1
|
Nazeri P, Pearce EN, Farrokhzad N, Baghalha F, Shariat M, Azizi F. Do Postpartum Maternal Iodine Status or Supplementation Affect Thyroid Function After Delivery? A Systematic Review and Meta-Analysis. Biol Trace Elem Res 2024; 202:3425-3441. [PMID: 37966688 DOI: 10.1007/s12011-023-03934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023]
Abstract
The aim of this systematic review and meta-analysis was, for the first time, to explore whether postpartum maternal iodine status or supplementation is associated with thyroid function after delivery. The MEDLINE/PubMed, Web of Science, Embase, and Scopus were searched up to December 2021 to identify relevant studies. The pooled mean thyroid stimulating hormone (TSH), free thyroxine (fT4), and thyroxine (T4) concentrations and 95% confidence intervals (CIs) were estimated based on maternal urinary iodine concentration (UIC) (< 50, 50-100, 100-200, and > 200 µg/L) or breast milk iodine concentration (BMIC) (< 100 µg/L vs. ≥ 100 µg/L) during postpartum. A fixed/random effects model was used based on the absence/presence of heterogeneity, respectively. The study is registered with PROSPERO, number CRD42022336145. A total of 2175 studies were identified, of which 18 were eligible for the meta-analysis. The pooled values for TSH, fT4, and T4 concentrations in all subgroups were within the normal range; however, except for TSH, comparing the 95% CI showed no statistically significant difference among different subgroups. The pooled mean for TSH concentration in women with UIC > 200 µg/L was 2.23 mIU/L, whereas the corresponding values in women with UIC < 50, 50-100 and 100-200 µg/L were 0.56, 0.56 and 0.95 mIU/L, respectively. Thyroid hormones in women with BMIC < 100 µg/L and ≥ 100 µg/L were within the normal range. Iodine supplementation during postpartum was not associated with any differences in thyroid parameters, compared to non-supplemented women. In conclusion, iodine status or supplementation had no effect on thyroid hormones in postpartum women.
Collapse
Affiliation(s)
- Pantea Nazeri
- Breastfeeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes and Nutrition, Boston University Chobanian & Avedisian School of Medicine, Boston, USA.
| | - Nahid Farrokhzad
- Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Baghalha
- Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mamak Shariat
- Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Mathews DM, Peart JM, Sim RG, Johnson NP, O'Sullivan S, Derraik JGB, Hofman PL. The SELFI Study: Iodine Excess and Thyroid Dysfunction in Women Undergoing Oil-Soluble Contrast Hysterosalpingography. J Clin Endocrinol Metab 2022; 107:3252-3260. [PMID: 36124847 PMCID: PMC9693785 DOI: 10.1210/clinem/dgac546] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Hysterosalpingography (HSG) with oil-soluble contrast medium (OSCM) improves pregnancy rates. However, OSCM has high iodine content and long half-life, leading to potential iodine excess. OBJECTIVE This work aimed to determine the pattern of iodine excess after OSCM HSG and the effect on thyroid function. METHODS A prospective cohort study was conducted of 196 consecutive consenting eligible women without overt hypothyroidism or hyperthyroidism. All completed the study with compliance greater than 95%. Participants underwent OSCM HSG (Auckland, 2019-2021) with serial monitoring of thyrotropin (TSH), free thyroxine (FT4), and urine iodine concentration (UIC) for 24 weeks. The main outcome measure was the development of subclinical hypothyroidism (SCH), defined as a nonpregnant TSH greater than 4 mIU/L with normal FT4 (11-22 pmol/L) in those with normal baseline thyroid function. RESULTS Iodine excess (UIC ≥ 300 μg/L) was almost universal (98%) with UIC peaking usually by 4 weeks. There was marked iodine excess, with 90% and 17% of participants having UIC greater than or equal to 1000 μg/L and greater than 10 000 μg/L, respectively. Iodine excess was prolonged with 67% having a UIC greater than or equal to 1000 μg/L for at least 3 months. SCH developed in 38%; the majority (96%) were mild (TSH 4-10 mIU/L) and most developed SCH by week 4 (75%). Three participants met the current treatment guidelines (TSH > 10 mIU/L). Thyroxine treatment of mild SCH tended to improve pregnancy success (P = .063). Hyperthyroidism (TSH < 0.3 mIU/L) occurred in 9 participants (5%). CONCLUSION OSCM HSG resulted in marked and prolonged iodine excess. SCH occurred frequently with late-onset hyperthyroidism occasionally. Regular thyroid function tests are required for 6 months following this procedure.
Collapse
Affiliation(s)
- Divya M Mathews
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Jane M Peart
- Department of Radiology, Auckland Radiology Group, Auckland 1050, New Zealand
| | - Robert G Sim
- Department of Radiology, Auckland Radiology Group, Auckland 1050, New Zealand
| | - Neil P Johnson
- Department of Obstetrics and Gynecology, Robinson Research Institute, University of Adelaide, Adelaide, South Australia 5006, Australia
- Department of Reproductive Endocrinology and Fertility, Repromed Auckland and Auckland Gynecology Group, Auckland 1050, New Zealand
| | - Susannah O'Sullivan
- Department of Endocrinology, Greenlane Clinical Centre, Auckland District Health Board, Auckland 1051, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| |
Collapse
|
4
|
Mullan K, McMullan P, Kayes L, McCance D, Hunter A, Woodside JV. Thyroglobulin levels among iodine deficient pregnant women living in Northern Ireland. Eur J Clin Nutr 2022; 76:1542-1547. [PMID: 35513447 DOI: 10.1038/s41430-022-01144-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Iodine deficiency has re-emerged among pregnant cohorts in the UK. Thyroglobulin (Tg) is a protein produced uniquely by the thyroid gland which appears to mount a U-shaped response to extremes of iodine status. Tg has been suggested as an alternative marker for chronic iodine deficiency but the value of Tg in pregnancy has not been fully elucidated. A recent non-European study suggested a median Tg ≤10 µg/L with <3% of values >44 µg/L was indicative of sufficiency in the second trimester of pregnancy. METHODS We measured serum Tg levels in each trimester in 241 pregnant women living in Northern Ireland, a population with mild iodine deficiency at all stages of pregnancy as defined by urinary iodine concentration (UIC) and iodine: creatinine ratio (ICR). Women with Tg antibodies (6% in 1st trimester) were excluded. RESULTS The median UIC in this cohort was in the deficient range at 73, 94 and 117 µg/L in sequential trimesters (adequacy ≥ 150 µg/L). Corresponding median Tg levels were 19, 16 and 16 µg/L respectively. Median Tg for all samples was 17 μg/L (IQR 11-31) suggestive of iodine deficiency. Tg was >44 μg/L in 14.3%, 9.4% and 12.4% of women in sequential trimesters respectively. Women with either UIC/ICR below the cut-offs 150 µg/L and 150 µg/g creatinine had higher Tg concentrations in 1st and 2nd trimester (p < 0.01; p < 0.001) but not in 3rd trimester. CONCLUSION This study adds to the evolving evidence that Tg measurement is of value in reflecting iodine status in pregnancy.
Collapse
Affiliation(s)
- Karen Mullan
- Royal Victoria Hospital (Regional Centre for Endocrinology and Diabetes), Belfast, Antrim, UK
| | - Paul McMullan
- Royal Victoria Hospital (Regional Centre for Endocrinology and Diabetes), Belfast, Antrim, UK
| | - Lucy Kayes
- Royal Victoria Hospital (Regional Centre for Endocrinology and Diabetes), Belfast, Antrim, UK.
| | - David McCance
- Royal Victoria Hospital (Regional Centre for Endocrinology and Diabetes), Belfast, Antrim, UK
| | - Alyson Hunter
- Royal Jubilee Maternity Hospital, Royal Victoria Hospital, Belfast, Antrim, UK
| | - Jayne V Woodside
- Centre for Public Health, Institute of Clinical Science, Queens University Belfast, Belfast, UK
| |
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW Iodine deficiency is a global concern, and in recent years, there has been a significant improvement in the number of countries identified as being iodine-sufficient. This review considers the best strategies to ensure iodine sufficiency among breastfeeding women and their infants. RECENT FINDINGS Fortification strategies to improve iodine intake have been adequate for school-age children (SAC); however, often, iodine deficiency remains for breastfeeding women and their infants. Daily supplementation with iodine is not an ideal strategy to overcome deficiency. Countries defined as iodine-sufficient, but where pregnant and breastfeeding women have inadequate intake, should consider increasing salt iodine concentration, such that the median urinary iodine concentration of SAC can be up to 299 µg/L. This will ensure adequate intake for mothers and infants, without SAC being at risk thyroid dysfunction. Consensus is required for thresholds for iodine adequacy for breastfeeding women and infants.
Collapse
|
6
|
Tian W, Yan W, Liu Y, Zhou F, Wang H, Sun W. The Status and Knowledge of Iodine among Pregnant Women in Shanghai. Biol Trace Elem Res 2021; 199:4489-4497. [PMID: 33462796 DOI: 10.1007/s12011-021-02587-4] [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] [Received: 11/19/2020] [Accepted: 01/10/2021] [Indexed: 11/27/2022]
Abstract
Iodine plays an important role in thyroid function. However, in daily practices, people lack the related details including the knowledge concerned iodine usage, attitudes towards it, and practice among pregnant women. The aim of the present study is to assess the iodine status of pregnant women in Shanghai, and their knowledge regarding iodine, with the goal of investigating the relationship between iodine and thyroid function during pregnancy. This is a cross-sectional study. We recruited 3 groups of participants including 145 pregnant women (12-16 weeks gestation), 101 pregnant women (24-28 weeks gestation), and 108 pregnant women (34-38 weeks gestation). Iodine status and dietary intake were calculated from 24-h urinary iodine concentration (UIC). Knowledge regarding iodine was collected through a questionnaire. We additionally examined TSH, FT3, FT4, and TPOAb of the participants. The median of UIC of the 354 pregnant women was 119.2 μg/L, and 68.9% had urinary iodine levels below 150 μg/L. The proportion of daily iodized salt consumption in pregnant women was only 78.0%. The median UIC of the pregnant women who had consumed iodized salt was significantly higher than that of the pregnant women without iodized salt intake (Z = - 5.087, P < 0.001). Pregnant women in weeks 34-38 with a high level of knowledge had significantly lower TSH levels than those with low knowledge level (P = 0.046). Among the 349 pregnant women, few were aware of the harm to the fetus (8.3%). Significant differences were found in the scores for the knowledge level of women with different educational levels (Z = - 5.413, P < 0.001). Pregnant women in Shanghai have mild iodine deficiency. Approaches to improve iodine status among pregnant women in Shanghai include raising their awareness of iodine intake and changing their dietary habits. Otherwise, the risk of iodine deficiency in pregnant women may continue to increase.
Collapse
Affiliation(s)
- Wenxia Tian
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenqing Yan
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
| | - Yang Liu
- Obstetrics and Gynecology, Shanghai Sixth People's Hospital East Campus, Shanghai, China
| | - Fangfang Zhou
- Obstetrics and Gynecology, Shanghai Sixth People's Hospital East Campus, Shanghai, China
| | - Haixia Wang
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
| | - Wenguang Sun
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
- Shanghai Municipal Key Clinical Specialty, Shanghai, China.
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
7
|
Jin Y, Coad J, Zhou SJ, Skeaff S, Ramilan T, Brough L. Prevalence of thyroid dysfunction in postpartum women with suboptimal iodine and selenium and adequate iron status. Clin Endocrinol (Oxf) 2021; 95:873-881. [PMID: 34008190 DOI: 10.1111/cen.14502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Postpartum women experience thyroid dysfunction at twice the prevalence of the general population. Adequate biosynthesis of thyroid hormones depends on three trace elements: iodine, selenium and iron. This study aimed to investigate thyroid dysfunction within a cohort of women at six months postpartum in relation to iodine, selenium and iron status. DESIGN This cross-sectional study was part of an observational longitudinal cohort Mother and Infant Nutrition Investigation; data obtained at six months postpartum are reported. SUBJECTS Mother-infant pairs (n = 87) were recruited at three months postpartum and followed up at six months postpartum (n = 78). MEASUREMENTS Thyroid hormones (free triiodothyronine, free thyroxine, thyroid-stimulating hormone) and thyroid peroxidase antibodies were measured. Urinary iodine concentration, breast milk iodine concentration, serum thyroglobulin, plasma selenium, serum ferritin and serum soluble transferrin receptors were determined. Nonparametric data were expressed as median (25th, 75th percentile). RESULTS Thyroid dysfunction was found in 18% of women, and 4% of women had iron deficiency. Median urinary iodine concentration was 85 (43, 134) µg/L, median breast milk iodine concentration was 59 (39, 109) µg/L, and median serum thyroglobulin at 11.4 (8.6, 18.6) µg/L, indicating iodine deficiency. Median plasma selenium concentration was 105.8 (95.6, 115.3) µg/L. Women with marginally lower plasma selenium concentration were 1.12% times more likely to have abnormal TSH concentrations (p = .001). CONCLUSIONS There was a high prevalence of thyroid dysfunction. Plasma selenium concentration was the only significant predictor of the likelihood that women had thyroid dysfunction within this cohort, who were iodine deficient and mostly had adequate iron status. Strategies are required to improve both iodine and selenium status to better support maternal thyroid function.
Collapse
Affiliation(s)
- Ying Jin
- School of Health Sciences, College of Health, Massey University, Palmerston North, New Zealand
| | - Jane Coad
- Nutrition Science, School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North, New Zealand
| | - Shao J Zhou
- School of Agriculture, Food and Wine, Faculty of Sciences & Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Sheila Skeaff
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Thiagarajah Ramilan
- School of Agriculture and Environment, College of Sciences, Massey University, Palmerston North, New Zealand
- School of Agriculture and Food, The University of Melbourne, Victoria, Australia
| | - Louise Brough
- Nutrition Science, School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North, New Zealand
| |
Collapse
|
8
|
Jin Y, Coad J, Zhou SJ, Skeaff S, Benn C, Brough L. Use of Iodine Supplements by Breastfeeding Mothers Is Associated with Better Maternal and Infant Iodine Status. Biol Trace Elem Res 2021; 199:2893-2903. [PMID: 33094447 DOI: 10.1007/s12011-020-02438-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/11/2020] [Indexed: 12/21/2022]
Abstract
Adequate iodine status during conception, pregnancy and lactation is essential for supporting infant neurodevelopment. Iodine status in adults and children was improved after two New Zealand government initiatives, but the status of breastfeeding women is unknown. This study aimed to investigate the iodine intake and status of lactating mother-infant pairs at 3 months postpartum and to assess maternal iodine knowledge and practice. Iodine intake was estimated by a weighed 4-day diet diary (4DDD). Maternal urinary iodine concentrations (UIC) in spot urine, breast milk iodine concentrations (BMIC) and infant UIC were measured. Questions about iodine-specific knowledge and practice were asked. In 87 breastfeeding mother-infant pairs, maternal iodine intake was 151 (99, 285) μg/day, and 58% had an intake below the estimated average requirement (EAR) of 190 μg/day. Maternal median UIC (MUIC) was 82 (46, 157) μg/L indicating iodine deficiency (i.e., < 100 μg/L). Women who used iodine-containing supplements had a significantly higher MUIC (111 vs 68 μg/L, P = 0.023) and BMIC (84 vs 62 μg/L, P < 0.001) than non-users. Infants fed by women using iodine-containing supplements had a higher MUIC (150 vs 86 μg/L, P = 0.036) than those of non-users. A total of 66% (57/87) of women had no or low iodine knowledge. The iodine knowledge score was a statistically significant predictor of consuming iodine-containing supplements [(beta = 1.321, P = 0.008)]. Despite a decade of initiatives to increase iodine intakes in New Zealand, iodine knowledge was low; iodine intake and status of these lactating women were suboptimal, but women who used iodine-containing supplement were more likely to achieve adequate status.Study Registration Number (Australia and New Zealand Clinical Trials Registry): ACTRN12615001028594.
Collapse
Affiliation(s)
- Ying Jin
- School of Health Sciences, College of Health, Massey University, Palmerston North, New Zealand
| | - Jane Coad
- Nutrition Science, School of Food and Advance Technology, College of Sciences, Massey University, Private Bag 11 222, Palmerston North, 4474, New Zealand
| | - Shao J Zhou
- School of Agriculture, Food and Wine, Faculty of Sciences & Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Sheila Skeaff
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Cheryl Benn
- Mid Central and Whanganui District Health Board, Palmerston North, New Zealand
| | - Louise Brough
- Nutrition Science, School of Food and Advance Technology, College of Sciences, Massey University, Private Bag 11 222, Palmerston North, 4474, New Zealand.
| |
Collapse
|
9
|
Iodine status of postpartum women and their infants aged 3, 6 and 12 months: Mother and Infant Nutrition Investigation (MINI). Br J Nutr 2021; 127:570-579. [PMID: 33858523 DOI: 10.1017/s000711452100129x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To alleviate the re-emergence of iodine deficiency in New Zealand, two strategies, the mandatory fortification of bread with iodised salt (2009) and a government-subsidised iodine supplement for breast-feeding women (2010), were introduced. Few studies have investigated mother and infant iodine status during the first postpartum year; this study aimed to describe iodine status of mothers and infants at 3, 6 and 12 months postpartum (3MPP, 6MPP and 12MPP, respectively). Partitioning of iodine excretion between urine and breast milk of exclusive breast-feeding (EBF) women at 3MPP was determined. In total, eighty-seven mother-infant pairs participated in the study. Maternal and infant spot urinary iodine concentration (UIC) and breast milk iodine concentration (BMIC) were determined. The percentage of women who took iodine-containing supplements decreased from 46 % at 3MPP to 6 % at 12MPP. Maternal median UIC (MUIC) at 3MPP (82 (46, 157) µg/l), 6MPP (85 (43, 134) µg/l) and 12MPP (95 (51, 169) µg/l) were <100 µg/l. The use of iodine-containing supplements increased MUIC and BMIC only at 3MPP. Median BMIC at all time points were below 75 µg/l. Infant MUIC at 3MPP (115 (69, 182) µg/l) and 6MPP (120 (60, 196) µg/l) were below 125 µg/l. Among EBF women at 3MPP, an increased partitioning of iodine into breast milk (highest proportion 60 %) was shown at lower iodine intakes, along with a reduced fractional iodine excretion in urine (lowest proportion 40 %), indicating a protective mechanism for breastfed infants' iodine status. In conclusion, this cohort of postpartum women was iodine-deficient. Iodine status of their breastfed infants was suboptimal. Lactating women who do not consume iodine-rich foods and those who become pregnant again should take iodine-containing supplements.
Collapse
|
10
|
Zhou Y, Yan L, Li H, Li X, Liu Y, Liu J. Patterns and Determinants of Essential and Toxic Elements in Chinese Women at Mid-Pregnancy, Late Pregnancy, and Lactation. Nutrients 2021; 13:nu13020668. [PMID: 33669610 PMCID: PMC7922563 DOI: 10.3390/nu13020668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/06/2021] [Accepted: 02/12/2021] [Indexed: 12/13/2022] Open
Abstract
Maternal status of essential and toxic elements affects the health of the mother, developing fetus, or breastfeeding infant. However, few studies have examined the patterns of these elements and their determinants in pregnant or lactating women. Plasma samples of 1211 healthy mid-pregnant, late pregnant, and lactating women enrolled in coastland, lakeland, and inland areas of China from May–July 2014, were analyzed for concentrations of 15 elements, using inductively coupled plasma mass spectrometry. The adjusted median concentrations of elements varied by physiologic stage and region. Lactating versus pregnant women showed higher concentrations of Zn, Cr, Mo, Ni, Sb, Cd and Pb, but lower concentrations of Cu, I, Al and Hg. In pregnant women, the concentrations of Fe, Zn, I, Mo, Ni, Al, Hg and Cd were higher in mid- versus late-pregnancy. Overall, the highest concentrations were observed in Zn, I, Mn, Al, and Pb in coastland, in Hg in lakeland, and in Fe in inland area. Element concentrations varied by maternal age, pre-pregnancy BMI, education, parity, delivery mode, feeding practice, and intakes of aquatic products and mutton. In conclusion, essential and toxic elements coexisted in pregnant and lactating women, and their concentrations varied by physiologic stages, regions, maternal socio-demographic characteristics and dietary factors.
Collapse
Affiliation(s)
- Yubo Zhou
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.Z.); (H.L.); (X.L.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Lailai Yan
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing 100191, China; (L.Y.); (Y.L.)
- Medical and Health Analysis Center, School of Public Health, Peking University, Beijing 100191, China
- Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
| | - Hongtian Li
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.Z.); (H.L.); (X.L.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Xiucui Li
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.Z.); (H.L.); (X.L.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Yaqiong Liu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing 100191, China; (L.Y.); (Y.L.)
- Medical and Health Analysis Center, School of Public Health, Peking University, Beijing 100191, China
- Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
| | - Jianmeng Liu
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.Z.); (H.L.); (X.L.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Correspondence: ; Tel.: +86-10-82801136
| |
Collapse
|
11
|
Dietary Choices of New Zealand Women during Pregnancy and Lactation. Nutrients 2020; 12:nu12092692. [PMID: 32899261 PMCID: PMC7551142 DOI: 10.3390/nu12092692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/17/2022] Open
Abstract
Dietary recommendations during pregnancy and lactation have become increasingly complex, and sources of information more numerous but not always reliable, potentially causing confusion and unsafe choices. Women were recruited during pregnancy or within six months postpartum and completed questionnaires on dietary choices, food safety, and sources of nutrition information. Women (n = 458) from around New Zealand participated in the study. They consumed a wide range of foods and beverages and reported various dietary changes. In pregnancy, women commonly avoided alcohol (92%), raw milk products (86%), and raw, smoked, or pre-cooked seafood and fish (84%), and made changes due to food safety concerns. Influential advice was acquired from a range of sources including midwives (37%) and the New Zealand pregnancy and breastfeeding guidelines (25%) during pregnancy. Food avoidance was less common in lactation. However, fewer women consumed milk products during lactation (64%) than pregnancy (93%). Potentially unreliable sources were used more frequently in lactation including alternative health practitioners (26%) and family or friends (12%), and dietary changes were often made in response to infant symptoms without supporting evidence. This study highlighted a need for good communication of evidence-based recommendations to women, especially during lactation.
Collapse
|
12
|
Jin Y, Coad J, Zhou SJ, Skeaff S, Benn C, Kim N, Pond RL, Brough L. Mother and Infant Nutrition Investigation in New Zealand (MINI Project): Protocol for an Observational Longitudinal Cohort Study. JMIR Res Protoc 2020; 9:e18560. [PMID: 32852279 PMCID: PMC7484772 DOI: 10.2196/18560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/31/2022] Open
Abstract
Background Thyroid dysfunction is associated with cognitive impairment, mood disturbance, and postnatal depression. Sufficient thyroid hormone synthesis requires adequate intake of iodine, selenium, and iron. Iodine deficiency was historically a problem for New Zealand, and initiatives were introduced to overcome the problem: (1) mandatory fortification of all bread (except organic) with iodized salt (2009) and (2) provision of subsidized iodine supplements for pregnant and breastfeeding women (2010). Subsequent to these initiatives, most adults and children have adequate iodine status; however, status among breastfeeding women and their infants remains unclear. This paper outlines the methodology of the Mother and Infant Nutrition Investigation (MINI) study: an observational longitudinal cohort study of breastfeeding women and their infants. Objective This study will determine (1) women’s iodine intake and status among supplement users and nonusers; (2) women’s intake and status of iodine, selenium, and iron relating to thyroid function; (3) associations between women’s selenium status, thyroid function, and postnatal depression; (4) infants’ iodine and selenium status relating to first year neurodevelopment. Methods Breastfeeding women aged over 16 years with a healthy term singleton infant were recruited from Manawatu, New Zealand. Participants attended study visits 3, 6, and 12 months postpartum. Maternal questionnaires investigated supplement use before and after birth, iodine knowledge, and demographic information. Dietary assessment and urine, blood, and breast milk samples were taken to measure iodine, selenium, and iron intake/status. The Edinburgh Postnatal Depression Scale was used repeatedly to screen for postnatal depression. Thyroid hormones (free triiodothyronine, free thyroxine, thyroid stimulating hormone, thyroglobulin, antithyroglobulin antibodies, and antithyroid peroxidase) were measured in blood samples, and thyroid gland volume was measured by ultrasound at 6 months postpartum. Infant iodine and selenium concentrations were determined in urine. The Ages and Stages Questionnaire was used to assess infant development at 4, 8, and 12 months. Results Data collection was completed. Biological samples analysis, excluding nail clippings, is complete. Data analysis and presentation of the results will be available after 2020. Conclusions This study will provide data on the current iodine status of breastfeeding women. It will also provide a greater understanding of the three essential minerals required for optimal thyroid function among breastfeeding women. The prospective longitudinal design allows opportunities to examine women’s mental health and infant neurodevelopment throughout the first year, a crucial time for both mothers and their infants. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12615001028594; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369324 International Registered Report Identifier (IRRID) DERR1-10.2196/18560
Collapse
Affiliation(s)
- Ying Jin
- School of Health Sciences, College of Health, Massey University, Palmerston North, New Zealand
| | - Jane Coad
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North, New Zealand
| | - Shao J Zhou
- School of Agriculture, Food and Wine and Robinson Research Institute, Faculty of Sciences, University of Adelaide, Adelaide, Australia
| | - Sheila Skeaff
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Cheryl Benn
- MidCentral District Health Board, Palmerston North, New Zealand
| | - Nicholas Kim
- School of Health Sciences, College of Health, Massey University, Wellington, New Zealand
| | - Rachael L Pond
- Institute of Education, College of Humanities and Social Sciences, Massey University, Palmerston North, New Zealand
| | - Louise Brough
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North, New Zealand
| |
Collapse
|
13
|
Azzeh F, Refaat B. Iodine adequacy in reproductive age and pregnant women living in the Western region of Saudi Arabia. BMC Pregnancy Childbirth 2020; 20:370. [PMID: 32571259 PMCID: PMC7310473 DOI: 10.1186/s12884-020-03057-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 06/16/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the serious maternal and foetal complications associated with iodine deficiency during pregnancy, surveys related to pregnant women in the Kingdom of Saudi Arabia (KSA) are lacking. This study, therefore, measured urine iodine concentrations (UIC) alongside the potential socioeconomic factors contributing towards iodine inadequacy in reproductive age and pregnant Saudi women from the Western province of KSA. METHODS Spot urine samples were collected from 1222 pregnant and 400 age-matched non-pregnant/non-lactating reproductive age women. The socioeconomic characteristics were obtained through a structured questionnaire. The WHO criteria for iodine sufficiency in non-pregnant (100-199 μg/L) and pregnant (150-249 μg/L) women were applied. RESULTS The median UIC in the non-pregnant women (101.64 μg/L; IQR: 69.83-143.55) was at the lowermost WHO recommended cut-off, whereas the pregnant group was iodine deficient (112.99 μg/L; IQR: 81.01-185.57). Moreover, the median UIC was below adequacy across the different trimesters. The use of non-iodised salt significantly increased the risk of iodine deficiency in the non-pregnant (OR = 2.052; 95%CI: 1.118-3.766) and pregnant women (OR = 3.813; 95%CI: 1.992-7.297), whereas taking iodine supplements significantly lowered the risk in both groups (OR = 0.364; 95%CI: 0.172-0.771 and OR = 0.002; 95%CI: 0.001-0.005, respectively). Passive smoking was also an independent risk factor for iodine deficiency in the non-pregnant (OR = 1.818; 95%CI: 1.097-3.014) and pregnant (OR = 1.653; 95%CI: 1.043-2.618) groups. Additionally, BMI correlated independently and significantly with median UIC in the non-pregnant and pregnant populations. However, multiparity (OR = 3.091; 95%CI: 1.707-5.598) and earning below the minimum wage (2.520; 95%CI: 1.038-6.119) significantly increased the risk of iodine deficiency only in the non-pregnant women. CONCLUSIONS This study is the first to show borderline iodine sufficiency in reproductive age Saudi women from the Western province, whereas mild iodine deficiency was observed in the pregnant population and could represent a serious public health problem. This study also advocates the necessity to establish routine iodine dietary advice services by the health authorities to foster adequate iodine intake in pregnant women to avoid the perilous consequences of iodine deficiency on maternal-foetal health.
Collapse
Affiliation(s)
- Firas Azzeh
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, PO Box 7607, Makkah, Saudi Arabia
| | - Bassem Refaat
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, Holy Makkah, PO Box 7607, Makkah, Saudi Arabia.
| |
Collapse
|
14
|
Nazeri P, Shab-Bidar S, Pearce EN, Shariat M. Thyroglobulin Concentration and Maternal Iodine Status During Pregnancy: A Systematic Review and Meta-Analysis. Thyroid 2020; 30:767-779. [PMID: 31910106 DOI: 10.1089/thy.2019.0712] [Citation(s) in RCA: 7] [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: 12/17/2022]
Abstract
Background: Literature to date has been inconclusive regarding the value of thyroglobulin (Tg) as a marker of iodine status in pregnant women. This systematic review and meta-analysis is one of the first to assess whether Tg concentration accurately reflects iodine status among pregnant women. Methods: We searched MEDLINE, the Web of Science, the Cochrane Library, Scopus, and other relevant databases to identify relevant studies published in the English language, between January 1988 and December 2018. The criteria for study inclusion in the systematic review were human studies, healthy pregnant women as participants, and available data for maternal urinary iodine concentration (UIC) and Tg level. Each study was assessed for quality and risk of bias. The pooled mean Tg values, and 95% confidence intervals were estimated in a population of women with UIC <150 and UIC ≥150 μg/L during pregnancy. Potential linear or nonlinear dose-response associations between maternal UIC and Tg concentration were examined. Results: Of 814 identified studies, 25 were eligible for inclusion in the meta-analysis. Studies included were conducted in Africa, Asia, Europe, South America, and the Oceania. The pooled mean (95% confidence interval [CI]) Tg concentration in iodine-deficient pregnant women was higher than that in iodine-sufficient pregnant women (10.73 μg/L [5.65-15.82] vs. 7.34 μg/L [2.20-12.47]); a comparison of the 95% CI showed that none of these values was significantly different. No significant differences were observed in Tg concentration between the two groups in each trimester of pregnancy. Dose-response meta-analyses revealed a significant nonlinear association between maternal UIC and Tg concentration during pregnancy. Among populations of pregnant women, an inverse association was found between UIC values <100 μg/L and Tg concentration (p-linearity = 0.007; p-nonlinearity = 0.027); however, higher values of UIC were not associated with Tg concentration. Conclusions: Our meta-analysis showed that Tg concentration can be a sensitive indicator of iodine deficiency, specifically in populations of pregnant women with median UIC <100 μg/L. Further studies are warranted to determine the sensitivity of Tg at different degrees of iodine deficiency during pregnancy.
Collapse
Affiliation(s)
- Pantea Nazeri
- Family Health Institute, Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Mamak Shariat
- Family Health Institute, Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
15
|
Adalsteinsdottir S, Tryggvadottir EA, Hrolfsdottir L, Halldorsson TI, Birgisdottir BE, Hreidarsdottir IT, Hardardottir H, Arohonka P, Erlund I, Gunnarsdottir I. Insufficient iodine status in pregnant women as a consequence of dietary changes. Food Nutr Res 2020; 64:3653. [PMID: 31983913 PMCID: PMC6958617 DOI: 10.29219/fnr.v64.3653] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 02/05/2023] Open
Abstract
Background Historically, Iceland has been an iodine-sufficient nation due to notably high fish and milk consumption. Recent data suggest that the intake of these important dietary sources of iodine has decreased considerably. Objective To evaluate the iodine status of pregnant women in Iceland and to determine dietary factors associated with risk for deficiency. Methods Subjects were women (n = 983; 73% of the eligible sample) attending their first ultrasound appointment in gestational weeks 11–14 in the period October 2017–March 2018. Spot urine samples were collected for assessment of urinary iodine concentration (UIC) and creatinine. The ratio of iodine to creatinine (I/Cr) was calculated. Median UIC was compared with the optimal range of 150–249 μg/L defined by the World Health Organization (WHO). Diet was assessed using a semiquantitative food frequency questionnaire (FFQ), which provided information on main dietary sources of iodine in the population studied (dairy and fish). Results The median UIC (95% confidence interval (CI)) and I/Cr of the study population was 89 μg/L (42, 141) and 100 (94, 108) μg/g, respectively. UIC increased with higher frequency of dairy intake, ranging from median UIC of 55 (35, 79) μg/L for women consuming dairy products <1 time per week to 124 (98, 151) μg/L in the group consuming dairy >2 times per day (P for trend <0.001). A small group of women reporting complete avoidance of fish (n = 18) had UIC of 50 (21, 123) μg/L and significantly lower I/Cr compared with those who did not report avoidance of fish (58 (34, 134) μg/g vs. 100 (94, 108) μg/g, P = 0.041). Women taking supplements containing iodine (n = 34, 3.5%) had significantly higher UIC compared with those who did not take supplements (141 (77, 263) μg/L vs. 87 (82, 94), P = 0.037). Conclusion For the first time, insufficient iodine status is being observed in an Icelandic population. There is an urgent need for a public health action aiming at improving iodine status of women of childbearing age in Iceland.
Collapse
Affiliation(s)
- Solveig Adalsteinsdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Ellen Alma Tryggvadottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Laufey Hrolfsdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,Institution of Health Science Research, University of Akureyri and Akureyri Hospital, Akureyri, Iceland
| | - Thorhallur I Halldorsson
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Bryndis Eva Birgisdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | | | - Hildur Hardardottir
- Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland Reykjavík, Iceland
| | - Petra Arohonka
- Forensic Toxicology Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Iris Erlund
- Forensic Toxicology Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Ingibjorg Gunnarsdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
16
|
Zhou H, Ma ZF, Lu Y, Pan B, Shao J, Wang L, Du Y, Zhao Q. Assessment of Iodine Status among Pregnant Women and Neonates Using Neonatal Thyrotropin (TSH) in Mainland China after the Introduction of New Revised Universal Salt Iodisation (USI) in 2012: A Re-Emergence of Iodine Deficiency? Int J Endocrinol 2019; 2019:3618169. [PMID: 31687019 PMCID: PMC6800896 DOI: 10.1155/2019/3618169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/02/2019] [Accepted: 09/11/2019] [Indexed: 12/11/2022] Open
Abstract
Iodine deficiency during pregnancy can cause iodine deficiency disorders (IDD). However, it is unclear about iodine and thyroid status of Chinese pregnant women and neonates after the implementation of the revised universal salt iodisation (USI) level in 2012. Therefore, the aim of the cross-sectional study was to determine iodine nutrition and thyroid status among pregnant women and their neonates in China after the implementation of USI. Medical records of pregnant women and neonates in Northern Jiangsu People's Hospital between January 2016 and December 2017 were reviewed and included. We included 3060 mother-and-newborn pairs in the study. Mean age of participants was 28.2 ± 4.1 years. TSH, FT3, and FT4 of participants were within normal reference range. The overall mean neonatal TSH, birth weight, and prevalence of low birth weight (LBW) were 4.86 ± 2.06 mIU/L, 3358 ± 455 g, and 3.2%, respectively. The prevalence of neonatal TSH values >5 mIU/L was 29.3%, suggesting iodine deficiency in the region. In conclusion, our results indicated iodine deficiency in the region, according to the neonatal TSH cutoff recommended by WHO/UNICEF/IGD. More efforts are urgently required to improve iodine status of pregnant women in the region in order to prevent a re-emergence of iodine deficiency.
Collapse
Affiliation(s)
- Hang Zhou
- Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
- Department of Clinical Nutrition, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China
| | - Zheng Feei Ma
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou 215123, Jiangsu Province, China
| | - Yiming Lu
- Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
- Department of Orthopedics, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China
| | - Binyu Pan
- Department of Clinical Nutrition, The First People's Hospital of Wujiang District, Suzhou 215200, Jiangsu Province, China
| | - Jian Shao
- Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
- Department of Clinical Nutrition, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China
| | - Liya Wang
- Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
- Department of Clinical Nutrition, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China
| | - Yanyan Du
- Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
- Department of Clinical Nutrition, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China
| | - Qihua Zhao
- Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
- Department of Clinical Nutrition, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China
| |
Collapse
|
17
|
Jin Y, Coad J, Weber JL, Thomson JS, Brough L. Selenium Intake in Iodine-Deficient Pregnant and Breastfeeding Women in New Zealand. Nutrients 2019; 11:nu11010069. [PMID: 30609662 PMCID: PMC6356683 DOI: 10.3390/nu11010069] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/22/2022] Open
Abstract
Selenium plays a role in antioxidant status and, together with iodine, in thyroid function. Iodine deficiency exists in New Zealand during pregnancy and lactation, and selenium deficiency may further affect thyroid function. This study investigated selenium intakes of pregnant and lactating women, in Palmerston North, in the North Island of New Zealand. Dietary intake was estimated using three repeated 24-h dietary recalls. Dietary intake in pregnancy was also estimated from 24-h urinary excretion of selenium. Selenium concentrations were determined in urine and breastmilk using inductively-coupled plasma mass spectrometry. Median selenium intakes based on dietary data were 51 (39, 65) μg/day in pregnancy and 51 (36, 80) μg/day in lactation, with 61% and 68% below estimated average requirement (EAR). Median daily selenium intake in pregnancy based on urinary excretion was 49 (40, 60) µg/day, with 59% below EAR. Median selenium concentration in breastmilk was 11 (10, 13) µg/L and estimated median selenium intake for infants was 9 (8, 10) µg/day, with 91% below the Adequate Intake of 12 μg/day. These pregnant and breastfeeding women were at risk of dietary selenium inadequacy. Further research is required to assess selenium status in relation to thyroid function and health in this group.
Collapse
Affiliation(s)
- Ying Jin
- School of Health Sciences, College of Health, Massey University, Palmerston North 4442, New Zealand.
| | - Jane Coad
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North 4442, New Zealand.
| | - Janet L Weber
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North 4442, New Zealand.
| | - Jasmine S Thomson
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North 4442, New Zealand.
| | - Louise Brough
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North 4442, New Zealand.
| |
Collapse
|
18
|
Butts CA, Hedderley DI, Herath TD, Paturi G, Glyn-Jones S, Wiens F, Stahl B, Gopal P. Human Milk Composition and Dietary Intakes of Breastfeeding Women of Different Ethnicity from the Manawatu-Wanganui Region of New Zealand. Nutrients 2018; 10:nu10091231. [PMID: 30181524 PMCID: PMC6164561 DOI: 10.3390/nu10091231] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 08/28/2018] [Accepted: 08/31/2018] [Indexed: 01/12/2023] Open
Abstract
Human milk is nutrient rich, complex in its composition, and is key to a baby’s health through its role in nutrition, gastrointestinal tract and immune development. Seventy-eight mothers (19–42 years of age) of Asian, Māori, Pacific Island, or of European ethnicity living in Manawatu-Wanganui, New Zealand (NZ) completed the study. The women provided three breast milk samples over a one-week period (6–8 weeks postpartum), completed a three-day food diary and provided information regarding their pregnancy and lactation experiences. The breast milk samples were analyzed for protein, fat, fatty acid profile, ash, selected minerals (calcium, magnesium, selenium, zinc), and carbohydrates. Breast milk nutrient profiles showed no significant differences between the mothers of different ethnicities in their macronutrient (protein, fat, carbohydrate, and moisture) content. The breast milk of Asian mothers contained significantly higher levels of polyunsaturated fatty acids (PUFAs), omega-3 (n-3) and omega-6 (n-6) fatty acids, docosahexaenoic acid (DHA), and linoleic acids. Arachidonic acid was significantly lower in the breast milk of Māori and Pacific Island women. Dietary intakes of protein, total energy, saturated and polyunsaturated fat, calcium, phosphorus, zinc, iodine, vitamin A equivalents, and folate differed between the ethnic groups, as well as the number of serves of dairy foods, chicken, and legumes. No strong correlations between dietary nutrients and breast milk components were found.
Collapse
Affiliation(s)
- Christine A Butts
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Duncan I Hedderley
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Thanuja D Herath
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Gunaranjan Paturi
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 92169, Auckland 1142, New Zealand.
| | - Sarah Glyn-Jones
- Danone Nutricia NZ Limited, 56-58 Aintree Avenue, Mangere, Auckland 2022, New Zealand.
| | - Frank Wiens
- Danone Nutricia Research, Upsalalaan 12, 3584 CT Utrecht, The Netherlands.
| | - Bernd Stahl
- Danone Nutricia Research, Upsalalaan 12, 3584 CT Utrecht, The Netherlands.
| | - Pramod Gopal
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.
- Riddet Institute, Massey University, Palmerston North 4442, New Zealand.
| |
Collapse
|
19
|
Yu Y, Wang Y, Wang Y, Dong J, Min H, Chen J. Maternal marginal iodine deficiency delays cerebellar Bergmann glial cell development in rat offspring: Involvement of Notch signaling pathway. Neurotoxicology 2018; 68:159-166. [PMID: 30121210 DOI: 10.1016/j.neuro.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 12/24/2022]
Abstract
During early pregnancy, iodine deficiency (ID) is linked to adverse effects on child motor and psychomotor function. Maternal marginal ID has become a common public health problem. It is unclear whether marginal ID influences the development of the cerebellum or its underlying mechanisms. Thus, the purpose of this study was to determine the effects of marginal ID on the development of cerebellar Bergmann glial cells (BGs) and investigate the activation of the Notch signaling pathway, which is crucial for the development and morphology of BGs. We treated Wistar rats with an ID diet (iodine content 60 ± 1.5 ng/g) supplemented with deionized water containing different concentrations of potassium iodide (KI) (183, 117, and 0 μg/L for the control, marginal ID, and severe ID groups, respectively) during pregnancy and lactation. We explored the morphology of the BGs by Golgi-Cox staining and immunofluorescence and investigated the Notch signaling pathway using western blot. Our results showed that the marginal ID and severe ID groups had decreased cerebellar BG fiber lengths (P < 0.05 and 0.01, respectively) and numbers (P < 0.01 for both) on postnatal day (PN) 7, PN14, and PN21 compared to the control group. Moreover, the data showed that severe ID significantly reduced Dll1, Notch1, RBP-Jκ, and BLBP protein levels at all three time points. Marginal ID slightly reduced the expression of Notch1 on PN7 (P < 0.05) and PN21 (P < 0.01), RBP-Jκ on PN14 (P < 0.01) and PN21 (P < 0.05), and BLBP on PN7 (P < 0.05). There was no significant difference in Dll1 protein levels between the marginal ID and control groups at any time point. Our study suggests that marginal ID leads to mild damage to BG morphogenesis in the cerebellum. The abnormal regulation of the Notch signaling pathway may be involved in the damage to BGs.
Collapse
Affiliation(s)
- Ye Yu
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang, PR China
| | - Yuan Wang
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang, PR China
| | - Yi Wang
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang, PR China
| | - Jing Dong
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang, PR China
| | - Hui Min
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang, PR China
| | - Jie Chen
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang, PR China.
| |
Collapse
|
20
|
Henjum S, Brantsæter AL, Kurniasari A, Dahl L, Aadland EK, Gjengedal ELF, Birkeland S, Aakre I. Suboptimal Iodine Status and Low Iodine Knowledge in Young Norwegian Women. Nutrients 2018; 10:nu10070941. [PMID: 30037088 PMCID: PMC6073112 DOI: 10.3390/nu10070941] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 11/18/2022] Open
Abstract
Previous studies have documented mild to moderate iodine deficiency in pregnant and lactating women in Norway. This study focused on non-pregnant young women because their future children may be susceptible to the adverse effects of iodine deficiency. We assessed urinary iodine concentration (UIC), iodine intake from food and supplements, and iodine knowledge in 403 non-pregnant women, mainly students, aged 18–30 years. Iodine concentration was measured in spot urine samples analyzed by inductively coupled plasma mass spectrometry and iodine intake was calculated from a self-reported food frequency questionnaire. Knowledge about iodine was collected through the self-administered, paper-based questionnaire. Median (p25–p75) UIC was 75 (42–130) µg/L and 31% had UIC < 50 µg/L. Habitual iodine intake was 100 (69–136) µg/day. In multiple regression models, supplemental iodine, use of thyroid medication, and iodine intake from food were positively associated with UIC, while vegetarian practice was negatively associated, explaining 16% of the variance. Approximately 40% of the young women had low iodine knowledge score and no differences were found between women in different study programs. Young women in Norway are mild to moderately iodine-deficient, and public health strategies are needed to improve and secure adequate iodine status.
Collapse
Affiliation(s)
- Sigrun Henjum
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, 0310 Oslo, Norway.
| | - Anne Lise Brantsæter
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, 0403 Oslo , Norway.
| | - Astrid Kurniasari
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, 0310 Oslo, Norway.
| | - Lisbeth Dahl
- Institute of Marine Research (IMR), P.O. Box 1870 Nordnes, 5817 Bergen, Norway.
| | - Eli Kristin Aadland
- Faculty of Education, Western Norway University of Applied Sciences, 5063 Bergen, Norway, .
| | - Elin Lovise Folven Gjengedal
- Faculty of Environmental Sciences and Natural Resource Management, Norwegian University of Life Sciences, Aas 1433, Norway.
| | - Susanne Birkeland
- Faculty of Environmental Sciences and Natural Resource Management, Norwegian University of Life Sciences, Aas 1433, Norway.
| | - Inger Aakre
- Institute of Marine Research (IMR), P.O. Box 1870 Nordnes, 5817 Bergen, Norway.
| |
Collapse
|
21
|
Nazeri P, Kabir A, Dalili H, Mirmiran P, Azizi F. Breast-Milk Iodine Concentrations and Iodine Levels of Infants According to the Iodine Status of the Country of Residence: A Systematic Review and Meta-Analysis. Thyroid 2018; 28:124-138. [PMID: 29334343 DOI: 10.1089/thy.2017.0403] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Iodine, an essential micronutrient, plays a critical role in normal growth and development, especially during the first two years of life. This systematic review and meta-analysis is among the first to evaluate breast-milk iodine concentrations and infant iodine status in countries characterized by iodine sufficiency or deficiency. METHODS PubMed, Web of Science, Cochrane Library, Google Scholar, and other relevant databases, as well as reference lists of previous reviews, were searched for relevant studies published between 1986 and 2016. Mean or median breast-milk and infant urinary iodine concentrations, along with other relevant data, were extracted from eligible studies. Each study was assessed for quality and risk of bias. RESULTS Of the 496 identified studies, 57 met the criteria for inclusion in the meta-analysis. The mean (confidence interval [CI]) iodine concentrations in maternal colostrum were 152.0 μg/L [CI 106.2-198.7 μg/L] and 57.8 μg/L [CI 41.4-74.1 μg/L] in iodine-sufficient and -deficient countries, respectively, indicating a significant difference between the two iodine statuses. By contrast, the corresponding values in mature milk did not differ significantly between mothers in iodine-sufficient and -deficient countries (71.5 μg/L [CI 51.0-92.0 μg/L] and 28.0 μg/L [CI -13.8 to 69.9 μg/L], respectively]. The weighted urinary iodine levels [CIs] of breast-fed infants in iodine-sufficient countries were significantly higher than those in iodine-deficient countries (164.5 μg/L [CI 116.4-212.7 μg/L] vs. 70.4 μg/L [CI 46.2-94.6 μg/L]). Similarly, a significant difference was observed in the pooled estimates of urinary iodine levels [CIs] among formula-fed infants in iodine-sufficient versus iodine-deficient countries (310.3 μg/L [CI 287.4-342.1 μg/L] vs. 38.3 μg/L [CI 23.4-53.2 μg/L]). CONCLUSION The meta-analysis reveals that in iodine-sufficient countries, the mean iodine concentrations in colostrum and mature breast milk corresponded to iodine sufficiency among infants. The results are thus compatible with the international recommendation that lactating women and infants younger than two years of age who reside in iodine-sufficient countries do not require iodine supplementation.
Collapse
Affiliation(s)
- Pantea Nazeri
- 1 Family Health Institute, Breastfeeding Research Center, Tehran University of Medical Sciences , Tehran, Iran
- 2 Nutrition and Endocrine Research Center, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Ali Kabir
- 3 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences , Tehran, Iran
| | - Hosein Dalili
- 1 Family Health Institute, Breastfeeding Research Center, Tehran University of Medical Sciences , Tehran, Iran
| | - Parvin Mirmiran
- 2 Nutrition and Endocrine Research Center, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Fereidoun Azizi
- 4 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| |
Collapse
|
22
|
Reynolds AN, Skeaff SA. Maternal adherence with recommendations for folic acid and iodine supplements: A cross-sectional survey. Aust N Z J Obstet Gynaecol 2017; 58:125-127. [PMID: 28990157 DOI: 10.1111/ajo.12719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/23/2017] [Indexed: 11/29/2022]
Abstract
We conducted a survey of 535 New Zealand women to determine supplement use pre-pregnancy, during pregnancy and while breastfeeding to evaluate adherence with national recommendations for folic acid and iodine supplementation. Our findings suggest that despite these women being well-educated and motivated to complete an online survey, there was low adherence to recommendations for folic acid and iodine supplements. Only 38% of women reported supplement intake that met both folic acid and iodine recommendations. This cross-sectional survey provides information useful to policy makers, clinicians and researchers seeking to protect and promote maternal and infant health.
Collapse
Affiliation(s)
- Andrew N Reynolds
- Department of Human Nutrition, University of Otago, Otago, New Zealand.,Edgar National Centre for Diabetes and Obesity Research, University of Otago, Otago, New Zealand
| | - Sheila A Skeaff
- Department of Human Nutrition, University of Otago, Otago, New Zealand
| |
Collapse
|
23
|
Mridha MK, Matias SL, Paul RR, Hussain S, Khan MSA, Siddiqui Z, Ullah B, Sarker M, Hossain M, Young RT, Arnold CD, Dewey KG. Daily Consumption of Lipid-Based Nutrient Supplements Containing 250 μg Iodine Does Not Increase Urinary Iodine Concentrations in Pregnant and Postpartum Women in Bangladesh. J Nutr 2017; 147:1586-1592. [PMID: 28615379 DOI: 10.3945/jn.117.248963] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/03/2017] [Accepted: 05/22/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Maternal iodine deficiency during pregnancy and lactation is common in Bangladesh.Objective: We evaluated the effect of lipid-based nutrient supplements for pregnant and lactating women (LNS-PL) on urinary iodine concentration (UIC).Methods: We conducted a cluster-randomized controlled effectiveness trial in which we enrolled 4011 pregnant women at ≤20 gestational weeks. Women in 48 clusters received iron and folic acid (IFA; 60 mg Fe/d + 400 μg folic acid/d) and women in 16 clusters received LNS-PL (20 g/d, 118 kcal) containing 22 vitamins and minerals (including 250 μg I). We randomly selected a subsample of 1159 women for repeated urine sample collection, i.e., at enrollment, at 36 wk of gestation, and at 6 mo postpartum, for UIC analysis, a secondary outcome of the trial.Results: The geometric mean UIC at 36 wk of gestation and at 6 mo postpartum did not differ significantly between the IFA and LNS-PL groups. The median (quartile 1, quartile 3) UIC at 36 wk was 27.4 μg/L (16.9, 52.7 μg/L) in the IFA group and 30.2 μg/L (17.7, 56.6 μg/L) in the LNS-PL group; at 6 mo, these were 23.0 μg/L (10.0, 45.9 μg/L) in the IFA group and 22.2 μg/L (9.1, 50.4 μg/L) in the LNS-PL group.Conclusion: Daily consumption of LNS-PL containing 250 μg I did not increase the UICs of pregnant and lactating women in Bangladesh. Iodine from lipid-based nutrient supplements may have been stored in the thyroid gland or secreted in breast milk instead of being excreted in urine. Additional research that uses other biomarkers of iodine status is needed to determine how to meet the iodine requirements of pregnant and lactating women in Bangladesh and similar settings. This trial was registered at clinicaltrials.gov as NCT01715038.
Collapse
Affiliation(s)
- Malay K Mridha
- Department of Nutrition, University of California, Davis, Davis, CA; and .,Divisions of Nutrition and Clinical Services
| | - Susana L Matias
- Department of Nutrition, University of California, Davis, Davis, CA; and
| | | | | | - Md Showkat Ali Khan
- Health System and Population Studies, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Zakia Siddiqui
- Health System and Population Studies, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Barkat Ullah
- Department of Nutrition, University of California, Davis, Davis, CA; and
| | | | | | - Rebecca T Young
- Department of Nutrition, University of California, Davis, Davis, CA; and
| | - Charles D Arnold
- Department of Nutrition, University of California, Davis, Davis, CA; and
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA; and
| |
Collapse
|
24
|
Knowledge about Iodine in Pregnant and Lactating Women in the Oslo Area, Norway. Nutrients 2017; 9:nu9050493. [PMID: 28505075 PMCID: PMC5452223 DOI: 10.3390/nu9050493] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 12/24/2022] Open
Abstract
Background: Lack of knowledge about iodine may be a risk factor for iodine deficiency in pregnant and lactating women. The aim of this study was to assess knowledge about iodine and predictors of iodine knowledge scores among pregnant and lactating women. The study also examined whether iodine knowledge scores were associated with iodine status. Methods: A cross-sectional study was performed on 804 pregnant women and 175 lactating women from 18 to 44 years of age in 2016 in the Oslo area, Norway. Knowledge about iodine was collected through a self-administered, paper-based questionnaire. Iodine concentrations in urine and breast milk were measured using an inductively coupled plasma mass spectrometer (ICPMS). Results: 74% of the pregnant women and 55% of the lactating women achieved none to low iodine knowledge scores. Higher educated pregnant women and those who had received information about iodine had significantly higher knowledge scores. In lactating women, increased age was associated with higher knowledge scores. Knowledge scores were not associated with participants’ iodine status. Conclusion: This study revealed a lack of knowledge about the importance of iodine in pregnant and lactating women, as well as about the most important dietary sources. Public education initiatives are required to increase the awareness about iodine in these population groups.
Collapse
|
25
|
Sun D, Codling K, Chang S, Zhang S, Shen H, Su X, Chen Z, Scherpbier RW, Yan J. Eliminating Iodine Deficiency in China: Achievements, Challenges and Global Implications. Nutrients 2017; 9:E361. [PMID: 28379180 PMCID: PMC5409700 DOI: 10.3390/nu9040361] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 11/30/2022] Open
Abstract
The prevention of iodine deficiency through salt iodization has been recognized as a global success story, and China stands at the forefront of this achievement with one of the most successful programs in the world. High level political commitment, national mandatory legislation, a state-managed edible salt industry and a complex and highly sophisticated surveillance system have facilitated the success of the program. Challenges have arisen however, including: (i) concern that adequate iodine status in pregnant women cannot be achieved without causing above adequate iodine intakes in children; (ii) declining iodine intake as a result of reductions in salt consumption and increased consumption of processed foods, which may not be made with iodized salt; (iii) the existence of areas with high iodine content in the water; and (iv) declines in household use of iodized salt due to concerns about excess iodine intake and thyroid disease. This article reviews the achievements and challenges of the Chinese Iodine Deficiency Disorders (IDD) Elimination Program and reflects on lessons learned and implications for other national salt iodization programs.
Collapse
Affiliation(s)
- Dianjun Sun
- Centre for Endemic Disease Control, China Chinese Centre for Disease Control and Prevention, Harbin Medical University, 157 Baojian Road, Harbin 150081, China.
| | - Karen Codling
- United Nations Children's Fund, 12 Sanlitun Lu, Beijing 100600, China.
- Iodine Global Network, P.O. Box 51030, 375 des Epinettes, Ottawa, ON K1E 3E6, Canada.
| | - Suying Chang
- United Nations Children's Fund, 12 Sanlitun Lu, Beijing 100600, China.
| | - Shubin Zhang
- Parasitic and Endemic Disease Prevention and Control Division of the National Health and Family Planning Commission of China, 14 Zhichun Road, Beijing 100088, China.
| | - Hongmei Shen
- Centre for Endemic Disease Control, China Chinese Centre for Disease Control and Prevention, Harbin Medical University, 157 Baojian Road, Harbin 150081, China.
| | - Xiaohui Su
- Centre for Endemic Disease Control, China Chinese Centre for Disease Control and Prevention, Harbin Medical University, 157 Baojian Road, Harbin 150081, China.
| | - Zupei Chen
- Iodine Global Network, P.O. Box 51030, 375 des Epinettes, Ottawa, ON K1E 3E6, Canada.
| | - Robert W Scherpbier
- Iodine Global Network, P.O. Box 51030, 375 des Epinettes, Ottawa, ON K1E 3E6, Canada.
| | - Jun Yan
- Parasitic and Endemic Disease Prevention and Control Division of the National Health and Family Planning Commission of China, 14 Zhichun Road, Beijing 100088, China.
| |
Collapse
|
26
|
Bath SC, Pop VJM, Furmidge-Owen VL, Broeren MAC, Rayman MP. Thyroglobulin as a Functional Biomarker of Iodine Status in a Cohort Study of Pregnant Women in the United Kingdom. Thyroid 2017; 27:426-433. [PMID: 27762729 PMCID: PMC5337401 DOI: 10.1089/thy.2016.0322] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Though iodine deficiency in pregnancy is a matter of public-health concern, a functional measure of iodine status is lacking. The thyroid-specific protein thyroglobulin (Tg), which reflects thyroid size, has shown promise as a functional measure in studies of children and adults, but data in pregnancy are sparse. In a cohort of mildly to moderately iodine-deficient pregnant women, this study aimed to explore whether serum Tg is a sensitive functional biomarker of iodine status and to examine longitudinal change in Tg with gestational age. METHOD A total of 230 pregnant women were recruited at an antenatal clinic at 12 weeks of gestation to the Selenium in PRegnancy INTervention study, in Oxford, United Kingdom. Repeated measures of urinary iodine-to-creatinine ratio, serum thyrotropin (TSH), and Tg at 12, 20, and 35 weeks of gestation were made. Women were dichotomized by their iodine-to-creatinine ratio (<150 or ≥150 μg/g) to group them broadly as iodine deficient or iodine sufficient. Women with thyroid antibodies were excluded; data and samples were available for 191 women. RESULTS Median Tg concentrations were 21, 19, and 23 μg/L in the first, second, and third trimesters, respectively. In a linear mixed model, controlling for confounders, Tg was higher in the <150 μg/g group than it was in the ≥150 μg/g group (p < 0.001) but there was no difference in TSH (p = 0.27). Gestational week modified the effect of iodine status on TSH (p = 0.01) and Tg (p = 0.012); Tg did not increase with gestational week in the ≥150 μg/g group, but it did in the <150 μg/g group, and TSH increased more steeply in the <150 μg/g group. CONCLUSIONS Low iodine status (<150 μg/g) in pregnancy is associated with higher serum Tg, suggesting that the thyroid is hyperstimulated by iodine deficiency, which causes it to enlarge. Tg is a more sensitive biomarker of iodine status in pregnancy than is TSH.
Collapse
Affiliation(s)
- Sarah C Bath
- 1 Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey , Guildford, United Kingdom
| | - Victor J M Pop
- 2 Department of Primary Care, University of Tilburg , Tilburg, The Netherlands
| | - Victoria L Furmidge-Owen
- 1 Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey , Guildford, United Kingdom
- 3 Danone Nutricia Early Life Nutrition , Trowbridge, United Kingdom
| | - Maarten A C Broeren
- 4 Department of Clinical Chemistry, Máxima Medical Center , Veldhoven, The Netherlands
| | - Margaret P Rayman
- 1 Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey , Guildford, United Kingdom
| |
Collapse
|
27
|
Nazeri P, Mirmiran P, Tahmasebinejad Z, Hedayati M, Delshad H, Azizi F. The Effects of Iodine Fortified Milk on the Iodine Status of Lactating Mothers and Infants in an Area with a Successful Salt Iodization Program: A Randomized Controlled Trial. Nutrients 2017; 9:nu9020180. [PMID: 28241419 PMCID: PMC5331611 DOI: 10.3390/nu9020180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/06/2017] [Accepted: 02/17/2017] [Indexed: 11/20/2022] Open
Abstract
Iodine deficiency during the first two years of life may cause irreversible brain damage and mental retardation. The aim of the present study was to investigate, for the first time, the effect of iodine fortified milk on the iodine status of lactating mothers and their infants. In this multicenter randomized controlled trial, 84 lactating mother-infant pairs from health care centers were randomly selected. After meeting the inclusion criteria, lactating mothers were randomly assigned to two groups: the iodine fortified milk group and the control group (n = 42 each). Maternal and infant urine and breast milk samples were collected at 3–5 (baseline), 7, 10, 14 days, and 1 month postpartum, for a measurement of the iodine concentration. A total of 84 lactating mothers, with a mean age of 28.2 ± 4.5 years, and 84 infants, with a mean age of 4.2 ± 0.7 days, were included in the study. Compared to mothers of the control group, mothers receiving iodine fortified milk had higher urinary (p < 0.001) and breast milk (p < 0.001) iodine concentrations. Urinary iodine levels in infants revealed no significant differences between the two groups. The findings of this study indicate that supplementation with daily iodine fortified milk provides iodine nutrition adequacy among lactating mothers. However, it had no effect on the iodine status of infants, who were previously iodine sufficient.
Collapse
Affiliation(s)
- Pantea Nazeri
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
- Department of Nutrition and Clinical Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, 19395-4741 Tehran, Iran.
| | - Zhale Tahmasebinejad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| | - Mehdi Hedayati
- Cellular and Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| | - Hossein Delshad
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| |
Collapse
|
28
|
Binns C, Lee MK, Kagawa M. Ethical Challenges in Infant Feeding Research. Nutrients 2017; 9:E59. [PMID: 28085057 PMCID: PMC5295103 DOI: 10.3390/nu9010059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/23/2016] [Accepted: 01/09/2017] [Indexed: 01/14/2023] Open
Abstract
Infants have a complex set of nutrient requirements to meet the demands of their high metabolic rate, growth, and immunological and cognitive development. Infant nutrition lays the foundation for health throughout life. While infant feeding research is essential, it must be conducted to the highest ethical standards. The objective of this paper is to discuss the implications of developments in infant nutrition for the ethics of infant feeding research and the implications for obtaining informed consent. A search was undertaken of the papers in the medical literature using the PubMed, Science Direct, Web of Knowledge, Proquest, and CINAHL databases. From a total of 9303 papers identified, the full text of 87 articles that contained discussion of issues in consent in infant feeding trials were obtained and read and after further screening 42 papers were included in the results and discussion. Recent developments in infant nutrition of significance to ethics assessment include the improved survival of low birth weight infants, increasing evidence of the value of breastfeeding and evidence of the lifelong importance of infant feeding and development in the first 1000 days of life in chronic disease epidemiology. Informed consent is a difficult issue, but should always include information on the value of preserving breastfeeding options. Project monitoring should be cognisant of the long term implications of growth rates and early life nutrition.
Collapse
Affiliation(s)
- Colin Binns
- John Curtin Distinguished Emeritus Professor of Public Health, Curtin University, Perth 6845, Australia.
| | - Mi Kyung Lee
- Department, School of Health Professions, Murdoch University, Perth 6150, Australia.
| | - Masaharu Kagawa
- Institute of Nutrition Sciences, Kagawa Nutrition University, Saitama 350-0214, Japan.
| |
Collapse
|
29
|
Stinca S, Andersson M, Weibel S, Herter-Aeberli I, Fingerhut R, Gowachirapant S, Hess SY, Jaiswal N, Jukic T, Kusic Z, Mabapa NS, Nepal AK, San Luis TOL, Zhen JQ, Zimmermann MB. Dried Blood Spot Thyroglobulin as a Biomarker of Iodine Status in Pregnant Women. J Clin Endocrinol Metab 2017; 102:23-32. [PMID: 27732337 DOI: 10.1210/jc.2016-2829] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/06/2016] [Indexed: 11/19/2022]
Abstract
CONTEXT Thyroglobulin (Tg) could be a sensitive biomarker of iodine nutrition in pregnant women (PW). A dried blood spot (DBS) assay would simplify collection and transport in field studies. OBJECTIVES Our aims were to (1) establish and test a reference range for DBS-Tg in PW; (2) determine whether co-measurement of Tg antibodies (Abs) is necessary to define population iodine status. DESIGN, SETTING, AND PARTICIPANTS Standardized cross-sectional studies of 3870 PW from 11 countries. For the DBS-Tg reference range, we included TgAb-negative PW (n = 599) from 3 countries with sufficient iodine intake. MAIN OUTCOME MEASURES We measured the urinary iodine concentration and DBS thyroid-stimulating hormone, total thyroxin, Tg, and TgAb. RESULTS In the reference population, the median DBS-Tg was 9.2 μg/L (95% confidence interval, 8.7 to 9.8 μg/L) and was not significantly different among trimesters. The reference range was 0.3 to 43.5 μg/L. Over a range of iodine intake, the Tg concentrations were U-shaped. Within countries, the median DBS-Tg and the presence of elevated DBS-Tg did not differ significantly between all PW and PW who were TgAb-negative. CONCLUSIONS A median DBS-Tg of ∼10 μg/L with <3% of values ≥44 μg/L indicated population iodine sufficiency. Concurrent measurement of TgAb did not appear necessary to assess the population iodine status.
Collapse
Affiliation(s)
- Sara Stinca
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich 8092, Switzerland
| | - Maria Andersson
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich 8092, Switzerland
| | - Sandra Weibel
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich 8092, Switzerland
| | - Isabelle Herter-Aeberli
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich 8092, Switzerland
| | - Ralph Fingerhut
- Swiss Newborn Screening Laboratory, Children's Research Center (CRC), University Children's Hospital of Zurich, Zurich 8032, Switzerland
| | | | - Sonja Y Hess
- Department of Nutrition, University of California, Davis, Davis, California 95616
| | - Nidhi Jaiswal
- St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore 560034, India
| | - Tomislav Jukic
- Department of Oncology and Nuclear Medicine, University of Zagreb School of Medicine, Sisters of Charity University Hospital Centre, Zagreb 10,000, Croatia
| | - Zvonko Kusic
- Department of Oncology and Nuclear Medicine, University of Zagreb School of Medicine, Sisters of Charity University Hospital Centre, Zagreb 10,000, Croatia
| | | | - Ashwini Kumar Nepal
- Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Ghopa, Dharan 56700, Nepal
| | | | - Jia Qing Zhen
- Shanxi Institute for Endemic Disease Prevention and Treatment, LinFen 041000, China
| | - Michael Bruce Zimmermann
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich 8092, Switzerland
| |
Collapse
|
30
|
Urinary iodine concentration identifies pregnant women as iodine deficient yet school-aged children as iodine sufficient in rural Niger. Public Health Nutr 2016; 20:1154-1161. [PMID: 27974077 DOI: 10.1017/s1368980016003232] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess iodine status among pregnant women in rural Zinder, Niger and to compare their status with the iodine status of school-aged children from the same households. DESIGN Seventy-three villages in the catchment area of sixteen health centres were randomly selected to participate in the cross-sectional survey. SETTING Salt iodization is mandatory in Niger, requiring 20-60 ppm iodine at the retail level. SUBJECTS A spot urine sample was collected from randomly selected pregnant women (n 662) and one school-aged child from the same household (n 373). Urinary iodine concentration (UIC) was assessed as an indicator of iodine status in both groups. Dried blood spots (DBS) were collected from venous blood samples of pregnant women and thyroglobulin (Tg), thyroid-stimulating hormone and total thyroxine were measured. Iodine content of household salt samples (n 108) was assessed by titration. RESULTS Median iodine content of salt samples was 5·5 ppm (range 0-41 ppm), 98 % had an iodine content 40 µg/l. CONCLUSIONS In this region of Niger, most salt is inadequately iodized. UIC in pregnant women indicated iodine deficiency, whereas UIC of school-aged children indicated marginally adequate iodine status. Thus, estimating population iodine status based solely on monitoring of UIC among school-aged children may underestimate the risk of iodine deficiency in pregnant women.
Collapse
|
31
|
Jorgensen A, O'Leary P, James I, Skeaff S, Sherriff J. Assessment of Breast Milk Iodine Concentrations in Lactating Women in Western Australia. Nutrients 2016; 8:nu8110699. [PMID: 27827913 PMCID: PMC5133086 DOI: 10.3390/nu8110699] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 11/16/2022] Open
Abstract
Breast-fed infants may depend solely on an adequate supply of iodine in breast milk for the synthesis of thyroid hormones which are essential for optimal growth and cognitive development. This is the first study to measure breast milk iodine concentration (BMIC) among lactating women in Western Australian (n = 55). Breast milk samples were collected between 2014 and 2015 at a mean (±SD) of 38.5 (±5.5) days post-partum. The samples were analysed to determine median BMIC and the percentage of samples with a BMIC < 100 µg/L, a level considered adequate for breast-fed infants. The influence of (a) iodine-containing supplements and iodised salt use and (b) consumption of key iodine-containing foods on BMIC was also examined. The median (p25, p75) BMIC was 167 (99, 248) µg/L and 26% of samples had a BMIC < 100 µg/L. Overall, BMIC tended to be higher with iodine-containing supplement usage (ratio 1.33, 95% confidence interval (CI) (1.04, 1.70), p = 0.030), cow's milk consumption (ratio 1.66, 95% CI (1.23, 2.23), p = 0.002) and lower for Caucasians (ratio 0.61, 95% CI (0.45, 0.83), p = 0.002), and those with secondary school only education (ratio 0.66, 95% CI (0.46, 0.96), p = 0.030). For most women, BMIC was adequate to meet the iodine requirements of their breast-fed infants. However, some women may require the use of iodine-containing supplements or iodised salt to increase BMIC to adequate levels for optimal infant nutrition.
Collapse
Affiliation(s)
- Anita Jorgensen
- School of Public Health, Curtin University, Perth 6102, Australia.
| | - Peter O'Leary
- Faculty of Health Sciences, Curtin University, Perth 6102, Australia.
| | - Ian James
- Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch 6150, Australia.
| | - Sheila Skeaff
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | - Jillian Sherriff
- School of Public Health, Curtin University, Perth 6102, Australia.
| |
Collapse
|
32
|
Miller JC, MacDonell SO, Gray AR, Reid MR, Barr DJ, Thomson CD, Houghton LA. Iodine Status of New Zealand Elderly Residents in Long-Term Residential Care. Nutrients 2016; 8:nu8080445. [PMID: 27455319 PMCID: PMC4997360 DOI: 10.3390/nu8080445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/10/2016] [Accepted: 07/19/2016] [Indexed: 11/23/2022] Open
Abstract
In response to the re-emergence of iodine deficiency in New Zealand, in 2009 the government mandated that all commercially made breads be fortified with iodized salt. There has been no evaluation of the impact of the program on iodine status of the elderly, despite this population group being vulnerable to iodine deficiency or excess. The aim of this study was to describe the iodine status of elderly New Zealanders in residential aged-care homes following the implementation of the bread fortification program. A cross-sectional survey was conducted, involving 309 residents (median age 85 years) from 16 aged-care homes throughout NZ. Information on socio-demographic, anthropometric, dietary and health characteristics were collected. Casual spot urine samples were analysed for urinary iodine concentration (UIC). Blood samples were analysed for serum thyroglobulin, thyroglobulin antibodies, and other biochemical indices. The median UIC (MUIC) of the residents was 72 μg/L, indicating mild iodine deficiency, and 29% had a UIC < 50 μg/L. Median thyroglobulin concentration was 18 ng/mL and 26% had elevated thyroglobulin concentration (>40 ng/mL), suggesting iodine insufficiency. Diuretic use was associated with lower MUIC (p = 0.043). Synthetic thyroxine use was associated with lower odds of having a UIC < 50 μg/L (OR 0.32, p = 0.030)) and lower median thyroglobulin (−15.2 ng/mL, p = 0.001), compared with untreated participants. Frailty was associated with elevated thyroglobulin (p = 0.029), whereas anemia was associated with lower thyroglobulin (p = 0.016). Iodine insufficiency persists in New Zealanders residing in residential aged-care homes despite increasing iodine intake from fortified bread. Research is required to establish optimal iodine intake and status in the elderly.
Collapse
Affiliation(s)
- Jody C Miller
- Department of Human Nutrition, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand.
| | - Sue O MacDonell
- Department of Human Nutrition, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand.
| | - Andrew R Gray
- Department of Preventive and Social Medicine, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand.
| | - Malcolm R Reid
- Trace Element Centre, Department of Chemistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand.
| | - David J Barr
- Trace Element Centre, Department of Chemistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand.
| | - Christine D Thomson
- Department of Human Nutrition, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand.
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand.
| |
Collapse
|
33
|
Koukkou E, Ilias I, Mamalis I, Adonakis GG, Markou KB. Serum Thyroglobulin Concentration Is a Weak Marker of Iodine Status in a Pregnant Population with Iodine Deficiency. Eur Thyroid J 2016; 5:120-4. [PMID: 27493886 PMCID: PMC4949369 DOI: 10.1159/000446070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/08/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the reliability of thyroglobulin (Tg) as a marker of iodine status during pregnancy. DESIGN 299 women aged 30.5 ± 4.8 years (mean ± SD) were studied. METHODS In every subject, we measured urinary iodine concentration (UIC), serum thyrotropin (TSH), Tg, free thyroxine (fT4), Tg autoantibodies (TgAbs) and human chorionic gonadotropin (hCG) levels. We excluded samples with increased TgAbs from the analysis. RESULTS According to WHO criteria, the study population was iodine deficient in every trimester. Serum Tg levels did not differ during the three trimesters of pregnancy. Serum hCG levels fell significantly as pregnancies advanced. A weak, significantly negative correlation (limited to the 3rd trimester) was found between Tg and UIC (ρ = -0.187, p = 0.039). Serum fT4 decreased as pregnancies advanced and TSH increased. Serum fT4 was negatively correlated with TSH (ρ = -0.161, p = 0.006) and positively with hCG (ρ = +0.165, p = 0.005). The multiple regression equation of Tg based on hCG, TSH, UIC and trimester of pregnancy was significant but weak (F = 4.057, p = 0.003; R(2) = 0.055), with hCG as a significant predictor Tg (p for log hCG = 0.041). CONCLUSIONS Tg cannot be considered as a valid marker of iodine deficiency in pregnancy, at least in a mildly iodine-deficient environment. Further studies in a larger patient cohort with differences in iodine status, as well as studies on Tg changes after improving iodine status in pregnant women, are needed in order to corroborate these results.
Collapse
Affiliation(s)
- Eftychia Koukkou
- Department of Endocrinology, E Venizelou Maternity Hospital, Athens, Greece
| | - Ioannis Ilias
- Department of Endocrinology, E Venizelou Maternity Hospital, Athens, Greece
| | - Irene Mamalis
- Departments of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Georgios G. Adonakis
- Departments of Obstetrics and Gynecology, University of Patras Medical School, Patras, Greece
| | - Kostas B. Markou
- Departments of Endocrinology, University of Patras Medical School, Patras, Greece
- *Kostas B. Markou, MD, Thisseos Street 6, GR–26500 Ovria Patras (Greece), E-Mail
| |
Collapse
|
34
|
Nazeri P, Zarghani NH, Mirmiran P, Hedayati M, Mehrabi Y, Azizi F. Iodine Status in Pregnant Women, Lactating Mothers, and Newborns in an Area with More Than Two Decades of Successful Iodine Nutrition. Biol Trace Elem Res 2016; 172:79-85. [PMID: 26631051 DOI: 10.1007/s12011-015-0575-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
Pregnant women, lactating mothers, and their newborns constitute the target population for prevention and control of iodine deficiency. Hence, the aim of this study was to evaluate the iodine nutrition status among these vulnerable groups in an area with more than two decades of successful elimination of iodine deficiency. In this cross-sectional study conducted in health care centers of Tehran, 100 pregnant women and 84 lactating mothers and their newborn were randomly selected. Urinary iodine concentration and iodine content of salts were measured using the Sandell-Kolthoff and titration methods, respectively. Urinary iodine concentration <150 μg/L for pregnant women and <100 μg/L for lactating mothers and newborns was considered as iodine nutrition inadequacy, respectively. Median (interquartile range [IQR]) urinary iodine concentration (UIC) was 103 (59-155) μg/L in pregnant women, 77 (42-194) μg/L in lactating mothers, and 198 (84-260) μg/L in newborns. Median (IQR) iodine content of salt was 26 (21-30) ppm and 25 (18-28) ppm in pregnant women and lactating mothers, respectively (P = 0.462). Iodine content of salt was significantly correlated with UIC of pregnant women (r = 0.24, P = 0.019), but no correlation was found among lactating mothers (r = 0.12, P = 0.316). Neonatal UIC was significantly correlated with iodine content of salt consumed by their mothers (r = 0.49, P = 0.001). Despite suboptimal iodine status among subgroups of Tehranian pregnant and lactating women, iodine nutrition status of newborns was within optimal levels, which may be explained by a compensatory mechanism in the mammary glands.
Collapse
Affiliation(s)
- Pantea Nazeri
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Hedayati
- Cellular and Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, # 24, Aerabi St., Yaman St., Chamran Exp, P.O. Box: 19395-4763, Tehran, Iran.
| |
Collapse
|
35
|
|
36
|
Abstract
BACKGROUND Thyroglobulin, produced exclusively by the thyroid gland, has been proposed to be a more sensitive biomarker of iodine status than thyrotropin or the thyroid hormones triiodothyronine and thyroxine. However, evidence on the usefulness of thyroglobulin (Tg) to assess iodine status has not been extensively reviewed, particularly in pregnant women and adults. SUMMARY An electronic literature search was conducted using the Cochrane CENTRAL, Web of Science, PubMed, and Medline to locate relevant studies on Tg as a biomarker of iodine status. Since urinary iodine concentration (UIC) is the recommended method to assess iodine status in populations, only studies that clearly reported both Tg and UIC were included. For the purpose of this review, a median Tg <13 μg/L and a median UIC ≥100 μg/L (UIC ≥150 μg/L for pregnant women) were used to indicate adequate iodine status. We excluded studies conducted in subjects with either known thyroid disease or those with thyroglobulin antibodies. The search strategy and selection criteria yielded 34 articles of which nine were intervention studies. The majority of studies (six of eight) reported that iodine-deficient pregnant women had a median Tg ≥13 μg/L. However, large observational studies of pregnant women, including women with adequate and inadequate iodine status, as well as well-designed intervention trials that include both Tg and UIC, are needed. In adults, the results were equivocal because iodine-deficient adults were reported to have median Tg values of either <13 or ≥13 μg/L. Only studies in school-aged children showed that iodine-sufficient children typically had a median Tg <13 μg/L. Some of the inconsistent results may be partially explained by the use of different methodological assays and failure to assess assay accuracy using a certified reference material. CONCLUSIONS These data suggest that Tg does hold promise as a biomarker of iodine deficiency. However, it is associated with limitations. A median Tg cutoff of 13 μg/L warrants further investigation, particularly in adults or pregnant women, as there is a lack of both observational and intervention studies in these groups.
Collapse
Affiliation(s)
- Zheng Feei Ma
- Department of Human Nutrition, University of Otago , Dunedin, New Zealand
| | | |
Collapse
|
37
|
Iodine deficiency in pregnant women living in the South East of the UK: the influence of diet and nutritional supplements on iodine status. Br J Nutr 2014; 111:1622-31. [PMID: 24398008 DOI: 10.1017/s0007114513004030] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Iodine is a key component of the thyroid hormones which are crucial for brain development. Adequate intake of iodine in pregnancy is important as in utero deficiency may have lifelong consequences for the offspring. Data on the iodine status of UK pregnant women are sparse, and there are no such data for pregnant women in the South East of the UK. A total of 100 pregnant women were recruited to a cross-sectional study carried out at the Royal Surrey County Hospital, Guildford, at their first-trimester visit for an ultrasound scan. The participants provided a spot-urine sample (for the measurement of urinary iodine concentration (UIC) and creatinine concentration) and 24 h iodine excretion was estimated from the urinary iodine:creatinine ratio. Women completed a general questionnaire and a FFQ. The median UIC (85·3 μg/l) indicated that the group was iodine deficient by World Health Organisation criteria. The median values of the iodine:creatinine ratio (122·9 μg/g) and of the estimated 24 h iodine excretion (151·2 μg/d) were also suggestive of iodine deficiency. UIC was significantly higher in women taking an iodine-containing prenatal supplement (n 42) than in those not taking such a supplement (P< 0·001). In the adjusted analyses, milk intake, maternal age and iodine-containing prenatal supplement use were positively associated with the estimated 24 h urinary iodine excretion. Our finding of iodine deficiency in these women gives cause for concern. We suggest that women of childbearing age and pregnant women should be given advice on how to improve their iodine status through dietary means. A national survey of iodine status in UK pregnant women is required.
Collapse
|
38
|
Brough L, Jin Y, Shukri NH, Wharemate ZR, Weber JL, Coad J. Iodine intake and status during pregnancy and lactation before and after government initiatives to improve iodine status, in Palmerston North, New Zealand: a pilot study. MATERNAL AND CHILD NUTRITION 2013; 11:646-55. [PMID: 23782592 DOI: 10.1111/mcn.12055] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Iodine deficiency during pregnancy and lactation may adversely affect fetal and infant development. Two initiatives were introduced in New Zealand to prevent deficiency: (1) mandatory fortification of bread with iodised salt; and (2) provision of a subsidised iodine supplement (150 μg) for all pregnant and breastfeeding women. The aim of this study was to assess iodine intake and status among a self-selecting sample of pregnant and lactating women in Palmerston North, both before and after the two initiatives. Pregnant and breastfeeding women were recruited before (n = 25 and 32; 2009) and after (n = 34 and 36; 2011) the initiatives. Iodine concentration was determined in 24-h urine and breast milk samples using inductively-coupled plasma mass spectrometry. Use of supplements and salt, knowledge of iodine deficiency, and awareness of the initiatives were determined by questionnaire. Median urine iodine concentration (UIC) was higher in 2011 compared with 2009 for both pregnant (85 and 47 μg L(-1) ) and breastfeeding (74 and 34 μg L(-1) ) participants; median UIC were below the cut-offs for adequate iodine status. However, in 2011, the estimated daily iodine intake during pregnancy was 217 μg day(-1) ; 74% of women achieved the Estimated Average Requirement. Knowledge of the initiatives was low, only 28-56% were aware of the need for iodine supplements and only 15-22% were aware of the mandatory addition of iodised salt to bread. Despite initiatives, UIC of these women indicates iodine deficiency, however, dietary intakes appear adequate. Ongoing surveillance of supplement use and iodine status among pregnant and lactating women throughout New Zealand is needed to fully assess the efficacy of the initiatives. Alternative strategies may require evaluation to ensure all women have adequate iodine during pregnancy and breastfeeding.
Collapse
Affiliation(s)
- Louise Brough
- Institute of Food, Nutrition and Human Health, Massey University, Palmerston North, New Zealand
| | - Ying Jin
- Institute of Food, Nutrition and Human Health, Massey University, Palmerston North, New Zealand
| | - Nurul Husna Shukri
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | | | - Janet L Weber
- Institute of Food, Nutrition and Human Health, Massey University, Palmerston North, New Zealand
| | - Jane Coad
- Institute of Food, Nutrition and Human Health, Massey University, Palmerston North, New Zealand
| |
Collapse
|