[The study of blood serum trace elements in comparison with the structural and functional characteristics of goiter and the carriage of antithyroid antibodies in some regions of Russia]

The study of the sufficiency with essential trace elements in the context of thyroid pathology is especially relevant, since the development and progression of thyroid diseases have various pathogenetic mechanisms, which largest proportion is provoked by insufficient intake of key trace elements, primarily iodine. The aim of the research was obtaining primary data on the sufficiency with essential trace elements of the population in the some regions of the Russian Federation, comparing the data obtained with the prevalence of goiter and the carriage of antibodies to thyroid peroxidase (AT-TPO). Material and methods. The Cross-Sectional Population Study was conducted in medical institutions of the Republics of Crimea, Republics of Tuva and Bryansk region (persons applied for outpatient consultations). The scope of the study was 387 people aged 18 to 65 years (the average age was 40±5 years). All of them underwent: collection of medical history, endocrinologist examination with palpation of the thyroid gland (TG), ultrasound examination of TG, blood sampling to assess the levels of thyroid-stimulating hormone (TSH), AT-TPO, iodine, selenium, zinc. Ultrasound of the TG was performed in the supine position using a portable ultrasound machine LOGIQe (China) with a multi-frequency linear probe 10-15 MHz. During the study, the volume of the thyroid gland, the presence of nodular formations and their characteristics according to the TIRADS classification, TG structure and its echogenicity were assessed. Iodine, selenium and zinc level were measured using tandem mass spectrometry with ionization in inductively coupled plasma (Agilent 8900 ICP-MS Triple Quad). TSH and Ab-TPO were determined by chemiluminescent immunoassay on the Architect i2000 automatic analyzer. Results. All regions are comparable in terms of iodine availability, but differ in the severity of natural iodine deficiency. The median concentration of iodine in blood serum practically coincided in all three regions, amounting to 39.8 μg/l in the Republic of Crimea; 38.8 μg/l in the Republic of Tyva and 43.4 μg/l in the Bryansk region. Comparing these results with foreign data, as well as with our results on urinary iodine level, obtained by routine cerium-arsenite method, we can assume that iodine content in blood serum corresponded to the lower limit of the normal target values. The median concentration of selenium in blood serum also practically coincided in all three regions, amounting to 68.2, 72.1 and 62.8 μg/l, respectively, and probably meets the criteria for optimality. The median serum concentration of zinc in Bryansk region residents corresponded to a deficiency (491.3 μg/l) and was significantly lower compared to the indicator in the Republics of Crimea and Tyva (1633.2 and 1667.6 μg/l, respectively, values above optimal). Among the examined, the proportion of people with AB-TPO carriership was 23.5% (Republic of Crimea - 20.9%, Republic of Tuva - 26.4%, Bryansk region - 20.7%), with impaired thyroid function - 9.6% (6.2% - hypothyroidism, 3.4% - thyrotoxicosis). The frequency of goiter varied from 10 to 13.8%. There were no significant differences in the frequency of occurrence, ultrasonic characteristics of goiter and thyroid nodules by regions. Conclusion. However, the results obtained do not allow to unequivocally judge the absence of micronutrient deficiency in the population of the regions of the Russian Federation, since used the ICP-MS method requires the development of our own reference values of trace elements; in the absence of the latter, data from similar foreign studies were taken as standards. In addition, in further studies it will be important to take into account additional criteria for assessing trace element deficiency, for example, activity of superoxide dismutase and alkaline phosphatase as indirect markers of zinc deficiency, etc. Correlation between blood serum concentration of trace elements and the frequency and structural characteristics of goiter, the carriage of Ab-TPO, and dysfunction of the TG was not revealed.

[On integration of the iodine deficiency elimination and salt reduction programs]

Excessive salt intake is a risk factor for noncommunicable diseases, but salt iodization is the most effective method of population-based prevention of iodine deficiency. Therefore, an assessment of dietary iodine intake from the use of iodized salt in the food industry and potential reductions in salt intake is needed. Objective. To assess the feasibility of integrating iodine deficiency prevention and salt reduction programmes among the adult population in the Republic of Belarus. Material and methods. Using the thiocyanate-nitrite method, the determination of iodine in various types of foods was carried out. Taking into account the actual dietary intake, estimated using the frequency method among 583 respondents over 18 years old, living in Minsk, from various socioeconomic groups, alimentary iodine intake was assessed at different levels of salt use in households. The level of iodine sufficiency was additionally estimated on the base of urinary excretion data obtained by the cerium-arsenite spectrophotometric method in 100 healthy adults over the age of 18 living in Minsk (65 women and 35 men). Results. As part of the legal framework for the use of iodized salt in food production, there has been a steady increase in iodine levels in the target products (bakery and meat products to 42.0 and 133.3 μg/100 g respectively). The content of the discussed micronutrient in the diet of the adult population has raised at least 1.9-fold in recent decades, to 237.3 μg/day in the most realistic consumption model. The main source of iodine among this subpopulation is commercially produced foods with iodized salt, which forms 30-58% of the alimentary iodine exposure. Consumption of salt in Belarus averages 10.6 g per day, which poses a risk of developing noncommunicable diseases and necessitates programmes to reduce the level of salt in the diet. Modeling of scenarios with reduction of salt use in households in accordance with the recommendations of the World Health Organization (WHO) shows that the main contribution to dietary iodine exposure will be made by bread products (38%), about 1/3 will be formed by table salt, the value of non-target fortified products (milk and eggs) will increase (up to 21%). The contribution of table iodized salt to the dietary iodine exposure reaches 43% at actual consumption levels and will decrease to 18% if it is reduced to the WHO recommended values. The median of ioduria among those surveyed is 136.8 μg/l, indicating adequate iodine supply. Conclusion. In implementing joint programs on prevention of iodine deficiency and cardiovascular diseases associated with excessive salt intake, it is necessary to consider national conditions - mandatory use of iodized salt in food industry, its level of fortification, content of this micronutrient in foodstuffs and structure of their consumption among certain population groups.

Medico-social effectiveness of biological monitoring of iodine deficiency status (IDS) among women of reproductive age in Kazakhstan

INTRODUCTION

Iodine deficiency is one of the most important public health problems in the world. It mostly affects pregnant women and children. The lack of iodine leads to an increase in the numbers of perinatal mortality and mental retardation.

MATERIAL AND METHODS

In 2012-2014, a survey was carried out of 2,342 women, of whom 2284 were analyzed for salt to measure the content of iodine, and 2,242 women of reproductive age had their urine samples analyzed by the cerium-arsenite method based on the Sandell-Kolthoff reaction. Determination of the medical and social effectiveness of biological monitoring of IDS was carried out in 3 stages.

RESULTS

The study revealed that in the eastern Kazakhstan region the relative risk (RR) of overall prevalence of iodine deficiency among women was 1.1 times higher (95% ID: 0.35-3.61; Z statistic = 0.192) among household respondents (≤15mkg/kg). In the Pavlodar region, the RR of the prevalence of total iodine deficiency is 0.5 times higher in households where the salt was not sufficiently iodized. In the Zhambyl region the RR of the iodine deficiency prevalence was about twice as high due to insufficient iodized salt.

CONCLUSIONS

The introduction of biological monitoring of IDS among women, especially pregnant women, may positively affect the detection of the risk limits for the birth of infants with reduced mental abilities or other diseases during pregnancy, using timely targeted preventive measures to exclude factors that affect the spread of IDS.

[Prevention of iodine deficiency diseases: solved and unsolved problems]

This article was prepared on the basis of the presentations of the co-authors at the plenary and breakout sessions of the V Congress of Endocrinologists in Moscow. These reports provided up-to-date information on the state of the problem of eliminating iodine deficiency diseases (IDD), and also discussed a number of controversial scientific aspects of the control and prevention of IDD.

[The awareness of the prevention of iodine deficiencies in Russia, Byelorussia, and Turkmenistan]

The article presents an analysis of qualitative studies of the level of awareness, attitudes to the problem and the actions of consumers of fertile age in Russia, Belarus and Turkmenistan on the prevention of iodine deficiency diseases (IDD), conducted by the author in 1999-2004. at the initiative of the ministries of health of these states and representative offices of the United Nations Children's Fund (UNICEF).The aim of the study was to develop a communication campaign strategy for mass iodine prophylaxis in these countries.

[REShENNYE I NEREShENNYE VOPROSY ENDEMIChESKOGO ZOBA I YODTsEFITsITNYKh SOSTOYaNIY (LEKTsIYa)]

Iodine deficiency, in addition to the development of an enlargement of the thyroid gland - goiter, leads to a number of other pathological conditions, which are commonly called iodine deficiency diseases. The spectrum of iodine deficiency diseases is wide and depends on the period of life when iodine deficiency affects the body. Iodine deficiency during pregnancy and embryonic development leads to a high prevalence of spontaneous abortion, especially in the first trimester of pregnancy; high perinatal and infant mortality, congenital malformations, congenital hypothyroidism with a lag in physical and mental development. In childhood and adolescence, iodine deficiency is accompanied by an increase in the thyroid gland, in some cases with a violation or delay in physical, mental and sexual development. In the mature period, iodine deficiency is accompanied by varying degrees of thyroid enlargement. Cretinism in iodine-deficient areas occurs with a frequency of 1 to 10%.