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Objective:To explore the medical reference values, distribution characteristics and influencing factors of serum iodine in adults with different thyroid health conditions, and to evaluate the importance of serum iodine in evaluating individual iodine nutrition.Methods:From February 2017 to November 2018, multi-stage stratified cluster sampling was used to select one community and one agricultural (fishing) village in the coastal Yingkou City and the inland areas of Shenyang City of Liaoning Province as survey sites. Cluster sampling of adults over 18 years old who had lived for five years were conducted with questionnaire survey, clinical physical examination and thyroid ultrasound examination. Fasting venous blood samples and one random urine sample were collected from all subjects for serum iodine, thyroid hormone, antibody and urine iodine detection. The 95% medical reference value of serum iodine was established by using the percentage quantile method, and the reference value, distribution characteristics and influencing factors of serum iodine in adults with different thyroid health status were analyzed. The diagnostic value of iodine nutritional indicators in thyroid diseases was evaluated by the receiver operating characteristic (ROC) curve.Results:A total of 2 931 adults were surveyed, with serum iodine levels of 62.1 (53.6, 72.2) μg/L, ranging from 5.6 to 642.3 μg/L; urine iodine was 167.6 (111.2, 244.2) μg/L, and the overall iodine level was at an appropriate level. A total of 1 089 patients with thyroid diseases were examined, with a detection rate of 37.2% (1 089/2 931); among them, there were 597 cases of thyroid nodules, 56 cases of endemic goiter, 42 cases of hypothyroidism, 161 cases of subclinical hypothyroidism, 27 cases of hyperthyroidism, 18 cases of subclinical hyperthyroidism, and 474 cases of autoimmune thyroid disease (AITD). There was a statistically significant difference in the detection of thyroid diseases among adults with different levels of serum iodine (χ 2 = 13.80, P < 0.05). The reference values of serum iodine in normal adults, hypothyroidism (without thyroid hormone intervention), hyperthyroidism (without anti thyroid hormone drug treatment), AITD, endemic goiter, and thyroid nodules were 37.2 - 103.0, 12.5 - 52.8, 49.9 - 163.1, 34.3 - 129.3, 27.3 - 92.8, and 37.9 - 119.5 μg/L, respectively. The ROC curve analysis results showed that the serum iodine area under curve(AUC) of patients with hyperthyroidism, subclinical hyperthyroidism, endemic goiter, thyroid nodules, and AITD were 0.94, 0.61, 0.55, 0.53, and 0.52, respectively. The results of univariate analysis showed that there were statistically significant differences in adult serum iodine levels among different positions, regions, age, education level, occupation, iodine intake, blood pressure, and body mass index ( P < 0.05). Conclusions:There are significant differences in serum iodine levels among adults with different thyroid health conditions, and evaluation standards and systems should be developed separately. Serum iodine is an important indicator for evaluating individual iodine nutrition.
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Objective To analyze the iodine nutritional status of children and pregnant women in Liaoning Province,and the iodine content of edible salt suitable for iodine nutrition level,to provide a basis for adjusting the suitable salt iodine content standard of key population.Methods In 2015-2018,a cross-sectional survey method was used to conduct iodine nutritional status surveys in counties (districts) within the jurisdiction of Liaoning Province.One township (community) was selected in each county (district)according to the east,west,south,north,and middle directions.Forty children aged 8-10 (age and gender distribution balanced) and 20 pregnant women were selected in each township (community),urine and household salt samples were collected from children and pregnant women,to test urine and salt iodine levels;and the water samples from all township (community) water supply plants in the province were collected for water iodine detection in 2017;and all respondents were calculated the dietary iodine intake.The multi-order linear curve was used to fit the salt iodine content suitable for children and pregnant women.Results A total of 1 549 townships (communities) were surveyed,including 1 125 centralized water supply townships (communities) with water iodine ＜ 40 μg/L;50 820 children aged 8-10 and 26 707 pregnant women were selected from the centralized water supply towns.The average iodine content of edible salt was 24.0 and 23.9 mg/kg,respectively.The median urinary iodine level of children was 168.5 μg/L,at the appropriate level of iodine;the median urinary iodine level of pregnant women was 137.8 μg/L,at the deficiency level of iodine.The average dietary intake of iodine in children was 228.4 μg/d,which was 3.51 times of the standard iodine requirement (EAR,65 μg/d) and 2.54 times of the recommended intake (RNI,90 μ g/d).The average dietary intake of iodine in pregnant women was 273.4 μg/d,which was 1.71 times of the EAR (160 μg/d) and 1.19 times of the RNI (230 μg/d),and 21.4％ (5 728/26 707) of pregnant women had lower iodine intake than RNI,the iodine intake was insufficient.After multi-level linear curve fitting combined with monitoring data,the iodine content range of edible salt in children's urine was suitable and the iodine intake in RNI-tolerable intake (UL,300 μg/d) was 13-25 mg/kg (20 mg/kg + 20％);the iodine content range of edible salt in pregnant women's urinary iodine was suitable and the iodine intake in RNI-UL (600 μg/d) is 25-37 mg/kg (31 mg/kg + 20％).Conclusions Under the current salt iodine content standard (25 mg/kg) in Liaoning Province,children's iodine nutrition is generally at the level of iodine appropriate;pregnant women's iodine nutrition is generally at the level of iodine deficiency.It is recommended that all regions should revise the iodine content standard for edible salt in due course in combination with the iodine nutritional status of key populations within the jurisdiction.
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Objective To study the status of prevention and control of iodine deficiency disorders (IDD),master the iodine nutritional status of children and pregnant women in Liaoning Province.Methods One hundred counties (districts) of Liaoning Province,34 counties (districts) were randomly selected to carry out a cross-sectional survey on iodine nutritional status of the population according to "National Surveillance Program on IDD" in 2016.Five townships (communities) were randomly selected according to their sub-area positions of east,west,south,north and center,1 primary school was randomly selected in each township (communities),40 non boarding students aged 8-10 (half males half females) were selected from each school.The radial size of the thyroid was measured by Ultra-portable Doppler Diagnostic Ultrasound System and the volume was calculated.Twenty pregnant women were randomly selected in each township (communities).Their salt and random urine samples were collected;salt iodine level and urinary iodine level were tested.Results The mean of salt iodine content of 6 874 children's family salt samples was (24.0 ± 4.7) mg/kg,the iodized salt coverage rate was 98.4％ (6 761/6 874) and the consumption rate of qualified iodized salt was 95.5％ (6 567/6 874).The median urinary iodine (MUI) of 6 874 children's urine samples was 168.0 μg/L,and children's goiter rate was 1.6％ (111/6 874).The mean of salt iodine content of 3 404 pregnant women's family salt samples was (24.1 ± 4.3) mg/kg,the iodized salt coverage rate was 99.0％ (3 369/3 404) and the consumption rate of qualified iodized salt was 84.6％ (2 880/3 404).The MUI 3 404 of pregnant women's urine samples was 135.8 μg/L (＜ 150 μg/L).Conclusions In 2016,8-10 years old children's urinary iodine is at adequate level.But the pregnant women are in iodine deficiency.
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Objective To master the disease trend of Keshan disease in Liaoning Province, and provide a scientific basis for control and elimination of Keshan disease. Methods Retrospective method was used to analysis the Keshan disease monitoring in Liaoning Province.From 1995 to 2007,a sentinel surveillance method was used in Qingyuan County,and seriously ill villages were selected as monitoring sites. From 2008 to 2014, a sample random sampling method was adopted to randomly select 1 - 4 diseased villages as monitoring sites in Qingyuan, Xinbin, Huanren and Xifeng each year. The residents in surveillance sites were surveyed through questionnaire, clinically examined and did electrocardiogram (ECG), suspected cases were taken anterior chest X-rays in the distance of 2 meters, and diagnosis of Keshan disease was based on the "Standard of Diagnosis of Keshan Disease" (GB 17021-1997)and the"Keshan Disease Diagnosis" (WS/T 210-2011). Results From 1995-2014,no new cases of acute and subacute Keshan disease were detected in Keshan disease monitoring sites in Liaoning Province,Keshan disease detection rate was the highest in 2007(6.6%,55/838),the lowest was in 2012(0.4%,3/836),cases of Keshan disease had been concentrated among non-key groups,the highest abnormal rate of ECG was found in 2011 (24.5%,424/1 728), for 176 cases of suspected Keshan disease, the anterior position of 2 m chest X-ray was taken and 50.0% (88/176) of the changes were increased. Conclusion After 20 years of monitoring and prevention, the condition of Keshan disease in Liaoning Province has been in a relatively stable state. But we still should strengthen the monitoring of Keshan disease,emphasize the importance of case search,continue to carry out the monitoring.
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Objective To master the prevalence of drinking-water-borne endemic fluorosis of children in the disease affected areas of Liaoning Province and to understand the effect of water improvement measures in prevention and control of fluorosis.Methods The data of 18 water improvement projects in drinking-water-borne endemic fluorosis areas of Liaoning Province from 2011 to 2016 were collected by retrospective method,and the data of dental fluorosis in children aged 8 to 12 years old were analyzed.The prevalence and detection rate of dental flaorosis in children aged 8 to 12 years old were analyzed.To compare the incidence of dental fluorosis among children from villages with qualified water fluoride and those from villages with unqualified water fluoride.Results From 2011 to 2016,in the annual survey of 18 water engineering projects in 18 monitored villages,normal operating rate was between 94.44％ (17/18)-100.00％ (18/18),water fluoride qualified rate was between 88.89％ (16/18)-100.00％ (18/18).In the monitored village,4 941 children aged 8 to 12 were examined,and the detection rate of dental fluorosis was 9.8％ (484/4 941).The dental fluorosis index was 0.19.The detection rate (14.0％,10.7％,10.7％,8.7％,6.6％,8.1％) of dental fluorosis was decreasing year by year (x2trend =24.3,P ＜ 0.05).The total detection rate of children's dental fluorosis in monitored villages (8.1％,356/4 422) with normal operation of water improvement projects and qualified water fluoride was lower than that in monitored villages with excessive water fluoride (24.7％,128/519,x2 =145.1,P ＜ 0.05).Conclusion After water improvement measures are implemented in drinking water fluorosis areas of Liaoning Province,the dental fluorosis of children in the affected areas is effectively controlled,but the problem of excessive fluoride in water improvement projects still exists,and the management of water improvement projects should be strengthened in the future.
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Objective To understand the condition of iodine deficiency disorders,and the iodine nutritional status of population before adjustment of iodine level in edible salt in Liaoning Province.Methods Thirty countries (cites,districts) which were divided into coastal,inland,city,rural areas according to location and population characteristics were sampled by population probability sampling method in the whole province; one township (town,street office) was sampled from each country (city,district); one village (neighborhood) and one school were chosen from each township(town,street office).Forty children aged 8-10 were selected from each school to measure their thyroid volumes and household salt samples were collected to detect their iodine content; fourteen of those 40 children were selected to detect their urinary iodine content.In each village (neighborhood),five drinking water samples were collected in the east,the west,the south,the north and the center positions.Two tap water samples were collected to detect their iodine content if the water supply was centralized.Around each school; three townships were selected,in each township,random urine samples were collected from 5 pregnant women and 5 lactating women to detect their iodine content.Thyroid volume was examined by ultrasound method; the salt iodine was tested by the method of direct titration; iodine content of urine and drinking water was tested by arsenic cerium catalytic spectrophotometry.Results Totally one thousand two hundred and nineteen children aged 8-10 were examined; twenty-nine children were diagnosed goiter,and the goiter rate was 2.4％(national standards:＜ 5％).One thousand two hundred and nineteen edible salt samples were tested,and the median salt iodine level was 30.1 mg/kg.The iodized salt coverage rate was 99.3％(1 211/1 219),and the consumption rate of qualified iodized salt was 97.9％(1 194/1 219).Four hundred and eighty urine samples were tested,and the median urinary iodine level was 189.0 μg/L(suitable content of salt iodine was 100-199 μg/L) ; urinary iodine ＜ 20 μg/L accounted for 0.6％(3/480).Ninety-nine drinking water samples were selected,and the average iodine content of the drinking water was (5.9 ± 5.7)μg/L.Four hundred and fifty-one urine samples of pregnant women and four hundred and fifty urine samples of lactating women were selected,and the median urinary iodine level of pregnant women and lactating women was 163.2,151.0 μg/L(suitable contents of urinary iodine in pregnant women and lactating women were 150-249 μg/L,＞ 100 μg/L).The median urinary iodine of pregnant women was 135.4 μg/L in coastal city,138.0 μg/L in coastal rural,168.0 μg/L in inland city,171.1 μg/L in inland rural.The difference of urinary iodine between coastal region and inland region was significant(H =14.287 6,P ＜ 0.05).Conclusions The iodine nutrition conditions of pregnant women,lactating women and children are adequate in Liaoning Province,but the iodine nutritional status is insufficient in pregnant women from the coastal areas.