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

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

[The problem of iodine deficiency and its solution in the republic of Belarus].

The problem of iodine deficiency is relevant to the Republic of Belarus. It's confirmed by virtually commonly found geophysical iodine deficiency in soils and waters. Data on iodine deficiency initiated the development of a state strategy for the elimination of iodine deficiency in the population. This strategy determined the mandatory use of iodized salt only in the country in the food industry and catering as the main event for the elimination of iodine deficiency. The aim of this work was a comprehensive evaluation of the results of the implementation of the strategy for elimination of iodine deficiency among the population of the Republic of Belarus. Medical monitoring of the assessment of the efficacy showed the decrease in the incidence of simple non-toxic goiter in adolescents from 1215,23 per 100,000 population in 1998 to 341,25 in 2013 (3.6 times), and indices ofprimary morbidity rate in children fell by 2.9 times. Over the period from 1998 primary morbidity rate of simple nontoxic goiter decreased significantly in adults from 379.9 to 31,71 people per 100,000 of the population in 2013 respectively (almost 12 times). Data of the assessment of ioduria in Belarus indicate that 89.2% of children enrolled in the study have iodine excretion of more than 100 pg/L. Thus, in the Republic of Belarus there was achieved the level of an adequate intake of iodine with foodstuffs. This model ofprevention of iodine deficiency, as well as the traditional approach based on the adoption of the law, is a versatile and cost-effective mode.

[The preva-lence and pattern of autoimmune thyroid disease in young patients with type 1 diabetes mellitus].

This study whose purpose was to examine the prevalence and pattern of autoimmune disease of the thyroid gland (TG) in young patients with type I diabetes mellitus (DM1) involved 288 individuals with DM1 whose age was 5.5 to 30years; the average duration of DM1 was 5.5+4.7 years. In all the patients, thyroid ultrasonography was performed, thyroid antibodies (Abs) [thyroid peroxidase antibodies (TPO-Abs) and thyroglobulin antibodies (TG-Abs)] were determined, thyroid function was evaluated by measuring the level of thyroid-stimulating hormone (TSH) and free reactions of thyroid hormones were assessed. The detection rates of TPO-Abs and TG-Abs were 22.2 and 20.5%, respectively, which was substantially greater than those in apparently healthy individuals matched by age and gender. The frequency of positive thyroid Abs was significantly higher in females. Age at the moment of examination and the duration of DM1 were not found to have an impact on the detection rate of thyroid Abs. The ultrasound signs of autoimmune thyroid diseases were revealed in 19.1% of the cases. 10.0% of the patients with DM1 were found to have these or those TG dysfunctions the most common of which was subclinical hypothyroidism (6.60%). A comprehensive TG assessment in the young patients with DM1 demonstrated the typical signs of autoimmune thyroid disease in 14.2% of the examinees. In the patients with autoimmune thyroid disease, the thyroid was significantly larger and the levels of TSH, TPO-Abs, and TG-Abs were higher than the patients without autoimmune thyroid disease and those at risk for the latter. The proportion of females was significantly higher among the patients 19 with concomitant autoimmune thyroid disease than that among those without the signs of this condition. It has been concluded that the high incidence of autoimmune thyroid disease in young patients with DM1 permits the authors to recommend a screening for its early detection, which involves the measurement of the serum level of TPO-Abs and TG ultrasonography in all females with first detected DM1.

[Effect of acute levodopa load on blood prolactin concentration in patients with thyroid diseases]. / Vliianie ostroi nagruzkoi levopoi na soderzhanie prolaktina v krovi u bol'nykh s patologiei shchitovidnoi zhelezy.

In 14 thyrotoxic patients and 5 persons with endemic euthyroid goiter the blood plasma prolactin content was studied under the action of an acute oral load of levodopa in a dose of 0.5 g. It was found that the basal prolactin level was significantly higher in the blood of patients of both sexes with thyrotoxicosis and endemic euthyroid goiter than that in the control group (10 healthy humans). The blood plasma prolactin content markedly decreased in thyrotoxic patients under levodopa effect, regardless of the sex, whereas in patients with endemic euthyroid goiter the drug exhibited no considerable action on the prolactin level. A possible mechanism of hyperprolactinemia in the thyroid hyperfunction is discussed.

[Calcitonin and calcium content of the blood of patients with thyroid pathology]. / Soderzhanie kal'tsitonina i kal'tsiia v krovi bol'nykh s patologiei shchitovidnoi zhelezy.

The blood calcitonin and calcium content was studied in 38 patients with thyrotoxicosis, 20 subjects with endemic euthyroid goiter and 7 persons with primary hypothyrosis. The blood calcium and calcitorim levels were not changed in males and females with endemic euthyroid goiter in comparison with those of 19 healthy controls. Calcitonin content was markedly decreased in patients with hypothyrosis. Calcium level was significantly increased in males, remaining practically unchanged in females. Calcium and calcitonin levels were dependent on thyrotoxicosis severity. Calcitonin content remained unchanged in moderate thyrotoxicosis and lowered in the severe stage of the disease. The blood calcium level remained unchanged both in males and females suffering from severe thyrotoxicosis and in males with the moderate form of the disease. Calcium content diminished in the blood serum of females with moderate thyrotoxicosis.