Network E-Bulletin
Volume 1 Issue 8, December 2005
Welcome to the eight first issue of the Electronic Bulletin from the Network for Sustained Elimination of Iodine Deficiency.
The current Bulletin includes:
1. State of the World’s Children 2006: Excluded and Invisible
UNICEF launched the 2006 State of the World's Children report on 14 December 2005. The report provides an assessment of the world's most vulnerable children which explores the causes of exclusion and the abuses children experience. These children are growing up beyond the reach of development campaigns and are often invisible in everything from public debate and legislation, to statistics and news stories.
Without focused attention, millions of children will remain trapped and forgotten in childhoods of neglect and abuse, with devastating consequences for their long-term well-being and the development of nations. The report argues that any society with an interest in the welfare of its children and its own future must not allow this to happen.
Meeting the Millennium Development Goals depends on reaching vulnerable children throughout the developing world" said UNICEF Executive Director Ann M. Veneman, launching the report in London. "There cannot be lasting progress if we continue to overlook the children most in need - the poorest and most vulnerable, the exploited and the abused."
Visit the following website which includes the full report, statistics and charts, profiles of excluded and invisible children and a number of other multimedia features. The statistics include updated figures on proportion of household iodized salt consumption. http://www.unicef.org/sowc06/fullreport/full_report.php
2. USI Review in Nicaragua
UNICEF Nicaragua assigned a consultant, Dr Frits van der Haar, to assess national progresses in eliminating IDD through USI, and extract “practices and lessons learned” from the history of national efforts to share them among partners in and outside of UNICEF. Among the lessons learned, special attention was desired on an analysis of the revolving fund established in Nicaragua shortly after the year 2000 for the purposes of guaranteeing premix access by salt processors and self-sufficiency in the salt industry for future procurements of the basic fortificant, KIO3.
The consultant visited Nicaragua from October 21 to 25, 2005 and interviewed key stakeholders. The assessment suggested that Nicaragua has succeeded in elimination of IDD through USI and there were two key factors that contributed to this achievement i.e. (a). the KIO3 acquisition and Yodocal supply management system for ensured iodization, and (b). the ongoing monitoring and surveillance of population iodine nutrition for constant proof that iodization works well. The recommendations include a further development and consolidation of salt industry and strengthening the monitoring system for iodine nutrition to sustain elimination of iodine deficiency.
3. Goitre decline in Italy and contribution of the silent and active prophylaxis.
Vella V. Br J Nutr. 2005 Nov;94(5):818-24.
Goitre has been declining in Italy since the 1970s and because active prophylaxis (AP) has been very limited, it has been suggested that in most places the decline was due to silent prophylaxis (SP). SP is related to the natural increase in iodine intake because of higher consumption of iodine-rich products associated with socioeconomic development. The hypothesis tested in the present study is that SP has increased iodine intake in Italy with subsequent reduction of goitre and that such changes can be quantified. The analysis is based on surveys carried out between the 1970s and the 1990s where goitre and urinary iodine, a proxy of consumption, were measured in schoolchildren. The contribution of the SP can be quantified in an annual increase in urinary iodine excretion between 2.1 and 4 microg/l, and an annual decline in goitre prevalence between 2.1 and 3.6 %. In the few areas with AP, there was an annual increase in urinary iodine between 6.5 and 13.1 microg/l, while the average annual decline of goitre was between 4.4 and 10 %. The present results could be used by policy-makers to predict the future trends in the excretion of urinary iodine and prevalence of goitre in Italy with and without AP. AP is about three times faster than SP in increasing iodine intake, but policy-makers should estimate the incremental cost-effectiveness of AP net of the iodine increase already occurring naturally with the SP.
Source: http://amedeo.com/p2.php?id=16277787&s=nut
4. Iodine deficiency in Papua New Guinea: Sub-clinical iodine deficiency and salt iodization in the highlands of Papua New Guinea.
V. Temple, P. Mapira, K. Adeniyi, P. Sims. Journal of Public Health, Volume 27, Number 1, pp. 45-48
Data on the status about iodine nutrition in children in Papua New Guinea (PNG) are scarce. This study attempts to determine the mean daily per capita consumption of salt, the iodine content of salt in the households and retail shops and the urinary iodine concentration in children (6–12 years) in Hella Region, Southern Highland Province (SHP), PNG. The mean daily consumption of salt was 2.62 ± 1.29 g. The iodine content of salt was >30 p.p.m. in 95 per cent of households and 100 per cent of retail shops. The median urinary iodine concentration of 48.0 mg/l for all the children indicates moderate iodine deficiency. The median urinary iodine concentrations for the male (67.0 mg/l) and female (44.0 mg/l) children indicate mild and moderate iodine deficiency, respectively. 68.42 per cent of the male and 81.82 per cent of the female children have urinary iodine concentration <100 mg/l, indicating that iodine deficiency is a potential public health problem in the Hella region. These results indicate a need for further assessment of the implementation of the universal salt iodization strategy for the elimination of iodine deficiency in the SHP, PNG.
Source: http://jpubhealth.oxfordjournals.org
5. Attention to the hiding iodine deficiency in pregnant and lactating women after universal salt iodization: A multi-community study in China.
Yan YQ, Chen ZP, Yang XM, Liu H, Zhang JX, Zhong W, Yao W, Zhao JK, Zhang ZZ, Hua JL, Li JS, Yu XQ, Wang FR. J Endocrinol Invest. 2005 Jun; 28(6):547-53.
Background: Monitoring of iodine nutrition depends chiefly on the urinary iodine concentration in representative samples from the population. International groups have recommended school-age children as a convenient group for surveys, because of their accessibility and young age, but the relevance of this group to others, especially pregnant women, is not well established.
Objective: The purpose was to compare different approaches to assessing iodine nutrition within communities, especially for pregnant and lactating women. DESIGN: In an urban and a rural site from each of the 11 Chinese provinces, covering a wide geographic and socioeconomic range, we measured the iodine content of household salt and drinking water, the thyroid volume in school children, and the urinary iodine concentration in five population subsets; in some sites we also assessed iodine in breast milk and thyroid size in adult women.
Results: The median urinary iodine concentrations for pregnant and lactating women were well below those of the schoolchildren from the same community in most study sites, the difference between medians, at overall level, being about 50 µg/L for the pregnant and 40 µg/L for the lactating women, respectively. When ranked by median urinary iodine concentrations at overall level, the order of the groups was: all infants, schoolchildren, women of childbearing age, lactating women and pregnant women in both urban and rural sites. This relative distribution was constant among the study sites. From it, we derived a relationship to predict the median values for other groups, based on the data of schoolchildren. The median iodine content of salt was 30.9 ppm in urban sites and 31.3 ppm in rural sites, respectively, close to the nationally mandated 35 mg/kg. Water had low iodine content (3.7 µg/L) in both urban and rural sites except in a rural site from Tianjin. Ultrasonography showed that 6.5% of 1329 children in urban sites and 5.3% of 1431 children in rural sites had thyroid enlargement. Breast milk had a median iodine content of 135.9 µg/L in the urban and 157.5 µg/L in the rural. The goiter prevalence by palpation was low (2.0%) among all women examined (3367), but higher in pregnant women (2.7%) than in lactating women or other adult women.
Conclusions: An effective iodized salt program has brought iodine sufficiency to most of China, but pregnant women in some areas may still risk deficiency and need further supplements. We suggest other countries and international agencies pay more attention to pregnancy, where iodine deficiency has its worst consequences.
6. History of endemic goiter in Croatia: from severe iodine deficiency to iodine sufficiency.
Kusic Z, Jukic T. Coll Antropol. 2005 Jun;29(1):9-16.
At the time after the Second World War, endemic goiter was present in most parts of Croatia with a prevalence of more than 50% and presence of cretinism. In the village of Rude near Zagreb, goiter was detected in 85% of school children with 2.3% of cretins in the village population. In 1953 the first regulation on obligatory salt iodination, requiring 10 mg of potassium iodide (KI) per kg of salt was established in former Yugoslavia. A three-fold reduction of goiter prevalence, together with disappearance of cretinism was recorded ten years later In 1992, the National Committee for Eradication of Goiter was founded. The survey performed during 1991-1993 exhibited prevalence of goiter among school children between 8% and 35% and urinary iodine excretion under 10 microg/dL in most of the children from continental parts of the country. The new obligatory regulation, requiring 25 mg of KI/kg of salt, was proposed by the National Comittee and finally established in 1996. In 2002 thyroid volumes and medians of urinary iodine excretion were normal according to the ICCIDD criteria. Overall median of urinary iodine excretion for schoolchildren in Croatia was 14 ug/dL. Croatia crossed a path from severe iodine deficiency detected in the 1950's to the period of mild to moderate iodine deficiency during the 1990's, and finally, nowadays, iodine sufficiency has been achieved.
7. Thyroglobulin as an index of mild iodine deficiency.
SA Skeaff, CD Thomson, S McLachlan, and A Morgen. Asia Pac J Clin Nutr, January 1, 2005; 14 Suppl: S42.
Background: The most commonly used indices to assess iodine status are urinary iodine concentration (UIC), thyroid volume (TV), and thyroid stimulating hormone (TSH). However, the measurement of TV requires trained personnel and access to an ultrasound machine, while changes in TSH, although metabolically significant, fall within normal ranges in mild iodine deficiency (IDD). Thyroglobulin (Tg) is the most abundant protein of the thyroid gland and shows promise as a sensitive index of mild IDD.
Objective: To determine the relationship between Tg and other indices of iodine status of iodine status using data from the New Zealand (NZ) National Children's Nutrition Survey (CNS02) conducted in 2002.
Design: The CNS02 was a cross-sectional survey of 3275 school children aged 5-14 years. Blood drawn from an antecubital vein and a casual morning urine sample was obtained from 1154 children. UIC, serum TSH and Tg concentration, and plasma free tri-iodothyronine (ft3) and free thyroxine (ft4) concentration were determined.
Outcomes: The median UIC of the children was 67 mug/L, and 28% of the children had a UIC <50 mug/L, indicative of mild IDD. The concentrations (mean +/- SEM) of TSH (1.72 +/- 1.70 mU/L), fT3 (6.0 +/- 0.0 pmol/L), and fT4 (14.9 +/- 0.2 pmol/L) were similar to values published for children in other countries. The median Tg concentration was 12.8 ng/mL and fell within the range of 10-20 ng/mL; also indicative of mild IDD. Furthermore, children who had an UIC<50 mug/L had a significantly higher (P=0.000) serum Tg concentration than children with a UIC above this level, suggesting hyperplasia of the thyroid gland in children with lower UIC.
Conclusions: These data suggest that Tg is a sensitive index of mild IDD in NZ children.
The Iodine Network Bulletin is prepared by the Network for Sustained Elimination of Iodine Deficiency and posted on its website, www.IodineNetwork.net. If you have any information to share or queries please contact Dr. Juliawati Untoro, IDD Network Secretary at Info@IodineNetwork.net |
