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Jha RK, Das S, Dey S, Dutta S, Khan N, Lakshminarayanan S, Pillai A, Raut MK, Reddy JC, Varghese M. National and Sub-National Estimates of Household Coverage of Iodized Salt and Urinary Iodine Status among Women of Reproductive Age in India: Insights from the India Iodine Survey, 2018-19. J Nutr 2023; 153:2717-2725. [PMID: 37390906 DOI: 10.1016/j.tjnut.2023.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Iodine deficiency is a significant public health problem for many populations worldwide, including India, particularly during the "first 1000 days" of life. Though Universal Salt iodization (USI) is mandatory in India, prior to 2018-19, there was no state-wide survey with estimates of iodine concentrations in salt using iodometric titration. Taking cognizance of this fact, Nutrition International commissioned the first-of-its-kind national-level survey in India, titled the India Iodine Survey 2018-19. OBJECTIVES The study was conducted across the country to provide national and subnational estimates of iodine concentrations in household salt using iodometric titration and iodine nutrition status among women of reproductive age (15-49 y). METHODS The survey adopted a multi-stage randomcluster probability proportional to size sampling design, covering 21,406 households in all the states and union territories (UTs) of India. RESULTS At the national level, the household coverage of edible salt with adequate iodine (content ≥15 parts/million) was 76.3%. At the sub-national level, the coverage varied, with 10 states and 3 UTs achieving USI and 11 states and 2 UTs falling below the national average, with the highest among all the states and UTs, being Jammu and Kashmir and the lowest being Tamil Nadu. At the national level, the median urinary iodine concentration for pregnant women was 173.4 μg/L, for lactating women was 172.8 μg/L, and for non-pregnant, non-lactating women, it was 178.0 μg/L, which is within the adequate iodine nutrition range according to the WHO guidelines. CONCLUSIONS The survey results can be widely used by various stakeholders, including government, academia, and industry, to understand the iodine nutrition status of the population, enable the scale-up of sustained efforts toward consolidating gains and achieving USI, leading to the reduction and elimination of Iodine Deficiency Disorders.
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Affiliation(s)
| | - Susmita Das
- Nutrition International, Asia Regional Office, New Delhi, India
| | - Suvabrata Dey
- Nutrition International, Asia Regional Office, New Delhi, India
| | - Sucharita Dutta
- Nutrition International, India Country Office, New Delhi, India
| | - Noor Khan
- Nutrition International, Headquarters, Ottawa, Canada
| | | | - Aarati Pillai
- Nutrition International, Asia Regional Office, New Delhi, India
| | - Manoj Kumar Raut
- Nutrition International, Asia Regional Office, New Delhi, India.
| | - J C Reddy
- Nutrition International, Asia Regional Office, New Delhi, India
| | - Mini Varghese
- Nutrition International, India Country Office, New Delhi, India
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Asfaw A, Tamiru D, Belachew T. Mandatory Versus Voluntary Implementation of Salt Iodization Program for the Last Two Decades in Ethiopia: A Comparative Review of Existing Literatures. Food Nutr Bull 2022; 43:500-516. [PMID: 35903899 DOI: 10.1177/03795721221114523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Ethiopian government was implementing mandatory salt iodization program for the last decade to eliminate iodine deficiency disorders, but several recent studies reported mixed findings. OBJECTIVE This review aimed to assess the difference in implementation of iodized salt program 10 years before and after mandatory salt iodization being implemented in Ethiopia since 2011. METHODS In Ethiopia, legislation that enforces salt producers to iodize all salts used for human consumption started in February 2011. All studies about iodine deficiency and iodized salt conducted in Ethiopia in the last 2 decades were searched. Searches were performed in PubMed database. Google Scholar, Iodine Global Network, and Ethiopian Public Health Institute websites were also searched. RESULTS A total of 235 titles and abstracts were identified. After scanning the abstracts and full papers, 43 articles were remained for final data synthesis. In this review, all studies conducted before 2011 reported a urinary iodine concentration (UIC) value of < 100 μg/L and 66.7% of them reported a goiter prevalence of > 30%. On the other hand, among studies conducted after 2011, 88.9% reported UIC value < 100 μg/L and 73.7% reported goiter prevalence of > 30%. Household availability of adequately iodized salt increased from nearly 20% in pre 2011 to more than 50% in post 2011 period. CONCLUSION Despite the efforts made by the Ethiopian government on mandatory salt iodization for the last decade, iodine deficiency is sustained in the country. Moreover, the goal of universal salt iodization program is offtrack and needs urgent revision. REGISTRATION Registered on PROSPERO register with reg. no CRD42021251124.
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Affiliation(s)
- Agize Asfaw
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Gubrei, Wabe Bridge, Ethiopia
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3
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Milevska-Kostova N, Miladinova D, Kuzmanovska S, Majstorov V, Ittermann T, Völzke H. Universal salt iodization potentially contributes to health equity: socio-economic status of children does not affect iodine status. J Pediatr Endocrinol Metab 2022; 35:1154-1160. [PMID: 35976132 DOI: 10.1515/jpem-2022-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Many studies have shown that socio-economic status (SES) contributes to health inequalities, with nutrition as one of the major risk factors. Iodine intake entirely depends on external sources, and deficiencies are known to be more prevalent in lower social groups, especially in countries with limited access to iodized salt. This study aimed to determine the influence of SES on iodine status and iodine availability from household salt in North Macedonia. METHODS Using cluster sampling, 1,200 children were recruited, and 1,191 children participated (response rate: 99.2%). Iodine status was assessed through urinary iodine concentration (UIC), and iodine availability through iodine content in household salt requested from participants. SES was assessed using standardized Family Affluence Score (FAS). RESULTS No statistically significant correlation was found between FAS and iodine in salt. Median regression revealed no significant associations of middle vs. low FAS (β=0.00; 95%-confidence interval (CI)=[-0.61, 0.62]; p=0.999) or high vs. low affluence (β=0.48; 95% CI=[-1.37, 0.41]; p=0.291) with iodine content in household salt. UIC levels were significantly lower in middle FAS children compared to low FAS children (β=-16.4; 95% CI=[-32.3, -0.5]; p=0.043). No statistically significant differences in UIC were found between children with high and low affluence (β=-12.5; 95% CI=[-35.5, 10.5]; p=0.287), possibly due to lowered statistical power for this comparison. CONCLUSIONS Universal salt iodization (USI) proves to be a cost-effective measure for appropriate iodine intake in healthy children and adults, irrespective of their social status. It can thus be concluded that USI contributes to reducing health inequalities related to iodine status among population of different social strata.
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Affiliation(s)
| | - Daniela Miladinova
- Faculty of Medicine, Institute for Pathophysiology and Nuclear Medicine, University "Ss. Cyril and Methodius", Skopje, North Macedonia
| | - Sonja Kuzmanovska
- Faculty of Medicine, Institute for Pathophysiology and Nuclear Medicine, University "Ss. Cyril and Methodius", Skopje, North Macedonia
| | - Venjamin Majstorov
- Faculty of Medicine, Institute for Pathophysiology and Nuclear Medicine, University "Ss. Cyril and Methodius", Skopje, North Macedonia
| | - Till Ittermann
- University Medicine Greifswald, Institute for Community Medicine, Greifswald, Germany
| | - Henry Völzke
- University Medicine Greifswald, Institute for Community Medicine, Greifswald, Germany
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Kuay LK, Chin TB, Ying CY, Hussain H, Mahmud NA, Kassim MSA, Harith AA, Man CS, Salleh R, Aris T. Pregnant Women Are Iodine Deficient While School-Aged Children Demonstrate Adequate Iodine Status in Sarawak, Malaysia. Food Nutr Bull 2021; 42:406-413. [PMID: 34024187 DOI: 10.1177/03795721211002079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A mandatory universal salt iodization (USI) has been implemented in Sarawak, Malaysia since 2008. OBJECTIVES The aim of this study is to assess the current iodine status among school-aged children (SAC) and pregnant women (PW) after 10 years of USI implementation in Sarawak. METHODS This cross-sectional survey among school-aged children and pregnant women was conducted between July and October 2018 in Sarawak. The multistage proportionate to population size sampling technique was used to select 30 schools and 30 maternal and child health care clinics. A total of 1200 children aged 8 to 10 years and 750 first-trimester pregnant women were randomly selected to participate in the study. Iodine excretion level in urine was determined according to the World Health Organization classification. RESULTS A total of 988 children and 677 PW participated in the study with a response rate of 82.3% and 90.2%, respectively. The overall median urinary iodine concentration (UIC) level among the children was 126.0 μg/L (interquartile range [IQR], 71.0-200.9 μg/L) and classified as adequate iodine status. The median UIC among PW was 123.9 μg/L (IQR, 56.5-192.1μg/L) indicating inadequate iodine status. CONCLUSION The present findings indicate that despite adequate iodine status in children, the majority of PW still showed inadequate iodine status. Thus, comprehensive monitoring of the iodine deficiency disorder problem among PW is warranted.
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Affiliation(s)
- Lim Kuang Kuay
- Institute for Public Health, 106269Ministry of Health, Malaysia
| | - Tan Beng Chin
- 91000Sarawak State Health Department, Ministry of Health, Malaysia
| | - Chan Ying Ying
- Institute for Public Health, 106269Ministry of Health, Malaysia
| | - Husniza Hussain
- 60608Institute for Medical Research, Ministry of Health, Malaysia
| | - Nur Azna Mahmud
- Institute for Public Health, 106269Ministry of Health, Malaysia
| | | | | | - Cheong Siew Man
- Institute for Public Health, 106269Ministry of Health, Malaysia
| | - Ruhaya Salleh
- Institute for Public Health, 106269Ministry of Health, Malaysia
| | - Tahir Aris
- Institute for Public Health, 106269Ministry of Health, Malaysia
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5
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Abstract
Background: There has been tremendous progress over the past 25 years to control iodine deficiency disorders (IDDs) through universal salt iodization (USI). In 2019, using the median urinary iodine concentration (MUIC), only 19 countries in the world are classified as iodine deficient; in contrast in 1993, using the total goiter rate (TGR), 113 countries were classified as iodine deficient. However, few analyses have tried to quantify the global health and economic benefits of USI programs, and the shift from TGR to MUIC as the main indicator of IDDs complicates assessment of progress. Methods: We used a novel approach to estimate the impact of USI on IDDs, applying a regression model derived from observational data on the relationship between the TGR and the MUIC from 24 countries. The model was used to generate hypothetical national TGR values for 2019 based on current MUIC data. TGR in 1993 and modeled TGR in 2019 were then compared for 139 countries, and using consequence modeling, the potential health and economic benefits realized between 1993 and 2019 were estimated. Results: Based on this approach, the global prevalence of clinical IDDs (as assessed by the TGR) fell from 13.1% to 3.2%, and 720 million cases of clinical IDDs have been prevented by USI (a reduction of 75.9%). USI has significantly reduced the number of newborns affected by IDDs, with 20.5 million cases prevented annually. The resulting improvement in cognitive development and future earnings suggest a potential global economic benefit of nearly $33 billion. However, 4.8 million newborns will be affected by IDDs in 2019, who will experience life-long productivity losses totaling a net present value of $12.5 billion. Conclusions: The global improvements in iodine status over the past 25 years have resulted in major health and economic benefits, mainly in low- and middle-income countries. Efforts should now focus on sustaining this achievement and expanding USI to reach the continuing large number of infants who remain unprotected from IDDs.
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Affiliation(s)
- Jonathan Louis Gorstein
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Iodine Global Network, Ottawa, Canada
- Address correspondence to: Jonathan Louis Gorstein, PhD, Department of Global Health, University of Washington, 6016 1st Avenue NW, Seattle, WA 98107, USA
| | | | - Elizabeth N. Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Roland Kupka
- Nutrition Section UNICEF-HQ, New York, New York, USA
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Teng D, Yang W, Shi X, Li Y, Ba J, Chen B, Du J, He L, Lai X, Li Y, Chi H, Liao E, Liu C, Liu L, Qin G, Qin Y, Quan H, Shi B, Sun H, Tang X, Tong N, Wang G, Zhang JA, Wang Y, Xue Y, Yan L, Yang J, Yang L, Yao Y, Ye Z, Zhang Q, Zhang L, Zhu J, Zhu M, Shan Z, Teng W. An Inverse Relationship Between Iodine Intake and Thyroid Antibodies: A National Cross-Sectional Survey in Mainland China. Thyroid 2020; 30:1656-1665. [PMID: 32586221 DOI: 10.1089/thy.2020.0037] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Iodine intake is associated with thyroid autoimmunity. In this study, we evaluated the changes in thyroid autoimmunity after 20 years of universal salt iodization (USI) in China. Methods: A total of 78,470 subjects (18 years or older) from 31 provincial regions of mainland China participated in the study. Serum thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), TSH receptor antibody, thyrotropin (TSH), and urinary iodine concentration (UIC) were measured. Results: Positive TPOAb and TgAb were detected in 10.19% [CI 9.80-10.59] and 9.70% [CI 9.28-10.13] of the subjects, respectively. The prevalence of positive isolated TPOAb (i-TPOAb), positive isolated TgAb (i-TgAb), and double positive TPOAb and TgAb (d-Ab) was 4.52%, 4.16%, and 5.94%, respectively. The prevalence of thyroid antibody positivity was the highest in the iodine-deficient (UIC <100 μg/L) groups. The prevalence of i-TPOAb was inversely associated with more than adequate iodine intake (MAI) and excessive iodine intake (EI); the odds ratio (OR) was 0.89 [CI 0.81-0.98] for MAI and 0.90 [CI 0.81-0.99] for EI. We observed that i-TgAb, like i-TPOAb, was a high-risk factor for subnormal TSH levels (OR = 3.64 [CI 2.62-5.05]) and elevated TSH levels (OR = 1.62 [CI 1.49-1.77]). The prevalence of thyroid antibody positivity varied among five ethnic groups. Conclusions: After two decades of USI, the prevalence of thyroid antibody positivity has remained low. MAI and EI had an inverse relationship with TPOAb positivity, which reveals that UIC between 100 and 299 μg/L is optimal and safe for thyroid autoimmunity. These conclusions need to be confirmed in a follow-up study because this study was a cross-sectional study.
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Affiliation(s)
- Di Teng
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Wenqing Yang
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Xiaoguang Shi
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Yongze Li
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Jianming Ba
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Bing Chen
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Jianling Du
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
| | - Lanjie He
- Department of Endocrinology, Cardiovascular and Cerebrovascular Disease Hospital of Ningxia Medical University, Yinchuan, P.R. China
| | - Xiaoyang Lai
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Yanbo Li
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
| | - Haiyi Chi
- Department of Endocrinology, Hohhot First Hospital, Hohhot, P.R. China
| | - Eryuan Liao
- Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Chao Liu
- Research Center of Endocrine and Metabolic Diseases, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R. China
| | - Libin Liu
- Department of Endocrinology and Metabolism, Fujian Institute of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, P.R. China
| | - Guijun Qin
- Division of Endocrinology, Department of Internal Medicine, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, P.R. China
| | - Yingfen Qin
- Department of Endocrine, First Affiliated Hospital of Guangxi Medical University, Nanning, P.R. China
| | - Huibiao Quan
- Department of Endocrinology, Hainan General Hospital, Haikou, P.R. China
| | - Bingyin Shi
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Hui Sun
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, P.R. China
| | - Nanwei Tong
- Department of Endocrinology and Metabolism, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, P.R. China
| | - Jin-An Zhang
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences-Affiliated Zhoupu Hospital, Shanghai, P.R. China
| | - Youmin Wang
- Department of Endocrinology, The First Hospital of An Hui Medical University, Hefei, P.R. China
| | - Yuanming Xue
- Department of Endocrinology, The First People's Hospital of Yunnan Province, Kunming, P.R. China
| | - Li Yan
- Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Jing Yang
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Lihui Yang
- Department of Endocrinology and Metabolism, People's Hospital of Tibet Autonomous Region, Lhasa, P.R. China
| | - Yongli Yao
- Department of Endocrinology, Qinghai Provincial People's Hospital, Xining, P.R. China
| | - Zhen Ye
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, P.R. China
| | - Qiao Zhang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Guiyang Medical University, Guiyang, P.R. China
| | - Lihui Zhang
- Department of Endocrinology, Second Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Jun Zhu
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, P.R. China
| | - Mei Zhu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, P.R. China
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7
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Li Y, Teng D, Ba J, Chen B, Du J, He L, Lai X, Teng X, Shi X, Li Y, Chi H, Liao E, Liu C, Liu L, Qin G, Qin Y, Quan H, Shi B, Sun H, Tang X, Tong N, Wang G, Zhang JA, Wang Y, Xue Y, Yan L, Yang J, Yang L, Yao Y, Ye Z, Zhang Q, Zhang L, Zhu J, Zhu M, Ning G, Mu Y, Zhao J, Shan Z, Teng W. Efficacy and Safety of Long-Term Universal Salt Iodization on Thyroid Disorders: Epidemiological Evidence from 31 Provinces of Mainland China. Thyroid 2020; 30:568-579. [PMID: 32075540 DOI: 10.1089/thy.2019.0067] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Mandatory universal salt iodization (USI) has been implemented in China for 20 years. Although iodine deficiency disorders are effectively controlled, the risk of excess iodine have been debated. Methods: A nationally representative cross-sectional study with 78,470 enrolled participants, aged 18 years or older, from all 31 provincial regions of mainland China was performed. The participants were given a questionnaire and underwent B-mode ultrasonography of the thyroid. Serum concentrations of thyroid hormones, thyroid antibodies, and urine iodine concentration (UIC) were measured. Results: The median UIC of the adult population was 177.89 μg/L. The weighted prevalence of thyroid disorders in adults were as follows: 0.78% of overt hyperthyroidism, 0.44% of subclinical hyperthyroidism, 0.53% of Graves' disease, 1.02% of overt hypothyroidism, 12.93% of subclinical hypothyroidism, 14.19% of positive thyroid antibodies, 10.19% of positive thyroid peroxidase antibodies, 9.70% of positive thyroglobulin antibodies, 1.17% of goiter, and 20.43% of thyroid nodules. Iodine excess was only associated with higher odds of overt hyperthyroidism and subclinical hypothyroidism, while iodine deficiency was significantly associated with higher odds of most thyroid disorders. In addition, increased iodine intake was significantly associated with elevated serum thyrotropin levels but was inversely associated with thyroid antibodies and thyroid nodules. Conclusions: The long-term mandatory USI program with timely adjustments is successful in preventing iodine deficiency disorders, and it appears to be safe. The benefits outweigh the risks in a population with a stable median iodine intake level of up to 300 μg/L.
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Affiliation(s)
- Yongze Li
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Di Teng
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Jianming Ba
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Bing Chen
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Jianling Du
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
| | - Lanjie He
- Department of Endocrinology, Cardiovascular and Cerebrovascular Disease Hospital of Ningxia Medical University, Yinchuan, P.R. China
| | - Xiaoyang Lai
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Xiaochun Teng
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Xiaoguang Shi
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Yanbo Li
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
| | - Haiyi Chi
- Department of Endocrinology, Hohhot First Hospital, Hohhot, P.R. China
| | - Eryuan Liao
- Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Chao Liu
- Research Center of Endocrine and Metabolic Diseases, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R. China
| | - Libin Liu
- Department of Endocrinology and Metabolism, Fujian Institute of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, P.R. China
| | - Guijun Qin
- Division of Endocrinology, Department of Internal Medicine, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, P.R. China
| | - Yingfen Qin
- Department of Endocrine, First Affiliated Hospital of Guangxi Medical University, Nanning, P.R. China
| | - Huibiao Quan
- Department of Endocrinology, Hainan General Hospital, Haikou, P.R. China
| | - Bingyin Shi
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Hui Sun
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, P.R. China
| | - Nanwei Tong
- Department of Endocrinology and Metabolism, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, P.R. China
| | - Jin-An Zhang
- Department of Endocrinology, Shanghai University of Medicine and Health Science Affiliated Zhoupu Hospital, Shanghai, P.R. China
| | - Youmin Wang
- Department of Endocrinology, The First Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yuanming Xue
- Department of Endocrinology, The First People's Hospital of Yunnan Province, Kunming, P.R. China
| | - Li Yan
- Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Jing Yang
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Lihui Yang
- Department of Endocrinology and Metabolism, People's Hospital of Tibet Autonomous Region, Lhasa, P.R. China
| | - Yongli Yao
- Department of Endocrinology, Qinghai Provincial People's Hospital, Xining, P.R. China
| | - Zhen Ye
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, P.R. China
| | - Qiao Zhang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Guiyang Medical University, Guiyang, P.R. China
| | - Lihui Zhang
- Department of Endocrinology, Second Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Jun Zhu
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, P.R. China
| | - Mei Zhu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Guang Ning
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, Rui-Jin Hospital Affiliated with Shanghai Jiao-Tong University School of Medicine, Shanghai, P.R. China
| | - Yiming Mu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Jiajun Zhao
- Department of Endocrinology, Shandong Provincial Hospital affiliated with Shandong University, Ji'nan, P.R. China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, P.R. China
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van der Haar F, Knowles J, Bukania Z, Camara B, Pandav CS, Mwai JM, Toure NK, Yadav K. New Statistical Approach to Apportion Dietary Sources of Iodine Intake: Findings from Kenya, Senegal and India. Nutrients 2018; 10:nu10040430. [PMID: 29596369 PMCID: PMC5946215 DOI: 10.3390/nu10040430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/13/2018] [Accepted: 03/27/2018] [Indexed: 01/13/2023] Open
Abstract
Progress of national Universal Salt Iodization (USI) strategies is typically assessed by household coverage of adequately iodized salt and median urinary iodine concentration (UIC) in spot urine collections. However, household coverage does not inform on the iodized salt used in preparation of processed foods outside homes, nor does the total UIC reflect the portion of population iodine intake attributable to the USI strategy. This study used data from three population-representative surveys of women of reproductive age (WRA) in Kenya, Senegal and India to develop and illustrate a new approach to apportion the population UIC levels by the principal dietary sources of iodine intake, namely native iodine, iodine in processed food salt and iodine in household salt. The technique requires measurement of urinary sodium concentrations (UNaC) in the same spot urine samples collected for iodine status assessment. Taking into account the different complex survey designs of each survey, generalized linear regression (GLR) analyses were performed in which the UIC data of WRA was set as the outcome variable that depends on their UNaC and household salt iodine (SI) data as explanatory variables. Estimates of the UIC portions that correspond to iodine intake sources were calculated with use of the intercept and regression coefficients for the UNaC and SI variables in each country’s regression equation. GLR coefficients for UNaC and SI were significant in all country-specific models. Rural location did not show a significant association in any country when controlled for other explanatory variables. The estimated UIC portion from native dietary iodine intake in each country fell below the minimum threshold for iodine sufficiency. The UIC portion arising from processed food salt in Kenya was substantially higher than in Senegal and India, while the UIC portions from household salt use varied in accordance with the mean level of household SI content in the country surveys. The UIC portions and all-salt-derived iodine intakes found in this study were illustrative of existing differences in national USI legislative frameworks and national salt supply situations between countries. The approach of apportioning the population UIC from spot urine collections may be useful for future monitoring of change in iodine nutrition from reduced salt use in processed foods and in households.
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Affiliation(s)
- Frits van der Haar
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Jacky Knowles
- Large Scale Food Fortification Initiative, Global Alliance for Improved Nutrition, 1211 Geneva, Switzerland.
| | - Zipporah Bukania
- Center for Public Health Research, Kenya Medical Research Institute, 00202 Nairobi, Kenya.
| | - Boubacar Camara
- Comité Scientifique de l'Ecole Doctorale, Université Cheikh Anta Diop de Dakar, B.P. 5005 Dakar-Fann, Sénégal.
| | - Chandrakant S Pandav
- All India Institute of Medical Sciences, Iodine Global Network, New Delhi 110029, India.
| | - John Maina Mwai
- Ministry of Health, Nutrition and Dietetics Unit, P.O. Box 43319-00100, Nairobi, Kenya.
| | - Ndeye Khady Toure
- Cellule de Lutte contre la Malnutrition, B.P. 45001 Dakar-Fann, Sénégal.
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.
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Chen C, Xu H, Chen Y, Chen Y, Li Q, Hu J, Liang W, Cheng J, Xia F, Wang C, Han B, Zheng Y, Jiang B, Wang N, Lu Y. Iodized Salt Intake and Its Association with Urinary Iodine, Thyroid Peroxidase Antibodies, and Thyroglobulin Antibodies Among Urban Chinese. Thyroid 2017; 27:1566-1573. [PMID: 29092685 DOI: 10.1089/thy.2017.0385] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Whether iodized salt increases the risk of thyroid disease has been strongly debated in China, especially in the urban areas of coastal regions, in recent years. This study aimed to investigate the status of iodized salt in terms of urinary and serum iodine concentration in urban coastal areas, and to explore further whether consumption of iodized salt or non-iodized salt is associated with autoimmune thyroid disease (AITD). METHODS The data source was SPECT-China, a cross-sectional study in East China. A total of 1678 subjects were enrolled from 12 communities in downtown Shanghai. The type of salt consumed, the urinary iodine concentration (UIC), serum iodine, thyroid peroxidase antibodies (TPOAb), and thyroglobulin antibodies (TgAb) levels were obtained. AITD was defined as serum TPOAb and/or TgAb >60 kIU/L (TPO/TgAb [+]). RESULTS The prevalence of AITD was 10.5% in men and 21.4% in women. The median UIC and serum iodine concentration were 106.4 μg/L and 60.9 μg/L, respectively. Among all the subjects, 46.4% consumed non-iodized salt; the prevalence of iodine deficiency among those subjects was significantly higher than that of the subjects who consumed iodized salt (54.2% vs. 40.1%; p < 0.001). Consumption of non-iodized salt was positively associated with AITD in all participants (odds ratio [OR] = 1.49 [confidence interval (CI) 1.15-1.95]; p = 0.003) and in women (OR = 1.63 [CI 1.20-2.21]; p < 0.01) after multivariable adjustment. Additionally, the association between low UIC and AITD was observed among all subjects (OR = 1.50 [CI 1.10-2.05]; p = 0.01) and in women (OR = 1.45 [CI 1.02-2.07]; p = 0.038). CONCLUSIONS In coastal areas, which are believed to be rich in iodine, consuming non-iodized salt still led to lower UIC levels and a higher prevalence of iodine deficiency. The consumption of non-iodized salt and low UICs might be a risk factor for AITD, especially for women, which should be further confirmed by longitudinal studies.
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Affiliation(s)
- Chi Chen
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Hao Xu
- 2 Shanghai Changning Center for Disease Control and Prevention , Shanghai, China
| | - Yi Chen
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Yingchao Chen
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Qin Li
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Jie Hu
- 2 Shanghai Changning Center for Disease Control and Prevention , Shanghai, China
| | - Weijiu Liang
- 2 Shanghai Changning Center for Disease Control and Prevention , Shanghai, China
| | - Jing Cheng
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Fangzhen Xia
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Chiyu Wang
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Bing Han
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Yanjun Zheng
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Boren Jiang
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Ningjian Wang
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Yingli Lu
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai, China
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Doggui R, El Ati-Hellal M, Traissac P, Lahmar L, El Ati J. Adequacy Assessment of a Universal Salt Iodization Program Two Decades after Its Implementation: A National Cross-Sectional Study of Iodine Status among School-Age Children in Tunisia. Nutrients 2016; 9:E6. [PMID: 28029137 PMCID: PMC5295050 DOI: 10.3390/nu9010006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/05/2016] [Accepted: 11/10/2016] [Indexed: 12/13/2022] Open
Abstract
In the framework of a worldwide policy to eliminate iodine deficiency (ID) disorders, universal salt iodization was adopted in Tunisia two decades ago. The present study aims to evaluate this strategy, using both performance and impact indicators. A total of 1560 children, aged 6-12 years, were randomly sampled using a national, two-stage, stratified, cross-sectional cluster survey in 2012. Urinary iodine concentration (UIC) of the subjects, and household salt iodine content, were analyzed. The national median UIC was 220 µg/L (95% confidence interval (CI): 199-241), indicating an acceptable iodine status at the population level. Only 11.4% (95% CI: 8.6-14.9) of the children had UIC <100 µg/L, but with large regional disparities (4.3% to 25.5%, p < 0.01); however, more than a quarter of the subjects were at risk of adverse health consequences due to iodine excess. Children from households of low socio-economic levels were more prone to inadequate UIC. The national median iodine concentration of household salt was 22 mg/kg (95% CI: 21-23). Only half of the households used adequately iodized salt (15-25 ppm), with large regional disparities. National ID rates are now well below the target criteria of WHO (World Health Organization) certification (<20% of children with UIC <50 µg/L and <50% with UIC <100 µg/L). The coverage of adequately iodized salt fell short in meeting the goals of USI (Universal Salt Iodization), i.e., >90% of households. Regular monitoring of iodized salt production lines must be strengthened with involvement by producers.
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Affiliation(s)
- Radhouene Doggui
- INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 Rue Jebel Lakhdar, babSaadoun, Tunis 1007, Tunisia.
| | - Myriam El Ati-Hellal
- Institut Préparatoire aux Etudes Scientifiques et Techniques, Toxicology Research and Environment Research Laboratory, 10, Rue Abou El KacemChabbi, Montfleury, Tunis 1008, Tunisia.
| | - Pierre Traissac
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911, Av Agropolis, 534394 Montpellier CEDEX, France.
| | - Lilia Lahmar
- Hôpital d'Enfants, Pediatric Radiology Department, Bab Saadoun, Tunis 1007, Tunisia.
| | - Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 Rue Jebel Lakhdar, babSaadoun, Tunis 1007, Tunisia.
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Ursu HI, Toader OD, Podia-Igna C, Delia CE, Firta AR, Tupea CC, Tudor LM, Gheorghiu ML, Suciu N. IODINE STATUS IN PREGNANT WOMEN AFTER A DECADE OF UNIVERSAL SALT IODIZATION IN ROMANIA. Acta Endocrinol (Buchar) 2016; 12:161-167. [PMID: 31149082 DOI: 10.4183/aeb.2016.161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective To assess iodine status (median urinary iodine concentration) in 118 pregnant women during the third trimester from endemic or non-endemic areas, a decade after implementation of Universal Salt Iodization in Romania. Subjects and methods One hundred and eighteen pregnant women in the third trimester were included in the study group (age range: 16 - 46 years, mean age: 28.78 years). Median urinary iodine concentration (UIC) and body mass index (BMI) were evaluated. Data regarding region of provenance, smoking habits during pregnancy, education level, iodized salt intake, bread intake, iodine supplements, comorbidities (iron deficiency anemia) and birth weight were assessed. Morning urine was collected to measure median UIC. The study was approved by the Local Ethics Committee. Results Median UIC in the study group was 206 mcg/L, reflecting iodine sufficiency during pregnancy. There is a statistically significant difference between pregnant women with and without iodine supplements from rural areas (281.5 versus 196.1 mcg/L, respectively, p=0.023). In the subgroup without iodine supplementation, there was a significant difference between overweight and obese subjects vs. normal weight subjects (232.5 versus 194 mcg/L, p=0.012). Only in the subgroup with a daily intake of less than 5 slices of bread (usually containing iodized salt) we found significant differences between those with and without iodine supplements (245.2 versus 128.3 mcg/L). Iron deficiency anemia was found in 29.66% and 19.49% were current smokers during pregnancy. Conclusions Median UIC in the study group was 206 mcg/L, reflecting iodine sufficiency during pregnancy. The difference between the subgroup with iodine supplements and the subgroup without iodine supplements was not statistically significant, probably due to the excessive consumption of bread and other bakery products which is traditional in Romania.
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Affiliation(s)
- H I Ursu
- "C. I. Parhon" National Institute of Endocrinology, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - O D Toader
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Alfred Rusescu" Institute for Mother and Child, Bucharest, Romania
| | | | - C E Delia
- "Alfred Rusescu" Institute for Mother and Child, Bucharest, Romania
| | - A R Firta
- "Alfred Rusescu" Institute for Mother and Child, Bucharest, Romania
| | - C C Tupea
- "C. I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - L M Tudor
- "Alfred Rusescu" Institute for Mother and Child, Bucharest, Romania
| | - M L Gheorghiu
- "C. I. Parhon" National Institute of Endocrinology, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - N Suciu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Alfred Rusescu" Institute for Mother and Child, Bucharest, Romania
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Dong W, Zhang H, Zhang P, Li X, He L, Wang Z, Liu Y. The changing incidence of thyroid carcinoma in Shenyang, China before and after universal salt iodization. Med Sci Monit 2013; 19:49-53. [PMID: 23314590 PMCID: PMC3629016 DOI: 10.12659/msm.883736] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 06/28/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND An increase in the prevalence of thyroid disease has been found with increasing iodine intake, since universal salt iodization (USI) was instituted throughout China in 1996. The aim of this study was to analyze the incidence of thyroid carcinoma (TC) before and after USI in Shenyang, a city of northeastern China. MATERIAL/METHODS The pathology reports were collected from patients with thyroid diseases who underwent surgery in the First Hospital of China Medical University from January 1, 1992 to December 31, 2009. The detection rate, the constituent ratio, the changes of sex, age, and concomitant thyroid diseases of each histological type of TC were analyzed. RESULTS The detection rate of TC, papillary thyroid carcinoma (PTC), and medullary thyroid carcinoma (MTC) increased; that of follicular thyroid carcinoma (FTC) decreased; and that of undifferentiated thyroid carcinoma (UTC) showed no change after USI. The constituent ratio of PTC increased, that of FTC and UTC decreased, and that of MTC showed no change after USI. The mean age of female patients with TC decreased after USI. The incidences of PTC complicated with either nodular goiter or chronic lymphocytic thyroiditis increased after USI. CONCLUSIONS The detection rate of TC increased significantly, PTC predominated in the histological types of TC, and the mean age of female patients with TC decreased after USI. The patients with either nodular goiter or chronic lymphocytic thyroiditis under high iodine intake should be followed up.
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Affiliation(s)
- Wenwu Dong
- Wenwu Dong, e-mail: , and Hao Zhang, e-mail:
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Mahfouz MS, Gaffar AM, Bani IA. Iodized salt consumption in Sudan: present status and future directions. J Health Popul Nutr 2012; 30:431-438. [PMID: 23304909 PMCID: PMC3763614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Iodine Deficiency Disorders (IDD) Control Programme in Sudan adopted salt iodization as the long-term strategy in 1994. In 2000, it was found that less than 1% of households were using adequately-iodized salt. The objectives of this study were to: (i) study the coverage and variation of different geographical regions of Sudan regarding access to and use of iodized salt, (ii) explore the possible factors which influence the use of iodized salt, (iii) develop recommendations to help in the implementation of the Universal Salt Iodization (USI) strategy in Sudan. This paper is based on the Sudan Household Health Survey (SHHS) dataset. A total sample of 24,507 households was surveyed, and 18,786 cooking salt samples were tested for iodine levels with rapid salt-testing kits. Nationally, the percentage of households using adequately-iodized salt increased from less than 1% in 2000 to 14.4%, with wide variations between states. Access to iodized salt ranged from 96.9% in Central Equatoria to 0.4% in Gezira state. Population coverage with iodized salt in Sudan remains very low. The awareness and political support for USI programme is very weak. National legislation banning the sale of non-iodized salt does not exist. Utilization of the already-existing laws, like the National Standardization and Metrology Law (2008), to develop a compulsory national salt specification, will accelerate the USI in Sudan.
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Affiliation(s)
- Mohamed Salih Mahfouz
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.
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