Iodine nutritional status of school children in a rural area of Howrah district in the Gangetic West Bengal

The objective of the study was to assess the status of iodine nutrition in an area of Howrah district where iodine deficiency disorders (IDD) were reported despite the introduction of iodised salt for general use. A total of 969 school children in the age group 6-12 years of both sexes were clinically examined for goitre. On the spot 242 urine samples were collected from the children to study the iodine and thiocyanate excretion pattern and 108 edible salt samples were collected from the homes of the children to measure iodine level. Drinking water samples were collected to evaluate the bioavailability of iodine in the region. The total goitre prevalence was 37.6% (Grade 1: 32.6%; Grade 2: 4.9%). The median urinary iodine level was 35 microg/dL, 12.5% urine samples had iodine level below 10 microg/dL and no sample was found to contain iodine below 5 microg/dL. In 51.9% salt samples iodine level was below 15 ppm and the iodine level in the drinking water was about 82 microg/L. The people of the area consume foods from the vegetables of the Brassica family and mean thiocyanate level was 0.747+/-0.21 mg/dL. The-findings of the present study indicated that as per clinical criteria of WHO/UNICEF/ICCIDD, IDD is a severe public health problem though apparently there is no biochemical iodine deficiency. Overall results indicate that factors other than iodine deficiency may have a role in the persistence of endemic goitre in the post salt-iodisation in this region.     

碘缺乏病的监测结果动态分析

目的了解那坡县食盐中碘元素的含量情况以及尿碘检测碘含量情况,为消除碘缺乏病提供科学依据。方法根据《实现消除碘缺乏病目标县级考核评估方案》中所制定的评定标准,和按照卫生部2007年颁布的《全国碘缺乏病监测方案(试行)》。碘盐检测采用GB/T 13025.71999中直接滴定法,川盐、强化盐采用氧化还原滴定法测定,尿碘检测采用WS/T 107-2006催化还原分光光度法,合格碘盐判定标准为20～50mg/kg,合格尿碘判定标准为>100μg/L。结果 2010年前三年中碘盐合格率、合格碘盐食用率和碘盐覆盖率2007年为97.19%、96.18%、98.96%,2008、2009年均为100.00%,尿碘含量低于100μg/L的比例不超过20%。结论 2010年经省级考核评估,那坡县碘盐"三率"和尿碘含量均达到了国家碘缺乏病消除目标。     

某市近50年碘缺乏病防治措施及效果

目的总结分析荆门市近50年碘缺乏病(IDD)防治措施及效果,为今后巩固消除IDD防治成果决策提供依据。方法收集整理IDD历年防治资料,按照抽样调查、普查普治、防治监测及效果评估等4个不同防治阶段统计数据,分析效果,找出问题。结果近50年来,采取以落实加碘盐为主的综合防治措施,居民甲状腺肿患病率已从1975年25.29%降至1985年1.6%,7~14岁儿童甲状腺肿率已从1990年32.5%降至1994年的15.47%,8~10儿童甲状腺肿率已从1996年26.17%降至2007年6.88%,有效的控制了IDD的危害,20年无新发克汀病患者;居民户盐碘值(M)已从1994年前14.8mg/kg升至2001年的35.88mg/kg,连续9年≥30mg/kg;居民户碘盐合格率、碘盐覆盖率及合格碘盐食用率,连续9年达到90%以上;儿童尿碘中位数,连续10年≥300μg/L。结论 5县(市、区)于2009年达到消除IDD的考评标准,取得了显著成绩。但8~10岁儿童尿碘值过高是由于居民户碘盐过高所致,建议尽快进一步下调盐碘浓度;5年级学生IDD知晓率不高,健康教育工作不容忽视。     

Persistence of iodine deficiency 25 years after initial correction efforts in the Khumbu region of Nepal.

AIMS: To assess the current status of, and understanding about iodine deficiency disorders among Sherpa residents of the Khumbu region of Nepal, 25 years after the introduction of iodised oil injections. METHODS: Several groups of Khumbu Sherpas were studied and goitre rate, urinary iodine level and cretinism prevalence were measured as indicators of iodine deficiency. Subjects were also questioned in detail about their food consumption, with particular reference to salt use, and about their understanding of the causes and treatment of iodine deficiency disorders. RESULTS: The prevalences of goitre, deaf-mutism and cretinism were 21%, 1.3% and 0.5% respectively (compared to 92%, 4.7% and 5.9% in 1966). No cretins had been born since 1966. The median urine iodine concentration was 35 microg/L. Most people preferred uniodised Tibetan rock salt, although 44% regularly consumed iodised salt. All granulated salt tested from the local market contained adequate amounts of iodine. Only 11% of those surveyed knew that goitre was caused by iodine deficiency CONCLUSIONS: Although prevalences of iodine deficiency disorders are much less than 30 years ago, iodine deficiency continues to be a major problem in Khumbu and demands a clear control strategy, combining ongoing iodine supplementation and education. Iodised salt is usually the best approach to control of iodine deficiency disorders for most regions of the world but the Khumbu experience shows that local cultural and commercial factors can severely limit its impact. To be successful, control programme for iodine deficiency disorders also needs assessment of the salt trade, monitoring, education and occasional targeted interventions with iodised oil or other supplements.     

The Swiss Commission of Goiter of January 21, 1922

The Swiss Commission of Goiter met for the first time the 21st of January, 1922 and has been the first step of an historical event in terms of Public Health: the first requirement for salt iodination for the prevention of goiter. The minutes of this commission as well as the following scientific publications until 1930 indicate that the debate was still very vigorous about this recommendation but mainly about the origin of goiter and the iodine dose to be used. This dose went progressively from less than 10 mg of iodine per kilo of salt to the present WHO recommendation of 20 to 40 mg of iodine per kilo of salt. Another key point was the strategy of implementation of iodine. Two complementary approaches were proposed and implemented: iodine supplement to children at school and iodized salt available for the whole population. One point seemed clear for everyone at that time: iodine was not the source of goiter. Later scientific studies have shown that iodine deficiency was indeed the origin of goiter and associated pathologies.     

Status of iodine deficiency amongst school children in twenty four districts in southern India

The central legislation banning sale of non-iodized salt for edible purposes in the entire country was withdrawn by the Government in the year 2000. The present study was conducted in the year 2001 immediately after lifting the central ban to establish the baseline urinary iodine excretion levels in twenty four districts of Southern India. In each district all the senior secondary schools were enlisted and one school was selected by random sampling. About 120 children in the age group of 11 to 18 years were selected using the random number tables. The urinary iodine excretion levels were analysed using the wet digestion method. It was found that districts Rangareddy, Kolar, Yanam and Perambalour had median UIE levels less than 100 microg/l, indicating iodine deficiency. The findings of the present study highlights the success of Universal salt iodisation programme. The Government of India should reinitiate the process of central ban on sale of non iodised salt in the country to prevent the iodine deficiency disorders.     

江西省第6次碘缺乏病病情调查结果分析

目的通过调查全省碘缺乏病病情和居民碘营养水平,为调整江西省食盐加碘浓度提供依据。方法按人口比例概率抽样方法在全省抽取30个县（市、区）的30所小学．每所小学采用B超法测定40名学生甲状腺容积．抽取上述小学8～10岁儿童尿样345份,并在每所学校周边的3个乡（镇）分别采集孕妇和哺乳期妇女尿样共894份．采用砷铈催化分光光度法进行尿碘含量检测,并对学校所在村分别采集饮用水进行水碘含量检测。结果监测结果表明．全省儿童学生甲状腺肿大发生率为1．25％;盐碘中位数为30．80mg／kg,居民合格碘盐食用率为97．00％;儿童、孕妇和哺乳期妇女尿碘中位数分别为308．95、206．75、206．72μgg/L,其中儿童尿碘大于或等于300μg／L的样品数占52．20％,而孕妇尿碘小于150μg/L的样品数占34．73％;全省水碘中位数4．62μg/L。结论江西省人群碘缺乏状况总体控制良好,仍要加强对重点人群碘营养水平的监测,适时调整碘盐浓度。     

Goiter in rural area of Aligarh district

The survey of iodine deficiency disorder (IDD) and an inquiry about intake of goitrogenic items in two villages of the Aligarh District with a population of 1819 was done. Out of 1152 subjects examined, 348 had goiters but no other abnormality related to the IDD could be found in these subjects. The goiter positivity was 30.2% with visible goiter (grade II & III) rate 8.5%. Six of the subjects had multi nodular goiter of grade III. Urinary iodine levels in 316 of the goitrous subjects were lower (4.939 +/- 1.593 micrograms/dL, M +/- SD, P < 0.001, Median 4.9 micrograms/dL) than 50 urban inhabitants (6.638 +/- 1.372 micrograms/dL). Through in most of the cases (83.9%) T3, T4 and TSH were within normal range, in 35% of the 69 from whom the blood samples were drawn, T3 levels > 150 ng/dL and in 41% of the cases TSH levels > 3.5 mU/L was seen. As in most of the goitrous subjects T3, T4, TSH levels were within normal limits, only iodine deficiency could not be the causative factor for the goiter in 30.2% (severe endemia) of the total population of these two villages. Consumption of millets by the villagers, known to contain goitrogens along with the iodine deficiency in the food and drinking water appears to be responsible for the higher goiter rate in these villagers.     

Determination of urinary iodine excretion to assess iodine deficiency level and iodine intake in primary school children, Bahir Dar, northwest Ethiopia

BACKGROUND: Iodine deficiency is a major public health problem all over the world, particularly among preschool children and pregnant women in low-income countries like Ethiopia and it is known to be the most common cause of preventable brain damage. OBJECTIVES: to determine urinary iodine concentration and to assess the level of iodine deficiency disorders. METHODS: A cross-sectional study was conducted in 386 randomly selected primary school children to determine urinary iodine concentrations as to assess level of iodine deficiency and iodine in take in Bahir Dar town. RESULTS: Median urinary iodine excretion was 58.8 mg/L (12.89 mg/L to 564.5 mg/L) which indicated the presence of mild iodine deficiency. Eighty seven percent of the children had urinary iodine excretion of below 100 mg/L and the intake of iodine was below 150 mg/day. CONCLUSIONS: Mild iodine deficiency disorder was found in Bahir Dar primary school children, Iodine intake was also found insufficient. Therefore, use of salt ionization should be advocated and strengthened.     

Iodide excretion in a salt-restriction trial

Twenty-four hour urinary iodide excretion was measured twice, with a four month interval, in 133 individuals who were in a 12-month salt-restriction study in an area where iodine-deficiency goitre was once common and where most household salt is iodised. Half the subjects were salt restricted; their mean 24 h sodium excretion after eight months was 89 mmol for men and 73 mmol for women. Iodide excretion correlated with sodium excretion in the whole group on each occasion. After eight months mean 24 h iodide excretion in the salt-restricted group (men 1.3 SD 0.6 mumol, women 1.1 SD 0.4 mumol) was lower (p less than 0.01) than that in the control group (men 1.8 SD 0.8 mumol, women 1.7 SD 0.8 mumol), but was reasonable in terms of recommended dietary allowances (1.2 mumol, 150 mg). Mean iodide content of local milk was 1.3 mumol/l. Any salt that is used in the home should continue to be iodised. However, it has become unnecessary in this population to use salt (ie, iodised salt) simply in order to avoid iodine deficiency, so long as other foodstuffs continue to contain iodine as at present. As the other sources of iodine may be subject to change, the adequacy of intake of iodine from these sources should be monitored from time to time in samples of the population.     

Equine goiter associated with excess dietary iodine

Naturally occurring goiter cases are described in 2 newborn Arabian foals whose mares were supplemented with excess iodine during the final 24 w of the pregnancy. Six nursing foals and 2 mares were also affected clinically with thyroid hypertrophy. At least 12 times the maximum tolerable level of iodine supplementation was given, as the daily iodine intake for each mare was 299 mg. The prevalence of goiter cases was 2 and 9% in the mares and foals, respectively.     

新疆南疆地区微量元素锂和碘与地方性甲状腺肿的关系

研究碘缺乏病流行地区除严重缺碘外,微量元素锂对甲状腺的影响。方法对新疆拜城县的两个乡进行流行病学调查,测定当地外环境碘含量,对当地的饮水和妇女的血清锂用原子吸收光谱法进行测定。结果：该地区外环境明显碘缺乏,饮水,土盐,土壤和粮食碘含量均低于国家标准。     

The nutritional status of a rural community in KwaZulu-Natal, South Africa: the Ndunakazi project.

OBJECTIVES: To assess the nutritional status of six month to 11 year old rural Black children and their mothers as a first phase in a nutrition intervention project. DESIGN: Cross sectional study. SETTING: A rural African community +/- 60 km northwest of Durban, KwaZulu-Natal, South Africa. SUBJECTS: A random sample of 127 mothers and 105 pre-school and 131 primary school children were selected from this community. MAIN OUTCOME MEASURES: Anthropometric (height and weight), biochemical and dietary and socio-demographic information was collected. RESULTS: Among the pre-schoolers anaemia was present in 23.8%, iron deficiency in 19.8%, while marginal vitamin A deficiency was observed in 44.9%. Urinary iodine levels indicated moderate iodine deficiency in 31.8% and severe iodine deficiency in 9.1%. In primary school children the prevalence of anaemia was 22%, while marginal vitamin A deficiency was observed in 50.8%. Moderate iodine deficiency was observed in 37.9% of primary school children while 13.6% presented with severe iodine deficiency. The prevalence of goitre in this group was 22.1%. Almost 22% of mothers were anaemic and 18.9% were iron deficient. Only 1.6% of mothers were marginally vitamin A deficient. An enlarged thyroid was observed in 26.7% of mothers of which 17.3% were palpable and 9.4% visible. Of mothers 43.4% were overweight while 33.8% were obese. CONCLUSION: The rural community in KwaZulu-Natal, showed a high prevalence of anaemia, marginal vitamin A deficiency and iodine deficiency. The information gathered during this cross sectional study served as a basis to plan and implement an intervention study aimed at addressing the nutritional deficiencies.     

忻州市碘缺乏病监测结果分析

目的通过调查居民普及食用碘盐,主动改变生活行为,评估其对防治碘缺乏病(IDD)的效果。方法调查合格碘盐食用率、非碘盐率、碘盐覆盖率、碘盐合格率、儿童智力测验、IDD健康教育知晓率。结果居民食用合格碘盐、8～10岁儿童尿碘水平处于较适宜状态。甲状腺肿大率为4.1%,IDD健康教育知晓率五年级学生为76.7%,育龄妇女为94.4%。8～10岁儿童智商与理论值比较智商水平向中下偏移。结论 IDD宣传干预措施不到位,局部呈下滑趋势,加强IDD健康教育,促进群众健康行为生活方式的形成,预防和减少碘缺乏病的危害,是今后工作的重点。     

昆布 鳖甲治疗孕妇碘缺乏的研究

目的探讨中药昆布、鳖甲对孕妇碘营养状况及其新生儿神经行为能力的作用。方法选取2007年6月至2009年12月在张家口市妇幼保健院参加孕期保健及住院分娩的1 200名孕妇,进行尿碘检测。抽取其中200例碘缺乏者进行试验,随机分为2组,实验组服用中药昆布、鳖甲补碘治疗,对照组服用维生素C,1、2、4周后分别进行尿碘检测。收集孕妇同期分娩的新生儿200例,取其脐血进行甲状腺功能测定,以及新生儿神经行为能力测定。结果张家口市区孕妇尿碘中位数为179.2μg/L。其中265例碘摄入量不足,占所调查样本的18.9%;补碘后实验组尿碘值与对照组相比差异有统计学意义(P<0.01);对照组新生儿促甲状腺激素(TSH)>5 mU/L者比例明显多于实验组(8.0/19.0,P<0.01),神经行为能力情况两组相比差异有统计学意义(P<0.01)。结论张家口市区近1/5的孕妇碘摄入量不足,中药昆布、鳖甲对孕妇碘缺乏病有治疗作用,并可降低新生儿神经行为能力发育缓慢的发生率。     

Lipiodol therapeutic indications from 1901 to 1930

Iodine and iodide used to be very successful drugs, sometimes at massive doses. Highly iodinated oil such as lipiodol from Lafay discovered in 1901 were part of expanding the therapeutic use of iodine for various pathologies such as syphilis, cardiovascular and respiratory diseases, leprosy, goiter... The present publication reviews unpublished documents and publications from 1901 to 1930 on lipiodol to give an overview of therapeutic indications for this agent and the rationale behind it. In some areas such as asthma, iodide was still in use until the eighties. Prevention and treatment of endemic goiter is the only remaining domain for the therapeutic usage of lipiodol. It is the only reason why this product is on the WHO essential drugs list.     

Thyroid disease in Tikur Anbessa Hospital: a five-year review

Diseases of the thyroid are not uncommon particularly in the highlands of Ethiopia. To see the pattern of surgical thyroid disorders, a review of operated cases of thyroid diseases in the period 1997-2001 was conducted in Tikur Anbessa Hospital, Addis Ababa. During the period, 472 patients underwent surgery for goiter. Of these, records of 377 patients could be retrieved and form the basis for this analysis. The mean age was 35 (range, 15-73) years. The sex ratio, M : F was 1: 3.8. The mean duration of symptoms on admission was 7 years. The most frequent presenting feature was goiter. Symptoms of airway obstruction and hyperthyroidism were not rare. About 12% of patients were clinically and biochemically categorized toxic. Location of goiter was specified in 349 cases. Of these, 56.7% had bilateral disease. Nodular colloid goiter was the most common pathological type. Neoplasm of the thyroid appeared not to be rare. The mean pre- and postoperative hospital stays were 12 and 6 days, respectively. About 66% of patients had partial or subtotal thyroidectomy. Significant intraoperative hemorrhage requiring blood transfusion occurred in 12 (3%) patients. Some post operative complications including pneumonia, wound infection, recurrent nerve or parathyroid gland injury, and recurrent goiter or hyperthyroidism were noted. One case developed thyroid crisis. Less radical surgical procedures, we believe, are adequate for all benign and most malignant goiters in Ethiopia. In areas where thyroxin is in short supply and follow-up is erratic total thyroidectomy as is recommended else where should be reserved for only few selected cases.     

Iodine supplementation: benefits outweigh risks.

In 1990, iodine deficiency affected almost one-third of the world population and was the greatest single cause of preventable brain damage and mental retardation. Following a resolution adopted by the World Summit for Children in 1990. major programmes of iodine supplementation were implemented by the governments of the affected countries with the support of major donors. Iodisation of salt was recognised as the method of choice. Nine years later, by April 1999, 75% of the affected countries had legislation on salt iodisation and 68% of the affected populations had access to iodised salt. The prevalence of iodine deficiency disorders decreased drastically in most countries and the deficiency disappeared completely in some such as Peru. This result constitutes a public heath success unprecedented with a non-infectious disease. However, occasional adverse effects occurred. The principle effect is iodine-induced hyperthyroidism which occurs essentially in older people with autonomous nodular goitres, especially following iodine intake that is too rapid and of too massive an increment. The incidence of the disorder is usually low and reverts spontaneously to the background rate of hyperthyroidism or even below this rate after 1 to 10 years of iodine supplementation. The possible occurrence of iodine-induced thyroiditis in susceptible individuals has not been clearly demonstrated by large epidemiological surveys. Iodine supplementation is followed by an increased prevalence of occult papillary carcinoma of the thyroid discovered at autopsy but the prognosis of thyroid cancer is improved due to a shift towards differentiated forms of thyroid cancer that are diagnosed at earlier stages. Iodine-induced hyperthyroidism and other adverse effects can be almost entirely avoided by adequate and sustained quality control and monitoring of iodine supplementation which should also confirm adequate iodine intake. Available evidence clearly confirms that the benefits of correcting iodine deficiency far outweigh the risks of iodine supplementation.     

用模糊数学(综合评判法)分析地克病影响因素

本文就地方性克汀病(地克病)患病率的影响因素:缺碘、营养、年龄、遗传等,运用模糊综合评判法作了分析,结果显示:缺碘相对比重最大,其次是营养、年龄、为早发现、早防治地克病明确重点,提供依据。     

Severe iodine deficiency in two endemic goitre areas of Zimbabwe.

The purpose of the study was to investigate the iodine status of the population and the possible role of goitregens (that are metabolised to thiocyanate), in two endemic goitre areas of Zimbabwe. This was done through estimation of iodine (I) and thiocyanate (SCN) levels in spot urine samples collected from goitrous and non-goitrous subjects. Mean and median urine iodine concentrations respectively for Wedza (n = 50) were 1.4 micrograms/dl and 1.0 micrograms/dl and for Chiweshe (n = 60) were 2.1 micrograms/dl and 1.65 micrograms/dl. The differences between the two districts are significant (P = 0.005) and mirror the overall differences in goitre rates found. Urine I levels were generally lower in goitrous than non-goitrous subjects, but the difference was not significant. Mean urine SCN concentrations and mean I/SCN ratios respectively for Wedza were 0.5 micrograms/dl and 2.9 micrograms/dl and for Chiweshe were 0.7 micrograms/dl and 3.4 micrograms/dl. These results indicate that the populations studied are affected by severe iodine deficiency, but that thiocyanate does not have a significant goitrogenic effect. The implications of the results, and the reasons for the discrepancies between them and ones obtained in earlier studies, are discussed.