Low environmental selenium availability as an additional determinant for goiter in East Java, Indonesia?

Iodine deficiency, which is most visibly indicated by goiter, is highly prevalent in Indonesia. Since 1994, Indonesia has a decree that all salt used for human, livestock, and industry must be iodized. However, despite the increased distribution of iodized salt, pockets with significantly higher prevalence of goiter still remain. This situation may be consequence of selenium (Se) deficiency. This study aimed to assess the Se level in the environment of goiter prevalent areas. Five hundred eleven school children participated in this study. Goiter was measured using both ultrasound and palpation. Ninety-nine eggs were collected from free-living chicken in 11 villages, and the Se contents of egg yolk and egg white were determined by neutron activation analysis. In the villages studied, Se concentration in egg yolk ranged from 0.15 to 1.52 microg/g and in egg white from 0.18 to 2.97 microg/g. The prevalence of goiter measured by palpation ranged from 18.4% to 70% and by ultrasound from 0% to 100%. Because of the inconsistency of goiter rate measured by palpation and ultrasonography, the question remains whether low availability of Se in the environment might be an additional contributing factor for goiter.

Urinary iodine excretion is the most appropriate outcome indicator for iodine deficiency at field conditions at district level.

To empower local authorities to plan and evaluate adequate interventions, appropriate iodine deficiency disorders (IDD) indicators need to be identified. The aim of this study was to describe the magnitude and severity of IDD with different outcome indicators and associate them with functional indicators. Schoolchildren (n = 544) aged 8-10 y were assessed in 11 villages within five subdistricts of Malang District, East Java, Indonesia. Outcome indicators of IDD were goiter size as measured by palpation and ultrasonography (USG), urinary iodine excretion (UIE) and serum thyroid stimulating hormone (TSH) concentration in blood as well as functional indicators such as intellectual performance (IQ: Catell's Culture Fair Intelligence Test) and anthropometric indices. The total goiter rate (TGR) measured by palpation and USG were 35.7 and 54.4%, respectively. Based on UIE and TSH, the prevalence of iodine deficiency was 63.7 and 3.4%, respectively. In individuals, goiter, thyroid volume and UIE were associated significantly (r = -0.35; P < 0.001 and r = -0.30; P = 0.02 respectively). Among villages, TGR measured by palpation was significantly correlated with thyroid volume (r = 0.61; P = 0.045) and UIE (r = 0.68; P = 0.021), whereas TSH was not significantly associated with any of the observed indicators in individuals or groups. Multiple regression analysis showed that USG (beta = -0.67; P < 0.001) and UIE (beta = 4.39; P = 0.008) related significantly with cognitive performance (IQ). The associations between IDD indicators and cognitive performance and height-for-age Z scores suggest that socioeconomically advantaged children had better iodine status. We suggest that UIE is the best indicator for local authorities to assess iodine deficiency.

The association between BMI and haemoglobin and work productivity among Indonesian female factory workers.

OBJECTIVE: To investigate the relationship between body mass index (BMI), haemoglobin (Hb) concentration and work productivity in Indonesian female industrial workers engaged in cigarette rolling. DESIGN: Randomized-stratified, cross-sectional study. SETTING: A clove cigarette factory in Central Java Province, Indonesia. SUBJECTS: Two-hundred and thirty female cigarette-rollers. METHODS: Anthropometric variables (height, weight, mid-upper arm circumference, BMI), body composition (lean body mass and fat mass from skinfolds thicknesses), Hb, work productivity (cigarettes/hour) were determined. RESULTS: Of the 230 selected subjects 40.4% were anaemic and 41.3% had BMI < 18.5. Average production was 620 +/- 86 cigarettes/h. Productivity was positively correlated with work experience (r = 0.214, P < 0.01), lean body mass (r = 0.183, P < 0.01), height (r = 0.150, P < 0.05), Hb (r = 0.141, P < 0.05), and arm muscle area (r = 0.120, P < 0.05). Anaemic subjects produced 4.9% less (P < 0.01) than the non-anaemic ones. No linear relationship existed between BMI and productivity, but subjects with a BMI < 18.5, or < 17.0, produced respectively 5.1% (P < 0.05) and 6.8% (P <0.05) less than subjects with BMI between 18.5-22.5. CONCLUSIONS: Work productivity of persons with low BMI and Hb may be reduced. However, BMI was not a good screening tool to detect low producers. When using BMI < 18.5 and a production < 550 cigarettes/h as cut-offs sensitivity (64.7%) and specificity (55.5%) were low.