement and Human Health Laboratory of Heilongjiang Province, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Lanchun Liu
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Tingting Qian
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Meng Zhao
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Wenjing Che
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Peng Liu
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
- Key Laboratory of Etiology and Epidemiology, Education Bureau of Heilongjiang Province (23618504) and Ministry of Health, Microelement and Human Health Laboratory of Heilongjiang Province, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Dianjun Sun
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
- Key Laboratory of Etiology and Epidemiology, Education Bureau of Heilongjiang Province (23618504) and Ministry of Health, Microelement and Human Health Laboratory of Heilongjiang Province, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
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Liu T, Li Y, Teng D, Shi X, Yan L, Yang J, Yao Y, Ye Z, Ba J, Chen B, Du J, He L, Lai X, Teng X, Li Y, Chi H, Liao E, Liu C, Liu L, Qin G, Qin Y, Quan H, Shi B, Sun H, Tang X, Tong N, Wang G, Zhang JA, Wang Y, Xue Y, Yang L, Zhang Q, Zhang L, Zhu J, Zhu M, Shan Z, Teng W. The Characteristics of Iodine Nutrition Status in China After 20 Years of Universal Salt Iodization: An Epidemiology Study Covering 31 Provinces. Thyroid 2021; 31:1858-1867. [PMID: 34806437 DOI: 10.1089/thy.2021.0301] [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: 02/05/2023]
Abstract
Background: Despite the implementation of the universal salt iodization (USI) program for correction of iodine deficiency in China for ∼20 years, the actual iodine nutrition status of Chinese residents and the prevalence of iodine deficiency and iodine excess are issues that need to be addressed. This nationally representative cross-sectional study was conducted across all 31 provinces of mainland China to gather extensive data on iodine nutrition status and the influential factors. Methods: This study included 78,470 participants, aged 18 years or older, who were interviewed and asked to answer a questionnaire. Urine iodine concentration (UIC) was measured by the inductively coupled plasma mass spectrometry method, and goiter was examined by thyroid ultrasonography. In addition, sixty 9-11 years old school children in each province were randomly selected to evaluate the UIC and thyroid ultrasonography. The iodine nutrition status was determined according to the World Health Organization guidelines. Results: The iodized salt coverage was 95.37%. The median urine iodine (MUI) was 177.89 μg/L (interquartile range [IQR], 117.89-263.90 μg/L) and goiter prevalence was 1.17% (confidence interval [95% CI 0.95-1.43]) in the adult population. The MUI was 199.75 μg/L (IQR, 128.41-303.37 μg/L) in school-age children, and goiter prevalence was 3.50% [95% CI, 2.93-4.13]. The percentage of individuals with UIC <50 μg/L was 3.43%, <20%. Analysis indicated that sex, age, geographic factors, body mass index, and smoking habits influence the iodine nutrition level. Conclusion: The mandatory USI program has successfully eliminated iodine deficiency disorders, and the findings indicate that the iodine nutrition level in the general population is within the safe range.
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Affiliation(s)
- Tingting Liu
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Yongze Li
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Di Teng
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Xiaoguang Shi
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Li Yan
- Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Jing Yang
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Yongli Yao
- Department of Endocrinology, Qinghai Provincial People's Hospital, Xining, P.R. China
| | - Zhen Ye
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, P.R. China
| | - Jianming Ba
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Bing Chen
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Jianling Du
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R. China
| | - Lanjie He
- Department of Endocrinology, Cardiovascular and Cerebrovascular Disease Hospital of Ningxia Medical University, Yinchuan, P.R. China
| | - Xiaoyang Lai
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Xiaochun Teng
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Yanbo Li
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
| | - Haiyi Chi
- Department of Endocrinology, Hohhot First Hospital, Hohhot, P.R. China
| | - Eryuan Liao
- Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Chao Liu
- Research Center of Endocrine and Metabolic Diseases, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R. China
| | - Libin Liu
- Department of Endocrinology and Metabolism, Fujian Institute of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, P.R. China
| | - Guijun Qin
- Division of Endocrinology, Department of Internal Medicine, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, P.R. China
| | - Yingfen Qin
- Department of Endocrine, First Affiliated Hospital of Guangxi Medical University, Nanning, P.R. China
| | - Huibiao Quan
- Department of Endocrinology, Hainan General Hospital, Haikou, P.R. China
| | - Bingyin Shi
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi P.R. China
| | - Hui Sun
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, P.R. China
| | - Nanwei Tong
- Department of Endocrinology and Metabolism, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, P.R. China
| | - Jin-An Zhang
- Department of Endocrinology, Shanghai University of Medicine & Health Science Affiliated Zhoupu Hospital, Shanghai, P.R. China
| | - Youmin Wang
- Department of Endocrinology, The First Hospital of An Hui Medical University, Hefei, P.R. China
| | - Yuanming Xue
- Department of Endocrinology, The First People's Hospital of Yunnan Province, Kunming, P.R. China
| | - Lihui Yang
- Department of Endocrinology and Metabolism, People's Hospital of Tibet Autonomous Region, Lhasa, P.R. China
| | - Qiao Zhang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Guiyang Medical University, Guiyang, P.R. China
| | - Lihui Zhang
- Department of Endocrinology, Second Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Jun Zhu
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, P.R. China
| | - Mei Zhu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
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Exploration of the optimal range of urinary iodine concentration in Chinese pregnant women in mildly iodine-deficient and -sufficient areas. Eur J Nutr 2021; 61:1221-1230. [PMID: 34739565 DOI: 10.1007/s00394-021-02693-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE There is some uncertainty about the optimal ranges for urinary iodine concentration (UIC) during pregnancy. This study aimed to explore associations between maternal UIC and thyroid function in iodine sufficient and mildly iodine deficient areas. METHODS It was a cross-sectional study in which 1461 healthy pregnant women were enrolled to collect their blood and urine samples during their routine antenatal care in Tianjin and Wuqiang, China. Wuqiang was a mildly iodine-deficient region, while Tianjin was iodine sufficient. UIC, free triiodothyronine (FT3), free thyroid hormone (FT4), thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), serum iodine concentration (SIC) including total serum iodine concentration (tSIC) and non-protein bound serum iodine concentration (nbSIC) were assessed during the routine antenatal care visits. RESULTS The median UIC in pregnant women was 174 (113, 249) μg/L in Tianjin and 111 (63, 167) μg/L in Wuqiang, respectively. Compared with Tianjin, UIC, FT3 and TSH were lower, and FT4, tSIC, nbSIC, rates of TPOAb and TgAb positivity and the thyroid dysfunction rate (TDR) were higher in Wuqiang (P < 0.001). FT3, FT4, tSIC and nbSIC increased during pregnancy in Tianjin with increasing UIC, while only FT3 and nbSIC increased in Wuqiang (P < 0.05). In Tianjin, the TDR increased with UIC and peaked at UIC ≥ 500 μg/L (P = 0.002), while in Wuqiang, the TDR showed a weak "U-shaped" relationship with UIC and the rate was lowest with UIC 100-149 μg/L. CONCLUSIONS In iodine-deficient areas, there was a lower TDR in pregnant women with UIC 100-149 μg/L. We suspected that the optimal UIC criteria recommended by WHO may be a little high for pregnant women in mild-to-moderate iodine-deficient countries.
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Dong J, Liu S, Wang L, Zhou X, Zhou Q, Liu C, Zhu J, Yuan W, Xu WY, Deng J. Iodine monitoring models contribute to avoid adverse birth outcomes related more than adequate iodine intake. BMC Pregnancy Childbirth 2021; 21:454. [PMID: 34182950 PMCID: PMC8240367 DOI: 10.1186/s12884-021-03936-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/04/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Iodine plays an important role in pregnancy. How to maintain adequate iodine intake amongst pregnant women in each trimester of pregnancy to prevent adverse birth outcomes in central China is a challenge for clinical practice. METHODS 870 pregnant women and their infants were enrolled in the study. Urinary iodine concentration (UIC) was measured using an inductively coupled plasma mass spectrometry (ICP-MS). Maternal and newborn information were obtained during follow-up. Multinomial logistic regression models were established. RESULTS Median UIC of pregnant women was 172 ± 135 μg/L which is currently considered to be sufficient. Multivitamin supplements containing iodine, iodized salt intake and frequent milk intake were significantly associated with higher UIC. Multivariate logistic regression analysis showed that multivitamin supplements containing iodine and milk consumption were risk factors for more than adequate iodine (UIC ≥ 250 μg/L). Iodine-rich diet was significantly related to heavier birthweight, larger head circumference and longer femur length of the newborns while more than adequate iodine intake (UIC ≥ 250 μg/L) was a risk factor for macrosomia. Logistic regression models based on potential risk factors involving iodine containing supplements and iodine-rich diet were established to predict and screen pregnant women with high risk of more than adequate iodine intake among local pregnant women in different trimesters and guide them to supplement iodine reasonably to prevent the risk. CONCLUSIONS Multivitamin supplements containing iodine and milk consumption were risk factors for maternal UIC ≥ 250 μg/L which was a risk factor for macrosomia. Iodine monitoring models were established to provide guidance for pregnant women to reduce the risk of more than adequate iodine intake, thereby contributing to reduce the risk of having a macrosomia.
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Affiliation(s)
- Jinju Dong
- Department of Gynaecology and Obstetrics, Xiangyang No.1 People's Hospital, Hubei University of Medcine, Xiangyang, 441000, China
| | - Shouyan Liu
- Department of Obstetrics, Pingdingshan No.1 People's Hospital, Pingdingshan, 467000, China
| | - Lingyun Wang
- Biotecan Medical Diagnostics Co., Ltd, Zhangjiang Center for Translational Medicine, Shanghai, 201204, China
| | - Xingjian Zhou
- Department of Gynaecology and Obstetrics, Xiangyang No.1 People's Hospital, Hubei University of Medcine, Xiangyang, 441000, China
| | - Qinghong Zhou
- Department of Gynaecology and Obstetrics, Xiangyang No.1 People's Hospital, Hubei University of Medcine, Xiangyang, 441000, China
| | - Congli Liu
- Department of Gynaecology and Obstetrics, Xiangyang No.1 People's Hospital, Hubei University of Medcine, Xiangyang, 441000, China
| | - Jingrui Zhu
- Department of Obstetrics, Pingdingshan No.1 People's Hospital, Pingdingshan, 467000, China
| | - Weilan Yuan
- Biotecan Medical Diagnostics Co., Ltd, Zhangjiang Center for Translational Medicine, Shanghai, 201204, China
| | - Wang-Yang Xu
- Singlera Genomics (Shanghai) Ltd, Shanghai, 201318, China.
| | - Jie Deng
- Department of Gynaecology and Obstetrics, Xiangyang No.1 People's Hospital, Hubei University of Medcine, Xiangyang, 441000, China.
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Wang Z, Wu Y, Shi Z, Song J, Wang G, Xu C, Song Q, Jin W, Cui X, Wu C, Zang J, Guo C. Association of iodine-related knowledge, attitudes and behaviours with urinary iodine excretion in pregnant women with mild iodine deficiency. J Hum Nutr Diet 2020; 34:314-323. [PMID: 33210387 DOI: 10.1111/jhn.12837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Subsequent to the implementation of the universal salt iodisation policy, China has all but eliminated the iodine deficiency disorders. However, pregnant women are still experiencing mild iodine deficiency. The present study explored factors that could relate to mild iodine deficiency in pregnant women. METHODS In total, 2400 pregnant women were enrolled using a multistage, stratified, random sampling method in Shanghai. Data were collected via a standardised questionnaire. The urine samples and household cooking salt samples were collected for the detection of urinary iodine and salt iodine concentrations. RESULTS The median urinary iodine concentration (MUIC) was 148.0 μg L-1 for all participants, and 155.0 μg L-1 , 151.0 μg L-1 and 139.6 μg L-1 in the first, second and third trimesters. The MUIC in the third trimester was significantly lower than that of the first trimester (P < 0.05). The usage rates of iodised salt and qualified-iodised salt were 71.5% and 59.4%, respectively. Iodine-related knowledge score composition ratio was significantly different between the high and low UIC groups (P < 0.05). Participants' MUIC increased significantly with the increases in iodine-related knowledge score (P < 0.001). The third trimester was a significant risk factor for high UIC, whereas high iodine-related knowledge score, actively learning dietary knowledge and having a habit of consuming iodine-rich food were significant protective factors for high UIC (P < 0.05). CONCLUSIONS Iodine level is adequate among pregnant women in Shanghai during the first and the second trimesters, although it is is insufficient in the third trimester. Good iodine-related knowledge, attitudes and behaviours are important for pregnant women with respect to maintaining adequate urinary iodine.
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Affiliation(s)
- Z Wang
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Y Wu
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Z Shi
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - J Song
- Laboratory for the Determination of Biological Markers, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - G Wang
- Laboratory for the Determination of Biological Markers, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - C Xu
- Traditional Chinese Medicine Department, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Q Song
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - W Jin
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - X Cui
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - C Wu
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - J Zang
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - C Guo
- General Office, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
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Wang Z, Jin W, Zhu Z, Cui X, Song Q, Shi Z, Wu C, Zang J, Guo C. Relationship of household cooking salt and eating out on iodine status of pregnant women in environmental iodine-deficient coastal areas of China. Br J Nutr 2020; 124:971-978. [PMID: 32517819 DOI: 10.1017/s000711452000207x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
As city residents eat out more frequently, it is unknown that if iodised salt is still required in home cooking. We analysed the relationship of household salt and eating out on urinary iodine concentration (UIC) in pregnant women. A household condiment weighing method was implemented to collect salt data for a week. A household salt sample was collected. A urine sample was taken at the end of the week. Totally, 4640 participants were investigated. The median UIC was 139·1 μg/l in pregnant women and 148·7, 140·0 and 122·9 μg/l in the first, second and third trimesters. Median UIC in the third trimester was lower than in the other trimesters (P < 0·001). The usage rates of iodised (an iodine content ≥ 5·0 mg/kg) and qualified-iodised (an iodine content ≥ 21·0 mg/kg) salt were 73·9 and 59·3 %. The median UIC in the qualified-iodised salt group was higher than in the non-iodised group (P = 0·037). The median UIC in the non-iodised group who did not eat out was lower than in qualified-salt groups who both did and did not eat out (P = 0·007, <0·001). The proportion of qualified-iodised salt used in home cooking is low, but foods eaten out have universal salt iodisation according to the national compulsory policy. Household iodised salt did not play a decisive role in the iodine status of pregnant women. Pregnant women in their third trimester who are not eating out and using non-iodised salt at home require extra iodine.
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Affiliation(s)
- Zhengyuan Wang
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai200336, People's Republic of China
| | - Wei Jin
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai200336, People's Republic of China
| | - Zhenni Zhu
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai200336, People's Republic of China
| | - Xueying Cui
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai200336, People's Republic of China
| | - Qi Song
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai200336, People's Republic of China
| | - Zehuan Shi
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai200336, People's Republic of China
| | - Chunfeng Wu
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai200336, People's Republic of China
| | - Jiajie Zang
- Department of Nutrition and Health, Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai200336, People's Republic of China
| | - Changyi Guo
- General Office, Shanghai Municipal Center for Disease Control and Prevention, Shanghai200336, People's Republic of China
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