Goiter in Brazilian modernism paintings / Bócio em pinturas da arte moderna brasileira

Objective: To evaluate Di Cavalcanti's artworks in which goiters are represented before and after the introduction of iodized salt to the Brazilian population. Methods: One hundred and thirty paintings by Di Cavalcanti from the 20's to 70's demonstrating necks were evaluated. All the paintings were observed in reproductions. The neck circumference in the paintings was measured. Since there were no standard thresholds of neck circumference, cutoffs were based on the median. Baseline characteristics of artworks were compared based on high and normal neck circumference categories using Student's t-test, Mann-Whitney-Wilcoxon test, or chi square test. Results: We analyzed 29 artworks which portray the neck of 60 women (84.5%), 8 men (11.3%) and 3 children (4.2%). The analyses of the neck circumference showed 23.3% of women (14/60), 12.5% of men (1/8), and 33.3% of children (1/3) with an abnormal profile of the neck circumference. The neck circumference ratio in 29 paintings showed that the relative sizes of the necks painted between the 1920's and 1950's (r=0.45; p=0.03), and painted between the 1960's and 70's (r= 0.54; p=0.003) have linearly decreased. The decades in which the artworks were painted explained 40.0% of the variation in size of the neck circumference (p=0.002). Conclusion: Art imitates life. Di Cavalcanti was not a physician, and probably did not have the intention to illustrate a pathological condition, although the images observed in this study should be considered as goiter or enlarged neck.

Objetivo: Avaliar as obras de Di Cavalcanti em que bócios estão representados, antes e após a introdução da iodação do sal para a população brasileira. Método: Foram avaliadas 130 pinturas de Di Cavalcanti entre os anos 1920 e 1970 demonstrando pescoços. Todas as pinturas foram observadas em reproduções. A circunferência do pescoço nas pinturas foi mensurada. Como não existia limite-padrão da circunferência do pescoço, os limites foram baseados na mediana. As características básicas das obras de arte foram comparadas por categorias da circunferência do pescoço em elevadas e normais, usando o teste t de Student, o teste de Mann-Whitney-Wilcoxon ou o teste qui-quadrado. Resultados: Analisamos 29 obras de arte que representavam o pescoço de 60 mulheres (84,5%), 8 homens (11,3%) e 3 crianças (4,2%). Ao analisar a circunferência do pescoço, 23,3% das mulheres (14/60), 12,5% dos homens (1/8) e 33,3% das crianças (1/3) demonstraram perfil anormal dela. A relação da circunferência do pescoço em 29 pinturas demonstrou que as circunferências do pescoço relativas aos pescoços pintados entre os anos 1920 e 1950 (r=0,45; p=0,03) e pintados entre os anos 1960 e 1970 (r=0,54; p=0,003) reduziram linearmente. As décadas em que as obra foram pintadas explicaram 40,0% da variação no tamanho da circunferência do pescoço (p=0,002). Conclusão: A arte imita a vida. Di Cavalcanti não era médico e, provavelmente, não tinha intenção de ilustrar uma condição patológica, embora as observações das imagens, neste estudo, tenham sido consideradas como bócio ou com aumento de volume do pescoço

Iodine nutritional status in Brazil: a meta-analysis of all studies performed in the country pinpoints to an insufficient evaluation and heterogeneity

Objectives Iodine deficiency disorder (IDD) is the result of an inadequate dietary intake of iodine, which physiological consequences are endemic goiter and thyroid dysfunction. The objective of this study was to a analyze studies that assessed the status of Brazil’s population iodine nutrition and IDD prevalence. Materials and methods Systematic review using PRISMA statement. Electronic database: PubMed, Medline, SciELO and Lilacs. Quality of studies: Newcastle-Ottawa Scale. Meta-analysis was carried out with R Core Team Statistical Software, version 3.1.0 (2014). The summary measure (WMD) and its confidence interval (CI) of 95% were calculated. The “Funnel plot” graph assessed publication bias and heterogeneity. Results Seventeen papers were eligible: pregnant women (2), school children (9), adults/elderly (4) and preschool children/infants (2). Geographic distribution: North (1), Northeast (1), Midwest (2), Southeast (13), South (3). Twenty-three thousand two hundred seventy-two subjects were evaluated between 1997 and 2013 and all have use urinary iodine (UI) measurement. However, only 7 studies could be included in meta-analysis, all from Southeast region. The overall prevalence of IDD in school children in southeast region was 15.3% (95% CI, 13-35%), however this data had an important heterogeneity, expressed by the I2 Statistic of 99.5%. Conclusion Only few studies have been performed and enrolled populations from south/southeast region of Brazil. The actual IDD prevalence analysis is complex because it was detected bias due influence of individual studies and very high heterogeneity. IDD might still be high in some areas but this remained unknown even after this meta-analysis evaluation. The generation of a national program for analysis of iodine status in all regions is urgently required. Arch Endocrinol Metab. 2015;59(1):13-22 .

La endemia bocio-cretínica en la República Argentina. Reseña cronológica breve y actualizada / La Endemic goiter in Argentina. Nowadays statistical data

Desde épocas antiguas el bocio endémico fue considerado un problema grave, por su extensión y formas clínicas acentuadas, además de su asociación con el cretinismo, también endémico, especialmente en el NOA argentino, no así en el NEA, donde no se comunicaban casos de cretinismo. Estos problemas, de origen geológico, se dan por la pobreza de yodo en ese medio y, consecuentemente en las aguas de bebida. Este problema fue postergado hasta 1965 con la realización de dos encuestas nacionales, sobre muestras probabilísticas sobre 47.619 varones de 20 años en 10 provincias y, sobre 51.768 escolares. En 1967, con suficientes datos, por la extensión de la endemia se legisló con alcance nacional, con la Ley 17.259 que fue sancionada y promulgada en 1º de mayo de 1967. La misma establecía la obligatoriedad del expendio de sal yodada, para uso alimentario humano y animal con una parte de yodo en 30.000 partes de sal, que comenzó a hacerse efectiva en 1970. Investigaciones posteriores han demostrado la efectividad de las medidas sobre la patología tiroidea...

It was known since ends of XIX century the severity of endemic goiter and chretinism, specially in the northwest zone of the country. It has been considered a geological disease because of the lack of iodine in soils and waters. In 1965 the problem was considered and the first place steps were to qualificate how extense was the disease, and two surveys; one in probabilistic samples on 47,619 males of 20 years old, in 10 provinces, and another on 51,768 schoolchildren’s. In 1967 it was decided to legislate to reach the nation with the Law 17,259 approved in May the first, 1967. Effectiveness of the measures were probed by investigations made lately...

La deficiencia de yodo en Cuba / Iodine deficiency in Cuba

Objetivo: caracterizar la magnitud y la severidad de la deficiencia de yodo en Cuba. Métodos: se caracterizó la magnitud y la severidad de la deficiencia de yodo en Cuba mediante la determinación de la yoduria y la prevalencia de bocio por inspección y palpación. Se realizó un estudio epidemiológico de corte transversal utilizando un muestreo complejo por conglomerados bietápico en tres estratos de selección: urbano, rural y montaña, el cual incluyó 67 municipios del país con un total de 2 101 escolares de 6 a 11 años. Resultados: se encontraron yodurias deficientes en el 6,4 por ciento de los niños evaluados a predominio del estrato de montaña. Se evidenció una ingesta excesiva de yodo en todos los estratos. La prevalencia de bocio fue de 27, 3 por ciento, considerada como endemia moderada con una mayor cifra en la montaña y sexo femenino. Los hallazgos indicaron el impacto de la yodación de la sal evaluado a través de la excreción urinaria como indicador de ingesta reciente. Conclusiones: el bocio endémico continúa siendo un problema nutricional poblacional, lo que sugiere realizar estudios de mayor profundidad para identificar las posibles relaciones causales

Objective: characterize the magnitude and severity of iodine deficiency in Cuba. Methods: characterization of the magnitude and severity of iodine deficiency in Cuba was based on determination of iodinuria and the prevalence of goitre by inspection and palpation. A cross-sectional epidemiological study was conducted using complex two-staged cluster sampling of three selected strata: urban, rural and mountainous, including 67 municipalities and a total of 2 101 school children aged 6-11. Results: deficient iodinuria was found in 6.4 percent of the children evaluated, with a predominance of the mountainous stratum. Excessive iodine intake was present in all strata. Goitre was classed as moderately endemic, with a prevalence of 27.3 percent and a predominance in the mountainous stratum and the female sex. Findings revealed the impact of salt iodization, which was evaluated through examination of urinary excretion as an indicator of recent salt intake. Conclusions: endemic goitre continues to be a nutritional problem in the population, pointing to the need to conduct more profound studies to identify possible causal relationships

Epidemiological Assessment of Goiter.

Research Question: 1. What is the magnitude of problem of Goiter? 2. What is the level of iodised salt consumed by school children at school & home? Objectives: 1. To find out incidence of Goiter. 2. To find out level of iodised salt consumed by school children at school & home. Study Design: Cross-sectional study. Settings: School & houseto- house survey of urban & rural area of Raichur district. Participant: School children & general population of both sexes. Sample size: 45173. Statistical analysis: Proportion & Chi-squared test. Results: Total population covered 45173 in five talukas. Males were 23463 & females 21730, adult population 16404, children more than 15 yrs were 28769 & school population was 24984. School boys were 14269 & girls 10715. Highest prevalence of goiter found in Raichur taluka i.e. 5.68% and lowest in Lingsur taluka i.e. 0.86%. Over all prevalence of Goiter among surveyed villages is found to be 3.19 % (1439 cases). Higher prevalence has been reported among females in age group of 10- 14 yrs 5.25% & 15-19 yrs 4.66% compared to other age groups of village population. School children in Raichur district revealed the prevalence of Goiter 3.66%. Conclusion: Prevalence of Goiter among surveyed villages is found to be 3.19 % (1439 cases), which is less compared to the National figures. The people are consuming the iodated salt and ban on non-iodated salt may be effectively implemented in study region.

Tendencia de la nutrición de yodo durante las últimas décadas en escolares chilenos y sus consecuencias / Trend of iodine nutrition in recent decades and its consequences in Chilean schoolchildren

The endemic goiter, nutritional collective problem due to iodine deficience, constitutes a chronic disease with easy prevention and control, nevertheless still it constitutes a serious problem of public world health, being thought that about 650 million persons have goiter, 43 millions suffer from endemic cretinism and 1570 millions are in risk of suffering this disease for living in areas that present a deficit of iodine. Both patterns, deficit and the excess of iodine can conducted to a thyroid disease. The relation between the ingestion of iodine and the risk of disease corresponds to a U curve, where both, the low one and high ingestion of iodine it is associate to high risk of thyroid disease. To have a program of iodine supplementation, it should imply a constant vigilance of iodine nutrition to see its effect on the goiter prevalence in the population, to control his degree of fulfillment, to avoid a possible excess of ingestion of iodine it might help to correct any precocious alteration. Endemic goiter is not longer a problem in Chile. Salt iodination is in agreement with present legislation, but it is very important to have a continuous surveillance of iodine nutrition in Chile to control if salt fortification is appropiate.

Persistence of goitre in the post-iodization phase: micronutrient deficiency or thyroid autoimmunity.

Background & objectives: Despite years of salt iodization, goitre continues to be a major public health problem worldwide. We examined the prevalence of goitre in the post-iodization phase and the relationship of goitre with micronutrient status and thyroid autoimmunity in school children of Chandigarh, north India. Methods: Two phase study; in the first phase, 2148 children of 6 to 16 yr were screened for goitre by two independent observers as per the WHO grading system. In the second phase, a case-control study, 191 children with goitre and 165 children without goitre were compared with respect to urinary iodine, iodine content of salt, serum levels of T3, T4, TSH, anti-TPO (thyroid peroxidase) antibody, haemoglobin, ferritin and selenium. Results: Prevalence of goitre in the studied subjects was 15.1 per cent (13.9% in 6 to 12 yr and 17.7% in 13 to 16 yr age group, P= 0.03). Median urinary iodine excretion in both the groups was sufficient and comparable (137 and 130 µg/l). 3.2 per cent children with goitre and 2.4 per cent without goitre had hypothyroidism (subclinical and clinical) and only one child with goitre had subclinical hyperthyroidism. Nine (4.9%) children in the goitre group and 3 (1.9%) in control group had anti-TPO antibody positivity. The median serum selenium levels were not different in both the groups (181.9 and 193.5 µg/l). Seventy one (37.4%) of the goitrous children had anaemia (haemoglobin <12 g/dl) as compared to 41 (24.8%) of the control group (P <0.01). More number of goitrous children (39, 20.6%) were depleted of tissue iron stores (serum ferritin <12 µg/l) as compared to controls (11, 6.4%; P<0.001). Serum ferritin level negatively correlated with the presence of goitre (r = - 0.22, P =0.008) and had an OR of 2.8 (CI 1.20 - 6.37, P =0.017). Interpretation & conclusions: There was a high prevalence of goitre in young children despite iodine repletion and low thyroid autoimmunity. The concurrent iron deficiency correlated with the presence of goiter. However, the cause and effect relationship between iron deficiency state and goitre requires further elucidation.

Monitoreo de DDI en la provincia de La Rioja (2006) / Monitoring of DDI in the province of La Rioja (2006)

Un total de 712 alumnos de escolaridad primaria, de ambos sexos, fue estudiado en este monitoreo de bocio endémico en dos localidades de la provincia de La Rioja: Ciudad de La Rioja (442 niños) y Chilecito (270 niños). La edad de los escolares osciló entre 5 y 16 años. La palpación tiroidea fue hecha por el conjunto de los médicos participantes. Sin embargo, con la finalidad de aunar criterios con lo realizado previamente (1-24), se tomó como única referencia la palpación de H.N., que se llevó a cabo en la totalidad de los niños estudiados. La definición del grado de bocio fue similar a la utilizada en los otros relevamientos (1). Se determinó la yoduria en muestras casuales de orina emitidas por los niños una vez que fueron palpados (125 de La Rioja y 128 de Chilecito). Se recolectaron 251 muestras de sal de consumo hogareño de La Rioja y 141 de Chilecito, para medir su contenido en yodo. El examen palpatorio de los niños reveló la existencia de bocio grado 1 solamente. La prevalencia de bocio encontrada fue de 1,8% en La Rioja y de 2,6% en Chilecito. Los niveles de yoduria alcanzaron, en La Rioja, una media de 226 ± 181 (DS) μg/L y una mediana de 186μg/L, al tiempo que en Chilecito la media fue de 217 ± 161μg/L y la mediana de 185μg/L. El contenido de yodo de las sales, que aportaron los alumnos desde sus hogares, fue adecuado para casi todas las marcas. De esta manera, observamos que en la ciudad de La Rioja el promedio de yodo en la sal, tomada en conjunto, fue de 33,1 ± 12,5 mg/Kg, mientras que para Chilecito fue de 28,1 ± 8,2 mg/Kg. Al analizar las concentraciones de yodo <15mg/Kg, observamos que fue del 10,7% en La Rioja y del 9,5% en Chilecito. Teniendo en cuenta la línea de corte del 10% que fija el ICCIDD (25) como valor óptimo, podemos observar que la situación fue prácticamente satisfactoria en ambas poblaciones. Concluímos que en estas dos poblaciones de la provincia de La Rioja no existe, actualmente, bocio endémico por deficiencia de yodo. Estos resultados indican que la profilaxis con sal yodada fue óptima en esta provincia, dado que en el pasado solía ser una típica zona yodo-deficiente con un muy alto porcentaje de bocio endémico.

Monitoreo de DDI en la provincia de Entre Ríos (Costa del Río Paraná) (2005) / Monitoring of DDI in the province of Entre Ríos (Costa del Rio Paraná) (2005)

Un total de 561 alumnos de escolaridad primaria, de ambos sexos, fue estudiado en este monitoreo de bocio endémico en dos ciudades de la provincia de Entre Ríos, ubicadas sobre la costa del Río Paraná: Paraná (216 niños) y Diamante (345 niños). La edad de los escolares osciló entre 6 y 14 años. La palpación tiroidea fue hecha por el conjunto de los médicos participantes. Sin embargo, con la finalidad de aunar criterios con lo realizado previamente(1-22), se tomó como única referencia la palpación de H.N., que se llevó a cabo en la totalidad de los niños estudiados. La definición del grado de bocio fue similar a la utilizada en los otros relevamientos (1). Se determinó la yoduria en muestras casuales de orina emitidas por los niños una vez que fueron palpados (99 de Paraná y 142 de Diamante). Se recolectaron 204 muestras de sal de consumo hogareño de Paraná y 337 de Diamante, para medir su contenido en yodo. El examen palpatorio de los niños reveló la existencia de bocio grado 1 solamente. La prevalencia de bocio encontrada fue de 0,92% en Paraná y de 2,9% en Diamante. Los niveles de yoduria alcanzaron, en Paraná, una media de 201±133(DS)μg/L y una mediana de 161μg/L, al tiempo que en Diamante la media fue de 353±227μg/L y la mediana de 295μg/L. El contenido de yodo de las sales, que aportaron los alumnos desde sus hogares, fue adecuado en la mayoría de las muestras. De esta manera, observamos que en la ciudad de Paraná el promedio de yodo en la sal, tomada en conjunto, fue de 31,6 ± 6,1 mg/Kg, mientras que para Diamante fue de 31,6 ± 8,3 mg/Kg. Al analizar las concentraciones de yodo <15mg/Kg, observamos que fue del 2,6% en Paraná y del 3,7% en Diamante. Teniendo en cuenta la línea de corte del 10% que fija el ICCIDD (23) como valor óptimo, podemos observar que la situación es muy satisfactoria en ambas ciudades. Concluimos que en estas dos poblaciones de la provincia de Entre Ríos no existe bocio endémico. Los autores declaran no poseer conflictos de interés.

Monitoreo de DDI en la provincia de Corrientes (2005) / Monitoring of DDI in the province of Corrientes (2005)

Un total de 610 alumnos de escolaridad primaria, de ambos sexos, fue estudiado en este monitoreo de bocio endémico en dos localidades de la provincia de Corrientes: Ciudad de Corrientes (292 niños) y Paso de la Patria (318 niños). La edad de los escolares osciló entre 6 y 15 años. La palpación tiroidea fue hecha por el conjunto de los médicos participantes. Sin embargo, con la finalidad de aunar criterios con lo realizado previamente (1-23), se tomó como única referencia la palpación de H.N., que se llevó a cabo en la totalidad de los niños estudiados. La definición del grado de bocio fue similar a la utilizada en los otros relevamientos (1). Se determinó la yoduria en muestras casuales de orina emitidas por los niños una vez que fueron palpados (145 de Corrientes y 131 de Paso de la Patria). Se recolectaron 271 muestras de sal de consumo hogareño de Corrientes y 318 de Paso de la Patria, para medir su contenido en yodo. El examen palpatorio de los niños reveló la existencia de bocio grado 1 solamente. La prevalencia de bocio encontrada fue de 5,5% en Corrientes y de 4,1% en Paso de la Patria. Los niveles de yoduria alcanzaron, en Corrientes, una media de 190,4 ± 176,6 (DS) μg/L y una mediana de 159μg/L, al tiempo que en Paso de la Patria la media fue de 326 ± 348μg/L y la mediana de 282μg/L. El contenido de yodo de las sales, que aportaron los alumnos desde sus hogares, fue adecuado para la mayoría de las marcas de mayor consumo. Sin embargo, otras demostraron un déficit importante en sus niveles de yodación. Afortunadamente, estas últimas fueron la minoría y no repercutieron significativamente sobre la concentración global de yodo en la sal de consumo. De esta manera, observamos que en la ciudad de Corrientes el promedio de yodo en la sal, tomada en conjunto, fue de 28,2 ± 13,1 mg/Kg, mientras que para Paso de la Patria fue de 31,0 ± 14,3 mg/Kg. Al analizar las concentraciones de yodo <15mg/ Kg, observamos que fue del 20,3% en Corrientes y del 16,0% en Paso de la Patria. Teniendo en cuenta la línea de corte del 10% que fija el ICCIDD (24) como valor óptimo, podemos observar que la situación no fue muy satisfactoria, especialmente en la ciudad capital. Concluimos que en estas dos poblaciones de la provincia de Corrientes no existe bocio endémico por deficiencia de yodo, pero el hecho de que la capital correntina haya superado ligeramente el 5% podría deberse a la ingesta de bociógenos naturales, tales como la mandioca.

Consideraciones epidemiológicas de los desórdenes por deficiencia de yodo, criterios de evaluación y control / Epidemiological considerations of the iodine deficiency disorders, evaluation and control criteria

La eliminación de los desórdenes por deficiencia de yodo es una de las metas más importantes a cumplimentar a nivel mundial. Para ello, se han establecido las bases científicas mediante la formulación de normas, directrices y estrategias de alcance poblacional. La fortificación universal de la sal con yodo resulta la intervención más comúnmente empleada debido a su costo-efectividad. La evaluación de la magnitud y severidad de esta deficiencia incluye la utilización de medios sencillos y valiosos, como las encuestas de bocio y las determinaciones de yodo urinario. El presente trabajo abordó los aspectos relacionados con los criterios para definir a los desórdenes causados por esta deficiencia como problema de salud, indicadores de proceso e impacto en la gestión de programas globales para su eliminación sostenible.

The eradication of disorders due to iodine deficiency is one of the most important goals to be attained at the world level. To this end, scientific bases have been established by the formulation of norms, guidelines, and strategies of population scope. The universal strengthening of salt with iodine is the commonest intervention used due to its cost-effectiveness. The assessment of the magnitude and severity of this deficiency includes the use of simple and valuable means as the goiter surveys and the determination of iodine in urine. The present paper approached the aspects related to the criteria to define the disorders caused by this deficiency as a health problem, the process indicators and the impact on the management of global programmes for their sustainable elimination.

Elimination of iodine deficiency disorders--current status in Purba Medinipur district of West Bengal, India.

BACKGROUND AND OBJECTIVES: Towards sustainable elimination of iodine deficiency disorders (IDD), the existing programme needs to be monitored through recommended methods and indicators. Thus, we conducted the study to assess the current status of IDD in Purba Medinipur district, West Bengal. METHODS: It was a community based cross-sectional study; undertaken from October 2006-April 2007. 2400 school children, aged 8-10 years were selected by '30 cluster' sampling technique. Indicators recommended by the WHO/UNICEF/ICCIDD were used. Subjects were clinically examined by standard palpation technique for goitre, urinary iodine excretion was estimated by wet digestion method and salt samples were tested by spot iodine testing kit. RESULTS: The total goitre rate (TGR) was 19.7% (95% CI = 18.1-21.3 %) with grade I and grade II (visible goitre) being 16.7% and 3% respectively. Goitre prevalence did not differ by age but significant difference was observed in respect of sex. Median urinary iodine excretion level was 11.5 mcg/dL and none had value less than 5 mcg/dL. Only 50.4% of the salt samples tested were adequately iodised (> or = 15 ppm). CONCLUSION: The district is in a phase of transition from iodine deficiency to iodine sufficiency as evident from the high goitre prevalence (19.7%) and median urinary iodine excretion (11.5 mcg/dL) within optimum limit. But, salt iodisation level far below the recommended goal highlights the need for intensified efforts towards successful transition.

Goiter prevalence and iodine nutritional status of school children in a sub-Himalayan Tarai region of eastern Uttar Pradesh.

OBJECTIVES: The present work was undertaken to evaluate the prevalence of goiter, state of iodine nutrition of the population, distribution of iodine through edible salt, bioavailability of iodine, consumption of common goitrogenic food that generally interfere with iodine nutrition in Naugarh sub-division of Siddharthnagar district in Uttar Pradesh, India. SETTING: Five areas were selected from 5 Community Development (CD) Blocks taking one from each by purposive sampling method. In each area, Primary and Junior high schools were selected by simple random sampling to get representative target population. METHODS: Clinical goiter survey was conducted in 1663 school-aged children from both sexes (6-12 yrs), along with the biochemical analysis of iodine (I) and thiocyanate (SCN) in 200 urine samples, iodine content in 175 edible salt samples and 20 water samples collected from the selected study areas. RESULTS: The studied region is severely affected by Iodine deficiency disorders (IDD) as goiter prevalence is 30.2% (grade 1: 27.1% grade 2:3.1%).Median urinary iodine level was 96 microg/L indicating biochemical iodine deficiency. The mean urinary thiocyanate was 0.810+/-0.490 mg/dL and mean of I/SCN ratios in all the studied areas were above the critical level of 7. However, 22% of the individual had I/SCN ratio <or=7 indicating their susceptibility for the development of goiter. Only 12.6% of the salt samples had adequate iodine i.e., >or=15 ppm while iodine content in drinking water varied between 7.5-10.7 microg/L.CONCLUSION: Iodine deficiency is the primary cause, however the consumption of cyanogenic food may have important role for the persistence of IDD in the studied region during post salt iodization phase.

Desenvolvimento de um método para a determinação da iodúria e sua aplicação na excreção urinária de iodo em escolares brasileiros / Development of a semi-automated method for measuring urinary iodine and its application in epidemiological studies in brazilian schoolchildren

Desenvolvemos método semi-automatizado em placa para a determinação de iodo urinário; utilizamos, primeiramente, a digestão das amostras de urina com persulfato de amônio e, a seguir, estimamos a quantidade de iodo pela redução do sulfato cérico amoniacal. O método foi validado no inquérito nacional de monitoração da deficiência de iodo, realizado em 1994, que empregou um sistema de amostragem mista da população brasileira e analisou a iodúria em 16.803 amostras de urina de escolares obtidas por coleta casual. Em 401 municípios estudados encontramos 4 com deficiência de iodo de grau moderado (Almas, Arraias e Paraná, em Tocantins, e Cocos, na Bahia) e 116 de grau leve. Desta forma, este estudo mostrou a presença de regiões com deficiência de iodo em 1994, a despeito do programa de iodação do sal. Dados recentes de outros autores, com número menor de municípios, indicam excesso de ingestão de iodo. Assim, num país de dimensões continentais e heterogêneo como o Brasil, é necessária a realização de avaliações periódicas de amplitude nacional para a verificação da ingestão de iodo da população. O método apresentado neste estudo apresenta as características de simplicidade e eficiência necessários para este tipo de estudo populacional.

In this study we developed a semi-automated method for the measurement of urinary iodine using firstly ammonium persulfate for digestion of urine followed by estimation of iodine content in the Sandell-Kolthoff reaction, in which iodine acts as a catalyst for the reduction of cerium. This method was validated in the 3rd Brazilian National Survey of iodine deficiency in 1994. We studied 16,803 casual urine samples from schoolchildren of 401 cities and found 4 moderately-deficient towns (Almas, Arraias, and Parana, in the State of Tocantins, and Cocos, in the State of Bahia), and 116 mildly-deficient. This work suggests that despite the salt iodization program, there was some iodine-deficient areas in Brazil in 1994. Recent surveys, involving less cities, are indicating an excess of iodine ingestion. Therefore, in a country of continental dimensions and very heterogeneous in terms of public health, periodical evaluations are necessary to monitor the real situation of iodine nutrition in Brazil. The method developed in this paper is suitable for these surveys.

Prevalence of goitre in 6 -12 years school-going children of Panchmahal district in Gujarat, India.

BACKGROUND & OBJECTIVE: Iodine deficiency disorders (IDDs) are one of the worldwide public health problems of today. IDDs are endemic in various districts of Gujarat. We undertook this survey in Panchmahal district of Gujarat to study the prevalence of goiter in a sample of school children, to asses the level of iodine in salt samples, and to determine median urinary iodine concentration in a sample of children. METHODS: In a cross-sectional study, 15,900 school-going children in the age group of 6-12 yr were studied from 10 talukas. A total of 15 clusters were selected by cluster sampling method. Goitre was assessed in the children and urine and salt samples were studied for iodine concentration. RESULTS: The overall prevalence of goitre was 20.5 per cent among the children examined. The median iodine concentration was 70 mg/l indicating mild iodine deficiency; also 61 per cent of the urine samples examined showed iodine insufficiency. Iodine content was found to be adequate in 54.3 per cent of salt samples. INTERPRETATION & CONCLUSION: Our study showed that goitre is still an important public health problem in the district. This calls for identification of factors to strengthen NIDDCP and the need to reimpose ban on sale of non-iodized salt in Gujarat.

Tracking progress towards sustainable elimination of iodine deficiency disorders in Orissa.

OBJECTIVE: To assess the status of iodine deficiency in the population of Orissa and track progress of the elimination efforts. METHODS: A community based field survey was conducted. Data was collected using quantitative and qualitative research methods. Standard internationally recommended protocol and methodology was followed. Thirty clusters were selected using population proportionate to size sampling technique. School children aged 6 to 12 years were selected as target group. Goiter prevalence, urinary iodine excretion in the target group and iodine content of the salt at household were used as outcome variables. RESULTS: A total of 1200 children were studied. The total goiter rate was found to be 8.0%, of which 7.6% were grade I and 0.4% was grade-II goiter. The median urinary iodine excretion was found to be 85.4 microg/L and 32.2% of the subjects had urinary iodine levels less than 50 microg/L. Estimation of iodine content by titration method revealed that in only 45% of households salt was found to be adequately iodised. (Salt with iodine level 15 ppm). CONCLUSION: Iodine deficiency continues to be a public health problem in Orissa and the need to accelerate efforts to iodine sufficiency cannot be overemphasized.

Iodine deficiency in urban slums of Bhubaneswar.

OBJECTIVE: The present study aimed at assessing the population prevalence of goiter and iodine deficiency in school children of 6-12 yr living in urban slums of Bhubaneswer, the capital city of Orissa. METHODS: A cross-sectional study was performed using the 30-cluster sampling methodology and surveillance methods for iodine deficiency as recommended by WHO/ICCIDD/UNICEF. The total goitre rate (n=1248), urinary iodine concentration (UIC) (n=411) and iodine content of edible salt (n=368) were measured. RESULTS: The goitre prevalence was 23.6% (grade 1=18.9%, grade 2=4.7%) with no significant gender variation. Goitre prevalence was significantly higher in children of 10-12 yr (P=0.012) and scheduled caste and tribe (P=0.003). Median urinary iodine concentration was 50.0 microg/l with 85.7% of children having values less than 100 microg/l, indicating as biochemical iodine deficiency. Median UIC was inversely in association with gradations of goitre. Children of 10-12 yr and scheduled caste/tribe communities had significantly higher median UIC (P=0.001) than their counterpart peers. About 51% of children were consuming salt having stipulated iodine content of 15 ppm. CONCLUSION: The study indicates moderate iodine deficiency in the population, despite a mandatory salt iodization programme in Orissa that has been in force since 1989. There is a need to improve the situation through enforcing monitoring of salt iodization to ensure quality and increasing the level of awareness about the iodized salt for sustainable prevention and control of iodine deficiency.

Insufficient level of iodine content in household powder salt in Nepal.

Universal salt iodization (USI) is long term strategy for the control of iodine deficiency disorder (IDD) in Nepal. Standardized periodic testing of the iodine content in salt is a critical part of a salt iodisation programme. To achieve programmatic objective, this study was carried out to estimate the iodine content of household salt in Kavre, Lalitpur and Parsa districts of Nepal. Iodometric titration of 1803 salt samples collected from the households through the students of different schools revealed that 289 (16.0%) had less than 15 ppm iodine. Two hundred forty-one powder salt samples without two children logo (14.3% among total powder salt samples) had iodine below 15 ppm. It includes 25.8% of total salt samples from Parsa district of Terai ecological region. Among total, the largest proportion of the population accounting for almost 93.0% used powder salt. In total 1803 salt samples, mean and median iodine concentration were 31.8 ppm (95.0% CI=31.0-32.6) and 29.5 ppm respectively. The mean and median iodine concentration of phoda (dhike) salt were 22.1 ppm (95.0% CI= 19.2-25.1) and 18.9 ppm; powder salt were 32.6 ppm (95.0% CI= 31.7- 33.4) and 30.6 ppm respectively. In the community level, people are still using the non-iodized salt. To eliminate the IDD more efforts are required at program implementation and monitoring level.

Los monitoreos de DDI en Argentina: Segunda Parte / DDI monitoring in Argentina: Second Part

Continuando con las viñetas sobre el Programa Nacional de Monitoreos de DDI del CACDDI-FASEN, se hace referencia a los tres relevamientos que siguieron a los comentados en la Primera Parte, ellos son Misiones, San Juan y Cordillera Rionegrina