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Spina V, Baldini E, Cardarelli S, Oliva C, Venarubea S, Faraoni F, Pastore G, Tittoni R, Musella A, Squarcella A, Lori E, Renzi E, Feroci R, Mastrodonato F, Ciferri F, Virili C, Centanni M, Fabiani C, Rago R, Schiavi MC, Palazzetti P, D'Armiento E, Cantisani V, Sorrenti S, Ulisse S. Iodized Salt May Not Be Sufficient to Guarantee an Adequate Iodine Intake in Pregnant Women. Nutrients 2023; 15:4182. [PMID: 37836466 PMCID: PMC10574232 DOI: 10.3390/nu15194182] [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: 09/01/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Adequate iodine intake is of crucial importance in pregnancy to meet the thyroid hormone needs of both mother and fetus. In the present study, undertaken as a part of the surveillance actions following the introduction in Italy of a national salt iodination program in 2005, the iodine intake was investigated in 123 pregnant women and 49 control women living in the same area of central Italy. All the participants were screened for urinary iodine concentration (UIC), serum level of thyrotropin, free-thyroxine, free-triiodothyronine, and thyroid volume. Moreover, they were provided with a questionnaire on the use of iodine-containing salt or supplements. Control women had a median UIC of 102 µg/L, consistent with an iodine sufficiency, while in pregnant women the median UIC value was 108 µg/L, lower than the endorsed UIC of 150 µg/L. In addition, pregnant women showed a significantly increased median thyroid volume compared to controls. Interestingly, the median UIC did not differ between pregnant women not using iodine-containing salt or supplements and those regularly consuming iodized salt alone, while pregnant women with a daily intake of iodine-containing supplements had an adequate median UIC (168 µg/L). In conclusion, the data reported here showed that pregnant women and their fetuses are still exposed to the detrimental effects of iodine deficiency and that the consumption of iodine-containing supplements should be recommended in pregnancy.
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Affiliation(s)
- Vincenzo Spina
- Mother and Infant Department Unit, ASL-Rieti, 02100 Rieti, Italy
| | - Enke Baldini
- Department of Surgery, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Silvia Cardarelli
- Department of Surgery, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Cosimo Oliva
- Obstetrics and Gynaecology Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Stefano Venarubea
- Clinical Pathology Laboratory Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Franca Faraoni
- Pediatrics and Neonatology Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Giovanni Pastore
- Obstetrics and Gynaecology Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Rachele Tittoni
- Obstetrics and Gynaecology Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Angela Musella
- Obstetrics and Gynaecology Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Antonia Squarcella
- Obstetrics and Gynaecology Unit, "S. Camillo De Lellis" Hospital, 02100 Rieti, Italy
| | - Eleonora Lori
- Department of Surgery, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Elisabetta Renzi
- Mother and Infant Department Unit, ASL-Rieti, 02100 Rieti, Italy
| | - Roberta Feroci
- Mother and Infant Department Unit, ASL-Rieti, 02100 Rieti, Italy
| | | | - Fabiola Ciferri
- Mother and Infant Department Unit, ASL-Rieti, 02100 Rieti, Italy
| | - Camilla Virili
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, 04100 Latina, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, 04100 Latina, Italy
| | - Cristina Fabiani
- Mother and Infant Department, "Sandro Pertini" Hospital, 00157 Rome, Italy
| | - Rocco Rago
- Mother and Infant Department, "Sandro Pertini" Hospital, 00157 Rome, Italy
| | | | | | - Eleonora D'Armiento
- Department of Internal Medicine and and Medical Specialties, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Vito Cantisani
- Department of Radiological and Oncological Sciences and Pathological Anatomy, "Sapienza" University of Rome, 00185 Rome, Italy
- Teleradiology Complex Unit, ASL-Rieti, 02100 Rieti, Italy
| | | | - Salvatore Ulisse
- Department of Surgery, "Sapienza" University of Rome, 00185 Rome, Italy
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2
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Grossklaus R, Liesenkötter KP, Doubek K, Völzke H, Gaertner R. Iodine Deficiency, Maternal Hypothyroxinemia and Endocrine Disrupters Affecting Fetal Brain Development: A Scoping Review. Nutrients 2023; 15:nu15102249. [PMID: 37242131 DOI: 10.3390/nu15102249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
This scoping review critically discusses the publications of the last 30 years on the impact of mild to moderate iodine deficiency and the additional impact of endocrine disrupters during pregnancy on embryonal/fetal brain development. An asymptomatic mild to moderate iodine deficiency and/or isolated maternal hypothyroxinemia might affect the development of the embryonal/fetal brain. There is sufficient evidence underlining the importance of an adequate iodine supply for all women of childbearing age in order to prevent negative mental and social consequences for their children. An additional threat to the thyroid hormone system is the ubiquitous exposure to endocrine disrupters, which might exacerbate the effects of iodine deficiency in pregnant women on the neurocognitive development of their offspring. Ensuring adequate iodine intake is therefore essential not only for healthy fetal and neonatal development in general, but it might also extenuate the effects of endocrine disruptors. Individual iodine supplementation of women of childbearing age living in areas with mild to moderate iodine deficiency is mandatory as long as worldwide universal salt iodization does not guarantee an adequate iodine supply. There is an urgent need for detailed strategies to identify and reduce exposure to endocrine disrupters according to the "precautional principle".
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Affiliation(s)
- Rolf Grossklaus
- Department of Food Safety, Federal Institute for Risk Assessment, D-10589 Berlin, Germany
| | | | - Klaus Doubek
- Professional Association of Gynecologists, D-80337 Munich, Germany
| | - Henry Völzke
- Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, D-17475 Greifswald, Germany
| | - Roland Gaertner
- Medical Clinic IV, University of Munich, D-80336 Munich, Germany
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3
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Lisco G, De Tullio A, Triggiani D, Zupo R, Giagulli VA, De Pergola G, Piazzolla G, Guastamacchia E, Sabbà C, Triggiani V. Iodine Deficiency and Iodine Prophylaxis: An Overview and Update. Nutrients 2023; 15:nu15041004. [PMID: 36839362 PMCID: PMC9967346 DOI: 10.3390/nu15041004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
The thyroid gland requires iodine to synthesize thyroid hormones, and iodine deficiency results in the inadequate production of thyroxine and related thyroid, metabolic, developmental, and reproductive disorders. Iodine requirements are higher in infants, children, and during pregnancy and lactation than in adult men and non-pregnant women. Iodine is available in a wide range of foods and water and is susceptible to almost complete gastric and duodenal absorption as an iodide ion. A healthy diet usually provides a daily iodine consumption not exceeding 50% of the recommended intake. Iodine supplementation is usually necessary to prevent iodine deficiency disorders (IDDs), especially in endemic areas. The community-based strategy of iodine fortification in salt has eradicated IDDs, such as endemic goiter and cretinism, in countries providing adequate measures of iodine prophylaxis over several decades in the 20th century. Iodized salt is the cornerstone of iodine prophylaxis in endemic areas, and the continuous monitoring of community iodine intake and its related clinical outcomes is essential. Despite the relevant improvement in clinical outcomes, subclinical iodine deficiency persists even in Western Europe, especially among girls and women, being an issue in certain physiological conditions, such as pregnancy and lactation, and in people consuming unbalanced vegetable-based or salt-restricted diets. Detailed strategies to implement iodine intake (supplementation) could be considered for specific population groups when iodized salt alone is insufficient to provide adequate requirements.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Anna De Tullio
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Domenico Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Roberta Zupo
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, 70013 Bari, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giovanni De Pergola
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, 70013 Bari, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence:
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Matta Coelho C, Guimarães J, Bracchi I, Xavier Moreira N, Pinheiro C, Ferreira P, Pestana D, Barreiros Mota I, Cortez A, Prucha C, Martins C, Pinto E, Almeida A, Delerue-Matos C, Dias CC, Moreira-Rosário A, Ribeiro de Azevedo LF, Cruz Fernandes V, Ramalho C, Calhau C, Brantsæter AL, Costa Leite J, Keating E. Noncompliance to iodine supplementation recommendation is a risk factor for iodine insufficiency in Portuguese pregnant women: results from the IoMum cohort. J Endocrinol Invest 2022; 45:1865-1874. [PMID: 35635644 DOI: 10.1007/s40618-022-01813-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE After a recommendation for iodine supplementation in pregnancy has been issued in 2013 in Portugal, there were no studies covering iodine status in pregnancy in the country. The aim of this study was to assess iodine status in pregnant women in Porto region and its association with iodine supplementation. METHODS A cross-sectional study was conducted at Centro Hospitalar Universitário São João, Porto, from April 2018 to April 2019. Pregnant women attending the 1st trimester ultrasound scan were invited to participate. Exclusion criteria were levothyroxine use, gestational age < 10 and ≥ 14 weeks, non-evolutive pregnancy at recruitment and non-signing of informed consent. Urinary iodine concentration (UIC) was measured in random spot urine by inductively coupled plasma-mass spectrometry. RESULTS Median UIC was 104 μg/L (IQR 62-189) in the overall population (n = 481) of which 19% had UIC < 50 µg/L. Forty three percent (n = 206) were not taking an iodine-containing supplement (ICS) and median UIC values were 146 µg/L (IQR 81-260) and 74 µg/L (IQR 42-113) in ICS users and non-users, respectively (p < 0.001). Not using an ICS was an independent risk factor for iodine insufficiency [adjusted OR (95% CI) = 6.00 (2.74, 13.16); p < 0.001]. Iodised salt use was associated with increased median iodine-to-creatinine ratio (p < 0.014). CONCLUSIONS A low compliance to iodine supplementation recommendation in pregnancy accounted for a mild-to-moderately iodine deficiency. Our results evidence the need to support iodine supplementation among pregnant women in countries with low household coverage of iodised salt. Trial registration number NCT04010708, registered on the 8th July 2019.
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Affiliation(s)
- C Matta Coelho
- CINTESIS@RISE, Department Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - J Guimarães
- CINTESIS@RISE, Department Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - I Bracchi
- CINTESIS@RISE, Department Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - N Xavier Moreira
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
- Fluminense Federal University, Niterói, Rio de Janeiro, Brasil
| | - C Pinheiro
- CINTESIS@RISE, Department Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - P Ferreira
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - D Pestana
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School│FCM, Universidade Nova de Lisboa, Porto, Portugal
| | - I Barreiros Mota
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School│FCM, Universidade Nova de Lisboa, Porto, Portugal
| | - A Cortez
- Medicina Laboratorial Dr. Carlos Torres, Porto, Portugal
| | - C Prucha
- Department of Obstetrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - C Martins
- Department of Obstetrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - E Pinto
- REQUIMTE//LAQV, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Department of Environmental Health, School of Health, P.Porto, Porto, Portugal
| | - A Almeida
- REQUIMTE//LAQV, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - C Delerue-Matos
- REQUIMTE/LAQV, Instituto Superior de Engenharia, Politécnico do Porto, Porto, Portugal
| | - C C Dias
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Moreira-Rosário
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School│FCM, Universidade Nova de Lisboa, Porto, Portugal
| | - L F Ribeiro de Azevedo
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - V Cruz Fernandes
- REQUIMTE/LAQV, Instituto Superior de Engenharia, Politécnico do Porto, Porto, Portugal
| | - C Ramalho
- Department of Obstetrics, Centro Hospitalar Universitário S. João, Porto, Portugal
- Department of Ginecology-Obstetrics and Pediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, i3S, Universidade Do Porto, Porto, Portugal
| | - C Calhau
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School│FCM, Universidade Nova de Lisboa, Porto, Portugal
| | - A-L Brantsæter
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - J Costa Leite
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
| | - E Keating
- CINTESIS@RISE, Department Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal.
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de Oliveira Campos R, Lima SCR, de Souza Braga Filho J, de Jesus JS, Anunciação SM, Martins GF, de Jesus LM, Dos Anjos Santana A, de Oliveira Souza VC, Júnior FB, Ramos HE. Association of Salt Iodization and Urine Iodine Concentration in Schoolchildren from Public Schools in Northeast of Brazil. Biol Trace Elem Res 2021; 199:4423-4429. [PMID: 33595754 DOI: 10.1007/s12011-020-02571-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
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).
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Affiliation(s)
- Renata de Oliveira Campos
- Health and Science Center, Federal University of Bahia Reconcavo, BA, Santo Antonio de Jesus, Brazil
- Postgraduate Program in Interactive Processes of Organs and Systems, Health & Science Institute, Federal University of Bahia, Salvador, BA, Brazil
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Sara Cristina Rebouças Lima
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Jair de Souza Braga Filho
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Joice Santos de Jesus
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Sara Moreira Anunciação
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
- Health & Science Center, Federal University Recôncavo da Bahia, Santo Antonio de Jesus, Bahia, Brazil
| | - Gabriela Flor Martins
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Lorena Maia de Jesus
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Aline Dos Anjos Santana
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil
| | - Vanessa Cristina de Oliveira Souza
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering of University of São Paulo, Pirassununga, São Paulo, Brazil
| | - Fernando Barbosa Júnior
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto of University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Helton Estrela Ramos
- Postgraduate Program in Interactive Processes of Organs and Systems, Health & Science Institute, Federal University of Bahia, Salvador, BA, Brazil.
- Bioregulation Department, Health and Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 301, Salvador, BA, Brazil.
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Iodine Intake Estimated by 24 h Urine Collection in the Italian Adult Population: 2008-2012 Survey. Nutrients 2021; 13:nu13051529. [PMID: 34062834 PMCID: PMC8147380 DOI: 10.3390/nu13051529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/16/2022] Open
Abstract
Monitoring the population iodine status is essential for iodine deficiency eradication. This study assessed the average dietary iodine intake and the iodine status of a random sample of the Italian general adult population. The study population included 2378 adults aged 35–79 years (1229 men and 1149 women) from all 20 Italian regions, participating in the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 2008–2012 (OEC/HES), and were examined for iodine intake in the framework of the MINISAL-GIRCSI Programme. Dietary iodine intake was assessed by the measurement of 24 h urinary iodine excretion. The median daily iodine intake of the whole population was lower (96 µg/d, interquartile range 51–165) than the daily adequate iodine intake according to both EFSA and WHO recommendation (150 µg/d), with a significantly lower value among women (85 µg/d) compared with men (111 µg/d). Iodine intake diminished with age and increased with BMI (body mass index) in male but not in female participants, without achieving the adequate intake in any sex, age, or BMI category. In this random sample of Italian general adult population examined in 2008–2012, iodine intake still remained lower than the recommended values despite the implementation of a strategy of iodoprophylaxis based on salt iodization in 2005. These data represent a valuable reference for future monitoring of iodine status in our country.
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Zhou Q, Wang C, Xu H, Li X. Impact of Preconception Treatment Initiation for Hypothyroidism on Neurocognitive Function in Children. J Clin Endocrinol Metab 2020; 105:5897077. [PMID: 32841335 DOI: 10.1210/clinem/dgaa565] [Citation(s) in RCA: 5] [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: 04/14/2020] [Accepted: 08/24/2020] [Indexed: 01/16/2023]
Abstract
CONTEXT Levothyroxine treatment for hypothyroidism in early pregnancy has inconsistent outcomes. OBJECTIVE This study evaluated children's cognitive function to ascertain the impact of preconception maternal hypothyroidism treatment on fetal neurodevelopment. DESIGN AND SETTING This prospective, single-center cohort study was conducted at a tertiary-care hospital. PATIENTS Women were assigned to the before conception (BC) and after conception (AC; 8-14 gestational weeks) groups by time point of hypothyroidism diagnosis and treatment. INTERVENTIONS Levothyroxine treatment was adjusted based on results of a monthly thyroid function test. MAIN OUTCOME MEASURES The Gesell Development Diagnosis Scale (GDDS; Chinese version) was used to assess neurocognitive development of children at age 6, 12, and 24 months, with total score as the primary outcome. RESULTS Of the 466 participants, 187 and 279 were in the BC and AC groups, respectively. Both groups were comparable at baseline antenatal visit, except for a higher proportion of thyroid peroxidase (TPO) antibody-positive participants in the BC group (P < .001). No significant intergroup differences were evident on the GDDS neurodevelopmental assessment at age 6, 12, and 24 months (P > .05), except for unexpected slightly lower motor ability (P = .009) and total (P = .026) scores at 12 months and adaptability at 24 months (P = .037) in the BC group. Differences for motor ability (P < .001) and total score (P = .026) persisted on subgroup analysis for subclinical hypothyroidism, without significant differences in pregnancy and neonatal outcomes by severity and TPO status (P > .05). CONCLUSIONS Preconception levothyroxine treatment did not induce significantly better cognitive outcomes in children up to age 2 than treatment initiated at 8 to 14 weeks of gestation.
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Affiliation(s)
- Qiongjie Zhou
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, People's Republic of China
| | - Chunfang Wang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, People's Republic of China
| | - Huan Xu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, People's Republic of China
| | - Xiaotian Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, People's Republic of China
- School of Life Sciences, Institute of Biostatistics, Fudan University, Shanghai, People's Republic of China
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8
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Lisco G, De Tullio A, Giagulli VA, De Pergola G, Triggiani V. Interference on Iodine Uptake and Human Thyroid Function by Perchlorate-Contaminated Water and Food. Nutrients 2020; 12:nu12061669. [PMID: 32512711 PMCID: PMC7352877 DOI: 10.3390/nu12061669] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Perchlorate-induced natrium-iodide symporter (NIS) interference is a well-recognized thyroid disrupting mechanism. It is unclear, however, whether a chronic low-dose exposure to perchlorate delivered by food and drinks may cause thyroid dysfunction in the long term. Thus, the aim of this review was to overview and summarize literature results in order to clarify this issue. Methods: Authors searched PubMed/MEDLINE, Scopus, Web of Science, institutional websites and Google until April 2020 for relevant information about the fundamental mechanism of the thyroid NIS interference induced by orally consumed perchlorate compounds and its clinical consequences. Results: Food and drinking water should be considered relevant sources of perchlorate. Despite some controversies, cross-sectional studies demonstrated that perchlorate exposure affects thyroid hormone synthesis in infants, adolescents and adults, particularly in the case of underlying thyroid diseases and iodine insufficiency. An exaggerated exposure to perchlorate during pregnancy leads to a worse neurocognitive and behavioral development outcome in infants, regardless of maternal thyroid hormone levels. Discussion and conclusion: The effects of a chronic low-dose perchlorate exposure on thyroid homeostasis remain still unclear, leading to concerns especially for highly sensitive patients. Specific studies are needed to clarify this issue, aiming to better define strategies of detection and prevention.
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Affiliation(s)
- Giuseppe Lisco
- ASL Brindisi, Unit of Endocrinology, Metabolism & Clinical Nutrition, Hospital “A. Perrino”, Strada per Mesagne 7, 72100 Brindisi, Puglia, Italy;
| | - Anna De Tullio
- Interdisciplinary Department of Medicine—Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari “Aldo Moro”, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Puglia, Italy; (A.D.T.); (V.A.G.)
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine—Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari “Aldo Moro”, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Puglia, Italy; (A.D.T.); (V.A.G.)
- Clinic of Endocrinology and Metabolic Disease, Conversano Hospital, Via Edmondo de Amicis 36, 70014 Conversano, Bari, Puglia, Italy
| | - Giovanni De Pergola
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Puglia, Italy;
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine—Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari “Aldo Moro”, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Puglia, Italy; (A.D.T.); (V.A.G.)
- Correspondence:
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9
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Bonofiglio D, Catalano S. Effects of Iodine Intake and Nutraceuticals in Thyroidology: Update and Prospects. Nutrients 2020; 12:nu12051491. [PMID: 32443880 PMCID: PMC7284370 DOI: 10.3390/nu12051491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Daniela Bonofiglio
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende (CS), Italy
- Centro Sanitario, University of Calabria, 87036 Rende (CS), Italy
- Correspondence: (D.B.); (S.C.); Tel.: +39-0984-496208 (D.B.); Fax: +39-0984-496203 (D.B.)
| | - Stefania Catalano
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende (CS), Italy
- Centro Sanitario, University of Calabria, 87036 Rende (CS), Italy
- Correspondence: (D.B.); (S.C.); Tel.: +39-0984-496208 (D.B.); Fax: +39-0984-496203 (D.B.)
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