Nutritional status of iodine in pregnant and non-pregnant adolescents assisted at the Family Health Strategy in Vespasiano, MG / Estado nutricional de iodo em adolescentes gestantes e não gestantes assistidas na ESF em Vespasiano, MG

Abstract Objectives: to evaluate the nutritional status of iodine in pregnant adolescents, taking into account the increase in the demand for iodine during pregnancy and the absence of iodization strategies for this population. Methods: cross-sectional study conducted with 62 pregnant and 71 non-pregnant adolescents assisted in primary care. The nutritional status of iodine was determined by urinary samples. The iodine concentration in the consumed culinary salt was also evaluated. For the comparative analyses of categorical variables, the Chi-square test was used and for the continuous variables, the Kruskal-Wallis test, considering a 95% confidence interval (CI) and significance level of 5%. Results: the mean iodine concentration in household salt was 25.1 mg/kg (CI95%= 11.1-67.5 mg/kg), with higher mean content in culinary salt in the group of pregnant women (p<0.028). Regarding the nutritional status of iodine, 71% of pregnant adolescents were deficient and 29% iodine-sufficient, with significant difference when compared to 38% of deficiency and 62% of sufficiency in the control group (p<0.001). Conclusions: there was an iodic deficiency among pregnant adolescents, even in the face of higher concentrations of iode in household salt, exposing a paradox between higher consumption and lower sufficiency in this group. Thus, it is suggested to consider iodine supplementation during pregnancy, seeking to minimize the effects of this deficiency on maternal and child health.

Resumo Objetivos: avaliar o estado nutricional de iodo em adolescentes gestantes, levando-se em consideração o aumento na demanda de iodo na gestação e a ausência de estratégias de iodização para essa população. Métodos: estudo transversal realizado com 62 adolescentes gestantes e 71 não gestantes assistidas na atenção primária. O estado nutricional de iodo foi determinado pela concentração de iodo em amostras urinárias. O teor de iodo no sal culinário também foi avaliado. Para as análises comparativas das variáveis categóricas utilizou-se o teste de qui-quadrado e para as variáveis contínuas o teste Kruskal-Wallis, considerando intervalo de confiança (IC) de 95% e nível de significância de 5%. Resultados: a média da concentração de iodo no sal domiciliar foi de 25,1 mg/kg (IC95%= 11,1-67,5 mg/kg), com maior teor médio no sal culinário de gestantes (p<0,028). Em relação ao estado nutricional de iodo, 71% das adolescentes gestantes mostraram-se deficientes e 29% iodo-suficientes, com diferença significativa quando comparadas aos 38% de deficiência e 62% de suficiência no grupo controle (p<0,001). Conclusões: observou-se deficiência iódica entre adolescentes gestantes, mesmo diante de maiores concentrações de iodo no sal domiciliar, expondo um paradoxo entre maior consumo e menor suficiência neste grupo. Assim, sugere-se considerar a suplementação de iodo na gestação, buscando-se minimizar os efeitos desta carência sobre a saúde maternoinfantil.

Food Iodine Content Table compiled from international databases / Tabela do Conteúdo de Iodo de Alimentos compilada de bancos de dados internacionais

ABSATRCT In Brazil, there are no data on the iodine content of foods, making it difficult for the population to assess their consumption of iodine. Such information is necessary for public policies aimed at establishing nutritional goals. The objective this article is to construct a table of the iodine content of foods. For the construction of the table, databases from 14 countries were used. The foods used were those listed in the 2008-2009 Household Budget Survey, except those containing added salt, and the doubts about whether or not the food was submitted to any kind of preparation. The compilation of international databases of iodine content resulted in 266 foods, which were grouped into 15 groups. Iodine was also quantified by food group and iodized salt. Data were presented as median, minimum, and maximum. A broad variation in the iodine content of foods was found between countries and inter- and intra-food groups. Those with the highest content were fish and seafood, and dairy products. Regarding salt iodization, these countries followed the recommendation of the World Health Organization, except for Spain, Norway and Turkey. The Food Iodine Content Table can be a useful tool for assessing iodine intake, being important in research on nutritional status, food guidance, and public health programs.

RESUMO O objetivo deste trabalho é construir uma tabela de conteúdo de iodo de alimentos visto que tais informações são necessárias para que políticas públicas possam estabelecer metas nutricionais e no Brasil não existem dados do conteúdo de iodo dos alimentos, dificultando a avaliação do consumo pela população. Na construção da tabela utilizou-se bancos de dados de 14 países. Os alimentos utilizados foram aqueles listados na Pesquisa de Orçamentos Familiares de 2008-2009, exceto aqueles que continham sal de adição e os que suscitaram dúvidas em relação à existência de submissão ou não a algum preparo. A compilação dos bancos de dados internacionais do conteúdo de iodo resultou em 266 alimentos, os quais foram reunidos em 15 grupos. Foi realizada também a quantificação de iodo por grupo de alimentos e no sal iodado. Os dados foram apresentados como mediana, mínimo e máximo. Foi encontrada grande variação no conteúdo de iodo dos alimentos entre os países e inter e intra grupos de alimentos. Os que apresentaram maiores conteúdos foram o dos pescados e frutos do mar e dos laticínios. Em relação à iodação do sal, os países seguiram a recomendação da Organização Mundial da Saúde, exceto, Espanha, Noruega e Turquia. A tabela do conteúdo de iodo de alimentos poderá ser um instrumento útil para avaliação da ingestão de iodo, sendo importante em pesquisa do estado nutricional, orientação alimentar e programas de saúde pública.

Efeito da forma de aquecimento em parâmetros de qualidade e identidade de óleos vegetais / Effect of the heating means in quality and identity parameters of vegetable oils

Objetivou-se com este trabalho avaliar parâmetros de identidade e qualidade de óleo de abacate produzido nacionalmente, comparativamente a azeite de oliva e óleo de arroz, após aquecimento em bloco digestor ou micro-ondas. Avaliaram-se amostras sem aquecimento (controle) e aquecidas por 1:30 h em bloco digestor ou 3 min em micro-ondas. Determinaram-se a acidez e os índices iodo e refração. Os resultados indicaram que houve aumento de acidez, redução no índice de iodo e índice de refração após o aquecimento. Apesar do maior valor de acidez após o aquecimento, o óleo de abacate sofreu menor elevação em relação ao controle (cerca de 4 vezes) do que as demais amostras. O impacto do aquecimento foi maior no óleo de arroz, seguido do azeite de oliva. O aquecimento por micro-ondas afetou mais a qualidade das amostras que o aquecimento em bloco digestor.

Encuesta de ioduria como control de la ingesta de iodo / Survey on urinary iodine as iodine intake control / Pesquisa de iodúria como um controle da ingestão de iodo

Desde 1964, año en que se incorporó iodo a la sal de mesa, ha disminuido notoriamente el bocio endémico en Uruguay. Por haberse modificado con posteridad, en dos oportunidades la proporción del iodo en la misma, se tornó imprescindible reevaluar los niveles de la ingesta poblacional siguiendo las recomendaciones de la OMS. Los objetivos de este estudio fueron evaluar los niveles de iodo en la población a través de las iodurias, seleccionar la mejor forma de expresar su excreción y estudiar la relación de las mismas con el sodio urinario. Se analizaron 491 muestras de orina de niños en edad escolar, de nueve departamentos del Uruguay y se determinó iodo, sodio y creatinina. Se observó una mediana de 0,248 mg/L de iodo, valor adecuado según las recomendaciones de la OMS (0,100-0,300 mg/L), una distribución no paramétrica de la ioduria expresada como cociente de Iodo/ creatinina en mg/g que discrimina mejor los valores atípicos respecto de la expresión de iodurias en mg/L, una pobre relación entre la excreción de iodo y el sodio, (r2=0,199) lo que indica que su aporte no es exclusivo de la sal de mesa y un predominio de excreción más elevado en los niños de menor edad respecto de los mayores.

The presence of endemic goiter in Uruguay has decreased markedly since the addition of iodine to table salt in 1964. It was essential to evaluate the population levels of iodine intake accordingly to WHO specifications, since iodine support to the table salt has been modified twice. The aims of this study were to evaluate the levels of iodine in the population through the urinary iodine levels, select the best way to express their excretion and study the relationship thereof with urinary sodium. Four hundred ninety- one urine samples were analyzed from school children from nine states of Uruguay and sodium, creatinine and iodine were measured. The iodine median was 0.248 mg/L, an adequate value according to WHO specifications (0.100-0.300 mg/L). The expression of urinary iodine as the ratio between urinary iodine and urinary creatinine (mg/g) had a non-parametric distribution that discriminate the atypical values better than the urinary iodine (mg/L). The relationship between iodine excretion and sodium was poor (r2=0.199), indicating that the input of iodine does not come exclusively from table salt. Younger children had a greater excretion than older ones.

Desde 1964, quando o iodo foi adicionado ao sal de mesa, diminuiu acentuadamente o bócio endêmico no Uruguai. Por ter sido modificada posteriormente, em duas oportunidades, a proporção do iodo no mesmo, tornou-se essencial reavaliar os níveis de ingestão da população seguindo as recomendações da OMS. Os objetivos deste estudo foram avaliar os níveis de iodo na população através das iodúrias, selecionar a melhor maneira de expressar sua excreção e estudar a relação das mesmas com o sódio urinário. 491 amostras de urina de crianças em idade escolar, de nove departamentos do Uruguay foram analisadas, determinando-se iodo, sódio e creatinina. Foi observada uma mediana de 0.248 mg/L de iodo, valor apropriado de acordo com as recomendações da OMS (0.100-0.300 mg/L), também uma distribuição não paramétrica expressa como quociente de iodo/creatinina em mg/g que discrimina de uma maneira melhor os valores atípicos para a expressão de iodúrias em mg/L, uma pobre relação entre a excreção de iodo e de sódio, (r2=0,199 ), indicando que a sua contribuição não é exclusiva do sal de mesa e uma predominância de excreção maior nas crianças mais novas em relação às maiores.

Yoduria y concentración de yodo en sal de consumo en escolares peruanos del nivel primario / Ioduria and iodine concentration in table salt in Peruvian elementary schoolchildren

RESUMEN Objetivos Determinar la yoduria y concentración de yodo sal de consumo en escolares peruanos del nivel primario. Materiales y métodos Se realizó un estudio transversal. Se incluyó 8023 escolares del nivel primario, que participaron voluntariamente. Se realizó un muestreo probabilístico, multietápico y estratificado, la selección se realizó por muestreo sistemático. La determinación de yoduria se realizó por espectrofotometría (método de Sandell-Kolthoff) y la evaluación de yodo en sal se realizó por volumetría. El procesamiento de datos se realizó mediante análisis para muestras complejas con factor de ponderación. Se calculó medianas, percentiles e intervalos de confianza, se usó la prueba de U Mann Whitney y Kruskall Wallis cuando correspondía. Resultados A nivel nacional, la mediana de yoduria en los escolares fue 258,53 ug/L, siendo mayor en los varones (265,90 ug/L) que en las mujeres (250,77 ug/L). La mediana de yoduria en el área urbana fue mayor (289,89 ug/L) que en el área rural (199,67 ug/L), mientras que en los colegios privados fue 315,48 ug/L y en los públicos fue 241,56 ug/L (p<0,001). La mediana de yodo en sal fue 28,69 mg/kg. El 23,1% de las muestras de sal, tuvieron menos de 15 mg/kg de yodo. Conclusiones La mediana de yoduria en los escolares del nivel primario presenta niveles superiores a las necesarias, según lo recomendado por la OMS, con diferencias entre la zona urbana y rural, y colegios públicos y privados.

ABSTRACT Objectives To determine the ioduria and iodine concentration in table salt in Peruvian elementary schoolchildren. Materials and methods A cross-sectional study was performed. A total of 8,023 elementary schoolchildren, who voluntarily participated, were included. Multistage stratified probability sampling was performed, and the sample was obtained by systematic selection. Ioduria was determined via spectrophotometry (Sandell-Kolthoff method), and the amount of iodine in salt was evaluated volumetrically. The data were processed by means of analysis for complex samples with a weighting factor. Medians, percentiles, and confidence intervals were calculated, and the Mann-Whitney U and Kruskal-Wallis H tests were used, where appropriate. Results Nationwide, the median ioduria in schoolchildren was 258.53 ug/L, being higher in boys (265.90 ug/L) than in girls (250.77 ug/L). The median ioduria in urban areas was higher (289.89 ug/L) than that in rural areas (199.67 ug/L), while it was 315.48 ug/L in private schools and 241.56 ug/L in public schools (p<0.001). The median iodine concentration in table salt was 28.69 mg/kg. Of the total salt samples, 23.1% contained less than 15 mg/kg of iodine. Conclusions The median ioduria in elementary schoolchildren exceeded normal levels, according to the criteria of the World Health Organization, with differences between urban and rural areas and public and private schools.

Systematic review of studies evaluating urinary iodine concentration as a predictor of 24-hour urinary iodine excretion for estimating population iodine intake / Revisión sistemática de estudios que evalúan la concentración urinaria de yodo como factor predictivo de la excreción urinaria de yodo de 24 horas para calcular la ingesta de yodo en la población

OBJECTIVE: To examine the usefulness of "spot" urine iodine concentrations (UICs) in predicting 24-hour urine iodine excretion (UIE) for estimating average population iodine intake. METHODS: An electronic literature search was conducted for articles published through 19 May 2013 in MEDLINE (from 1950), EMBASE (from 1980), and the Cochrane Library (from 1993) using the terms "urinary excretion (timed or spot or random) and (24 h or 24 hour), iodine (iodine deficiency), iodine (intake)," and "urine (timed, spot, random, 24-hour)." Full-text articles about studies that examined > 40 healthy human subjects and measured UIE using the 24-hour urine collection method and UIC and/or UIE using one alternative method (spot (random), timed, and "overnight" (first morning urine), fasting or not fasting) were selected and reviewed. RESULTS: The review included data from 1 434 participants across the six studies that met the inclusion criteria. The main statistical methods for comparing data from the 24-hour urine collections with the values obtained from the alternative method(s) were either regression (β) or correlation (r) coefficients and concordance analysis through Bland-Altman plots. The urine samples collected using the alternative methods were subject to greater intra-individual and inter-individual variability than the 24-hour urine collections. There was a wide range in coefficient values for the comparisons between 24-hour URE measured in 24-hour urine collection and 24-hour UIE estimated using the alternative sampling methods. No alternative sampling method (spot, timed, or "overnight") was appropriate for estimating 24-hour UIE. CONCLUSIONS: The results of this systematic review suggest current data on UICs as a means of predicting 24-hour UIE for estimating population sodium intake are inadequate and highlight the need for further methodological investigations.

OBJETIVO: Analizar la utilidad de la concentraciones urinarias de yodo en una muestra puntual de orina como predicción de la excreción urinaria de yodo de 24 horas para calcular la ingesta promedio de yodo en la población. MÉTODOS: Se realizó una búsqueda de bibliografía electrónica de artículos publicados hasta el 19 de mayo del 2013 en MEDLINE (desde 1950), EMBASE (desde 1980) y la Biblioteca Cochrane (desde 1993) que utilizaran los términos "urinary excretion (timed or spot or random) y (24 h or 24 hour)", "iodine (iodine deficiency)", "iodine (intake)", y "urine (timed, spot, random, 24-hour)" ("excreción urinaria [programada o puntual o aleatoria] y [24 h o 24 horas]", "yodo [carencia de yodo]", "yodo [ingesta]", y "orina [programada, puntual, aleatoria, 24 horas]"). Se seleccionaron y analizaron artículos de texto completo acerca de estudios que hubieran examinado como mínimo a 40 personas sanas y medido la excreción urinaria de yodo mediante la recolección de orina de 24 horas, y la concentración urinaria de yodo o la excreción urinaria de yodo mediante un método alternativo (recolección puntual [aleatoria], programada y "de toda la noche" [primera orina de la mañana], en ayunas o no). RESULTADOS: La revisión incluyó datos de 1 434 participantes de los seis estudios que reunieron los criterios de inclusión. Los principales métodos estadísticos utilizados para comparar los datos de las recolecciones de orina de 24 horas con los valores obtenidos a partir de los métodos alternativos fueron los coeficientes de regresión (β) o correlación (r) y los análisis de concordancia mediante el gráfico de Bland-Altman. Las muestras de orina recolectadas mediante métodos alternativos presentaron una mayor variabilidad interpersonal y para una misma persona que las recolecciones de orina de 24 horas. Se observó una amplia gama de valores de los coeficientes en las comparaciones entre la excreción urinaria de yodo de 24 horas medida mediante la recolección de orina de 24 horas y la excreción urinaria de yodo de 24 horas calculada mediante métodos de muestreo alternativos. Ningún método de muestreo alternativo (puntual, programado o "de toda la noche") resultó apropiado para calcular la excreción urinaria de yodo de 24 horas. CONCLUSIONES: Los resultados de esta revisión sistemática indican que los datos actuales en cuanto a la concentración urinaria de yodo como factor predictivo de la excreción urinaria de yodo de 24 horas para calcular la ingesta de yodo en la población son inadecuados y subrayan la necesidad de nuevas investigaciones metodológicas.

Iodine nutrition in elementary state schools of Queretaro, Mexico: correlations between urinary iodine concentration with global nutrition status and social gap index / Consumo de iodo em escolas de ensino fundamental de Querétaro, México: correlação entre a concentração urinária de iodo, o estado nutricional geral e o índice de desigualdade social

OBJECTIVE AND METHODS: To estimate median urinary iodine concentration (UIC), and to correlate it with global nutrition indicators and social gap index (SGI) in 50 elementary state schools from 10 municipalities in the State of Queretaro, Mexico. RESULTS: 1,544 students were enrolled and an above of requirements of iodine intake was found (median UIC of 297 µg/L). Iodine status was found as deficient, adequate, more than adequate and excessive in 2, 4, 19 and 25 schools, respectively. Seventy seven percent of table salt samples showed adequate iodine content (20-40 ppm), while 9.6% of the samples had low iodine content (< 15 ppm). Medians of UIC per school were positively correlated with medians of body mass index (BMI) by using the standard deviation score (SDS) (r = 0.47; p < 0.005), height SDS (r = 0.41; p < 0.05), and overweight and obesity prevalence (r = 0.41; p < 0.05). Medians of UIC per school were negatively correlated with stunting prevalence (r = -0.39; p = 005) and social gap index (r = -0.36; p < 0.05). Best multiple regression models showed that BMI SDS and height were significantly related with UIC (p < 0.05). CONCLUSIONS: There is coexistence between the two extremes of iodine intake (insufficient and excessive). To our knowledge, the observed positive correlation between UIC and overweight and obesity has not been described before, and could be explained by the availability and consumption of snack food rich in energy and iodized salt.

OBJETIVO E MÉTODOS: Estimar a concentração de iodo urinário (CIU) mediana e correlacioná-la com os indicadores de nutrição geral e com o índice de desigualdade social (IDS) de 50 escolas estaduais de ensino fundamental de 10 municípios do estado de Querétaro, no México. RESULTADOS: Utilizou-se um total de 1.544 crianças e encontrou-se uma ingestão acima das necessidades de iodo (CIU mediana de 297 µg/L). O nível de iodo determinado foi deficiente, adequado, mais do que adequado e excessivo em 2, 4, 19 e 25 escolas, respectivamente. Setenta e sete por cento de amostras de sal de mesa mostraram uma quantidade de iodo adequada (20-40 ppm), enquanto 9,6% das amostras tinham um teor de iodo baixo (< 15 ppm). As medianas de CIU por escola foram correlacionadas positivamente com as medianas do índice de massa corporal (IMC) usando o desvio-padrão da contagem (DP) (r = 0,47; p < 0.005), o DP da altura (r = 0,41; p < 0.05) e a prevalência de sobrepeso e de obesidade (r = 0,41; p < 0,05). As medianas de CUI por escola foram correlacionadas negativamente com a prevalência de desnutrição (r = -0.39; p = 005) e com o índice de desigualdade social (r = -0.36; p < 0,05). Os melhores modelos de regressão múltipla mostraram que a DP do IMC e a altura foram relacionados significativamente com a CIU (p < 0,05). CONCLUSÃO: Existe uma convivência entre os dois extremos de ingestão de iodo (insuficiente e excessiva). Em nosso conhecimento, a correlação positiva entre a CIU, o excesso de peso e a obesidade não foi descrita anteriormente e poderia ser explicada pela disponibilidade e consumo de alimentos ou refeições ricos(as) em energia e sal iodado.

A Comparison of the Use of Contrast Media with Different Iodine Concentrations for Multidetector CT of the Kidney

OBJECTIVE: To determine the optimal iodine concentration of contrast media for kidney multidetector computed tomography (MDCT) by comparing the degree of renal parenchymal enhancement and the severity of the renal streak artifact with contrast media of different iodine concentrations. MATERIALS AND METHODS: A 16-row MDCT was performed in 15 sedated rabbits by injection of 2 mL contrast media/kg body weight at a rate of 0.3 mL/sec. Monomeric nonionic contrast media of 250, 300, and 370 mg iodine/mL were injected at 1-week intervals. Mean attenuation values were measured in each renal structure with attenuation differences among the structures. The artifact was evaluated by CT window width/level and three grading methods. The values were compared with iodine concentrations. RESULTS: The 370 mg iodine/mL concentration showed significantly higher cortical enhancement than 250 mg iodine/mL in all phases (p < 0.05). There was however no significant difference in the degree of enhancement between the 300 mg iodine/mL and 370 mg iodine/mL concentrations in all phases. There is a significant difference in attenuation for the cortex-outer medulla between 250 mg iodine/mL and 300 mg iodine/mL (p < 0.05). The artifact was more severe with a medium of 370 mg iodine/mL than with 250 mg iodine/mL by all grading methods (p < 0.05). CONCLUSION: The 300 mg iodine/mL is considered to be the most appropriate iodine concentration in an aspect of the enhancement and artifact on a kidney MDCT scan.

Microwave digestion for urine iodine determination

Digestion is an important step in urine iodine determination methods. High temperatures and long heating durations can be considered as weaknesses of the present methods. The aim of the study was assessment of microwave use for digestion of urine and decompostion of interfering substances, aimed at shortening the time and increasing safety in the procedure. Random urine samples were processed by conventional acid digestion and also by new microwave optimized digestion methods. After digestion, iodine levels of samples, digested by the two mentioned methods, were also determined using chemical colorimetric kinetic reaction Ce+4 and Ce+3 according to the well known Sandell-Kolthoff reaction. Microplate reading format by ELISA reader was used to increase speed and precision of reading. Sensitivity, precision and comparison results were assayed in both the methods as well. Optimized microwave digestion showed that merely a 10 min duration is adequate for complete digestion of urine samples. Intra- and inter- assay coefficients of variation were 6.7- 9.3% and 9.8-12.3% respectively. The final results of the comparison of iodine contents of samples, were obtained through the two microwave and conventional methods, showed acceptable correlation [r=0.928]. The assay recovery was 91-113% and the sensitivity 5 micro g/dL. The results of this study showed that the microwave procedure for urine digestion is acceptable. The digestion method obtained comparable results with conventional digestion methods, and can hence replace conventional electrical heat digestion methods

O selênio e a glândula tireóide: um estudo em pacientes portadores de disfunções tireoidianas nos estados de Ceará e São Paulo / The selenium and thyroid gland: a study in patients with thyroid dysfunction in the states of Ceara and Sao Paulo

Introdução: O Selênio é um mineral fundamental para o homem, participa dos mecanismos antioxidantes, influencia o sistema imune e participa ativamente da homeostase da glândula tireóide.Objetivo: Avaliar o estado nutricional relativo ao selênio de pacientes adultos portadores de hipotireoidismo e hipertireoidismo em atendimento ambulatorial no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e no Hospital Universitário Walter Cantídio da Universidade Federal do Ceará. Metodologia: Foram avaliados quatro grupos de pacientes com doença de Graves (Graves), Bócio Multinodular Tóxico (BMNT), Hipotireoidismo pós-tireoidectomia (Hipotireoidismo) e tireoidite de Hashimoto (Hashimoto) em dois estados, São Paulo e Ceará e paralelamente dois grupos controle (São Paulo e Ceará). Foram realizadas caracterização antropométrica e clínica. O Se foi analisado no plasma e eritrócitos, foi medida a atividade da GSH-Px, iodúria, MDA plasmático e dosagens de hormônios tireoidianos e Anti-TPO. O consumo alimentar foi estimado utilizando-se a técnica de recordatório 24 horas...

Avaliação ultra-sonográfica da tiróide, excreção urinária de iodo em escolares de 6 a 14 anos e grau de iodação de sal em diferentes regiões do estado deSão Paulo / Echographic evaluation of the thyroid gland, urinary iodine concentration and the salt iodization in schollchildren from distinct regions of the state of São Paulo

O objetivo do estudo foi avaliar a ingestão de iodo em regiões do Estado de São Paulo. 964 escolares foram avaliados e os volumes da glândula tiróide elevaram-se com a idade, guardando correlação positiva com a superfície corporal. 2,9 por cento dos escolares apresentavam bócio e hipoecogenicidade da glândula foi vista em 11,7 por cento da amostra. Houve excessiva excreção urinária de iodo nesta população em 76,8 por cento das amostras. Concluímos que a população de escolares estudados apresenta excessiva ingestão diária de iodo, a qual, poderá induzir várias alterações da função tiroidiana.

The objective of this study was to evaluate the iodine nutrition in distinct regions of the state of São Paulo. 964 schoolchildren were examined and there was a progressive increase of the thyroid volume with aging with a positive correlation with the body surface area. The enlarged thyroid gland was present in 2.9 per cent and a few thyroid gland abnormalities were noticed such as hemiagenesia (0.5 per cent), nodules (0.2 per cent), cysts (0.7 per cent) and hypoechogenicity (11.7 per cent). The urinary excretion of iodine was elevated being above 300ug Iodine/L in 76.8 per cent of the schoolchildren examined. We conclude that the schoolchildren population of the State of São Paulo may be under an excessive daily ingestion of iodine. This may induce a subclinical hyperthyroidism in the elderly and possibly an increment in the prevalence of cronic autoimmune thyroiditis.

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

OBJECTIVES: To assess the status of the iodine deficiency in the population of Bihar and track progress of the elimination efforts. METHODS: A community based field survey was conducted. Using quantitative and qualitative research methods, data was collected by following internationally recommended protocol and methodology. Thirty clusters were selected using population proportionate to size technique. School age children (6 to 12 years) were the target group studied. Urinary iodine in target children and iodine content of salt at households were the indicators used. RESULTS: Total of 1169 children were studied. The median urinary iodine concentration was found to be 85.6 microg/L. Urinary iodine concentration was less than 50 microg/L in 31.5% of the subjects. Only 40.1% of the household salt samples were found to be adequately iodised as determined by titration method (> or =15 ppm iodine). CONCLUSIONS: Study results show existence of iodine deficiency in the state. There is need to accelerate our efforts to achieve iodine sufficiency and this should be done on a war-footing.

Iodine nutritional status of children in North East India.

OBJECTIVE: To assess the iodine nutritional status of school children in selected areas of Imphal West District of Manipur where endemic goitre and associated iodine deficiency disorders (IDD) are prevalent in the post-salt iodization period. METHODS: A total of 961 school children in the age group 6-12 yrs of both sexes were clinically examined for goiter from three study areas- one from rural block and two from urban areas. One hundred twenty urine samples were analysed for iodine and thiocyanate respectively. One hundred and five edible salt samples were also collected from the households to evaluate the iodine content. Drinking water samples from different sources were collected and iodine level was analysed to study the bioavailability of iodine in the region. RESULTS: The total goiter rate was 34.96% (Grade 1- 32.15%; Grade 2- 2.81%) showing that IDD is a severe public health problem. The median urinary iodine levels in the studied areas were in the ranges from 12.5-17.5 microg/dl indicating no biochemical iodine deficiency in the region. Mean urinary thiocyanate level was 0.839+/-0.33 mg/dl showing that the people consume sufficient foods containing thiocyanate precursors. About 82% salt samples had iodine level more than 30 ppm and the iodine content in salt samples less than 15 ppm was only about 3% indicating the salt samples at house hold contain adequate iodine. CONCLUSION: Iodine content in drinking water samples ranged from 1.8-2.6 microg/l showing that the studied region is environmentally iodine deficient. Inspite of the consumption of adequate iodine, the existing goiter prevalence among school children during post salt iodization phase ensures that environmental factors other than iodine deficiency may have the possible role in the persistence of endemic goiter in the population. The role of thiocyanate in this regard may not be ruled out.

Estimation of iodine in salt fortified with iodine & iron.

BACKGROUND & OBJECTIVE: The National Institute of Nutrition (NIN), Hyderabad has developed double fortified salt (DFS) containing both iodine and iron to control the twin problems of iodine deficiency disorders (IDD) and iron deficiency anaemia (IDA). When the iodine content of DFS was estimated by the conventional iodometric titration using sulphuric acid (H(2)SO(4)), problems such as wide variation between duplicate analysis and under/overestimations of iodine content were encountered, which led to inconsistent results. This study was undertaken to develop a modified method for the estimation of iodine in DFS so as to get reliable iodine content of DFS. METHODS: A modified method was developed using orthophosphoric acid (H(3)PO(4)) and the sensitivity of the method was confirmed by estimating the iodine content of potassium iodate (KIO(3)) standard at different concentrations of iodine (0 to 100 ppm). The iodine content of DFS and iodized salt (IS) from local market and factory was estimated by the modified method as well as the conventional iodometric titration and the results were compared. RESULTS: The pH of DFS was acidic. The time gap between the additions of acid and potassium iodide (KI) played a crucial role in getting the actual iodine content of DFS. The H(2)SO(4) and ferrous sulphate (FeSO(4)) interfered with the estimation of iodine in DFS resulting in underestimation or overestimation of iodine. Modified method (H(3)PO(4)) produced consistent and reliable iodine content of DFS. Both H(2)SO(4) and H(3)PO(4) gave same results when tested with KIO(3) standard, Reference salt and IS (both experimental and purchased from local market). Actually 0.50 ml of 1 per cent KI was sufficient to estimate the iodine content of DFS or IS. INTERPRETATION & CONCLUSION: The results of the present study showed that the conventional method using H(2)SO(4) was not suitable for the estimation of iodine in DFS. The modified method using H(2)PO(4) was ideally suited for the estimation of iodine in DFS. Also, iron from DFS did not interfere during estimation of iodine by this method. As both the conventional and the modified methods gave the same results for the iodine content of IS, it is practically prudent to use the modified method (H(2)PO(4)) for both DFS and IS instead of following one method (H(3)PO(4)) for DFS and another (H(2)SO(4)) for IS. The quantity of KI is also reduced and the order of additions of reagents is changed in the modified procedure.

Iodine nutritional status & prevalence of goitre in Sundarban delta of South 24-Parganas, West Bengal.

BACKGROUND & OBJECTIVE: In post salt iodization phase endemic goitre and associated iodine deficiency disorders (IDD) were found prevalent in a randomly selected rural area of Sundarban delta and its adjoining areas of West Bengal. The present investigation was thus undertaken to study the total goitre rate, urinary iodine and thiocyanate excretion pattern of the school going children, iodine content in edible salt and drinking water in the Sundarban delta of South 24-Parganas in West Bengal. METHODS: A total of 4656 school children (6-12 yr) were clinically examined for goitre from 13 different areas in the delta region. Urinary iodine and thiocyanate levels were measured in 520 (40 from each area) samples collected randomly to evaluate the iodine nutritional status and consumption pattern of dietary goitrogen. Simultaneously iodine content was determined in 104 (8 from each area) drinking water samples and 455 (35 from each area) edible salt samples collected from the areas. RESULTS: Children of all the areas were affected by endemic goitre. The prevalence rates were in the ranges from 25-61 per cent; overall goitre prevalence was 38.2 per cent (grade 1--34.0%; grade 2--4.2%). Median urinary iodine level in the studied areas was 225 microg/l (range 115-525 microg/l) indicating no biochemical iodine deficiency in the region. Mean urinary thiocyanate levels were in the range from 0.326-1.004 mg/dl. Iodine content in drinking water samples were in the ranges from 22-119 microg/l, and 55.6 per cent edible salt samples had iodine level above the recommended 15 ppm at the consumption point. INTERPRETATION & CONCLUSION: The severity of endemic goitre was high in the studied population though the iodine nutritional status was found satisfactory in the region indicating no biochemical iodine deficiency. The people of the region consumed iodine through iodized salt but about 44 per cent of the salt samples at household level contained inadequate iodine, however their iodine intake was compensated through iodine in water and food. They also consumed dietary goitrogen. Environmental factors other than iodine deficiency may have possible role for the persistence of endemic goitre in the region. More investigations are thus necessary to arrive at certain definite cause of high goitre rates in this population.

Prevalence of iodine deficiency disorders among schoolchildren in three blocks of Bardhaman District and Bardhaman Municipal area of West Bengal, India: a comparative study.

Urinary iodine levels in children (6-12 years) living in three rural blocks and in the municipal urban area of Bardhaman District, West Bengal, were analyzed to compare the status of recent iodine nutrition in the rural and urban population of the district. Goiter, indicating previous iodine status, was simultaneously estimated. Iodine levels in salt samples, that provide insight into the usage of iodized salt, were estimated. Data indicated that 56.6% of urban children and 51.1% of rural children were biochemically iodine repleted and had urinary iodine excretion (UIE) levels > or = 10microg/dl. Urban children (29.4%) and rural children (37.1%) were found to have goiter. Eighty percent and 50% of the rural and urban salt samples, respectively, were found to have iodine levels below 10 ppm; with significant urban-rural differences. The results indicate that iodine repletion in the surveyed area needs continuous surveillance of the proper distribution and use of iodized salt.

Frequency distribution of urinary and breast-milk iodine concentrations in postpartum period, Gorgan, 2003

Adequate dietary iodine is essential for the production of thyroid hormones. Breastfed infants are reliant on adequate maternal iodine intake. The aim of this study was to evaluate iodine sufficiency in lactating women in Iran. The study population included 100 randomly selected lactating mothers referred to the Taleghani Hospital of Gorgan between April and June 2003. Subjects were within the 1[st]-6[th] month of their postpartum period. Goiter was graded according to WHO classification. Spot urine [2-3 ml] and breast-milk [5-10 ml] samples were collected for the measurement of iodine concentrations using acid digestion method. Urine iodine concentrations [UIC] of <100 and breast-milk iodine concentrations [MIC] of <50 micro g/L were considered as iodine deficiency. Mean [ +/- SD] age of women was 25.6 +/- 1.6 years. 43% and 8% had grade 1 and 2 goiters, respectively. The median [range;%95 CI] UIC was 259micro g/L [35-519; 226-275]. UIC of <100 micro g/L was detected in 16%, 50-99 in 13% and 20-49 micro g/L in 3%. Grade 1 and 2 goiters were present in 8% and 8% of mothers with UIC <100 micro g/L, respectively. The median [range;%95 CI] MIC was 93.5 micro g/L [17-696; 97-137]. MIC of <50 micro g/L was reported in 19%, 35-49 in 13%, 20-34 in 3%, and <20 micro g/L in 3%. Grade 1and 2 goiters were present in 11% and 8% of women with MIC <50 micro g/L, respectively. MIC was significantly correlated with UIC levels [r=0.44, p < 0.0001]. Meanwhile, there was a significant association between iodine-deficiency and goiter [p < 0.0001]. UIC and MIC levels show sufficient iodine supplementation in Gorgan. However, some infants remain at risk for low iodine intake via breast milk

Avaliação ultra-sonográfica da tireóide e determinação da iodúria em escolares de diferentes regiões do Estado de São Paulo / Echographic evaluation of the thyroid gland and urinary iodine concentration in schoolchildren from distinct regions of the State of Sao Paulo, Brazil

A iodação do sal é eficiente no combate às doenças decorrentes da deficiência de iodo, sendo empregada em todo território nacional desde 1995. O Estado de São Paulo é considerado uma área ioda-suficiente. Para avaliar a ingesta de iodo, foram selecionados aleatoriamente 844 escolares entre 6 e 14 anos, de seis regiões do Estado. Foram avaliados, sob o ponto de vista ecográfico da tireóide, 423 meninos e 421 meninas. Os volumes da glândula tireóide elevaram-se progressivamente com a idade, guardando correlação positiva e significativa com a superfície corporal. Cerca de 1,6 por cento dos escolares apresentava bócio. Nódulos, cistos, hemiagenesia foram detectados em 1,4 por cento dos examinados. Notamos excessiva excreção urinária de iodo nesta população, cerca de 53 por cento eliminou acima de 300µg Iodo/L e valores acima de 600µgI/L foram encontrados em 21 por cento dos escolares. As amostras de sal doméstico apresentavam valores entre 28,1 e 63,3mg Iodo/kg de sal. Concluímos que a população escolar do Estado de São Paulo apresenta excessiva ingestão diária de iodo, a qual, extrapolada para a população em geral, pode induzir várias alterações da função tireóidea, como hipertiroidismo subclínico (em idosos) e tireoidite crônica autoimune na população adulta, em geral.

Current status of iodine nutriture and iodine content of salt in Andhra Pradesh.

A cross sectional survey was conducted in the year 2001, to establish the current status of iodine nutriture and level of salt iodisation in the state of Andhra Pradesh, India. All the 23 districts were included. The data was collected in each district through school approach. A total of 3706 salt samples and 1952 casual urine samples were collected. Nearly 45% of the population was found to be consuming iodised salt. All the districts had adequate iodine nutriture except Rangareddy and Cuddapah. The districts which were earlier found endemic to iodine deficiency namely Srikakulam, Vizianagaram, Visakhapatnam, Godavari, Khammam, Adilabad and Warrangal were found with adequate iodine nutriture as reflected by median UIE level of more than 100 microg/L. The study revealed success of salt iodisation program in the state.