Exploring educational inequalities in hypertension control, salt knowledge and awareness, and patient advice: insights from the WHO STEPS surveys of adults from nine Eastern European and Central Asian countries.

OBJECTIVE: To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician's advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. DESIGN: Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. SETTINGS: Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). PARTICIPANTS: Nationally representative samples of 30 455 adults aged 25-65 years. RESULTS: HBP awareness, treatment and control varied substantially by education. The coverage of physician's advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician's advice on salt reduction. CONCLUSIONS: There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries.

Prevalence and risk factors of hypothyroidism after universal salt iodisation: a large cross-sectional study from 31 provinces of China.

OBJECTIVES: To investigate the prevalence and risk factors of hypothyroidism after universal salt iodisation for 20 years in mainland China. DESIGN: Nationwide, cross-sectional survey. SETTING AND PARTICIPANTS: The Thyroid Disorders, Iodine Status and Diabetes epidemiological study included adults from 31 provinces of China. Data included demographic, physical characteristics, urine, serum thyroid-stimulating hormone (TSH), thyroid-peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb) and thyroid ultrasonography. Subclinical hypothyroidism (SCH) was classified into severe SCH (TSH >10 mU/L) and mild SCH (TSH 4.2-9.9 mU/L). A total of 78 470 (38 182 men and 40 288 women) participants were included in the final analysis. RESULTS: The prevalence of hypothyroidism was 13.95%. The prevalence rates of overt hypothyroidism (OH) and SCH were 1.02% and 13.93%, which mild SCH was significantly higher than severe SCH (12.18% vs 0.75%). Prevalence was higher in women than in men, and this gender difference was noted among all age groups. The prevalence of mild SCH, severe SCH and OH increases by 1.16%, 1.40% and 1.29% for every 10 years older. TPOAb or/and TgAb positive were significantly associated with OH and severe SCH (OR 15.9, p<0.001). However, SCH was positively correlated with increased urine iodine concentration, but this correlation was only in antibody-negative female patients. In non-autoimmune and male populations, there was a U-shaped relationship between severe SCH and OH and urine iodine concentration. CONCLUSIONS: Mild SCH is the most common form of hypothyroidism, which is related to iodine intake. Severe SCH is more similar to OH which autoimmune is the main cause. The various effects of iodine on hypothyroidism depend on thyroid autoimmune and gender.

Factors Analysis of the Compliance Rate of Hypertension Detection Control and Self-Assessment Control in Community Outpatient Clinics.

Objective: To understand the related influencing factors of outpatient hypertension detection and control and self-test control compliance rate. Methods: A total of 637 hypertensive patients who visited the outpatient clinic of our hospital from January 2021 to December 2021 were selected for investigation and research, and the relevant information such as blood pressure, treatment detection, and other related information of the patients were counted, and the detection and control of outpatient hypertension were explored through regression analysis and the related factors of the self-test control compliance rate. Results: There was no statistically significant difference in the number of patients who met the standard or not under the gender difference (P > 0.05), and it can be found that there was no statistically significant difference in the age of patients who met the standard and those who did not (P > 0.05). The proportion of patients with self-test hypertension control at home was 64.68%, and the compliance rate of self-test blood pressure was 42.54%. The compliance rate of blood pressure control in outpatient testing was 61.85%. Heart rate, exercise, smoking, medication compliance, and other factors are important factors affecting the control of hypertension. Knowing hypertension-related knowledge, regular follow-up, office blood pressure compliance, smoking, excessive salt intake, and hypertension complications are important factors affecting the self-test control of hypertension in the family. Conclusion: By urging patients to do daily physical exercise, admonishing patients to quit smoking, and improving patients' medication compliance, the control rate of hypertension in outpatient clinics can be effectively improved. Understanding the knowledge of hypertension, controlling the salt content in the diet, and receiving regular follow-up surveys from doctors can effectively improve the effect of self-measurement and control of blood pressure at home and further improve the control rate of hypertension.

Green tea could improve elderly hypertension by modulating arterial stiffness, the activity of the renin/angiotensin/aldosterone axis, and the sodium-potassium pumps in old male rats.

Hypertension is a major health problem common in the elderly people. Green tea is a popular beverage recommended in folk medicine for lowering blood pressure. However, the molecular mechanisms involved in the antihypertensive effects of green tea are not fully understood. Therefore, the aim of this study was to investigate the antihypertensive effects of green tea on high-salt diet-induced hypertension in old male rats. Forty old male rats were divided into five groups: control, hypertensive, and hypertensive-green tea (2, 4, and 6 g/kg). Heart rate (HR) and systolic blood pressure (SBP) were measured. Cardiac and renal histology were also performed. Lipid profile, NO, angiotensin II (Ang II), and aldosterone were determined, and the expression of eNOS, ATIR and ATIIR, aldosterone receptor, and Atp1a1 were measured. Green tea could significantly decrease HR and SBP, lipid profiles, renin-angiotensin II-aldosterone system activity, and Ang II signaling in kidney tissue of hypertensive rats (p < .01). It also increased Atp1a1, Nrf2, and eNOS expression along with antioxidant enzymes activity and NO concentration (p < .05) and decreased NF-ĸB and iNOS expression and IL-1ß levels in the heart, kidneys, and aorta of rats with hypertension. It can be concluded that green tea can improve salt-induced blood pressure by modulating the function of the renin-angiotensin-aldosterone system, enhancing the synthesis of nitric oxide in the endothelium, increasing antioxidant activity and suppressing inflammation in the heart and kidney, improving the expression of the sodium-potassium pump, and reduction in serum lipids and glucose in aged male rats. PRACTICAL APPLICATIONS: The results of this study showed that green tea could improve hypertension in elderly rats by modulating (1) the expression of the sodium-potassium pump in the heart, kidney, and aortic tissues, (2) the activity of the renin-angiotensin II-aldosterone system in kidney, (3) enhancing antioxidant and anti-inflammatory activities in the heart, aorta, and kidneys, (4) enhancing the synthesis of nitric oxide in the endothelium, and (5) lowering lipid profile. The results of these studies show that the consumption of green tea and its products can be a good candidate for the prevention of cardiovascular diseases such as hypertension in the elderly. In addition, attention to its bioactive compounds can be considered by researchers as an independent therapeutic strategy or adjunctive therapy for the treatment of hypertension.

Impact of the first announced state of emergency owing to coronavirus disease 2019 on stress and blood pressure levels among patients with type 2 diabetes mellitus in Japan.

AIMS/INTRODUCTION: After the first coronavirus disease 2019 state of emergency announcement, there was an increase in stress that might have affected the self-management of patients with type 2 diabetes mellitus. This study identified the changes in clinical findings and stress among patients with type 2 diabetes mellitus, and investigated the characteristics of patients who experienced an increase in blood pressure (BP) after the announcement. MATERIALS AND METHODS: Retrospectively, we scrutinized 310 patients with type 2 diabetes mellitus who were treated by the Sagamihara Physicians Association. After the announcement, 164 and 146 patients showed an increase (ΔBP >0 group) and decrease in BP (ΔBP ≤0 group), respectively. The propensity score matching method was used to compare the differences in clinical findings and stress-related questionnaire responses between the two groups. RESULTS: After the announcement, 47% of patients experienced an increase in daily stress. Furthermore, 17% and 36% reported worsening dietary intake and a decrease in exercise, respectively. More patients reported that their dietary and salt intake had worsened in the ΔBP >0 group than in the ΔBP ≤0 group (9% vs 20%, P = 0.02, and 3% vs 10%, P = 0.04, respectively). Additionally, both systolic and diastolic BP measured in the office were significantly increased (P = 0.02 and P = 0.03, respectively); however, systolic BP measured at home significantly decreased (P = 0.01). The total stress scores were higher in the ΔBP >0 group than in the ΔBP ≤0 group (0.05 ± 2.61 and 0.93 ± 2.70, respectively, P = 0.03). CONCLUSIONS: An increase in stress and, particularly, worsening dietary and salt intake were noted among patients with type 2 diabetes mellitus who experienced an increase in BP after the state of emergency announcement.

Treatment of congenital adrenal hyperplasia in children aged 0-3 years: a retrospective multicenter analysis of salt supplementation, glucocorticoid and mineralocorticoid medication, growth and blood pressure.

Objectives: International guidelines recommend additional salt supplementation during infancy in classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. The influence of corticoid medication and growth has not been assessed. Aim: To investigate the current use of salt supplementation, fludrocortisone (FC) and hydrocortisone (HC) dosage as well as weight, height, BMI and blood pressure (BP) in CAH children aged 0-3 years. Methods: Retrospective multicentre analysis using data from the I-CAH registry. Salt-treated (ST) and non-salt-treated (NST) children were compared regarding FC and HC dosage, weight, height and BP at 0, 3, 6, 9, 12, 18, 24, 30, and 36 months. Results: We analysed 2483 visits of 331 patients born after year 2000 in 13 countries (male, n = 145) with 203 ST patients (61%). NST children had significantly higher FC dosages at 1.5-4.5 months and higher HC dosages until 1.5 months of age. No differences in weight, length and BP between subgroups were observed. Children of the whole cohort showed increased BMI-SDS during the study period and about half of the reported BP readings were >P95. Conclusion: In children treated with additional salt supplementation, FC and HC dosages are lower during the first months of life but without differences in weight, length and BP until 3 years of age compared to NST children. All children showed an increase in BMI-SDS and a high rate of BP readings >P95 until 3 years, indicating the start of weight gain and negative effects on blood pressure already in very early life.

GLOBAL ENDOCRINOLOGY: Global perspectives in endocrinology: coverage of iodized salt programs and iodine status in 2020.

Iodine deficiency has multiple adverse effects on growth and development. Diets in many countries cannot provide adequate iodine without iodine fortification of salt. In 2020, 124 countries have legislation for mandatory salt iodization and 21 have legislation allowing voluntary iodization. As a result, 88% of the global population uses iodized salt. For population surveys, the urinary iodine concentration (UIC) should be measured and expressed as the median, in µg/L. The quality of available survey data is high: UIC surveys have been done in 152 out of 194 countries in the past 15 years; in 132 countries, the studies were nationally representative. The number of countries with adequate iodine intake has nearly doubled from 67 in 2003 to 118 in 2020. However, 21 countries remain deficient, while 13 countries have excessive intakes, either due to excess groundwater iodine, or over-iodized salt. Iodine programs are reaching the poorest of the poor: of the 15 poorest countries in the world, 10 are iodine sufficient and only 3 (Burundi, Mozambique and Madagascar) remain mild-to-moderately deficient. Nigeria and India have unstable food systems and millions of malnourished children, but both are iodine-sufficient and population coverage with iodized salt is a remarkable 93% in both. Once entrenched, iodine programs are often surprisingly durable even during national crises, for example, war-torn Afghanistan and Yemen are iodine-sufficient. However, the equity of iodized salt programs within countries remains an important issue. In summary, continued support of iodine programs is needed to sustain these remarkable global achievements, and to reach the remaining iodine-deficient countries.

Individual and community level factors associated with use of iodized salt in sub-Saharan Africa: A multilevel analysis of demographic health surveys.

INTRODUCTION: Iodine deficiency disorder a common problem in sub-Saharan Africa (SSA). It affects not only the health of the affected individual but also the economic development of the country. However, to the best of our knowledge, there is a scarcity in literature about the associated factors of iodized salt utilization in sub-Saharan Africa. Therefore, this study aimed to identify both individual and community level determinants of iodized salt utilization in sub-Saharan Africa. METHODS: This study used the appended datasets of the most recent demographic and health survey from 31 sub-Saharan countries. A total weighted sample of 391,463 households was included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of iodized salt utilization in SSA. P value ≤ 0.05 was used to declare statistically significant variables. RESULTS: Those households with primary (AOR = 1.53, 95% CI = 1.50-1.57), secondary (AOR = 1.81, 95% CI = 1.76-1.86) and higher education level (AOR = 2.28, 95% CI = 2.17-2.40) had higher odds of iodized salt utilization. Households with middle (AOR = 1.05, 95% CI = 1.02-1.08), richer (AOR = 1.13, 95% CI = 1.09-1.17) and richest wealth index (AOR = 1.23, 95% CI = 1.18-1.28) also had an increased chance of using iodized salt. Households from high community media exposure (AOR = 2.07, 95% CI = 1.71-2.51), high community education level (AOR = 3.78, 95% CI = 3.14-4.56), and low community poverty level (AOR = 1.29, CI = 1.07-1.56) had higher odds of using salt containing iodine. CONCLUSION: Both individual and community level factors were found to be associated with use of salt containing iodine in sub-Saharan Africa. Education level, media exposure, community poverty level, wealth index, community education, and community media exposure were found to be associated with use of salt containing iodine in SSA. Therefore, to improve the use of iodized salt in the region, there is a need to increase access to media sources and develop the socioeconomic status of the community.

Establishing the efficacy and safety of the novel use of common salt for the treatment of pyogenic granuloma.

BACKGROUND: Recurrent bleeding episodes are often a cause of significant anxiety in patients with pyogenic granuloma (PG). The idea of using common salt for the treatment of PG arose from the need for a relatively safe and effective treatment because of the recurrent nature of the lesion. METHODS: A prospective open-label uncontrolled study of 50 patients was conducted. All cases were treated with ordinary table salt from a commercially available package. White soft paraffin was first applied over the perilesional skin, then sufficient salt to cover the entire lesion was applied and the area was occluded with surgical adhesive tape. All patients were followed up for any complications or recurrence. RESULTS: Complete resolution of the lesion without any residual scar was seen in 100% of the cases, and 94% reported a decrease in the bleeding tendency of the lesion as an immediate response. The mean time to complete resolution was 14.77 days. Recurrence was noted in one patient after 11 months of resolution. CONCLUSION: Owing to the relative ease in application, lack of scarring and excellent response, we consider salt application to be an ideal treatment for PG lesions, especially in children and anxious patients reluctant to undergo any procedure.

Can Double Fortification of Salt with Iron and Iodine Reduce Anemia, Iron Deficiency Anemia, Iron Deficiency, Iodine Deficiency, and Functional Outcomes? Evidence of Efficacy, Effectiveness, and Safety.

BACKGROUND: Anemia, iron deficiency, and iodine deficiency are problems of important public health concern in many parts of the world, with consequences for the health, development, and work capacity of populations. Several countries are beginning to implement double fortified salt (DFS) programs to simultaneously address iodine and iron deficiencies. OBJECTIVE: Our objective was to summarize the evidence for efficacy and effectiveness of DFS on the full range of status and functional outcomes and across different implementation and evaluation designs essential to successful interventions. METHODS: We conducted a systematic review and meta-analysis of published and gray literature examining the effects of DFS on nutritional status, cognition, work productivity, development, and morbidity of all population groups. We searched for articles in Medline, Embase, CINAHL, Cochrane Central Register, and ProQuest for randomized trials, quasi-randomized trials, and program effectiveness evaluations. RESULTS: A total of 22 studies (N individuals = 52,758) were included. Efficacy studies indicated a significant overall positive effect on hemoglobin concentration [standardized mean difference (95% CI): 0.33 (0.18, 0.48)], ferritin [0.42 (0.08, 0.76)], anemia [risk ratio (95% CI): 0.80 (0.70, 0.92)], and iron deficiency anemia [0.36 (0.24, 0.55)]. Effects on urinary iodine concentration were not significantly different between DFS and iodized salt. The impact on functional outcomes was mixed. Only 2 effectiveness studies were identified. They reported programmatic challenges including low coverage, suboptimal DFS quality, and storage constraints. CONCLUSIONS: Given the biological benefits of DFS across several populations in efficacy research, additional evaluations of robust DFS programs delivered at scale, which consider effective implementation and measure appropriate biomarkers, are needed.

"Silent" iodine prophylaxis only partly corrects iodine deficiency: the Hungarian story (1970­2020) / A "silent" jódprofilaxis csak részben korrigálja a jódhiányt: a magyar történet (1970-2020).

Összefoglaló. A szerzo a bevezetoben emlékeztet a több mint 50 évvel korábbi publikációjára (Orv Hetil. 1968; 109: 360-363) és annak utóéletére: az 1970-es években megállt a jódprevenció fejlodése. Ezt követoen ismerteti az utóbbi 50 év jódellátottságra vonatkozó fontosabb hazai eredményeit. A számszeru adatok szerint az iskolás gyermekek, várandós anyák, idosek és újszülöttek jódellátottságára, valamint az anyatej jódtartalmára vonatkozó sorozatvizsgálatok az ezredforduló elott egybehangzóan enyhe, illetve mérsékelt jódhiányra utaltak. Az utóbbi két évtizedben egyre többször váltak adekváttá az ugyanezen kategóriák jódellátottságát jelzo eredmények. A szabályozatlan jódozottsó-forgalom (fakultatív jódprevenció) ellenére, valószínuleg a sikeres felvilágosítási kampányok miatt, a lakosság jódellátottsága határozottan javult. Ezt a szituációt nevezik "silent" profilaxisnak. Ezzel a módszerrel nem lehet a jódhiányt teljesen felszámolni. A legnagyobb kockázatot a várandós anyák (közel felének!) hiányos jódpótlása jelenti az utódok agyfejlodésének veszélyeztetése miatt. A befejezésben az EUthyroid Consortium "Krakkói kiáltvány"-ának (2018) rövid ismertetése tartalmazza a teendoket. A kötelezo jódprevencióhoz a nem jódozott sót ki kell váltani jódozott sóval szinte minden élelmiszerben. A graviditás alatt megnövekedett igényt az élelmiszerekben lévo jód gyakran nem fedezi, ilyenkor több jódpótlásra van szükség. Az egészségügyi szerveknek meg kell valósítaniuk a jóddúsító program összehangolt, rendszeres monitorozását és kiértékelését a lakosság optimális jódellátottságának biztosításához. Orv Hetil. 2020; 161(50): 2107-2116. Summary. In the introduction, the author reminds the readers of his publication presented more than 50 years ago in the same journal ("Data to the present state of the goiter problem in Hungary", 1968) and of its afterlife: the development of iodine prevention stopped in the 1970s. Then the major Hungarian results are reviewed related to the iodine supply gained in the latter 50 years. Numerical data are presented showing mild or moderate iodine deficiency according to the results of a range of screening studies among schoolchildren, pregnant women, elderly people and newborns as well as by iodine content of breast milk before the millennium. In the same categories, the data indicating the level of iodine supply became increasingly adequate in the recent two decades. The iodine supply of the people improved markedly, in spite of unregulated iodized salt trade (facultative prevention), presumably because of the successful public-information campaigns. This situation is called "silent" prophylaxis. The total eradication of iodine deficiency is impossible with this method. The highest risk is the deficient iodine supply of pregnant women (almost the half!) due to the endangerment of the offspring's brain development. In the end, a brief review of the Krakow Declaration on Iodine of the EUthyroid Consortium comprises the round of the duties. To the mandatory iodine prevention, iodized salt should replace non-iodized salt in nearly all food productions. During pregnancy, the increased need for iodine is frequently not covered by food sources, more iodine supplement is needed. Health authorities should perform harmonized monitoring and evaluation of fortification programs at regular intervals to ensure optimal iodine supply to the population. Orv Hetil. 2020; 161(50): 2107-2116.

Inherited salt-losing tubulopathies are associated with immunodeficiency due to impaired IL-17 responses.

Increased extracellular sodium activates Th17 cells, which provide protection from bacterial and fungal infections. Whilst high salt diets have been shown to worsen autoimmune disease, the immunological consequences of clinical salt depletion are unknown. Here, we investigate immunity in patients with inherited salt-losing tubulopathies (SLT). Forty-seven genotyped SLT patients (with Bartter, Gitelman or EAST Syndromes) are recruited. Clinical features of dysregulated immunity are recorded with a standardised questionnaire and immunological investigations of IL-17 responsiveness undertaken. The effects of altering extracellular ionic concentrations on immune responses are then assessed. Patients are hypokalaemic and hypomagnesaemic, with reduced interstitial sodium stores determined by 23Na-magnetic resonance imaging. SLT patients report increased mucosal infections and allergic disease compared to age-matched controls. Aligned with their clinical phenotype, SLT patients have an increased ratio of Th2:Th17 cells. SLT Th17 and Tc17 polarisation is reduced in vitro, yet STAT1 and STAT3 phosphorylation and calcium flux following T cell activation are unaffected. In control cells, the addition of extracellular sodium (+40 mM), potassium (+2 mM), or magnesium (+1 mM) reduces Th2:Th17 ratio and augments Th17 polarisation. Our results thus show that the ionic environment typical in SLT impairs IL-17 immunity, but the intracellular pathways that mediate salt-driven Th17 polarisation are intact and in vitro IL-17 responses can be reinvigorated by increasing extracellular sodium concentration. Whether better correction of extracellular ions can rescue the immunophenotype in vivo in SLT patients remains unknown.

Thyroid Cancer Incidence in Bulgaria before and after the Introduction of Universal Salt Iodization: An Analysis of the National Cancer Registry Data

Background: Thyroid cancer is the most common malignancy of the endocrine system and it has become the fastest growing cancer among women. The suspected risk factors include increased exposure to ionizing radiation during childhood, environmental pollutants, possible iodine deficiency, and excessive iodine exposure. Aims: To analyze the thyroid cancer incidence between 1980 and 2013 in Bulgaria and to determine the incidence rate before and after the introduction of universal salt iodization in 1994 in regions with different iodine deficiency levels. Study Design: Retrospective cohort. Methods: The study was a retrospective analysis of the total number of thyroid cancer cases with all histological types in Bulgaria (thyroid cancer, ICD10 code C73), diagnosed between 01/01/1980 and 31/12/2013, and retrieved from the anonymous cancer registry database of the Bulgarian National Cancer Registry. Age-standardized rates of thyroid cancer per 100,000 persons were calculated for each year of the periods mentioned below by sex and age, utilizing the WHO world reference populations with a special statistical module of the Bulgarian National Cancer Registry's software CancerRegBG, 2011. Incidence rates were reported by age, sex, and period of diagnosis (1980-86, 1987-93, 1994-99, 2000-2006, 2007-2013). Trends among males and females were analyzed separately, as well as by age category: 0-19, 20-44, 45-64, and 65+. Annual percentage changes of age-standardized incidence rates were analyzed by Joinpoint regression to determine trends using the Joinpoint statistical software SEER* Stat Software, Version 4.1.1, 2014. Results: The age-standardized rates of thyroid cancer in Bulgaria has been increasing since 1990, being higher among women compared to men (4.68 vs 2.81). The highest age-standardized rates of thyroid cancer was observed in women in the 2007-2013 period. The only significant joinpoint was recorded in 1990 for females and in 1991 for males. The highest incidence rates was in the Smolyan district, a region with historically existing iodine deficiency and relatively high post-Chernobyl radiation exposure. Conclusion: Our results showed that, in different regions, the age-standardized thyroid cancer rates between endemic and non-endemic differ greatly depending on the radiation dose from the Chernobyl accident. The role of iodine intake in thyroid cancer remains uncertain, but iodine deficiency could be a contributing factor to the increased risk of thyroid cancer.

Low intake of iodized salt and iodine containing supplements among pregnant women with apparently insufficient iodine status - time to change policy?

BACKGROUND: Iodine is an essential nutrient for human health throughout the life cycle, especially during early stages of intrauterine life and infancy, to ensure adequate neurocognitive development. The growing global reliance on desalinated iodine-diluted water raises the specter of increased iodine deficiency in several regions. The case of Israel may be instructive for exploring the link between iodine status and habitual iodine intake in the setting of extensive national reliance on desalinated water. The aim of this study was to explore the relationship between iodine intake, including iodized salt and iodine-containing supplements intake, and iodine status among pregnant women residing in a sub-district of Israel that is highly reliant on desalinated iodine-diluted water. METHODS: A total of 134 consecutive pregnant women were recruited on a voluntary basis from the obstetrics department of the Barzilai University Medical Center during 2018. Blood was drawn from participants to determine levels of serum thyrotropin (TSH), thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and thyroglobulin (Tg). An iodine food frequency questionnaire (sIFFQ) was used to assess iodine intake from food, IS and ICS. A questionnaire was used to collect data on demographic and health characteristics. RESULTS: A total of 105 pregnant women without known or reported thyroid disease were included in the study. Elevated Tg values (≥ 13 µg/L), were found among 67% of participants, indicating insufficient iodine status. The estimated iodine intake (median, mean ± SD 189, 187 ± 106 µg/d by sIFFQ) was lower than the levels recommended by the World Health Organization and the Institute of Medicine (250 vs. 220 µg/day respectively). The prevalence of iodized salt intake and iodine containing supplement intake were 4 and 52% (respectively). Values of Tg > 13 µg/L were inversely associated with compliance with World Health Organization and Institute of Medicine recommendations. CONCLUSIONS: While the Israeli Ministry of Health has recommended the intake of iodized salt and iodine containing supplements, this is apparently insufficient for achieving optimal iodine status among Israeli pregnant women. The evidence of highly prevalent probable iodine deficiency in a sample of pregnant women suggests an urgent need for a national policy of iodized salt regulation, as well as guidelines to promote iodine containing supplements and adherence to them by caregivers. In addition, studies similar to this one should be undertaken in additional countries reliant on desalinated iodine-diluted water to further assess the impact of desalinization on maternal iodine status.

Appropriate Range of Median Urinary Iodine Concentration in 8- to 10-Year-Old Children Based on Generalized Additive Model.

Background: The appropriate range of median urinary iodine concentration (MUI) in children has always been controversial. To prevent the occurrence of a goiter epidemic in Shanghai, we explored the appropriate range of MUI by integrating multiple monitoring results. Methods: This study summarized and analyzed the monitoring data from 1997, 1999, 2011, 2014, and 2017 of children living in Shanghai. In each monitoring year, the probability-proportional-to-size sampling technique was used to select 30 sampling units. In each sampling unit, one primary school was randomly selected. From each selected school, 40 children 8- to 10-year-old were randomly recruited to measure thyroid volume (Tvol) and their household salt iodine intake. Results: In 1997, 1999, 2011, 2014, and 2017, MUI of 8- to 10-year-old children was 228, 214, 182, 171, and 183 µg/L, and median Tvol (MTvol) was 2.9, 1.2, 1.0, 1.8, and 2.8 mL, respectively. There was a linear correlation between goiter rate and MTvol (r = 0.95, p = 0.014; 100 × goiter rate = 1.314 × MTvol -1.287). Generalized additive model (GAM) was used to predict MTvol as follows, MTvol = 0.60689 + 0.00302 MUI +0.999928 s (MUI) -0.05172 mean salt iodized concentrations (MSIs) +0.03481 × 100 × iodized salt coverage rate +0.00000969 per capita disposable income +0.271422 s (per capita disposable income) -0.38772 × monitoring year gap. The results revealed that the average relative error between predicted and actual value was 15.2%. GAM results showed that at 27-277 µg/L MUI, the goiter rate was <5%. Conclusions: Iodine status is appropriate in Shanghai. Under the existing economy and MSI, the optimal range of MUI should be 70-277 µg/L in 8- to 10-year-old children living in Shanghai.

[Iodine status of vulnerable populations in Henan Province of China three years after the implementation of new iodized salt standard].

Iodine nutrition surveillance of vulnerable population was conducted in 18 cities of Henan Province in 2015. The medians and quartiles of urinary iodine concentration in women of reproductive-age (n=3 318), pregnant women (n=36 366), lactating women (n=4 153), infants <2 years of age (n=1 017), and children aged 8-10 years (n=4 806) were 202.1(124.0, 310.0), 192.4(133.6, 262.4), 168.3(119.1, 248.3), 214.2(156.1, 272.3) and 90.0 (121.8, 285.6) µg/L, respectively. Iodine status of the vulnerable populations was generally regarded as adequate in Henan Province. But the median of urinary iodine concentration of reproductive-age women were slightly above the adequate level. The proportions above iodine adequate level were 26.7% in reproductive-age women, 29.4% in pregnant women and 22.5% in children aged 8-10 years.

Changes in subtypes of overt thyrotoxicosis and hypothyroidism following iodine fortification.

OBJECTIVE: To investigate the impact of mandatory iodine fortification (IF) on the incidence of nosological subtypes of overt thyrotoxicosis and hypothyroidism. DESIGN: We identified and scrutinized all possible new cases of overt thyrotoxicosis and hypothyroidism in an open cohort in Northern Jutland (n = 309 434; 1 January 1997) during the years 2014-2016. Individual medical history was evaluated to verify and detail the incidence of overt thyroid dysfunction and for classification into nosological subtypes. A number of cases were excluded during final verification due to spontaneous normalization of thyroid function, as they had no medical history suggesting a known condition, which could transiently affect thyroid function (subacute/silent thyroiditis, PPTD and iatrogenic thyroid dysfunction). An identical survey was conducted in 1997-2000 prior to mandatory IF of salt (13 µg/g) that was in effect from year 2001. RESULTS: The standardized incidence rate (SIR) of verified overt thyrotoxicosis decreased markedly from 97.5/100 000/year in 1997-2000 to 48.8 in 2014-2016 (SIRR: 0.50 [95% CI: 0.45-0.56]). This was due to a distinct decrease in the SIR of multinodular toxic goitre (SIRR: 0.18 [0.15-0.23]), solitary toxic adenoma (SIRR: 0.26 [0.16-0.43]) and to a lesser degree Graves' disease (SIRR: 0.67 [0.56-0.79]). SIR for overt hypothyroidism was unaltered by 2014-2016 (SIRR: 1.03 [0.87-1.22]). However, age distribution shifted with more young and fewer elderly cases of verified overt hypothyroidism. CONCLUSION: Mandatory IF caused a substantial reduction in SIR of verified overt thyrotoxicosis (especially of nodular origin) while avoiding an increase in SIR of verified overt hypothyroidism.

Predicting potential to benefit from an iron intervention: a randomized controlled trial of double-fortified salt in female Indian tea pluckers.

OBJECTIVE: The present study examines characteristics of those who benefited from a dietary Fe intervention comprised of salt double-fortified with iodine and Fe (DFS). DESIGN: Data from a randomized controlled trial were analysed to identify predictors of improved Fe status and resolution of Fe deficiency (serum ferritin (sFt) < 12 µg/l) and low body Fe (body Fe (BI) < 0·0 mg/kg) using non-parametric estimations and binomial regression models. SETTING: A tea estate in West Bengal, India. PARTICIPANTS: Female tea pluckers, aged 18-55 years. RESULTS: Consuming DFS significantly (P = 0·01) predicted resolution of Fe deficiency (relative risk (RR) = 2·31) and of low BI (RR = 2·78) compared with consuming iodized salt. Baseline sFt (ß = -0·32 (se 0·03), P < 0·001) and treatment group (ß = 0·13 (se 0·03), P < 0·001) significantly predicted change in sFt. The interaction of baseline BI with treatment group (ß = -0·11 (se 0·06), P = 0·08) predicted the change in BI. DFS did not significantly predict change in Hb and marginally predicted resolution of anaemia (Hb < 120 g/l). CONCLUSIONS: Baseline Fe status, as assessed by sFt and BI, and consumption of DFS predict change in Fe status and resolution of Fe deficiency and low BI. Anaemia prevalence and Hb level, although simple and inexpensive to measure, may not be adequate to predict resolution of Fe deficiency in response to an intervention of DFS in similar populations with high prevalence of Fe deficiency and multiple nutritional causes of anaemia. These findings will guide appropriate targeting of future interventions.