Control of Iodine Deficiency Disorders Following 10-Year Universal Salt Iodization in Hebei Province of China

Objective To evaluate the effectiveness of universal salt iodization （USI） for the control of IDD in Hebei province since it was implemented in 1995, identify the problems currently encountered in the implementation of USI and provide practical proposals for addressing these problems. Methods Probability proportionate to size sampling （PPS） was employed in the surveillance of IDD, for which a total of 1200 school children aged 8-10 years were randomly selected from 30 counties around the whole province during each IDD survey. The iodine content of salt was determined quantitatively with the titration method. The iodine content of urinary samples was measured by the method of ammonium persulfate oxidation. Results The coverage of iodized salt increased from 65.0% in 1995 to 98.0% in 1999, then decreased to 88.1% in 2005 which was below the national standard of 90%. The median urinary iodine of children aged 8-10 years varied between 160.1 μg/L and 307.4 μg/L, which was above the national standard. The proportion of urinary samples with iodine content above 300 lag/L was over 30% in 2005, implying exorbitant iodine nutrition among the children. The goiter rate （TGR） among children aged 8-10 years dropped from 11.8% in 1995 to 2.7% in 2005, indicating that the spread of endemic goiter was under control. Conclusion Preliminary elimination of IDD was achieved by USI in Hebei province. Nevertheless, some problems still existed in USI such as non-iodized salt competition, over iodization and un-standardized iodization. In order to address these problems, the management and supervision of salt market needs to be strengthened to prevent non-iodized salt from reaching households; updating equipment and modifying techniques are also necessary to ensure the quality of iodized salt; to clarify the causes of excessive urinary iodine content, the various sources of iodine from the diet need to be investigated in the future.

Time Series and Spatial Epidemiological Analysis of the Prevalence of Iodine Deficiency Disorders in China

Objective To recognize the spatial and temporal characteristics of iodine deficiency disorders(IDD),China national IDD surveillance data for the years of 1995–2018 were analyzed.Methods Time series analysis was used to describe and predict the IDD related indicators,and spatial analysis was used to analyze the spatial distribution of salt iodine levels.Results In China,the median urinary iodine concentration increased in 1995–1997,then decreased to adequate levels,and are expected to remain appropriate in 2019–2022.The goiter rate continually decreased and is expected to be maintained at a low level.Since 2002,the coverage rates of iodized salt and the consumption rates of qualified iodized salt(the percentage of qualified iodized salt in all tested salt) increased and began to decline in 2012;they are expected to continue to decrease.Spatial epidemiological analysis indicated a positive spatial correlation in 2016–2018 and revealed feature regarding the spatial distribution of salt related indicators in coastal areas and areas near iodine-excess areas.Conclusions Iodine nutrition in China showed gradual improvements.However,a recent decline has been observed in some areas following changes in the iodized salt supply in China.In the future,more regulations regarding salt management should be issued to strengthen IDD control and prevention measures,and avoid the recurrence of IDD.

Role of medical resource level in iodine deficiency disorder

Background:Iodine deficiency disorders(IDDs)refer to a series of diseases caused by the human body's insufficient iodine intake.Edible salt became iodized in China in 1996,which yielded remarkable results.We have known that IDDs is associated with iodine in the human body,but it is not clear whether IDDs is related to medical resource level.Methods:We collected the number of IDDs cases and an index for the level of medical resource from 31 provinces,autonomous regions and municipalities directly under the central government in China.All data came from the China Statistical Yearbook of Health and Family Planning issued in 2013 by the Peking Union Medical College Publishing House.Data standardization and linear regression analysis were used.Results:The results showed that IDDs correlated with the number of beds in medical and health institutions,number of medical health personnel,number of medical and health institutions,total health expenditure,average health expenditure per capita,medical insurance for urban resident and new rural cooperative medical rural residents(P<0.01).In a multiple linear regression,IDDs was most significantly associated with the number of beds in hospitals,the number of rural health personnel,the number of basic medical and health institutions and government health expenditure for these institutions. Conclusion:Based on the experimental data,we concluded that IDDs had a positive connection with the medical resource level,and basic and rural areas had a more significant association with IDDs.This analysis provides new and explicit ideas for iodine prevention and control work in China.

Iodine deficiency and women’s health: Colonialism’s malign effect on health in Oromia region, in Ethiopia

Objectives: Iodine is an essential nutrient needed for the synthesis of hormone thyroxin. Hormone thyroxin is involved in the metabolism of several nutrients, the regulation of enzymes and differentiation of cells, tissues and organs. Iodine deficiency (ID) impairs the development of the brain and nervous system. It affects cognitive capacity, educability, productivity and child mortality. ID hinders physical strength and causes reproductive failure. The objective of this paper is to explore if the health impacts of ID are more common and severe among women. Design: Using primary data (notes from a visit) and secondary data, this paper examines if the effects of ID are more common and severe among Oromo women inEthiopia. Findings: The health impacts of ID are more common and severe among women. Conclusions: ID is an easily preventable nutritional problem. In Oromia, the persistence of ID is explained by the Ethiopian government’s colonial social policies. Preventing ID should be seen as part of the efforts we make to enhance capacity building, promote health, gender equity and social justice. Implications: Iodine deficiency has a wide range of biological, social, economic and cultural impacts. Preventing ID can be instrumental in bringing about gender equity and building the capacity of people.

Iodized salt consumption and iodine deficiency status in China: a cross-sectional study

Objective:To monitor iodized salt consumption and evaluate iodine deficiency status in 2014 in China.Materials and Methods:In 2014,a nationwide cross-sectional survey was conducted in 31 provinces (in this study,provinces,autonomous regions and municipalities in China's Mainland were named as provinces).Probability proportional to size sampling method was adopted to recruit children ages 8-10 and pregnant women.47,467 children's and 18,994 pregnant women's urine samples were collected and 47,706 children's thyroid volumes were examined.Iodine content in salt was determined with 46,900 edible salt samples from children's households;urinary iodine concentration (UIC) was tested from children and pregnant women's urine samples;thyroid volume of children was assessed by ultrasound.Results:The national coverage rate of iodized salt and consumption rate of qualified iodized salt were 96.3％ and 91.5％,respectively.Median iodine content in iodized salt was 25.2 mg/kg.In 22 of 31 provinces,the provincial coverage rates of iodized salt were over 95％.And consumption rates of qualified iodized salt were more than 90％ in 21 provinces.In this study,the national median urinary iodine concentration (MUIC) of children in China was 197.9 μg/L.At the provincial level,MUIC of children in 19 provinces was 100-199 μg/L,which in 12 provinces was 200-299 μg/L.The national MUIC of pregnant women in 2014 was 154.6 μg/L,slightly higher than the lower limit of the WHO criteria for adequate (150-249 μg/L).At the provincial level,MUIC of pregnant women in 18 provinces was 100-149 μg/L,which in 13 provinces was 150-249 μg/L.The national prevalence of goiter among children in 2014 was 2.6％,of which only Shandong province (5.6％) exceeded the national standard (5％).Conclusions:In China,iodine deficiency disorders (IDD) has been eliminated since 2005.And in 2014,the IDD-free status still remained.

Relationship between Iodine Content in Household Iodized Salt and Thyroid Volume Distribution in Children

Objective To assess the effect of different levels of salt iodine content on thyroid volume（ThV） distribution using data from the 1999, 2011, and 2014 Chinese national iodine deficiency disorder（IDD） surveys. Methods Probability proportion to size（PPS） sampling method was used to obtain a representative national sample of 34,547, 38,932, and 47,188 Chinese children aged 8-10 years in 1999, 2011, and 2014 Chinese national IDD surveys, respectively. The iodine content in household iodized salt and urinary iodine concentration were measured and thyroid ultrasound examination was performed. The data were analyzed by SAS software using histograms and box plots. The skewness and kurtosis were calculated for testing the normality of ThV. Results The median iodine content in household iodized salt dropped from 42.30 mg/kg in 1999 to 25.00 mg/kg in 2014. The median urinary iodine concentration of children aged 8-10 years decreased from 306.0 μg/L in 1999 to 197.9 μg/L in 2014. The median and interquartile range（IQR） of ThV in 1999, 2011, and 2014 surveys were 3.44 m L and 1.50 m L, 2.60 m L and 1.37 m L, 2.63 m L and 1.25 m L, respectively. The skewness and kurtosis of ThV distribution in 1999, 2011, and 2014 surveys were 1.34 and 5.84, 0.98 and 3.54, 1.27 and 5.49, respectively. Conclusion With reduced salt iodization levels, the median urinary iodine concentration and median ThV of children decreased significantly, and the symmetry of the ThV distribution improved.

Iodine Fortification Study of Some Common African Vegetables

Iodine Deficiency Diseases (IDDs) occupy important positions in the health problems of developing countries. Salt Iodisation has been the common approach to solving these problems. However, apart from the problems of lack of compliance by salt manufacturers, and inculturation of the consumers, health conditions aggravated by high salt intake by humans have become increasingly relevant. These problems can be eliminated if the commonly produced and consumed plants are fortified with Iodine. The prospects are in the inclusion of Iodine-containing compounds in the inorganic fertilizers used by farmers. In this study, Potassium Iodide and Potassium Iodate were used as inoculants. Five different concentrations—0.1 M, 0.2 M, 0.3 M, 0.4 M, and 0.5 M of Potassium Iodide and Potassium Iodate solutions were used to inoculate the soils on which the following edible African plants were planted: Murraya koenigii;Ocimum gratissimum;Cucurbita pepo;Solanum nigrum;Amaranthus hybridus and Abelmoschus esclentus, Corchorous olitoruis, Solanum lycopersicum, Zingiber officinale, Telfairia occidentalis, Talinium triangulare, Solanum melongena. Controls were also planted. After 14 days, alkaline dry ash method was used to determine the Iodine concentrations in the plants. The results showed that Murraya koenigii showed the highest absorption of Iodine 6.90 mg/kg at 0.3 M using KI, followed by Amaranthus hybridus 6.40 mg/kg at 0.1 M. Solanum nigrum, Ocimum gratissimum and Zingiber officinale also showed good absorption. Other plants except Murraya koenigii, Ocimum gratissimum, Solanum nigrum and Zingiber officinale showed very low tolerance to KI absorption. The result also showed that Telfairia occidentalis showed the highest absorption of iodine 8.20 mg/kg at 0.2 M of KIO3 followed by Cucurbita pepo 6.40 mg/kg at also 0.2 M of KIO3. Murraya koenigii, Ocimum gratissimum, Solanum nigrum, Zingiber officinale also showed good absorption of KIO3. Some of the plants were not able to tolerate the absorption at higher concentration for both KI and KIO3. All the plants were poisoned at concentration of 0.5 M for both Ki and KIO3. Murraya koenigii, Ocimum gratissimum, Solanum nigrum, Zingiber officinale can be used in iodine biofortification using KI and KIO3 at concentration < 0.5 M. The overall result may be very significant, when it is considered that Iodine is a micronutrient, with a daily intake requirement of 100 - 150 μg/kg. It can be seen that there is hope in achieving this kind of biofortification.

Iodine deficiency disorders in Gansu Province in 2014

Objective To master the situation of iodine deficiency disorders(IDD)and the people’s iodine nutritional status after implementation of the new salt iodine standard in Gansu Province in 2012.Methods Totally 30 counties(cities)were selected in Gansu Province by population proportionate to size sampling(PPS)method in 2014,and one primary school was selected in

中国碘缺乏病(IDD)监测方案评估的定性研究

目的探讨《全国碘缺乏病监测方案(试行)》的管理、实施、效果和可能存在的问题,为我国完善碘缺乏病(iodine deficiency disorders,IDD)监测方案、最终消除IDD提出建议和科学依据。方法选取新疆维吾尔自治区、西藏自治区、甘肃省、山东省、河北省、广东省、吉林省、四川省以及云南省为研究现场,对不同工作层面的IDD防治工作人员进行个人深入访谈。结果 IDD监测方案的实施促进了我国IDD监测体系的完善,为消除IDD做出了巨大的贡献,各级卫生行政部门及监测单位基本能够按照监测方案的要求开展监测工作,但监测过程中重点抽样监测与随机抽样监测的时间间隔短、重点抽样监测抽样范围规定死板、高危监测范围扩大化、各部门间缺乏配合以及全国碘盐监测管理信息平台不稳定等问题在一定程度上影响了监测工作的顺利开展。结论我国IDD监测已经形成了一个有机的监测体系,《全国碘缺乏病监测方案(试行)》是可行、有效的,但是实施细则有待进一步完善。

一种理论与实验相结合的IDD健康教育模式探讨及效果评价

对杭州市某小学９ ～１１ 岁学生进行ＩＤＤ及预防常识和碘盐半定量测定实验教学，再通过学生对其家长和亲友进行宣教。结果宣教后学生与家长等ＩＤＤ及预防常识知晓率均显著高于宣教前（Ｐ＜ ０－００１）；９４ ％ 的学生能较好掌握碘盐半定量检测方法与结果判断；碘盐合格率９２－３％ （３５８／３８８ 份） 。表明以小学生为主体的理论加实践健康教育模式，知与行相结合，由学校到社区具有放大效应，宣教效果良好。

2022年云南省德宏州孕妇和儿童碘缺乏病监测结果分析

目的:分析2022年云南省德宏州孕妇和儿童碘缺乏病监测结果,掌握各项指标控制情况,以便及时提出调整干预策略。方法:将德宏州5个县(市)划分成5个抽样片区,每个片区随机抽取1个乡镇,每个乡镇随机抽取1所小学,每个小学随机抽取8~10岁非寄宿学生40人;所抽取的每个乡镇里随机抽取20名孕妇。采集两类人群家中食盐及尿液,儿童还需检查甲状腺容积。结果:共收集了1609份家庭盐样,其中儿童家庭1073份,孕妇家庭536份。1609份样品的合格碘盐食用率为96.89%,碘盐合格率为97.07%,盐碘中位数为23.27 mg/kg。德宏州各县(市)居民合格碘盐食用率比较,差异有统计学意义(χ^(2)=28.491,P<0.01)。儿童尿碘中位数为257.50μg/L,各县(市)儿童尿碘中位数比较,差异有统计学意义(H=259.399,P<0.01)。孕妇尿碘中位数为203.05μg/L,各县(市)孕妇尿碘中位数比较,差异有统计学意义(H=44.743,P<0.01)。1073名儿童甲状腺肿大率为0.56%。结论:2022年德宏州各县(市)均维持了国家碘缺乏病消除标准,部分县(市)有碘营养过量的风险,需持续进行碘监测工作,找出碘过量原因,进一步加强精准化和差异化干预。

IDD病区不同智商水平儿童精神运动功能状况

目的 观察IDD病区不同智商水平儿童精神运动功能状况,评估碘盐防治后儿童亚克汀病患病率。方法 先用CRT-C_2图册和CRT-RC_2测试,判定在校7～14岁儿童智商,再用JPB和T分数检测,确定1630名各智商组儿童精神运动功能。结果IDD重、中病区轻度智力落后组儿童的精神运动功能异常率为57.8％,智力边缘组儿童异常率为25.1％,智力正常和优秀儿童的精神运动功能均正常。结论 JPB证实轻度智力落后儿童的精神运动功能显著低于同龄者,推算出长期供应碘盐IDD重、中病区儿童的亚克汀病患病率为2.8％。

2020—2022年烟台市长岛海洋生态文明综合试验区碘缺乏病监测分析

目的:分析2020—2022年烟台市长岛海洋生态文明综合试验区重点人群尿碘、盐碘水平、甲状腺肿大率等情况,及时掌握人群碘营养状况及病情的消长趋势,为相关管理部门制定防控措施和科学调整干预策略提供依据。方法:收集监测对象食用盐样、尿样进行碘含量检测分析;测量8~10岁儿童甲状腺容积,计算甲状腺肿大率。结果:2020—2022年,长岛海洋生态文明综合试验区8~10岁儿童合格碘盐覆盖率为12.34%,盐碘中位数为23.1mg/kg,尿碘中位数为175.4μg/L,甲状腺肿大率为2.30%;孕妇合格碘盐覆盖率为8.11%,盐碘中位数为24.5mg/kg,尿碘中位数为113.4μg/L,补碘率为100.00%。结论:2020—2022年,长岛海洋生态文明综合试验区8~10岁儿童碘营养处于适宜水平,孕妇碘营养处于缺乏水平,满足国家碘缺乏病消除评价标准基本技术指标及两项辅助技术指标,实现碘缺乏病的消除目标。相关管理部门应针对不同人群做好分类指导、科学补碘,做到既要消除碘缺乏病,又要防止碘摄入过量。

山东省学龄儿童尿碘监测结果分析

目的了解山东省现阶段学龄儿童碘营养状况,通过这一目标人群,对全省居民碘营养状况作一客观评价,提出相应的防治措施。方法对1995、1997、1999、2000及2002年5次山东省碘缺乏病抽样监测中的1685名学龄儿童尿碘进行了测定分析。结果5次监测学龄儿童尿碘中位数分别为234.1、453.0、276.3、165.6和200.0 μg/L;尿碘> 100 μg /L的百分比分别为75.8%、96.7%、86.5%、79.3%、82.5%。尿碘< 20 μg/L的样本占总样本的1.2%,尿碘< 50 μg/L的占5.8%,尿碘< 100 μg/L的占15.5%。不同年龄、不同性别学龄儿童尿碘水平比较差异无显著意义(P> 0.05)。结论目前山东省人群碘摄入量可以满足机体需要,机体碘营养状况良好。坚持食用合格碘盐,完全可以达到防治碘缺乏病的目的。

华北平原饮用地下水碘分布及碘盐分区供应探讨

自20世纪末实施全面加碘盐以消除碘缺乏病政策以来,我国碘缺乏病状况得到了极大改善,但高碘致病问题也引起了越来越多的关注和讨论.基于4 136组饮用地下水碘数据分析了华北平原饮用地下水碘的空间分布及其水文地质效应,并基于流行病学提出了饮用水合理碘含量限值的建议,据此将华北平原划分为极缺碘水区（≤4 μg·L-1）、缺碘水区（＞4～8μg·L-1）、适碘水区（＞8～50 μg·L-1）、可饮用碘水区（＞50～100 μg·L-1）、高碘水区（100～200 μg·L-1）和超高碘水区（＞200 μg·L-1）.针对不同分区计算了食盐的合理加碘量,并从饮用水碘含量的角度将华北平原划分为需用加碘盐区、不需加碘盐区和不宜加碘盐区,这对于指导该区加碘盐政策的科学优化、解决食盐加碘带来的负面影响具有科学指导意义.研究发现,受水文地质条件和地下水循环特征控制,缺碘饮用地下水主要分布在燕山—太行山山前冲洪积平原及黄河冲洪积平原濮阳段,尤其近山的冲洪积平原是极缺碘饮用地下水的分布区;高碘地下水则主要分布在黄河冲洪积平原、东部滨海平原.计算结果表明,极缺碘水区与缺碘水区为需用加碘盐区,目前使用的20～ 50 μg·g-1加碘盐能满足人体碘需求;适碘水和可饮用碘水区为不需加碘盐区,食盐碘含量应不大于9.2 μg·g-1;高碘水和超高碘水区为不宜加碘盐区,建议仅供应无碘盐.

2002年广东省碘缺乏病防治监测结果分析

目的 了解广东省实现消除碘缺乏病阶段目标后各地防治工作进展情况及存在问题。方法 按卫生部下发的《关于全国第 4次碘缺乏病监测方案的实施意见》要求进行监测。结果 盐碘中位数为 33.4 mg/ kg,居民户合格碘盐食用率为 88.6 % ,碘盐覆盖率为 93.2 3% ;8～ 10岁儿童甲状腺肿大率为 4 .70 % ;儿童尿碘中位数为 184 .5 0 μg/ L,尿碘 <5 0 μg/ L 的儿童占 5 .9% ;水碘中位数为 6 .4 1μg/ L。结论 虽然全省碘盐供应及病情基本稳定 ,人群尿碘水平下降至更理想的水平 ,但在珠江三角洲及沿海地区仍然存在非碘盐冲销现象 。

加碘盐与人体健康

20世纪90年代以来,全世界实行普遍食盐碘化(universalsaltiodization,USI)政策,在我国食盐加碘是持续消除碘缺乏病的重要策略,关系到国计民生。本文对碘缺乏危害(IDD)进行了详尽的介绍,包括其概念、临床症状以及缺碘与人口素质的关系,对依照《全国碘盐监测方案》开展的碘盐监测结果进行分析比较,并对今后IDD控制工作提出了建议。

甲状腺功能亢进症住院率与食盐碘含量关系

且的探讨城市居民甲状腺功能亢进症（甲亢）住院率及其关联因素。方法收集江苏省常州市区1991～2004年甲亢患者住院病历；抽查1995～2004年市售食盐，以直接滴定法检测食盐碘含量，用描述流行病学方法进行比较分析。结果1993年甲亢年住院率最低，为1．46／10万；实施全民食盐加碘（USI）后，甲亢年住院率曲线表现为一过性升高，1999年达峰值，为27．74／10万，随后逐步下降到2004年的8．83／10万。年住院率女性与男性之比危险度（RR）为3．175（95％CI=2．90～73．460）；40岁及以上与40岁以下比较，相对危险度（RR）为2．321（95％CI=2．152--2．503）；USI前后比较，RR为4．658（95％CI=4．116～5．270）。结论甲亢住院率变化与全民食盐加碘关联最明显，应加强对碘所致甲亢病例的监测。

2002年广西自治区碘缺乏病监测结果分析

目的 了解广西自治区实现消除碘缺乏病阶段目标后的防治现状。方法 每个地 (市 )随机抽取 2～ 3个县 (市 ) ,对盐碘、儿童尿碘、水碘、儿童甲状腺肿大率、儿童智商水平、健康教育等指标进行监测分析。结果 合格碘盐食用率为 90 .7% ;8～ 10岁儿童甲状腺肿大率为 3.1% ;儿童尿碘中位数为 2 5 1.6 μg/ L;儿童智商水平平均为 95 .6 ,智商 <6 9的占 4 .8%。结论 90 %以上的广西居民食用合格碘盐 。

2002年陕西省碘缺乏病监测结果分析

目的掌握陕西省基本实现消除碘缺乏病阶段目标后的防治状况,完善可持续防治策略。方法按《全国第四次碘缺乏病监测实施意见》进行。结果居民合格碘盐食用率由1999年的78.3%上升到2002年的87.7%,且连续3年保持在90.0%左右;儿童尿碘中位数稳定在260.0 μg/L左右;儿童甲状腺肿大率由1999年的9.34%下降到2002年8.74%;儿童智力水平与非病区相当,人群碘营养状况得到了显著的改善。结论陕西省在2000年基本实现消除碘缺乏病阶段目标的基础上,可持续消除碘缺乏病机制运转正常,防治成果得到了进一步巩固与提高。