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Iodine Deficiency In At-Risk Groups: Current Status and Elimination Strategies

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Micronutrients and Human Health".

Deadline for manuscript submissions: closed (31 October 2021) | Viewed by 30295

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Special Issue Editor

Dr. Kristen Hynes

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Guest Editor

Menzies Institute for Medical Research, University of Tasmania, Hobart TAS 7000, Australia
Interests: iodine nutrition; iodine deficiency; neurodevelopment; supplementation; gestation; educational outcomes; epidemiology; pregnancy; breastfeeding; dietary practice

Special Issue Information

Dear Colleagues,

Iodine is an essential micronutrient that is crucial for the formation of thyroid hormones involved in a wide range of neurodevelopmental and metabolic processes. While great progress has been made globally to eliminate iodine deficiency (ID) and its associated adverse outcomes from many regions, insufficient dietary iodine continues to be the leading cause of preventable brain damage in humans.

Concerningly, even in countries and regions where ID has been rectified in the “general population”, at-risk sub-groups remain. Examples include pregnant and breast-feeding women and their offspring; adolescent girls and women of child-bearing age; and people whose diets—for lifestyle or medical reasons—restrict iodine-containing foods.

Addressing ID in at-risk groups is complex. Fortification programs and supplementation recommendations need to target those at risk, and must consider the impacts of excessive iodine intake. Education of those at risk is required, and monitoring needs to be ongoing.

This Special Issue of Nutrients welcomes the submission of original research, reviews, and meta-analyses reporting on iodine nutrition in at-risk groups. Topics include, but are not limited to:

ID in at-risk groups;

Strategies to eliminate ID: population prophylaxis, USI, fortification, supplementation;

Maternal ID during gestation and lactation: consequences for offspring;

Pre-conception ID;

Iodine-restricting diets;

ID in older adults;

Iodine knowledge in at-risk groups;

Public health and education interventions;

Iodine nutrition policy;

Animal models of iodine-restricting diets;

Excess iodine concerns.

Dr. Kristen Hynes
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

iodine deficiency
pre-conception iodine nutrition
iodine supplementation
iodine fortification
pregnancy and breastfeeding
neurocognitive development
restrictive diets
public health intervention

Published Papers (7 papers)

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Research

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32 pages, 17805 KiB

Open AccessArticle

Consumer Acceptance and Market Potential of Iodine-Biofortified Fruit and Vegetables in Germany

by Ann-Kristin Welk, Ruth Kleine-Kalmer, Diemo Daum and Ulrich Enneking

Nutrients 2021, 13(12), 4198; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13124198 - 23 Nov 2021

Cited by 6 | Viewed by 2895

Abstract

Biofortification of food crops with iodine is a novel approach to preventing iodine deficiency in humans. The present study analyses the consumer target groups and the market potential of iodine-biofortified fruit and vegetables in Germany. For this purpose, an online survey of 1016 German fruit and vegetable consumers was conducted to investigate the acceptance of different product categories as well as relevant criteria for the market launch. The results show that iodine-biofortified fruit and vegetables are particularly attractive to consumers who purchase at farmers’ markets, organic food shops, and farm stores. Out of this group, 39% of consumers rate such iodine-rich foods as very appealing. They attach importance to food that naturally contains iodine and prefer produce from integrated domestic cultivation. With their focus on sustainability and naturalness, this group of consumers clearly differs from typical users of dietary supplements, who are primarily concerned with health benefits. However, overall about 85% of respondents would prefer biofortified fruits and vegetables to supplements to improve their iodine supply. The greatest market potential for iodine-biofortified fruit and vegetables is to be expected in supermarkets, as this is the preferred food shopping location for most consumers. A total of 28% of those who buy here rate the biofortified foods presented as very appealing. Nevertheless, a successful market launch requires that the benefits of the new products are communicated according to the potential consumer group needs. Full article

(This article belongs to the Special Issue Iodine Deficiency In At-Risk Groups: Current Status and Elimination Strategies)

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13 pages, 938 KiB

Open AccessArticle

Nutritional Iodine Status in Pregnant Women from Health Area IV in Asturias (Spain): Iodised Salt Is Enough

by Silvia González-Martínez, María Riestra-Fernández, Eduardo Martínez-Morillo, Noelia Avello-Llano, Elías Delgado-Álvarez and Edelmiro Luis Menéndez-Torre

Nutrients 2021, 13(6), 1816; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13061816 - 27 May 2021

Cited by 8 | Viewed by 3600

Abstract

Background: Iodine deficiency during pregnancy may have adverse effects on the neurodevelopment of the foetus. Recent studies of pregnant women in Asturias (Spain) indicate that nutritional iodine levels are sufficient. The objective of this study was to confirm the appropriate nutritional iodine status and to analyse the influence of the ingestion of iodine on maternal urinary iodine concentration (UIC) and thyroid function. Methods: An observational study was carried out between May and June 2017 on women in the first trimester of pregnancy from Health Area IV in Asturias. The women completed a questionnaire related to their consumption of iodine and samples were taken to analyse UIC and thyroid function. Results: Three hundred and eighteen pregnant women were involved. Of these, 51.10% used iodised salt, 48.90% consumed ≥ 2 servings of dairy products daily and 87.08% took iodine supplements. The median UIC was 171.5 μg/L (116–265 μg/L) and 60.41% of women had UIC ≥ 150 μg/L. Multivariate logistic regression analysis demonstrated that iodised salt had a protective effect on UIC < 150 μg/L (odds ratio (OR) 0.404 (0.237–0.683), p = 0.001), but not iodine supplements (OR 0.512 (0.240–1.085), p = 0.080). The average level of thyroid stimulating hormone (TSH) was 2.26 ± 0.94 mIU/L; 68.40% of pregnant women taking iodine supplements had TSH < 2.5 mIU/L compared to 30.00% of those who were not taking supplements (p = 0.031). Conclusions: The pregnant women in our health area are maintaining appropriate nutritional iodine levels. The consumption of iodised salt protects against iodine deficiency; thus, iodine supplements should be taken on an individualised basis. Full article

(This article belongs to the Special Issue Iodine Deficiency In At-Risk Groups: Current Status and Elimination Strategies)

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13 pages, 929 KiB

Open AccessArticle

Vegans, Vegetarians and Pescatarians Are at Risk of Iodine Deficiency in Norway

by Synne Groufh-Jacobsen, Sonja Y. Hess, Inger Aakre, Elin Lovise Folven Gjengedal, Kristina Blandhoel Pettersen and Sigrun Henjum

Nutrients 2020, 12(11), 3555; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12113555 - 20 Nov 2020

Cited by 33 | Viewed by 6974

Abstract

Low iodine intakes have been documented in different population groups in Norway. We aimed to assess iodine status, dietary intake, supplement and macroalgae use, and iodine knowledge in vegans, vegetarians and pescatarians. In this study, 115 vegans, 55 vegetarians and 35 pescatarians from the Oslo region of Norway, aged 18–60 years, participated. A spot urine sample was collected along with a dietary assessment of iodine intake, supplement and macroalgae use. The median urinary iodine concentration (MUIC) in vegans was 43 µg/L (moderate iodine deficiency), in vegetarians 67 µg/L and in pescatarians 96 µg/L (mild iodine deficiency). In multiple linear regression analysis, use of iodine supplements was one of the strongest predictors of UIC. About half of the participants had median 24-h iodine intakes below estimated average requirement (EAR) of 100 µg/day. Fifty percent had low knowledge score, while 27% had very low knowledge score. Vegans, vegetarians and possibly pescatarians in Norway, are unable to reach the recommended iodine intake merely from food and are dependent on iodine supplements. There is an urgent need for dietary guidance targeting vegans, vegetarians and pescatarians to avoid inadequate iodine intake in non-supplement users, as well as avoiding excess iodine intake in macroalgae users. Full article

(This article belongs to the Special Issue Iodine Deficiency In At-Risk Groups: Current Status and Elimination Strategies)

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12 pages, 870 KiB

Open AccessArticle

Familial Aggregation of Endemic Congenital Hypothyroidism Syndrome in Congo (DR): Historical Data

by Christian X. Weichenberger, Maria Teresa Rivera and Jean Vanderpas

Nutrients 2020, 12(10), 3021; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12103021 - 02 Oct 2020

Cited by 1 | Viewed by 2266

Abstract

Familial aggregation of endemic congenital hypothyroidism (CH) in an iodine-deficient population from northern Congo (Democratic Republic (DR)) was analysed on data collected four decades ago (1979–1980). During a systematic survey of 62 families, 46 endemic CH subjects (44 myxedematous and 2 neurological) were identified based on clinical evidence within a village cohort of 468 subjects. A distribution analysis showed that two families presented significant excess of cases versus a random background distribution. Both families were characterised by two healthy parents having all of their five offspring affected by some form of endemic CH. Goitre prevalence in endemic CH was lower than that in the general population, while goitre prevalence in the unaffected part of the cohort (parents and siblings) was similar to that of the general population. Some unidentified genetic/epigenetic factor(s) could contribute to the evolution of some iodine-deficient hypothyroid neonates through irreversible and progressive loss of thyroid functional capacity during early childhood (<5 years old). Besides severe iodine deficiency, environmental exposure to thiocyanate overload and selenium deficiency, factors not randomly distributed within families and population, intervened in the full expression of endemic CH. Further exploration in the field will remain open, as iodine deficiency in Congo (DR) was eliminated in the 1990s. Full article

(This article belongs to the Special Issue Iodine Deficiency In At-Risk Groups: Current Status and Elimination Strategies)

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15 pages, 915 KiB

Open AccessArticle

Changing Dietary Habits in Veneto Region over Two Decades: Still a Long Road to Go to Reach an Iodine-Sufficient Status

by Simona Censi, Jacopo Manso, Susi Barollo, Alberto Mondin, Loris Bertazza, Massimo De Marchi, Caterina Mian and on behalf of the Food and Nutrition Hygiene Services (SIAN)

Nutrients 2020, 12(8), 2399; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12082399 - 11 Aug 2020

Cited by 16 | Viewed by 2961

Abstract

Background: Fifteen years after a nationwide voluntary iodine prophylaxis program was introduced, the aims of the present study were: (a) to obtain an up-to-date assessment of dietary iodine intake in the Veneto region, Italy; and (b) to assess dietary and socioeconomic factors that might influence iodine status. Methods: Urinary iodine concentration (UIC) was obtained in 747 school students (median age 13 years; range: 11–16 years). Results: The median UIC was 111 μg/L, with 56% of samples ≥ 100 μg/L, but 26% were < 50 μg/L, more frequently females. Iodized salt was used by 82% of the students. The median UIC was higher among users of iodized salt than among non-users, 117.0 ug/L versus 90 ug/L (p = 0.01). The median UIC was higher in regular consumers of cow’s milk than in occasional consumers, 132.0 μg/L versus 96.0 μg/L (p < 0.01). A regular intake of milk and/or the use of iodized salt sufficed to reach an adequate median UIC, although satisfying only with the combined use. A trend towards higher UIC values emerged in regular consumers of cheese and yogurt. Conclusion: Iodine status has improved (median UIC 111.0 μg/L), but it is still not adequate as 26% had a UIC < 50 μg/L in the resident population of the Veneto region. A more widespread use of iodized salt but also milk and milk product consumption may have been one of the key factors in achieving this partial improvement. Full article

(This article belongs to the Special Issue Iodine Deficiency In At-Risk Groups: Current Status and Elimination Strategies)

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Review

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9 pages, 851 KiB

Open AccessReview

Iodine Status of 6–12-Year-Old Children in Russia over the Past 10 Years: A Scoping Review

by Rimma Korobitsyna, Andrey Aksenov, Tatiana Sorokina, Anna Trofimova and Andrej M. Grjibovski

Nutrients 2022, 14(4), 897; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14040897 - 21 Feb 2022

Cited by 1 | Viewed by 2112

Abstract

Iodine is an essential element for growth and development of children. Ensuring adequate iodine intake and monitoring iodine intake are important public health concerns. According to the World Health Organization, a population-based assessment of iodine status is often done by measuring urine iodine concentration (UIC) in children aged 6–12 years. National data for large countries may hide regional differences in the UIC. Currently, there is limited data on the iodine status of children in Russia. We summarized the evidence on the iodine status of children in Russia using both international and local literature in accordance with the PRISMA guidelines. A total of 2164 studies were identified, 12 of which met the selection criteria and covered 10 of 85 federal subjects. For most of the Russian regions there was no information on UIC. A range of methodologies were used to determine UIC. The median UIC ranged from 46 μg/L in the mountainous areas in the Republic of Kabardino-Balkaria, which corresponds to a moderate iodine deficiency (ID), to 719 μg/L in the town of Turinsk (Sverdlovsk region) indicating excessive of iodine intake. Nationwide monitoring should be implemented in Russia and public health measures should be adjusted to regional and local conditions to ensure adequate iodine nutrition for all citizens. Full article

(This article belongs to the Special Issue Iodine Deficiency In At-Risk Groups: Current Status and Elimination Strategies)

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15 pages, 877 KiB

Open AccessReview

Is There an Ideal Diet to Protect against Iodine Deficiency?

by Iwona Krela-Kaźmierczak, Agata Czarnywojtek, Kinga Skoracka, Anna Maria Rychter, Alicja Ewa Ratajczak, Aleksandra Szymczak-Tomczak, Marek Ruchała and Agnieszka Dobrowolska

Nutrients 2021, 13(2), 513; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13020513 - 04 Feb 2021

Cited by 29 | Viewed by 8345

Abstract

Iodine deficiency is a global issue and affects around 2 billion people worldwide, with pregnant women as a high-risk group. Iodine-deficiency prevention began in the 20th century and started with global salt iodination programmes, which aimed to improve the iodine intake status globally. Although it resulted in the effective eradication of the endemic goitre, it seems that salt iodination did not resolve all the issues. Currently, it is recommended to limit the consumption of salt, which is the main source of iodine, as a preventive measure of non-communicable diseases, such as hypertension or cancer the prevalence of which is increasing. In spite of the fact that there are other sources of iodine, such as fish, seafood, dairy products, water, and vegetables, the high consumption of processed food with a high content of unionised salt, alternative diets or limited salt intake can still lead to iodine deficiency. Thus, iodine deficiency remains a relevant issue, with new, preventive solutions necessary. However, it appears that there is no diet which would fully cover the iodine requirements, and iodine food supplementation is still required. Full article

(This article belongs to the Special Issue Iodine Deficiency In At-Risk Groups: Current Status and Elimination Strategies)

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