Worldwide Recall Rate in Newborn Screening Programs for Congenital Hypothyroidism.

CONTEXT: Neonatal mass screening program for congenital hypothyroidism provides the best tool for prevention of its devastating effects on mental development. Despite the overall success of the screening programs in detecting congenital hypothyroidism and eliminating its sequelae and new developments made in the program design, high recall rate and false positive results impose a great challenge worldwide. Lower recall rate and false positive results may properly organize project expenses by reducing the unnecessary repeated laboratory tests, increase physicians and parents' assurance and cooperation, as well as reduce the psychological effects in families. EVIDENCE ACQUISITION: In this review, we assessed the recall rate in different programs and its risk factors worldwide. METHODS: Publications reporting the results of the CH screening program from 1997 to 2016 focusing on the recall rate have been searched. RESULTS: Recall rates vary from 0.01% to 13.3% in different programs; this wide range may be due to different protocols of screening (use of T4 or TSH or both), different laboratory techniques, site of sample collection, recall cutoff, iodine status, human error, and even CH incidence as affected by social, cultural, and regional factors of the population. CONCLUSIONS: It is suggested to implement suitable interventions to reduce the contributing factors by improving the quality of laboratory tests, selecting conservative cut off points, control iodine deficiency, use of iodine free antiseptic during delivery, and use of more specific markers or molecular tests. Applying an age dependent criteria for thyrotropin levels can be helpful in regions with a varied time of discharge after delivery or for preterm babies.

Iodine nutrition status in lactating mothers residing in countries with mandatory and voluntary iodine fortification programs: an updated systematic review.

BACKGROUND: The aim of this review is to assess data available on iodine nutrition status in lactating mothers residing in countries with mandatory and voluntary iodine fortification programs and/or iodine supplementation. SUMMARY: A systematic review was conducted by searching articles published between 1964 and 2013 in Pub Med, ISI Web, and Cochrane Library using iodine nutrition, lactation, iodine supplementation, and iodine fortification as keywords for titles and/or abstracts. Relevant articles were included if they reported urinary iodine concentration (UIC) in lactating mothers and, if determined, the type of iodine fortification program and/or iodine supplementation. Forty-two studies met the inclusion criteria. Among these, 21 studies assessed lactating mothers in countries with a mandatory iodine fortification program, 17 studies were from countries with voluntary and/or without iodine fortification programs, and four studies assessed iodine nutrition status in lactating mothers undergoing iodine supplementation. Among countries with mandatory iodine fortification programs, the range of salt iodization level in lactating mothers with a UIC <100 µg/L was between 8 and 40 ppm, whereas among lactating mothers with UIC >100 µg/L, it was between 15 and 60 ppm. Levels of UIC <100 µg/L were observed among lactating women in India, Denmark, Mali, New Zealand, Australia, Slovakia, Sudan, and Turkey, whereas in countries such as Chile, Iran, Mongolia, New Guinea, and Nigeria, the median or mean of UIC was >100 µg/L. There was a median or mean UIC <100 µg/L in nearly all lactating mothers residing in countries where implementation of universal salt iodization program was voluntary, including Switzerland, Australia, New Zealand, Ireland, and Germany. However, in some countries with voluntary iodine fortification programs, such as the United States, Spain, and Japan, a mean or median UIC of >100 µg/L has been reported. CONCLUSIONS: Although universal salt iodization is still the most feasible and cost-effective approach for iodine deficiency control in pregnant and lactating mothers, UIC in lactating mothers of most countries with voluntary programs and in areas with mandatory iodine fortification is still within the iodine deficiency range, indicating that iodine supplementation in daily prenatal vitamin/mineral supplements in lactating mothers is warranted. However, further investigations are still recommended in this regard.

Relationship between goiter and gender: a systematic review and meta-analysis.

Several studies have reported inconsistent findings for the effect of gender on goiter prevalence. We undertook a systematic review and meta-analysis to investigate the effect of gender on goiter prevalence in different age groups and with differing iodine status. We systematically searched Medline, Embase, the Cochrane Library and Persian databases for trials published between 1950 and May 2012. We included studies assessing the goiter in both genders using palpation or ultrasonography, without age limitation. Summary estimates of pooled prevalence proportions were calculated with a quality effects model. Of 3286 candidate articles, 143 were eligible (606,714 participants). Proportional prevalence of goiter was greater for females than males 0.54 (95 % CI = 0.53-0.56) versus 0.46 (95 % CI = 0.44-0.47), these proportions for subgroups of longstanding iodine deficiency and recent (<10 years) iodine sufficiency were 0.59 versus 0.41 and 0.54 versus 0.46, respectively; however, no gender difference was observed in proportional prevalence of goiter in the subgroup of longstanding (>10 years) iodine sufficiency (0.50 vs. 0.50). These proportions for grade 1 of goiter were 0.54 versus 0.46 and for grade 2 were 0.63 versus 0.37; for children were 0.54 versus 0.46 and for adults were 0.74 versus 0.26 for females and males, respectively. Subgroup analyses showed that there was an increasing trend in gender differences around the age of 15 years. Goiter is more frequent in females. This gender difference in prevalence of goiter is more prominent in iodine-deficient areas, and with grade 2 of goiter, notably after puberty.

Dietary trends in the Middle East and North Africa: an ecological study (1961 to 2007).

OBJECTIVE: Middle Eastern and North African countries are undergoing nutrition transition, a transition which is associated with an increased burden of non-communicable diseases. This necessitates the evaluation of dietary patterns in these regions. The present study aimed to assess changes in dietary patterns in Middle Eastern and North African countries between 1961 and 2007. DESIGN: Availability of energy and fifteen main food items during 1961-2007 was examined using FAO food balance sheets from the FAOSTAT database. SETTING: Fifteen countries including nine in the Middle East and six in North Africa were selected and the average availability of total energy and different food items in these regions were compared. RESULTS: Over the 47 years studied, energy and food availability (apart from animal fats and alcoholic beverages) has increased in the Middle East and North Africa. In both regions the proportion of energy derived from meat and vegetable oils has increased significantly while that from cereals decreased significantly. In addition, the proportion of energy from milk and dairy products and vegetables has shown an ascending trend in North Africa while the proportion of energy from fruits has shown a descending trend in the Middle East. CONCLUSIONS: The study results reveal an unfavourable trend towards a Westernized diet in the Middle East and, to a certain extent, in North Africa. Tailored nutritional education encouraging healthy eating for prevention of the burden of chronic diseases in these countries seems essential.