Excess urinary iodine concentration and thyroid dysfunction among school age children of eastern Nepal: a matter of concern

Nutritional status of school-age children (5-19 years) in South Asia: A scoping review

Information on malnutrition for school-age children and adolescents (5-19 years) in South Asia is fragmented and inconsistent, which limits the prioritization of nutrition policies, programmes and research for this age group. This scoping review aimed to synthesize existing evidence on the burden of malnutrition for children and adolescents aged 5-19 years in South Asia, and on interventions to improve their nutritional status. Cochrane Library, EMBASE, Medline and Google Scholar were systematically searched for articles published between January 2016 and November 2022. Eligible studies reported the prevalence of undernutrition, overweight/obesity, micronutrient deficiencies and unhealthy dietary intakes, and interventions that aimed to address these in South Asia. In total, 296 articles met our inclusion criteria. Evidence revealed widespread, yet heterogeneous, prevalence of undernutrition among South Asian children and adolescents: thinness (1.9%-88.8%), wasting (3%-48%), underweight (9.5%-84.4%) and stunting (3.7%-71.7%). A triple burden of malnutrition was evident: the prevalence of overweight and obesity ranged from 0.2% to 73% and 0% to 38% (with rapidly rising trends), respectively, alongside persistent micronutrient deficiencies. Diets often failed to meet nutritional requirements and high levels of fast-food consumption were reported. Education, fortification, supplementation and school feeding programmes demonstrated beneficial effects on nutritional status. Comprehensive and regular monitoring of all forms of malnutrition among children and adolescents, across all countries in South Asia is required. Further, more large-scale intervention research is needed to ensure policy and programmes effectively target and address malnutrition among children and adolescents in South Asia.

Adequacy of Iodine Status and Associations with Gut Health: A Prospective Cohort Study among Infants in 8 Low- and Middle-Income Countries

BACKGROUND

Environmental enteric dysfunction increases the likelihood of micronutrient deficiencies among infants, but few studies have assessed the potential impact of gut health on urinary iodine concentration (UIC) among this vulnerable group.

OBJECTIVES

We describe the trends of iodine status among infants from 6 to 24 mo old and examine the associations between intestinal permeability, inflammation, and UIC from 6 to 15 mo of age.

METHODS

Data from 1557 children enrolled in this birth cohort study conducted in 8 sites were included in these analyses. UIC was measured at 6, 15, and 24 mo of age by using the Sandell-Kolthoff technique. Gut inflammation and permeability were assessed using the concentrations of fecal neopterin (NEO), myeloperoxidase (MPO) and alpha-1-antitrypsin (AAT), and lactulose-mannitol ratio (LM). A multinomial regression analysis was used to assess the classified UIC (deficiency or excess). Linear mixed regression was used to test the effect of interactions among biomarkers on logUIC.

RESULTS

All studied populations had adequate (≥100 μg/L) to excess (≥371 μg/L) median UIC at 6 mo. Between 6 and 24 mo, 5 sites displayed a significant decline in the infant's median UIC. However, median UIC remained within the optimal range. An increase of NEO and MPO concentrations by +1 unit in ln scale reduced the risk of low UIC by 0.87 (95% CI: 0.78-0.97) and 0.86 (95% CI: 0.77-0.95), respectively. AAT moderated the association between NEO and UIC (P < 0.0001). The shape of this association appears to be asymmetric and in a reverse J-shape, with a higher UIC observed at both lower NEO and AAT concentrations.

CONCLUSIONS

Excess UIC was frequent at 6 mo and tended to normalize at 24 mo. Aspects of gut inflammation and increased permeability appear to reduce the prevalence of low UIC in children aged 6 to 15 mo. Programs addressing iodine-related health should consider the role of gut permeability in vulnerable individuals.

Iodine deficiency and thyroid dysfunction: Current scenario in Nepal

Iodine deficiency is a major cause of thyroid disorders worldwide. Nepal lies in the endemic area of iodine deficiency which was previously referred to as Himalayan goiter belt, with high prevalence of iodine deficiency disorders including goiter, cretinism and hypothyroidism. With effective implementation of universal salt iodization program, Nepal has a successful public health story to share having drastically reduced the iodine deficiency disorders. Moreover, challenge has appeared with rising number of excess iodine states. Thyroid dysfunction is growing higher and the increasing proportion of hyperthyroidism is particularly concerning. Time has come for us to suitably review the standards of salt iodization and control the increasing number of cases with thyroid dysfunction by the coordinated efforts of all stakeholders, along with sustaining the optimal level of iodine.

The Magnitude of Hidden Hunger and Cognitive Deficits among Children Living in Orphanages in Kumasi, Ghana

This study assessed the magnitude of hidden hunger (micronutrient deficiencies) and cognitive deficits of 130 school-aged children (6–13 years old) living in three selected orphanages in Kumasi, Ghana. Sociodemographic data assessment, anthropometric assessment (BMI for age and height for age), dietary assessment (3-day repeated 24-hour dietary recall), urinary iodine level assessment, and cognitive performance assessment (Raven’s Coloured Progressive Matrices) were performed. Boys formed 50.8% of the study population, while girls formed 49.2%. The median age of participants was 10.50 years. About 12.3%, 7%, and 10.0% of participants were stunted, thin, and overweight/obese, respectively. The prevalence of mild iodine deficiency (i.e., 50–99 μg/L) was 16.2%. Iodine deficiency was significantly higher (23.6%) in participants who had lived for at least 7 years in the orphanage compared to those who had lived less than 7 years (10.7%) ( $p=0.047$ ). About 17% of the participants performed poorly (<50%) on the cognition test. Mean cognition test scores were significantly different among the orphanages ( $p=0.027$ ). The majority of participants, 89.2%, 54.6%, 76.9%, and 77.7%, had adequate intake of iron, zinc, vitamin C, and folate, respectively, whereas intake of vitamins A and B12 was inadequate for the majority of participants (90.8% and 50.8%, respectively). There was no significant correlation between micronutrient intake and cognitive performance. However, mean cognition test scores were significantly different between participants with adequate and inadequate iron and vitamin A intake ( $p=0.007$ and $p<0.001$ , respectively). The findings of this study warrant a closer look at nutritional intakes in orphanages to improve hidden hunger and cognitive performance.

Excessive iodine in iodized household salt in Nepal

Iodine is an essential trace element required for the regulation of physiological processes involving the thyroid gland. However, inadequate and excessive intake of iodine are responsible for health problems, such as iodine deficiency disorders, hypothyroidism, hyperthyroidism, thyroiditis, thyroid papillary cancer, and thyrotoxicosis. The Universal Salt Iodization (USI) program has become successful in providing supplemental iodine at the population level globally. Packaging quality, fortification level, and transportation and storage conditions of iodized salt determine the availability of iodine. Previous studies have reported severe health issues caused by excessive iodine intake after the implementation of the USI program. To understand the levels of iodine, we collected 2117 household salt samples from seven districts of Nepal and tested them for iodine content; among them, 98.1% were iodized. Overall median concentration of iodine was 53.9 ppm (range: 43.5-61.4 ppm). The majority (67.2%) of samples had iodine in the range of 45-75 ppm. Approximately 0.9% of samples had inadequate, 13.3% contained adequate, and 83.9% had excessive iodine than the World Health Organization-recommended value. Iodine content varied among the sampling districts and seasons, to some extent. Our study confirmed that iodized salt is widely used in Nepal and is excessively iodized. Excessive intake of iodine through iodized salt requires further attention by policy makers. The iodine level may need adjustment to address the health impact.

Association of Salt Iodization and Urine Iodine Concentration in Schoolchildren from Public Schools in Northeast of Brazil

Iodine deficiency (ID) is recognized as a leading risk factor for child development. Universal salt iodization (USI) is an effective and well-established intervention strategy for the prevention of iodine deficiency disorders (IDD). To evaluate the levels of iodine in household salt samples and the urinary iodine concentration (UIC) in schoolchildren aged 6 to 14 years in public schools in Bahia, Brazil. A cross-sectional study was conducted with 1231 students (6 to 14 years old) from 17 public schools in Bahia. The iodine concentration was evaluated in salt and UIC samples. The adapted Sandell-Kolthoff reaction was used to determine urinary iodine levels. A spectrophotometer (UV-Vis) was used to examine the reduction of ceric ammonium sulfate. A standard iodine solution using a potassium iodate was used to extrapolate the iodine concentrations. The total of 665 salt samples had a median iodine concentration of 24 mg/kg (25th-75th percentile 17.0 to 28.5 mg/kg). The largest proportion (79.6%) of salt samples had iodine concentration in the recommended range, 17.6% of the samples presented iodine at a salt concentration below the established level (<15 mg/kg) and a small proportion was above it (2.8%). The general mean urinary iodine concentration (MUIC) was 217.53 ± 28.30 μg/L and median was 205.50 μg/L. The students evaluated and the salt samples analyzed showed satisfactory results, as recommended by Brazilian legislation and nutritional recommendations of the World Health Organization (WHO).

Política mundial de yodación de sal: desafíos

Objetivo Identificar los desafíos que conlleva la implementación de la política mundial de yodación de sal para el consumo humano. Métodos Se realizó una revisión de la literatura publicada entre el año 2000 y 2021 en PubMed, con los términos MeSH yodo, política pública, cloruro de sodio y los términos complementarios yodo/deficiencia, exceso. Se obtuvieron 141 artículos y se revisaron 50 aplicando como criterio de inclusión el abordaje de la implementación de la política de yodación. Resultados Se identificaron siete desafíos: sostenibilidad de la política, eliminar la brecha entre la explotación y la comercialización de la sal, prevenir la fortificación indiscriminada de los alimentos, promover la educación sobre la ingesta de sal yodada, controlar la ingesta excesiva de yodo, equilibrar la ingesta óptima de yodo con la reducción del consumo de cloruro de sodio y producir suficiente información oficial sobre la política. Conclusión La yodación universal de la sal es una política que requiere mayor sensibilidad a las situaciones locales de cada país para mitigar efectivamente el problema de salud pública de los desórdenes por deficiencia y exceso en la ingesta de yodo alrededor del mundo.

Comparison of Thyroid Hormone Levels between Women Farmers and Non-Farmers in Banten Indonesia

Pesticides are suspected of being endocrine disruptors. This cross-sectional study measured serum samples for levels of thyroid hormones including thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), free T3 (FT3), and free T4 (FT4) among Indonesian female farmers (n = 127) and non-farmers (n = 127). A questionnaire was used to collect information on demographics and risk factors including work characteristics and frequency, and the use of home and agricultural pesticides. Results showed that there were no significant differences in the distribution of the clinical categories of thyroid levels between farmers and non-farmers except for FT3 and T4. However, in multivariable regression controlling for confounders, FT3 and T4 were significantly higher for farmers compared to non-farmers. In addition, 32% of farmers had clinically low iodine levels and 49% of non-farmers had clinically high iodine levels. We conclude that pesticide exposure may not be as important as iodine intake in explaining these findings. We recommend counseling by health workers about the importance of using iodized salt for farmers and counseling about high iodine foods that need to be avoided for non-farmers.